Be strong, fit and healthy in your pregnancy

The Forge Clinic - prenatal adviceExpecting a baby should be a wonderful time, but changes to your body may cause you to experience pain or discomfort, writes Lara Maddison, a specialist physiotherapist in Women’s Health at The Forge Clinic.

This guide aims to help you improve your posture, tone your muscles and ease back or pelvis pain and other complaints such as leg cramps and rib flare.

Protecting your pelvis and back in pregnancy

Your pelvis forms a ring with one joint at the front and two joints at the back. During pregnancy one or more of these joints may be affected resulting in some lower back or pelvic dysfunction. Reasons for this include:

  • pregnancy hormones allow ligaments to become more lax so joints have less stability
  • changes in your posture, weight and centre of gravity increase the strain on your back and pelvis
  • as your bump grows your tummy muscles, which support your spine and pelvis, become stretched and weakened.

For these reasons it is important to listen to your body, pace yourself as pregnancy progresses and pay particular attention to your posture.

Posture when standing

  • Lightly engage your tummy muscles by drawing your belly button towards your spine.
  • Gently tuck your tailbone under to decrease the arch in your lower back and lengthen your spine.
  • Draw your shoulders away from your ears to open up your chest and support your upper back.
  • Keep your ears, shoulders and hips in line.

Posture when sitting

  • Sit on a firm chair, which fully supports the whole length of your thigh.
  • Place a rolled up towel in the small of your back to help provide additional support.
  • Sit so your knees are level with your hips.
  • Avoid crossing your legs.

If you do experience back or pelvic pain you may find some of the following advice helpful:

Everyday activities

  • Avoid staying in one position for too long – try to have a posture break every 30 minutes.
  • Avoid heavy lifting and try to carry shopping equally in each hand.
  • Avoid twisting movements eg vacuuming, carrying toddlers on one hip.
  • Wear supportive footwear eg trainers and avoid flat shoes eg ballet pumps, flip-flops.
  • When getting in and out of bed or in and out of a car keep your knees together.
  • When using stairs lead up with your stronger leg and lead down with the weaker one.
  • Try using a hot water bottle or heat pack to soothe achy areas.
  • Sleep on your side with a pillow supporting your bump. Have your bottom leg straight and your top leg bent so that you are positioned slightly forwards. This will relieve pressure from your bottom hip.

The all-important pelvic floor!

The pelvic floor muscles stretch like a hammock from your tailbone at the back to the pubic bone in front. They support all your pelvic organs and are essential for continence, sexual function and providing lower back and pelvic stability. During pregnancy they are placed under extra strain due to supporting your growing baby.

Pelvic floor muscle exercises

Pelvic floor strengthening is important for all mums-to-be. This exercise can be done lying, sitting or standing.

Firstly imagine a zip running between your legs from the back to the front.

For the SLOW contractions:

  • Take a breath in to prepare and as you exhale firmly close your back passage as if you are stopping yourself from passing wind.
  • Draw that same contraction forwards and upwards as if you are doing up a zip between your legs and trying to stop the flow of urine.
  • Once you feel the pelvic floor muscles lift, hold onto this contraction, BREATHE and count steadily to a maximum of 10 seconds.
  • SLOWLY release all the way.
  • Rest for 3 seconds.
  • Repeat 10 times.

For the FAST contractions:

  • Lift and squeeze your pelvic floor muscles as tightly as you can.
  • Hold for 1 second.
  • Release all the way.
  • Rest for 1 second.
  • Repeat 10 times.

Exercise often

You should practise both of these exercises 3 times daily. Find some regular activities to remind you to do your pelvic floor eg while you are feeding your baby. Remember – these exercises are for life and will help prevent incontinence and pelvic organ prolapse as well as aid healing.

Extra tip

Practise tightening your pelvic floor muscles before you cough. The reflex that makes you do this naturally can stop working after having a baby. Regular practice protects your pelvic floor muscles and helps to train them to work automatically with a cough or sneeze.

Core muscle exercises

Your transverse abdominis muscle runs around you like a human corset. It is your deepest tummy muscle and provides support to your lower back and pelvis. To ensure it continues to provide this support during your pregnancy it is important for you to keep working it.

Bracing/engaging transversus

  • Place your fingertips on your lower tummy just under your bump.
  • Take a breath in to prepare.
  • As you breathe out gently contract your lower tummy muscles by drawing your bump away from your fingertips.
  • Hold for 5 – 10 seconds as you continue to breathe.
  • Practise little and often throughout the day – particularly while you are walking, before lifting anything and before changing position.

Pelvic tilt

  • Lie with your knees bent and your feet flat with the support of 2 – 3 pillows behind you.
  • Gently pull in/brace your tummy muscles as above.
  • Rock your pelvis back until you feel your lower back gently press into the floor/bed.
  • Hold as you breathe in.
  • As you breathe out gently return your pelvis back to the starting position.
  • Relax.
  • Repeat 5-10 times.
  • This exercise can also be performed while sitting and standing

Chest stretch

While sitting or standing:

  • place your hands behind your back at the base of spine
  • draw your elbows together until you feel the stretch into the front of your chest.

General exercise advice

Provided you do not suffer from any medical or obstetric complications light to moderate exercise is recommended throughout your pregnancy. It can help your body cope with the stresses and strains as well provide mental stimulation.

Recommendations

  • Avoid high impact or contact sports.
  • Avoid starting any new or vigorous activity during pregnancy.
  • Use the ‘talk test’ to ensure you aren’t pushing yourself too hard ie you should be able to carry on a conversation while exercising.
  • If participating in a group exercise class always tell your instructor you are pregnant so they can adapt any of the exercises for you if required.
  • Avoid prolonged periods laying flat on your back after 16 weeks.
  • Walking/pilates/yoga are all excellent forms of exercise during pregnancy.
  • Avoid breaststroke when swimming as this can often aggravate the lower back and pelvic joints.
  • Make sure you stay hydrated and be careful to avoid overheating.
  • Listen to your body – it is normal to slow down as your pregnancy progresses.

Common pregnancy complaints

Pregnancy can put quite a strain on your body and sometimes the changes taking place will cause irritation or discomfort. There is rarely any need to worry, but if you have any concerns talk to your maternity team.

Take care of yourself with these helpful tips outlined below

Leg cramps

  • These are due to changes in your body chemistry.
  • Avoid wearing high-heeled shoes.
  • Avoid sitting cross-legged.
  • Apply heat and do gentle stretching exercises before bedtime.
  • Circle ankles 10 times briskly in each direction.

Rib flare

  • You may experience discomfort in your ribs particularly as your baby gets bigger and pushes your rib cage up and out of its normal position.
  • It can help to stretch by bending your upper body sideways away from the side of the pain and raising the arm of that side up and over your head.
  • Hold for 15 seconds and then return to a normal sitting position.
  • Repeat 3 times.

Carpal tunnel syndrome

With increased fluid volume during pregnancy some women experience pain, numbness or tingling in their hands due to the pressure placed on nerves in the wrist. To ease the symptoms:

  • place your hands and wrists in cool water
  • sleep with your wrist and hand slightly elevated to encourage fluid drainage
  • massage the fluid away from your hands by using long sweeping strokes in one direction from your hand to your upper arm with a moisturiser
  • circle your wrists in one direction and then the other – 5 times each way.

Expert help for expectant mothers

The Forge Clinic in Richmond offers a range of specialist services to support you through your pregnancy and can help you get back into shape after your baby is born. If you would like more information or advice, please call us on 020 8332 6184 or email us at info@theforgeclinic.com.

Pelvic, Obstetric and Gynaecological Physiotherapy (POGP formerly ACPWH) has produced a guide to help you cope with the physical demands of your pregnancy. You can download ‘Fit for Pregnancy’ here.