At Hudson Valley Physical Therapy, we aim to provide the highest level of personalized care for our patients. In order to meet that objective, it is our job to stay up to date with the research out there. Our patients rock at Hudson Valley Physical Therapy because they are motivated and want to learn more. I’ll periodically bring you the latest and greatest research summarized and broken down.
The literature I chose to share comes from the British Journal of Sports Medicine. Bø K et. al spent a few years compiling research on pregnancy and exercise. The paper published “Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women” takes years of research and bundles it into specific guidelines for women during and after pregnancy. At Hudson Valley Physical Therapy, we treat a large number of post-partum moms and pregnant females. I have found that many of our patients have led an active life and aren’t sure how that lifestyle fits in during and after pregnancy.
And just to be clear: these guidelines are put into place for healthy/ uncomplicated pregnancies. Safety is priority. Always consult with your OBGYN for a proper screening especially if you are an elite or high level athlete and plan to continue training at an advanced level or have a complex medical history.
If you experience any of the warning signs below, put exercise on hold and pay a visit to your doctor
- vaginal bleeding
- regular painful contractions
- amniotic fluid leakage
- Shortness of breath prior to exertion
- chest pain
- muscle weakness
- calf pain or swelling
Recommendations for pregnant individuals aren’t all too different from guidelines for the general population, but moms to be must make some modifications. When you’re growing a person, more than just the obvious anatomical changes take place. Keep in mind that altered blood flow, metabolism, pulmonary system, and new hormones will play a role in exercise response.
If you’ve been to a prenatal yoga class, you’ve surely noticed that the instructor keeps everyone off their backs. Growing baby can compress some major blood vessels and decrease blood flow and cause dizziness upon standing. Modify and perform exercise in side-lying, sitting at an angle, or in standing.
Now most of us living in the tri-state area aren’t doing too much high altitude training, but pregnancy would not be the time to do some burpees on a mountain top while vacationing in Denver. High altitudes result in decreased oxygen availability for mom and baby. Furthermore, any sports with direct trauma risks should be avoided. Maybe it’s your dream to compete in extreme winter sports, but this may be the year to put dreams of ski jumping on hold.
When it comes to strength training, precautions should be taken to ensure optimal lifting mechanics and that the valsalva maneuver be avoided. The valsalva maneuver is breath holding with exertion. As pelvic floor therapists, we hate the valsalva because it puts a ton of pressure on the pelvic floor, and when you’re pregnant, the pelvic floor is already has enough work to do. Bø et. al recommends contracting the pelvic floor prior to lifting to avoid excess strain. Pelvic floor training also has added benefit down the line during the delivery process by reducing the length of labor and post baby by reducing the risk of incontinence. And that is where a pelvic health specialist comes in. Your pelvic floor physical therapist can teach you how to activate your pelvic floor and apply that training in situations like weight lifting.
If you experienced a stress fracture in your foot, there’s no way you’re heading out for a 10 mile run the day you take the boot off. Return to exercise postpartum should be treated with the same mentality. Think like you’re coming back from an athletic injury.
The progression back to exercise can be split into three segments
Return to participation: reintroduction to exercise but at a lower level than before pregnancy
Return to “sport”: return to pre-pregnancy exercise regimen but maybe at a lower performance level than before baby
Return to performance: return to physical activity and exceeding pre-pregnancy levels of performance
Light endurance training like walking that does not stress the pelvic floor excessively can be initiated soon after delivery. Women who trained at a moderate level can expect their VO2 max (aerobic endurance) to return to pre-pregnancy or better levels after delivery.
Strength training post pregnancy should incorporate pelvic floor training. When lifting, a pelvic floor muscle contraction should be performed with an exhale to counteract increased intra-abdominal pressure. Strengthening should focus on the core and back. Strength is a must to avoid the aches and pains that can accompany all the lifting of baby and equipment.
Exercise when breastfeeding is safe. For comfort purposes, nursing moms may prefer to exercise following feeding. A fitted and more supportive sports bra may be more comfortable to accommodate to increased breast size and weight.. A more supportive bra could help mitigate potential back pain.
Bø et. al goes a step above exercise recommendations and addresses common postpartum conditions. They recommend physical therapy to address pelvic floor dysfunction, low back and pelvic girdle pain, diastasis recti, and pelvic pain. In addition, postpartum moms who resume exercise shortly after birth should give themselves a bit of a break and expect to be at their pre-pregnancy weight after 6 months. (That being said, everyone’s body operates a little bit differently so if it takes a little longer that’s okay too!)
For more information you can read for yourself (citation listed below). Whether you’re an expecting mother or new mom, we can address conditions related to pregnancy and childbirth and assist you in continuing or resuming exercise. At Hudson Valley Physical Therapy we specialize in a variety of conditions including but not limited to urinary and fecal incontinence, diastasis recti, pelvic organ prolapse, pelvic pain, hip and low back pain, and cesarean scar pain.
Megan Fosko PT, DPT
Bø K, Artal R, Barakat R, et al Exercise and pregnancy in recreational and elite athletes: 2016/2017 evidence summary from the IOC expert group meeting, Lausanne. Part 5. Recommendations for health professionals and active women. Br J Sports Med 2018;52:1080-1085.