by Nicole Dority, DPT, MSPT, OCS
We need to start to discuss overall fitness and the ways our bodies change and alter during pregnancy. Pregnancy affects absolutely every system of the body. We have to remember this when trying to get out there and exercise when we are pregnant. It is important to continue moving and using our body during pregnancy is good for mental health, physical health and postpartum health. But, finding the exact balance of where the body is optimized is key and totally individual.
a. Posture (generalized): During pregnancy, we have an increase in the lumbar curve to counterbalance the weight of the baby. In turn, we will have an increase in the anterior pelvic tilt to accommodate the pregnancy. In turn, women will tend to widen their base of support to improve their stability. This affects the hip girdle and affect the foot, ankle and knee. This can, in turn, affect the entire body during athletics.
b. Feet: As discussed above, the wider base of support can affect the foot and ankle. The increased ligamentous laxity can also affect the feet and cause more issues of the plantar fascia and cause the feet to widen and spread. This spreading can increase the pressure on the nerves of the feet and might increase the risk of morton’s neuroma. Wearing good arch support during exercise is a good idea to complement the increased laxity of the feet.
c. Knees: Due to the increased ligamentous laxity, the knees may hyperextend more readily during pregnancy. As a result, reduced stability can occur which will, in turn, cause more sheering at the knee and potentially more knee pain. Being aware of this during exercise is essential, and maintaining leg strength is definitively indicated.
d. Hip: The hip girdle can be affected by increased laxity over time due to the increased joint play within the joint. This interplay between the laxity of the hip (either anterior hip capsule or anterior/posterior) can create increased sheer load to the sacroiliac joint and lumbar spine of that side. Being aware of muscle activation patterns in exercise, sitting postures and awareness can help improve this type of dysfunction.
e. Lumbopelvic Region/Pubic Region: The SIJ and lumbosacral complex can be the most affected by pregnancy. This area can start to get a lot of sheer and torque loads due to the weight of the baby, the changes in increased extension of the spine and increased torque due to the changes in body habitus. Engaging the abdominal wall gently, addressing slight activation of the pelvic floor with exercise and reducing the tension in the lumbar spine can help to reduce these loads. SI belts or pelvic stability belts can also offer support.
f. Thoracic Spine (and “Baby Back”)/Shoulder Girdle: Being aware of significant rotational activities, bracing self when you have a cold and have to sneeze or cough acutely and engaging the core can all help reduce the loads to the thoracic spine. The concept of baby back starts once the baby starts to take shape due to the way the body counterbalances the weight of the body and goes into a pelvic tilt. Working to neutralize the spine can help reduce the loads that are placed on the thoracic spine. Sleeping with support under the abdomen can be very helpful as well. Maintaining an active core during exercise can help counter this as well as some engagement of the muscles between the shoulder blades to maintain stability. This area may get more rounded just to accommodate all the other changes in the body.
g. Cervical Spine: Some people will fall into a forward head posture in pregnancy due to the changes alignment from lower in the spine. To counter and increased thoracic curve (kyphosis), some girls will start to bring their heads forward to find their center of gravity. Due to the increased ligamentous laxity, this can cause to some serious neck pain and potentially headaches. It can also cause more sheer to the thoracic spine. Being more aware of the core can help, as well as working on excellent head and neck posture with movement.
h. Elbows: Due to the laxity, pregnancy can cause an increased amount of laxity in the elbows which can put more pressure in the hands. This must be considered when clients are engaging in fitness activities such as planks, push-ups, all fours, and many yoga poses. Being mindful of keeping a micro-bend in the elbows is essential to keep the elbow safe.
i. Wrist and Hands: Pregnant women are at increased risk of carpal tunnel and ulnar tunnel issues due to the increased in blood volume, swelling, and laxity of the ligaments. It is a real issue that must be managed quickly. Any exercise that exacerbates symptoms should be addressed and figured out to reduce the load to the tissue. And, the laxity in the wrists should be managed well and intrinsics of the hands must be addressed.
j. PELVIC FLOOR!!!! We must address the pelvic floor and ensure continued activation to provide nice support to the baby and increased growth of the fetus and amniotic fluid/placenta. Maintaining the strength and balance of these muscles are important during sports.
We also have to consider the visceral (organ) changes in the body. These include (but are not limited to):
a. Increase in blood volume due to the sheer nature of pregnancy. This just increases the amount of fluid in the body and can affect things like varicose veins, swelling in the hands and feet.
b. Reduced lung volume due to the increased volume that the baby can take up on the abdomen. People can describe episodes of shortness of breath during pregnancy or an inability to get a full breath in during pregnancy.
c. Stomach and esophageal challenges due to pressure from the abdomen as well as increased ligamentous laxity of the tissues and the sphincters.
d. Separation of the abdominal wall and the effect on the abdominal visceral cavity
e. Collagen and connective tissue: As we have stated, collagen and connective tissue become laxer during pregnancy. We must address this and provide external support as needed. This may be to accommodate even during exercise episodes to help keep the person more stable.
When we consider all of these changes, we must also consider the amount of change our tissue has to manage through sports and fitness while we are pregnant. Keeping your rate of perceived exertion low, not increasing your blood pressure greater than 120 bpms, maintaining a low core temperature, and being conservative is a great plan during our pregnancy. Regular exercise (unless your provider says the opposite) is an excellent way to keep you healthy during your pregnancy. Remembering to stay away from all activities that are ill-advised is key. Avoiding activities that can cause trauma to you or your baby is a good rule of thumb, per my previous blog post on exercise and pregnancy.
Be mindful, and if you don’t know the answer, ask the question. Take care of you, your body, and your baby! Congrats to you and your growing family!
Nicole received her BS in pre-PT/Biochemistry from the University of Miami in 1996. She then served as an officer in the US Army in the Medical Service Corps. In 2000, she moved to Colorado to study PT and received her Master & Doctorate in Physical Therapy in Denver. She is board certified in orthopedics, women’s health, and is certified in TPDN. She is a certified neuromuscular massage therapist & Polestar Pilates Rehab Professional and integrates both disciplines in her PT practice. She has also received advanced clinical practitioner education through Washington University (Sahrmann-based movement systems analysis) and women’s health education through the Herman & Wallace Institute. Nicole is very involved in teacher training and education of both Pilates & Yoga. She specializes in treating pelvic pain, incontinence issues, women’s & men’s health, lower back pain & sacroiliac dysfunction, pregnancy & pregnancy-related issues, postpartum & orthopedic care.