By April Douglas, PT, DPT, MTC

Magnetic Resonance Imaging (MRI) is a tool used by physicians and radiologists in order to see most soft tissue and bony structures inside the body. It works by using a strong magnetic field that records the frequencies emitted by the excited cells within the body. Getting an MRI can be very helpful with diagnosis of a variety of issues ranging from an ACL tear to cancer.

Getting an MRI seems to be the right thing to do after you get injured, and especially when you don't understand what is going on. The research suggests otherwise, especially when it comes to low back pain.

Research has shown that low back issues found in MRIs do not necessarily correlate with the pain that the patient feels^2,3. What does this mean?

For example, if someone has low back pain and discovers that he/she has a herniated disc, the automatic assumption is that the herniated disc is the reason why the patient is having so much pain. Current research is saying that many people have a herniated disc and have variable symptoms. Some people have a lot of low back pain, while others are doing heavy lifting pain free. This means that your MRI may be giving you too much information and not necessarily telling you the cause of your pain.

Researchers have also found that there has been an over-utilization of MRIs, most noted for low back pain, causing increased costs in the healthcare system. The main causes for over-utilization is from fear of litigation, lack of physician accountability and pressure from patients requesting the testing¹.

MRIs are an extremely valuable diagnostic tool but can be over utilized and sometimes too much trust is put in cause and effect for low back pain.

Emery DJ, Shojania KG, Forster AJ, Mojaverian N, Feasby TE. Overuse of Magnetic Resonance Imaging. JAMA Intern Med. 2013;173(9):823-825. doi:10.1001/jamainternmed.2013.3804.
Chou, Dean MD, Samartzis, Dina DSc, Bellabarba, Carlo MD, Patel, Appesh MD, Luk, Keith DK MBBS. Degenerative Magnetic Resonance Imaging Changes in Patients With Chronic Low Back Pain: A Systematic Review Spine: 1 October 2011 Vol 36 Issue pS43-S53.
Endean, Alison, Palmer, Keith, Coggon, David. Potenial of MRI Findings to Refine Case Definition for Mechanical Low Back Pain in Epidemiological Studies: A Systemic Review. Spine Jan 15, 2011; 36(2): 160-169.

By Mandy Johnston, PTA

Pregnancy can be one of the happiest times of a women's life. She gets to feel her growing bundle of joy practice for their turn at the Work Cup and indulge in a few extra desserts without feeling guilty. One of the most important things to remember during pregnancy is a healthy lifestyle. This includes a nutritionally balanced diet, appropriate care for baby and mom as well as exercise. Many women feel scared to exercise thinking it could harm the baby when in fact exercise is extremely beneficial (when cleared by MD).

Some benefits of exercise during pregnancy are an increase in endorphins making mommy feel happy, decreased fatigue, decreased constipation and decreased pain associated with postural changes. Exercise can also assist in maintaining strength in the abdominal muscles as they stretch. One of the most common diagnoses we see during pregnancy and post-partum is diastasis recti. A diastasis recti, DR, is the splitting of the rectus adbdominis muscle at the linea alba. One study has shown that a DR can occur in as many as half of all pregnancies (Chiarello, C ).

This study showed that the size of DR in non-exercising pregnant women was significantly larger than those found in pregnant women who participated in an abdominal exercise program. Non-exercising pregnant women measured a DR of 38.9mm above the umbilicus, 59.5mm at the umbilicus and 60.4mm below umbilicus while women who completed an abdominal exercise program measured 9.6mm above the umbilicus, 11.4 mm at the umbilicus and 8.2mm below the umbilicus (Chiarello, C). Based on this data, it is extremely important for pregnant and post-partum women to be screened for a DR and begin treatment including appropriate exercise.

During pregnancy and post-patrum, appropriate exercises include training of the Transverse Abdominis (TrA) muscle. One of the most effective ways in which to activate the TrA while pregnant is in the quadruped position (hands and knees). Here you can exhale while feeling like you are using your abdominal muscles to hug the baby. There should be no movement of the spine however the belly will rise and feel supported. The TrA muscle would be utilized in all strengthening exercises when rehabing a DR from quadruped breathing to plank and eventual return to controlled abdominal curls.

Other treatment techniques that are used with exercise to correct a DR are the application of Kinesiotape or the use of an abdominal binder. The Kinesiotape application can provide support where the separation of the muscle is present while still allowing completely free motion. There are various techniques for tape application, all of which can be self applied and worn during an exercise program. An abdominal binder is slightly more supportive than the tape application because it covers a greater area. There are many binders out there, ranging in size and look. A new abdominal binder we have available at CTS is the FITSplint. The FITSplint is able to be worn during pregnancy and post-partum. It can be used during exercise and while seated to provide support for DR and pain in the abdominal region. Both Kinesoptape and an abdominal binder reinforce the physical therapy treatment at home, provide support during daily activities, are cost effective and are easy to use.

If you feel you may have a Diastasis Recti it is important to be screened by a medical professional. There are treatment options available that can prevent current or future pain associated with a DR. Please visit our facebook page to see a video on how to screen yourself for a DR or contact CTS with any questions.

Chiarello, Cynthia M., PT, PhD, Laura A. Falzone, PT, MS, Kristin E. McCaslin, PT, MS, Mita N. Patel, MS, and Kristen R. Ulery, PT, MS. "The Effects of an Exercise Program on Diastasis Recti Abdomi... : Journal of Women's Health Physical Therapy." The Effects of an Exercise Program on Diastasis Recti Abdomi... : Journal of Women's Health Physical Therapy. N.p., Spring 2005. Web. 09 July 2014.

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In This Issue

MRIs and Low Back Pain

Diastasis Recti

Pilates

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Group Apparatus

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