At Purple Mountain Physical Therapy we specialize in treating pregnant and postpartum women and advising them on exercise in pregnancy. We are keenly aware of the strength and capacity a person who is pregnant has! You’re growing another human being and also living an active life! It’s pretty cool what we women can do and having an active pregnancy, if you are cleared to do exercise in pregnancy, has wonderful benefits for you.
When pregnant it can be a time to make careful choices when it comes to exercise.
Just this week a pregnant mom asked us about exercise during pregnancy:
“what are your thoughts on my doing the splits when pregnant? Years ago I could do them no problem, but it has been a long time and I was playing with my daughter and she did them, so then I did them and then I wondered if it wasn’t a good idea.”
And another pregnant mom recently was planning to run a 5K during her pregnancy and asked us for guidance about that. Read on for some of our suggestions for exercise in pregnancy.
Moms-to-Be, it is recommended that you exercise during pregnancy if you have an uncomplicated, typical risk pregnancy.
ACOG’s recommendation:
“Women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during and after pregnancy.”
The benefits of exercise when pregnant can be significant. They help you circulate blood, burn calories, keep strong, maintain cardiovascular fitness and improve mood. You are heading into a wonderful labor/delivery experience and exercise helps to keep your body strong for the baby’s birthday.
During labor, which may occur for hours at home or in the hospital, it can help advance labor if you can move, change positions and walk around. You need arm, leg and core strength to adopt the positions that may help you to progress your labor (hands and knees, walking, squatting, rolling side to side). After your baby is born, your body is truly going to need your muscles to function well. You will be lifting your baby and the car seat + baby. Keeping strong is an important benefit of exercise during pregnancy.
The pregnant and postpartum women we work with usually tell us they just aren’t sure which exercises would be best to do.
We evaluate each person and develop a customized program for their body’s needs and their goals.
We assess and treat every pregnant person for a Diastasis Recti Abdominis. What is a DRA?
Diastasis recti abdominis is a normal part of the third trimester of pregnancy. However, there are elements of DRA that are normal and other times a person can have a DRA that is not normal and/or too large and/or not showing good capacity to transfer load through your abdominal wall. The abdominal muscles transfer load with every step you take. When walking, the load from your right leg transfers up your foot, into your pelvis and upto your abdominals. Your abdominals on the right leg will then transfer that load through the linea alba into the left side of the abdomen and left side of the body. A healthy, strong abdominal wall can transfer this load no problem. When a person has a diastasis recti abdominis (DRA), the ability to transfer this load is compromised. When this happens the abdominal muscles will dome or cave under the pressure. There are specific exercises that can be completed in pregnancy that have been shown to have a protective effect on DRA development. And there are also important things to avoid. At Purple Mountain PT we will thoroughly assess your abdominal wall and give you the confidence and very clear instructions on what you should be doing and what is not advised.
How we handled a patient this week who is 7 months pregnant and has a 4 finger diastasis recti abdominis:
Just this week we checked a pregnant person who is a runner/walker for a diastasis recti abdominis and found that in her 7th month she has a 4 finger DRA. Her DRA exhibits load transfer problems, visible when I had her move in a variety of ways, by lifting her legs or moving her arms or lifting her head. What she and I both saw was a dome of the linea alba when she tried some movements, but not every movement. This is not ideal to have the doming and, in order to avoid her DRA advancing past these 4 fingers, we needed to develop a treatment plan, that included safe exercises, for her to do at home and in our appointments. Therefore, we were able to work very closely in her 55 minute appointment to come up with the specific exercises that were safe for her to complete at this point in her pregnancy and which ones were not safe. The list we developed was very specific to the findings we saw for her body on this day. To assess her I was lying on the floor with my fingers watching and feeling her linea alba as she performed various moves. I also had her lying on her back and standing up and checked her linea alba while she attempted a variety of movements. At Purple Mountain PT we keep up with the latest research regarding how to prevent and treat a diastasis recti abdominis. For this woman I counseled her on what to be working on today. Also, remember that she is a jogger/runner. Unfortunately, her abdominal wall was clearly overpowered and strained when I had her demonstrate jogging. We tried to modify it several ways, by altering breathing, arm movements and stride length, but her DRA was problematic with everything we tried. Therefore, my recommendation to her is to stop jogging at this time and walk instead. She admitted that jogging had not felt good in the last month and she had really cut back on how much she was doing, opting to mostly walk. So when I suggested no more jogging, she was not surprised and did not find this defeating, thank goodness. When she was walking, her DRA could handle it, we checked that as well. And, if you are wondering, we do have a private area to check this, which is important because her shirt was lifted up the entire time so I could look at and feel her linea alba. I also counseled her that it will be very important for her to complete a postpartum recovery program that specifically addresses her DRA before she attempts to get pregnant again. She understood this would be important and admitted that she thinks she never got rid of her DRA from her first pregnancy, which was less than 2 years ago.
How we helped guide another patient’s decision whether she should run/walk a 5K or not, while pregnant:
Running when pregnant can be just fine for some women. Each woman is different and that’s why if you are our patient you will be evaluated and treated with a plan specific to your body’s needs. Regarding my other patient who was planning to run a 5K when pregnant: I assessed her capacity to run and found that she was not well stabilized in her feet, knees, hips or pelvis. Before I did this check, she told me that she thought she would be walking most of the 5K with some bouts of jogging during the 5K. But then I took her through a series of very specific movements that are easier than running/jogging and she and I both saw she struggled with them. In contrast to the woman above, whose diastasis recti abdominis was the problem, this patient’s abdominal wall had good integrity and no concerning DRA issues when she was jogging. But, it was her foot, knee, hip, pelvis alignment and lack of gluteal strength that was not looking good to her and me. Based on these findings, she understood it was not wise to jog at any point in the 5K; I would be worried she might hurt herself. You can develop any number of strains when jogging with extra weight from being pregnant, such as achilles tendinitis, patellar tendinitis, gluteal tendinopathy, SI joint pain, pubic pain, lower back pain and pelvic floor dysfunction. Because jogging was not a good choice for her body at this time, she and I came up with strengthening exercises that would address the weakness and balance deficits we identified. I have had many other patients who pass my tests related to running in pregnancy and jogging a 5K is perfectly fine for these women.
What should you do if you are pregnant and develop urinary incontinence? Is this normal?
Urinary incontinence is not normal, not even in pregnancy! Many women are surprised to learn this. Somehow in our society we have developed the wrong societal messaging that seems to have implicitly told women “if you lose urine when pregnant, it’s normal because you are pregnant.” Wrong. Public service announcement: most women who are pregnant are not leaking urine. If you are leaking urine it is a sign of pelvic floor dysfunction and the research and recommendations on this are clear: treating your urinary incontinence during pregnancy reduces your risk of problems afterwards. Not treating it in pregnancy raises your chances of having ongoing bladder control problems after you have your baby. If you experience pelvic floor dysfunction, you should find a highly qualified pelvic health physical therapist. We specialize in helping pregnant and postpartum people and anyone who has pelvic floor dysfunction or urinary incontinence. A high quality treatment program will include a combination of manual therapy plus exercises. We will also teach you how to breathe and control your intra-abdominal pressure better. If you want to read more on this topic, check out this blog we wrote about our care. So many women express to us that they are so grateful to have found us.
If you want a focused list of exercise during your pregnancy or postpartum period, together we can assess your needs and develop something that is safe for you, focused on your goals and effective!
Some considerations on exercise in pregnancy:
–Be certain to get clearance from your physician first. Generally low impact and non-contact exercises you did before pregnancy tend to be safe during most pregnancies. But some people have higher risks, such as placenta previa, abnormal bleeding, incompetent cervix or any other factor that may make your physician advise you to limit your exercise. Be smart about your exercise choices so you keep yourself and your baby safe.
–If you are cleared for exercise during pregnancy aim to get 150 minutes of moderate exercise per week. This follows the guidelines. You can get this by walking just over 20 minutes a day. Or you may choose to continue your normal workout routines, perhaps modifying them to be less intense and lower impact.
–If you are wiped out during your first trimester, consider that two 10 minute walks every day gets you upto 140 total minutes for the week.
–A combination of strength training to keep your body strong and cardiovascular training to keep your heart & lungs strong and to get the blood flowing is recommended. We benefit from doing both.
–Stretching can feel wonderful during pregnancy and can be very helpful as you will notice various areas of your body getting tight. However, you want to be careful with stretching, as your pelvis may be expanding and your center of gravity is shifting. In very broad terms, sometimes rotations/twisting exercises are not advised. It may be best to modify your stretching methods to move gently, supported and carefully when pregnant. A good pelvic physical therapist knows how to advise you well. For my patient who wanted to do the splits during pregnancy I advised her that the splits may not be the best choice. It has been a long time since she last did them and I have treated enough women to know that taking the body to full, end range such as is needed to do the splits, will generate a lot of torque on the pelvis and might contribute to things like SPD (symphysis pubis dysfunction), lower back pain, a torn hamstring or tailbone pain.
–A certified prenatal yoga instructor is specifically trained in how to take you through safe and effective stretching and strengthening exercises. Prenatal yoga can quiet your nervous system, help keep strength in your legs and address low back and hip tightness that may occur during pregnancy.
–Some Pilates instructors have prenatal training: A good Pilates instructor will know how to modify workouts for safety with a pregnant client. You and the instructor should be able to troubleshoot to find and adapt the workouts to keep them safe and effective for your core, hips and abdominal wall.
–Contact sports or activities where you might fall or be bumped by another player, place you and your baby at higher risk and may be best to avoid during pregnancy. Because your center of gravity changes as the baby grows, a woman can find herself surprised to lose her balance more readily. Contact sports are not a good idea when pregnant, because you never can anticipate if your abdomen will get hit. An activity where you can fall should also be modified for safety to ensure both you and your baby are not at risk.
-The benefits of exercise during pregnancy are incredible:
*Lower risk for gestational diabetes. This is HUGE! Ladies, even if you don’t have gestational diabetes, please understand that when you workout you are beneficially changing your blood glucose (unless you are hypoglycemic). We have evidence now that gestational diabetes is a risk factor for developing diastasis recti abdominis. We know that diabetes impairs the healing of wounds and now we know that it seems to alter both the muscles and the collagen in the abdominal wall. Exercise in pregnancy helps to keep blood glucose stable for all women and reduces risk for developing gestational diabetes.
*Maintaining your own optimal weight gain during pregnancy. We will gain weight during pregnancy and need to do this. When you are pregnant, however, it is a myth that you are “eating for two” and can eat twice as much food as normal. When pregnant, you should work to eat a well balanced diet that provides a variety of foods and nutrition for your and your baby. Optimizing weight gain during pregnancy is also very important as we consider diastasis recti abdominis risk factors, because higher body mass index (BMI) is linked to greater risk for developing a DRA.
*Less low back pain, pelvic pain and other pain! Yes, meta-analysis of studies showed an 8-12 week exercise program during pregnancy resulted in less low back pain, less pelvic pain and less sick time from work! We love this finding and want to encourage you exercise during pregnancy! We have found a lot of our patients say things like “well, every woman has back pain when pregnant, don’t they?” The answer is “No.” Lower back pain during pregnancy is not normal. If you are pregnant and you have any pelvic pain, such as tailbone pain, SI joint pain, lower back pain or symphysis pubis pain, this is not normal and high quality pelvic PT can help you resolve this.
*Improvement or maintenance of overall fitness: Isn’t this empowering to know that when you are pregnant you may be able to improve your fitness? At the very least, exercising during pregnancy will help maintain your overall fitness.
*Enhancement of mood: Ladies, we don’t want to be in bad moods, anxious and in the dumps. If you find yourself irritable during pregnancy, why not try a walk outdoors to see if you can improve your mood? Enhancing mood is a proven benefit of exercise, so if you are struggling with mood related issues when pregnant, please talk to your physician about this because some women do develop pregnancy related anxiety and depression. And, also consider exercise as one means to enhance mood.
*Lower risk for cesarean: Did you know this one? Labor is not leisurely, it takes endurance and strength. We know that women who exercise during pregnancy have a lower risk for cesarean. Just think, each workout helps prepare you for the birthday! It’s fun to imagine!
Being pregnant is such an incredible and overwhelming time. If you are experiencing any pelvic pain, urinary incontinence, constipation or back pain, see a pelvic health PT to get this treated. If you are uncertain about your abdominal wall and whether you have a diastasis recti abdominis or not, we can help you. The women we work with send us birth announcements with the nicest notes letting us know that the time they spent with us helped power them through their labor and delivery and gave them peace of mind with regard to their exercise routine and its safety and effectiveness for their body. Connect with our knowledgeable staff here or call us at (616) 516-4334.
Peace,
Purple Mountain Physical Therapy, located in Grand Rapids, Michigan, is a specialty pelvic health physical therapy clinic. We help women who are pregnant have a strong and healthy pregnancy. Our program for pregnant women includes birth preparation, where we practice birthing positions and labor strategies to help your baby descend into your pelvis, teach you how to push without blowing out & tearing your pelvic floor and show you how to optimize your abdominal wall. We treat pregnant and postpartum women so they can be strong and healthy in their pelvis, abdominals, hips and back. We help women overcome their pelvic problem, pelvic pain, bladder control issues and pain with sex. We have been exclusively focused on pelvic health for over 20 years and offer a level of expertise and holistic care that you won’t find elsewhere! If you are wondering if we may be able to help you, call 616-516-4334 to learn more, or submit this online inquiry and we will be in touch. We offer telehealth visits for people who prefer an online appointment. Yes, during telehealth we can assess your abdominal wall and pelvic stability, for example. We consider this work an honor and find great joy in helping pregnant women feel empowered and well prepared for their birth.
References:
Acog.Org, 2022, www.ACOG.org.
