Dear Dr. Oz: Diastasis and (Gasp!) Crunches??

To honor all the “flat belly” New Years resolutions out there, I thought I would post a letter I wrote to Dr. Oz a few years ago. It is a cautionary tale that still applies today: Diastasis and crunches do not mix! I have updated the letter a little with some links to other blogs and vlogs, and new information.

Dear Dr. Oz,

Your show is always full of encouragement toward healthy living and healthy choices. As a fellow health practitioner I appreciate the information, enthusiasm and motivation you give your viewers. I am a physical therapist and educator who specializes in returning women to fitness after pregnancy.

I was glad to see you offering your viewers conservative, exercise-based options for closure of a post-partum abdominal separation, aka Diastasis, by inviting your trainer to give some tips ( http://bit.ly/6J8W2w). Often women are told their only available option is expensive surgery, and it is usually not covered by insurance.

I did however have a concern I wanted to share with you about the information provided for women with a post-partum Diastasis. The Crunches and rotational crunches recommended in the segment will actually make a Diastasis worse. This is because the connective tissue at the linea alba (center line of the six-pack) is designed to expand and allow for a growing baby. However, this flexible tissue is also the insertion site for eachof the abdominal muscles. A strong abdominal contraction such as a crunch will create a pull at this insertion that cannot be matched if this tissue has been separated during the pregnancy. It will result in pulling the opening further apart. Rotational activities have a similar result due to the pull of the obliques against the weakened area.

In the exercise demonstration segment, you can see Annie’s belly rise with each crunch repetition. This reinforces opening the Diastasis with each rep, instead of closing it. As you know, an unresolved Diastasis can result in hernias, contribute to incontinence, and reduce the supportive role abdominals have for low backs and posture.

The vulnerability of this midline connective tissue is a great reason not to encourage crunches during pregnancy, too. This will help reduce the possibility of abdominal disruption or separation in the first place.

There are other specific exercise options for Diastasis closure, and recent investigations have looked at the integrity of that abdominal connective tissue as a determinant for conservative care vs. the need for surgery. Correcting postures that contribute to pulling the separation apart and improved breathing patterns to activate the deep core can also help maintain closure.

Thank you for alerting women to the condition and how to test for it on themselves,  a truly valuable first step that you and the trainer provided. Conservative Diastasis resolution is possible with good education and appropriate training.