What in the world is Abdominophrenic Dyssynergia??

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Do you look 6 months pregnant no matter what you eat or how often you work out? Is your GI stumped by your always bloated belly? Have you tried various diets and exercises with no luck? ….. You may have APD! 

Abdomino-phrenic dyssynergia (“APD”) is a functional GI disorder that occurs because of an abnormal brain-gut reflex. Typically, the diaphragm muscles should relax when the gut senses fullness due to food, liquids, or gas and allow expansion. However, with APD, the diaphragm contracts and the abdominal muscles relax instead. The outcome is a patient who may experience significant bloating and distention, discomfort, and often says “I always look like I am pregnant” despite diet modifications and exercise. Luckily, if you are diagnosed with APD, physical therapy can help you wear that crop top again or just feel like yourself!

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Often, but not always, APD is seen in conjunction with pelvic floor muscle dyssynergia. This type of dyssynergia happens when the pelvic floor muscles (the sling of muscles involved with bladder, bowel, and sexual function) are not coordinating properly. They too may be contracting when they should be relaxing and the patient may have difficulty going to the bathroom and may experience constipation, and/or abdominal and pelvic pain.

APD/Pelvic Floor physical therapy works just like going to PT for your back injury! Your physical therapist will work with you to release the muscles that need lengthening (ie those tight diaphragm muscles and possibly pelvic floor muscles) and teach proper engagement of the muscles that need strengthening (your abs and obliques) so your body feels like your own again…. and that distended belly reduces! 

Treatment may include: 

  • Lifestyle and posture modifications

  • Manual therapy to diaphragm, thoracic cage and abdominal viscera

  • Core strengthening

  • Taping techniques

  • Self diaphragm release techniques

  • Self abdominal massage to encourage peristalsis (involuntary intestinal movement) 

  • Global relaxation strategies to encourage general muscle release

  • Breathing techniques 

  • Biofeedback:  offers a visual representation as to what one’s muscles are doing followed by retraining for proper coordination. 

  • Patient education on proper toileting habits, and strategies to avoid muscle clenching throughout the day and straining while going to the bathroom

  • Referral to dietician and GI as appropriate

Your physical therapist will guide you with take-home tools to continue muscle lengthening and strengthening at home as with any physical therapy, to keep working towards goals every day even when you are not at PT.  

If you have any questions about this elusive diagnosis or how we can help to address your symptoms, please connect with us at (212) 353-8693 or info@zionpt.com!   

Francesca Warner PT, DPT, CSCS

Additional Research: 

https://www.ncbi.nlm.nih.gov/pubmed/21540894
https://www.ncbi.nlm.nih.gov/pubmed/28508867