Prepare for the "Extreme Sport" of Pregnancy and Childbirth
Women are having babies later in life compared to our ancestors. With increasing maternal age and sedentary lifestyles, there is a greater risk of lumbopelvic pain and other dysfunctions. Throw in pelvic girdle dysfunction from past experiences of traumas and falls from sports, surgeries and even infertility, and the problems are magnified.
Lumbopelvic pain is defined as pelvic girdle pain and occurs in 24-90% of women while they are pregnant (Van Benten et al, 2014). How do you know if you have pelvic girdle pain? Unlike pain generated from the spine or muscles, pelvic girdle pain is SHARP and TRANSIENT and frequently occurs with transitional activities, such as rolling in bed, getting out of a chair, walking, stair climbing or standing on one leg. Shaving while standing on one leg during pregnancy was almost always a guarantee for me, especially with my last pregnancy. I have had my hip and back give way recently while walking in my kitchen on my peak ovulation day (mid cycle), causing me to almost black out. My last pregnancy was 10 years ago (that's me in the picture with my last baby). Sadly, over one-third of women still have pain one year after delivery (JOSPT, 2014).
The pelvis is comprised of the hip bones, sacrum/ tailbone and 35 muscles which are intricately connected to support the bony skeleton and internal organs. Pregnancy hormones influence joint stability as a result of ligamentous laxity, especially in the pelvic girdle. Having multiple pregnancies further puts the pelvis at risk of instability. The problem is not that the joints move, it is that they get stuck and often remain stuck. In addition, there is no comfortable position to unweight the pelvic girdle, other than being immersed in water up to your head. Relief does not come from lying down and often worsens when you remain in one position. As a result, the emphasis of exercise before, during and after pregnancy should be on pelvic girdle stability to keep the joints from moving and getting stuck out of position.
According to researchers, criteria for pelvic girdle pain includes:
pain between the hip bones and the gluteal fold
pain with weight-bearing and lingering pain in the pelvic girdle
diminished ability to stand, walk or sit
positive clinical diagnostic tests that reproduce pain
no nerve root symptoms (negative straight leg raise test)
Pelvic girdle pain can interfere with productivity and lost days and time off for pain and dysfunction. The good news is that there is moderate evidence for the positive effect of exercise on pain, disability and sick leave for the treatment of pelvic girdle pain during pregnancy and patient education is a helpful intervention (Van Benton 2014). The problem is, there is a limited number of professionals that can provide evidence-based and effective exercise instruction for pelvic girdle pain in pregnancy.
So what exercises are most beneficial? Fortunately for you, I have delivered three babies and have over 17 years of experience in the field of physical therapy known as women's health. Our clinic was opened 7 years ago with the goal of restoring function to the core of the body, especially for women during and after pregnancy. Based on my personal and professional experience, the most important muscles groups to work are the glutes, quads, hip rotators and the transversus abdominus (most important and deepest of the four abdominal muscles). It is even more beneficial to work these muscle groups simultaneously or synergistically. These are my TOP THREE recommended exercises as you prepare or begin your pregnancy:
BRIDGE WITH BALL SQUEEZE
Lie on your back with knees bent and arms at your sides. While EXHALING, squeeze a ball or pillow between your legs and raise your hips off the floor, pressing your arms and feet into the floor (to engage the lats, quads, inner thighs and glutes simultaneously). Repeat 10 times.
SQUAT WITH BALL SQUEEZE
Place a physioball behind your low back and place a ball between your knees. INHALE and squat until your thighs are parallel to the floor. EXHALE as you draw in your lower abdomen, gently squeeze the ball and return to a standing position. Keep your knees behind your toes to avoid pain at the kneecap. Repeat 10 times.
CORE ACTIVATION WITH BALL SQUEEZE
Sit upright in a chair or on a ball with your hips and knees bent to 90 degrees with a small ball between your knees. Hold onto a sturdy object for balance, if needed. EXHALE and draw in the lower abdominal muscles while gently squeezing the ball. Repeat 10 times.
PILATES POSTURE OF POWER (Bonus Exercise/ Pose)
Lie on your back with heels pressed together, shoulder blades towards your back pockets and chin level while you squeeze your buttocks together and tighten your thighs. Hold for 30 - 60 seconds while breathing slowly in through the nose and out through the mouth. This can also be done in a standing position.
Talk to your doctor or health care provider about physical therapy. A referral is not needed in the state of Ohio (and most states) to be evaluated and treated by a physical therapist. However you will want to know any precautions and get clearance from your health care provider before beginning an exercise routine in pregnancy. If you are not currently pregnant and thinking of becoming pregnant soon, why not prepare your pelvis for the "extreme sport" it is about to go through for the next 12 months.
Van Benton et al, 2014. Recommendations for physical therapists on the treatment of lumbopelvic girdle pain during pregnancy: a systematic review. JOSPT. 44 (7), 464-473.
Pregnancy and low back pain: physical therapy can reduce back and pelvic pain during and after pregnancy. JOSPT 2014. 44 (7), 474.