The exercise program used in the study was developed by certified personal trainer Leah Keller, founder of Every Mother. The study was published online ahead of print in the Journal of Women’s Health Physical Therapy.

DRA occurs when the two sides of the abdominal muscles, commonly called the “six pack,” stretch or separate due to the growth of the baby during pregnancy. Affecting up to 60% of women after childbirth, it sometimes resolves naturally. But for many women, the muscle separation remains.

“As evidenced by the large number of women who expressed interest in our study in a short period of time, as well as by many of my own patients, DRA is a huge area of concern for postpartum women,” said Ellen Casey, MD, a sports medicine physiatrist at the Women's Sports Medicine Center at HSS and lead investigator. “It can have a major impact on quality of life.”

HSS investigators set out to determine if the specific online, video-based exercise program to strengthen the core abdominal muscles could be beneficial. Musculoskeletal ultrasound, a critical component, was used to measure the space between the muscles, called the inter-rectus distance (IRD). DRA was defined as a gap of more than three-quarters of an inch between the abdominal muscles.

“The primary aim of our study was to assess changes in IRD following participation in the program,” said Dr. Casey. “The secondary aim was to investigate whether the program improved DRA-related symptoms, including lower back pain, stress urinary incontinence, pelvic floor dysfunction, and body image.”

The 12-week exercise program featured daily videos that could be accessed on a computer or mobile device. “The program focuses on isometric activation of the deep abdominal muscles with coordinated breathing and pelvic-floor muscle engagement,” explained Ms. Keller. “Forward-flexion exercises such as sit-ups and crunches were excluded, as they can be counterproductive and may even make diastasis recti worse.”

The videos also provided instructions and coaching on alignment, posture, and proper core engagement while performing daily activities; education on how to optimally engage the core muscles during exercise; and specific low-impact weekly workouts with aerobic and resistance exercises to promote core engagement.

Out of the original enrollment, 43 healthy women between the ages of 18 and 45, and 12 weeks to 36 months postpartum, completed the study. To determine if the exercises led to improvement in DRA, researchers used ultrasound to measure the IRD before the women started the program and again after 12 weeks of participation. A subset of 19 women took part for an additional 12 weeks and their outcomes were assessed at 24 weeks. The researchers also evaluated participants’ overall satisfaction with the program.

This study found that women experienced a significant reduction in IRD after 12 weeks of the core strengthening program. Significant improvements in disability related to lower back pain and incontinence were also reported. No differences in pelvic floor function or body image were observed.

Those who participated in the additional 12-week maintenance phase had greater improvements in their IRD at 24 weeks, but the extended program did not lead to further improvement in lower back pain or incontinence.

Patient satisfaction with the program was high overall, averaging 7.5 on a scale of 1 to 10, and 95 percent of participants said they would recommend the program to a friend.

“Our findings suggest that a video-based core strengthening exercise program offers an accessible and effective treatment strategy for postpartum women with DRA,” said Dr. Casey, “and further investigation regarding the optimal timing, duration, and sequence of exercises is warranted.” 

The researchers conclude their findings demonstrate a need for further interventions to reduce concussion rates, such as the required use of protective head equipment in women’s sports, the adoption of neck-strengthening exercises and other prevention training, and greater enforcement of rules to decrease levels of contact in men’s sports.

Concussions can occur in a wide range of sports, affecting not only professional athletes but youth athletes as well. There are approximately 1.7 million to 3.8 million sports concussions reported in the nation each year^1,2,3 as well as 1.1 million to 1.9 million pediatric recreation-related concussions.⁴

For the first paper, "Sex-Based Differences in the Incidence of Sports-Related Concussion: Systematic Review and Meta-analysis," first published on September 30, 2019, in the journal Sports Health, senior author Daphne Ling, PhD, MPH, a sports medicine epidemiologist at HSS, and colleagues conducted a meta-analysis of sex-based differences in concussion incidence in lacrosse, soccer, baseball/softball, basketball, track and field and swimming/diving. They found that the concussion incidence rates for females were statistically significantly higher compared to males in both soccer and basketball.

“While the causes are unknown, we suspect this sex difference in concussion incidence in soccer and basketball might be attributed to females having decreased head and neck strength, greater peak angular acceleration and increased angular displacement compared to males. Female athletes are also more likely to disclose their symptoms to coaches and parents. This is important for physicians to consider when treating patients who participate in these sports,” concluded Dr. Ling.

For the second paper, "Women Are at Risk for Concussions Due to Ball or Equipment Contact in Soccer and Lacrosse," published online ahead of print on October 17, 2019, in the journal Clinical Orthopaedics and Related Research (CORR), senior author Ellen Casey, MD, a sports medicine physician with the Women’s Sports Medicine Center at HSS, and colleagues conducted a meta-analysis of 10 studies published from January 2000 to December 2018. The studies reported concussion incidence for both male and female athletes who participated in the following sports: ice hockey, soccer, basketball, baseball/softball and lacrosse. The objective was to identify in which sports female athletes were less likely to experience concussions from player contact versus ball or equipment contact.

In female athletes, the main cause of concussions was contact with the ball or equipment in lacrosse, and heading the ball in soccer. Additionally, female hockey players were more likely than male players to experience concussions after contact with the ice surface. The researchers found no differences between male baseball and female softball players for ball/equipment-induced concussions. Similarly, there was no difference observed between male and female basketball players for surface or ball contact.

Furthermore, the pattern of the underlying concussion-causing mechanism was the same regardless of differences between the male and female versions of the sport. It is suggested that sex hormones; decreased neck strength in female athletes, which reduces their ability to withstand external forces; and increased neck and torso strength in male athletes, which allows them to better absorb impact in the upper body versus in the head alone, may play a role in the sex differences in concussion incidence.

To reduce their risk of concussion, Dr. Casey advises women to participate in exercises to enhance neck strength, stiffness and neuromuscular control, as females tend to have deficits in these areas relative to males. “Depending on the sport, exercises and training to optimize technique with high-risk movements, such as heading the ball in soccer, are also critical in reducing concussion risk."

Dr. Casey concluded, "If we truly want to reduce the impact of sports concussions, more research is needed on what causes concussions so that prevention measures can be put in place as well as better reporting of sex and gender differences across sports.”

Jennifer Cheng, PhD, Brittany Ammerman, BA, Kristen Santiago, BA, Bridget Jivanelli, MLIS, all from HSS, were co-authors for both manuscripts. Jo A. Hannafin, MD, PhD, and Emerald Lin, MD, from HSS were co-authors for the CORR and Sports Health publications, respectively.

References:

1) Daneshvar DH, Nowinski CJ, McKee AC, Cantu RC. The epidemiology of sport related concussion. Clin Sports Med. 2011;30:1-17.

2) Harmon KG, Drezner JA, Gammons M, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med. 2013;47:15-26.

3) Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil. 2006;21:375-378.

4) Bryan MA, Rowhani-Rahbar A, Comstock RD, Rivara F; Seattle Sports Concussion Research Collaborative. Sports- and recreation-related concussions in US youth. Pediatrics. 2016;138:e20154635.

The panel was titled "Being Your Best Self." Panelists included:

Dr. Karen Sutton, a Board-certified orthopedic surgeon at HSS specializing in helping athletes with hip, knee and shoulder injuries, spoke on the importance of a positive view during the healing process. She explained that it’s critical to treat not only the body, but the mind when recovering from an injury to stay both physically and mentally strong.

Dr. Ellen Casey, a physiatrist at HSS and award-winning gymnast, focused her remarks on taking a holistic approach when treating pain or a physical limitation. Understanding "who" you are and "what" you ultimately want to accomplish is just as important as "why" the issue is happening. Whether you’re an 80-year old who wants to maintain independence or a 35-year old who wants to run a marathon, understanding the full picture will ultimately result in a better outcome, according to Casey.

Heidi Skolnik, a nationally recognized sports nutritionist at HSS, has influenced millions through her media work, writing, and thriving consulting business.  She spoke on the importance of eating to be healthy versus eating to lose weight as we age. 

Cindy Rudbart, SVP, wealth advisor at the Blue Sandstone Group at Morgan Stanley, emphasized how good health and wealth strategies support each other. She explained that women should have a holistic view of their finances, while maintaining good health habits. This helps them live longer, feel better and minimize health care costs in retirement. 

The panel was moderated by Mary Gibbons Gardiner, First Vice President and Financial Advisor at the Blue Sandstone Group at Morgan Stanley. "We felt that sharing all of this valuable information with our clients was critical to their long-term physical and financial well-being," said Mary. "These practical and thoughtful strategies will help them enjoy their lives more fully now and through retirement."

Morgan Stanley Wealth Management, a global leader, provides access to a wide range of products and services to individuals, businesses and institutions, including brokerage and investment advisory services, financial and wealth planning, cash management and lending products and services, annuities and insurance, retirement and trust services.  

Morgan Stanley (NYSE: MS) is a leading global financial services firm providing investment banking, securities, investment management and wealth management services.  With offices in more than 41 countries, the Firm's employees serve clients worldwide including corporations, governments, institutions and individuals.  For more information about Morgan Stanley, please visit www.morganstanley.com.

The Women’s Sports Medicine Center at HSS is a nationally recognized health resource for active women of all ages and abilities, from professional athletes to eager novices. These professionals focus on a holistic and interdisciplinary approach to health and wellness. HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019).

As the fetus grows a tremendous amount of pressure is placed on the abdominal muscles causing them to stretch separate at the midline. This separation is associated with lower back pain, urinary leaking and cosmetic concerns.  A new study from Hospital for Special Surgery (HSS) will determine if core strengthening exercises can resolve this condition. 

“While exercise during and after pregnancy continues to be a hot topic, there is a strong need for scientific data on what exercises are best to decrease the abdominal separation,” said Ellen Casey, MD, physiatrist at HSS and primary investigator of the study. “This condition is sometimes viewed simply as a cosmetic issue, but the abdominal muscles are a key part of core musculature which has proven to be important for musculoskeletal and gynecological reasons. It’s time that we figure out how to heal the abdominal wall after pregnancy and give women much needed guidance in restoring their musculoskeletal health.”

The study hypothesizes that participation in a core strengthening program will decrease the inter-recti distance (IRD), increase the abdominal wall muscle strength, and reduce low back pain and urinary incontinence in postpartum women with DRA. 

This randomized controlled trial will follow 46 patients over a 24 week period. The patients will be divided evenly into two groups – Group A will participate in weekly online classes with one certified personal trainer and will also complete daily homework assignments. After 12 weeks, Group A members will exercise on their own.  The control group, B, will continue their baseline level of exercise and activity for the first 12 weeks and then participate in the same weekly online class for the final 12 weeks that Group A originally did. 

At the end of 12 and 24 weeks, each participant’s IRD and muscle contraction will be measured using musculoskeletal ultrasound. 

Additionally, the investigators will measure a variety of secondary outcomes such as abdominal wall function, lower back pain, pelvic function, stress urinary incontinence and body image.

“If we can show that core strengthening is effective, and specifically which exercises are effective, then all women could have access to postpartum rehabilitation to help avoid long-term secondary complications of DRA,” added Dr. Casey.

This study is a joint effort between HSS, Weill Cornell Medicine and Leah Keller, personal trainer and founder of Every Mother, a pre- and postnatal exercise program.

DRA occurs when the abdominal walls separated during pregnancy fail to return back to normal.

Ellen Casey, MD, physiatrist at HSS, had confirmed that Sharon indeed did have DRA and noted that up to 60-70 percent of postpartum women have this condition. Symptoms can include: tenting of abs, back pain, constipation, incontinence and even hernias.

"The core, as we know, is so key for stabilizing our spine, letting us do sports activities, maintaining continence and all those things. So if it separates, you lose the integrity of the core which is so important," said Dr. Casey.

Dr. Casey has launched the first randomized controlled clinical trial on this topic, teaming up with personal trainer Leah Keller, in order to find out how exercises can close the gap in the abdominal wall without surgery.

"So it might be that any core exercise is helpful, or it might be that specific core exercises are helpful, that's what we want to figure out so there can be evidence-based strategies," said Dr. Casey.

Phillips explains how she was seeing quick results after physical therapy. The trial is currently still enrolling patients.

View the segment at NY1.com. It first aired during the October 17, 2018 broadcast.

By overusing the thumb to text or scroll, Dr. Casey explained that the median nerve in the carpal tunnel can get pinched which leads to swelling.

Additionally, keeping an elbow bent while you are talking on the phone or texting could increase pressure on the ulnar nerve and compress it.

Read the full article at self.com.

The two-day annual symposium will provide clinicians with guidance on how to care for athletes of all levels. Topics to include: the athlete’s elbow, shoulder instability, the rotational athlete, multiligament knee, concussion management, the female athlete, the athlete’s hip, tendonopathy, and the young athlete’s knee.

The symposium is provided by HSS Office of Continuing Medical Education, Department of Rehabilitation and HSS Sports Medicine, and is co-directed by HSS sports medicine surgeon, Anil S. Ranawat, MD, and HSS physical therapist and certified athletic trainer John Cavanaugh, PT, MEd, ATC, SCS.

"At HSS, we treat over 400 elite athletes a year from over 80 professional teams and over 100 Division 1 programs," said Cavanaugh. "We have a front seat to all of the unique injuries that occur as well as the cutting-edge research performed in our labs. This symposium is a way for us to share our expertise with medical professionals who may be in an outpatient setting and not have the same exposure."

The symposium will take place on March 23-24, 2018 at the Richard L. Menschel Education Center at HSS (535 East 70th Street, 2nd floor, New York, NY 10021) and will also be live streamed online.

Consisting of 3 main sessions, 4 concurrent sessions, 3 mini courses, 8 concurrent workshops, and a new lunch & learn option, this year’s symposium includes a keynote address from Gilles Walch, MD, acclaimed shoulder surgeon from Hopital Privé Jean Mermoz in France, on his surgical approach to shoulder instability.

There will also be a live surgery of an anterior shoulder stabilization performed by Joshua S. Dines, MD, sports medicine surgeon at HSS, as well as two optional instructional courses.

The session The Female Athlete will cover gender differences in sports medicine, graft choice for ACL reconstruction, stress fractures, training considerations and sports psychology. The session is moderated by Lisa R. Callahan, MD, primary care sports medicine physician at HSS. Presentations will be made by members of the Women’s Sports Medicine Center:

• Ellen Casey, MD
• Karen M. Sutton, MD
• Marci A. Goolsby, MD
• Polly de Mille, RN, MA, RCEP, CSCS, USAT
• Deborah N. Roche, PhD

HSS serves as the official hospital and team physicians and rehabilitation specialists for over 20 professional and collegiate teams and organizations and is one of only three hospitals in the nation appointed a FIFA Medical Centre of Excellence.

CONTACTS:

Sherry Randolph / Monique Irons / Tracy Hickenbottom

Hospital for Special Surgery

mediarelations@hss.edu

212-606-1197

According to the article, women's physical ability was historically questioned due to their reproductive system, even though there was no scientific evidence to support this. The article reported that one myth was that the women's uteruses would fall out from playing sports.

HSS physiatrist Ellen Casey, MD addressed the myth. "The uterus seems to have been brought up numerous times. There's really no evidence that the uterus itself is damaged from impact or running or anything like that."

Additionally, Dr. Casey explained that the idea that women aren't built for sports is unfounded.

"What history has shown us is that these limitations probably were not based on science, and there was a complete lack of research. Generally speaking, the limitations have proved to be unnecessary," said Dr. Casey.

She noted that there are gender differences rooted in biology, as men generally have larger bones and more muscle, while women have looser ligaments.

"It's amazing to me as a female physician in this day and age that this stuff was said without factual data, but I guess it was, and unfortunately that has been perpetuated for way longer than anyone would expect. Hopefully, as women continue to push boundaries as they have for decades, things will shift," Dr. Casey said.

Read the full article at newsweek.com.