The mum from Slimum® Case Sharing had side bent and rotated spine, there is a larger crease on her left side than on her right side with her spine rotated to her right and her paraspinal muscles along the right side are thicker than those on her left. A 10-session massage therapy has improved her condition tremendously and bring relief to her pain.

We may never be totally symmetrical, small efforts in correcting the following habits goes a long way to improve our posture and eliminate back pain.

When sitting, centre yourself and not lean on any one side.‍
Avoid uneven weight-bearing activities such as carrying a child on your hips.‍
If you are a side sleeper, sleep on both sides evenly and not on just one side.
Do not stand with one knee bent and one knee straight

The post 4 Tips To Resolve Imbalance Hip appeared first on Restoring Mums.

Excessive Pressure Pushing Womb Out of Position

Following childbirth, the womb takes about six weeks to return back to its size. What is not normally emphasised is the womb also needs to be back to its proper position for homeostasis and homeodynamics. When there is a strong downward pressure on the lower abdomen, it can cause your womb to prolapse or further weaken the pelvic floor muscles. Read our article to know more about this subject as to how a displaced womb can affect a woman’s health considerably.

When you wear a belly wrap or waist cincher (loosely termed as postpartum corset) and you feel pressure on your perineum or a sensation of “something” is bulging out of your vagina – these are signs that you are wearing your wrap too tightly. The pelvic floor muscles supports your bladder, womb and bowels. Having a weak pelvic floor makes it harder for you to squeeze the muscles at the bottom of your bladder and cause accidental leaks when you cough, sneeze or am holding your pee.

Excessive Pressure – Side View

Considering the above, a panty-like corset compression garment works better by ensuring the compression effect is even throughout the abdominal area. An even better option is the traditional abdominal binding method, which wraps your abdomen specifically according to your body shape instead of just choosing the closest-fitting size. The ideal is of course giving yourselves a treat of traditional binding and massage treatments.

Traditional Abdominal Binder

However, when an abdominal binding service is not an option, choose a postpartum compression garment that you feel is comfortable enough to wear over a period of two to three months post-delivery for best effect.

Karen Loke – Founder and Practitioner, Restoring Mums Limited腹部包裹型 (Belly Wrap)和腰夾式塑身型 (Waist Cincher)的產後束腹帶跨越整個腰部。他們都是很好的產後修身(腰圍和腹部)工具。但是我見過很多過分熱衷的媽媽以產後束腹帶把自己長時間包得太緊，想達到縮小自己腰圍和腹部的最大效果。這一番”努力”當然會幫助媽媽們達到縮小腰圍和腹喇，但是當有太大的外來壓縮力施予媽媽的腹部時，這便有很大可能造成對媽媽子宮和盆底肌肉的傷害。

太大的外來壓縮向下擠壓

分娩後，子宮大約需要六週才會自然的回到它在產前的大小。除此以外, 許多媽媽也忽略了子宮須回到正確的位置以達到媽媽身體機能的自然調節. 當下腹部位有太大的外來壓縮向下擠壓時，這可能會導致媽媽的子宮下垂或進一步削弱盆底肌肉。(建議讀者細閱”子宫的位置決定妳的健康”一文，以了解這個問題。)

當媽媽們穿上腹部包裹型 (Belly Wrap)和腰夾式塑身型 (Waist Cincher)的產後束腹帶修身，妳會感覺到陰部會有一些壓力或感覺到有些“東西”在陰道鼓起時 – 這些都是妳的產後束腹帶包裹得太緊的跡象。盆底肌肉在支撐着媽媽的膀胱，子宮和腸道。弱的盆底肌肉使媽媽們更難擠縮在膀胱底部的肌肉, 造成當你咳嗽，打噴嚏或憋尿時會有尿失禁的問題。

太大的外來壓縮向下擠壓 – 側面圖

鑑於上述情況，産後束衣 – 內褲型(Postpartum Panty-Like Corset) 是一個更好的選擇因為它的設計是確保壓縮力均勻分佈在整個腹部區域。但是我個人認為沒有比[傳統馬甲式束衣]更完美的，它的專門設計是根據媽媽不同的體型按腹部和腰圍去施予足夠但不會太大的壓縮力，這就是選擇最接近自己合身的尺寸的普通產後束腹帶所不能比擬的地方。

傳統馬甲式束衣

話雖如此，當媽媽們身邊未能找到傳統專業產後修身的服務時, 那選擇一個合適自己身型, 穿戴舒適的產後束腹帶(建議讀者細閱”産後媽媽最關注又最貼身的課題是…?”一文，以了解這個課題。)， 穿上兩到三個月後也可以達到一定的效果。

Restoring Mums創辦人和治療師Karen Loke

The post Proper Use of Postpartum Corset And Your Health appeared first on Restoring Mums.

It is common for Malay or Indonesian masseurs to correct the positioning of the womb for a women’s wellness, for the Malays believe the womb is a woman’s core and her outward beauty is a reflection of the condition of her womb. In South East Asia, “No cold drinks” and “No lifting of heavy objects” are common words of advice given by our grandmothers and mothers, believed to maintain womb health and wellbeing.

So what really does it mean to have a “low hanging uterus or womb”?

When I first studied Malay postnatal massage, be it in a university setting, in a modern spa or via traditional Malay masseurs, I was taught the position of the womb and how to massage – yet many of my questions on anatomy were never convincingly answered.

However, when I studied The Arvigo Techniques of Maya Abdominal Therapy® by Dr Rosita Arvigo, I realised how similar these two cultures are in terms of correcting womb positioning, and exactly how a misaligned uterus affects our health. Dr Arvigo has derived her specific therapy technique to help reposition reproductive organs and improve blood flow to digestive organs using an external, non-invasive hand manipulation method.

Here I’d like to share what I learnt and explain what it means when you are told that your uterus (or womb) has “dropped”.

A uterine prolapse is commonly known medically and refers to a condition when the uterus slips down into the vagina. A hollow, muscular organ roughly the size of a fist in a non-pregnant state, the uterus is suspended in the pelvis by fourteen ligaments and connective tissue and supported by the pelvic floor muscles. It is positioned in the lower medial pelvis, slightly above the bladder and in front of the colon, which allows for maximum circulation of arterial blood, nerve supply from the spinal column, exiting venous blood and lymphatic drainage.

The uterus is connected to the vagina by the cervix in a continuous flow of tissue.

Prolapse occurs when the pelvic floor muscles and ligaments are stretched and weaken, no longer providing adequate support for the uterus, which slips down into or protrudes out of the vagina.

Potential causes of uterine prolapse include:

• Damage to supportive tissues during pregnancy and childbirth
• The effects of gravity over time
• Loss of oestrogen as the woman matures
• Repeated straining over the years

The uterus can also slip out of place because ligaments and connective tissue are subject to lengthening and shortening and occasionally become distorted or inelastic. A displaced uterus can also be referred to as the following:

• Tilted uterus or tilted womb
• Retroflexed uterus
• Retroverted uterus
• Anteflexed uterus

The Arvigo Techniques of Maya Abdominal Therapy® teach that proper knowledge and application of repositioning techniques helps them to heal. So why does it matter to know the condition of our womb?

Following are some common symptoms of a displaced uterus:

1. Menstrual problems – painful periods; late, early or irregular periods; unusually dark, thick blood at the onset or end of menstruation; related headaches or migraine
2. Urinary issues – frequent urination, bladder infections and incontinence
3. Ovulatory symptoms – irregular or painful ovulation
4. Musculoskeletal indications – low backache, sore heels when walking

What causes these conditions? According to Dr Arvigo, the main reasons are:

1. Repeated pregnancies close together with difficult deliveries

When pregnancies occur close together, there is insufficient time for the length and strength of uterine ligaments to normalise before the next baby is conceived, especially in the case of large babies or complicated deliveries.

2. Undue pressure is placed on the uterus during pregnancy, birth and postpartum

The abdominal organs above the uterus can weigh up to 40-60lbs. When a woman lifts a heavy object, the diaphragm places downward pressure on her abdominal organs. The pelvic floor muscles (which have experienced recent strain during childbirth) may be unable to withstand further pressure and weight from above. This often results in a uterine prolapse. Carrying heavy objects may also harm the uterine ligaments and muscular wall, which takes time to heal. The Mayans believes in wearing a “faja” (abdominal wrap or postnatal corset) and similarly the Malays wear a “bengkung” – both are made of cloth and support the uterus until the ligaments have time to heal and revert back into their proper position and length.

Womb Position At 40 Weeks Pregnant

The above picture shows a stretched Round Ligament, Broad Ligament and Uterosacral Ligament, connecting the uterus to the pelvis and sacrum. (Source: The Growing Uterus Chart: 40 weeks pregnant at term picture.)

Additionally, Dr Arvigo also lists the following as potential causes for a displaced uterus:

• Scarring from adhesions as a result of endometriosis or fibroids
• Injury to sacrum or tailbone from a fall or accident
• Wearing high-heeled shoes
• Running on cement surfaces; high-impact dancing, aerobics or sports
• Chronic cough
• The aging process

Similarly, the Malays believe the uterus needs to be returned to its original position following childbirth to prevent prolapse and side effects such as incontinence. The sixty-day period following delivery is the recommended timeframe to care for the uterus to allow it to heal and return to its pre-pregnancy size and position, especially given the fact that the relaxin hormone is still naturally present in the body during this time.

Karen Loke, Founder and Practitioner, Restoring Mums如果妳曾經進行由印尼或馬來人主理的產後按摩，妳會知道甚麼叫「子宮下垂」。在馬來語中，它被稱為「peranakan jatuh」。我能夠讀寫馬來語，因此我很高興可以研究現存極少部分可用的文獻，以及與很多經驗豐富但非常謙虛的馬來傳統產後護理治療師對談，交換意見並從中學習相關知識。

馬來或印尼的按摩師以糾正子宮的位置去調理女性的健康是很常見的事。馬來人認為子宮是女性身體的核心，她的外在美反映了子宮的健康情況。在東南亞，我們的祖母和媽媽輩經常提醒我們「戒生凍食物」和「不要提重物」，去保持子宮的健康和福祉。

到底，「子宮下垂」的真正意思是甚麼呢？

當我第一次學習馬來產後按摩時，無論是在大學學府、現代水療中心學院或通過傳統的馬來按摩師的指導，我都會學習到子宮的位置和按摩方法，但是我有好多關於從人體解剖學角度瞭解子宮按摩的科學根據問題還未得到有說服力的解答。

可是，當我到美國猶他州學習Rosita Arvigo博士的Maya腹部治療Arvigo技術®時，說到還原子宮位置和錯位的子宮究竟是如何影響我們的健康時，我終於明白到這兩種馬來與馬雅女性護理文化是如何地相似。Arvigo博士導出特定治療技術，使用外部的、非入侵性的手動操作方法去幫助重新定位生殖器官和改善血液流向消化器官的情況。

接下來我想分享我所學的，以及解釋一下當妳被告知「子宮下垂」時，究竟是甚麼意思。

子宮脫垂是醫學上常見的名稱，指的是子宮滑落到陰道。子宮是一個在非妊娠狀態時有著拳頭大小、中空的肌肉器官。它由14條韌帶和結締組織懸吊在骨盆內，以及由骨盆底肌肉支持著。它位於內側骨盆的下部分，略高於膀胱和在結腸的前面。這允許動脈血可以作最大的循環、從脊柱供應神經、排出靜脈血液和淋巴引流。

子宮是由子宮頸以一條連起來的組織連結至陰道。

當骨盆底肌肉和韌帶被拉長和削弱，不再提供足夠的支持予子宮時，子宮就會脫垂，滑落至或突出陰道。

子宮脫垂的潛在原因包括：

• 支持組織在懷孕和分娩過程損壞
• 地心吸力的影響
• 女性成熟時雌激素減少
• 多年反覆的用力

子宮滑落的原因也可以是因為韌帶和結締組織受到拉伸和縮短，而有時變得扭曲或失去彈性。子宮脫位也可以被簡稱為：

• 子宮傾斜
• 子宮後翻
• 子宮後傾
• 子宮前屈

Maya腹部治療Arvigo技術®教授了正確的知識和子宮重新定位的技術，去幫助醫治子宮脫垂的問題。那麼，為甚麼知道自己子宮的狀況是那麼重要呢？

以下是一些子宮脫位的常見症狀：

• 月經問題──經痛；經早、經遲或月經不調；月經開始或結束時不尋常的深色和血厚；相關的頭痛或偏頭痛
• 泌尿問題──尿頻、膀胱受到感染和尿失禁
• 排卵期的症狀──不規則或排卵痛楚
• 骨關節肌肉的症狀──下腰腰酸，走路時腳後跟痛

是甚麼原因導致這些情況？根據Arvigo博士，主要原因是：

1. 頻密的懷孕和難產

懷孕頻密時，就沒有足夠的時間讓子宮韌帶在下一次受孕前還原它的長度和強度，特別是在體型大的胎兒或難產的情況下。

2. 懷孕、分娩時和產後不必要的壓力被施加在子宮上

子宮上方的的腹部器官可重達40至60磅。女性提重時，膜片就會向下施加壓力予腹部器官上。（在分娩時剛承受過負擔的）骨盆底肌肉可能不能夠承受進一步的壓力和重量，因而時常引致子宮脫垂。提重還可能會損害子宮韌帶和肌壁，並需要時間來癒合。瑪雅人的「faja」（腹部包紮或產後束腹帶）和馬來人的「bengkung」，兩者都由布料製造，可以支持子宮，直至韌帶癒合和回復到其原本的位置，長度。

Womb Position At 40 Weeks Pregnant

上圖顯示了被拉伸了的圓韌帶、闊韌帶和子宮骶骨韌帶，連接子宮至骨盆和骶骨。（來源：The Growing Uterus Chart: 40 weeks pregnant at term picture.）

此外：Arvigo博士還列出以下子宮脫位的潛在原因：

• 因子宮內膜異位和子宮肌瘤而引致的黏連疤痕
• 骶骨或尾骨因跌倒或事故而受傷
• 穿著高跟鞋
• 在水泥表面跑動；高強度的舞蹈、健美操或運動
• 久咳不愈
• 老化過程

同樣，馬來人相信在產後是需要讓子宮回復原位的，以防止子宮脫垂和其他併發症，例如失禁。產後的60天是最好的時間，去讓子宮復原至懷孕前的大小和位置，特別是因為考慮到鬆弛激素在這段時間仍然殘留於體內而可以被引導幫助媽媽修身。

Restoring Mums創辦人和治療師Karen Loke

The post Womb Position Can Determine Your Health appeared first on Restoring Mums.

I was naïve to think that I would return to my pre-pregnancy size after giving birth to my first baby. After gaining 18kg (thanks to an excellent appetite both before and after delivery, not to mention a bar of chocolate every day), it struck me two months after delivery that I just wasn’t getting any smaller in size. I could hardly pull up my jeans or even fit into my tops without stretching the front buttons.

It was only after having my third child that I learnt about relaxin, the hormone naturally secreted during pregnancy, which is responsible for opening and softening the cervix and vagina to aid the process of childbirth. Relaxin also loosens the ligaments at the front of the pelvis (pubis symphysis) and the sacroiliac joints, and allows it to widen, both to support the growing baby and for ease of delivery. Incidentally, relaxin makes you slightly more susceptible to ankle and wrist sprains, and can be blamed for broader shoulders, a widened waistline, and a larger shoe size!

Many women notice their hips are wider after pregnancy, even after returning to their pre-pregnancy weight. The reason for this is because your growing baby pushed them out, eventually engaging in your pelvic cavity. Remember, the pelvic bone is not one big bone; it consists of four bones that are joined together by ligaments. After childbirth your hips looks wider not because your hipbones have grown, but because the ligaments that connect the four bones in your pelvis have loosened and are therefore “stretchable”.

The fact is that relaxin is still present in a mother’s body some eight weeks after delivery, and even longer if you are still breastfeeding.

This is where hip binders (or postnatal corset) come in. By leveraging the relaxin still present in a mother’s body after birth, wearing a hip binder provides an outer compression to gently guide the widened pelvic bones back to their original shape. By capitalising on these normal physiologic changes associated with pregnancy, a hip binder, when worn after delivery, applies pressure directly to your hips to help you return to your pre-pregnancy size.

There are a few hip binders on the market, namely Shrinkx Hips and Hip Slimmer that really help bring in your hips so you can fit into your old clothes once again. Additionally abdominal binding techniques will do the same job most effectively.

I have tried it, and I can attest that it works – I’m back to my size “0” jeans!

Karen Loke, Founder and Practitioner, Restoring Mums.[adrotate banner=”10″]

我很天真地以為我在生下第一個寶寶後就會回復懷孕前的身形。可是當我增重18公斤後（都是因為懷孕前後太開胃了，我每天都要吃一包巧克力），我驚覺自己在產後兩個月根本沒有減到磅。我不能再穿上產前買下的牛仔褲，我甚至要鬆開鈕扣才可以穿上產前買下的襯衫。

在我誕下第三個孩子後我才只知道什麼叫鬆弛激素。鬆弛激素是一種在懷孕時自然產生的一種荷爾蒙，負責打開和軟化子宮頸和陰道，幫助分娩。鬆弛激素也會鬆開盆骨（恥骨聯合）和骶髂關節前的韌帶，令它們可以變寬，支撐著正在成長的胎兒和幫助分娩。順便提一下，鬆弛激素會令您的腳踝和手腕稍微更容易扭傷，並會使肩部、腰圍和足部變得寬大。

很多女性注意到，即使她們回復懷孕前的體重，她們的臀部在懷孕後仍然很大。原因是懷孕時，妳的寶寶在妳的肚內一邊長大，一邊把妳的臀部及骨盆腔向外推。請記住，骨盆並不是一塊很大的骨塊；它包括四塊由韌帶連接在一起的骨頭。分娩後妳的臀部看起來很寬大，這不是因為妳的臀骨增生，而是因為在骨盆內連接那四塊骨頭的韌帶已經被拉鬆了。

事實是，分娩後的約八週內，鬆弛激素仍然存在於母體內。如果妳是母乳餵哺，鬆弛激素的留存時間會更長。

這就是束臀帶（及產後束腹帶）的由來。透過影響在產後仍然在母體內的鬆弛激素，穿束臀帶可以向變寬了骨盆施予外壓，引導其回復原狀。通過利用與懷孕有關的日常生理變化，在產後穿上束臀帶，它就會直接在妳的臀部施加壓力，幫助你回到你懷孕前的身形。

市面上有幾款束臀帶(臀圍帶)，名叫Shrinkx Hips和Hip Slimmer，它們真的能夠幫妳修臀，令妳可以再次穿回產前買下的衣褲。另外束腹技術也可以做到同樣的功效。

我已經試過了，我可以證明它是有效的──我可以穿回尺寸「0」的牛仔褲了！

Restoring Mums創辦人和治療師Karen Loke

The post What Good Do Hip Binders Do Me After Birth? appeared first on Restoring Mums.

*Application: 20 ml bleach in 5 ml water; same ratio applied if more solution is needed to clean a larger area

*Use bleach solution with care and keep away from children!!!

Karen Loke – Founder and Practitioner, Restoring Mums在妳的浴室，特別是在浴簾上生長的黴菌或霉不僅礙眼，還可能引致潛在的健康問題，特別是對污染物過敏的嬰兒或幼兒。去除黴菌或霉，最好是用海綿以漂白劑溶液*洗擦浴簾。洗擦後，用清水沖洗乾淨並擦乾，再確保把浴簾攤開，讓它風乾。在清潔之前，請確保妳已經打開窗戶或打開抽氣扇，令浴室可以通風。在妳的浴室去除黴菌或霉時，妳可能要戴上護目鏡和膠手套。

*做法：將20毫升的漂白水倒入五毫升的水；如果需要更多漂白劑溶液去清潔更大的面積，請用相同的比例。

*請謹慎使用漂白劑溶液，並勿讓兒童接觸喎！！！

Restoring Mums創辦人和治療師Karen Loke

The post Goodbye Mildew appeared first on Restoring Mums.

Before packing, (1) get a plastic bag, (2) roll your clothes, and (3) group them inside the bag.

This simple idea can be perfected by using a large “Ziploc” bag and by repeating the same act. Once you have filled up the “Ziploc” bag, secure the zipper, leaving half an inch opening, squeeze the “Ziploc” bag to get rid of the air (vacuum effect) in the bag. Now this airtight “Ziploc” bag can be placed in the luggage and you will be amazed by how many more items you can add in the same luggage.

Karen Loke – Founder and Practitioner, Restoring Mums我喜歡玩得安全。當我有了頭兩個寶寶時，我總是用上一個小時去收拾我的行李，之後才可以安心地帶著我的小朋友外出。不過，當有了第三個寶寶後，我愈來愈煩惱怎樣可以一樣的行李箱，但有更多的空間供使用。我的行李清單變得很長，我要收拾更多東西，但我的行李箱大小是不變的。我用了一個我在十幾歲時學到的簡單慳位方法，它令我很醒目 以下是那個慳位方法，我覺得很有用。

收拾行李前，（一）取出一個膠袋，（二）將妳的衣物捲起來，再（三）把它們分類放入膠袋。

這個簡單的方法如果用一個大的真空收納袋，效果會更好。當妳裝滿了真空收納袋，拉上拉鍊，只留下半英寸的開口，擠壓收納袋令空氣排出（真空效應）。現在妳可以將這個密封的的真空收納袋放入行李箱。妳會很驚訝竟然可以用同一個行李箱放更多的東西。

Restoring Mums創辦人和治療師Karen Loke

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During pregnancy, the stomach muscle is stretched as the womb grows. After giving birth, a palpable gap can be felt between the borders of the superficial abdominal muscles, i.e. Rectus abdominis, and the stretched connective tissue of the abdominal muscle, i.e. linea alba. The likelihood of the gap closing naturally over time depends on multiple factors: age of the mother, number of pregnancy, whether it was an easy pregnancy or not, fitness condition before pregnancy, etc.

The reason why the muscles, joints, and ligaments are easily stretched during pregnancy is due to the hormone relaxin. It is produced from around 7^th to 10^th week through the rest of pregnancy. The effect of the hormone lasts 1 to 3 months after giving birth. It is during this window period that the abdominal separation is easiest to manage. After 3 months post pregnancy, trying to close the abdominal gap is much harder work either due to internal factors (muscle weakness, muscle memory, postural) or external factors  (baby getting more active, less time to do exercise)

To check your abdominal separation:

• Lie on your back, bend your knees, keep your feet on the ground
• Put your hand above the belly button with fingers pointing towards groin
• Lift your head off the ground and see how many fingers you can fit into the separation

From physiotherapy perspective, one way to reduce the abdominal diastasis (separation) is by exercise. And not just any exercise: Pelvic floor muscle (PFM) and deep abdominal muscle exercise. The PFM rarely works in an isolated way. This means that when the PFM contracts, the deep abdominal muscle is activated too.

Self Examination – Abdominal Diastasis

Abdominal Diastasis

The 2 abdominal muscles to focus on are:

• Superficial abdominal muscle, i.e. Rectus abdominis (six pack muscle)
• Deep abdominal muscle, i.e. Transverse abdominis (corset muscle)

Rectus abdominis muscle is 2 bands of fibers that run from the lower rib down towards pubic bone, and are connected to each other by soft tissue called linea alba. Due to this, rectus abdominis is easily stretched and “separated” during pregnancy to make room for the growing baby.

Transverse abdominis muscle fibers encircle the abdominal region, starting on the left of the spine and ending against the right side of the spine. If activated properly, this muscle acts like a natural corset for the body. This is also called the core muscle, which has become popular in Pilates, yoga, and fitness training industry.

The PFM and transverse abdominis usually work together, so by activating PFM the transverse abdominis will contract which supports the abdominal region and lessens the abdominal separation.

PFM exercise is more commonly known as Kegel exercises described by Arnold Kegel in 1948. (http://en.wikipedia.org/wiki/Arnold_Kegel)

To test how well your PFM is contracting on your next visit to the toilet, stop your pee mid flow. The muscle used to do this action is PFM. Or the feeling as if you want to pull your tampon in further. Try to remember this pelvic floor contraction feeling. When you are pulling the PFM up, you will notice the lower abdomen (stomach region below belly button) getting flat. If the whole abdomen is flat, or even hollow, you are probably “sucking-in” your stomach and most likely holding your breath while doing so. This is a common mistake. With some training and body awareness, you will be able to get the correct contraction.

If you think you are doing PFM contraction correctly, go back to the “checking abdominal separation” position:

• Lie on your back with feet on the ground and knees bend up
• Put your hand above the belly button with fingers pointing towards groin
• Pull your PFM up, keep breathing normally
• Lift your head up
• Your separation should be noticeably less compared to when you are not activating your PFM

If the abdominal separation is still the same, it is usually due to weak PFM or overactive rectus abdominis. If you are not sure whether you are activating your PFM correctly, visit your doctor or physiotherapist for a consultation.

Gita Go, BSc (Hons) Physiotherapy (Hong Kong Polytechnic University), Registered Physiotherapist下次做產後檢查時，問問您的醫生有關”腹部直肌分離”吧！”腹部直肌分離”，又稱為腹部或胃部肌肉分離，是一種懷孕後常見的情況。

懷孕時，腹部的肌肉因為子宮生長而拉伸。分娩後，淺層腹部肌肉（即腹直肌）的邊緣和腹部肌肉被拉伸的結締組織（即臍白線）之間會出現一條明顯的間隙。隨著時間，該間隙的自然癒合取決於以下因素，包括年齡、懷孕次數、懷孕是否容易、健康情況等等。

肌肉、關節和韌帶在懷孕期間容易拉伸的原因是由於鬆弛激素的作用。鬆弛激素在大約懷孕第七至十週產生。它的作用在分娩後持續一至三個月。腹直肌分離在這段窗口期是最容易調理的。在產後三個月後嘗試去收復腹部的間隙會更加困難，一是因為內在因素（肌肉軟弱無力、肌肉記憶、姿勢），又或是因為外在因素（寶寶變得越來越活躍，更少時間做運動）。

要檢查你的腹直肌分離：

• 仰卧，彎曲妳的膝蓋，保持妳的腳在地面上。
• 把妳的手放在肚臍的上方，手指指向腹股溝。
• 抬起妳的頭，看看妳能有多少隻手指可以放入間隙。

從物理治療的角度來說，減少腹部直肌分離的其中一個方法是做運動，但不是任何運動，而是盆骨底肌肉(PFM)運動和深層腹部肌肉運動。盆骨底肌肉很少單獨運作，即是當盆骨底肌肉收縮時，深層腹部肌肉同時運動。

自我檢查”腹部直肌分離”

腹部直肌分離圖

我們要留意的兩種腹部肌肉是：

• 淺層腹部肌肉，即腹直肌（六塊肌）
• 深層腹部肌肉，即腹横肌（胸肌）

腹直肌是由下肋骨延伸到恥骨的兩組肌肉纖維，並且由稱為臍白線的軟組織連結在一起。基於這個原因，在懷孕時腹直肌很容易拉伸和「分離」，以騰出空間給胎兒生長。

腹横肌包圍腹部範圍，由脊柱的左側延伸到右側。如果正常運動，它就像一個身體的自然束腹帶。它也被稱為核心肌肉，在彼拉提斯，瑜伽，健身訓練行業中經常會聽到個名字。

PFM和腹横肌經常一同運作，所以激活PFM會令腹横肌收縮，幫助支持腹部範圍和減輕腹直肌分離。

PFM運動通常被稱為凱格爾運動，由阿諾•凱格爾於1948年公布。(http://en.wikipedia.org/wiki/Arnold_Kegel)

要測試妳的PFM的收縮情況，下次如廁時，在小便中作停頓。作出這個動作的肌肉就是PFM。這感覺就像妳將月經棉塞往內塞一樣。儘量記住這個骨盆底部收縮的感覺。當妳拉扯PFM時，妳會注意到小腹（肚臍下方的腹部）會變得平服。如果整個腹部都是平服的，甚至凹陷的，妳可能正在「吸吮」胃部，這很大可能是因為妳在做這動作時正在屏住呼吸。這是一個常見的錯誤。當妳接受了一些訓練和對身體有了意識後，妳就可以做到正確的收縮動作。

如果妳覺得妳可以正確做到收縮PFM的動作，請回到「檢查腹直肌分離」的部分：

• 仰卧，彎曲妳的膝蓋，腳保持在地面上
• 把妳的手放在肚臍的上方，手指指向腹股溝
• 拉扯妳的PFM，保持正常呼吸
• 抬起妳的頭
• 妳的腹直肌分離應該比PFM沒有運動時明顯地減少了

如果妳仍然有腹直肌分離，通常是因為PFM太弱或腹直肌的過度活躍。如果妳不肯定妳是否正確地激活妳的PFM，請向妳的醫生或物理治療師諮詢。

Gita Go，香港理工大學物理治療（榮譽）學士，註冊物理治療師

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