Do you have a tummy gap? How can you check?

 Do you have a tummy gap?

A tummy gap?

What is that?

Is it normal?

Do I have one?

I often hear these questions when I am doing a mummy MOT post-natal check. A tummy gap, or a diastasis recti, is an abnormal gap between the 2 six-pack muscles of the tummy. It often occurs after childbirth, but not always.

So, let’s start at the beginning. There are 4 layers of tummy muscles, the external obliques running down and inwards, the internal obliques running upwards and inwards, the rectus abdominus (the six pack), from the top down to the pelvis, and the deepest layer the transverse abdominus (TVA) running horizontally around like a corset. The right and left side muscles never touch. They are separated by the linea alba, a strong connective tissue called fascia that holds the 2 halves together and closes the midline.



During pregnancy the abdominal muscles separate and the linea alba becomes stretched. This is normal. After pregnancy the muscles usually come back together, if they don’t then there is a tummy gap remaining. The current research on the size of a normal gap is inconclusive, anything upto 1-2cm can be normal, the latest research suggests that the tension that can be generated in the linea alba is much more important than the size of the gap.

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Pelvic Health and the Menopause

 Pelvic health

As we’ve all heard in the peri-menopausal and menopausal age our hormones fluctuate and oestrogen levels decline. Dietary changes and exercise are important to help manage your symptoms and maintain your cardiac and bone health, but what about your pelvic health?

1 in 3 women will have pelvic floor dysfunction at some point in their lifetime.

Changing hormones could cause reduced integrity of the pelvic floor muscles and pelvic fascia leading to symptoms such as

  • Leaking
  • Prolapse
  • Intercourse pain
  • Low back and hip pain

Many of these pelvic health issues are easy to recognise, but how would you know if you had a pelvic organ prolapse?

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Stop, breathe, relax and let go…

sunrise in Kefalonia

Sunrise in Kefalonia


I’m sure you are all either on or about to go off on your summer holidays. It is the perfect time to stop, breathe, relax and let go…….

I spend a lot of time teaching pelvic floor exercises to help women suffering from incontinence and prolapse.

But I also spend a lot of time teaching how to relax the tummy muscles and pelvic floor. Most people find this confusing and have never thought that their pelvic floor and tummy muscles could be tight or overactive. But you would be surprised at how much of a problem this over activity is. It can stem from stomach holding to make ourselves look slimmer to fit active sports people. Also, when feeling stressed or anxious cortisol and adrenaline floods through your body and your breathing becomes more shallow and fast. For different reasons, from time to time, we all breathe really badly.

Overactive and tight muscles can lead to serious problems such as dysfunctional voiding, constipation, pelvic pain and sexual dysfunction.  I will often start treatment with breathing and breath awareness.

If you click on this image courtesy of Burrell Education you can see that as we breathe in and the diaphragm descends the stomach should release and the pelvic floor should drop. On the out breath the diaphragm lifts, therefore creating a negative pressure that pulls in the tummy and lifts the pelvic floor.

Burrell Education

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Tummy Massage (Visceral Mobilisation)

Visceral structures

Do you still have a muffin top? Have you had abdominal surgery? Do you have abdominal scar tissue that may be stuck and referring pain?

I was fortunate to go on a visceral mobilisation study day last weekend. Whilst you were enjoying the warm beautiful sunshine outdoors, I was laying down in the Chelsea and Westminster hospital physiotherapy department having my tummy massaged! Weird how I spend my weekends you must be thinking.


What is Visceral Mobilisation/Tummy massage?

Visceral mobilisation or tummy massage is the treatment of the deep abdominal fascia. Fascia is a thin cling film like substance that coats all our organs, muscles and soft tissues. It extends from our head down to the toes. It is that thin film like substance you find wrapped around raw chicken pieces.

 Why would it need treating?

Trauma such as whiplash or abdominal surgery can lead to adhesions or scar tissue, which may lead to the organs being restricted in their normal movement. This could lead to pain, which could be anywhere in the back, abdomen, or pelvic area. Sometimes the pain can be longstanding and often will not ease with physiotherapy treatment of the back or pelvis. Scar tissue can cause a ‘divide’ in the abdomen with the upper half of the abdomen not engaging with the lower half.

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Why do you need a Mummy MOT?

mummy mot logo

So who needs a mummy MOT and why?

The feedback from almost all mummy MOT’s I have done so far is always, “I’m so glad I found you” or “I wish I had known about you ages ago” or “That was so useful” or and this is one that I find the most difficult to answer “Why isn’t this service offered routinely” and the answer I think lies in what another lady summed up as “because money is not invested in prevention”. What a shame.

What is a mummy mot?

It is actually an examination that systematically and thoroughly examines the post natal posture, alignment, breathing, tummy gap closure and pelvic floor function. This is not a new service, it is not new research findings. Women’s Health Physio’s have been providing this service for a long time.

  • What is new is offering it as ‘complete package’.
  • A one stop shop.
  • A full MOT.
  • An all round thorough assessment from which you will receive a report on the recovery of your post natal body and what to do next. What exercise to do and how to do it safely. How to return to your usual level of activity without danger of causing problems later on.

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Incontinence? A leak? A dribble? A Taboo?

women with incontinence symptoms

The Government’s first female chief medical officer Professor Dame Sally Davies published her annual report a few days ago encouraging women to talk about, and seek help for, taboo issues such as incontinence and menopause. It also talks about obesity and ovarian cancer.

Dame Sally said that Urinary and faecal incontinence affects more than 5 million women in the UK and, along with prolapse, costs the NHS more than £200 million a year in treatment and support. Six weeks after pregnancy, 33% of women report urinary incontinence and 10% report faecal incontinence.

She said “We need to challenge taboos around the menopause and incontinence to make sure embarrassment is never a barrier to better health.”

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Acute Low Back Pain

low back painLow back pain is a common problem that will affect most people at some time in their lives. Acute Low Back Pain can be triggered by moving awkwardly or lifting incorrectly and is generally not caused by a serious condition. It is usually short lived and will improve within a few weeks. ‘Acute low back pain’ is the term used to describe pain that has a short history rather than chronic pain, which has usually been present for over 6 months.

Most episodes of acute low back pain will resolve spontaneously and no treatment may be necessary. The majority of acute low back pain is non-specific and serious conditions are rare. Most commonly, there is a soft tissue injury of the joints, muscles, ligaments or neural tissue and less often a disc injury The body’s response is to create muscle tension to protect your spine and produce an inflammatory response to promote healing.

 Top tips to facilitate a speedy recovery.

  • Firstly, ensure you have adequate analgesia. It is important to control the pain to allow healing and movement.
  • remain as active as possible but avoid taking up anything new or strenuous
  • use ice packs in the first 24-48 hours, usually applied for 10 minutes at a time. This will cause the blood vessels to constrict and prevent excessive bruising or swelling.
  • then alternate, or move onto using heat packs. Heat will create movement and allow fresh nutrients into the area and remove fluid build up or bruising.

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Top Tips for correct posture

We are spending more and more time sat at electronic devices or hunched over mobile devices on the go. There is a steady increase in the number of children presenting with back and neck problems. Is this just coincidence or related to the current addiction to electronic devices? Postural education and awareness is important for everybody, at the workplace, in schools and now even on the go!

common text neck postureCorrecting your posture may feel awkward at first because your body has become so used to sitting and standing in a particular way. You will need to retrain your body to sit and stand correctly. Initially, this may require a bit of conscious effort, but with practice good posture will become second nature and allow you to get the best out of your body and keep it working for you for many years to come.

Good posture helps us stand, walk, sit, and lie in positions that place the least strain on supporting muscles and ligaments during movement and weight-bearing activities. Therefore preventing aches and strains.

What is correct posture?

Correct posture;

  • Helps keep bones and joints in correct alignment so that our muscles are used correctly, decreasing the abnormal wearing of joint surfaces that could result in degenerative arthritis and joint pain
  • Reduces the stress on the ligaments holding the spinal joints together, minimizing the likelihood of injury
  • Allows muscles to work more efficiently, allowing the body to use less energy and, therefore, preventing muscle fatigue
  • Helps prevent muscle strain, overuse disorders, and even back and muscular pain.

Several factors can contribute to poor posture-most commonly, stress, obesity, pregnancy, weak postural muscles, abnormally tight muscles, and high-heeled shoes. In addition, decreased flexibility, a poor work environment, incorrect working posture, and unhealthy sitting and standing habits can also contribute to poor body positioning.

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