Tag Archives: pregnancy exercise

abdominals in pregnancy

Should you work your abdominals in pregnancy?

What do you think?  Should you work your abdominals in pregnancy?  Or are they a no-go area?  And if so, what exercises are appropriate.

When I polled people about this recently I had a varied response but most tended towards yes you should, but gently.

My answer is… it depends.

It depends what you think of as the abdominal muscles.  For most people, it’s the ones you can see – the six pack muscles. The guidelines for these muscles (the rectus abdominis) is there should be no direct work on them after you reach the 12 weeks mark.

So that’s a no to these abdominals in pregnancy.  No crunches, sit ups, hanging knee lifts, or lying on your back with both legs lifted etc.

But the abdominals actually comprise of four sets of muscles and as a unit are essential in pregnancy as they support the spine, keeping it moving well, helping to maintain a good posture and minimising back pain.

The innermost set of muscles is the transverse abdominis. This is just one part of your core along with the pelvic floor, the back muscles and the diaphragm. So proper breathing, tied in with pelvic floor work, is also an essential part of core work – it’s never about the abdominals in isolation.

The best way to work the core in pregnancy – and postnatal and beyond – is with whole body, functional exercises.  The core should be stabilising the spine as you move your body.  So look at your posture when exercising.  Look at how you’re breathing (and if you’re breathing!)  Also look at how the exercise will serve you.  What’s the point of it?  Is a plank useful?  Or are there exercises that work your core in a functional way that also prepares you for your day-to-day activities?

For example, the exercise below uses a single heavy weight on one side to challenge the core to keep the spine stable by not leaning one way or the other.  Ideally ribs and hips should stay in alignment as you walk.  You should be breathing normally throughout the exercise.

It’s also great practice for when carrying a car seat or heavy shopping bags!

Farmers carry in pregnancy

How you can help your pelvic floor

I was asked by someone this week about rehabbing the pelvic floor post birth, in preparation for getting back to running.  I was so pleased that she was aware of the importance of taking her time – things keep popping up in my timeline about postnatal classes where people are running with buggies, skipping and even doing jumping jacks! All of this can have a deleterious effect on the pelvic floor and continuing to overstress a weakened pelvic floor can lead to prolapse.

However taking your time, making a few lifestyle changes and building up core strength can mean that even if you’re currently experiencing pelvic floor dysfunction (any leaking, back pain, heaviness in the pelvis) you may be able to get back to your previous exercise routine.

I prolapsed after my first child and was given very little advice about it other than being told I would probably need a hysterectomy when I go through menopause.  Because of this experience I have spent my time learning more and applying it to my own life as well as in my work with others.

First thing I implemented was no impact.

As someone who wasn’t a runner, this wasn’t a big change.  But I did have to stop jumping around in my aerobics classes and also give my trampette a wide berth…!  I can now run for the bus without worrying and I played rounders in the summer where I was sprinting for quite a while with no effect.  So I could probably run now if I wanted to but I’m still choosing to stay low impact most of the time.

Second thing was no crunches

The downward pressure created by crunches/sit-ups will push on the pelvic floor.  Full planks and press-ups and exercises with both legs lifted also creates a lot of pressure and so I avoided them.  However there are alternatives – for example in press-ups performing them on an incline, plus incorporating crunchless core exercises – so there is no reason to stop exercising, just make a few changes.  Bear in mind that sitting straight up in bed is also a crunch (and how many times do you do that a night?) – I roll over to get out of bed instead.

It’s not all about what you shouldn’t do though. There are things that I needed to start doing:

  • alignment/posture

particularly the with respect to the pelvis.  Try tucking your tailbone under and bringing your hips towards your ribs.  Lift the pelvic floor now.  Then take your hips away from your ribs, allowing your lower back to arch more, then lift the pelvic floor.  Then bring yourself to a neutral pelvis where your level through the front and the back of the pelvis (think of it like a bowl) – the pelvic floor lift should feel easier in this position.  Pelvic floor works best when we are in alignment, with the head, shoulders, rib cage, pelvis and heels all stacked up in line

  • breathing

both looking at how you breathe during exercise and from day to day.  During exercises you need to breathe out on the effort and lift pelvic floor at the same time.  This also applies when you are lifting a weight – baby, shopping etc. – and also when you go from seated to standing (The knack – as you go from sit to stand but vice versa too).  The other aspect of breathing is to stop breath holding and sucking your stomach in.  When you breathe in your stomach should actually swell not suck in.  I see so many people who’s stomachs stay still when breathing and instead their shoulders lift.  Try lying on your back with your knees bent, feet flat on the floor.  Put one hand on your chest and one hand on your stomach.  As you breathe in you should feel your chest move first then your stomach.  Your stomach lowers as you breathe out and then your chest.

All these changes I’ve made have meant that my prolapse has improved and I’m hoping to avoid that hysterectomy!  I know that there’s still work to do and I’m currently learning more about another part of the puzzle:

  • relaxation

stress can affect the pelvic floor, there’s also some evidence that lower limb injuries and back injuries will impact the pelvic floor too, even years after healing or the pain has stopped. There may also be scar tissue from episiotomies or tears.  I’ve just learnt some trigger point release for that – sitting on one of the spiky balls!  It’s uncomfortable but definitely has an effect – I will let you know how that goes!  And it’s also helped to introduce deep breathing, mindfulness and relaxation practices into my daily life.

 

So when looking at rehabbing the pelvic floor, it’s not just about a list of exercises to do – we need to think of the body as a whole and the pelvis at the centre of that, and looking at improving in all these areas

Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP) is a secretive, not often talked about thing.  And yet last week every single day I ended up speaking with people about their prolapse so it just seemed destined that that is what I would write about today!

Prolapse is the descent of one or more internal organs that then push into the vaginal wall.  There are different stages – mild, moderate to extending outside the body.  There are many symptoms, many of which could be attributed to other ailments.

  • Urinary incontinence or urine retention – feeling of never fully emptying bladder
  • Constipation or faecal incontinence
  • Feeling of dragging, like your insides are falling out or heaviness/ache in rectum/vagina
  • Lump or bulge in vagina
  • Inability to hold a tampon in
  • Lower back or pelvis pain
  • Vaginal/rectal pain
  • Painful intercourse/lack of sensation
  • Leakage of urine/stool during sex

The earlier prolapse is discovered the better as there are preventative measures – surgery can be avoided or its severity lessened.  They will also help post-surgery.  Typically one prolapse can lead to another unless steps are taken to prevent this.  Understanding more about how it occurs can also help prevent it.

Causes of prolapse are many and varied

  • Childbirth – 50% of all women who have given birth will prolapse
  • Menopause and age related drop in oestrogen levels
  • Chronic constipation
  • Chronic coughing
  • Obesity
  • Genetics
  • Neuromuscular conditions
  • Heavy lifting
  • Diastasis recti
  • High impact aerobic activities – running, jogging, high impact aerobics

It’s worth noting though that POP doesn’t happen overnight – typically many factors over a number of years will build up to cause it.  What’s crucial is intra-abdominal pressure – the build up of this results in bearing down on the pelvic floor. It’s a necessary bodily phenomenon – without it we couldn’t poo – but if there’s a constant downward pressure it can be more than the pelvic floor can cope with.

And this is where the knack comes in.  By mindfully contracting the pelvic floor before we stand, lift, cough, sneeze etc. we prepare for the force to come.  Practicing the connection with your outbreath and your pelvic floor contraction can retrain the body and help it to do it’s job.

Other things to bear in mind

  • Weight control – particularly the amount of abdominal fat you’re carrying
  • Lifting technique – never hold your breath.  Always exhale on exertion and lift pelvic floor
  • Toilet technique – no straining.  Try to have feet on a stool (2 toilet rolls will do) to raise knees above hips.   Vocalising can also help!
  • Exercise – pelvic floor safe exercises for those with a weak pelvic floor, prolapse or have had gynaecological surgery. Gentle Pilates. Core strength and pelvic floor activation. Exercises to avoid – crunches, double leg lifts, full plank position, high impact sports. Ultimately you need to decide what to stop and what to continue with – you can get support for exercise, from supportive shorts to sea sponges and pessaries.

For more information and support see the APOPS website at www.pelvicorganprolapse.support.org.  They also have a private Facebook group – pelvic organ prolapse.  Also Pelvic Floor First at www.pelvicfloorfirst.org.au

Good books – Sherrie Palm, The Silent Epidemic and Sue Coult, Pelvic Floor Essentials.  I have copies if anyone would like to borrow them

Get a kegel app for your phone – lots of free ones but the one most recommended by women’s health physiotherapists is the NHS Squeezy app

And as they say on Channel 4 – “if you have been affected by this” please feel free to get in touch.  I would be glad to give any help and advice.

The Knack – pelvic floor health

Do you sneeze wee? You need the Knack!

Do you sneeze wee? You need the Knack!

I was listening to an interview with acclaimed women’s health physiotherapist Michelle Lyons last week and was surprised to learn that going from seated to standing puts more pressure through the pelvic floor than lifting a 20lb weight! Bearing down on the pelvic floor that many times throughout a day could lead to, or worsen, pelvic floor disorders – such as incontinence and prolapse.

I have been working on correct standing technique with my pregnancy class for a while now but changed the emphasis last week and gave ‘the Knack’ to them as homework.  Now it’s your turn to practice daily! This is not just for pre and postnatal women – 40-70% of ALL WOMEN have incontinence and 50% of women who have given birth will develop prolapses.  These are stats worth avoiding!!  The Knack is a preventative measure to be used throughout our lifetime.

How to do it

1.  Sit at the edge of your chair, up on your sit bones, heels in line with your knees.

2.  Breathe in.  As you breathe out allow your pelvic floor to relax.

3.  Breathe in.  As you breathe out think of drawing your pelvic floor in and up.

4.  Continue breathing out and lifting the pelvic floor as you stand up.

5.  Once standing, allow the pelvic floor to relax.

You can see a video of me showing the knack here

At first try to practise this standing up after every visit to the loo.  Once you get used to it start to introduce the Knack every time you stand up from a chair.  Keep practising until it becomes second nature.  I’m still practising!