Pregnancy & Physical Therapy pt. 2

In part 1 of Pregnancy and Physical Therapy I discussed why pregnancy can be so taxing on the musculoskeletal as well as some common orthopedic problems experienced by pregnant women: Low back pain, sacroiliac pain, pubic symphysis pain, foot and ankle pain, rib cage pain, and carpal tunnel syndrome just to name a few! If you haven’t read part 1 yet, I highly recommend going back and checking it out first!

Part 2: What Can Be Done About All of This?

1. Physical Therapy

    • a. Use of traditional modalities such as ultrasound, laser, and electrical stimulation may be limited; however, exercise guided by a licensed physical therapist and gentle massage performed by a licensed physical therapist or massage therapist can be very beneficial.

i. The American Pregnancy Association indicates that while it is imperative to find a practitioner certified in prenatal massage, with a properly licensed individual, prenatal massage can be extremely beneficial:

“Studies indicate that massage therapy performed during pregnancy can reduce anxiety, decrease symptoms of depression, relieve muscle aches and joint pains, and improve labor outcomes and newborn health. Massage therapy addresses different needs through varying techniques, one of which is called Swedish Massage.”

    • b. The benefits of exercising while pregnant are endless. There are a number of safe exercises that can be performed during pregnancy to help reduce back pain as well as the other orthopedic aches and pains discussed in part 1 of this blog. These exercises (described below) are safest when monitored by a physical therapist (especially when you’re first getting started) to ensure proper performance, application, and safety.

“If you are healthy and your pregnancy is normal, it is safe to continue or start most types of exercise, but you may need to make a few changes. Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery. However, it is important to discuss exercise with your obstetrician or other member of your health care team during your early prenatal visits. If your health care professional gives you the OK to exercise, you can decide together on an exercise routine that fits your needs and is safe during pregnancy….Some women are nervous to exercise during the pregnancy, but it is very safe. According to the American College of Obstetricians and Gynecologists (ACOG), it is suggested that women should exercise 3-4 times per week for 15 minutes at a time, at a heart rate of 140 beats per minute. Exercise includes walking, yoga, swimming, and pelvic floor/core exercises.”

2. At Home Excercises

  • a. Always consult with your physician before beginning any exercise routine
  • b. According to the American Pregnancy Association, as long as it has been cleared by your medical provider: “The important thing is to be active and get your blood flowing.”
  • c. See this page from the American Pregnancy Association for “do’s and don’ts” of exercise while pregnant.
  • d. Walking, stationary biking, and swimming can all be safe cardiovascular exercise during pregnancy.
  • e. According to Therapeutic Associates Physical therapy:
    “…most important are stabilization exercises, which include the core and pelvic floor muscles that help to stabilize the pelvis and lower back during movement.”
  • f. If you’ve consulted with your physician / OB GYN and your physical therapist, a few specific exercises that may be appropriate for helping with low back stabilization are as follows:

    i. Bird Dog:

    Start on all 4’s. Stabilize your back by gently engaging your core. Slowly slide one arm away from your base while simultaneously sliding the opposite side leg away. Only go as far away from your midline as you are able to stabilize. Bring arm and leg back into below your trunk, and repeat on the other side. **Remember to breathe slowly in and out for the duration of the movement.

    ii.Side Lying Clam Shells:

    Start lying on your side. Gently engage core. Gently press your heels
    together and raise top leg without letting your trunk roll backwards. To make this exercise harder try adding a band around your knees. Repeat on both sides. **Remember to breathe slowly in and out for the duration of the movement.

    iii. Unweighted Squats:

    Squats are excellent for working all of the muscles in your hips. According to AmericanPregnancy.org maintaining mobility for a squat throughout pregnancy can help prepare your body for childbirth. Check out this great post on some safe variations of squats for pregnant women. Start with feet about hip distance apart and feet slightly turned out. Try not to lean forward as you sink towards the floor. Only go as far as you feel comfortable. Hold onto sink or counter for safety as needed; remember, your body may feel slightly more off balance as you grow! **Remember to breathe slowly in and out for the duration of the movement. Check out this post for tips on safe Squats in every trimester.

    iv. Upper Body Elevated Bridges:

    After the first trimester it is important to avoid laying flat on your back. An elevated bridge can help you avoid this potentially dangerous positioning. Bridges are excellent at activating and strengthening the glutes. Carefully position your upper body on a physioball while sitting on the ground. It may be helpful to start with the ball against a corner or a wall for safety. Alternatively, have a friend stabilize the ball for you. Bring your heels close towards your glutes, and engage glutes as you lift your hips towards the ceiling. Give your glutes a squeeze at the top and slowly lower back down towards the ground. You do not need to touch the ground every time, but keep the range of motion in the middle for the duration of the set. Make sure not to go too high to avoid possible strain of low back. If you feel secure on the ball, place your hands behind head to protect your neck from feeling strained. Remember to breathe slowly in and out for the duration of the movement.

    v. Standing “Super Glute”:

    Super Glute is a great exercise for hitting all three of the gluteal muscles. Start by standing on one leg. Keeping core gently engaged, move one leg in front of you. Slowly make a semi-circle around your body with your leg without letting your torso tip forward. Hold on to a sink or counter for safety especially in 2nd & 3rd trimesters when your center of gravity starts to change. 2. For additional challenge, put a light theraband around your ankles. 3. **Remember to breathe slowly in and out for the duration of the movement. Bridges are excellent at activating and strengthening the glutes. Carefully position your upper body on a physioball while sitting on the ground. It may be helpful to start with the ball against a corner or a wall for safety. Alternatively, have a friend stabilize the ball for you. Bring your heels close towards your glutes, and engage glutes as you lift your hips towards the ceiling. Give your glutes a squeeze at the top and slowly lower back down towards the ground. You do not need to touch the ground every time, but keep the range of motion in the middle for the duration of the set. Tip: Make sure not to go too high to avoid possible strain of low back. If you feel secure on the ball, place your hands behind head to protect your neck from feeling strained. **Remember to breathe slowly in and out for the duration of the
    movement.

  • g. For more “at home” exercises while pregnant check out this great YouTube video by health coach Alessandra Scutnik who gives a fantastic explanation of how and why to maintain normal breathing throughout these exercises.

    i.Tip: Remember, it may not be safe to lay on your back after the first trimester. Always consult with your doctor before beginning any exercise program.

  • h. There are of course some exercises that are unsafe to perform while pregnant. According to WhatToExpect.com, these include but are not limited to:

    i. Exercise in which there is a high risk of falling or being struck in the abdomen (this includes contact sports)
    ii. Exercises while lying flat on your back (especially after 2nd and 3rd trimesters)
    iii. Exercises in which there are drastic altitude or temperature changes
    iv. Back bends or other contortions
    v. Jumping, jerking, hopping, or other dynamic plyometric movements vi. Exercises in which you may be holding your breath
    vii. Motionless exercise

3. Prenatal Yoga

  • a. According to the American Pregnancy Association, “Prenatal yoga focuses on poses for pregnant women, in order to increase strength and flexibility. It also helps pregnant women to develop proper breathing and relaxation techniques for easier and more comfortable labor.” “Remember to moderate your yoga routine to about 30 minutes and to never push yourself. Yoga is a means to relax, so there is no reason to push yourself, which isn’t safe or healthy for an expecting mother. While there are many benefits to yoga, it is important to remember that not all yoga is safe for pregnant women. Yoga, such as Bikram, and other practices of yoga that require a hot environment, are not safe for the expecting mother. Doing those hot forms of yoga can cause hyperthermia.”
  • b. Check out this post from WhatToExpect.com to read about the differences between prenatal yoga and regular yoga as well as what you can expect from your first prenatal yoga class.

4. Water Exercise
If you have access to a pool, certain pool exercise can be a great way to safely work resistance exercise without the strain of using weights while pregnant. Water exercise (including swimming) can have myriad of positive effects from reduced swelling to overall reduced strain on joints. It is imperative to avoid hot water > 104° F as this can increase risk for miscarriage especially in the first 4-6 weeks. Check out this post from TodaysParent.com for 10 safe moves to try in the water while pregnant.

5. Indoor, Stationary Cycling
While outdoor cycling may be unsafe due to risk of falling or other accidents, indoor cycling can be a good and safe exercise for a pregnant woman.
According to the American Pregnancy Association:
“The best thing about biking is that the bike supports your weight, so there is less stress on your body. A stationary bike is great exercise because there is a low risk of falling. As you grow, your center of gravity is shifting so you are at an increased risk of falling. As your abdomen grows, it can put a lot of stress on your back. Start slowly and do not overexert yourself.”

Summary

There are myriad safe exercises that can be performed by pregnant women. One should be cleared by her OB GYN before beginning any exercise program; however, most exercise programs are safe to continue if they were performed prior to pregnancy, although it may be necessary to make modifications and / or lower intensity. A licensed physical therapist can help a pregnant woman get started safely on a gentle exercise program which can ultimately help reduce musculoskeletal pain; especially pain brought on by physical bodily changes from pregnancy. Massage, yoga, breathing exercises, gentle resistance exercises, water exercise, and indoor stationary bicycling can all be be safe options for pregnant women.

For more information or to receive expert physical therapy while pregnant, give us a call!

Written by: Jillian Chiappisi PT, DPT, SCS

Posted in: physical therapy

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