When it comes to movement and exercise, women frequently have two concerns during and immediately following pregnancy – managing low back pain and performing the correct amount and type of exercises.
Managing low back pain
Physical therapists are educated to help patients overcome injuries to muscles, ligaments and bones. Many injuries can happen in these structures during and after pregnancy due to naturally occurring changes in the body.
- Weight gain from the pregnancy changes your posture by increasing the curve in your low back (lumbar lordosis). It also increases stress on your back, hip and knee joints. Education regarding correct sitting and standing postures can help decrease stress on your neck, back, shoulders and legs, thus decreasing pain in these areas. It is much easier to achieve correct postural alignment for various activities around the house before the baby arrives than after he or she gets here!
- The increased curve in your low back contributes to the very high prevalence of low back pain in pregnant women (Borg-Stein & Dugan, 2007). Physical therapists have manual skills that can correct misaligned bones in the spine and pelvis during pregnancy and decrease lumbar and sacroiliac pain.
- Because of the hormonal changes involved in preparing the pelvic opening for delivery, ligaments and joints loosen during pregnancy. This decreases the stability of the pelvis and is a precursor for injury. A physical therapist can instruct patients in exercises to improve pelvic stability.
- Factors which may lead to persistent low back pain postpartum include; low endurance of stomach muscles, older age and pain in early pregnancy (Gutke, Ostgaard & Oberg, 2008).
Although most back and pelvic pain will disappear after one to three months, 37% of women continue to have pain that lasts beyond the post partum period, often developing into chronic pain (Rochetti, Vleeming & van Wingerden, 2008)
. Addressing orthopedic problems with physical therapy early during pregnancy through exercise, education and manual skills may prevent development of long-term problems.
A study by Norman, Sherburn, Osborne and Galea (2012)
found that physical therapy exercise and education prenatally also has been shown to improve the well being of new mothers. The participants in this study significantly improved in well being scores and depressive symptoms at eight weeks and this was maintained for four weeks after completion of the program.
Performing the correct amount and type of exercises
The recommendation is an accumulation of 30 minutes of exercise on most, if not all, days of the week. Pregnant women who were sedentary before pregnancy should follow a gradual progression up to 30 minutes a day.
Dynamic lumbar muscle stabilization exercises are used to strengthen the core and should be part of a home exercise program. Normal flexibility needs to be maintained, but exercises should be individualized and modified appropriately to accommodate for the increased looseness of structures that occur during pregnancy.
Water exercise has been found to be a safe activity with advantageous effects on swelling, body temperature and unweighting your body, otherwise known as buoyancy (Berry, Katz & McMurray, 1989)
. Unweighting your body in the water, thus decreasing stress on the joints, is a safe and enjoyable exercise option.
As women get back into running post partum, we are learning that running patterns and pelvis movements may need to be evaluated and modified to be more efficient and less stressful on joints.
Additional exercise tips:
- Perceived exertion has been helpful in monitoring the intensity of exercise in pregnancy. Exertion should be described as “somewhat hard.”
- Exercise should be performed in a temperature-controlled environment (air conditioned in the summer).
- Dietary concerns and hydration always have to be considered during an exercise program, especially during pregnancy.
- Exercising in 15-minute intervals has been recommended to prevent concerns about over heating with exercise during pregnancy.
- Activities which increase the chance of falling should be avoided.
- Always check with your obstetrician before beginning an exercise program if you are pregnant.
A physical therapist can assist with making pregnancy and the transition to motherhood a more enjoyable experience. Pregnancy should not be a time of confinement and women with uncomplicated pregnancies are encouraged to continue to exercise for their mental and physical well being! ■
For more information contact:
Deborah W. Marchese, PT, DPT
Sheltering Arms - Hull Street