physical therapy & exercise - fit-n-wise...yourself to get up and exercise due to the increased...

Physical Therapy & Exercise

D U R I N G P R E G N A N C Y

W O M E N ’ S H E A LT HFIT-N-WISE

www.Fit-N-Wise.com

Pregnancy & Physical Therapy

Physical therapy during and after pregnancy can prove to be useful for remedying common discomforts associated with this wonderful time in your life. Back pain ails more than 50% of all pregnant women and although the reasons vary, pain is usually the result of:

• An increase in hormones• A change in the body’s center of gravity• Gaining additional weight• A decline in posture• Added stress in life

Women searching for ways to live with the pain day to day might be surprised to know that physical therapy can impact the majority of these factors. With manual techniques and a program designed specifically for you, relief can be close at hand.

Physical therapy is a medically-based profession specializing in the relief of pain. Physical therapists work closely with you to develop a plan specific to your pain by identifying and addressing its causes. They work to find whether your pain is being caused by posture, joint alignment, muscle strength, flexibility or nerve involvement. The use of aquatic physical therapy has been shown to allow for the same intensity of land exercise with the benefits of a lower heart rate and decreased swelling. Physical therapists will recommend or provide exercise, manual techniques including joint mobilizations and massage, cold and heat treatment, belts or supports, relaxation techniques, instruction in body mechanics and postural education.

While no treatment is able to prevent all pain associated with pregnancy, with the addition of physical therapy, the progression of pain can be reduced greatly. Common ailments that physical therapy can help are:

• Neck and Upper back pain• Numbness, tingling, or pain in the arms or legs• Carpal Tunnel Syndrome• Rib pain• Low back pain• Sacro iliac (SI) pain• Sciatica• Pubic bone pain• Coccyx or tailbone pain• Incontinence • Swelling in the legs or feet• Foot pain

The addition of physical therapy and home exercise has many benefits for the expectant mother. These benefits include:

• A decreased risk of low back and pelvic pain• Prevention of preeclampsia• Easier labor and recovery period• Strength and flexibility improvements• An improvement in pelvic floor strength

Is the pain permanent?Most of the time, back pain during pregnancy resolves

on its own; however, in those with moderate to severe low back pain, it can continue into the postpartum period. It has been estimated that up to 70% of those with moderate to severe back pain continue to have pain after delivery. The quicker problems are resolved, the easier they are to fix. Don’t live with the pain!

Not only can physical therapy help the expectant mother, but it can also help new mothers recover from the effects of pregnancy and labor and delivery. Due to the continued circulation of hormones, added stress and the physical toll labor takes on women, many new moms find themselves having pain even after pregnancy. Those women can find relief by visiting with a physical therapist. In addition to looking at musculo skeletal dysfunction including upper and lower back pain, physical therapy can help with pelvic floor pain due to muscular dysfunction or episiotomy/tearing, pain associated with c-section scar, urinary or fecal incontinence, pelvic floor weakness and uterine prolapse.

Back pain ails more than 50% of all

pregnant women.

Exercise & Pregnancy

Exercise is important to both the pregnant and non pregnant population. It may be difficult to motivate yourself to get up and exercise due to the increased fatigue, low back pain, and excess swelling, but if you can, there are many benefits. Staying active is healthy and safe for most pregnant women. Before exercising it is important to consult your physician to make sure it is appropriate for you.

Benefits of Exercise:• Improvement in overall maternal fitness and well- being• Regular exercise has been shown to improve placental growth and function• Improvement in cardiovascular health for the mother• Treatment for preeclampsia and gestational diabetes• Increase in energy• Improvement in sleep quality• Shorter time and less exhaustion in labor• Needing fewer medical interventions during labor• Less likely to gain excess weight

Guidelines for exercise during pregnancy for a healthy woman

• Perform exercise at a regular, moderate intensity and duration• Exercise at least 3 times per week is preferred to intermittent activity• Recommended exercises include: stretching, stationary cycling, swimming, and walking• Avoid jerky, bouncy, and wide range of motion movements and exercises that involve straining, jumping, or sudden changes in direction• Avoid exercise that has the potential for even mild abdominal trauma• Avoid exercise that is performed flat on your back after the 1st trimester• Heart rate should not exceed 140 beats per minute• Stop exercise when you become fatigued and consult a physician if any unusual symptoms occur

Reasons to stop physical activity and consult your health care provider:

• Excessive shortness of breath• Chest pain• Painful uterine contractions (more than 6–8 per hour)• Vaginal bleeding• Any “gush” of fluid from vagina (suggesting premature rupture of the membranes)• Dizziness or faintness

Contraindications to Exercise• Pregnancy induced hypertension• Ruptured membranes• History of premature labor• Persistent bleeding after 12 weeks• Incompetent cervix• Poor fetal growth• Multiple birth pregnancy• History of 3 or more miscarriages

Exercises to Avoid During PregnancyExercises that make the diastasis recti (the separation of the belly muscles) worse are any movements that require the rectus abdominus (the long muscle in the front of your stomach) to contract strongly against gravity. When the rectus is asked to contract strongly, if the integrity of the muscle is lost, the two halves of the muscle will shorten and contract as two separate units with each half moving laterally. This, in turn, opens the separation further. Precautions need to be taken during any supine exercises that involve lifting the head and shoulders off the ground or lifting both lower extremities off the ground, as well as during plank or push-up positions.

Safe Pregnancy TrainingSafe abdominal strengthening during pregnancy should look deeper than the rectus and focus on training of the internal obliques and the transversus abdominus (TVA). Training of the TVA is particularly beneficial because contraction of the TVA directly supports the uterus, and a well toned TVA will help keep the rectus halves closer together and prevent the diastasis from opening excessively. Therefore, TVA training can reduce the size of the diastasis. In addition, training the TVA also helps women prepare for delivery, as one of the roles of this muscle is to assist during forceful expiration (i.e. pushing).

Gentle abdominal exercises—such as knee folds, heel slides, pelvic tilts and head lifts—are acceptable and are often much more challenging than one would expect as the abdominal muscles are becoming increasingly weakened.

General Pregnancy Body MechanicsGeneral Pregnancy Body MechanicsGeneral Pregnancy Body MechanicsIf you have specific questions about unique situations, consult a physical therapist to learn more about the best posture and body mechanics.

Neutral Standing Posture• Stand with feet shoulder width apart• Balance your weight over the middle of your feet• Keep your knees soft – not locked• Rest your shoulder blades down and back• Don’t let your stomach sag forward, keeping a neutral spine• Gently drop chin down

General Pregnancy Body Mechanics If you have specific questions about unique situations, consult a physical therapist to learn more about the best posture and body mechanics.

Neutral Standing Posture

• Stand with feet shoulder width apart • Balance your weight over the middle of your feet. • Keep your knees soft – not locked. • Rest your shoulder blades down and back • Don’t let your stomach sag forward, keeping a neutral spine • Gently drop chin down

Neutral Bending “Hip Hinge”

• Do not allow your low back to bend • Bend your knees and hips. • Perform abdominal brace. • Keep your weight centered over your feet • Push down through your legs to lift your

body • Don’t use your back to pull the weight up













Neutral Bending “Hip Hinge”• Do not allow your low back to bend • Bend your knees and hips• Perform abdominal brace• Keep your weight centered over your feet • Push down through your legs to lift your body• Don’t use your back to pull the weight up

Nutrition During Pregnancy

Pregnancy Exercise Program

Yoga Stretch• Stand feet together and back straight• Take a deep breath in and bend forward at the waist, keeping back straight• Relax into position with hips square• Hold for 8 deep breaths

Progression• Stand with feet staggered• Follow the steps above• Repeat with other leg forward

Increase stretch by lowering surface

Cat & Camel• Get on hands and knees• Breathe in and arch back up• Breathe out and let back arch down• Repeat 20 times

Fit-N-Wise strongly recommends that you consult with your physician before beginning any pregnancy exercise program. You should understand that when participating in any exercise or exercise program, there is the possibility of physical injury. If you engage in this exercise or exercise program, you agree that you do so at your own risk, are voluntarily participating in these activities, assume all risk of injury to yourself, and agree to release and discharge Fit-N-Wise from any and all claims or causes of action, known or unknown.


Lunge & Overhead Press• Place right foot in front of left foot• Lunge forward, keeping your right knee over your right heel• At the same time, press light weights over your head• Return to starting position• Repeat with left leg forward

Perform 3 sets of 10 on each leg

Abdominal Brace Kegal Exercise• Lie in a slightly elevated position• Breathe in and relax• Breathe out and gently pull abdominal muscles up and in• While performing brace, draw pelvic floor up• Hold 5-10 seconds• Breathe in and relax• Repeat 10 times

ProgressionMove to seated and standing positions

Deep Squat/Hip Opener• Get into a deep squat position• You may use your elbows to gently push your knees outward as is comfortable• Hold for 10 seconds, repeat 10 times

Reminder: Don’t let your knees fall past your toes to help prevent knee pain


Pelvic Openers• Sit with heels together• Use a towel or belt to help hold your heels as close to your pelvis as is comfortable• Let the inside of your hips gently stretch as you let your knees fall towards the floor• Hold for 8 to 10 breaths

Progression• Lean back onto a pillow or bolster in order to open your chest • Let the inside of your hips gently stretch as you let your knees fall to the floor• Hold for 8 to 10 breaths, up to 1 minute

Squat & Bicep Curl• Stand with knees slightly bent, toes turned outward• Using light weights, bend your knees as you perform a bicep curl• Keep back straight as you perform the squat• Repeat 3 sets of 15

Reminder: Don’t let your knees fall past your toes to help prevent knee pain

Wise Regional Health System940-626-1360

609 Medical Center DrDecatur, TX 76234

physical therapy & exercise - fit-n-wise...yourself to get up and exercise due to the increased...

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