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  • Deborah Thomas BPT MCSP MAPPI Chartered Physio

Physiotherapy for the Abdominal Wall

The abdominal wall is an interesting structure, comprising muscles and other non-contractile connective tissue layers. It is an integral part of the ‘canister’ structure that connects the pelvic girdle to the rib-cage and supports breathing, digestion, continence, reproduction, posture, and many other systems in our body.

Throughout our lives, men & women may encounter a variety of situations that may interrupt, injure, or affect the integrity of the abdominal wall. The whole structure may undergo significant stretches such as in pregnancy or obesity; any form of surgery, whether it’s keyhole or a full incision - such as a cesarean section, appendectomy, gall bladder surgery, abdominal hysterectomy, hernia repairs (inguinal or umbilical) and many more - will affect and possibly interrupt with the function of the muscles and connective tissue, and people may experience post-operative scar adhesions that can influence the works of our internal organs; chronic respiratory conditions such as asthma and COPD, or chronic sinusitis – will all affect the workings of the diaphragm – and therefore the effort and functions required from the abdominal muscles to compensate for that.

As a physiotherapist – I am often asked to assess and treat conditions such as Caesarean scar adhesions, Diastasis Recti (abdominal separation), post-operative pain & scar management, and chronic constipation to name but a few. People want to know – how they can return to safe exercise and when. Is there anything they can do to help the healing, condition, and strength of these muscles, is there anything they should avoid?

The abdominal wall comprises several muscles and layers of connective tissue:

Looking at this image we can see:

Deep inside, we have the ‘corset muscle’ – the Transversus Abdominis, and this one is a part of our ‘core system’ or ‘the canister’. Its fibres run horizontally and wrap around our middle. Further out, we have the Internal Oblique muscle, with fibres running diagonally from the pelvis up to the ribcage. Over this we have the External Oblique muscle – (these last two are often referred to as ‘the obliques’) – its fibres run down and in from the ribs to the pelvis. In the centre, you can see a muscle group that runs vertically – this is the ‘Rectus abdominis’ the ‘straight muscle’ – although many refer to this as ‘the six-pack’ – it’s actually an eight pack!

These last three, although often referred to as ‘the core’ – are in fact not a ‘core’ at all. Think of an apple: its core is deep inside, and the outer layers are the flesh and the peel. So these last three muscles are strong, large muscles that are designed to provide movement to the trunk and transfer loads across it, whereas the deeper corset muscle is our actual ‘core’ (it’s not alone, but that’s another blog).

All these muscles have attachments onto the ribs, pelvis and the white looking connective tissues: named the ‘Rectus sheath’, and centrally, the ‘Linea Alba’:

These thick layers of connective tissue, also known as ‘fascia’ are there to form attachments, provide the ability to transfer loads between the pelvic girdle and ribcage, allow the smooth gliding of the layers of the muscles, and provide support for ‘intra-abdominal pressure’ (click HERE for a link to a blog about Intra-Abdominal pressure).

When we go through pregnancy, or any other stretch to the wall, or undergo ANY surgery in these regions, the whole complex is affected.

We may find a change in the shape of the abdomen; people may find the have a ‘tummy gap’ or doming. The scar tissue our body forms to help these layers heel can often in itself affect the smooth gliding and sliding of these structures, as well as form adhesions to the internal organs such as the bowel or bladder and affect those organs’ function. People may complain they have deep tightness and catching, or a change in bowel and bladder patterns. It is common to feel one cannot quite exercise as they did before. Digestion and breathing may change.

In physiotherapy – I perform a comprehensive examination of all these factors: the trunk, pelvis and spine; the breathing, movement and ability to take loads. I assess the integrity of the abdominal wall and provide tailored exercise programmes to rehabilitate and help you return to exercise. I will often teach people how to massage the abdominal wall to aid digestion and constipation, as well as treat caesarean scar and other post-operative adhesions. When the pelvis and the internal organs' function is affected – I may assess the pelvic floor muscles and treat them as required – as they are part of ‘the canister’.

So if you are experiencing any of the these:

  • Diastasis Recti (separation of abdominal muscles / or ‘tummy gap’)

  • You have had ANY abdominal or pelvic surgery (for example: hysterectomy, hernia repair, caesarean section, gall stones removed, appendectomy)

  • Chronic constipation or abdominal pain

  • Pelvic pain

  • Chronic breathing conditions: (Asthma, Bronchiectasis, COPD…)

Contact me to see how I can help you!


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