Top Three Exercises for Women of Childbearing Age

Today's women have more obstacles to exercise than ever before, juggling multiple balls in the air at the same time and exercise often falls to the back burner. I am going to give my top three exercises to maximize the benefit of daily exercise that can be done in under five minutes! Start with these simple exercises that will take less than 240 seconds (4 minutes) to complete. There are 86,400 seconds in a day so that gives you 86,160 seconds to do other things. Discipline and commitment is key and for some, it is accountability. Find a friend that will commit to doing this with you or start a journal that you can log and visually see your accomplishments. Women have unique bodies and there are specific muscles we should be targeting with exercise. Running and exercising in a boot camp is not the place to start until you have established stability in your pelvic girdle. I often have to down train women who are overexercising or doing advanced exercise and suffering with instability and dysfunction.

The sacroiliac (SI) joints are located in the pelvic girdle where the spine and pelvis connect on each side. The job of the SI joint is to transmit forces from the lower limbs to the torso in what is known as "load transfer". The SI joints also sit directly behind the cecum and sigmoid colon. SI joint dysfunction is a source of problems for most women at some point in the childbearing years. According to Canadian physiotherapist Diane Lee, this is due to the inherent difference in form closure compared to males. Form closure is the structural support offered by the bones and skeletal system. Force closure is the muscular and ligamentous support. Every month there are fluctuating hormones, particularly Progesterone, that influence the laxity of ligamentous support and pelvic girdle stability, requiring more force closure or muscular support. Progesterone levels are lower at the beginning of the cycle with higher levels starting with ovulation, in the second half of the cycle. Progesterone is also in the highest concentrations during pregnancy, when women are considered a Progesterone factory. It is the hormone that causes food cravings, especially carbs, and creates a rise in core temperature to make the womb hospitable for human life. Without help from ligaments, muscles have to work harder to stabilize the pelvis. This instability can be even worse for women who are multiparous, or who have had more than one pregnancy.

I should know since I have had a total of five pregnancies. After my third baby (fifth pregnancy), I could not walk without feeling like my hips were a tennis match. What I later discovered was that the pain in my left buttock and low back was influenced by tightness in my right hip. Dr. Vladimir Janda, a 20th century Czech physician, describes this as cross patterning as muscles have a very predictable pattern of tightness and weakness when there is a dysfunction. I have also experienced my SI joint and hip give out mid cycle, during ovulation, when I have a surge of Progesterone. I can actually feel my pelvis move and shift out of position. Pain sets in when the joint gets stuck, creating an inability to bear weight on my hip and walk. The problem with the SI joint is not that it moves, but that it gets stuck and treatment is often required to restore it to the proper anatomical position. Symptoms of SI joint dysfunction include pain in the low back or buttock that is often one-sided, hip pain, discomfort with bending over or standing after prolonged sitting and pain during transitional movements, such as rolling in bed, shifting weight, standing on one leg and walking.

Because of this inherent pelvic girdle instability in women, the emphasis of exercise should be to stabilize the SI joint using the deep core muscles, namely the transversus abominus, pelvic floor, diaphragm and mutifidus, along with the help of the gluteals. Once the core is disrupted with pregnancy, surgery, or truama, a very predictable pattern occurs in which certain muscles shut down or become inhibited. Dr Janda described what happens in the presence of dysfunction. In the lumbopelvic region, the muscles that become inhibited include the gluteals, quadriceps, transversus abdominus, multifidus, long inner thigh muscles (adductors) and eccentric or lengthening action of the hamstrings. While certain muscles become weak, other muscles become hypertonic, or abnormally tight, including the hamstrings, psoas (hip flexor), piriformis (buttock), short groin muscles, quadratus lumborum (between the ribs and pelvis), pelvic floor and rectus abdominus (one reason we do not prescribe crunches or sit-ups at our clinic). Click here to read our blog on Diastasis Recti.

These three exercises help retrain the muscles that become inhibited, in order to prevent compensations from other helper muscles. If the helper muscles are over compensating and causing pain, it might be necessary to get help from a physical therapist who specializes in the pelvis before beginning these exercises.

1. BRIDGE WITH BALL SQUEEZE

With this exercise, four things are happening simultaneously to provide the maximum benefit: 1. EXHALE 2. Gently squeeze the ball between your legs 3. Lift your hips so the body is in a straight line 4. Press your elbows into the floor. Repeat 10 times for two to three sets, three times a week OR one set of ten daily (what I usually recommend when starting out). This should not cause or increase pain and if it does, STOP and seek the help of a professional.

2. CORE ACTIVATION

This exercise can be done sitting in a chair, or on a ball for a greater challenge. EXHALE and make a sound such as "ss" or "sh" as you draw in the lower abdomen for a count of five. For maximum benefit, do a Kegel, or pelvic floor contraction, at the same time. Imagine you are drawing the bones in the front of your hips together. Place your hands on your lower abdomen to confirm that the muscles are tensing and you can also cue the muscle by tapping on it. Repeat ten times, three to five times a day, either sitting straight in a chair or on a ball with the hips at a 90 degree position, as shown. This helps to retrain the diaphragm to draw in the pelvic floor and abdomen when exhaling during everyday activities, such as lifting.

3. POSTURE OF POWER

This is a Pilates power pose and one that I wish I had known earlier in my life! By rotating the hips outward with heels together, the pelvic floor gets lifted like a hammock. Stand next to a wall if you have poor balance. Squeeze your gluteals and thighs, draw your shoulder blades down into your back pockets, place your chin on a shelf and breathe rhythmically like an ocean wave, in and out, for up to one minute. This can be repeated througout the day or modified during periods of prolonged standing to include just the heels together and toes outward. This is helpful to avoid shifting the hips to either side or crossing the arms at the chest. This pose is also an excellent position to do Pilates 1oo's by holding the position and pumping the arms at your side 100 times (palms facing backwards).

Exercise should never increase or worsen pain. If you are unable to do any of these exercises without pain or if your pain does not improve, you should seek the help of a physical therapist who specializes in the pelvis. At Healthy Core, we provide one-on-one manual therapy to address pelvic alignment, adhesions and muscle tension that contributes to SI joint or pelvic girdle dysfunction. Often the hip joint is tight and the sacrum or pelvic bone is rotated, which can make one leg appear longer. Ice and anti-inflammatories can be helpful to reduce discomfort. This is a treatable condition and can be managed for pain-free living.

References:

Lee L-J, Lee D. 2011. Chapter 7: Clinical Practice - The Reality For Clinicians. The Pelvic Girdle, 4th edition. Elsevier, Edinburgh.

Janda V, Va'Vrova'. 1996. Sensory motor stimulation. In Liebenson C (ed). Rehabilitation of the Spine. Wilkins & Wilkins: Baltimore. 319-328.

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