A follower writes in with the following question:
I would like to get more information about conservative ways to tighten fascia. I am a physical therapist that works with post partum mothers and trying to find a way to tighten abdominal fascia is a great interest of mine. Thank you!
As I am sure you know, fascia has no active way of shortening, only muscle does.
That’s not quite true, since fibroblasts have actin in them, and through their integral and other adhesive molecular connection to the fascia they can exert some contraction into the fascial net, especially in their modified form as myofibroblasts – see Gabbiani – which are very active in wound healing, but have also been shown to create significant Newtons of pull in large sheets like the thoracolumbar and crural fascia. (Wow, that was a long sentence)
Unless you can think of a way to stimulate these myofibroblasts in postpartum women – and oxytocin is one of their stimulants, so breastfeeding is definitely helpful – your restoration of the proper tone in the abdominal sheets is going to be a matter of muscle recruitment, strengthening, and standing tone.
The problem is that simply increasing tone willy-nilly is that the linea alba will simply be pulled more apart by the increasing shortness. The muscles need to be taught to ‘hug’ the organs. Your colleague Diane Lee is stellar on this subject, so read The Pelvic Girdle.
Of course it depends on the individual circumstances – what’s the state of the pubic symphysis, iliolumbar ligament, SI joint stability, and what happened in the birth with the pelvic floor? There are some cases where the conservative approach is not going to work and surgical repair is the quickest road up.
But here’s a general conservative approach to such tightening to try first:
Kneel behind your seated client and your arms around their waist, roughly paralleling the transversus, but meeting in the middle, around the navel – probably where the worst thinning is. Using your hands as encouragement, can you find the way for them to use the Valsalva or similar to bring the belly in and hug the organs?
I try cue after cue until i get them to stop ‘efforting’ at this contraction – which just pulls the edges more apart – to where it ‘just happens’ and you feel an encircling contraction of the whole complex that begins to contain the abdomen. Reinforce this idea of the gentle but steady contraction, and then have them practice all the time between sessions – driving is usually a good time to practice, but of course it depends on their habits.
Clients tend to return to efforting (“I wanted to get it done faster”), so keep reinforcing the idea of gentle contraction of the abdominal balloon, the waist, without interfering with breathing or over-contracting the pelvic floor.
It’s not whether they’re contracting the abdominals, it’s how. And once you have the huggy how, then it’s a matter of repetition until the increased tone becomes their standard habit.
Thanks for the question, and good luck and good skill.
PS. The Valsava maneuver is detailed in video in our webinar, Your Chair as a Movement Tool
Your Chair as a Movement Tool$20.00
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