Pregnancy & prenatal physiotherapy care

As a pregnancy progresses it is obvious that the body has to adapt, so as to accommodate a baby’s development within the womb. These changes bring with them challenges, but with careful planning it is possible to continue a physically active lifestyle through to full term. Just like any changes in life, adapting to them will take time and effort. Education concerning the musculoskeletal changes that are about to happen is the first step.

Musculoskeletal changes during pregnancy

Externally, weight gain is the most evident change in a woman’s body, and can be anywhere from twenty to forty pounds. Internally though there is even greater change, as the uterus expands from the size of a pear to a watermelon. This growth causes the uterus’ orientation to move nearer the front of the body, with the centre of gravity adjusting in the opposite direction over the pelvis.

Although this shift is a natural response to assist the body from falling, the expansion of the uterus can also see the centre of gravity move higher, and this can effect the body’s stability. Also with excess weight already causing strain on the body, this shift upwards can further strain ligaments and muscles that support the spine, potentially causing back pain and an exaggerated lumbar curve.

As excess weight increases during pregnanacy, the effects of gravity will see the circulation of blood and body fluids slow down. This results in a retention of fluid and the swelling of the legs, feet and hands, with the latter also being susceptible to carpel tunnel syndrome. Pregnancy also increases hormone levels, that although essential, create a loosening of the ligaments and joints throughout the body. Add to this the effects all of this has on the pelvic floor and it is no wonder that even the most committed athlete would be unwise to attempt or tolerate pre pregnancy levels of exercise.

Exercise to compliment pregnancy

This is where adaptation plays its role, so that exercise can be used to compliment pregnancy and assist in post pregnancy health, with the view of returning to a pre pregnancy level of exercise. Physiotherapy advice as to what exercises should be considered can help, as care should be taken when choosing what exercises to perform. These exercises will take into account the stage of pregnancy, as this will determine the range of movement and the amount of stress placed on the lower back, along with other areas of the body.

In general terms low impact exercise will provide the best protection to joints. Swimming, cycling on a stationary bike and brisk walking are all gentle and safe exercises. In particular aqua natal classes are ideal during pregnancy, as the buoyancy of water supports the body as it grows, reducing the risk of injury, whilst being able to performing exercises that combine both strength and aerobics. Exercising in water will also help keep the body cool, and this is important as an increase in body temperature of 38.3 celsius or higher can be of concern. Consequently hot water above 28-30 degrees, including spas and sauna, should be avoided.

Yoga and Clinical Pilates are also great for strengthening the body, provided that they are run by an instructor qualified in teaching pregnant women.

Whatever you choose, a variety of these exercises for 30 minutes a day for most days of the week, will place you in good stead. The exercise duration can be broken up depending on your fitness level and the stage of pregnancy, so you may opt for three sessions of ten minutes, spread throughout the day. Regardless of what exercise and duration you choose it is important to listen to your body and rest if needed.

During exercise it is important not to over exert yourself. Although you may be used to judging your effort with a heart rate monitor, a simpler rule for the ideal level of intensity, is that you should be able to hold a normal conversation whilst exercising.

If you experience any pain throughout exercise, dizziness, shortness of breath, have difficulty walking or any other changes that may cause alarm, then it is best to consult your doctor and physiotherapist to reassess what exercise you should be doing. There are also many many medical conditions and variables in pregnancy that may mean exercise is not advisable, but once again consultation with your doctor and physiotherapist will keep you informed as to your options.

Further physiotherapy assistance during pregnancy

A physiotherapist will also be able to help assist you with pelvic floor strengthening that can provide greater stability and support whilst performing your exercises. As the pregnancy progresses this strength will become more important, even for the carrying out of daily tasks.

Being able to confidently contract the pelvic floor muscles may take some time, so it is best to start early and check with your physiotherapist that your are performing the exercise correctly. Weak pelvic floor or not, it is best to avoid any activities that involve twisting, such as vacuuming, and ensure that you sit evenly and not cross legged. To further protect your pelvic floor, when going to the toilet place your feet on a box, lean forward, keep your tummy relaxed and avoid straining.

When awake and standing it is important for your pelvis to have the strength and stability to support the growing weight of the pregnancy, and to ensure good posture, gait and spinal alignment. A strong pelvic floor and exercise will help this along with your overall body strength and stability. Further to this a physiotherapist can advise on how to achieve correct posture and advise what can be used to compliment your postural strength and stability. For example compression is a brilliant way to reduce strain on the lower back and to help support the growing belly. Maternity shape wear can be worn underneath clothing, just ensure that it covers the entire belly, with the seam just below the bra line. As it is worn against the skin make sure you buy a breathable material, that is smooth and does not effect circulation through bunching. It is also important to take off the compression before going to bed.

Your body also needs care whilst asleep, so it is important to keep your pelvic bones aligned, as this will ease the pressure placed on the pelvis and back. You can achieve this by placing a pillow between the legs, as this will assist in keeping your knees and hips in a good position. Pillows or soft cushions can also be placed under your belly, or you can choose from a variety of purpose made, pregnancy pillows. Also consider how you get in and out of bed, as rolling on you side with you knees together is best, and then using your arms to push yourself up or lower yourself down, as you swing your legs on or off the bed.

In general, your body will thank you for maintaining symmetry throughout child bearing. Simple things such as standing with your weight evenly through both legs, with a straight back, will pay off in the long run. So too will a well organised exercise routine. Add to this a healthy diet with some serious relaxation time, and the days ahead will hopefully be smooth sailing for the both of you.