Low back pain, hip pain, pubic symphysis dysfunction, and diastasis recti are very common during pregnancy. Changes in your body such as normal weight gain, the hormone relaxin causing hypermobility in your ligaments, and postural changes can all be related to pain and dysfunction during pregnancy. Pubic symphysis dysfunction is characterized by pelvic pain and increased mobility of your pelvis and has been reported to affect 31% of pregnant women. Diastasis recti is a characterized by the rectus abdominis muscle separating during and after pregnancy.
It is important that you alter your daily activities and exercise habits to protect both you and your baby. Making certain changes now may actually make you labor easier and help you recover faster after giving birth. Below are some tips and tricks that you can try during pregnancy.
For daily activities:
-Standing: try to not ‘sink into your hips’ by putting weight forward on your toes, engaging your core and un-tucking your pelvis to reduce low back pain and abdominal/pelvic pressure. You may also consider wearing compression socks, as this will reduce the swelling in your feet.
-Sitting: sit as tall as you can on your ‘sitz bones’ instead of your tailbone/sacrum. This will help reduce abdominal and pelvic pressure, thus protecting your pelvic floor and organs. This will also help prevent low back pain.
-Lying/Sleeping: try not to lie on your back, as this can cause your baby to put pressure on the large vein that transports blood to your heart. Instead, prop your head up with multiple pillows to ensure that your head is above heart level, or lie on your left side with a pillow between your knees.
-Lifting/Lowering: when lifting or lowering an object, be sure to engage your core by visualizing bringing your abdominal muscles toward the midline of your body and ‘hugging your baby.’
-Toileting: Do not squat over the toilet, do not Valsalva (bear down) during bowel movement; try to avoid constipation through diet, supplementation, and water intake
-Self-monitor: You do not need to stop exercising the moment you find out you’re pregnant. In fact, it is highly encouraged that you continue exercising throughout your pregnancy, as this will make your labor and delivery easier!
Rule of thumb: exercise similarly to how you were exercising prior to finding out you were pregnant. If you were exercising with your heart rate at or above 140 beats per minute, it is perfectly safe to continue to do so in the early stages of pregnancy. If you were not exercising at that intensity, you may want to consult with a physician to see what is best for you. A good way to stay safe in the later stages of pregnancy is to use the ‘Talk Test.’ If you can’t comfortably speak a short sentence, it’s time to decrease your intensity.
What to wear: Tight, high-waisted leggings or a stability wrap will serve as a good reminder for you to engage your core while exercising. They can also provide a little extra support for your abdomen and pelvis. As your belly grows you can turn to maternity support garments specific to exercise.
Engage transverse abdominis (TrA): be mindful of your transversus abdominis! This is our deepest lower abdominal muslcle and helps keep your rectus abdominis from separating throughout and after pregnancy (which can lead to diastasis recti, or ‘mommy tummy’). As with lifting and lowering objects, think of bringing your abdominals closer to the midline of your body and ‘hugging your baby’ throughout exercise.
Avoid crunches and rigorous core work: crunches tend to cause ‘coning’ (where your tummy makes a cone shape when you bring your head up like a crunch), and actually increases the likelihood of getting diastasis recti. It may be smarter to avoid crunches altogether! This applies to more than just exercise: be mindful of crunching motions in your daily activities, such as getting out of bed or getting into/out of a car. Instead of rolling straight up from lying, roll to your side and push your trunk up with your arm. While getting into a car, sit first and then swing your legs in while keeping your knees together.
Physical therapy during pregnancy can address and treat a wide variety of issues such as:
Pubic bone pain
Treatment may include, but not be limited to:
Pelvic Floor strengthening
Scar massage for previous tearing/episiotomy/c-section
Safe exercises and what to avoid during pregnancy
Exercises and stretches that can help prepare the body for delivery and faster post-partum recovery
Merci Ortenzi Treaster is a pelvic health therapist at Functionize Health & Physical Therapy. She treats prenatal and postpartum clients, pelvic pain, urinary/fecal incontinence, constipation/ IBS, diastasis recti, and supportive dysfunctions. Merci received her Doctor of Physical Therapy degree from Mercer University.