By Tegan Johnson-Galvez, DPT, CCI, CSCS and Amy Lee, SPT
With pregnancy, women experience many changes to her body whether it’s physically or physiologically. For example, with approximately 25-30 lb. weight gain, the female body begins to produce various pregnancy hormones, such as the relaxin. Relaxin increases the elasticity of ligaments around the pelvic as well as other areas to accommodate for the pregnancy. As the women enter further into her trimester, their center of gravity shifts which can cause an increase in the lower back curve thus putting excessive strain on the sacroiliac joints and ligaments. Generally, our sacroiliac joints are very stable but the shift in the body’s center as well as the production of pregnancy hormones can alter the laxity of the joints causing pain.
Diastasis Rectus Abdominis
Another common occurring during pregnancy is Diastasis Rectus Abdominis (DRA). Rectus abdominis is a muscle in our body that attaches from our sternum and rib cage all the way down to our pubic bone. DRA is the separation of the rectus abdominis at the midline which is not an indication of a muscle tear nor a lesion. It is simply a separation of the connective tissue fibers that are able to come back together. You can check the width of separation by placing your fingers 4 cm from the belly button. Lift your head and if the width is two fingers or less, it is normal.
Exercise During Pregnancy
Exercise is an important component during pregnancy. According to Department of Health and Human Services, 50 minutes of exercise is recommended with moderate intensity. There is no heart rate restriction but it is not the time to pick up new cardio program. It is advised to avoid supine exercises during the first trimester due to the possible pressure of the enlarged uterus and the fetus on the inferior vena cava.
Examples of exercises you can perform are:
❏ Squats with variation
❏ You can hold a dumbbell for weighted intensity
❏ Lean on a swiss ball against the wall to go into a squat
*Use the counter for assistance as you progress through your pregnancy
*Keep the core engaged
*Lower yourself slowly so that your bottom is last to touch
❏ Standing Rows with Resistance Band
❏ Abdominal Crunch
❏ You may “splint” the abdominal wall with a towel to provide additional support to the linea alba to prevent further diastasis rectus abdominis.
Remember to stretch throughout your pregnancy in addition to the above exercises.
Post Natal Exercise
Wait approximately 6-8 weeks before returning to exercise after pregnancy. You can start pelvic floor exercises immediately to help prevent stress incontinence (ie. kegels exercise). Pregnancy hormones affect you over 6 months after birth, so avoid high impact exercise during this period.
It is important to maintain good body mechanics and posture during and even after pregnancy to prevent injuries. Here are several tips regarding post-natal ergonomics:
Carrying the Baby
❏ Carry the baby at the center of your body
❏ Helps keep your center of balance
❏ Reduces strain on your back
❏ Do NOT carry your baby on your side with your hips out
❏ Table height should be slightly below elbows
❏ Place all necessary diaper materials within arm’s reach
❏ Place one leg on stool to relieve strain on low back
Car Seat Carry
❏ Always use two hands
❏ Keep infant carrier close to body
❏ Prop one foot on the floor of the car to reduce reaching
❏ For large vehicle, prop knee onto seat
❏ Brace abdominal muscle!!
❏ Don’t bend or twist spine too much
❏ Adjustable handles are recommended
❏ Elbows slightly bent and shoulders relaxed
❏ Keep wrist straight
❏ Pull shoulders down and back
❏ Lead with chest with stroller close to body
Blocked Milk Ducts
When milk gets backed up, the duct can become swollen and inflamed causing a blockage. It may typically mean the breasts are not getting emptied regularly. If you are also stressed, it can lead to decreased production of oxytocin which is what helps produce milk.
❏ Small, hard lump that are sore/tender to touch
❏ Relief of symptoms after breast feeding
You can treat this through frequent pumping, breast massage, anti-inflammatory meds, or contacting your local lactation specialist at: www.ilca.org/home
About the Author:
Tegan encourages her patients to incorporate their rehabilitation and fitness goals into their daily activities. Tegan uses a multitude of treatment techniques including but not limited to manual therapy, Pilates-based exercise, therapeutic exercise, manual lymphatic drainage, multi-layered bandaging, taping techniques, custom orthotic evaluation, habituation exercises, gait training, sports specific injury prevention, and postural education. At home, Tegan is a wife and mother of three very active and healthy children.
Specialties include: General Orthopedic, TMJ Dysfunction, Vestibular and Lymphedema Care.
Professional Honors and Credentials: Credentialed Clinical Instructor, Member of the American Physical Therapy Association (APTA)
Amy is a student at University of St. Augustine in San Marcos, CA who will be receiving her Doctorate of Physical Therapy in Dec of 2017. During her time in school, she worked as a student physical therapist in various rehabilitation settings including skilled nursing facility, workers’ compensation, and an outpatient orhopedic. When she is not busy studying for school, she enjoys outdoor rock climbing and looking up new recipes for baking.