Tag Archives: prenatal

The Inside Scoop on Exercise During Pregnancy

 Prenatal 3

Something is in the water! As I’ve attempted to embrace my first pregnancy, with a balance of privacy and sharing my experiences with other women, pregnant ladies have come out of the woodworks – and they’re all curious about how they should exercise during pregnancy. It has long been my passion to make sure that people feel supported and confident about their health and exercise choices, so, without delay, it’s time to jump into the deep end. Whether you’re currently pregnant, planning to be pregnant one day, or have a relative going through this season of her life, I encourage you to read and share! *Insert my favorite corny hashtag: #knowledgeispower.*  

These initial insights on how to approach exercise during pregnancy are just that; beginning steps and considerations for how to cope with the new changes in a pregnant woman’s body. Unfortunately, it’s difficult for many practitioners and trainers to broach this topic in detail because every woman’s body – especially while pregnant – is unique and requires special, individualized care. For this reason, there is no single perfect routine for a pregnant woman, especially because her physical needs change from trimester to trimester! Nonetheless, I will do my best to walk you through a lot of information to consider for your personal needs. I know, all this stuff can really can make one’s head spin. Don’t worry. We’ll get it screwed back on the right way.

In the sections that follow, I will attempt to paint a high-level picture of universal prenatal exercise considerations. In the future, I will also post an article including exercises that have been modified to meet the needs of a growing belly.

 

Benefits of Exercise during Pregnancy: 

  • Improvements in energy, self-esteem and mood
  • Improvements in posture and reduction of back pain
  • Promotion of muscle strength, endurance and tone
  • Promotion of positive sleep patterns
  • Reduction of constipation, incontinence, bloating and swelling
  • May help prevent or improve gestational diabetes
  • Improvements in circulation which may relieve leg cramps, nausea, varicose veins, insomnia, fatigue and edema
  • Reduction of instances of hypertension, diastasis recti, deep venous thrombosis and bone-density loss
  • On average, 30% shorter active stage labor, 50% reduction in need for labor inducing drugs, and 75% reduction in need for C-section and/or forceps

Note: This is just a short list of benefits for the mommy-to-be, not to mention a plethora of benefits for the little one if you exercise just 3x/week!

For more information, and signs that you should STOP exercising, please refer to the American College of Obstetrics and Gynecology’s (ACOG) guidelines and precautionary measures for exercise during pregnancy: http://bit.ly/1yoHwgl

Also, check out the American College of Sports Medicine’s (ACSM) comments on this topic: http://bit.ly/1ihe1GH

 

Prenatal 4

 

Prenatal Exercise 101:

Woo hoo! You’ve peed on a stick and discovered that life is now growing inside you!

First thing I want you to know is that relaxin, a hormone that can cause your joints/muscles to be looser than normal (in preparation for Junior’s big debut!), kicks in on day one, literally. Some women can experience small changes in their body’s laxity very soon after conception. Interestingly, that is one of the first ways I knew I was pregnant – I woke up on day 25 of my cycle with my back totally out of whack. I didn’t sleep on it weird or do anything to aggravate it the day before, so the only thing I could think of was that hormones may be shifting already. A couple days later, when I went on a run with a friend, I was unreasonably out of breath and had to ask her to walk with me. It was then, in between gasps for air, that I was certain I was pregnant. On day 28, I snuck into the bathroom without telling my husband and did the classic pee-on-a-stick, and there it was – pregnant! Not every woman will experience these changes at such an early stage, but they are anecdotal evidence that hormonal changes are the REAL DEAL. Fo sho.

Due to relaxin and impending changes in elastin and progesterone (other hormones that can loosen soft-tissue), you’re going to have to see how loose and/or unstable your body feels as you enter your workouts. Hardcore high-intensity interval training or workouts with sudden lateral or twisting movements may become contraindicated. In addition to being less safe for your muscles and joints, maximal bouts of exercise also have the potential to divert oxygen away from your fetus to your large muscles. For obvious reasons, this isn’t ideal for the growing life inside you. Additionally, maximal bouts of exercise are likely to be more challenging to recover from, so it’s best to stick with what feels like “exercise in moderation.”

Some women may feel that running a half marathon is manageable because they’re in a long-distance running routine already and happen to be blessed with enough energy during their pregnancy to handle it. More power to ya – have no idea how you do it! Other women may find that their normal exercise routines feel incredibly laborious all of the sudden and/or they may have challenges getting into the gym due to nausea and/or dizziness. The point: You have to see how your body is responding to pregnancy and then make a day-by-day game plan. This is one time in your life when it’s best to set an intention for exercise, but to wake up and see what your body can actually manage, rather than pushing yourself through a set-in-stone weekly routine because you “have to.”  Pregnancy is NOT the time to push your body beyond its abilities. Let yourself off the hook a little if you’re feeling stressed about it. Don’t go signing up to train for something you’ve never done before. Your baby told me he/she won’t be very happy about it. 😉

 

Cardio Guidelines:

Unless your doctor has told you otherwise, feel free to run, use the cardio equipment at the gym, swim, dance, or anything else that suits your fancy. What’s important is to avoid sudden, uncontrolled movements and exercises/sports where you may be at risk for blunt trauma to your abdomen and/or falling (contact sports, downhill skiing, mountain biking, etc.). These guidelines seem strict, but, if you want to play it safe, it’s a good idea to modify your activities. Mind you, I’ve seen women ignore some of these guidelines and, luckily, avoid injury, buuutttttttt, I’m not going to be one to suggest risk taking.

To ensure that you’re exercising at an appropriate intensity, use the “talk test.” If you can talk while exercising, you’re good to go. If you’re feeling really out of breath though, you should probably take down the intensity. You may only need to reduce the intensity for a few minutes, or you may have to switch up your routine in its entirety.

I like to tell non-pregnant clients to use a scale of 1-10 to assess their workout intensity. A 1 means you’re lying on your couch watching Desperate Housewives. A 10 means that you’re working out as hard as possible – a level that’s not sustainable for longer than a minute or two, at most. For pregnant clients, I like to use the same scale. I counsel them that it’s no longer going to be appropriate to reach a 10 on the scale during their workouts, but that exercising up to a 7 is going to be just fine. You might even hit an 8, from time to time, if you’re really fit. But, it’s best not to linger in that zone for very long – especially if you’re feeling really out of breath.

 

Prenatal 1

 

Strength Training Guidelines:

You may be gaga for your beach body workouts or CrossFit, but pregnancy can definitely take some of the oomph out of your weight lifting routine. If you find that lifting your normal weights is a lot harder than it was before getting pregnant, then it’s a good idea to reduce the weight to a safe level. You will want to keep your heart rate in an appropriate range (see the 1-10 scale of exertion mentioned in “Cardio Guidelines” above). A lot of women find they can’t lift as heavy due to cardiac changes taking a toll on energy (ex: blood pressure drops, dizziness, fatigue). But, again, listen to your body.

You should also be extra conscientious to keep proper exercise form since it can have positive or negative consequences for your changing body. Thus, choose the weights that feel appropriate and don’t be surprised if you’re a wee bit deflated by having to step down from the heavier weights that you were so proud to lift before. Weights that you can control will be best for your body!  In fact, many women find that they have to opt for lower weights with higher reps. Do what you’ve gotta do! No self-shaming.

Full-body workouts are always going to be the golden ticket, but, during pregnancy, you may want to put a little more emphasis on hip and core exercises since these areas will be largely impacted by the growing weight of your uterus and baby. For optimal core strength, begin focusing on your transverse abdominus through planks and stabilizing exercises instead of crunches. Crunches may still feel okay for a little while during the first trimester, depending on how quickly your body changes, but they can 1) weaken the pelvic floor and 2) place inappropriate stress on a stretching belly (which can cause diastasis recti).

Pregnancy is a great time to focus on back exercises. These are super important for postural support and can minimize lower back discomfort (common in the 2nd and 3rd trimesters) and upper back discomfort (commonly results from breastfeeding and consistently holding your new bundle of joy).

Other considerations:

  • While weight lifting, always remember to breathe so you don’t get faint.
  • Avoid exercises lying flat on your back once you’re putting on significant weight and/or the pressure becomes uncomfortable. This may be towards the end of your first trimester, especially if this is not your first baby, or it may be around the end of the fourth month of pregnancy for new moms who are slower to expand.
  • Aim for stability and moderation. Sticking with safer routines doesn’t mean you can’t get a great workout.
  • Don’t compare what you can do to what another pregnant woman can do for exercise. ‘Nuff said.
  • KEGALS!!!!!! 😉

 

 

Prenatal 5

 

Stretching Guidelines:

After the first trimester a lot of women may need to avoid static, prolonged stretches in some or all areas of the body (esp. the stomach), and may find that foam rolling becomes difficult due to a growing belly and/or foam rolling’s impact on blood pressure. Stretching to the point of discomfort, for any period of time, is going to be contraindicated throughout the entire pregnancy, for all women.

Some women may find that their regular yoga class feels comfortable for a while. A lot more women will probably find that prenatal classes are a better option once they are well into their second trimester or early third trimester. Plenty of yoga and stretching exercises can relieve some pressure and discomfort in areas that get tight from daily exercise and/or the physical burden of carrying extra weight; however, the pregnant body needs modified versions of many poses and stretches.

Ultimately, your body now craves a lot more stability to counteract the natural loosening of soft-tissue, so I encourage you to consider the following:

If you’re performing yoga or stretching exercises and you notice an increase in discomfort, rather than a decrease, you should consider finding alternative routines and exercises. Plenty of women will find short-term relief of discomfort when stretching due to the increase in circulation that takes place; however, if you’re uncomfortable a few short hours later, you may try skipping yoga/stretching for a week and replacing it with stability exercises. If your discomfort decreases then there is your answer; your body is craving stability, not stretching. If you’re not noticing any change in regular discomfort, and you’ve already consulted a qualified exercise professional to learn appropriate stabilizing exercises, then it’s probably time to schedule an appointment with a physical therapist. They can give you modified exercises and hands-on care to relieve your pain.

 

Fueling Your Workouts with Food:

Since you’re growing a new life, you’re going to need to eat back the calories you burn. First time you’re ever going to consider doing that, right?! 😉 In general, the first trimester you can eat for weight maintenance since you don’t need many more calories per day (baby is still itty bitty). During the second trimester you need approximately 300 extra calories/day. The third trimester, depending on your pre-pregnancy BMI and your current pregnancy weight gain, may vary and go up to as much as 500 extra calories/day. Mind you, it’s best to keep track of your weight and discuss these things at your OB check-ups, especially if you have a rapid weight gain or loss at any point during pregnancy. Lastly, if you’re an expectant mama of multiples, you will need even more! Eat up!

If you’re experiencing nausea, try to eat a light carb-based snack before you exercise. This may help ease the symptoms and will give you the necessary fuel to get moving.

If you’re exercising regularly at ANY point in pregnancy, make a note that you may need to talk to your doctor about getting additional iron through your diet so that you don’t develop full-blown anemia (very common in pregnancy).

Lastly, although carbs are probably the first good group on your pregnant brain, it’s still important to eat plenty of healthy fats and proteins. A great time for eating a healthy portion of protein is immediately following your workout.

 

Prenatal 2

Please don’t hesitate to ask me questions if you’re expecting or expecting to be expecting! No one should have to feel “in the dark” when it comes to pregnancy and exercise. You have a built in support system right here!

Yours in health and wellness,

Maggie

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Two Sources of Pain for Women

At some point in life, lots of women experience pain in their stomach, back, hips and/or knees. The sources of these pain points may feel elusive, but in many scenarios, there are two culprits to blame. I’m here today to help you identify whether you, or a woman you care about, has one of these conditions.

Q Angle

 PAIN SOURCE #1: LARGER Q-ANGLE

Women have wider hips than men. This is not surprising information. In some women, a wider pelvis results in a steeper angle between two landmarks: the ASIS and the patella.

The ASIS stands for Anterior Superior Iliac Spine. Don’t be intimidated – this is easier to identify on your body than it is to pronounce. Place your hands on your hips, like you’re standing with a little sass (thumbs pointing back and fingers forward). Feel where your middle and ring finger fall on the front of your hips. Slide your fingers slightly inwards and you will feel a bony part of your pelvis if you push into your flesh. You found it!

Next, place two fingers on your kneecap. You found the patella! So much easier. 

The Q-Angle is an angle measured between these two landmarks. It’s best done by a physical therapist or qualified fitness professional using a goniometer. Yuck, so many dull scientific words.

For a great visual, check out the illustration on this website: http://bit.ly/1CWkk4X (scroll down just a little on the page)

Why is this relevant to you? 

If you’ve experienced knee pain or instability, ACL issues, pain with running or jumping, and/or hip pain, then you may have a “large” Q-Angle. This doesn’t mean there is anything wrong with you, so don’t panic! It simply means that your kneecap tends to be pulled at a harsh angle, causing stress on the surrounding soft-tissue structures.

Although it’s super unfair that nature has made women more prone to knee pain than men, there are simple ways to ensure knee health. Here are a few:

1) Strengthen your quadriceps. Your quads are the large muscles on the front side of your thighs. These muscles are above the knee and help stabilize your kneecap’s movement. You can strengthen these muscles through controlled leg extensions, leg presses, and squats.

Leg Extension

2) Foam roll your IT bands. Your IT-bands are dense, connective tissue on the outside/lateral aspect of your thigh. Tight IT-bands can add tension and stress to the knee.  Since there is already a strong pull on your kneecap based on a large Q-Angle, it’s important not to add any unnecessary tension to the knee.

A foam roller is a cylinder made of densely packed foam. You can roll your body back and forth on the roam roller to relieve tension in any area. It’s like you’re a big ball of dough on a rolling pin! Not what a woman wants to imagine herself as, I know, but the analogy works!

If foam rolling hurts a lot, it’s a sign your connective tissue is really tense and needs this release. You can reduce discomfort by placing one leg in front of the other, distributing your body weight into the assisting leg.

Note: It’s really important that you don’t roll directly over joints. Ouch. 

3) Control knee stability during lower body exercises. If you watch yourself in a mirror, or even look down at your knees, while performing a lower body exercise, you may notice that your knees drift slightly inwards. When your knees drift towards one another, it creates stress on the joint capsule. Although this may improve with leg strengthening exercises, it may also be a factor of form.

You can increase your awareness by simply being mindful of your form. If you notice that your knees are drifting inwards, simply exert a little effort and move them wider. It doesn’t have to be excessive. It should feel more comfortable and will help you feel better balanced.

4) Strengthen your “outer thighs.” This may surprise you, but there aren’t any “outer thigh” muscles per say. When you perform exercises to target this area, you’re actually working muscles in the outer region of your hips/gluts. More specifically, muscles called your gluteus medius and gluteus minimus. 

A wider Q-Angle means that these muscles are pulled and elongated a bit more than usual, resulting in them being less stable and strong. Since knee health depends a lot on ankle and hip stability, it’s a good idea to strengthen these oft-forgotten muscles. You can do this through side lunges, lateral movements, lying side leg lifts, clams, and more.

 

PAIN SOURCE #2: DIASTASIS RECTI

Even if your baby-making years are far ahead or behind you, this is relevant information because it may impact you some day, or it may have taken place during pregnancy without your awareness. For women who plan to have children soon, or who are currently pregnant, listen even closer.

Diastasis Recti

We’ve all admired another person’s six-pack at some time or another, right? Well, imagine that the rippled six pack has an enormous split down the middle, separating and pulling the two halves away from one another so that the abdomen looks a little more like two three packs. This is what Diastasis Recti looks like. For a great visual, click here: http://bit.ly/1JQoYaS

Why does this happen?

When a woman gains weight with pregnancy and extra pressure is placed on the abdomen as it stretches, the core muscles are under great strain. The six-pack muscle naturally stretches with a growing uterus, but in the case of Diastasis Recti, the connective tissue that coats your core (the linea alba) gets stretched to a greater degree. The split can sometimes appear as a ridge in the abdomen and can be felt by placing fingers into the crevice. Diastasis Recti is usually diagnosed when the space is two finger widths.

What are the consequences?

Diastasis Recti can compromise a woman’s overall core strength, leading to secondary conditions that challenge overall health and wellbeing. Some women also experience a post-pregnancy “pooch” that they just can’t seem to get rid of because it isn’t a factor of weight loss. Diastasis Recti may present with multiple other conditions such as:

  • Back pain and instability
  • Compromising posture
  • Pelvic floor dysfunctions Hernia
  • Pelvic pain and instability
  • Gas and Digestive problems
  • Fecal incontinence (Constipation)
  • Pelvic floor dysfunction (SPFD)
  • Urinary incontinence
  • Pelvic organ prolapsed

One of our readers shares her personal experience…

When Jenna knew something was wrong:

“Sometime in the middle of my third trimester (while pregnant with my first child), I realized that I had Diastasis Recti. I was only aware of the condition because of my background in nursing school. The particular activity that made me aware of my abdominal separation was trying to sit up in bed (the wrong way). As my stretched-out abs attempted to engage, I saw what looked like a mountain ridge down the middle of my abdomen. This was a little frightening to see and though I was not experiencing pain, I could tell something was not right. When I mentioned this event to my caregiver, I received no concern and no education was given regarding how to protect myself when bearing weight or how to properly exercise my core post pregnancy.

Roughly two years later, I gave birth to my second child and suffered three tears. Even after my injuries healed, my pelvic pain lingered. It was noticeable with long periods of standing at my kitchen counter or when taking long walks outside. The pain was especially acute when I would sit up from a reclined position in bed after nursing my newborn for night-time feedings. I made an appointment to discuss the pain with my provider. She recommended pelvic physical therapy for my ‘pubic symphysis dysfunction.'”

How Jenna got better:

“I am so thankful that I took this recommendation! My pelvic PT taught me about the anatomy of the female pelvis and how childbirth impacts and often compromises core strength. I learned how to measure my diastasis recti and what exercises I could practice to help approximate the abdominal muscles. I learned how to protect my core by creating a “pelvic brace” for exercising and weight lifting. I also learned the proper posture for carrying my baby, how to get in and out of bed, and safe body mechanics for lifting my car seat.

Over a five week period, my pain significantly improved and was rarely noticeable! Only after a two week period of not exercising did my pain return (minimally). I discovered the reason for this is because I’m still breastfeeding my baby and this allows the relaxin hormone to linger, thereby creating instability at the pubic symphysis and also making it difficult to build muscle. While breastfeeding, maintaining my core stability means that I have to exercise regularly (4-5 times a week) and practice Kegel exercises daily. If I can commit to these practices, I remain pain free!”

Thank you, Jenna, a million times over for sharing this personal journey!!! It takes a lot of courage to share it and no doubt other women will benefit from hearing it. 

How do I exercise to prevent or correct Diastasis Recti?

If you believe that you have diastasis recti, then I suggest you work with a reputable physical therapist for at least a few sessions, to get on the right track. As mentioned in the former testimonial, it’s important to learn proper biomechanics for sitting up in bed, lifting heavy objects, and bracing your core during exercises. A great place to start is by checking these exercises, performed by my lovely former colleague, Alison, and presented by my wonderful friend and former PT Cari: http://www.releasept.com/videos/low-back-core/ (The first nine videos work on core bracing in a gentle, but effective, way.)

Jenna’s PT, Stephanie Fournier, has also been extremely generous with her time, and has offered us some answers to important questions about this condition. See her interview below.

 

INTERVIEW WITH WOMEN’S HEALTH CLINICAL SPECIALIST

Maternal Health

1) How many women do you encounter postpartum who have severe pelvic and core instability, and/or a diagnosable condition?

First, I would define severe pelvic and core instability as any pain or dysfunction in the postpartum period that is affecting activities of daily living. This could include severe pain, restriction in activities, avoidance of activities, or slowing a woman down in her normal activities. That being said, the exact number is hard to quantify since I treat in an outpatient clinic where I am only going to encounter those women who do have problems (core instability and/or pain) and who are coming to me via doctor or self-referral. However, I do believe that pain and dysfunction in the postpartum period go largely under diagnosed. What I hear most often from patients is that they tried to talk to a friend, family member, or healthcare provider about their pain/instability/limitation and they are told things such as, “That is normal, you just had a baby,”… “It will get better after the pregnancy,”… “You just have to live with it.”

Some research numbers to reflect on:

  • Incidence of lower back pain and pelvic girdle pain (PGP) in pregnancy range from 68.5% to 76% in prospective studies (Wang, 2004; Kristiansson, 1996; Ostgaard, 1991). And the incidence of PGP alone in pregnancy was 20%, in one prospective ,study (Vleeming, 2008). Why the discrepancy? Most likely pain is under reported.
  • 70% of women experience some sort of lower back or pelvic pain during pregnancy.
  • 1/3 of women report severe limitations in activities of daily living as a result of back and pelvic pain (Ostgaard, 1991). The risk for back pain increases postpartum (Ostgaard, 1997).
  • Most importantly, women having back and pelvic pain are 3x as likely to have postpartum depressive symptoms than those without pain (Gutke, 2007).

2) How do most women identify that they have Diastasis Recti? What tips do you have for identifying it as early as possible?

Most women that I see in the clinic do not realize that they have a diastasis recti (DrA). Often, they are coming to me for pelvic pain (posterior pelvic girdle pain, pubic symphysis dysfunction, lateral hip pain, or abdominal pain) and it is something that we find during our evaluation. They might have noticed a tent or pooch in their abdominal area with sits ups, supine to sit (getting in and out of bed) but didn’t exactly know what it meant. For identifying early on, women can measure themselves with their fingers or a tape measure or just look at their tummy when they are rolling in bed or sitting up in bed.

To measure; the patient starts in supine with their knees flexed. They can place their fingers horizontally in the umbilicus and raise their head up. They are measuring how many fingers they can place inside the gap in the rectus abdominis. [It should be noted that this finger method is highly unreliable and it is better to use a tape measure, however the tape measure is hard to do on yourself]

Some more research numbers to be aware of:

  • 66% of women develop a DrA by their 3rd trimester.
  • 39% of women have a significant DrA several years after delivery. Significant is defined as separation of 2.5cm or more (Ranney, 1990).
  • More than 50% of women presenting for urogynecological examination presented with a DrA. These are postmenopausal women. Likely, the DrA developed during the child bearing years and never fully resolved postpartum, leading to poor core stability and pelvic organ prolapse (Spitznagle, 2007) .
  • DrA is associated with varying degrees of stress urinary incontinence, fecal incontinence, and pelvic organ prolapse (Spitznagle, 2007). This is why treating DrA early on in the postpartum period is so important to me. We could potentially be helping women to avoid major symptoms and even surgery.

Also, Parker (2008) found that women with DrA tend to have higher degrees of pelvic or abdominal pain.

3) How soon after pregnancy can women start working their core muscles again? How do you suggest they start?

I recommend that women return to activity postpartum as they feel comfortable. However, I do have a few recommendations for those women who do have a DrA [separation of 2.5cm or more at the umbilicus, 4.5cm superior to the umbilicus, and 4.5cm inferior to the umbilicus].

  • Avoid obliques, regular crunches/situps, and planks until the DrA is reduced to 2.5cm or less OR the woman can affectively activate a co contraction (transverse abdominis + pelvic floor muscle contraction)
  • When treating a DrA, I start with initiation of TrA (transverse abdominis) which they can start day one postpartum with or without a c-section
  • Progress to DrA curlup (Neville, 2008)
  • Various TrA stabilization activities or progressions, depending on the individual
  • Consider corset or elastic binder per the individual
  • Avoid bearing down (valsalva) and sitting straight up (in bed/jack-knife)
  • As always, ensure proper pelvic floor muscle activation (including power, endurance, and coordination)

Thank you, Stephanie, for sharing your wisdom and expertise! You went above and beyond!

If you have any questions about this content and/or exercises to improve your health, then please don’t hesitate to reach out! Upon request, I’m happy to share the medical studies that Stephanie referenced too.

Being a woman can be tough stuff, but there’s no reason why we can’t feel amazing and pain free!

Yours in health and wellness,

Maggie

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References:

https://www.abdominalconnections.com/diastasis-recti/

http://gregnuckols.com/2013/07/17/do-women-need-to-train-any-differently/

http://www.webmd.com/baby/guide/abdominal-separation-diastasis-recti