Diastasis recti and barbells?

[ithryn]

I used the search function, and even accounting for the guy who called it diactis recti, there's only a couple posts on this from a few years ago.

Have you (or anyone in the SSC world) trained postpartum women with this condition? I feel like somebody has to have. There's a lot of terror online about how all kinds of 'core exercises' and strength training will make it worse, or make you require surgery, but I'm almost positive squats would make it better.

My wife suspects she has it after six kids (sorry to do that to you, wife). I think she's willing to try to strength training but it would be encouraging if anyone has had a postpartum client that didn't come to regret doing the squats that the internet scolded her not to do.

[Mark Rippetoe]

A midline hernia and diastasis recti are the same thing, if the separation is along the linea alba. My understanding is that pregnant women heal a midline hernia much more quickly than men, since it commonly occurs during pregnancy and the species has persisted anyway through some mechanism. Since most of my female members have had babies, I assume it's not a a problem except on the internet.

If I were you, I'd stop trying to talk your wife into training.

[Dr.T]

Midline hernia and diastasis recti are similar in that they both involve the fascia and both manifest in the midline. But there are significant differences.

A hernia is a true defect or hole in the abdominal wall fascia, through which viscera can protrude. Because the viscera can be trapped on the outside (incarceration) and then the blood supply can be cut off (strangulation), a hernia is a medical condition and its repair is covered by insurance.

Diastasis recti is a manifestation of a global abdominal fascial laxity, usually due to pregnancy or visceral obesity (or both). It is typically worsened with each pregnancy. Because the linea alba is truly devoid of muscle, when it is stretched in this condition, the rectus abdominus separates in the midline and there is a pseudodefect. This is not a true hernia, as there is no true fascial “hole” through which viscera can protrude. Therefore, it is not considered a medical condition and its repair is not covered by medical insurance. Repair of this fascial laxity is considered cosmetic and is frequently included in an abdominoplasty or “tummy tuck”.

Training cannot tighten loose fascia (or loose skin for that matter) and definitely cannot close a hernia defect. In fact, these are both collagen-based structures, and there is really nothing on earth that will tighten them other than sutures. So we know training will not IMPROVE either condition.

Whether training WORSENS either condition is a more interesting question. My guess is training would not worsen abdominal fascial laxity, especially if one contracts the abdominal wall during exertion.

An acute large increase in intraabdominal pressure during exertion is a well-known cause of hernia incarceration, though incarceration is a rare event under any circumstances. Chronically increased intraabdominal pressure can slowly increase the size of the defect. If somebody with a hernia asked me if they should train, I would say get it repaired, let it heal 6 weeks, and then proceed as usual. I have had bilateral hernia repairs and they never bother me during training.

With regards to somebody that suspected they had diastasis, SS training should neither improve nor worsen her postpartum fascial laxity. Visceral obesity, time and pregnancies will worsen it, and only surgery will improve it. If she were concerned about hernia, she should be seen by a general surgeon to rule it out, as it is a true medical condition as described above.

[Mark Rippetoe]

Excellent input. Thanks Troy.