Q: What do hernias, diastasis recti, bulging discs, and pelvic organ prolapse have in common?

A: Intra-abdominal pressure

“What does that mean??”  

In order to understand, we are going to think about your trunk (the area between your shoulders and your hips) as a coke can. 

The sides of your coke can are your abdominal muscles and the muscles around your spine. Specifically 2 muscles called the transverse abdominus (TA) and the multifidus.

The bottomof your coke can is your pelvic floor. These are the muscles that you use to stop the flow of urine. They also keep all your organs inside your body. (Thanks, pelvic floor!)

The top of your coke can are all the things involved in breathing: your diaphragm, which is the muscle that expands your lungs, the thoracic cavity where your lungs live, and the vocal chords which must open to allow air to move in and out of your lungs. (But I’m a PT and PTs like to talk about muscles, so we are mainly going to focus on the diaphragm!)

 These 4 muscles (Diaphragm, Pelvic floor, Transverse Abdominus, Multifidus) keep us stable and help the coke can maintain its shape. 

Sometimes we need a little help with stability, like when we are lifting weights or standing up from a chair that is low to the ground, and our other abdominal muscles kick in. When that happens, it’s a lot like someone shaking the coke can up and then squeezing it. It increases the pressure.

As long as we breathe, squeezing the coke can isn’t really an issue. Breathing, specifically exhaling, is like popping the top on the coke can to let the extra pressure out. But what happens when you hold your breath?

Increased Intra-abdominal pressure.

If you hold your breath when you move or lift things, the pressure can’t escape from the top of the coke can. But the pressure still has to find SOMEWHERE to go. So, it looks for weak spots. 

What are the weak spots?

Weak spots in the groin, umbilicus (belly button), and diaphragm result in HERNIAS.

Weak spots in the abs result in DIASTASIS RECTI.

Weak spots in the spine may result in BULDGING DISCS. 

Weak spots in the pelvic floor result in PELVIC ORGAN PROLAPSE.

* Side Note- “weak spot” doesn’t necessarily mean the muscle itself is weak

* Other Side Note- these pathologies aren’t always caused by increased intra-abdominal pressure

And sometimes, if the pressure can’t find a weak spot (or if it’s so much pressure even the weak spot isn’t enough), the pressure will just expand the abdomen as a whole. Know anyone with a great big round belly that isn’t proportionate to the rest of their body and is hard as a rock? 

That big belly is probably hollow. It’s the result of years of breath holding. Fat is soft and squishy, so if it’s hard enough to bounce a quarter off of it- you’ve got a pressure issue.

So how do you know if this is what is causing your problem? It’s easy to test! If you are sitting to read this, just stand up. If you make this face……

 That means you are probably a chronic breath holder. 

Okay, you probably didn’t turn that red. But did you notice that you stopped breathing as you stood up and then exhaled once you got to the top? If so, you aren’t managing the pressure in your coke can very well. 

The same thing goes for lifting weights. Or picking up your baby. Or rolling over in bed. Or moving furniture. Or driving your truck. Or pooping (yep, I went there.) Starting to see a pattern? 

You’ll start to catch yourself holding your breath with all sorts of things. Once you do, you can start to address the problem by practicing something we like to call “Blow and Go.” Any time you are about to do something strenuous (i.e. something you have caught yourself holding your breath for), exhale with the hard part of the movement, or “blow and then go.” In other words, pop the top on your coke can before you squeeze it. When in doubt, breath out!

So you might be wondering, “WHY am I a breath holder?” Well, we can’t tease out the exact reason without a physical therapy examination. It might be that you have transverse abdominus weakness. It might be that you are hypermobile everywhere. It might be that your diaphragm doesn’t move great, or maybe you have an overactive pelvic floor. 

The bottom line: For whatever reason, your body feels unstable.

If you’d like to get to the bottom of the “why,” come see us at Delta Physical Therapy for a full evaluation and treatment plan designed to change what moves you!


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