Planks and Crunches for Abdominal Diastasis: Totally Tabu, or OK for You?

Planks and Crunches for Abdominal Diastasis: Totally Tabu, or OK for You? Blog

Abdominal diastasis, known clinically as diastasis recti abdominis, or DRA, is the separation that occurs along the midline of the rectus abdominis, or RA (the six-pack muscle) during and after pregnancy. As the fetus grows, the linea alba, the connective fascial tissue that binds the right and left halves of the RA, thins and stretches to make room for the growing fetus.

In most cases, DRA resolves itself within several weeks after childbirth. But for some women, the halves of the RA remain separated. In an attempt to resolve DRA and regain a normal, pre-pregnancy waistline, many new mothers turn to exercises, particularly those that target the abdominal muscles. However, in recent years, there has been a growing clinical consensus that traditional core strengthening exercises like planks and crunches are off-limits to women with DRA.

Why Ab Exercises Are Contraindicated for DRA

Certain types of abdominal exercises increase pressure within the abdomen, causing the two sides of the RA to grow farther apart, rather than come together. Crunches are a prime example of an exercise that increases intra-abdominal pressure, causing the RA to separate. However, there are techniques to overcome the separation by engaging the transverse abdominis muscle prior to contracting the RA, which can be learned and integrated into a progressive exercise program.

In the case of planks, it has been argued that horizontal planks allows gravity to exert force on the visceral organs, thereby increasing pressure on the RA, encouraging further separation. While this seems to make sense, the truth is that structures and tissues within the abdominal wall hold the viscera in place, regardless of the body’s position in relation to gravity.

So Are Ab Exercises Safe for Patients With DRA?

The answer is, it’s complicated. There exist varying degrees of DRA, and a diverse body of DRA patients. To paint all cases of DRA with a broad brush is to do a disservice to women seeking to resolve the condition. Before prescribing a one-size-fits-all treatment for DRA, clinicians should take a number of factors into account, including:

  • Fitness level of the mother before, during and after pregnancy
  • BMI or some other assessment of body mass
  • Nutritional status of the patient
  • Willingness of the patient to comply with recommendations and adhere to a treatment program

Many women with post-pregnancy DRA are able to resolve it with the help of a targeted progressive exercise program. However, treatment should not focus on the abdominal muscles alone, but should take into consideration the overall function of the core and pelvic muscles, and how they connect to the central stability system. Breathing, muscle recruitment patterns and overall alignment during exercise are foundational to resolving DRA.

Treatment for DRA in NYC

If you are suffering from DRA and are eager to resolve it, the postpartum specialists at NYDNRehab can help. We use state-of-the-art technology to diagnose and treat your condition. Our expert staff will help your retrain the muscles of your trunk and core to achieve proper function as you progress toward decreasing and resolving your DRA. Contact NYDNRehab today, and see why we are the best rehabilitation clinic in NYC for the treatment of DRA.

 

130 West 42 Street Suite 1055, New York NY 10036
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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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