Episode 1632 - Measuring IRD vs. strength: which matters more?

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan defines interrectus distance and how to measure it, how to functionally measure core strength, and the limitations of focusing on interrectus distance with patients. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today’s episode, I want to talk to you about VersaLifts. Today’s episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today’s show notes to get your VersaLifts today. ALEXIS MORGAN Good morning, PT on Ice. Getting both our cameras going here. Good morning, PT on Ice Daily Show. My name is Dr. Alexis Morgan, and I am excited to be with you on this morning, this new year. Happy New Year, everyone. And let's talk about measuring IRD or inter rectus distance versus measuring strength. Which one matters more? So to jump right into the topic here, Interrectus distance is a common measurement that individuals are going to be taking in pelvic health. WHAT IS INTERRECTUS DISTANCE (IRD)? So interrectus distance is the distance or the measurement of the linea alba width. It's that linea alba between the rectus abdominis on the left compared to on the right. What is that distance between? That's our interrectus distance. Many people advocate for measuring interrectus distance. Number one, it's measured in a lot of our scientific studies that is looking at diastasis recti. There's a lot of studies that are looking at it. And so if they're looking at it in the studies, well, maybe we should be looking at it in clinic as well. It's also repeatable. We can measure it the exact same way and we can see if there is change. And we like data that we can measure and we can see if there is change. So people are definitely advocating for its use. There are some benefits from measuring change. Obviously, you're here at ICE, you know that we are recommending to be able to test and retest to see those differences in all aspects of care. So, of course, we should be recommending that here, right? Well, we do recommend testing and retesting in this space. MEASURING STRENGTH However, we recommend measuring strength. So, measuring strength entails getting functional with your clients. One of our favorite tests is the sit-up test. We talk about it in our online course, and it is a way in which you can measure how strong an individual's rectus abdominis is. So they're sitting up. How much support do they need from their legs? How much support do they need from their arms? Do they need to whip themselves up or can they control themselves up? Do you need to hold onto their feet or not? This gives you a score. And with that score, we can then track change over time. It's extremely functional. This is what individuals are doing when they're getting out of bed or when they're getting up out of the floor with their little ones. This is also very functional for all populations. So not just the postpartum individual, but this is also helpful for individuals who are post hernia surgery or pre-hernia surgery. This is great for individuals with varying levels of adiposity. You don't have to measure, you don't have to assess something and be distracted or be, oh, I don't really know what I'm looking at because there's adiposity. We're just measuring strength. We're just testing the functionality. LIMITATIONS OF IRD When we think about the limitations of measuring the interrectus distance, Really, I could go on for a long time here. There's actually no known pathological number or centimeter or measurement. There's no known measurement that we all are in agreeance of like, yes, that number is pathological. We don't have that. In 2021, a recent paper came out and actually I believe Rachel did a podcast on this exact paper. So I'm not going to go into all of the details. You can search back to listen to this, but in 2021, a paper came out looking at individuals ages 20 to 90 males and females of all BMI sizes, looking at their CT scans and they measured the interrectus distance. With all of these people, 57% had greater than two centimeters in that interrectus distance. Now for reference, over the last 70 years, much of the data, much of the science that is looking at diastasis is using measurements, oftentimes in centimeters, and they vary. There's no agreeance in these studies. So sometimes there are two, sometimes it's 2.2, sometimes it's 2.5, that that one particular study calls pathological because there's no known pathological. But around that two centimeter mark, Well, now we have this study just in 2021, looking at what is normal. And we see that 57, so over half of the individuals actually had greater than two centimeters. So there's a problem here. We can't call this pathological of more than half of the individuals of all ages, of all BMIs, parity being one risk factor, but BMI and age also being risk factors. We can't use that. Not to mention in all these studies there's a variety of tools that are being used. So measuring with just fingers, measuring with calipers, measuring using a ultrasound machine. There's a lot of different ways to measure and of course those are going to be different between different tools. We don't have any standards. We don't know where exactly should we measure. In all of these studies, sometimes it's a couple centimeters above the belly button, sometimes it's more, sometimes it's less, sometimes it's right at, sometimes they avoid. There is no absolute on where we should measure, nor the type. It's all over the place. And one of the aspects that I think is the most concerning here is that, well, I've just laid out one, the fact that we don't have any agreement on any of this. Why are we doing, why are we measuring? FOCUS ON FUNCTION AND NOT APPEARANCE But number two, when we're measuring, we are perpetuating this focus on the looks. We're focused on what they look like and what that measurement is has nothing to do with their function. We talk a lot in our level one course on diastasis and a big aspect that I'll have to leave for another podcast on another day, or you can join us in our course, but another aspect of this is body image. And many individuals are very concerned and have body image dissatisfaction. If we can help them by shifting the focus to function in our little space, absolutely we recommend referring out to mental health professionals to help with that. But in our little space that is the physical world, If we can help by shifting the focus to physical and to function, then why would we not do that? Especially when there's a lack of evidence for clarity on measuring that inter-rectus distance. Our newest research in this space in the last handful of years, our newest research has shifted in this direction. it shifted in measuring abdominal torque. the rotational torque that is that one can generate power. Why? Because that's functional. Or that sit-up test, like I mentioned, it's functional. Our newest evidence is heading in this direction. Let's not wait 20 years. Let's go ahead and jump on this train and let's start measuring function today, this year, for 2024. Let's measure function and let's focus on what matters. for our clients, and let's follow this research. And when we do that, we know we can absolutely help them increase in their function. We've got no doubt about it. I know for sure if you can't do a full setup, I'm gonna give you the modifications and I'm gonna give you that home exercise program that will allow you to do a full setup in due time. I have no doubt about it. I can sell that so easily and I would hope that you can too. So let's stop focusing on interrectus distance. Let's start focusing on function. Our recommendation is that if somebody comes in and asks for an interrectus distance measurement, if they're asking you to measure, and they fully believe in its importance in their rehab, that would be the only time in which you would use measurement. Other than that, other than they're asking for it and there is a significant belief in its importance, If those two things are not both on the table, then we need to set the measuring IRD aside and focus in on strength. Thank you so much for joining me this morning. I hope it made you think. It's something we've been thinking a lot about, both in reading the evidence and in practicing clinically. And I hope it helps you focus in on what matters this year for your patients. This material and a whole lot more is in our online level one course. Our course starts next week. It's absolutely sold out. We are closing, we will be selling out for the March cohort well before March as well. So if you are wanting to get into this level one course, it's been revamped, all brand new. If you want in, you should go ahead and register for that March cohort. If you've taken our online courses before, online level one before, then you will be interested in our online level two course. And that is a brand new course, which starts April 30th. If you want to catch us live, we're going to be on the road a lot in 2024. All of that's on the website. You can see it. I'll just mention the few that are coming up in January and February. We are going to be in Raleigh, North Carolina, January 13th and 14th, Hendersonville, Tennessee, January 28th and 29th, and Bellingham, Washington, February 3rd and 4th. We are so excited to see you all out on the road in 2024 and can't wait to see you all online as well. Have a great day. Happy New Year. And we'll catch you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.