Author: Rachel Tinius

Among the many physical changes of pregnancy is an ever-expanding tummy.  As your abdomen grows, the muscles that provide support for your core need to remain strong and require a shift in the type of exercises required to build strength. 

Pregnancy-induced changes cause the connective tissue that joins the two sides of the rectus abdominis muscles “six-pack muscles” (they span vertically from your ribs to pelvis) to thin and widen, separating the recti muscles’ two sides. This thinning and widening of the two recti muscles’ distance is called a “diastasis recti.”

The development of a diastasis recti is extremely common during pregnancy, especially third trimester, and postpartum. It is not pathologic unless it interferes with activities and quality of life. The incidence and degree of separation can be increased by:

• Rapid changes in weight
• Obesity
• Genetics
• Age
• Multiple pregnancies
• Poor body mechanics

It’s important to be aware of the tension put on the diastasis recti to help avoid increasing tension and further separation. It is important to be mindful of movements that may increase midline tension.

What to avoid:

• *Sit up type exercises (puts a lot of pressure on your midline with the loaded spinal bending). However, after delivery or in the 4th trimester, consult with a pelvic health physical therapist for exercise recommendations on how to optimize rectus abdominus function, which will likely include curling up types of activities.
• *NOTE: This type of curling exercise can be very helpful when performed correctly at the appropriate time. If you have questions, consult with a pelvic health physical therapist.
• Poor body mechanics (twisting when lifting, raising up from a supine position without support).
• lifting heavy objects if that is not part of your normal pre-pregnancy exercise routine.
• Bearing down while holding your breathe when lifting or toileting.

Improving abdominal support with proper exercises can help prevent musculoskeletal discomfort and speed postpartum abdominal recovery. As your pregnancy progresses, you won’t be able to strengthen core muscles with this movement effectively.

Instead, focus on exercises that target the transverse abdominis muscle, a corset-like band of muscle that is crucial for maintaining good belly support.

Best abdominal exercise for pregnancy:

• Isometric contractions of the transverse abdominis in a variety of positions (sitting, standing, on hands and knees, side lying)
• Supine and modified supine (after the first trimester) leg slides and knee raises and extensions. NOTE: this does not apply to everyone. If you are a weight lifter or avid exerciser, then these may be way too easy and not load your tissues enough. This is more for women who are inactive or minimally active leading into pregnancy.
• Working functionally to provide abdominal support with movement by making a habit of tightening the lower tummy and holding as you lift, bend, and move. Make sure to match the amount you’re tightening with the difficulty of the task. You do not need to tighten as much when lifting a kleenex. You should tighten more if lifting a heavy grocery bag. Think about the muscle as a “dimmer switch” with the ability to span a range of tightness as opposed to an “on/off” switch. 
• Use your breathing to enhance your ab exercises by blowing out as if trying to fog your glasses to clean them as you are doing each contraction (you’ll feel how that pulls your tummy inward).
• Practice the “basic breath” where contract your lower tummy and pelvic floor and hold as you keep breathing normally. Use the basic breath to tighten your tummy and pelvic floor before lifting.

Benjamin DR, van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014;100(1):1–8

Berg-Poppe P, Hauer M, Jones C, Munger M, Wethor C. Use of exercise in the management of postpartum diastasis recti: A Systematic Review. J Women’s Health Phys Ther. 2022;46(1): 35-47. doi: 10.1097/JWH.0000000000000231

Dufour, Sinéad PT, PhD1; Bernard, Stéphanie PT, MSc2; Murray-Davis, Beth PhD, RM3; Graham, Nadine PT, MSc1 Establishing Expert-Based Recommendations for the Conservative Management of Pregnancy-Related Diastasis Rectus Abdominis: A Delphi Consensus Study, Journal of Women’s Health Physical Therapy: April/June 2019 – Volume 43 – Issue 2 – p 73-81 doi: 10.1097/JWH.0000000000000130

Catherine Cram, MS and Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

© WKU {2022} All rights reserved.

You probably already know that exercise helps your body deal with pregnancy changes by keeping you strong and flexible. But, did you know that maintaining an exercise routine throughout your pregnancy may help you have a lower chance of a complication during your labor and delivery?

Research in the field of prenatal exercise has suggested that there may be birthing benefits that include a lower incidence of preterm labor and cesarean section in women who exercised to the end of their pregnancy. Some research has found that exercise significantly reduce the duration of the second stage of labor in women who exercising throughout pregnancy. Exercise, such as walking, during pregnancy can also lower the odds of you needing to be induced! There’s even evidence that exercise such as yoga may help ease pain perception during labor—possibly by training the mind to focus more effectively and incorporate relaxation techniques during times of stress. Knowing that exercise may positively impact your labor and delivery can provide even more motivation to keep fit.

Here are the takeaway points for improving your odds of complication-free labor and delivery:

• Do some type of aerobic exercise 5-6 days a week.
• Add flexibility training and yoga to your routine.
• Make sure you strength train three days a week.
• Modify your fitness routine as needed so you’re able to continue exercising to the end of your pregnancy (that’s important for keeping weight gain within normal limits and, in turn, keeping baby weight from getting too high, which can increase the risk of C-section).

References

Am J Obstet Gynecol 2017;216:335–7.Berghella V, Saccone G. Exercise in pregnancy

J Gynecol Obstet Hum Reproduction 2020 Jun;49(6):101736. The effect of antenatal exercise on delivery outcomes: A systematic review and meta-analysis of randomized controlled trials. Ahmed Taher Masoud¹, Mohammed M AbdelGawad¹, Norihan Hatem Elshamy¹, Omar Magdy Mohamed¹, Zeinab Y Hashem¹, Ahmed K Abd Eltawab¹, Ahmed Samy², Ahmed M Abbas

Int J Environ Res Public Health. 2020 Aug; 17(15): 5274.  Effect of Antenatal Exercises, Including Yoga, on the Course of Labor, Delivery, and Pregnancy: A Retrospective Study

Yogyata Wadhwa,¹ 

Pereira IB, Silva R, Ayres-de-Campos D, Clode N. Physical exercise at term for enhancing the spontaneous onset of labor: a randomized clinical trial [published online ahead of print, 2020 Mar 29]. J Matern Fetal Neonatal Med. 2020;1-5. doi:10.1080/14767058.2020.1732341

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If you fell and broke your leg, you wouldn’t hesitate to call your doctor and seek help. Mental health is just as important as physical health! If you think you are depressed, stressed, anxious, or sadder than normal during pregnancy, you should talk to your doctor.

One in every four pregnant women experience a mental health concern, and this is nothing to be ashamed of! That is almost 4 times more common than gestational diabetes, yet all pregnant women get screened for that and talk openly about the results. For some women pregnancy is the happiest time of their life, for others, it is a really difficult time both mentally and physically. A big change is on the horizon, and change can be stressful! Just because you feel sad, doesn’t mean you don’t love your unborn baby or that there is anything wrong with you! This can be totally normal!! Pregnancy is hard enough without the added challenge of fighting mental health concerns. There are many options for helping you to feel better and be the happiest version of yourself!

https://www.who.int/mental_health/maternal-child/maternal_mental_health/en/

Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric Disorders in Pregnant and Postpartum Women in the United States. Arch Gen Psychiatry. 2008;65(7):805–815. doi:10.1001/archpsyc.65.7.805

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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 women’s health PT 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 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.

A Women’s health physical therapist (WHPT) is a licensed clinician trained to evaluate and treat neuromuscular conditions related to pregnancy, postpartum, and pelvic pain. We commit ourselves to learning and caring for women in all phases of life. 

Written by Women’s Health Physical Therapist: Dr. Emily Davenport, PT, DPT, WCS

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A kegel is an important exercise to do both during pregnancy and postpartum. This pelvic floor contraction can help strengthen the pelvic floor muscles, support the pelvic organs (uterus, bowel, and bladder), and help reduce the chance of pelvic floor disorders such as incontinence and pelvic organ prolapse. However, 1 in 2 women do not know how to perform a kegel correctly even if given verbal directions. This is why seeing a pelvic health physical therapist is very important, as they will assess your ability to activate these muscles and provide individualized coaching to help optimize your muscle performance and eliminate/prevent symptoms.

The kegel is a two-fold exercise of contraction and relaxation; both are equally important. To do a kegel, you’ll want to contract and lift the pelvic floor, try longer holds of 5-10 seconds and shorter holds of 1-2 seconds, then fully relax.

When contracting and lifting the pelvic floor, here are a few do’s and don’ts to help you get it right.

Do:

– Do be sure you lift the pelvic muscles up and in. If you place a flat hand under your perineum (the space between the vagina and anus) either directly on skin or over your clothing, you should feel the perineum pull away from your hand. When you relax, you should feel the perineum gently rest back into your hand with the same amount of pressure you felt before starting the kegel exercise. 

– Do fully relax at the end of the kegel

Don’t:

– Don’t contract surrounding muscles like your glutes, abs, or thighs

– Don’t squeeze as hard as you can. More isn’t necessarily better.

– Don’t do kegels while you are in the middle of urinating or having bowel movement unless specifically prescribed by a pelvic floor physical therapist

Having trouble with targeting the correct muscles?

– Visualization can be helpful. Imagine picking up a blueberry with your vagina. Strange, I know, but this can help you target the lifting action of the kegel as well as reminding you to lift gently.

– Check yourself. As long as you are comfortable, you can check yourself internally as you perform a kegel. Simply insert 1 clean finger into your vagina. As you perform a kegel, confirm that you feel both a contraction and a lift of muscles around your finger and that the contraction happens equally all around. Don’t feel comfortable inserting a finger? That’s OK!! You can follow the same steps over your underwear with a flat hand and fingers on your perineum (the space between the vagina and the anus). You should feel this area lift away from your hand/fingers as your squeeze and feel it fall back into your hand as you relax. Still uncomfortable? You can also check this using a hand held mirror with your underwear off. Instead of feeling, you will be watching in the mirror to see the perineum pull up and in on the squeeze and return to the starting position on the relax.

– Schedule an appointment with a pelvic floor physical therapist. They can do internal and external checks to ensure you are properly performing a kegel as well as prescribe specific kegel exercise patterns as needed.

Casey Thomas-Hardesty, MS, NTP & Jenny LaCross, PT, DPT, PhD(c), WCS, ATC, CLT-LANA

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Everyone loves a good snack. Here is a list of healthy snack ideas to keep you full and satisfied as you go through your day. It is also important to eat a snack before exercising or prior to attending a physical therapy session.

• Hard boiled eggs
• Apples and nut butter
• Smoothie
• Chia pudding
• Full fat greek yogurt with berries
• Edamame
• Carrots and string cheese
• Raw vegetables and yogurt based or hummus dip
• Grapes and cheddar cheese
• Orange and pumpkin seeds
• Guacamole and bell pepper
• Whole grain crackers and cheese
• Pineapple and cottage cheese
• Dark chocolate and nuts

Casey Thomas-Hardesty, MS, NTP

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