Journal of Bodywork and Movement Therapies
Volume 12, Issue 4 , Pages 333-348 , October 2008

Stability, continence and breathing: The role of fascia following pregnancy and delivery

  • D.G. Lee, BSR, FCAMT, CGIMS

      Affiliations

    • Corresponding Author InformationCorresponding author. Tel.: +16045388338.
    web addressweb address
  • ,
  • L.J. Lee, BSc, BSc (PT), FCAMT, CGIMS
  • ,
  • L. McLaughlin, BHScPT, DScPT, FCAMT, CMAG

Received 28 March 2008 ,Revised 30 April 2008 ,Accepted 1 May 2008.

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PII: S1360-8592(08)00088-0

doi: 10.1016/j.jbmt.2008.05.003

Journal of Bodywork and Movement Therapies
Volume 12, Issue 4 , Pages 333-348 , October 2008