Warmup
3 min: Breathing
3 rounds:
5 per side shinbox
5 per side shoulder tap
Core
3 rounds:
5 per side heel slide
5 per side heel tap
Pushup
3 rounds, 8 reps
Rest 60 seconds between rounds
Note: Pushup to wall or other elevated surface
Workout
3 rounds:
8 standing banded row
8 box squat
5 per side step-up
Cooldown
2 rounds:
5 wall angels
Relax:
1 min child’s pose
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During pregnancy, your usual energy level may take a dip at times, especially as your body adapts to hormonal shifts and increased body weight. Sometimes you may feel like lying on the couch all day, but inactivity can increase your fatigue. Try the following tips to help boost your energy level on those days that you’re feeling tired.
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A Women’s Health Physical Therapist (WHPT) is a licensed healthcare clinician trained to evaluate and treat neuromuscular conditions related to pregnancy, postpartum, incontinence, and pain. We commit ourselves to learning and caring for women in all phases of life.
PRENATAL/PREGNANCY
Your body is supporting and growing a child. It is essential you are at your best in order to carry to term, deliver, and care for this life. A WHPT understands the needs of women and the changes that occur during pregnancy, labor and delivery, and postpartum. During pregnancy a WHPT can help address the pains associated with your changing body. These include but are not limited to lower back pain, , pelvic pain/pressure, neck/shoulder pain, bladder and bowel issues (leaking, constipation), and abdominal wall concerns (e.g. diastasis recti). Although many attribute these as “normal” conditions, these are issues that are not normal but ARE manageable and treatable! A women’s health specialist can improve your quality of life through the pregnancy, prepare you for delivery, and prepare you to care for your new baby postpartum
POSTPARTUM
You have taken care of yourself to deliver your baby. Now, let’s talk about how to take care of you! Your body has changed over the last 9 months and will continue to change over the next 6-18 months. While many physical changes are very common after pregnancy and delivery (for example, leaking urine), they are not normal and you do not have to live with them! Urinary incontinence (leaking urine for any reason) is considered normal for 2 weeks after delivery, as well as some pelvic heaviness and pressure (prolapse).
If these problems persist after 2 weeks, a WHPT can help with exercises and lifestyle/behavioral modifications to reduce and potentially reverse your issues. They can also help with the aches and pains associated with childcare activities including: neck and back pain, wrist and hand pain, prolonged or painful postures, and/or numbness and tingling in arms, legs, or pelvic area. Other issues that can occur are diastasis recti (separation of abdominal muscle), swelling in the legs or pelvis, and pelvic pain with vaginal penetration. It is important to address these problems early so you may return to your previous activity level and care for your baby without interference or pain.
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What is your pelvic floor?
Your pelvic floor is a group of muscles, ligaments, and tissues running from your pubic bone to your tail bone that supports your pelvic organs, bladder, uterus, and bowel. If you think about your pelvis as a bowl, the pelvic floor is the bottom of the bowl.
Why is it important?
Maintaining an appropriate level of tension in the pelvic floor allows you to have the support necessary to hold up the pelvic organs while also allowing the relaxation necessary for urination, bowl movements, and painful sex.
Common pelvic floor disorder symptoms:
Pregnancy naturally places an increased demand and pressure on the pelvic floor. Tendencies such as breath holding, prolonged postures or alignment, bearing down into the pelvic floor, muscle tension, and constipation may also increase your risk for pelvic floor disorders at this time. Because of this, it is important for you to be aware of your daily tendencies as well as strategies during exercise in order to reduce your risk of pelvic floor symptoms during pregnancy and after delivery.
If you are unaware of your current tendencies, please seek out a Pelvic Floor Physical Therapist or a qualified pregnancy and postpartum fitness specialist to help you understand your movement patterns more during this time.
Casey Thomas-Hardesty, MS, NTP // Two Peas Wellness
© WKU {2022} All rights reserved.
**link article to WHPT article
What is diastasis recti?
Diastasis recti, or Diastasis Rectus Abdominus (DRA), refers to the spreading and thinning of the fascia (fancy word for connective tissue) between the two sides of your rectus abdominis (6-pack ab muscles). One result of this is a widening of the distance between the 2 sides of the muscle. Having an increase in this distance alone does NOT mean that you have a DRA. The goal is to have good tension in that tissue during movement, meaning it has good bounce back when you press on it. Previously it was thought that the distance between the muscles should be less than or equal to 2 finger widths but this has more recently been called into question. You can have good tension and more than 2 finger width (functional diastasis), less tension and 2 finger width, or less tension and more than 2 finger width. A diastasis recti is generally not dangerous and not pathologic. It is a term simply describing how the tissues of the belly feel and how they are performing. It can occur at 3 different locations: above the belly button (most common), at the belly button, and/or below the belly button (least common).
Will your OBGYN check you for this at your postpartum visit?
Checking for diastasis recti is not a normal part of a postpartum exam and outside of the scope of treatment for your OBGYN beyond surgical intervention. Many other testing and treatment options exist. A visit with a qualified pelvic floor physical therapist early postpartum is recommended for a thorough check of both your core and pelvic floor.
Do only postpartum women get diastasis?
No. Diastasis is a pressure management issue on the tissue where continued outward pressure has stretched the linea alba. This can happen in pregnant women, in women pre-pregnancy, and even men. Pregnancy does increase your risk of an increase in the distance between the two sides of the 6-pack muscles due to the expanded outward pressure on the midline of the stomach. Learning your breathing and pressure tendencies as early as possible during pregnancy can help you reduce your risk and prevent symptoms.
What are some symptoms of diastasis?
– Coning vs doming – Does your stomach come to a point down the middle when doing a movement like a sit-up or push-up (coning) or does the whole abdomen seem to protrude out like a loaf of bread (doming)? Some clinicians do not differentiate between the two, some do. Doming is not indicative of DRA. Coning during movement and exercise can indicate that a DRA is present, but if it is soft when you press into it and you do not have symptoms (abdominal and/or pelvic pain, pelvic pressure, urinary leakage) then this is likely not a problem and not a reason to stop exercising.
– Is there a gap? How is the tension? – Yes, the distance between the two sides of the 6-pack muscle can be measured with a variety of tools, but the tension of the fascia of the linea alba is just as, if not more important.
Breaking up some diastasis myths:
– MYTH: You have to close the gap.
Width of the gap isn’t the end all be all in terms of function. Can you approximate, or close, the rectus with different strategies? Have you built back up your strength and tension where these strategies are automatic responses for your movement? If you have built back tension and can control symptoms, the gap may not matter.
This one is important. While not everyone woman will develop a DRA, there is no data that shows diastasis recti can be prevented. You can, however, look at movement and breathing strategies, as well as other techniques to help decrease the pressure on the linea alba (especially during pregnancy).
-MYTH: DRA is dangerous and pathologic
In some studies, up to 100% of women have an increase in the distance between the sides of their six-pack muscle by the third trimester. This can be a helpful normal anatomic response to pregnancy to create more space for the baby and the growing uterus. This increase in distance, by itself, is not DRA and is not pathologic. It can be absolutely safe to move if a healthcare provider tells you that you have a DRA. If, however, you have symptoms of abdominal pain, urinary leakage, vaginal pressure/heaviness, or bowel symptoms, while exercising it would be beneficial to see pelvic health physical therapist to help you keep moving without symptoms. Motion is lotion!
– MYTH: Surgery is the only way to fix diastasis recti.
It’s one way. However, many people are able to work with a qualified coach or pelvic floor physical therapist to gain better core connection and pressure management strategies to help rehab a diastasis. Even if surgery is scheduled, this can be an invaluable step beforehand.
– MYTH: There are specific exercises to help you fix or close a diastasis.
There is no specific exercise or combination of exercises to close, repair, or heal diastasis recti. Any exercise can be an exercise for DRA. Diastasis recti is a multi-factorial issue which takes an individual and multifaceted approach. Core connection, pressure management strategies, and progressive overloading tailored to you is what is best.
Casey Thomas-Hardesty, MS, NTP // Two Peas Wellness; Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA
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The American College of Obstetricians (ACOG) states “Women who begin their pregnancy with a healthy lifestyle (eg, exercise, good nutrition, nonsmoking) should be encouraged to maintain those healthy habits. Women who do not have healthy lifestyles should be encouraged to view the prepregnancy period and pregnancy as opportunities to embrace healthier routines.” ACOG also states that benefits of exercise during pregnancy far outweigh the risks. You should feel encouraged to become or stay active to help you and your baby have a successful pregnancy and delivery!
That said, what are the safest activities, especially if you are getting started?
Below is a list of exercise modes that have been extensively studied and found to be both SAFE and BENEFICIAL!
Modified from Berghella V, Saccone G. Exercise in pregnancy! Am J Obstet Gynecol 2017;216:335–7.
Physical Activity and Exercise During Pregnancy and the Postpartum Period: ACOG Committee Opinion, Number 804. Obstet Gynecol. 2020;135(4):e178-e188.
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Exercise isn’t an all or nothing situation. Although you may not always be able to fit in a gym visit or run into your day, you can easily up your physical activity levels by incorporating these simple tips into your daily routine.
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As your pregnancy progresses and you move into your second trimester, you may start to experience a lower tummy tugging sensation with movement or burning sensation in your labia (the outer lips of the vulva). Typically, this discomfort is caused by your round ligaments being stretched and can vary between mildly uncomfortable to a sharp pain that spans from your lower belly to groin.
Your round ligaments are a key support for your uterus, spanning from each side of your uterus down to your pelvis. As your baby grows, tension is increased on the ligaments as they stretch. Activities that cause an up and down motion on your belly (such as running or walking) or fast movement to the side or raising upright can result in the ligament pain, especially during your baby’s growth spurts.
Round ligament pain is common during pregnancy, especially in later pregnancy, but there are ways to ease the discomfort and reduce the amount and frequency of pain. Keep in mind that if you experience abdominal pain that doesn’t ease with rest, is sustained, or becomes increasingly severe, contact your healthcare provider.
Tips for easing round ligament pain:
References
Chaudhry, S. R., & Chaudhry, K. (2018, December 15). Anatomy, abdomen and pelvis, uterus round ligament
https://www.ncbi.nlm.nih.gov/books/NBK499970/Tobah, Y. B. (2018, April 18). What causes round ligament pain during pregnancy?
https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/expert-answers/round-ligament-pain/faq-20380879h
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If you had a cesarean section or an episiotomy or vaginal tear during labor and delivery, the resulting scar tissue might become uncomfortable as it heals. As the scar heals, it can form adhesions (the layers of tissue bind tightly together) to underlying tissues, causing pain and soreness at the site. Over time, if the scar becomes tight and thick, it may make intercourse, elimination, and insertion of a tampon, menstrual cup, or diaphragm painful.
Once your scar is fully healed (no redness, scabbing or drainage) and the stitches removed or dissolved, you can use this simple technique to help prevent scar adhesions from developing. The method uses massage to help keep the tissues below the scar from sticking together and will help the skin maintain elasticity and may even improve the appearance of the scar tissue.
If you’re experiencing continuing symptoms of decreased scar mobility, such as continued pain at the scar with movement, discomfort with intercourse, or tampon or diaphragm insertion, ask your healthcare provider for a referral to a physical therapist who specializes in women’s health.
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After the arrival of your new baby, it is often very difficult to maintain or increase physical activity levels. There is a lot going on including a lack of sleep and a lack of consistent routines. Be easy on yourself- you are learning a new normal! During the first 4-8 weeks (and beyond for some women), your body is recovering from labor and delivery. It is important to allow your body time to heal before jumping back into an exercise routine. That said, even during the early weeks, gentle stretching, pelvic floor exercises, and walking can be safe and helpful! Some women are able to resume physical activities such as these within days of delivery. Sitting for long periods of time may make you feel worse! You should resume physical activities gradually as soon as you feel able! For some that may be days, for others, weeks. Talk to your doctor and pay attention to what your body is experiencing. If something hurts or is uncomfortable, do not do it. If an exercise makes you feel good, you should feel encouraged to do it. Exercise during and after pregnancy can help your recovery! Depending on the time of year, a great way to get exercise can be to take a walk with your baby. He/she will enjoy the fresh air, and so will you!
So maybe we have you convinced to be active during postpartum, but you are worried about how exercise during pregnancy could impact your ability to breastfeed. Regular exercise for women who are lactating improves maternal fitness and health without affecting milk production, milk composition, or the infant’s growth! The “myth” that exercise during pregnancy will impact your ability to feed your baby is NOT true! However, it is important, as always, to stay hydrated and eat enough to maintain your milk supply. Lactation does require more calories to be eaten, so if you exercise, you will need additional calories. Further, lactating women who exercise should consider feeding their infant or expressing milk just before beginning exercise to avoid discomfort. Lactating women should also consider wearing more supportive active wear/sports bras to provide additional support.
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