Many, if not all, women, who carry baby’s to anywhere near term, have tears or distortions in their abdominal fascia that leave them with “baby belly” – an abdomen, that, no matter how much they exercise, just will not return to its pre-baby shape. They can’t get back their six-pack abs, and, instead usually have a bit of flab below the belly button (umbilicus).
This is due to fascia – the covering of all of the muscles, bones, and organs, that gets torn or distorted in large or small ways during pregnancy and/or delivery. It works like this…when a muscle contracts, it uses the fascia that surrounds it as a stabilizer to allow the muscle to contract. What we call competent (that is – structurally sound) fascia is necessary for a muscle to have a good contraction and relaxation.
If the fascia is torn (from trauma, falls, birth, etc.) or distorted (from the same kinds of forces), then the muscle either can’t quite relax all the way, or it can’t contract fully, or both.
This leaves an abdomen that is not the way it was before being pregnant. It does not have the same tone (and it can’t because of the torn/distorted fascia). Because it does not have the same tone, it can’t do the same work – and that leaves the back muscles working harder than normal…and low back pain can be one of the results! To get an idea of how the fascia works, we can compare it to a sheet of plywood.
Plywood is wood that has been glued together in layers. In each layer, the wood grain goes in the opposite direction to the one it lays atop. This gives it strength. In the abdominal fascia there are three layers of muscle with fibers going in different directions to their neighboring layer (just like plywood). The muscle layers are covered with fascia and those fascial layers are aligned in the direction of the muscle.
If the fascia gets damaged all the way through, we call it a hernia (that is all three layers). It basically leaves a hole where the abdominal contents can come through (herniate).
Sometimes these can be repaired with prolotherapy (a type of injection), but many may require surgery to fix the hole. If the hole does not go through all of the layers, we call that a diastasis (in the abdomen – diastasis recti). It is a bulge, not a true hernia. These may be corrected surgically, but many surgeons prefer to leave these alone. What I am speaking of with “baby belly” is that, in a very small local area, parts of the fascia that cover the muscles tear and/or get distorted. Muscles can push through if the area is big enough, but weakness and possibly pain is the key symptom no matter what the size. In damaged fascia, the nerve endings become irritated.
This makes them painful and sore and they’re not working properly can affect your posture (which can lead to making more problems..including low back pain). If we keep it simple – if this damaged fascia hurts when palpated (pushed on), it is not working optimally. If it does not hurt when you push on it, it is working correctly.
Correcting the damage in the fascial layers restores the competency of the fascia – it helps it to heal and return to normal. The pain in the abdomen goes away. The fascia becomes strong again. The belly that you were never able to get flat, starts to flatten and get strong.
The back pain resolves… This correction can be accomplished using either/both direct osteopathic manipulation to the damaged fascia or prolotherapy/prolozone injections into the area. Changes are seen almost immediately and treatment should continue until no more pain/discomfort is experienced and the belly returns to full strength. Although it is described here in women, the same kind of injury can occur in men. If you would like more information or would like to schedule a consultation/treatment, please contact the Comella Foundation.