All About Physical Therapy: Obstetrics (Pregnancy and Exercise)

Muscles of the trunk (Photo credit: Wikipedia)

Exercise and Pregnancy

Regular exercise at the right intensity is an essential way of helping your body cope with the increased physical demands on your joints, muscles, heart and lungs during pregnancy. A recommended exercise, adequate diet, proper hydration, appropriate clothing, and optimal environment during exercise must be considered to obtain the best result.

I. Physiologic Changes during Pregnancy:

Pregnancy weight gain
Abdominal muscles are stretched and weakened
Increased deep of respiration; hyperventilation and dyspnea during late pregnancy
Increased tidal volume and increased minute ventilation
Increased oxygen consumption per minute (15-20%)
Ligamentous laxity secondary to hormonal changes - hypermobile joints
Frequent urination due to pressure in bladder
Stress incontinence due to pelvic floor dysfunction
Increased blood volume (40-50%); increased heart rate and cardiac output; decrease BP due to venous distensibility
Increased basal metabolic rate and increased heat production
Anemia may occur
May develop hypotension in supine position during late pregnancy from pressure on the inferior vena cava.

II. Postural Changes during Pregnancy:

Kyphosis with scapular protraction
Increased cervical lordosis
Forward head posture

III. Balance Changes during Pregnancy:

Changes in center of gravity -shift forward and upward
Wider base of support in standing

IV. Pathologies:

A. Diastasis Recti (Abdominal Separation)
A separation of the rectus abdominis muscles along the linea alba very common among pregnant women. Also common to newborn babies secondary to incomplete development and usually resolved without intervention. Men can possibly get it from weight cycling, doing wrong sit-ups or weightlifting, or from other causes.

Causes:
Exact cause in unknown. Pregnant women may have the condition because of increased tension on the abdominal wall. Multiple births or many pregnancies have higher risk.

Symptoms:
It looks like a ridge running down the midline of the abdomen, anywhere from the xiphoid process to the umbilicus and more prominent with muscle straining. Most easily seen when the baby tries to sit up. The top of the pregnant uterus is often seen bulging out of the abdominal wall in the late pregnancy. A trace of the unborn baby may be seen in some severe cases.

Testing:

Patient in hook lying position.
Place your fingers (palm facing you) just above your belly button.
Lift your head and neck very slightly off the floor and press down with your fingertips.
A gap felt greater than the width of two fingers indicates diastasis.
A diastasis recti gap is measured in the width of fingers.

Avoid :

Be careful with crunches, sit-ups, oblique (twists) combined with crunches that will strain your abdominal muscles.
Constipation and lifting heavy things.

Treatment:

No treatment is necessary for women while they are still pregnant.
Education in the causes of diastasis recti and on the inappropriate abdominal exercises to avoid.
Postpartum abdominal binding may be helpful in some cases because can help with awareness of the abs and for lower back support.
Perform deep abdominal exercises targeted to help narrow the separation between the muscles.
Observe body mechanics
Postural Awareness
Maternity Belly Band

B. Pelvic Floor Weakness

Pelvic floor muscles are muscular bottom part of the abdomen which are attached and span to the bottom of the pelvis. These muscles function to support pelvic floor organs, aid in sexual performance (orgasm), gives us control over the bladder and bowel, stabilize connecting joints, and act as a venous and lymphatic pump for the pelvis.They come under great strain in pregnancy and childbirth. Being pregnant and giving birth, these muscles of your pelvic can become overstretched and weak as early as 12 weeks into your pregnancy.

Effects of Weak Muscles:

As a result of weak pelvic floor muscles, the internal organs are not fully supported leading to difficulty controlling the release of urine, feces, or flatus (wind). It is quite common that you may accidentally leak a little urine when you coughing, sneeze, or exercise (stress incontinence) and it can continue after pregnancy. Constipation is common in pregnancy and adds more strain on your pelvic floor. Another thing, weak vaginal muscles may put your uterus, bowel or bladder to slip forward or down against the walls of your vagina (prolapse) making sex less satisfying, and feel less sensitivity in your vagina.

Pelvic Floor Exercise:

Strengthen the muscles of the pelvic floor helps to reduce or avoid stress incontinence even if you’re young and not experiencing from stress incontinence.A few daily pelvic floor exercises will help to treat bladder weakness or prolapse symptoms. Encourage strengthening of the muscle after each baby as muscles tend to weaken with age and will help to prevent problems later on. Keep your pelvic floor strong for the rest of your life since hormonal changes after the menopause worsen incontinence.

Kegels Exercise

Start with an empty bladder before you begin.

The way to check if you are doing it right is by inserting a clean finger into your vagina and try to squeeze the muscles surrounding it. If you feel pressure around your finger, then that's it.

Begin by contracting these muscles for 5-10 seconds, then relax, repeating 10-20 times. Do this at least three times a day.

It is perform without pulling in your tummy, squeezing your legs together, tightening your buttocks, or holding your breath.

V. Benefits of Exercise during Pregnancy

Support the extra weight of pregnancy.
Promote healing in incision area due to increase blood circulation
A more satisfying sex life
It can help reduce back pain, improve or maintain muscle tone, reduce leg cramps, swelling and constipation, and improve sleep patterns
often feel better about themselves and their changing body during pregnancy.
less likely to experience fatigue due to improved sleep pattern, are less anxious and experience reduced pain perception and neuromuscular tension.

VI. Postural Education during Pregnancy

Stand tall, with your abdominal muscles gently drawn in and your shoulders back, and gently drop your chin.
Watch and maintain a correct posture regularly during the day.

VII. Ideal exercises or activities during pregnancy (No complications)

Light stretching
Walking
Golfing
Low impact aerobics
Water aerobics
Pregnancy exercise classes
Stationary cycling
Swimming (freestyle not breaststroke)
Light weight training

VIII. Exercises activities to avoid during pregnancy

Skiing/Water skiing
Lifting heavy weights
High impact or jerky movements
Contact sports
Scuba diving
Excessive twisting and turning activities - Skating
Prolonged bouncing activities - Horseback riding
Any activities or exercises that cause pain or numbness, stop it immediately or advise the instructor if you are in a class.
Exercises that require you to hold your breath or shortness of breath.
Prolonged standing static exercises.
Exercises that involving sudden changes in direction.
Activities or exercise involving sudden changes in intensity.
Exercises that increase the curve in your lower back.
Avoid exercise in the supine position after the first trimester.
Stop exercising when fatigued and not exercise to exhaustion.