Could car crash have caused separated abdominal muscles?

Question: 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 can put enough stress on the connective tissue (called the linea alba) to separate the muscles.

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.

Q: 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.

A: 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.