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Abdominal Pain/Diastasis Recti
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Abdominal Pain/Diastasis Recti - August 24, 2006 5:47:00 AM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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I am seeing a 69 year old female with insidious onset of abdominal discomfort. Hx positive for "several low back injuries", but these symptoms are seemingly unrelated; no low back pain at this time. Only real positive findings are tenderness along the inferior margin of the right rib cage - anteriorly to roughly mid axillary line, discomfort with A-P mob or springing of ribs, rigid/hypomobile mid-low Tspine.
Besides a general bloated feeling, she also gets burning below inferior rib margin at night while lying on her back. Unable to provoke in the clinic and it does not appear to be related to diet; she has had a GI work up.
Questions:
1) Anyone have experience treating this as the primary diagnosis? I have seenit with several patients, but it has never been the reason for referrral or complaints.
2) Exercise suggestions or avoidence of certain behaviors/activities to prevent exacerbation of problem?
3) Treatment ideas / assessment ideas for pain complaints?
Any help would be much appreciated.
Thanks,
Eric Yarrington, PT
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Eric Yarrington, PT, MPT, OCS
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 8:00:00 AM
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PHSPT
Posts: 119
Joined: December 1, 2005
From: Oklahoma
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I find it strange she was referred to P.T for abd pain. Also dont have enough of med hx: CA, GI, ulcers, UTI's,trauma, etc,worsening/relieving factors, lab work results. If no yellow/red flags in med hx, id go on w/ this pnt
After clearing spinal involvement, id procede to the abdomen/flanks for examination.
If you divide the abdominal region in 4 quadrants. I would palpate and feel for reproduction of Sx's in any of the 4 mentioned regions. Look for "rebound phenomenon" and/or reproduction of Sx's while performing palpation.
Refer to anatomy as to what is located under each quadrant.
Ureteral and renal pain has been known to refer pain to flank/ant portion of abdomen "Goodmann and Snyder 2000"
Asses kidneys by palpation/tapping for reproduction of Sx's for possible renal involvement. Again a thorough review of past med hx : GI, urogenital, worsening/relieving of Sx's.
Many factors here, given her age and onset of Sx's Id probably think shes in the wrong place for medical assistance.
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 12:01:00 PM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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PHSPT:
Med hx - allergies, COPD, HTN, hysterectomy 1975, on Lipitor and HCTZ. Again, her symptoms seem more neuromuscular in origin as she has had a work-up by her physician for GI, urogential involvement.
Thank you for replying.
Eric
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Eric Yarrington, PT, MPT, OCS
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 12:13:00 PM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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Eric
Have a good look at the thoracic spine. It all sounds neural to me, especially with the telltale sign of 'burning'. You could test the Tx spinefor tenderness and reproduction of pain, and try lateral movements combined with Tx flexion, extension. Treat what you find, with some care so as not to flare the nerves.
Nari
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 12:42:00 PM
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Karie
Posts: 107
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From: Wisconsin
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How long has she been on Lipitor Eric?
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 1:31:00 PM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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Karie:
She did not remember, but it has been a fairly good while.
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Eric Yarrington, PT, MPT, OCS
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 1:36:00 PM
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yarringtonpt
Posts: 112
Joined: July 4, 2006
From: Waynesville, NC
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nari:
I could not reproduce any symptoms with central or unilateral mobs to the T-spine. Problem is, in the clinic she only presents with tenderness to palpation along the inferior margin of the rib cage. I have treated, successfully, the counterstrain point in the area (positioned in exaggerated right sidebending,thoracic flexion, and left rotation) only to have it return. Her pain is mostly at night, except for the bloated feeling that she has. In your opinion, should any prescriptive/corrective exercises be given to make up for the diastasis recti? Any elaboration on "trying lateral movements combined with flex / ext"?
Thanks for your help.
Eric
_____________________________
Eric Yarrington, PT, MPT, OCS
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 4:01:00 PM
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nari
Posts: 1568
Joined: November 14, 2003
From: Australia
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Diastasis recti? I would imagine that after this length of time (probably 20 years plus?) it would be irreversible and unlikely to respond to any treatment. However, I'm unsure that correcting something unrelated to the presenting symptoms is worthwhile.
Looks like you have already tested out the Tx area already; so I would try slump, to move the system under some mild tension.
The other possibility is some superficial soft tissue work along or near the "line" of pain. Often just giving the skin a stretch for some minutes is helpful in desensitising. I wouldn't go any deeper than the skin; start back at the thoracic spine at the level of the "line" of pain and move anteriorly.
Diane is more skilled in this desensitising approach...hope she posts..
Nari
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 4:10:00 PM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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Hmm, doesn't sound musculoskeletal to me, but if you feel confident in treating her, you might want to consider the diaphragm muscle. Check her breathing and do whatever releases/soft tissue work you know of for the diaphragm.
Thinking neurodynamically, have her get into the position that provokes pain at night and test the nerves in that position aka Shacklock.
Also try some fascial release/skin rolling over the lats and external obliques. Her history of back pain indicates she migth have been usingn compensatory strategies for stabilization. Just some guesses! Tough one Eric!
Sarah
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 4:14:00 PM
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srcase
Posts: 551
Joined: November 30, 2004
From: Michigan
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Hmmm, I reread your posts and a couple other thoughts occurred to me. Could be related to a compression fracture of the T-spine or nerve root compression. Does she have a history of osteoporosis?
Check the intercostal muscles along with the diaphragm. For treatment, I would start with teaching deep diaphragmatic breathing and do some gentle trunk movements with the arms to loosen up thoracic area.
Good Luck!
Sarah
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 4:17:00 PM
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Dr.Wagner
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From: Indianapolis
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All of you need to read the medical complexity forum on this site.
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Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 4:50:00 PM
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pwrandall
Posts: 66
Joined: May 14, 2004
From: Elk Grove, CA
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I was just thinking the same thing Dr. Wagner. I'm thinking a polite call/note to the referring MD may be in order.
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Re: Abdominal Pain/Diastasis Recti - August 24, 2006 7:24:00 PM
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Karie
Posts: 107
Joined: August 14, 2006
From: Wisconsin
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Eric,
I quite agree with the last post, I know you said she had a GI workup, but symptoms of bloating along with your palpation pointing to the area of the liver and gallbladder. It just still sounds medical. Sometimes they need us to rule out musculoskeletal and they go back and recheck and the second time around they find it. Good Luck Eric!
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