Episode One-Hundred-Twelve – Plantar Fasciitis – Diastasis Recti: Audio automatically transcribed by Sonix

Episode One-Hundred-Twelve – Plantar Fasciitis – Diastasis Recti: this mp4 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kevin:
Please help spread the message of Frequency Specific Microcurrent by clicking on the like button. You can subscribe to us on YouTube or any podcast app. If you have any questions, please leave them in the comments. You can find the podcast transcription at Frequency Specific Microcurrent as well as more information about Frequency Specific Microcurrent.

Kim Pittis:
Hi, everybody. Welcome. I'll let everybody file in here. Hope everybody's having a great Wednesday. This is the last Wednesday that you just have me. I'm sure everybody's excited to have Dr. McMakin back. I know I am. This is just not as fun without her. Although I am having a lot of fun and I've received a lot of very kind feedback. So thank you everybody for just making me feel good for doing this by myself and having some guests on. I'm still digesting all of Dr. Musnick's information from last week, so I'm sure Kevin's going to have his work cut out for him, getting everything edited and processed so we can watch it on replay and repeat and maybe slow it down.

Kim Pittis:
I typically listen to podcasts at like 1.5 speed, but I think the guests that I have on, I have to try to slow it down because there's just so much great information. So with that being said, today, there is no guest today, it's just me. What I decided to do was put together two conditions that I have this love-hate relationship treating with FSM, and I get probably the most questions emailed to me about these two conditions. So I'm going to talk a little bit about plantar fasciitis. And I'm going to talk a little bit about diastasis recti, because those seem to be two of the most really common topics. Share my screen.

Kim Pittis:
Those of you who are just listening on audio, I'm going to try to explain everything as best as I can. And you can always go to YouTube and watch the video part to get a visual of the slides. But like I said, I'm going to try to do my best. I do my best talks when I have something in front of me, like a PowerPoint, and if there was such thing as a professional PowerPoint, I'd probably try to do that just because I love all this stuff so much. So hopefully, like I said, I'm going to share my screen and podcast webinar 11/08/2023. So hopefully everybody sees that if you want to just put that in the chat or Q&A, that we're seeing the same thing, that would be very helpful for me otherwise I'm just going to start talking here. So you should see the plantar fasciitis Q&A people. Great. Oh, and Leif said he treated a friend's plantar fasciitis twice in two days and lifted her peripheral neuropathy. Wow. That's amazing. Okay, Q&A is hopefully will still work just because it's just me and I don't have Kevin or anybody else modifying that. I'm glad that you see it. Thank you. All right. So plantar fasciitis. I'm going to try to advance these slides a little bit better here. Like I said, I have a love-hate relationship with it because the feet can be extremely tricky to treat.

Kim Pittis:
Let me go to a slide show just so maybe you guys can see it better here. Let's see. Can you guys still see that? But is it better now because it's in a better slide format? Hopefully, you still see it. Let me know. Somebody on here. Yes. Perfect. Thank you. Alf. Okay, so your first question, when you have something like plantar fasciitis shouldn't be how long have you had this condition? What have you done to alleviate it and that's typically what we do for a lot of physical modalities and chronic pain. I typically like to say where did this come from? That should be my very first thought process because that will dictate how fast you can troubleshoot to fix it. I just want to go through some quick review about what plantar fasciitis is. I have a nice little picture here for those of you who are here live, but those of you who are not 2 million patients are treated for this condition every year. So it's a lot of people.

Kim Pittis:
Plantar fasciitis occurs when that strong band of tissue that's underneath the arch of your foot becomes irritated and inflamed. When this damage happens, we start to see things like inflammation, tearing, and bruising occurring. Obviously, you have lots of pain in the foot and through the Achilles.

Kim Pittis:
We say that it can result from high-impact activities like running and jumping, but we also see this condition with people who are just standing around for a long time. We see people who are overweight, flat footed. We see this in women who are pregnant and gain a lot of weight, obviously, baby weight and other things combining that with the ligature of the feet tend to soften. We'll see that in pregnant people, older people and the aging population tends to get this because that plantar fascia, like the fascia itself loses the elasticity and pliability, which makes it more vulnerable. So instead of tissue that can elongate, we see it more cracking and tearing happens.

Kim Pittis:
Your symptoms of people that come in with plantar fasciitis, we're going to see sudden or gradual. Sometimes we'll hear about it when your patients say, I just got out of bed and I slept funny and it started hurting or we'll see people say things like, it was really sore after walking for a little while and it never got better. So we'll hear things like that. Those sudden people typically will have that intense heel pain. So it's not typically on the arch of the foot, but they'll talk about it in the heel. On those first steps of the morning. We hear this a lot with runners who sometimes change their shoes or their socks or go on long runs, and they'll say that the pain happens after a long run, but not after the run but in the morning after.

Kim Pittis:
Then they'll say, once I get to the kitchen and I walk around for a little while, it starts to get a little bit better and then it starts to get sore after dinner again. So these are all pretty typical things that we'll hear. The gradual onset. That's the long-lasting pain. We'll hear things like, or we'll see things like their stride is a little bit shorter with running or walking, and we'll tend to see things like the weight will shift towards the front of the foot, away from the heel. So these people, when you're doing your standing assessment, you'll see them put more weight on the toes. And if you're doing a barefoot standing assessment, you'll see their toes, try to grip the floor a lot more because they're shifting the weight and all the weight is going through that forefoot, as opposed to being rooted in on the heels. Again, when you're doing your standing assessment for the practitioners that are there, you will see them, their quadriceps that anterior chain will be more activated. Again, when we're rooted through our heels, that's our hamstrings, the posterior lower leg. All of that is more engaged. So patients may also talk about knee pain. Just anything in that anterior compartment all of a sudden having trying to stabilize a bit more.

Kim Pittis:
Bone spurs. About 50% of people with plantar fasciitis will also have a heel spur. The popular theory is that the spur develops when the plantar fascia along the underside part of the foot pulls away from the heel from overuse, poor support, weight gain And so when you have that pull along the plantar fasciitis, then we start because of Wolff's law, getting that heel spur. The heel spurs themselves typically don't cause pain, but the plantar fascia or the tissues around the spur that are pulling at the spur is what creates the pain. And that's where the inflammation happens, and that's where the pain starts to occur. So we can definitely see spurs anywhere in the body that don't cause pain. But it's when there's friction along that spur is when we typically feel it.

Kim Pittis:
Bone spurs from plantar fasciitis is equivalent of what we see with Osgood-Schlatter's. And those of you who listened to any of my talks, that's another really popular one. I treat a lot of it with the teenage population, and the way that we think about it is like these Spurs didn't get like that from outer space, so the bone just doesn't develop a spur. It usually comes from this chronic tensile pull. And then when we think about how we do this with FSM, treating the bone will only get you so far. We really need to focus on the connective tissue that is surrounding that spur and then reeducating the mechanics.

Kim Pittis:
So we're going to talk a little bit about that. Frequencies. Obviously, we get the most bang for but we get the most benefit when we can be specific. So when we think about that tensile pull, that tissue that's under stress is causing it to tear and break. So like I said, especially in that older population where we are dealing with really decreased pliability and flexibility, malleability of a tissue, instead of it just elongating and repairing itself, it'll end up just tearing and breaking. In our world with FSM, 124 is usually the one that just jumps out at you, but then you have to start thinking what is torn and broken. Obviously, the fascia is torn and broken 142 but there's also tendons and ligaments, connective tissue. And then of course the periosteum that Saran wrap or as Carol calls it, the innervated felt that surround the bone can be very helpful. So torn and broken first and for a long period of time. And yes, the tissue is also inflamed acutely and chronically. So we can definitely add that in. So 40 for that acute inflammation, 284 for that chronic inflammation, I have 91, which is the hardening or the calcification and 13 for scarring. So, I'll typically pop that into periosteum, bursa, joint capsule, connective tissue, everything that's around that area, vascular tissue, adipose, I don't have all the numbers on here because I was just throwing this together really quick for you today.

Kim Pittis:
As for those of the practitioners that are listening, you want me to just get a nice picture of the foot in front of you. And when you're running frequencies through the ankle and through the foot, just stare at it. And then of course palpate and see what you're palpating. Of course, there's this huge fat pad. So it's not really on the slide, but scarring in the adipose 3,97. So 3 on A, 97 on B, it can be a real game changer for the underside of the foot.

Kim Pittis:
Again, breaking down the mechanism. What is causing the bone spur or plantar fasciitis? I tend to think that there's more than just wear and tear from high-impact activities. That's a part of it. When we're using frequency and even when we're not, I think the best practitioners are the ones that take a real global approach to this. So identifying the talocrural joint, range of motion through the ankle, what does the knee look like? What is the hip look like? Patients that are listening to this podcast. If you have foot pain make sure that you're very transparent talking to your clinicians about any old knee injuries or hip injuries, because sometimes those faulty mechanics have a way of finding themselves in that last link and that's in the foot and the ankle. So posterior compartment abnormalities, imbalances from sport, etc, we'll see that a ton.

Kim Pittis:
When we're doing any kind of work with frequencies, especially when it comes to the mobilization of scarring or dissolving the adhesions, we want to mobilize. And sometimes we get really caught up in the fact that mobilize equals manual therapy, and that's not always the case. Mobilizing the tissue just means that tissue needs to move, and it needs to have some tensile pull, and then it has to have some not tensile pull so that elongation and then the shortening of tissue. So 3/97 mobilizing the fat pad. In this picture, I've got a therapist using their thumbs to mobilize the adipose through the foot that can feel really good. Mobilizing the midfoot, checking the hind foot and the talus for abnormalities. Bilateral plantar fasciitis tends to be more of an issue with the cord. Anything that we see something bilateral, I'll always run 40/10 first to see if that helps. We can definitely get bilateral plantar fasciitis, plantar fasciitis on both sides. But usually it'll fluctuate. It's very rare that people wake up with bilateral plantar fasciitis. Something else that tends to be overlooked is 49 and 81. So increasing the vitality and the secretions to a foot can be very helpful. So when we think about the foot, we typically tend to think that it's avascular and we're on it all the time and it doesn't have very much pliability, but it can be very good for increasing that glide in the soft tissue.

Kim Pittis:
And you don't have to wait till the end. I think that's another thing that I used to do all the time, was wait to run 49 and 81 at the end of a treatment. I've definitely started using that in the beginning of a treatment, in the middle of the treatment, running it at the same time with one machine, especially in those really chronic conditions where you know that tissue hasn't been moving for a long time. So feel free to jump in with that anytime that you want. 77/142 are fantastic for the connective tissue, and the fascia is everywhere. And I think it goes without saying that the posterior compartment of the lower leg is 100% going to need treatment, which is rolling, manual therapy, and exercise therapy. There are very few structures of the foot that begin and end in the foot that contribute to plantar fasciitis.

Kim Pittis:
So it's really important that we take a look at what's happening in the posterior compartment because the foot can't move itself. So this slide just shows you some of those really deep posterior compartment muscles, the tibialis posterior, the flexor digitorum longus, the flexor hallucis longus, the calcaneal tendon. So all those really deep structures of the foot originated in the lower leg. So it's really important that the practitioners that are listening, identify what's happening and treat what's happening in the posterior lower leg. And then patients that are listening, it's also really important that you discuss calf cramps, knee pain, so on and so forth, because it can really help paint a really good picture.

Kim Pittis:
Again, just some more anatomy pictures to get a visual. Where did this all start? It very rarely just started within the foot, and even if it did start within the foot, it's definitely going to have some carryover up the chain as compensations happen. So as that patient who has that foot pain as they're changing their shoes, as they're changing their gait, as they're changing the way they stand, as they're changing the way that they walk, all of that is going to create different mechanics in the hip and knee because of the muscular attachments. So let's think about where this all started. We talk a lot about in the sports course, about starting superficial and going deep or starting deep and going superficial. This in my opinion, is a prime example when you need to work outside in or superficial deep. And I'm going to explain that in just a little bit. Essentially, though, when you release that fascia that is encapsulating tight tissue, that will help encourage the deeper muscles to start to release itself when there's more space. So, if you think about when I did the frozen shoulder talk and my slides for frozen Shoulder have an image of shrink wrap, that's what happens with the fascia.

Kim Pittis:
The fascia can just constrict and tighten around itself. So when you start with a frequency like fascia, everything can start to become mobilized. And there's more circulation to the area, and then there's more space and there's less noise in the area.

Kim Pittis:
So, 142, that's the fascia. When you release the fascia first, I say it creates good space, and that good space equals good circulation to the deeper tissues. So we release the fascia. And then we have 62/77 which are like the muscle, the connective tissue. And it can do the same thing. So now that constriction isn't there. The muscles are free to do what it needs to do. You've got circulation going in and out of the area. If you were listening a couple podcasts ago when we had Dr. Charlie Weingroff on, he had talked about energy in versus energy out, and I think about that quite a bit. We always want to be in flow, with everything, whether you're talking about just circulation or you're talking about energy, however, you want to talk about it, every religion, every spiritual element, every medical element, our body needs in and out. We need flow. So when we have space, we have to trust our bodies are going to want to use that space for good. So the connective tissue, the muscles can unwind and have space for those adhesions to dissolve and get into circulation.

Kim Pittis:
Once that happens, now we can go in and treat the periosteum and heal that bone spur. But in my opinion, just going after the bone first doesn't do too much because like I said, it didn't just come like that from outer space. It usually is coming from that tensile pull.

Kim Pittis:
So another slide here of looking at some anatomy. When we're talking about that posterior compartment we think about the gastrocnemius. That's our really superficial muscle. That's like those two big heads that we see when we're talking about the posterior compartment. We see those little heads on the back of the leg. Underneath that we have the soleus which is a flatter muscle. The gastrocnemius is really important. Why? Because it crosses two joints. It crosses the knee and it crosses the ankle. And that's important when we're looking at gait, when we're going through patient history, when we're talking about knee pain, when we're talking about all those things. So gastrocnemius crossing two joints, deep to the soleus we have muscles like the flexor hallucis longus and fibularis longus, the brevis, flexor digitorum longus, tibialis posterior, even deeper, popliteus. So these are all really deep muscles in that posterior compartment.

Kim Pittis:
When we're talking about mobilizing, it's not just having a manual therapist massage the area, manipulate the area. When you have a patient or patients that are listening, if you have a device, you can mobilize yourself by just doing activity. And the activity we want to hone in this area is length. So I'm pretty hesitant these days of using the word stretch because I know some of the bio tensegrity people don't. It's a scary word. We don't want to stretch and tear muscle, but I think if we can agree to disagree, that healthy length is always going to be beneficial, that's what we want to do, and that's definitely what we want to encourage with patients when they're at home. So doing some self-stretches. So I've got two examples here. I'm going to describe them both. One is a gentleman leaning into a wall. And he's got his front knee, bent knee right in line with toe and the back leg heel down. So that one picture we want to make sure the knee is straight when we are dealing with the gastrocnemius, like I said, it crosses the knee joint. So the gastroc flexes the knee a little bit. We want to make sure the knee is in extension when we're getting that muscle released. And a lot of people talk about the benefits of releasing superficial muscles first, even in exercise therapy. So that's what I'll typically prescribe, something like that wall press. And that'll be really good for the fascia all the way through the posterior compartment, through the lower back, through the hip, through the hamstring, across the back of the knee. It feels really good. Everybody can do this stretch. And then to get more specific we can start using the ankle a little bit more. So if you don't have one of those wedges that's shown in the picture, you can just put your foot or your toes up on the corner of the wall so that foot is dorsiflexed. So we're getting more of a stretch through the heel and then bending the knee. So taking the slack off of the gastroc driving the knee forward is going to help, not isolate, but I guess target those deeper muscles of the lower leg that don't cross the knee so they're not crossing the knee. The only way that those posterior compartment muscles are going to stretch or lengthen is by dorsiflexing or lifting up the toes. So these little wedges are great. You can get them for your patients on Amazon. You can make your own wedge at home or you can just put your foot up against the wall on the baseboards. Anything that you can do that's going to flex those toes up is very helpful.

Kim Pittis:
These are my favorite self-lengthening exercises as well. I like using the towels because I'm all over deep moist heat. It is my love affair. And why do I love deep moist heat? Heat creates circulation. We want to use, especially in the foot. So having a hot wet towel that you can stretch with can be very comforting, especially for tired feet. It feels really good. Some people do like to use ice on their feet. I'm going to explain why I don't like that in a brief second, but my favorite self-lengthen exercises are these. So basically you're getting like a hand towel or not something as big as a beach towel, but something that can be underneath the knee, underneath the ankle, through the top of the foot and have enough slack that you can pull. So you're going to be laying with your leg extended out in front of you. The towels on that underneath part of your calf up through the top of the foot, and you're just going to pull and make sure your toes are involved too. So you're getting dorsiflexion or that toe pulling that toe up towards your body. And at first, some patients might feel that it feels really bright behind the knee. That fascia and the adipose behind the knee can be quite irritating. So, you want to go nice and slow. You can bolster the knee up a little bit if you want. You don't need to, but what you want to do is just apply some long stretching to that area, some nice mobilization. And then you can transition into the foot. You can take that same towel, roll it up and have it underneath your toes and do those stretches that I was explaining with that previous slide. Having the posterior leg or that back leg straight, and then the toes are up just from the towel and then driving the knee forward. So one is for gastrox, which is the muscle that crosses the knee and then bending the knee and driving the knee a little bit knee over toe is going to get more of those deeper muscles.

Kim Pittis:
So the other benefit of using a towel with deep, moist heat is that you can clip your FSM right onto the towels and using two towels, of course, so you're creating two different channels, and then you can really expedite the stretch or the lengthen or the good flow or the space however you want to phrase it. And I'll talk about frequencies that I use for stretching in a second. But this is a really nice application for patients with or without FSM.

Kim Pittis:
After you've released the posterior compartment, the back of the leg, even the hamstring and the glute, then you can jump into mobilizing the foot. And I think what happens is people just jump into the foot far too fast and then nothing really holds. Like I said, all those attachments in the lower leg really need to be treated first. So on that left-hand side, this person's using a water bottle that they've frozen. I prefer to use a pickle jar with hot water or a mason jar with hot water if you want to start mobilizing the foot.

Kim Pittis:
So deep, moist heat is going to create circulation. And yes, the area is inflamed, but it's also chronically tight, so I don't mind people doing ice and then heat. I just don't like using straight up ice on the foot. We don't need those vessels to constrict any more than they already are. So if you do want to use a frozen water bottle to roll the foot, especially when it's really inflamed, I don't mind that. But using some heat afterwards on the calf with toes above nose, so lying down with it elevated and then doing some dorsiflexion with the ankle can be really helpful. If you're not wanting to use ice on the foot. We use different types of balls of different density to help mobilize the foot. So you can get yoga balls. Lacrosse balls are really hard, so careful with that. You can use tennis balls. Anything that you have to help stretch the arch of the foot. It can feel really good to just mobilize those tissues in through there. So those are some of my favorite mobilizations that I typically prescribe.

Kim Pittis:
And then once you have length and you've got healthy tissue, strengthening is going to be the next sort of thing you're going to want to target. And one of my favorite things is scrunching up a towel with the toes or picking up marbles and putting that in a cup. It's a really old exercise, but it works really well. People are like, I haven't seen marbles in a long time. Anything that's small Lego pieces, hair clips, anything that you can think of that's tiny. Just having the foot, the toes pick up that object and then moving the leg and dropping it in a bucket can be really helpful. Another exercise that I typically do is just having them stand barefoot, and you have your toes splayed out in front of you and just lifting the big toe while keeping the other toes on the floor. So you might have to physically hold the other toes down and just have the big toe flex and lift. And then next you want to leave the big toe down and have the other four toes lift. And it's very tricky, but once you get it a little bit, that neural connection happens. And that can be very helpful for just neural recruitment to the area.

Kim Pittis:
Any questions so far before I move on to diastasis about plantar fasciitis? Before I go further. You can go ahead and throw that in the Q and A. And if there's no questions, I'm going to assume that I'm just a fantastic instructor about the foot. What I will say about strengthening before I go too far here is to get the muscles in the feet to start moving effectively again.

Kim Pittis:
Going back to frequency, I will run 40/89 all the time. Again, we can expect the muscles and our bodies to move well if there is a perceived threat in the area. So if there is a bone spur, if there is inflammation, if there is tearing, we can expect all those muscles to fire up and engage the way that we want them to. So 40/89 first and then I will use that wipe and load. So we talk about that in the sports course at the very minimum using increasing secretions to the sensory motor cortex and the cerebellum while I'm doing exercises is what I always prescribe. And if you have questions, you can throw them in at the end.

Kim Pittis:
Diastasis Recti. So moving on that is the other one that is actually I'm going to go back one more thing here. And just to clarify with plantar fasciitis for the practitioners that are listening, this used to take me at least 8 to 10 treatments to resolve. And it didn't matter how long they had the plantar fasciitis for, it didn't matter the severity of the pain. I was always hovering around 8 to 10 treatments back then and even now, thinking that I'm a little bit smarter with what I'm running with frequency so it can be stubborn. I think having a patient take a custom care home with them so they can run things at home can be very beneficial.

Kim Pittis:
So that could possibly help expedite treatments, but usually it's 8 to 10 is what we seem to be or what I seem to be hovering in on for everything.

Diastasis recti. That is basically the the stretching of the linea alba, which is the connective tissue along your abdomen or the abnormal widening of the gap between the two inside ports of the rectus abdominus, which is your six pack muscle. For everybody else that's listening. There's a pretty controversial diagnosis going on. So we'll talk about that. It's usually pretty obvious when you see it though. There is that widening. We'll see tenting or doming quite a bit in the exercise world We usually say anything over 15 to 25mm is considered abnormal. And then depending on which level of the linea alba is measured, there is like this oval shape. So right at the belly button, it's going to be the widest split. And then as we move up towards the ribcage it narrows again. And as we go inferior towards the pubic symphysis again it goes a bit narrower. So it's always widest right around the belly button. We can see different different types of diastasis. So we have the paranormal, which again is what we typically want to see. There's a little bit of a split, but nothing severe and open diastasis is seen right beside it, where we definitely see that widest stretch around the belly button, and then it goes narrower superior and narrower inferior.

Kim Pittis:
We can see it just being inferior from the belly button down. We can see it just being superior from the belly button up, and then we can see it completely open, where just even segments of that rectus abdominus is separated in between those 6 or 8 pairs of muscle. In females, these are all different. You're going to want to see this on YouTube. Those of you that are listening. We see presentations, all different types. So we'll see just like a pooch or a bit of a ballooning in the tummy. Sometimes we see it with really loose skin on top. Sometimes we'll actually, as women get leaner after pregnancies, we'll see more of that space and scarring in the umbilicus in the belly button. Sometimes we see a little bit of asymmetry in the musculature in the abdomen, so it presents in all different types. Sometimes you won't see it unless a woman has actually flexed her abdomen, and we can see the muscles contract. So it's not always super, super obvious. We also see it in men, so women get all the attention when it comes to diastasis, especially after pregnancy. But we definitely see it in males as well. So here's a couple pictures of different types of diastasis in men. Sometimes we see just a major ballooning, almost like a beer belly gut. Sometimes we see that asymmetry even in lean, very fit males.

Kim Pittis:
We'll see just that whole in that one center picture. And then sometimes we just see doming or tenting when they contract like we see in that far left picture.

Kim Pittis:
The mystery is always in the history, so females is pretty easy. We typically will blame pregnancy on this, so we want to ask questions like how many pregnancies? How long ago were the pregnancies? Were there multiple pregnancies? How much time was in between the pregnancies. Now, that can be that can be very helpful. So women who has had multiple children, three and four kids back to back, that linea Alba does not have any chance or the rectus abdominus transverse, abdominus any of those muscles in the abdomen don't have time to get healthy and to contract again. So they're just like expanded and then left and expanded and left. So there's not a lot of healing that took place in between that. So we really want to ask questions about the spacing of their pregnancies. Males are a little bit more complex only because we can't blame anything on pregnancy typically with them. So we want to ask, has there been a lot of improper exercise where they haven't been bracing with their abdominal muscles properly? They've been doing crunches, sit ups, or planks improperly. Maybe they've gained a lot of weight. There could have been a hernia. There could have been family history sometimes, age, going back to plantar fasciitis. As we get older, we lose the elastin and the collagen.So things tend to stretch apart and rip. And they don't have that elastic property the way that they used to. Cirrhosis of the liver, abdominal wall cancer; these are all things that can lead to that linea alba just tearing apart.

Kim Pittis:
So when it comes to diagnosing, there's obviously the optical visual part of just looking and seeing the split. But we also want to measure, like I said, it's about 2.5 cm. So two fingers or greater is what we typically use. So when you're at the belly button and you're seeing that separation, having them contract the abdomen. And then you can palpate and measure for the degree of depth separation. So newer research indicates that the depth of the separation can be more of a telling indicator of diastasis recti severity. Lee and Hodges came up with that in 2016. Unlike the width assessment, there is no objective criteria for assessing depth. So I know with my own diastasis, I was feeling it, I'm like, oh geez, I think I'm palpating my spleen right now. It wasn't a very good feeling. Clinicians should press down on the gap to determine how taut or not it feels. The gap should feel shallow and taut, similar to the tissue underneath your chin when you lift your head. So everybody lift their head and put their fingers underneath their chin and press not on the bone, but just underneath that soft tissue.

Kim Pittis:
That's how pressing the abdomen should feel. Okay, the linea alba, that space, if there's a big space but that tissue still feels pretty taut, you're in pretty good shape. If the gap feels soft and smushy like your cheek, this could be more of a compromised case. So when you're feeling the abdomen and it feels soft and squishy like the cheek, then that connective tissue is a little bit more damaged and it can be a little bit trickier. So again, just a picture of measuring finger width apart for the clinicians at the belly button, how many fingers can you get in there that you can use a tape measure too. But we've got our fingers in there. And that's a good way of being like, oh, there's four centimeters as we're getting better going down to one. And then again going up the length of the linea alba and palpating deep to see what it feels like that squishiness.

Kim Pittis:
So again, the foundation in the way my head works of FSM is what's wrong and where is that occurring, going through the history, going through the exam. But when we go back to what's wrong, in layman's term, the linea linea alba has been blown to bits. It's been stretched apart. For weight gain, pregnancies, we've blown that apart. But now we get more specific. How long has it been in that really elongated, stretched-out position? How much scar tissue is present all along in that area? Because as we know, we can't just have something stretch without our body trying to repair it, and sometimes it gets a little bit too excited and it repairs it with scar tissue.

Kim Pittis:
So then we've got scar tissue present. And then what has this catastrophic event having no abdominal strength done for compensations. We typically see a ton of back pain. So we want to address and treat that in the back side. So always thinking what is tight and what is weak. And that's almost always occurring. And for the clinicians that are listening, if you can really start thinking about that quickly, that will really help guide you to what frequencies you're going to choose.

Kim Pittis:
Depending on that postpartum timeframe, tissue could have adhesions that need to be released and softened at the very least before you can start training for strength and recruitment. I think in general, once clinicians see the diastasis, they want to just jump on doing exercises, crunches, planks, Pilates. You can't just run and jump on those exercises when there's still a lot of scar tissue that's there. So we want to look at the way the back is moving and flexion and extension rotation. We want to take a look at what the hips are looking like. We want to look at pelvic mechanics like the innominate rotations in flares and out flares pubic subluxations and sacral torsions. So we never want to build on a faulty foundation.

Kim Pittis:
So making sure that all those things are in place first. And yes, you can throw in some exercises, but you don't want to just start training like crazy when the hips are out and the low back is in pain, because our brain will never allow us to do that.

Kim Pittis:
So quickly here, the multifidi, psoas, piriformis and QL, and we see this a lot with sacral torsions. So anytime the sacrum or that big bone on the base of your spine sandwiched in between your hip bones, I have a love affair with what the sacrum looks like. And when it's out, we typically can blame the piriformis, the psoas, the multifidi and the quadratus lumborum. Those are some of the deepest muscles that we have, big pain generators, and we typically think that we can treat them with our elbow, with these hooks and with needles, but they're some of the deepest muscles in the body. And I want to argue, and I get a lot of heat for this all the time. At least once a week I get some sort of email. That's not very nice, but I have a hard time believing that you're not creating tissue damage to superficial muscles with these modalities. It may feel like you're releasing your psoas, but what are you doing to everything on top of the psoas is what I think and I used to do this before there was another way.

Kim Pittis:
So how do we best dissolve adhesions? 13. Right. We typically think 13 is the best frequency for dissolving the adhesions, the cross bridges. But what really happened? What happened before the scar tissue developed? It tore. Why did it tear? Because there was pressure behind it. So we could talk about trauma. We could talk about bleeding. We could talk about a lot of things. So starting to really think about what happened in that case. And then where did it happen? Did it happen in the abdominal muscles, which was what we like to use for 62 or was it more connective tissue? Right. It's the linea alba, which is non-contractile anyways. So the linea alba itself doesn't contract. Whenever I see white on a diagram, I typically think 77 connective tissue and fascia. And of course, there's adipose there. So is it scarring? Is it fibrotic? Is it calcified? Could it be 3 which is sclerosis? So this helps bring a lot of other frequencies to the party that maybe wouldn't have come, because we're thinking about what would pair best with that B channel.

Kim Pittis:
I talk a lot about sequencing, how to layer frequencies, where to start? when to finish? when you start with one? does that mean you can't bring it back in again? And it all depends. So 124 is absolutely most definitely almost always the cause. Something toward the Linea Alba tore, it stretched. And because it's not, it doesn't have the actin and myosin to pull it together like contractile tissue does.

Kim Pittis:
It just stayed apart because it wasn't elastic enough. So this is a cause. This is what started it all, 124/77 and 124/142 for hours may be needed. I'm going to say must be needed. Why is this great? They can do this at home so they don't need to occupy a treatment table. They don't need you to just sit there and watch 124/77. So this is when sending them home with a CustomCare can be really great or just put them in a recliner in your clinic. You don't need to be hands-on for this stuff, but running it and running it and running it and running it.

Kim Pittis:
When they're with you as the clinician or patients that are listening, if you're going in for treatment because you're going to need somebody to help you with the manual therapy part and with the exercises after, we also have to make sure that we're treating the nerves right. There's nerve and artery, and then the tight fascia or the scarring on top of that can really constrict both of those structures. So running inflammation and scarring on the nerves are very helpful even if they don't have pain. When we start doing exercises, we want to make sure the nerve is free to do what it needs to. So treating the nerves and the inflammation. Treating the adipose 3/97. And treating the fascia and the other tissues. So like I said, 13 for scarring, 51 for fibrosis, 91 hardening calcification in the fascia, the connective tissue, and the muscle.

Kim Pittis:
And then the recovery protocols. So on the mode bank, we have a lot of really great options for patients to just pop them on. So a lot of my patients, a lot of my athletes are using the DOMS protocol all the time. So delayed onset muscle soreness. We've got concussion versus concussion and Vagus versus vagal tone. Right? The Vagus travels everywhere. But we have this big mess of the Vagus in through our gut. So if that is scarred or adhered, there's no way we're going to get good activity happening in those muscles in our core. So releasing scarring in those areas.

Digestive concerns. So if you have somebody that has food allergies or lactose intolerance, gluten sensitivities, they're going to be bloated. And definitely bloat is not helping muscles that we need to be flat. So making sure that and if you're not an expert in digestion stuff, you don't need to be send them to somebody who does know that can help you with testing and or help that patient with testing so they're not bloated is definitely going to be something you want to look into. And then post-treatment options and home support Like I said before. As they start doing exercises, things are going to be sore. So we want to make sure that people are feeling good when they start using muscles they haven't used in years and years.

Kim Pittis:
And treating the abdomen is very tricky because they're typically not going to get sore in their abdomen right away. They're going to get sore in their back and back Pain is scary. Patients don't want to feel back pain. So it's a slow start. So using a CustomCare at home or in your clinic right after an exercise session can be very helpful.

Kim Pittis:
I just put on here a little bit of a screenshot from before of the modes of workout, post recovery. I give that to patients a lot and then DOMS. So it just has a split screen here a little bit. A lot of the same frequencies running torn and broken in the connective tissue, the tendon, the ligaments, bleeding in those areas, torn and broken in the fascia, a lot of inflammation in the connective tissue, the muscle, the sarcomere, the fascia, the tendon, so on and so forth. Vitality to those areas and then delayed onset muscle soreness or the DOMS protocol a little bit longer, also a little bit shorter, but still having the bleeding, the torn and broken in the muscle, the fascia, the tendon, the immune response and then inflammation in all those areas. So good options that you have in your mode bank for running as these patients are starting to do exercises and potentially getting sore.

Kim Pittis:
Guess what? Birth is traumatic for everybody, not just the baby. So again, when we start thinking about how did the Linea Alba get torn and if it is due to pregnancy? I like running concussion in Vagus the emotional components and just using 94/294, which is trauma to the connective tissue and to the fascia. You can use concussion in the treatment room. I love having people take a CustomCare and running concussion at home. I enjoy seeing patients get that floaty feeling and getting happy and just feeling relaxed. Yes, but sometimes it's more helpful that they run things at home where they can just go to sleep after, treating the Vagus the emotional components, talk to them and feel it out. I'm not saying the emotional components have started the whole thing, but the emotional frequencies can definitely hold tissue in that place. So you may find a plateau sometimes as you're training them or as they're getting better. The back pain is getting better. The abdomen is feeling stronger, but then you hit a plateau. And so talking through those emotional components can be helpful.

Kim Pittis:
Like I said, the digestion support, the bloating is real, so bloating and any kind of GI distress can lead to further distension in the abdomen. So it doesn't matter how strong you're getting those muscles. If they're bloated, that's not going to help. So making sure you're able to run protocols for the GI, small test and large intestine, liver, pancreas, and sending them for food sensitivity testings, a GI doctor all those things.

Kim Pittis:
Post treatment support. Depending on how, and I have aggressive in quotes, your in-clinic treatment was, you may need to clean up the mess with a take-home or post-treatment option like: Soft tissue acute, general inflammation, concussion in Vagus, bleeding, torn and broken 40. So you don't have to stick to the script with the mode bank, you can just write frequencies for bleeding, torn, and broken. Like I said earlier, we want to use that torn and broken for a long time, so it's not unheard of for me to put 124/77 for an hour and just say, run it as many times as you can throughout the day, run it at night, so on and so forth.

Kim Pittis:
I love seeing patients and I want to spend time with them, but just watching 124/77 for an hour, especially when there's not a lot for me to do as far as manual therapy or exercise rehabilitation, I'll just put them in a different area, send them home with the machine, just to free up my space as a clinician. The other thing I want to talk about too, is it's not just 124. So all of my 124 programs will finish with vitality and increasing the circulation to the area or increasing the secretions to the area, especially when it comes to the linea alba. I'm not sure if I put this slide on here or not. Yes I did. So when something is split or torn and it has not gone back, you can't put tissue back that isn't there. You can't contract. You can't expect non-contractile tissue to contract. So that Linea Alba actually can't contract. It doesn't have actin and myosin. There is no sliding filament mechanism that can allow that layer of connective tissue to get shorter. All we can expect it to do is to become more pliable, so it's not going to tear.

Kim Pittis:
Muscles that are. Scarred or adhered cannot contract optimally. So when we move lateral to the actual muscles of the rectus, the abdomen muscles, we want to make sure that those muscles, the muscle fibers that are there even in the obliques and the transverse abdominis that they can contract. So you want to make sure there's no scar tissue in those deeper layers. The abdominal core group are prime candidates for what I like to say Wrong Strong or Macro Strong versus Micro Weak. So when we have big muscles that are always doing the job and not the smaller muscles and like I said, don't skip steps. The strength that these patients are going to redevelop depends on having the deeper tissues in the healthiest state that we can get them in.

Kim Pittis:
We say that you can't put tissue back that isn't there until we do that. So 81 increases secretions and in the case of fascia we think it's increasing ground substance, which is that gelatinous viscous like egg white of substance surrounding the cells. So chemically it's a mucopolysaccharide that's composed of hyaluronic acid proteoglycans. And basically its job is to lubricate collagen, allow things to slide around, helps with shock, and it holds tissues in place. So last time I checked pretty cool. And we want to have a lot of that.

Kim Pittis:
I always say phloof is the opposite of smoosh. I know Doctor Charlie Weingroff can't talk about smoosh because you need objective measures, and he's absolutely right. So yes, we are measuring the Linea alba and we're measuring strength. But there's also something so beautiful as a manual therapist, when you feel tissue starting to just give. So the phloof phenomenon could be the antithesis of smoosh, right? So it could be that filling up that we typically see when we use 81 anyways. So we like to use it with 142/77. So increasing the secretions obviously to the fascia, but I use 81/396 a ton when it comes to nerve nerve problems. So nerves that are adhered, trapped, tethered, constricted, unused, unrecruited, uncoordinated. I'll use 81/396 when there's numbness to just drive current through to the area. So don't be afraid of 81.

Kim Pittis:
When we talk about how we're going to apply FSM, you can use towels, you can use stickies. If you're going to use sticky pads, red and black along the back and on the front you're going to use bumblebee, black and yellow. Sorry. Red, green on the back. Black and yellow on the abdomen.

Kim Pittis:
Some of the biggest issues when it comes to Linea Alba or Diastasis Recti reconditioning is this tenting, coning, doming however you want to call it, and we typically will see that. So this picture is great for just showing how that happens. So when people are getting into flexion, sit ups, crunches, planks, overhead movements, pull ups, rowing, when you're doing any of those big exercises before the deep intrinsic abdomen is strong, we're going to see that tenting or that coning. So bracing muscle setting exercise is first laying on your back, planting your feet on the floor so your knees are bent, placing your hands on either side of your core and just thinking about pulling your belly button in and towards your spine. So we're just creating more space, and then have your patients or feel your hands feel the activation of your core. We see the corset muscles envisioning that tightening, and that's all we're going to do in the initial phases. You can use current 81/84, 294, 321, 81 on the sensory and motor cortex, increasing the secretions to the nerve. Those are all very helpful.

Kim Pittis:
And then once you've gotten some bracing done, then we can go with that concentric activation phase. So in this case I love using like a bed sheet under the back, crisscrossing it in front and then pulling it tight. So you're physically squeezing the linea alba together with force. And then you can start doing some concentric activation or some little baby crunches as you're squishing and pulling and approximating the tissue, and then increasing the secretions to the area, to the muscle, to the nerve.

Kim Pittis:
Then you can go to more progressions, way before you go to planks, we want to do tabletop. We want to do these activations just on hands and knees and gently lifting the arms. And you can go. Arms and legs. You can go unstable surfaces. You can use bands. So there's a lot of progressions that you can use here.

Kim Pittis:
But the most important thing when it comes to anything or any injury really, but especially with the diastasis, is teaching your patients how to avoid the most common injuries. Brushing your teeth and washing your face is going to be some of the hardest things when you don't have core control, so it's okay to brace onto the sink or onto the counter. So having them use their back muscles in their glutes to lower themselves can be very helpful.

Kim Pittis:
That's about it for today. I'm going to stop sharing my screen really quick because you've seen it all. Thank you so much. I appreciate you guys being here, letting me talk about all the things that I love talking about. The next time I'll definitely write this down. Talk about frequency for Synovium because I have a love-hate with that. And it's definitely something that I want to address and not just in a few seconds. So again, thank you so much. It's been so much fun hanging out with everybody and having our guests on next week. Dr. Carol McMakin is back so we can hear all about her world travels. Keep all those questions coming. Thank you for emailing. You can email me some more things about this presentation, [email protected]. Yeah, I'm sorry I couldn't get to all the Q and A's and the the chat was disabled. But hopefully you got some fun and some information out of this. So thanks everybody. We'll see you all next week.

Kevin:
The Frequency Specific Microcurrent podcast has been produced by Frequency Specific Seminars for entertainment, educational, and information purposes only. The information and opinion provided in the podcast are not medical advice. Do not create any type of doctor-patient relationship and unless expressly stated, do not reflect the opinions of its affiliates, subsidiaries or sponsors or the hosts or any of the podcast guests or affiliated professional organizations. No person should act or refrain from acting on the basis of the content provided in any podcast, without first seeking appropriate medical advice and counseling. No information provided in any podcast should be used as a substitute for personalized medical advice, and counseling. FSS Expressly disclaims any and all liability relating to any actions taken or not taken based on any contents of this podcast.

Sonix is the world’s most advanced automated transcription, translation, and subtitling platform. Fast, accurate, and affordable.

Automatically convert your mp4 files to text (txt file), Microsoft Word (docx file), and SubRip Subtitle (srt file) in minutes.

Sonix has many features that you’d love including share transcripts, automated subtitles, advanced search, collaboration tools, and easily transcribe your Zoom meetings. Try Sonix for free today.