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Pelvic Health Physical Therapy

Keeping fit through your pregnancy

Congratulations! Amidst the hectic calendar of your new life as an expectant mom, you might wonder: Am I safe to exercise through my pregnancy? How vigorous can my exercises get? Can I continue training? Be assured: you’ve chosen to pick up just the right read for that.

Is it safe to exercise during pregnancy? After having been cleared by your OB-Gyn as medically risk-free, YES! Initiating or continuing a physical activity or exercise program during your pregnancy is encouraged by the American College of Obstetricians and Gynecologists (ACOG). Research has also shown that physical activity of at least 30 minutes, 3-4 times up to 7 times a week can help prevent gestational diabetes, lower incidences of Caesarean birth delivery, decrease risk for preterm delivery and decrease risk for gestational hypertensive disorders.

Aerobic or cardiovascular exercises like walking, stationary cycling or swimming have been deemed safe to participate in throughout your pregnancy, even at the third trimester. What you may want to keep track of is exercise intensity. The recommended target heart rate is 60-80% of your age maximum heart rate. If you would rather just skip doing the math, try doing the Talk Test while your exercising. If you are able to carry on a full conversation while working out, then you are well within your exercise heart rate boundaries. If, however, you cannot finish a sentence or perceive your activity to be extremely difficult, then you may want to slow down or take a quick break.

What do you do if you have not been able to exercise for so long? Or if you are currently navigating through weight issues? You take it easy. Start slow, and then work your way up in a tolerable pace. There is substantial research on the benefits of moderate exercise for heavier participants during pregnancy towards weight loss and combating gestational diabetes. The benefits of exercise outweigh the minimal risks it might present during pregnancy.

Active women and athletes in training should be able to continue modified exercises through the third trimester. While your heart rate may appear to be at a slightly lower level, staying at a level of moderately hard in your exertion scale (Borg perceived exertion level 13-14) is recommended. Then again, the Talk Test still rings true here.

As your pregnancy progresses, your body transforms beautifully into the fullness of motherhood pride.  These changes may need to be considered when choosing the type of exercise to participate in. The body’s center of gravity shifts anteriorly, creating an increase of your low back arch. Your pelvis widens to accommodate the growing baby. It may be wise to avoid activities that have increased risk for falls or abdominal trauma. Scuba diving should be avoided because of its unhealthy effect to fetal development.

You may be a long-term runner who is pregnant at this time. You should be able to continue to train while pregnant, but be mindful of other musculoskeletal injuries you may compensate for. An injured knee or ankle can lead you to compensate at your low back or pelvis, and as a result lead to pelvic girdle pain. Your body is adapting to the growing life in you – you may be less stable around the low back and pelvic girdle. Incorporate hip muscle (your glutes), core (your transversus abdominis) and pelvic floor muscle strengthening (Kegel) exercises to help stabilize your running form. Do take care of your non-pelvic musculoskeletal issues, too. Strengthen your ankle and foot complex. Be knowledgeable of maintaining good knee and hip alignment in running.

If you are a novice runner thinking of starting a running routine to keep healthy during your pregnancy, it may be best to engage in a strengthening regimen first and walk-jog your way up. Strengthening exercises can include weights and rubber bands for resistance. Your own body weight is sometimes resistance enough for a lot of mat activities. Yoga and Pilates exercises have shown multiple benefits to the pregnant population. Research did look into the effects of repetitive heavy lifting during pregnancy, and this is something you might want to check with your OB-Gyn for maximum weight lifting limits.

The key to staying healthy as you push through these exercises is keeping yourself hydrated, maintaining adequate caloric intake for your energy expenditure as well as for your growing baby, and keeping yourself from getting overheated while exercising. Loose-fitting clothes and staying indoors during the summer months may be an option to consider when you are expecting. Most women who have normal pregnancy history should be able to exercise pain -free and without untoward events.

Finally, know when to stop. Recognize symptoms that may need medical attention. The ACOG lists them as: vaginal bleeding, abdominal pain, regular painful contractions, amniotic fluid discharge, dyspnea before exertion [or shortness of breath even before you begin any activity], dizziness, headache, chest pain, muscle weakness affecting balance, and calf pain or swelling.

If you are thinking of exercising and not sure where to start, a pelvic health physical therapist can guide you through a safe regimen. Why physical therapy? A pelvic Health PT can help expectant mothers strengthen their muscles essential to pregnancy, labor and delivery. (APTA).

Central Care PT offers introductory small group classes for expectant mothers. We can help you start a strengthening or cardiovascular program, and help you manage your pregnancy with safe exercises to prevent pain. Our goal is to help you keep fit throughout your pregnancy. 



Artwork by Chris Rodriguez



The Return of the Active Mom: 4 safe and easy exercises you do after childbirth

By Dr. Theresa Lugatiman, PT, DPT Pelvic Health Specialist @CentralCarePT


So, you have just given birth -- when is it safe to return to doing the exercises you love? Often,  new mothers are left with the question of when to start exercising and what exercises to initiate with.  Common sense will tell us to take it easy and slowly work your way up to your previous routines. But where do you start?

Changes happen to the female body as the uterus increases in size, accommodating the baby’s growth.  At around 22 weeks of pregnancy, relaxin hormone is released. As its name implies, it allows for relaxation of body structures, especially around the pelvis where the baby is nestled. Towards the third trimester, the pregnant woman’s center of gravity is shifted forward. The anterior shift will cause posterior structures to work slightly harder to prevent the body from leaning forward some more. Pressure is increased towards the pelvic floor muscles and like a net of the pelvic bowl it keeps abdominal contents in place. Back pain and pelvic pain may happen. If pain does not go away with positioning or supportive belts, a pelvic health physical therapist can guide you through your pregnancy with movement strategies and exercises.

After childbirth, structures are left lengthened and loose, often weaker than they were prior to the pregnancy. Fortunately, these structures begin to ease back to their pre-lengthened state at about 6 weeks. Your OB visit at about this time will mark your return to your usual activities.  Ask your OB provider if it is safe for you to begin exercises. If you have pain back pain,  pelvic pain or are leaking, a referral to pelvic health physical therapist may be necessary. Your Pelvic PT can guide you to start with pain-free Kegel exercises. Since your pelvic floor muscles have been lengthened during pregnancy, you might have a difficult time feeling the movement. These are the muscles you use to pause urine flow to catch it in a specimen cup. BUT IT IS NOT A GOOD PRACTICE TO STOP URINE FLOW! Think about pulling these muscles up and this may be easier done when you breathe out through pursed lips.

Do graduated exercises that improve your core strength. Sit ups, however, are not encouraged. In lieu of a full sit-up, curl-ups done with knees bent and laying on your back may be better. To avoid exerting too much pressure towards the abdominal area and pelvic floor, exhale or count loud as you lift just your head and shoulders off the mat.  If you notice a bulging or opening of your belly muscles as you come up, use a sheet around your abdominal area to draw the belly muscles closer together. Should you have pain or increased bulging while doing the activity, stop and consult your pelvic health physical therapist.

Another easy exercise that you can start with is a modified plank,  placing your hands on the kitchen counter and keeping your arms straight. If your wrists hurt, lean on your elbows. Try to maintain a straight line from you head to your feet. Flatten your low back and aim to hold  the position for 30 seconds. If you can only hold for a few seconds, that is perfectly fine. Repeating the activity will facilitate core muscle co-contraction and allow you to tolerate the hold for just a bit longer the next time.

While jumping and hopping exercises are to be avoided in the beginning of your recovery, you may initiate leg strengthening with a partial wall squat. With your back against the wall, move your feet forward about 12 inches. Remember to keep your knees over your heels as you slightly lower your hips, then use your leg muscles to push up into standing.  If you cannot keep your back flat against the wall, a rolled towel between the arch of your back and the wall will do the trick. Press your low back into the towel and feel your abdominal muscles activate. Your core, hip and thigh muscles will thank you later for initiating a great workout.

Lastly, remember to line up your joints in good body mechanics as you transition from one position to another. Carrying your newborn in your arms is only slightly different from carrying the child in your womb. While it is common to feel upper back aches and pains after delivery, it is also alright to seek help if the pain does not go away with just a heating pad or massage. It is a good idea to seek help if your muscles feel weak. Find pelvic / women’s health physical therapist in your area to give you a competent  assessment and guided progression to return to your athletic activities. Keep in mind, you carried a miracle in your womb for 9 months. Your body will begin to mend in 6 weeks and soon, you will be up and running with your new exercise buddy.

 

ACOG committee opinion. Exercise during pregnancy and the postpartum period. Number 267, January 2002. American College of Obstetricians and Gynecologists.Committee on Obstetric Practice - Int J Gynaecol Obstet - April 1, 2002; 77 (1); 79-81

MEDLINE is the source for the citation and abstract for this record

Metz, M., Junginger, B., Henrich, W., & Baeßler, K. (2017). Development and Validation of a Questionnaire for the Assessment of Pelvic Floor Disorders and Their Risk Factors During Pregnancy and Post-Partum. Geburtshilfe und Frauenheilkunde, 77(4), 358-365

Murphy, K., & Fosnight, A. (2018). The Role of Pelvic Floor Physical Therapy for the Female Patient. Physician Assistant Clinics, 3(3), 445–455. doi: 10.1016/j.cpha.2018.02.01

 

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