Could separated abdominal muscles come from car accident?

       DEAR DR. ROACH: A few months ago, an oncoming driver lost control of his car and hit me almost head-on, destroying my large SUV. Both vehicles were traveling about 40 mph, and we had less than 1 second to react. Although I was belted and all of the air bags worked, my body rotated counterclockwise. All of the emergency-room attention and follow-up was on my right arm and shoulder. As I was recovering, my wife asked if I was gaining weight, as my stomach was looking very large. She believed I had a separation of my abdominal muscles, and a doctor I saw in Europe confirmed this. I have a perfect tent that runs from roughly my navel to the base of my sternum. It is wide and tall and symmetrical. Could the accident have caused this? How do I get my abs corrected? — C.C.
       ANSWER: It sounds as though you have diastasis recti, a separation of the left and right halves of your abdominal muscle. The contents of the abdomen will push outward where the connective tissue separates the muscle. Some people are born with this condition, but I see it most in people who have had weight gain that separates the muscle. Normal pregnancy is a common reason.
       Although I had never heard of it, I did find a case report of a person who had separation of the stomach muscles in a motor vehicle accident. The seat belt (which undoubtedly helped save your life) can put enough stress on the connective tissue (called the linea alba) to separate the muscles. Of course, it’s possible it was there before and you just didn’t notice it (this seems unlikely, but it would be more likely if your weight changed after the collision).
       Exercise programs may help with this problem, ideally supervised by a physical therapist. Another option is the Tupler technique, which involves a splint device to reduce the pressure stretching the linea alba, followed by exercise: The idea makes sense, but it hasn’t been proven to be effective. Surgery is another option for large defects.
       DEAR DR. ROACH: In regard to a recent column on a 65-year-old losing hair on his legs, your answer hit on everything — except his DIABETES! When I developed Type 2 diabetes and started to see a podiatrist, he commented during the foot exam that the loss of hairs on one’s feet and lower part of the legs is very typical of someone with diabetes, because of nerve damage. You did not mention Type 2 diabetes at all! Was my podiatrist right? — Anon.
       ANSWER: Diabetes can indeed cause nerve damage, and the most common places the symptoms begin are the bottom of the feet and ankles. However, hair loss is not part of the nerve problem from diabetes.
       People with longstanding diabetes, especially if not well-controlled, are at higher risk of developing blockages in the small and large blood vessels of the feet. Since this can start about the same time as diabetic neuropathy, the message from the podiatrist may have been confusing. Yes, it could be the diabetes, but it’s the blood vessel damage, not the nerve damage, that seems to be most associated with hair loss.
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       Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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