As always daily patient flow is good fodder for blog topics, especially when a question comes up more than once in a week. This week’s theme was diastasis and abdominal exercises. We have had a fair crop of new moms this spring. Diastasis is a fairly common problem. The stretching of the abdominal wall can result in excessive soft tissue separation/stretching between the right and left abdominal muscle group, usually extending a few inches up and down from the umbilicus. It is sometimes accompanied by pain when contracting the abdomen but mostly it is non painful, however the new mom will notice the gaping area and sometimes an outward bulging.

The standard recommendation is to avoid any form of abdominal strength exercises. And while I think that is a very appropriate recommendation for 6-12 weeks after delivery, I take issue with it as an absolute recommendation for all women long term. There is a strong potential negative impact on the spine from limiting core strength building, and not all women have a manifestation of diastasis that will get worse with some form of abdominal strengthening exercises.

My approach is to assess each woman individually in the following way: first, palpate the resting width of the diastasis with the patient laying on their back with their knees slightly bent. Next, keeping my fingers in each side of the gap, have the patient engage their abdominal muscles in a variety of ways: table top leg lift, crunch, and plank. In each position, I will compare the starting width of the diastatis with the exercise width. If the distance increases, the exercise is making it worse. If the distance stays the same and the patient has no pain, the exercise is value neutral for the diastasis but not unsafe, and can be done beneficially for the lumbar spine. In many instances, the distance will actually decrease, suggesting that the exercise is actually beneficial in reducing the diastasis gap over time. In the past 10 years since I started assessing patients in this way, I would estimate that more than half of the patients actually see a benefit from finding the right kind of abdominal exercise. So remember that blanket recommendations in that regard are worth revisiting for your individual case.