Exercise during Pregnancy

Considering I just had a baby, this topic is quite relevant and fresh in my mind. As a physio, exercise is second nature to me. I found it rather enjoyable to exercise during my entire pregnancy, and as my body changed throughout the different trimesters, I just simply modified the type of activity I did to suit. (In fact, I exercised even up to the day of giving birth - going for a nice 90min walk in the middle of the day during my early labour contractions, and made me feel so much better!).

Simply put, it is important to exercise during pregnancy. It brings many benefits for the mother's physical, emotional and social health. Although physical activity is beneficial for most people, I must state that under some circumstances, physical activity is not recommended for the health of the mother and baby, and the obstetrician's instructions must be carefully adhered to.  

Body changes during pregnancy
Many changes occur to your body during pregnancy.

• Ligaments become more loose, due to hormones that are released during pregnancy (in particular, relaxin). This may affect the stability of your joints, such as low back, pelvic girdle, sacroiliac joints, and increases the chances of muscle strain/ligament sprain injuries.
• Your pelvic floor supports the uterus, bladder and intestines. The added weight of the uterus, increased fluid and tissue laxity may affect your pelvic floor muscles, leading to problems with incontinence. It is important to perform regular pelvic floor exercises to maintain and improve the control and strength of the pelvic floor muscles.
• Your weight will increase as pregnancy progresses, which will alter your body shape and weight distribution. As your tummy grows forward, your centre of gravity will also shift forward, affecting your sense of balance and coordination
• Your resting heart rate will be increased during pregnancy, so it is important to monitor your heart rate during physical activity. As a general rule, do not exercise above 140bpm. Another way of monitoring your exercise intensity is to use the Borg's Rating of Perceived Exertion Scale (RPE). You should be able to still talk and exercise at the same time. 
• The amount of fluid and blood in your body increases as your pregnancy progresses and so does your core body temperature. Make sure you don't exercise in hot/humid environments, and avoid sudden changes of position as that can cause sudden drops in blood pressure leading to fainting and dizziness.

Benefits of regular exercise during pregnancy

• Improve overall health
• Manage some symptoms of pregnancy such as nausea, tiredness, fatigue
• Reduce back and pelvic pain by strengthening back/abdominal/pelvic muscles (especially as the tummy grows)
• Maintain strong pelvic floor muscles to reduce incontinence
• Maintain pre-pregnancy cardiovascular fitness
• Control swelling (especially arms and legs) due to increased fluid in the body
• Improve posture
• Control healthy weight gain
• Relieve stress and anxiety
• Facilitate better sleep
• Prepare for the physical demands of labour 
• Assist recovery following labour and contraction of uterus
• Facilitate return to pre-pregnancy weight and fitness
• Assist in coping with the physical demands of motherhood

Exercise suggestions
Activities that are generally safe during pregnancy include:

• Walking
• Swimming
• Cycling
• Exercise in water (aquarobics/hydrotherapy)

Aquarobics

• Pilates

Swiss ball exercises

• Yoga 

Yoga

• Pelvic floor exercises (very important, as the pelvic floor muscles are weakened during pregnancy and birth - so it is crucial to perform these pre/during/post-pregnancy)

• Abdominal/Core stability exercises (very important, as the abdominal muscles support the lumbar spine and pelvis - the core)
• Back strengthening exercises 

Activities that are not advised during pregnancy include:

• Sit-ups or stomach crunches (as this may worsen the diastasis recti) 
• Contact sports (eg. basketball, soccer, netball)
• Jumping sports (eg. trampolining, gymnastics)
• Competitive sports 
• Activites requiring sudden and frequent changes of direction and speed (skiing, snowboarding, football) 
• Activites that increase your heart rate too much 

It is a good idea to consult a physiotherapist for a customised exercise program. They can also educate you on pelvic floor and core stability exercises, advise you on exercise progressions, and supervise you to ensure the movements are performed correctly.

Final words

• Exercise is important and beneficial during pregnancy
• Make sure you have variety in your exercise program to keep it interesting and include strengthening and fitness components 
• Drink lots of water
• Monitor your heart rate and temperature during exercise
• Watch for warning signs (such as headache, dizziness, chest pain, heart palpitations, abdominal cramps, vaginal bleeding, sudden change in baby's movements) and consult your doctor immediately
• Consult a physiotherapist for an individualised exercise program and advice on any other problems or questions. Contact us if you would like to be referred to a specialised physiotherapist.

Question received re: Neck and Shoulder tightness

QUESTION RECEIVED 23/8/10:

"How do you treat neck and shoulder tightness that has gone to the point of the muscles being almost as hard as rock?"

Interesting question.
I think the problem here is a postural issue leading to muscular symptoms.
If you work requires you to be always at a computer/laptop and hunched over for the majority of the day, then it is very common to develop neck and shoulder tightness and pain.

Posturally, your head and shoulders will be hunched forward, and if this posture is acquired for a prolonged period of time, it will place a lot of strain across your neck muscles (in particular, trapezius). Adding to the postural problems, stress and tension will make you naturally tense up in the neck and shoulder girdle, increasing the strain and tightness of those muscles.

Some helpful tips:

• Take regular breaks from your computer/laptop (hourly) - look away from the screen, stand up and walk around, stretch your neck and shoulders
• Ensure that your workstation ergonomics are set up appropriately and that you are sitting upright with a good chair

Computer Workstation Ergnomics

• Perform regular stretches to your neck muscles by tilting your head sideways, rotating both sides, bringing your head forward and backwards (hold each stretch for 15s, repeat 2-3x)

• Strengthening of the deep neck flexor muscles and the postural muscles around the neck and shoulders are also important
• Some people have also found alternative therapies such as massage, acupuncture, acupressure to be helpful
  

Flat Feet (or Pes Planus)

Lately I have had quite a few people ask me about flat feet.

Flat feet (or pes planus), is a condition where the arch of the foot is collapsed. This results in the sole of the foot being in partial or complete contact with the ground surface. Flat feet may occur unilaterally (one side) or bilaterally (both sides).

Flat foot

It may be common for young children to have flat feet, as their skeleton and musculature are still developing. Infant flat feet usually resolve by itself over time and normal arches start to develop from 4 years of age and onto adolescence. It is however important to monitor your child's walking as time progresses, looking out for excessive clumsiness, odd patterns of walking, or complaints of heel/foot/lower leg pain.

Causes
Adult flat feet can be caused by a number of factors, including:

• Faulty lower limb biomechanics
• Incorrect walking/running/sporting techniques
• Poor footwear (regular use of flat ballet type shoes, high heels, shoes with no arch or improper sole)
• Prolonged stress/pressure to the foot
• Injury
• Pregnancy

It is common for people with flat feet to over-pronate their foot (roll inwards) as they walk, and also complain of plantar fasciitis (an inflammatory condition of the plantar fascia, causing heel pain most notable first thing in the morning). Some adults may have flat feet without any symptoms; however once symptoms present, it is important to seek a physiotherapist or podiatrist's advice to work out the source of the problem and be treated appropriately.

Treatment
Depending on the cause of flat feet, some treatment options include:

• Taping to support the arch and reduce pain
• Orthotics (does not have to be custom-made, chemist ones are equally as good and cheaper)
• Physiotherapy for strengthening and proprioceptive exercises to retrain the muscles of the foot and ankle
• Correction of lower limb biomechanics (require assessment of the knee/hip/pelvis by a physio to assist with rehabilitation)
• Correction of walking/running/sporting techniques (by sports trainer or physio)
• Improve footwear 

Orthotics

More questions?
If you have any further questions or would like to be referred to a specialised physiotherapist, contact us.

Are you worried about your child's headshape or torticollis?

Plagiocephaly is a condition characterised by flattening of the side of the skull, commonly caused by a positional head preference towards that particular side.

Brachiocephaly is a condition characterised by flattening of the back of the skull.

Scaphocephaly is a condition characterised by a disproportionately long and narrow skull.

Torticollis is commonly associated with head shape abnormalities, in particular plagiocephaly. Torticollis, or wry neck, is a condition which results in tightness and shortening of the sternocleidomastoid muscle of the neck. This is often characterised by a limited range of motion in both cervical rotation and lateral flexion. The head is typically tilted in lateral flexion down towards the affected muscle and rotated toward the opposite side.

Tips for managing early headshape abnormalities:

• Monitor your child for any positional head preference(s)
• If plagiocephaly, facilitate lying on the non-affected side (with rolled towel or pillow placed behind to support spine) under supervision or lying on the back (pressure on back of head, not side)
• If brachiocephaly, facilitate alternate lying on both sides (with rolled towel or pillow placed behind to support spine) under supervision
• Perform regular stretches to the neck (plagiocephaly: towards non-affected side; brachiocephaly: both sides)
• Encourage and facilitate active head turning to strengthen neck muscles
• Perform regular tummy time to strengthen neck muscles
• Sit up in 'Fraser Chair' or baby seat to reduce prolonged time lying down
 

TIPS for managing torticollis:

• Perform regular stretches to the neck (every care), moving in opposite directions to the tight muscle (tilt head sideways towards non-affected side, rotate towards affected side). Hold stretches for approx 15secs and repeat 2-3x.
• Encourage and facilitate active head turning to strengthen neck muscles
• Perform regular tummy time to strengthen neck muscles
• Sit up in 'Fraser Chair' or baby seat to reduce prolonged time lying down

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Physio Questions is designed to provide reliable and evidence-based answers to your questions regarding any injuries or conditions that you may have. We will also be regularly posting up educational material about common injuries and conditions in an easy-to-understand format. If you have any comments, questions or suggestions, please feel free to send us an enquiry on the Contact page.