Youll be able to return to most activities after 6-8 weeks, but no heavy lifting may be done for 6-12 weeks after surgery. A classification and algorithm for treatment of functional abdominal wall morbidity after DIEP flap is provided. I would advise following up with your plastic surgeon for an evaluation if you have any additional concerns. Hopefully things will improve for you in the next few weeks x, Hi Simi thought I would try to help as you have not had any replies. 0000015551 00000 n 0000021214 00000 n If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. 0000028861 00000 n /ExtGState << /GS1 68 0 R >> /CapHeight 662 Sixteen studies reporting DIEP outcomes and 23 studies reporting free TRAM outcomes were used to estimate pooled complication rates. You may take sponge baths following discharge. DIEP flap reconstructioncan often benefit from minor touch-up orenhancement procedures, which are usually performed in an outpatient setting a few months after the initial surgery. I am so sorry to hear about the symptoms that you are experiencing despite all the exercises and stretches that you are doing. Independent of the surgeon's fee, the price of OR time and anesthesia can Can I wear a bikini 1 year after tummy tuck? A prescription for pain medication will be sent to your pharmacy. In the DIEP procedure, a flap of tissue containing fat and skin is removed from the lower abdomen and used to form a new breast. Abdominal wall morbidities are categorized, and an algorithm for management is provided. DIEP flap breast reconstruction takes place along on the lower abdomen and typically leaves a scar. Would you like email updates of new search results? endobj Abdominal wounds, nerve sacrificing procedures and obesity correlated with an increased incidence of weakness; these data were not statistically significant. /Info 42 0 R /LastChar 223 /Root 46 0 R 0000060530 00000 n Oncoplastic procedures like oncoplastic closure, reduction and lift, and local tissue flaps for volume loss preserve breast shape after a lumpectomy. >> Sometimes its necessary to remove a small piece of cartilage from the chest to access the vessel. Meta-analysis of flap perfusion and donor site complications for breast reconstruction using pedicled versus free TRAM and DIEP flaps. I can imagine that it must be so frustrating to be left with a lot of discomfort after your surgery. Its important to take care of the outermost layer of the skin as you disrupt the scar tissue. 0 0 0 0 0 250 0 250 250 0 0 0 250 0 0 0 0 0 500 0 444 444 0 0 0 250 0 0 0 0 The DIEP flap is the most common tissue flap procedure performed at the Friedman Center due to its natural-looking results. Featured. While we do connect people with vetted, board-certified doctors, we dont provide medical consultations, diagnosis, or advice. Tissue can be taken from your abdomen for breast reconstruction just once. ;Vq 0 ; 0000010368 00000 n You will have special adhesive glue or tape over the incisions. Because a portion of tummy tissue is removed and transplanted to the chest wall during this procedure, most patients experience Webappearance of an abdominal bulge following DIEP ap breast reconstruction is illustrated in Figure 1, and the appearance of the abdomen following repair of the bulge is illustrated in Figure 2. Just wrote an indepth edit to the Post and it vanished. I had DIEP flap back in I had DIEP flap back in January. A year. 0000011292 00000 n 0000025512 00000 n << 0000026267 00000 n Comparing the donor-site morbidity using DIEP, SIEA or MS-TRAM flaps for breast reconstructive surgery: a meta-analysis. The abdomen is the part of the body between the thorax and pelvis, in humans and in other vertebrates. 7](8t&Y.emQZ:c#gc8&1'6c0?G,`e`X9x(yo'w/w_8x:h;BpQccSyst#xcf9 HvIz]u{d[E#m$$r~"'L8iwv?RQII&Fe!=H'@?W;0P>r{>i//^U5_6Q(D- >> It is important to get a clear answer on the total cost of the procedure. Seven percent of patients who answered the BREAST-Q reported abdominal weakness. eCollection 2022. Breast Reconstruction with the free TRAM or DIEP flap: patient selection, choice of flap, and outcome. The incidence of abdominal weakness was evaluated by BREAST-Q data. Abdominal wall morbidity is classified as: type 1 abdominal weakness; type 2 smaller, unilateral abdominal bulge; and type 3 true abdominal hernia or large bilateral bulge. Of a surgical operation performed through an incision in the wall of the abdomen, which could be performed via a different route, e.g. Results: Of the 644 patients, 23 (3.6%) had a clinically significant bulge or hernia on exam postoperatively. Yes you can wear a bikini once swelling settles down and wounds are healed , which can be 3-6 months from surgery. ly adv. Biomed Res Int. Thank you Catherine - that's all very helpful. -, Mathes S.J., Nahai F. Classification of the vascular anatomy of muscles: Experimental and clinical correlation. Webect on flap and donor-site complications. Some surgeons quote their fee, and you are responsible for the anesthesia and facility costs, which fluctuate based on how long the procedure takes. 2. endobj Methods: A retrospective review of 644 patients who underwent abdominal based flap breast reconstruction between 2009 and 2018 and met selection criteria was performed. government site. xc```c``e`e`(bdf"FaV6B&aX6GpJqj\MShlWmpQdrj&G7&/AO%aS?5T5.xe5?5 y"YNtB.A^ Xp?l? Conclusions: A classification and algorithm for treatment of functional abdominal wall morbidity after DIEP flap is provided. Application of ointments, dressings, or lotions is not necessary. Robotic-assisted closed-chest management of a fungal-infected prosthetic aortic graft: a case report. Do not exceed 4000 mg of Tylenol (acetaminophen) from all sources in a 24 hour period. You might experience some loss of sensation, which is often temporary at the donor tissue site. Begin by running your fingertips back and forth over the length of the scar, applying light pressure in the beginning and working up to deeper, firmer pressure. PMC But I feel this piercing pain on the left side of my lower abdomen every time when I do exercise like sit ups. Just remember it is early days for you. Results: Ninety patients (54 An algorithm of treatment is presented, which includes physical therapy and surgical repair recommendations. If you missed the first part of my Cosmetic and Restorative Tattoo Series, take a look at the video included for instructions you can watch about how best to utilize the above techniques. Just wondering whether anyone out there has had problems in the reconstructed breast after DIEP flap op with hardness. Careers. On the basis of the newly developed and implemented diagnostic approach, we concluded that DIEP microsurgical breast reconstruction is a safe procedure without major complications at the donor site, even if long-term alterations of the rectus muscle are a common finding. Try to rest to let yourself heal you will get there in time there is no rushing this part of recovery as you have little control over it. This is a photo I took on my computer. [Myosonographic evaluation of rectus abdominis muscle function after DIEP flap breast reconstruction]. /OpenAction [ 47 0 R /Fit ] I had a DIEP reconstruction in March this year and like you felt very tight and uncomfortable for some months with some delayed healing around the navel which I found very Giammarino AT, Sarmiento IC, Scheinerman S, Winalski J, Lazzaro RS, Brinster DR, Hemli JM. Also if when you feel ready try to go for a swim once a week as again this helps stretch the area and prevent the tightness. Overall, only three patients were impacted by a long-term deterioration in their quality of life. doi: 10.1016/j.breast.2017.12.003. I get incredible tightness across my abdomen like you are describing ,making it feel that my recovery isn't going as well as it should ! 0000014491 00000 n Learn how to coordinate it with your reconstructive timing and approach. Simple steps such as changing to a firmer mattress or using an extra pillow to help support you whilst you sleep may help particularly as this discomfort is hurting your back. trailer An abdominal aortic aneurysm, or aortic aneurysm, is an enlarged area in the lower part of the body's main artery (aorta). You may choose to have breast reconstruction after a mastectomy (breast removal) or lumpectomy (partial Do not take a bath or submerge yourself in water. J. Surg. 500 500 500 500 333 389 278 500 500 722 500 500 444 480 200 480 541 250 0 0 DIEP Had DIEP Flap Surgery - Incision on Belly Splitting Badly, Recommendations for the Best Reconstructive Surgeons Who Do DIEP. If you would like a nurse to respond to your post please let us know or you could post a question to the nurses on our Ask Our Nurses area of the Forum. Nicholas T. Haddock, Abby J. Culver, Sumeet S. Teotia, Research output: Contribution to journal Article peer-review. t!c ? The abdominal incision for the DIEP flap procedure runs horizontally from hip bone to hip bone across the lower abdomen, about a third of the way between the top of your pubic hair and your belly button. The .gov means its official. Abdominal tightness may be related to the wound closure. /Type /Font endobj 0000000017 00000 n This is normal and not a cause for concern. Because DIEP flap surgery preserves the abdominal muscles, patients have better outcomes than with TRAM flap procedures: youll retain more core strength, feel less pain, have lower risk of abdominal hernias, and recover more quickly. If you did not have a nipple-sparing mastectomy and wish to havenipple reconstruction, that procedure also takes places once healing from your DIEP flap procedure is complete. I've kept asking aboutthe abdominal tightness/tugging, around the permanent stitches the surgeon added to the muscle fascia (below, and to the right of, the scar), and have been told that because I was slim, fit, and had never had children, thatit could take 18 months to 2 years to ease off. Good luck. * To protect your identity do not use your full name. i had my diep flap surgery six weeks ago, and like you, I'm struggling with recovery. Breast Cancer Now is a company limited by guarantee registered in England (9347608) and a charity registered in England and Wales (1160558), Scotland (SC045584) and the Isle of Man (1200). Developing an abdominal wound postoperatively and sacrificing nerves both correlated with an increased incidence of bulge or hernia (p < 0.05). /Ascent 694 DIEP flap breast reconstruction takes place along on the lower abdomen and typically leaves a scar. It usually gets better over time and you should consult your surgeon for advice. / Haddock, Nicholas T.; Culver, Abby J.; Teotia, Sumeet S. T1 - Abdominal weakness, bulge, or hernia after DIEP flaps, T2 - An algorithm of management, prevention, and surgical repair with classification, N1 - Funding Information: Your breast will likely have bruising and possibly some blistering on the skin, which is expected after a mastectomy. Is this pain normal? I remember walking hunched over for about 3 6 Breast: Edema 22%, (nerve)pain 21%, radiation damage 13%, other 9%.Abdomen: edema 8%, nerve pain 7%, other 19%. You have just undergone a breast reconstruction with the DIEP flap. Abdominal wall morbidity is classified as: type 1 - abdominal weakness; type 2 - abdominal tightness after diep flap 931-528-4000. 1981;67:177187. Plast Reconstr Surg. /H [ 1373 313 ] For this reason, the muscle is permanently weakened in the << Do not massage the incisions until we instruct you in the office (six weeks after surgery). /Contents [ 71 0 R 72 0 R 73 0 R 74 0 R 75 0 R 76 0 R 77 0 R 78 0 R 79 0 R Postoperatively, patients undergoing "contralateral reconstruction" appeared to exhibit fewer rectus muscle alterations. 2012 Nov;65(11):1474-80. doi: 10.1016/j.bjps.2012.07.001. The https:// ensures that you are connecting to the stream It is advisable to protect the scar from sunlight for unto 12 months as sun can make the scars darker. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. Seven percent of patients who answered the BREAST-Q reported abdominal weakness. @article{924d70bc0b5142fba790e519be910779. Its also called a stomachache. 2007;120:14431449. During recovery, physical activity must be limited. I've been lucky enough not to get any infections but the tightness around my whole tummy area is really uncomfortable. >> After surgery, many women enjoy having a flatter abdomen, similar to the effects of a tummy tuck.. Results: Of the 644 patients, 23 (3.6%) had a clinically significant bulge or hernia on exam postoperatively. doi: 10.1002/jso.25325. Breast. The DIEP procedure is named after the blood vessels that nourish the fat and skin of the lower abdomen, the deep inferior epigastric perforator vessels, which travel through the abdominal muscles. I would be happy to receive news and updates from Cancer Chat, NICE suspected cancer referral guidelines, Cancer Research UK for Children & Young People, DIEP FLAP surgery - abdominal tugging 16 months post-op. Other conditions may require urgent medical attention. Boston: Blackwell Scientific Publications; 1994. Post-meeting report of the 2022 On-site Padua Days on Muscle and Mobility Medicine, March 30 - April 3, 2022, Padua, Italy. Have just seen your post as am looking for answers too ! << A tummy tuck (abdominoplasty) is one of the more painful and longer recoveries when it comes to cosmetic surgery. While the location and pattern of abdominal pain can provide important clues, its time course is particularly useful when determining its cause. sharing sensitive information, make sure youre on a federal Plast Reconstr Surg. Taken from the PRMA website. Pat dry. /PageLabels 43 0 R Copyright 2016 by Houghton Mifflin Harcourt Publishing Company. Developing an abdominal wound postoperatively and sacrificing nerves both correlated with an increased incidence of bulge or hernia (p < 0.05). % Secondary procedures after a DIEP flap reconstruction can be done in about 3 months. Please bring this sheet to your appointment after surgery. Clipboard, Search History, and several other advanced features are temporarily unavailable. The information on RealSelf is intended for educational purposes only. Background: This study analyzes abdominal weakness, hernia, and bulge following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Abdominal wounds, nerve sacrificing procedures and obesity correlated with an increased incidence of weakness; these data were not statistically significant. And it seems to be having aneffect on my back and making that ache. Please do not drive while taking narcotic pain medication. They may be able to assess whether you need to be seen by the surgeon again or whether there are any exercises that may help relieve your pain. 0000028974 00000 n 8600 Rockville Pike You will stand more erect when you feel it loosen. I do hope that as time goes on your symptoms will improve. The benefits are therefore clear although it requires a longer operation than just having breast implants to make the new breast. Risk factors were analyzed. 82 0 obj The abdominal microsurgical flap based on the deep inferior epigastric artery perforator (DIEP) flap has become the most popular option worldwide for autologous breast reconstruction. 1. : of, belonging to, or affecting the abdomen. Read on for some guidance on technique. See this image and copyright information in PMC. << /Type /Catalog << Have questions or looking for support? Radiation can be an important part of your breast cancer treatment. abdominal tightness after diep flap 931-528-4000. Plast Reconstr Surg Glob Open. The scar may be higher than a tummy tuck (abdominoplasty) scar, but it often sits under the bikini line. Methods: A retrospective review of 644 patients who underwent abdominal based flap breast reconstruction between 2009 and 2018 and met selection criteria was performed. 0000058283 00000 n /Type /FontDescriptor The most common causes such as gas pains, indigestion or a pulled muscle usually aren't serious. 0000061227 00000 n Results: Both the breast and abdomen will have drains. The site is secure.  It is not a life-threatening problem, but an annoying one. /Encoding /MacRomanEncoding The authors declare no conflict of interest. Once my tummy wounds had closed, I did find moisturising and gentle massage helped. You have redness develop around the incisions. If youre experiencing a medical issue, please contact a healthcare professional or dial 911 immediately. Each of my patients is put into a physical therapy program for DIEP flap patients.This program is used starting 1 to 2 weeks after surgery. Please enable it to take advantage of the complete set of features! But need to nurture and take care of yourself emotionally and physically as your body heals.Good luck. Federal government websites often end in .gov or .mil. Background: This study analyzes abdominal weakness, hernia, and bulge following deep inferior epigastric perforator (DIEP) flap breast reconstruction. doi: 10.1097/GOX.0000000000003704. abstract = "Background: This study analyzes abdominal weakness, hernia, and bulge following deep inferior epigastric perforator (DIEP) flap breast reconstruction. 46 0 obj Ann Plast Surg. /ArtBox [ 9 9 603 801 ] In the DIEP procedure, a flap of tissue containing fat and skin is removed from the lower abdomen and used to form a new breast. Very small incisions are made through the muscle to access these vessels, which are reconnected to the new blood supply in the chest. The information on RealSelf is intended for educational purposes only. /FontBBox [ -167 -216 1009 878 ] Risk factors were analyzed. In arthropods it is the posterior tagma of the body; it follows the thorax or cephalothorax. 2010 Aug;126(2):367-374. doi: 10.1097/PRS.0b013e3181de1b7e. JAMA. The DIEP flap removes rectus abdominus muscle to reconstruct the breast. Working the whole abdomen during your massage can release tension in unexpected areas and help prevent or manage adhesions in other parts of the abdomen that are not directly beneath the visible scar. This DIEP option is not available in all cancer units and so most ladies have breast implants to make the breast which can also give excellent results. Thank you for your time and in-put! N2 - Background: This study analyzes abdominal weakness, hernia, and bulge following deep inferior epigastric perforator (DIEP) flap breast reconstruction. We offer procedures to help prevent as well as ease lymphedema, a condition where limbs swell after lymph node removal. I had a DIEP surgery in January 2013. Unlike TRAM flap surgery, another abdominal flap procedure,DIEP flapsurgery preserves the abdominal muscles. Disclaimer, National Library of Medicine official website and that any information you provide is encrypted In addition to nose-reshaping, our surgeons perform procedures that can alleviate breathing difficulties associated with deviated septum and internal nasal blockages. Learn how it works, its risks, and more. Methods: Over a 3-year period, 168 DIEP flap patients were retrospectively divided into a control group with no previous abdominal operations and a scar group with previous abdominal procedures. Risk factors were analyzed. MeSH << /FirstChar 37 xref DIEP flap surgery is a way to reconstruct your breast after breast cancer surgery. /FontDescriptor 50 0 R Be patient. 600 Northern Blvd, Suite 310, Great Neck, NY 11021. For less severe pain, you may take over the counter Tylenol (acetaminophen), instead of the prescribed pain medication. /Widths [ 833 778 180 333 333 500 564 250 333 250 278 500 500 500 500 500 and transmitted securely. 2021 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Bulge and hernia were evaluated on exam and then by imaging and/or operative exploration. Before 2016 Jul;138(1):16-28. doi: 10.1097/PRS.0000000000001747. Tightening the fascia or mesh support may be helpful. %PDF-1.3 2000;283:20082012. Then, use two fingers to make small circles along the scar and the surrounding area. This will help decrease the stress and tension on your abdominal incision. How much muscle is taken with the flap is an important consideration, but it is not the end-all-be-all. Results: Of the 644 patients, 23 (3.6%) had a clinically significant bulge or hernia on exam postoperatively. The borders of the abdominal cavity are comprised of the posterior peritoneal surface, the anterior abdominal wall, the inferior pelvic inlet, and the Numerous alterations in muscle physiology were observed due to surgical dissection of perforator vessels, and rectus muscle distress without functional impairment was a common result. Home; About; Areas of Expertise; Credentials; Resources; abdominal tightness after diep flap Our team can help you navigate surgical options from facelift and browlift to necklift and eyelid rejuvenation. Abdominal wall morbidity is classified as: type 1 abdominal weakness; type 2 smaller, unilateral abdominal bulge; and type 3 true abdominal hernia or large bilateral bulge. DIEP Flap Surgery Best for Natural Breast Reconstruction Results? Abdominal weakness, bulge, or hernia after DIEP flaps: An algorithm of management, prevention, and surgical repair with classification. It is best to safely secure the drains to your clothes with a safety pin. Comparison of Outcomes following Autologous Breast Reconstruction Using the DIEP and Pedicled TRAM Flaps: A 12-Year Clinical Retrospective Study and Literature Review. Hello,It is common to still have a feeling of tightness along the abdomen following DIEP flap reconstruction for up to 1 year. This usually gets better with time. Kssmann C, Peek A, Luxenhofer F, Scheufler O, Exner K. Handchir Mikrochir Plast Chir. This type of abdominal scar is a great candidate for scar massage, which can help to keep the scar from becoming firm and assist in overall abdominal healing.  During that time frame they wear a compression garment over the abdomen, avoid lifting object That's a very good question. The abdomen typically provides ample tissue for reconstruction and offer the same result as a tummy tuck as an added benefit. eCollection 2021 Dec. Plast Reconstr Surg Glob Open. Nahabedian MY, Momen B, Galdino G, Manson PN. Seven percent of patients who answered the BREAST-Q{\texttrademark} reported abdominal weakness. Analysis of 461 Consecutive Patients' Donor Site Morbidity following Abdominal Tissue-Based Breast Reconstruction without Fascia Reinforcement Graft. Abdominal wall morbidities are categorized, and an algorithm for management is provided. While scar massage is not always comfortable, you should not hurt yourself in the process. In a DIEP flap, fat, skin, and blood vessels are cut from the wall of the lower belly and moved up to your chest to rebuild your breast. You should find time to massage your scar two to three times a day for ten minutes at a time. >> endobj The abdomen refers to the region between the pelvis (pelvic brim) and the thorax (thoracic diaphragm) in vertebrates, including humans. Previous surgery or tissue damage may rule out one or more donor sites for breast reconstruction. Home; About; Areas of Expertise; Credentials; Resources; abdominal tightness after diep flap 0000002012 00000 n I am a little more than 5 months into recovering from my bilateral diep-flap reconstruction. Let your surgeon guide you as to when your scar is ready for massage. abdominal pain. /XObject 69 0 R Armitage P, Berry G. Statistical Methods in Medical Research. Unlike some DIEP and pedicled TRAM flaps: A comparison of outcomes. Breast reconstruction with superficial inferior epigastric artery flaps: a prospective comparison with TRAM and DIEP flaps. Not required Whether you're interested in direct-to-implant or expander implant reconstruction, we are experienced in both prepectoral and subpectoral approaches. To do that, you must apply pressure to the area. 0000003586 00000 n 2021 Dec 7;9(12):e3970. >> No separate wound care is required for the incisions. After a successful surgery, patients will be given supportive garments to wear on their breasts and around their stomachs. By continuing you agree to the use of cookies. In an effort to make you more comfortable with discharge home and to answer any questions you may have, the following instructions have been prepared for you. Would you like email updates of new search results? Based on the output, the drains will be removed one to 3 weeks after surgery. 0000001686 00000 n Epub 2017 Dec 8. J Plast Reconstr Aesthet Surg. The area occupied by the abdomen is called the abdominal cavity.  I generally tell patients to plan on being not themselves for about 6 weeks. Add small circles along the scar line. Patients in the umbilicus sacrificing cohort had an increased incidence of weakness (p < 0.05). Is there any way to find out what happened and remove the pain? endobj Your prescription pain medication may contain acetaminophen. Techno glitches galore this morning with responses. DIEP FLAP surgery - abdominal tugging 16 months post-op. WebFor the abdomen Your incision and belly button are covered in a special medical grade sealant, which will come off in the office, two-three weeks after surgery. Abdominal wall morbidities are categorized, and an algorithm for management is provided. I was slim so the closure was very tight but I could walk upright after around 8 or 10 days and I did all the post-op physio recommended. Please bring this sheet to your appointment after surgery. Effects of Obesity on Postoperative Complications After Breast Reconstruction Using Free Muscle-Sparing Transverse Rectus Abdominis Myocutaneous, Deep Inferior Epigastric Perforator, and Superficial Inferior Epigastric Artery Flap: A Systematic Review and Meta-analysis. J Natl Cancer Inst. Methods: A retrospective review of 644 patients who underwent abdominal based flap breast reconstruction between 2009 and 2018 and met selection criteria was performed. Specialized tattooing and micro-needling can help create or refine nipple reconstruction, manage scars, and more. /PageMode /UseNone Unless you gain a tremendous amount of weight, the underlying /Descent -213 Be aware that there may be some tightness around your abdomen as the skin, abdominal muscles and other tissues heal. In general, the abdomen is the preferred donor site for flap reconstruction, usually through the DIEP flap procedure. The https:// ensures that you are connecting to the Such screening isn't recommended for people who've never smoked. 2019;119:388396. doi: 10.1097/GOX.0000000000003970. Please notify us immediately if: 600 Northern Blvd, Suite 310 Greak Neck, NY 11021, 130 E 77th Street, 10th Floor New York, NY 10075, All Rights Reserved. An official website of the United States government. Abdomen Definition. I run a couple of times a week and do lots of stretching after each one already.But hearing from someone who's familiar withthis would be helpful/encouraging. These types of exercises can be progressed as able. Please enable it to take advantage of the complete set of features! (Cuz I dont want this to be just about me.) 0 0 0 0 760 0 0 0 250 0 0 250 564 250 250 0 500 250 250 250 250 250 0 0 250 The incidence of abdominal weakness was evaluated by BREAST-Q data. You have a sudden increase in swelling of the abdomen. I do hope it is healing now. CT; DIEP flap; abdominal wall; breast reconstruction; donor site morbidity; rectus muscle. >> 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 500 0 500 500 0 Ann Plast Surg. /N 6 /Subtype /Type1 The DIEP flap also gives you a flat tummy as a bonus. doi: 10.1097/00006534-198167020-00007. Using microsurgery, the plastic surgeon connects the tiny blood vessels in the chest to the vessels in the flap. For this reason, the muscle is permanently weakened in the abdomen and may be painful. Yep. Two levels of screening identified 37 relevant studies. Take the time to ensure proper technique.