The irony is one of the treatments we were taught for women with diastasis was a curl up. So we were told to avoid curl ups and then it was a curl up by trying to kind of like close the diastasis with our hands, which physiologically at this point in my career makes no sense. But yeah, but there was this weird mystery around it and was just better safe than sorry to stay away from it.
SPEAKER_02:In today's episode, we talk to Dr. Sarah Haig and have a fascinating conversation about the use of curl-up exercises with women with diastasis reptile. Sarah has completed a fantastic review for the Physio Network Research Reviews, looking at a randomized control trial that explored this very topic with some surprising and potentially reassuring outcomes. Sarah Haig is a physiotherapist and co-owner of Entropy Physiotherapy and Wellness in Chicago. Sarah specializes in women's and men's health and on treating the spine This is a great episode in which Sarah gives us some great insights into the treatment of women with diastasis. Sarah gives us so many takeaway tips that you'll be able to put into practice immediately. To learn more about these research reviews and how they can make keeping up to date so much easier for you, do click on the link in the show notes. I'm James Armstrong, and this is Physio Explained. So Sarah, welcome to the podcast. It is brilliant to have you on. Personally, I'm really excited by this because we're going to be talking about a paper you've done for the research reviews, which I've actually used in practice recently. So welcome to the podcast. I'm excited by this.
SPEAKER_00:Thank you so much for having me. I love talking about things like this.
SPEAKER_02:Wonderful. Right. So we're talking about this. So as I mentioned, you've recently reviewed this interesting paper for the Physio Network Research Reviews. First of all, Sarah, just introduce what's the title of the paper that you reviewed?
SPEAKER_00:So the title of the paper is Curl Up Exercises Improve Abdominal Muscle Strength Without Worsening Interrecti-Distance Women with Diastasis Recti-Abdominous Postpartum, a Randomized Controlled Trial.
SPEAKER_02:Wonderful. So we're going to talk about the paper and we're going to talk about how the listeners can use this paper in their practice. But I want to start with a really important question, first of all, and that is, Where did it start? How did this come about that we started avoiding curl-up exercises, abdominal exercises for patients with diastasis erecti?
SPEAKER_00:I have no idea. That's actually a great question and I did try to do a little Google on it and it really is kind of like that just dogma handed down, passed down and kind of almost this like fear-based background that sometimes we have treating patients people who are pregnant. Like we don't want to mess it up. We don't want to make things worse. But as I was thinking about this, I reflected on when I first started learning therapy for people pregnant postpartum. And the irony is one of the treatments we were taught for women with diastasis was a curl up. So we were told to avoid curl ups. And then it was a curl up, but trying to kind of like close the diastasis with our hands, which physiologically at this point in my career, it makes no sense. But yeah, but there was this weird mystery around it and was just better safe than sorry to stay away from it.
SPEAKER_02:Interesting. So is there any physiological reason why we might avoid this exercise?
SPEAKER_00:Not that I can think of, and certainly not pertaining to diastasis. There was a study that Paul Hodges and Diane Lee did some years ago now, where they actually looked at what happens to the diastasis with a curl-up versus a transversus abdominis activation. Because for a long time, the transversus was the preferable contraction to manage or treat diastasis. And what they found is that actually during a curl-up, the diastasis got smaller. Things came together. The transversus could change the tension. And for me, that paper actually spawned a whole bunch of questions as to like, well, why do we want to close it? Is that what we want or is it the tension? Then that's another whole rabbit hole we would need two more podcasts to discuss. Yeah.
SPEAKER_02:Definitely. And this is a big topic, but I think this is a really, really useful area for clinicians, particularly around sort of confidence building in treating this patient group. So let's dive into the research that you did for us on the research reviews. Tell us a little bit about the paper that you reviewed.
SPEAKER_00:So I was excited to see this because the results were kind of like so commonsensical, but of course, you can't just go with all common sense. You can study it. So basically, this study looked at the effect of a 12-week home-based abdominal exercise program, looking at headlifts, curl-ups, and the impact it had on the interrecti distance in women who had diastasis recti abdominis, 6 to 12 months postpartum. And the control group for this study, so one group got the abdominal home program. The other group was encouraged to not do abdominal exercises, but to kind of maintain their normal levels of activity. They weren't discouraged from doing anything else. And what was really interesting, basically, that people who were doing abdominal exercises, the interrectal diastasis didn't get worse or change any of the things that people often attribute to that DRA. So the pelvic floor disorders, low back pain, pelvic girdle pain, abdominal pain, which sometimes can be attributed to that diastasis, didn't change. However, the women who did do the abdominal exercises had thicker abdominal muscles and they were stronger, of course, because they were exercising those muscles.
SPEAKER_02:So really a positive change.
SPEAKER_00:Really a positive change. And I think probably the more positive impact this article could have and will hopefully have on practice is that you can do these activities without without making people worse. And I think this high level of fear that a lot of patients will come in with, where they don't want to do physical activity because they don't want to make it worse, when in reality, physical activity is important for a lot of things. Strong abdominals, good for a lot of things. They can do those things without worsening their diastasis.
SPEAKER_02:Definitely. And it makes me think a little bit about our total hip replacements and the restrictions that we used to in some still do with those. And it's almost creating that fear with a patient to say, actually, maybe you shouldn't do this. They're going to potentially then put that onto what else shouldn't I be doing? And we want to be flipping that around and say, what could I do? Let's do this, let's do that. So do you think that has a part to play as well, as you say, from that kinesiophobia, if you like?
SPEAKER_00:Absolutely. I mean, I've had people come into my clinic scared to stand up straight because they were told stretching their abdominals would worsen it. And then you think, I don't know, when you just kind of look at the pros and cons of activity versus no activity, movement versus no movement, and just overwhelmingly, the benefits are for movement, activity, enjoying things, and not being scared you're going to make something worse. And to kind of tie back to your first question, like, where does this come from? I don't know. And how it persists, I don't know. Because when you think about what's typically involved when people end up experiencing diastasis is a baby growing slowly in their belly for 40 weeks, slow stretch over time, you know, that distance is an accommodation, not a pathology.
SPEAKER_01:Are you struggling to keep up to date with new research? Let our research reviews do the hard work for you. Our team of experts summarize the latest and most clinically relevant research for instant application in the clinic, so you can save time and effort keeping up to date. Click the link in the show notes to try Physio Network's research reviews for free today. I
SPEAKER_02:think that's a quote for the episode, isn't it? It really is. It's an accommodation. Potentially, you could see it as a natural adaptation to that time to achieve what the body wants to achieve, not a pathology. And I love that. That's really good. So we're not treating a pathology. We're treating a person to get back to what they want to do in life, as it were.
SPEAKER_00:Absolutely. And I would say overwhelmingly, again, and just in my clinical practice, which I realize is a biased view, is that many of the women who are typically who I'm treating with diastasis, whatever they thought was their diastasis or whatever they were told or was measured postpartum, by the time I see them, even though their activities are still limited, their diastasis has resolved. And I think that's the other thing we really need to look at is that normal recovery, how long, if it's unsafe to do curl-ups, For how long? But so far, I haven't seen any evidence. And there's just another new article out basically saying it's safe. It is safe for people who are pregnant to do curl-ups.
SPEAKER_02:Absolutely. So for listeners listening to this, some may well be thinking, wow, okay, this is quite a big change, quite a shift in the paradigm that I'm used to having. Some may have read this paper and still be slightly skeptical. You know, one paper doesn't necessarily mean we can change our practice. But what does this paper, do you think, give to clinicians?
SPEAKER_00:I hope that this paper gives a little bit more confidence and actually maybe decreases the clinician fear that they're going to make someone worse if they end up doing curl-ups or if their patient wants to do curl-ups. It's one more hash mark on the side of activity is safe. It's not going to make them worse. And then just start trying it and see how it goes.
SPEAKER_02:Perfect. Perfect. With our patients with diastasis recto, any other advice? You know, it's an area of interest for yourself. What else would you tell our listeners that they can do that can help patients either with this and around this kind of time?
SPEAKER_00:Okay, so this is based on my clinical experience, based on the evidence as I know it, is to really talk to their patients about why they want to address the diastasis. And I will literally say to my patients, the people who come to see me, is it mostly cosmetic, which is a legitimate reason when people aren't shoppy with how they're looking? Is it because something's hurting? Or is it because there's something they can't do that they'd like to do that they're attributing to the diastasis? And then problem solve from there, because there are some really great clinical practice guidelines out there that really state the correlation between the diastasis and many of the things we attribute to diastasis. don't really match up. So things like pelvic girdle pain, low back pain, incontinence, it may be a player, but it isn't a strong correlation right now with the information we have. So don't just look at the diastasis, but really find out what is it that this patient is trying to improve.
SPEAKER_02:Okay. It comes back to so many episodes that I record with people here. It comes back to Listen to your patient and work with the person in front of you, not the pathology, if you want to call it, and then some scenarios or the presentation.
SPEAKER_00:Exactly. And so I think not be scared. Remember what is usually preceding the development of this. The forces created inside of our body and inside of our muscles. I still have not had someone who's been able to convince me that a curl up or anything could create more stress on those tissues than a term fetus. So to just think, what am I scared of? And from what we know about physiology, does that make sense?
SPEAKER_02:Yeah.
SPEAKER_00:What can I do to get more confidence or give my patient more confidence?
SPEAKER_02:Absolutely. Yeah, definitely. I think it's a really, really useful paper, this, especially from a confidence-building point of view for a lot of clinicians who maybe don't see this on a regular basis, but it's still part of their clinical practice. So I think it's been great. And the research review that you've done for the PhysioNetwork, has really brought out the key points to kind of help build people's confidence. So thank you for your research review as well, Sarah. It's been brilliant. And thank you for your time on the podcast today as well.
SPEAKER_00:Thank you so much for having me.
SPEAKER_02:Wonderful. As you can tell, the research reviews are exceptional ways of keeping up to date with the research that's out there, which is bombarded to us all the time. And if you're interested in reading this research review from Sarah on this topic or Thank you so much for having me. Lovely. Thanks, Sarah.