So excited to be here with two of the most amazing people on the planet, as well as some of our other live participants who we're getting to know, we're so thankful that you're here tonight.

My name is Dr. Kathy Dooley, I am a chiropractor, rehabilitation specialist, and an anatomy enthusiast of sorts, here with the amazing Dr. Anna Folkmer.

Hi everyone, I'm Dr. Anna Folkmer, one of your co-founders of Immaculate Dissection.

I'm an acupuncturist and herbalist, and also an anatomy enthusiast of sorts, and glad to be here.

And last but absolutely not least, Danny Quirk, our anatomic artist for Immaculate Dissection and co-founder.

Hey everybody, yeah, Danny here.

Yep, the artist for Immaculate Dissection and giant anatomy dork as well, so always excited to attend these and be a part of them, so looking forward to tonight.

So if you're joining us for the first time in our anatomy dorkness, as Danny very eloquently put it, which I do agree with, we decided to get together on Sundays and chat, and we started at the beginning of the pandemic, so it was March 2020, and we've gotten addicted to it, we love it.

It sparks ideas for us for our ID Collaborative, our online learning series, and it gives us, you know, ideas of just getting people excited about anatomy and talking about some various questions that you have.

Sometimes people will come to our courses and ask questions that's not always appropriate for the subject matter, and so this is kind of an open forum, and it's free, and we'd love that you guys join us on Sundays for this, if not live after the fact.

So we have some pretty cool questions from the gallery, and we thought that we might cover them.

So do you want to start with the first question that was asked?

Sure.

Okay.

Pull that back up.

The first question regarding the kinesiotape, okay.

So the question that we got on Facebook was, can bracing using external support like kinesiotape and diastasis recti cause changes in blood pressure?

Okay, so the first thing that we want to cover as an ID family is that we don't use kinesiotaping for anything other than the demonstration of ligament location, and I'd like to demonstrate the ilial lumbar ligament and the importance of iliacus and quadratus lumborum attaching to it, and anterior thoracolumbar fascia attaching to it, but I have to go from experience.

I used a kinesiotape from 2006, 2007, very religiously, every single patient, every single visit.

In the last year of my internship for chiropractic, I saw a lot of patients, and to me, it was very cumbersome, and I didn't find it to be as useful as it was expensive or time consuming.

So I found that giving proprioceptive cueing and other type of things worked a lot better for me.

Anna, I know that you said that you use magnets a little bit more?

I do, yeah.

Something that has a little bit more weight to it, just so that you're able to simulate some of those proprioceptors, and I use magnets for, I use silver and gold ones, kind of depending on the circumstances, but I find them a little bit better for proprioceptive cueing than some of the kinesiotape, at least as far as my work's concerned.

Yeah, the problem I have, I guess, with the question is that kinesiotape is brought up as being a support, and I guess I don't know what they mean by support, because if they're talking about structural support, that's not what kinesiotape is doing.

Kinesiotape is in the literature and supported as being something that's for more proprioceptive reasons or to encourage circulation, but it's not used as a structural support, like athletic tape, and so that's part of the thing that's good about it, is that it doesn't limit movement, and that you tape in certain directions, and that pull that's on the skin creates a dermal traction, and the whole theory is that you're encouraging things to move in a certain direction that you want to move in, and I see the appeal, for sure.

I think that because when you change directors of force so frequently, I particularly don't really love taping in a certain direction, because I think it's willing to change very quickly, and your body adapts.

I also know, I can give you a test right now, to the fact that once you tape something, you're going to accommodate to it, so make sure that you feel the back of your shirt right now, feel the back of your shirt, feel it hitting maybe your scapular region, feel that really intensely, great, awesome, so five seconds ago, you didn't feel that, and

I brought your attention to it, so one of the benefits, I guess, of kinesio tape is that you can see it, maybe it brings attention to it, but it's only for a short period of time before you filter it out again, just like you just did, now I can bring it back to your scapular awareness, and you feel the shirt on your scapula, it only took you a few seconds of me talking to distract you away from feeling that tape, so I have not found it to be as useful as the education of my patient, so when it comes to diastasis recti, it's a huge education for us in immaculate dissection on breathing mechanisms, and a lot of people are taping diastasis recti, they're taping it in the middle, in immaculate dissection, that's our last focus, we're focusing on lateral expansion of muscles like transversus abdominis, internal abdominal oblique, external abdominal oblique, that are forming the rectus sheaths, the aponeuroses that form around this rectus abdominis, so the worst part about diastasis recti is its name, I know diastasis is the separating of two pieces, but rectus abdominis, its two muscles were always separated and combined at the linea alba, and it's not just the rectus that's separating from midline, it's the aponeuroses, the rectus sheaths that are separating from midline, and what we correct with diastasis recti in a lot of people is their dysfunction on the anterolateral abdominal wall, and not just rectus abdominis, so for us, what are you going to do, you're going to kinesiotape TVA, IAO, EAO, rectus, anterior lateral thracolumbar fascia, iliacus fascia, psoas fascia, it would be a lot of tape. The second part of that question is about blood pressure changes, and I'm assuming they're talking about diaphragm hiatus, and aortic pulse, it's a lot of assumption, I'm hoping that I'm answering their question, and the ID team maybe can help me too as well, if I find that the person has diastasis recti, and has diaphragm dysfunction at the basically thoracic jamming at T12, and a really visible aortic pulse, kind of like the Andy's video that he did for our Instagram, he was talking about the bounding aortic pulse, I think that certainly you can monitor blood pressure through breathing, that's very provable by you just taking your pulse right now, inhaling, and as you exhale, the pulse slows, so certainly if you're harmonizing diaphragm, and it's pressure on the inferior vena cava, and abdominal aorta, you can certainly change things, as far as taping and blood pressure, I'm not sure that we're the right crowd to really answer that specifically, I wouldn't use tape at all, because I don't use kinesio tape at all, I instead educate my patients on where I want things to come from, and let them start to tap themselves, and give themselves proprioception, educate them through where things are supposed to be coming from, and that's our bigger focus, we're not antagonists to using taping, if you want to do all that, and use taping, great, but for me, I've had enormous success with using IDQs, and not needing any tape at all, it's an extra expense for me, and the patient to buy it, but Anna, do you have more to say on that, I'm sure you probably do.

I mean, there was a lot in that question, that certainly worth discussing, and you hit all those topics, but we talked about the application of bracing, and things like that, in an ID collaborative episode, really early on, and we don't apply any sort of bracing in diastasis recti, when we're addressing this, so I think it's really important, how many ways are you trying to connect dots here, with your patient, correlation and causation aren't the same thing, we know that, and really fun research articles, that have lined up two things simultaneously, and shows ways in which they look like they're correlating, but they're actually not, I certainly think that you could talk about this from the angle of, well, if there's a diaphragm dysfunction, and it could miscue the obliques, and then there could be a tendency to have something like diastasis recti, which may be accompanied by a blood pressure issue, if there is some sort of diaphragmatic compromise around that hiatus, but it's trying to thread a little too much together, I think with this question, and because if you try to match the problem and the strategy together, a lot of times, that sort of confirms whether you're on the right track or not, because if you made this an if-then statement, and said, well, does taping address blood pressure, or does taping not address blood pressure, I would say there's entirely too many factors that go into what a person's blood pressure is doing, and none of them are a tape deficiency, and none of them are ever fixed with tape, so to me, it just seems a little unrelated from that perspective, but if you're curious about the application of a brace and someone's blood pressure, I know with people who wear big, thick belts and stuff, I would say be careful about that, because it's certainly possible that the external support that you're trying to apply to the patient may be giving them a diaphragmatic dysfunction, which could be then throwing off their blood pressure, so there's lots of different ways that you can look at the relationship or non-relationship of these things.

I think it's an interesting question, so hopefully, I'm a little unclear which part to answer, but hopefully, there's enough said about each one of those things that the person feels like their question is answered there. Yeah, unfortunately, it's like a bomb going off with the question, because first of all, it postulates that the person needs to be taped on the anterior, which we're very against in that section. We're very much against trying to get them to open up the lateral sides, and then that will create a natural bind in the front through the actions, through the tendons. Second of all, we don't use kinesio tape, but you certainly can. I mean, if you're supporting that lateral wall and if you find the tape to be useful, if you find anything to be useful, you probably should be doing it, but we're not kin tapers as far as the

ID teaching team, so we're probably going to support you in your kin taping with ID principles, which are get the lateral wall moving. I just wanted to show you, Danny had painted this on one of our amazing colleagues, Frank Desiderio, and I'm just going to share my desktop with you guys really quickly and just show you. You can go to YouTube, and if you type in my last name or just duly noted diastasis recti, this is Danny actually painting Frank, and we show the diastasis recti in this diastasis recti video. Let me just get to the point to where you can see that we're talking about the rectus sheaths and the fact that diastasis recti doesn't come from here. It's coming from the lateral side of the wall, and then we have Frank lay down, and we do breathing strategies in supine, which is very important to us in diastasis recti, and you can see that I'm going to start coaching him through the ability to laterally breathe, and Anna, I think you might be filming this, are you not? I'm trying to remember if you or

Danny were filming it. I think so, yeah. You can see me trying to point out to the lateral side that we're trying to get the person to expand laterally and that the person that has diastasis recti tends to expand too much here, so I think that's what they mean by trying to kin tape them down here, but rather than trying to tape them down here when rectus is really not what's causing the problem, it's the fact that there's tightness here, the diaphragm's dropping down and forward, as Anna describes in ID1, and in the way that Danny paints this, he shows that what you're looking for actually is for our IDQs to be set neck long, chin tucked, chest wide, and for the person to be expanding more laterally, and so if you want to kin tape to encourage better blood pressure through better diaphragm function, that's very indirect and I would say almost a little bit too indirect for me to feel comfortable saying that they're correlated, like Anna said, correlation versus causation. I think that the biggest thing for us in ID is trying to encourage the person to not breathe through their neck, to breathe through the sides of the ribs in diastasis, and 100% of diastasis recti patients, they breathe too anteriorly and not enough laterally, so hopefully you can help them control their blood pressure, you can use taping if you like, but please don't just tape them, you need to make sure that they get a lateral expansion, and if you want to learn how to do all this, we teach all of this, all the intricacies in ID1 core concepts.

As Anna described too, just to show you, if you go to our website, maculardissection.com, you go to the ID Collaborative, we cover a lot of these breathing mechanics and the way that we coach breathing through the ID Collaborative, hopefully my internet will sustain here, folks, and I think it was episode three, yeah, this one right here, so you can just click on this one and it'll take you to where you can actually purchase this particular ID video just on the biomechanical breath, so if you're wondering how to navigate the website for these little videos, sorry, website's a little slow right now, my web is a little slow, it describes what you learn and what to do, and it's, you know, a pretty good 20 bucks spent, or you can sign up for the ID

Collaborative membership where we cover breathing, so that might prove to be really helpful, and we are on par this year to talk about diastasis recti as a separate unit, but you're welcome to, you know, enjoy the biomechanical breath and our discussions on what's actually happening in breathing, because that might benefit you more than just saying, let me throw some tape on the front of them, and hopefully that will help them bind up, I think that that bind up idea of trying to create tension in the front of the wall, those are tendons that are stretched out, they're tendons for muscles that are located out to the lateral side, so if you're wanting something to really bind in the front, you better get moving on the lateral side, dating also, oh sorry, I think we also covered diastasis recti in the third Ask Us Anything, maybe, and that should be up on YouTube, right, yeah, so there, it is, it's a topic we love to talk about, we talk about it so good, if you just join us for something, it'll probably come up, so yes, Danny, anything else to hit when it comes to diastasis recti, and you have an awesome video on our Instagram where you go over like sitting postures, and breathing, and the aortic pulse, and blood pressure, and how it's affected by the diaphragm, yeah, no, I mean, just basically, we're just going to add, and kind of just contribute to that though, again, like kind of, kind of, just kind of jump back off of what was kind of said before a little bit, but, but yeah, like really, really big important thing though, is to really kind of work on lateral sides of things, like even though the name, anterior located structures, it's really not the thing that's causing issues, and like,

I don't know, kind of the visual, I don't, hopefully it'll, hope it'll work this time, but

I had kind of done this beforehand, but you can kind of think of it like, let's see here now, so if you're doing too much, kind of pushing forward anteriorly, you're kind of split at the front, but you know, if you strengthen, strengthen from the sides, it's going to kind of take that, all that tension coming out from the front, and keep you more braced, and more supported, but I was kind of thinking about that though too, in terms of like, you know, in terms of braces, or in terms of things like that, like if it's, if it's giving support, but preventing any kind of movement from happening, you know, I feel, I feel like that could just cause like, any kind of like, you know, side-to-side movement from happening, that can definitely cause some issues as well down the road, and you know, it may not get you very far in that sense.

It's completely true, like the way you describe it too, is almost like a corset, like people get, they wear these binders after, like some people are assigned them after, you know, getting diastasis recti, the, the fallacy is that these people need to be compressed, these people need to be held in, because they think it's like a hernia, like a ventral wall hernia, and I do understand why people think that, but it's really because there's nowhere for the air to go, there's nowhere for the diaphragm to go, so it goes out to a path of least resistance, and because the linea alba is a bloodless plane, it's exactly like Danny showed you, it's bound up, the air, the pressure has to go somewhere, so it goes out to the front, it's not that the person needs a bind in the front that's extra, it's that they need to be opening through a 300, you know, degree breath, and they're so bound up on the lateral sides, especially after pregnancy, because the baby's expanding them so anteriorly, because the uterus is a midline structure, that the person could benefit not just from binding in the front, you, it's really hard to bind the front and not bind what's attaching to it, which are the, the muscles on the lateral side, so I love that analogy that you gave, it's great, it's perfect.

What I was going to say, too, is just kind of think about it as well, like from the days of doing landscaping, we would have, especially if you were like building walls or doing things like that, like it'd be like, you know, 100, 150 pound rocks that we're lifting at a time, and you know, our boss is really adamant about us using back braces for that time, and found that on days that actually wore the back braces would have more, would have more pain afterwards, because couldn't really take a really deep breath to really like, obviously, you know, learning, applying it to a physical moving environment like that, you know, just take really, really deep breaths, you know, really support that spine, really, really get that, that IAP going, and then, you know, being able to move like a lot more efficiently, and wouldn't have those restrictions, that those were the days that would feel sore the next day, as opposed to other days, so. Oh, I am not a proponent of bracing, and yeah, I think that that's such a good observation to make, that when I watch people wear braces, I know why they're doing it, they have mechanics anyway, and so they wear the brace to actually encourage poor mechanics, and you, if you would learn good mechanics, then you can use the brace only in a clutch, like I think that a good example is, similar to Danny's, is my business partner is a very heavy deadlifter, and he would only wear a brace in competition, because it gave him an edge, he would never wear it in training, he would wear it in competition, because it would compress everything, and he would be able to get out an extra rep, but he would only do it for three total reps of his entire year of training, and compared to like people that train with it, or work with it, and it weakens the tissue, because when you break, research is very supportive of this theory, when you brace something, you're shutting down the muscles relative to that, because if you're getting exogenous support, your body's going to shut down, it's going to down regulate its own need, it's like energy efficient, it's like, oh, something else is doing that, why would I turn on?

Absolutely, and also if those braces have to come off eventually, then we seem very vulnerable,

I know I have a patient right now that has a ventral wall incisional hernia, and he's not been able to do a lot of his rehab that he's used to being able to do, I think it sounds like in the, since the pandemic and everything closed down, there's been a lot of caution, and he's found, he wore a brace as advice to him by his surgeon, and his surgery was actually postponed, because the interesting thing about openings and things like that in the anterior abdominal wall is the bigger ones are usually less dangerous, it's the small keyhole ones that are problematic, because if stuff can pass freely back and forth, that's fine, but if it passes through and gets stuck on the other side, that's a problem, so for this patient, he had had, he had had an incisional one, and then a very small one, interestingly enough, the incisional hernia was created because of, there was an inguinal hernia, and then there was a surgery with mesh, the mesh came loose, created a bowel obstruction, and then there was a full incision to address the incisional hernia, so the whole thing actually started from hernial repairs in the first place, which is really interesting, I'm not against, you know, addressing something surgically when it needs to be done, but we have to at least, you know, look at the sort of cause and effect of all this, and so since being sort of locked in with coronavirus and the pandemic, he has been bracing much, much, much more than usual, and the last update that I got this week is that there are now four extra hernias, and now it is absolutely essential, because they're very small and sort of sporadic all over the anterior abdominal wall, so four additionals, there's six total now, and that's with somebody who's been in a brace, and my sort of hypothesis on what's happened there is that the brace is not on 24-7, and so once you get used to that kind of support, it's different than when it's like a one, you know, a PR, a one rep max, you can't be doing a one rep max for 24 hours a day, so if the minute you start to accommodate that, your tissue starts to accommodate to that sort of false sense of security, it'll come out, you still cough and sneeze and fart in the middle of the night, and you know, anytime something like that happens, you're going to have some sort of potential for pressure leak, and you know, things take the path of least resistance, so bracing is a really interesting thing that I think we are all on the same page about, and you know, everything is always case specific, so we try not to make general blanket statements about anything, but you know, look at this too, and really ask yourself, like, what are we actually doing here, and does this solution match the problem that we are sort of facing? Yeah, I can't agree with you more about, like, it's a tough observation to have with a patient that you know you don't agree with the bracing, and I think taping is a lot less, of course, than bracing, and I know we've probably gotten off topic by talking about the bracing, but the whole point of this is that that feeling that you have to brace this person up is not really super effective, and just remember Anna's story about the incisional hernias, and the more that you create a sense of bracing in the front, I know why they're taught that, because there's a hernia, and that's the best way to go through the wall is through coughing, sneezing, defecating, you know, but the real focus in the therapy should be opening the sides, and then aponeuroses are broad, flat tendons, and tendons have the tensile strength of steel, so if you're starting to breach away from midline, ask yourself, why are they pulling away from midlines? Because the sides of the muscles don't have extensibility, so improving the extensibility of the sides of the ribs, I'm sure that's something that Anna's working on with her patient, and once COVID's over, you can probably do a lot more of it in person, but also very, very good analogies put into place, and good examples of cases. So we had another question about hip compression, is that right? And they were asking, was it the mechanisms of hip compression, or? It was, review the signs and symptoms of a compressed femoral head in the acetabulum, just any information around that, signs, symptoms, things like that.