So in my last post I talked about the cause of a DR as the increased pressure against the abdominal wall from the inside out. Pregnancy is one example of why this might happen, however I am seeing, with considerable frequency, the same pattern happening in men. It seems clear that the main cause of the DR is posture. There are contributing genetic factors too, like hyper-mobility, which will make someone more prone to it. There are also occasions where a single event, like a sudden sneeze, coughing or lifting something heavy can bring about a hernia. However the chances are in both cases that the occurrence can be greatly reduced by maintaining appropriate tone in the abdominal wall and ensuring that you do not place too much pressure on it during habitual movement.

In my last post I identified four key areas that need to be addressed:

  1. Centering – asymmetry (unilateral imbalances) reduces the functionality of the Rectus Abdominis muscle. Before loading the abdominal wall you need to find centre.
  2. Releasing the shoulders – restrictions in shoulder movement leads to rib cage displacement. It may seem strange, but ensuring you have full ROM in the shoulder will reduce pressure on the abdominal wall.
  3. Release the rib cage – The ribs need to soften down. I drew a nice picture of this in my last post.
  4. Release the Hip Flexors – When the ribs are displaced, it makes it very hard to connect through the centre of the body, so when these clients do things like abdominal crunches with their legs in the air, they often tighten up in the Hip Flexors. This brings the pelvis into a forward tilt, also in my picture.

The following sequence is not a complete fix. It’s a starting point to address the main points mentioned above:

  1. Centering: start off by doing a low level centering exercise. My favorite is to lie down with pelvis raised onto one of those disc shaped wobble cushions, but a simple cushion does the trick too. You need to make sure that your ribs are not poking up to the ceiling so soften the rib cage and raise your head onto another cushion if needed. Start with pelvic rocks, then small clocks, rolling an imaginary marble around the pelvis. You can then draw one knee in and hold it with your hand and do a few knee stirs. Repeat on the other side. Then hold one knee in towards you to allow the other hip to open up. Change sides.
  2. Lateral Breathing: staying on the cushion but with both feet on the floor begin to breath into the sides of the ribs. As you exhale, allow the arms to lift up infront of you whilst you soften your ribs down. Then try to take one arm overhead, without displacing the rib cage. Keep softening the ribs down as the arm goes overhead. Repeat a few times to each side and then try this with both arms. Drop the ribs! Drop the ribs! Drop the ribs!
  3. You can now begin doing some low level abdominal work. Place your hands onto your belly, so that with each out breath you sink your belly away from your hands. Try drawing one knee in towards you at a time without swinging around on the cushion or collapsing your lower back into the floor. Then try to do the step up where you lift one leg, hold for an in breath and lift the second leg up to join it on the next out breath. Then reverse. Always breathing out when you either lift or lower the leg.
  4. Leg slides: With the pelvis still on the cushion and feet on the ground, you slide one leg down along the floor. As you do this try sinking the belly back towards the spine, breathing out all the way, and watch that the lower back doesn’t arch especially towards the end range of the knee extension. Hold the leg out there for an in-breath, and then press the heel into the floor, engage the muscles around the sits bones and drag the leg back in to the starting position. Repeat 3-4 times to each side, alternating legs.
  5. Bridge: press your heels into the floor as you raise the pelvis off the cushion. You want to think of lifting the pelvis from the muscles around the sits bones, keeping the ribs soft and opening the front of the hips. Remove the cushion from under the pelvis, and then roll the spine down to the floor bone by bone, focusing on releasing through the mid back. You can then repeat the bridge without the cushion a few times.
  6. Lunging HF stretch. Ok this one is just obvious, but don’t forget to avoid hanging into your lower back. As you lunge forwards you think of lifting out of the pelvis, keeping the ribs soft.

I’ve been busy writing this whilst suffering from a nasty cold, which means that I’ve had time to create a quick video of all of this (minus the lunge). It’s just a quick picture so that you know what to do when you’re on your own. Please excuse the red eyes and sore nose 🙂