There is a lot of talk on the internet about abdominal corsets and binders, which leaves us with the question: should women bind their bellies post partum?
Let's look at this from an orthopeadic perspective. When dealing with an ankle sprain or torn ACL, it is a no brainer to wrap, tape or brace the injured tissues to give enough external support for the joint to prevent excessive accessory movement and support the surrounding tissues while the ligaments and muscles heal from the injury and restore function with adequate load transfer.
Now, let's translate this to the post partum core. We know that:
100% of pregnant women will get a diastasis rectus abdominus (DRA) in their third trimester as measured by an enlarged inter recti distance (Mota et al 2014)
Some woman also stretch through the abdominal muscles (Brauman 2008)
Muscles that are lengthened loose contractile strength as seen on the length tension curve as their maximum force generated decreases (Gordon 1966)
45% of women experience low back pain (LBP) and Pelvic girdle pain (PGP) during pregnancy and 25% post partum (Wu et al 2004)
Transversus Abdominis (TvA) is inhibited or delayed during and after low back pain is experienced (Hodges et al 2003)
Multifidus (MF) is delayed on the painful side of the LBP group (MacDonald et al 2009)
PGP causes poor synchronization of the deep system (Lee D 2011), especially in PFM and TvA (Bo et al 2009)
The pelvic floor is stretched and/or torn during a vaginal delivery (Sleep et al 1984)
100% of women with a laparoscopic surgery had a DRA (Parker et al 2009)
Spontaneus healing of a DRA only occurs in the first 8 weeks post partum, beyond that intervention is needed (Coldron et al 2008)
So it stands to reason that just as many cultures around the world have used abdominal binding for centuries, we should consider using an abdominal binder to help restore function to the abdominal wall post partum. Remembering that an external support to the healing tissues needs to be coupled with restorative exercises to rebuild the internal system.
Things to consider when recommending an abdominal wrap:
She must wrap from the bottom up (just as you would wrap from distal to proximal for an ankle). Wrapping from top down will increase pressure on the uterus and pelvic organs causing a downward descent (prolapse)
Light compression to gently "hug" the belly and allow for involution of the uterus. Too much compression will increase IAP and compromise the pelvic floor
The wrap should be adjustable to fit the woman's torso and focus the support on where she needs it most.
The wrap should be elastic to allow movement and not restrict her breathing
She should wrap immediately post partum and for approximately 8 weeks, or until she has restored the ability to generate tension in her abdominal wall with her deep system (the Core4: Diaphragm, TvA, PFM and MF) during the desired activities. Women beyond the 8 weeks who are unable to create tension within the linea alba, may need to wrap beyond 8 weeks or for activities where they have a failed load transfer.
Remember just like with any external support, simple gentle rehab exercises need to be done to rebuild the Core 4 from the inside out!
Julia Di Paolo is a Pelvic Health Physiotherapist, the owner of PhysioExcellence a dedicated Women's and Pelvic Health Clinic in Downtown Toronto, the co-founder of Bellies Inc After Baby (AB) Wrap Complete System and the Core Confidence Exercise Program for preparing and recovering from birth. She has presented on DRA and the pelvic floor at the Ontario Physiotherapy Association conference, the Association of Midwives Conferences, Canadian Fitness Professionals (CanFitPro) international conference and the Canadian Personal Trainer Network (CPTN) conference. She also teaches courses to personal trainers and allied health professionals on Diastasis and the Pelvic Floor through www.belliesinc.com