Ahh,
pregnancy. The daily miracle
of our bodies nurturing a new
life, the anticipation of the
overflowing joy and love that
the new baby will bring, the
flowering of our maternal spirits,
the back aches, the edema, the
nausea, constipation, hemorrhoids,
stretch marks, weight gain,
and getting out of bed to use
the bathroom three or four times
every night. Ah yes, pregnancy.
Though the common physical
discomforts of pregnancy are
numerous, you don’t have
to grit your teeth and bear
it. Fortunately, there are many
simple steps you can take to
alleviate or avoid many of the
undesirable side effects of
pregnancy and postpartum.
Areas
of the Body Most Commonly Effected
During Pregnancy and Postpartum—Click
on a body part below to go directly
to information about his topic.
Biochemical
Changes Can Make You Susceptible
to Injury
During the last
half of pregnancy and early postpartum
periods, you need to be more cautious
during exercise and other physical
activities. In response to pregnancy
hormones, your ligaments and other
connective tissues lengthen, which
decreases joint stability. Instability,
in combination with the shift
in your center of gravity, reduces
neuromuscular coordination and
balance, leaving you more vulnerable
to injury.
These biochemical changes do
not destine you for injury,
however. Some simple adjustments
in your activities, environment
and preventative exercises can
significantly improve your prospects
for having an injury-free pregnancy.
The Feet
Put
Your Feet before Your Sense
of Style
The idea of “sensible
shoes” may seem like an
anathema for women who follow
fashion trends, but pregnancy
and postpartum-related foot
pain can make even the most
dedicated fashionista appreciate
the value of supportive, good-fitting
shoes. For the duration of your
pregnancy, shoes with high heels
and pointy toes are better left
in your closet than on your
feet.
Why
the Shoe Doesn’t Fit—At
Least for Now
Shoe-fit problems stem from
added body weight in conjunction
with ligament laxity and fluid
retention. This combination
of physical changes can stress
and flatten the longitudinal
and metatarsal arches
of the feet, and ultimately
affect they way your shoes fit.
With stretched ligaments and
swelling from water retention
and weight gain, your feet may
spread and swell enough to require
longer and/or wider shoes. Some
women will need to buy larger
shoes during pregnancy to accommodate
these changes. You’ll
notice foot swelling especially
at the end of the day.
How
to Take Care of Your Feet during
Pregnancy
|
•
|
Take frequent breaks to
keep from standing for long
periods of time. |
|
•
|
If your
feet tend to swell, elevate
your lower legs and feet
while sitting. |
| •
|
During the
last half of pregnancy,
get your feet re-measured
before buying shoes. |
|
•
|
Avoid walking
in your bare feet. |
•
|
To increase
blood flow and reduce swelling,
practice simple ankle exercises,
such as flex and point,
and ankle circles. |
• |
Select shoes
with a contoured foot bed
and a large, naturally shaped
toe, which support the arches
and prevent compression
of the forefoot and toes. |
Evaluating
the Condition of Your Shoes
Evaluate the condition of your
shoes to see if they’re
safe to wear during your pregnancy.
Check the heels and soles of
your shoes for wear. If, when
placed on a table or similar
flat surface, your shoes slump
in any direction, or the heels
show marked signs of wear on
one side, they’re too
worn to wear. Even if they are
your favorite pair, wearing
them can risk injury. And of
course, any shoe that causes
pain should not be worn for
the duration of your pregnancy.
Ankles
A history of ankle sprain, muscle
and tendon strain, or tendonitis
of the Achilles tendon put you
at higher risk for re-injury
during your pregnancy and postpartum
period. Ankle sprains most often
occur when walking down stairs,
stepping off sidewalks, or during
abrupt changes of direction.
For women with a history of
sprains and strains, hiking
or jogging on hard or uneven
surfaces during the last half
of pregnancy is not advisable.
Pregnancy
Safety Tips for Preventing Trips,
Falls, Sprains and Strains
|
•
|
When
using stairs, avoid carrying
loads that obstruct your
view, such as large loads
of laundry or stacks of
packages. |
|
•
|
Step down
from stairs and curbs with
greater caution than you
did before your pregnancy.
|
| •
|
Use handrails
to compensate for the shift
in your center of gravity. |
|
•
|
Practice
simple balance exercises
throughout your pregnancy
to maintain ankle motor-control
and adjust to center of
gravity shifts. See the
Balance
page of this web site for
more information and simple
balance exercise. |
• |
Enlist your
family and household members
in a campaign to keep the
floor and stairs clear of
obstacles or spills that
might trip you or cause
slip and fall accidents,
explaining that pregnant
women are more likely to
get injured if they “take
a spill.” |
| • |
Using nightlights
in hallways and bathrooms
can also help prevent trip
and fall accidents. |
Knees
Obviously, any exercise that
causes pain or discomfort in
any joint—and especially
the knee—should be avoided.
Women commonly feel knee-pain
during pregnancy and the postpartum
period. Fortunately, it’s
relatively easy to manage or
prevent knee pain. Usually,
simply building up strength
in the thigh—particularly
in the muscles that straighten
the knee—can relieve symptoms.
All prenatal and postpartum
exercise programs need to compensate
for ligament laxity and dynamic
instability.
To protect your knees, eliminate
exercises that may strain knee
ligament and cartilage from
your routine. These may include
jogging or running down hill,
squats, lunges, leg presses,
and weighted leg extensions.
Yoga style squats where the
knees extend beyond the toes
are also not recommended.
How
to Prevent or Cope with Knee
Pain
|
•
|
If you experience pain,
discomfort, or reduced range
of motion in your knee the
day after exercise, discontinue
the exercise. |
|
•
|
If you have
knee pain, don’t kneel,
squat, crawl on your knees,
or get down on your hands
and knees for housework,
gardening or exercise. |
| •
|
Avoid hyperextension
of the knee and positions
that may stress knee ligaments.
|
|
•
|
Perform
knee-protective exercises,
such as leg extension exercise
described below. |
Pre-and-Post
Natal Leg Extension Exercise:
|
1. |
Stand adjacent to a chair,
one hand resting on the
back of the chair for balance. |
|
2. |
Lift one
foot up to the inside of
your opposite knee. |
3.
|
Try to hold
your knee in place as you
straighten the lifted leg
out in front of you, positioning
it at a 45 to 90 degree
angle. |
4.
|
Hold the
extension for a moment. |
5. |
Slowly bend
your leg, returning your
foot to the opposite knee. |
6. |
Perform eight
repetitions on each leg. |
Pelvis: Pubic Bone
Usually, the right and left
pubic bones are fused together
at the midline: the pubic
symphysis.
The hormones of pregnancy, however,
soften the dense ligaments of
this joint, which allows the
pelvic outlet to expand during
childbirth. Occasionally, this
joint becomes unstable at the
end of pregnancy, during labor,
or in the early postpartum period.
The chief symptom of pubic instability
is pain directly at the pubic
symphysis. Groin pain, or an
inner thigh strain, is more
commonly felt slightly off center
of the joint, and can often
be mistaken for pubic bone instability.
Pelvic
Instability of Any Kind Needs
Professional Treatment
If your pubic bone is painful
after childbirth, make an appointment
with your OBGYN physician, and
get a referral for a Physical
Therapist who specializes in
pre-and-post natal exercise
prescriptions.
Precautions
to Take if You Have Pubic Pain
|
•
|
See
your doctor as soon as possible
to rule out pubic instability. |
|
•
|
Avoid straddle
stretches, side leg-lifts
and other groin stretches. |
| •
|
Always directly
face any object before you
lift or carry it. |
|
•
|
Refrain
from twisting and bending
movements when carrying
heavy loads. |
Pelvis:
Sacroiliac Joint
The sacroiliac joint
is where the back of the pelvis
connects with the sacral vertebrae
of the lower spine. Most body
types display a small dimple
on each side of the low back
at the sacroiliac joint. Generally,
this joint moves very little,
however; instability from increased
ligament laxity at this joint
can occur during the last half
of pregnancy and, more commonly,
the postpartum period.
Sacroiliac instability is painful
and may cause functional weakness
in one or both legs, and low
back muscle spasms. Bending,
lifting and carrying, sitting
with the legs crossed or to
one side, prolonged standing/slouching,
or walking up a steep hill may
aggravate the condition.
Take
Care of Sacroiliac Problems
Right Away
Directly after pregnancy, the
abdominal wall is lax and does
not have enough strength to
adequately support the lower
back and sacrum. Untreated sacroiliac
instability may worsen or become
chronic. If you think you might
have a sacroiliac problem, make
an appointment with your OBGYN
and get a referral for a Physical
Therapist or Chiropractor who
specializes in pre-and-post
natal problems.
How
to Prevent or Manage Sacroiliac
Problems
|
•
|
If you have pain in this
joint, do not sit with you
legs crossed, or with both
legs to one side. |
|
•
|
Never sit
without lower back support,
particularly while nursing. |
| •
|
Refrain from
all exercises that use straddle
positions, sitting with
the legs folded in front
of the body, or sitting
with the soles of the feet
together. |
|
•
|
Avoid all
yoga poses that stretch
the sacroiliac joint, including
all standing and seated
twisting poses, all “lotus”
variations, and “pigeon
pose.” |
•
|
Stay away
from most Pilates exercises,
including mat and reformer;
they are contraindicated
for sacroiliac instability. |
•
|
Do not lift
heavy loads. |
Tailbone
(Coccyx)
Many of us habitually sit slouched,
or rolled back off the pelvis,
with our spines curved in a
“C” shape. This
misplaces our body weight onto
lower spine and sacroiliac,
rather than on the bottom bone
of the pelvis, the ischium or
“sit bones”. Slouching
stresses the tailbone and sacroiliac
joint which are particularly
vulnerable during and after
pregnancy. During labor and
delivery, the natural curve
of the tailbone flattens and
is pushed outward as your baby’s
head passes through the pelvic
outlet. Not surprisingly, the
stress of delivery commonly
results in postpartum tailbone
pain. If you experience persistent
discomfort in your tailbone,
consult with your OBGYN.
How
to Prevent or Manage a Pain
in the Tailbone:
|
•
|
Sit up tall, with your weight
on the bottom bones of your
pelvis (the ischium or “sit
bones”) rather than
rolled back onto your coccyx
or sacrum. |
|
•
|
If seat cushions
are too deep for your frame,
use pillows behind the lower
spine to help avoid slouching.
|
| •
|
Place a small
rolled towel behind the
waistline to support a neutral
pelvis and lower spine. |
|
•
|
When seated,
keep your thighs on a slightly
downward diagonal position,
rather then parallel to
the floor; you may need
to elevate your seat height,
or use a solid wedge pillow
under the pelvis to attain
this position.* |
•
|
Do not use
donut-shaped pillows during
pregnancy and the postpartum
period; they weaken pelvic
floor muscles. |
•
|
Avoid any
roll-back exercises, either
sitting or on an exercise
ball, or Pilates style rolls,
as these types of exercises
are not recommended for
pregnancy and the postpartum
period. |
*This position is especially helpful
for women with tight hips and/or
lower back
Round
Ligament Pain
The round ligaments, found on
the right and left sides of
the uterus, attach to the pubic
bone and help support the placement
of the uterus in the abdominal
cavity. As the uterus expands,
these ligaments endure continual
stretching and are a common
source of pain in the latter
part of pregnancy. Pain, either
a sharp spasm or dull ache,
is felt on one, or sometimes
both, sides of the lower belly.
To relieve round ligament pain,
perform a “hip-hiker”
on the painful side to shorten
the ligament, reduce tensile
forces, and relieve pain.
Hip-Hiker
Exercise for Round Ligament
Pain
|
•
|
Stand adjacent to a wall,
back of a chair, or countertop
with your painful side facing
away from your support object.
|
|
•
|
Place your
near hand on the wall, chair,
or countertop for balance.
|
| •
|
Lift the
foot on your painful side
and bring it to your opposite
ankle. |
|
•
|
Lift the
hip bone (called a hip-hike)
on your painful side straight
upward, so that it moves
closer to your armpit. Try
to stay as upright as possible
on your supporting side
to prevent twisting or bending. |
• |
Hold for
ten seconds, or until pain
has subsided. |
|
•
|
Bring your
hip and foot back down and
stand evenly on both legs
for a moment or two. |
Lower
Back
Support
Garments: Habitual Use May Cause
More Harm than Good
Avoid over-relying on lower
back and belly-support garments
during pregnancy. Wearing a
support garment on a daily basis
inhibits the deep abdominal
muscles and deep spinal muscles
from doing the work intended
for them—i.e., supporting
your spine. When not worked,
core muscles will in fact weaken
and atrophy—exactly what
you don’t want to happen.
Maintaining
Core Strength Remains Superior
to Support Garment Use
In order to support your spine
and the growing weight of your
baby, build and keep your internal
girdle strong and supportive,
rather than wearing a support
garment. If by the end of the
day, you find that you no longer
have the stamina to support
your lower back, then by all
means, use a support garment
to ease symptoms for short periods
of time.
If you do decide to use a back-support
device, put it on while you
are lying on the floor, with
your pelvis and spine in the
neutral position. Putting on
any type of support garment
on while standing with your
pelvis and spine misaligned
will not help your back.
Exercises
for Relieving Back Pain
|
•
|
The “Cat Stretch”
—either on all fours,
or standing with your hands
on your knees—is a
great way to lengthen lower-back
muscles. |
|
•
|
Lying down
with your lower legs resting
on an ottoman or soft chair
seat, or with both knees
pulled up to the chest is
also effective in relieving
pain. During pregnancy,
watch for signs of dizziness
in this position. |
Ribcage
The ribcage expands enormously
during pregnancy to help make
room for the expanding uterus
and to maintain adequate lung
capacity. Many pregnant women
experience rib discomfort from
this expansion, as well as the
occasional little foot or knee
that might habitually press
against the ribs.
Tips
for Managing Rib-Pain
|
•
|
To help ease discomfort,
try gentle stretches and
spine-mobility exercises,
such as twists and upper-spine
extensions. |
|
•
|
Centered
breathing techniques, in
either a sitting or a side-lying
position will help to ease
discomfort. |
|
• |
After pregnancy,
perform rib-closure exercises
to re-bevel the ribcage
and re-narrow the waistline. |
Shoulder Girdle
Shoulder
pain is almost universal during
and after pregnancy. Alignment
changes, heavier breasts, and
a weakened core all conspire to
impair upper body alignment. When
bones are out of ideal alignment,
nearby muscle functioning is reduced.
Because new moms do so much lifting
and carrying throughout their
days, shoulder and upper-back
muscles strain easily.
How
Pregnancy Impacts the Shoulder
|
•
|
The shoulder girdle muscles
become imbalanced and inhibit
good body mechanics. |
|
•
|
The internal
rotators over-tighten and
external rotators weaken. |
|
• |
Muscles
that elevate the shoulders
tighten while muscles that
depress the shoulders weaken. |
Managing
and Preventing Shoulder Pain
|
•
|
Use gentle daily stretches
for the chest, neck, and
shoulders to improve upper-spine
alignment. |
|
•
|
Strengthen
muscles groups that tend
to weaken. |
|
• |
Avoid sleeping
with your head tilted back
or thrust forward. |
|
•
|
Use massage
or self-acupressure to relieve
muscle spasms. |
|
•
|
Remind yourself
to stand and sit up straight
to avoid slouching. |
•
|
Use ergonomic
breastfeeding positions.
A complete discussion of
ergonomic breastfeeding,
and lifting and carrying
can be found in my book,
"Exercise
After Pregnancy: How to
Look and Feel Your Best”. |
Neck and Forward Head Syndrome
Upper body misalignment and
neck-pain go hand-in-hand. When
the upper spine over-flexes,
the head compensates and slides
forward. The muscles that lift
the shoulders tighten and shorten
in response.
Neck-Related
Symptoms that Require Medical
Consultation
If you have severe muscle spasms,
persistent headaches, weakness
in one arm, or marked asymmetrical
mobility of the head, then see
a medical professional for an
evaluation.
For common neck stiffness,
try gentle stretches and head-rolls,
see the tips in the Managing
and Preventing Shoulder Pain
section of this web page.
|
•
|
Try to sleep in positions
where the back of the neck
is elongated, rather than
with the head thrust forward
or rolled backward. |
|
•
|
Pay particular
attention to your head alignment
while driving and other
seated postures. |
|
• |
Relaxation
and meditation techniques
are also valuable for relieving
chronic neck-tension. |
Exercise
to Re-align Forward Head:
|
1. |
Maintaining a neutral spine,
stand with your back and
head against a wall, your
legs slightly bent, and
your feet about a foot away
from the wall, about hip
distance apart. |
|
2. |
Roll your
chin toward your chest without
moving your head away from
the wall. |
3.
|
Press the
back of your head into the
wall as strongly as you
can for five slow counts. |
4.
|
Gradually
relax your muscular effort
and allow your head to glide
back in to the neutral position.
|
5. |
Perform
four repetitions. |
Wrist
Repetitive
Stress and Carpal Tunnel Syndromes
Pregnancy and the postpartum
period place women at an increased
risk for Carpal Tunnel Syndrome.
Swelling, fluid retention, and
increased blood-volume can restrict
and compress the medial nerve
as it passes through the wrist—the
carpal tunnel—and into
the hand, causing pain in the
hand, wrist and arm. Repetitive
stress injuries and Carpal Tunnel
Syndrome are increasingly common,
and because they have the potential
to cause long-term disability,
must not be ignored.
Carpal
Tunnel Symptom Checklist
|
•
|
Pain in your hand. |
|
•
|
Pain in your
wrist, sometimes extending
into the forearm. |
|
•
|
Weakness
in the hand. |
•
|
Numbness
and tingling in the fingers,
wrist and hand, especially
after several hours of use
or at night. |
If you have any of the symptoms
of Carpal Tunnel Syndrome or
other repetitive stress injury,
see a doctor or Physical Therapist
who specializes in repetitive
motion injuries and the diagnosis
and treatment of this condition.
Sometimes subtle problems may
compound and overlap. Pathology
or injury may originate in the
neck, shoulder, elbow or wrist.
An expert in nerve injuries
will be able to conduct the
proper tests and correctly diagnose
the problem. After your diagnosis,
you can receive the appropriate
therapy.
Be
Persistent: Don’t Take
“No” for an Answer
Increasingly, some HMO doctors
will advise a wait and see attitude,
or suggest to new moms that
they try not to use their wrists
and hands throughout the day
as they care for their newborns.
One student of mine was actually
advised not to pick up her baby!
Certainly, since wrist pain
can come from overuse and it
can be wise to cut back on unneeded
activity. But no activity is
another matter. If necessary,
squeak as much as you have to
get the grease from your medical
provider! Don’t take no
for an answer.
Tips
for Wrist Pain from Overuse
|
•
|
Set up an ergonomically
sound workstation. |
|
•
|
Refrain from
all exercises that flex
the wrist or bear weight
on the hands, such as push-ups,
bench presses, and quadruped
exercises. |
|
•
|
Don’t
use tools or exercise equipment
that require you to sustain
or repeatedly apply a tight
grip. |
|
•
|
Avoid tools
that require you to repeatedly
twist or flex your wrist. |
•
|
Take frequent
breaks from keyboard work
and other tasks that might
compromise areas prone to
repetitive motion injury,
such as the carpal tunnel. |
•
|
Try to maintain
a neutral wrist-position
(neither flexed or extended)
throughout your daily activities. |
•
|
When working
at a repetitive motion task
that makes it hard to keep
your wrists in a neutral
position, such as keyboard
work, or when having a flare-up
of symptoms at night, use
wrist braces to hold your
wrist(s) in the neutral
position and reduce stress.
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EXERCISE
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How
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