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- Okay. Welcome my friends to the Bob & Brad podcast.
Produced by Bob and Brad,
the two most famous physical therapists
on the internet, in our opinion.
I am Bob.
I am one half of the Bob & Brad team
and our guest today is a physical therapist and co-owner
of Entropy Physiotherapy and Wellness in Chicago, Illinois.
If you're in the area, stop by.
Her area of interest is in treating the spine and pelvis
with a specialization in women's and men's health.
In 2008, she received her Doctorate of Physical Therapy
and Master of Science Degree in Women's Health
from Rosalind Franklin University
and was awarded a board certification
as a Woman's Health Clinical Specialist in 2009.
She's a busy lady.
She has completed a certification
in Mechanical Diagnosis Therapy from the McKinsey Institute.
Which is excellent.
Brad and I have done that ourselves.
And is a registered yoga teacher.
She is passionate about learning more about the human body
in order to provide efficient and compassionate care
as she helps patients return to optimal functioning.
I want to introduce you to our guest today, Sarah Haag.
Hi Sarah.
- Hello, thank you for having me.
- Yeah Thanks for coming.
Like I said, I've read your book.
I'm gonna go ahead and mention that right away.
(Sarah laughing)
"Understanding and Treating Incontinence."
"What causes urinary incontinence
and how to regain bladder control."
So I read it actually a couple months ago
and I've been doing it.
I've been doing the Kegels exercise
and this is a little bit embarrassing,
but it's helped me with hemorrhoids.
And also, I was getting up twice a night.
Now I'm down to one.
So, - That's fantastic
- Yeah, I know that's one of my questions actually,
is how long before they tend to help?
But we'll get to that later.
- [Sarah] Sounds Good.
- So, can we just jump right in here?
- Yeah. Let's jump in.
- Do you think we can talk about diastasis recti or-
- Sure. If you'd like to.
- Why don't we start that right now?
- [Sarah] Okay.
- Why don't you define a diastasis recti.
Am I saying it right?
- Yeah. So some people say diastasis rectus abdominis.
There's a lot of different ways to say it
but most people will call it the gap in their belly.
So if we think about our six-pack muscles,
and I'm dating myself a little bit
'cause the example I always give is Arnold Schwarzenegger
in "Terminator" days, not governor days.
- Yeah. (laughing)
- So in a six pack, we see that little divot in the middle,
dividing the two, three packs.
And so that's our linea alba
and where our two rectus abdominis muscles come together.
Now very frequently during pregnancy
and by frequently, I mean, some studies showed
that a hundred percent of women will experience a diastasis
of some sort-
- [Bob] Wow.
- During their pregnancy.
- Wow.
- And so this isn't a rupture of the muscles
and there's actually a lot of great discussion right now
as if this is even a pathology.
Because I mean, if we think about what would happen
if those muscles didn't stretch that connect
or if that connective tissue
between those muscles didn't stretch.
I don't know what would happen.
And then, you know, it's important to remember
a lot of women get better after that.
So a lot of women do fine.
I will say there's a lot of
I don't wanna say mystery,
but a lot of varying ideas around diastasis
and how it should be treated,
if it should be treated,
and best approach.
And there is, thankfully,
if we look at the evidence,
some pretty straightforward things to try.
Understanding that some women
will need more help than others.
I might be getting a little ahead of you.
- Oh, that's fine.
- But yeah, so basically you asked for the definition.
Basically it's that separation
where then there's kind of a gap
between those two halves of our six pack muscles.
- Sure, and I know a lot of sites talk about,
and again, I have no experience with this whatsoever,
I've never treated it.
So one of the signs isn't it that you can actually,
well do you want to tell how to do it?
To check the-
- Yeah, so certainly the way I was trained
to test it, is to just have a woman lie on her back,
and quick side note, men do experience this as well.
They don't seek out help very often.
And also there's not tons of research.
There are a couple of people starting to look at it
but it's definitely, I would say,
predominantly looked at as a female issue,
especially postpartum.
But you would lie on your back with your knees bent
and then you would just do a crunch
and you can actually kind of feel around in the midline
and see, can I feel a distance between those two halves?
In the last, it's probably been three or four years now,
Paul Hodges and Diane Lee did a paper together,
looking at are we, are we more interested
in getting those spaces closer together
or do we just want to make sure
that it's firm between those two areas?
So for some women,
and again, I'd say this is at the end of the spectrum.
So this is not most women, you know
the diastasis stays pulled apart
and it's very soft.
So even when they try to create tension
in their abdominal wall, they're not able to.
So then there's a lot of different thoughts
and opinions as to what to do about that.
But many women do really great
with just restarting an exercise program they enjoy.
'Cause really there's not evidence
that a particular exercise will make it worse.
So for any woman who's read anything
that they're scared to do,
but would like to do,
but was told it would make things worse.
We don't have any evidence to support that.
There's also not any evidence
that any one particular activity
or approach will help them get better, sooner.
So I like to tell PTs, we can't fix this.
We can't say we're going to make the gap smaller
- I saw in the research too, but it doesn't stop.
I've seen articles saying you should be doing
these exercises and I've seen articles,
you should be doing these exercises.
- Yeah.
- So there's just no proof at this point
- There just isn't.
There is some evidence that shows being more active
versus not active at all is helpful.
Which actually, I'm good with that kind of a statement,
because if I never work on my abs
and they look a certain way,
and then I worked on my abs,
they're probably going to change.
So, I mean, that just makes good sense.
That doing nothing,
for fear of making it worse,
isn't helpful for a lot of reasons.
But you know, I've met women,
five years after their last baby
who still won't reach over their head
'cause they were told stretching their abs
would make their diastasis worse.
So yeah, so we need to not scare people.
Encourage them to get moving
but then there are probably people who are better
at helping people regain the function that they want
and the appearance that they want.
And you can find those too,
mostly their women's health therapists.
- So you really can't prevent this.
Correct?
- I haven't seen any evidence that would prevent it.
I think we can say safely there's like a genetic component,
like what's your connective tissue like
and how well does it recover?
But yeah, I would say that being strong,
being generally healthy would make your
connective tissue healthier.
- Sure.
- [Sarah] So that's what I would probably focus on.
- So no, are there any health implications
or complications associated with it?
- Great question.
We haven't found any.
So we used to think it might be associated with back pain,
pelvic organ prolapse, incontinence,
but really recent studies are showing
that women might have both,
but we're not finding a correlation
or even an increased prevalence.
You know, that women with a diastasis,
actually there was one study
where women without a diastasis
actually had more incidents of incontinence
- Oh, wow.
- than women who did have a diastasis.
So then you kind of wonder like,
well, thank goodness for the diastasis
- [Bob] Right.
- that maybe managed something better.
I don't know.
So there's, I think there's a lot, we don't know (sighing)
but I like to embrace like the strength
and resilience of the human body
and the adaptability of the human body.
I don't think that it's a,
I really think that we should step away
from calling it a pathology or a dysfunction.
- Right.
- There are cases where it is,
but most of the time it's just something
that women can recover from,
as long as we don't scare them into not recovering from it.
- So I think you've answered this question
really, in a sense.
I imagine you wouldn't recommend
wearing an abdominal binder, then.
- No, so there's no evidence
that shows an abdominal binder will help prevent
or reduce a diastasis.
Where a binder might come in handy
is if a woman feels
like she's having trouble creating that tension.
Which as you can imagine,
imagine a woman at full-term,
how stretched her abs are
and then the baby comes out.
Her abs are still that stretched.
It's going to be hard to create that tension.
So if getting a binder
that feels like a like a lovely hug in the middle
can help people feel better
and have them feel like they can do more.
Huge fan of that.
But again, as far as like reducing anything,
any particular claims, not so much.
So I recommend, women should do what feels good
and get moving.
- I love that you went over this subject
because again, it counters just about everything I've read.
So except for when I read research
and in what you're saying, supports the research
and the research supports you.
So I'm glad-
- Yeah. Well, I do thank the research
because I wouldn't have known.
I want to know what's most likely to help
and there are definitely.
I always wonder if it's
like taking advantage of a vulnerable population
there's a lot of kits and programs that claim things.
- Yes. Yes.
- And again, there can be benefits to having a program
that walks you through getting more active,
but that's the magic.
It's not the one particular exercise
that you did a particular way.
At least we don't have proof for that yet.
But we do know if you get moving
and stick with it
and stay active, it can be helpful.
- Thank you very much.
So I think we're gonna cut off here.
I want to again mentioned your book
for urinary incontinence,
"Understanding and Treating Incontinence,"
"What causes urinary incontinence
and how to regain bladder control."
Also I want to mention, they can find you on Twitter
at Sarah Haag,
S-A-R-A-H-H-A-A-G-P-T.
And then she has a website
for your clinic, correct?
- For the clinic. Yup.
- Entrapenny?
I keep saying this wrong,
(both laughing)
entropy.physio
.com. No.
- No, just .physio
- It should be .physio.
E-N-T-R-O-P-Y dot P-H-Y-S-I-O
proving I can spell a little bit.
Anything else, Sarah?
You're in Chicago.
If people want to look you up and
they certainly can on Twitter.
- Absolutely. Twitter I'm there quite frequently.
I'm in Chicago, I lived there.
Come in the summer when it's nicer
and everyone can be outside and safely distanced.
(both laughing)
- That sounds great.
Well, thank you again for taking the time to be on our show
and I hope we can have you in the future
and talk about some men's health, then.
- That would be great.
I feel like men are super underrepresented in pelvic health
so I'd love to have that opportunity.
Awesome.
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