Physiotherapy and Exercise in the Ante-Natal Period
Written by Abi Okell BSc MCSP, Senior Chartered Physiotherapist
Pelvic girdle pain and pregnancy related low back pain are common problems in the ante-natal population, occurring in approximately 50-70% of pregnancies. Typically, symptoms are likely to come on in the later stages of pregnancy. The sooner these problems are identified and assessed however, the better they can be managed. The good news is that maintaining a low to moderate level of activity and exercise throughout your pregnancy will reduce your chances of developing low back or pelvic girdle pain, and improve your overall experience of pregnancy.
Risk factors for developing pelvic girdle pain There are many reasons why you may develop pelvic girdle pain, including both physical and psycho-social factors. Some common factors are: Pre-existing spine or hip problems, Obesity, Hypermobility, Psycho-Social factors including poor job satisfaction or beliefs that pain will not improve, Hormonal changes.
How can we manage pelvic girdle pain? Pelvic girdle pain and low back pain will present slightly differently for each individual. Therefore, it is a good idea to have an assessment with a physiotherapist to help identify specific problems and develop an individualised management plan. Research has shown that strength and stability exercises can result in reduced pelvic girdle pain and increased function. As well as exercise, you may benefit from the use of a pelvic girdle belt, breathing exercises, mindfulness practice, massage techniques and manual therapy.
Exercise during pregnancy Exercise during pregnancy has not only been shown to reduce pelvic girdle pain, but also the incidence of gestational diabetes, the need for caesarean delivery, stress and anxiety. Physical benefits of exercise during pregnancy include maintaining a healthy weight and preventing obesity, maintaining muscle length and flexibility and improving post-natal recovery. There is also consistent evidence for improved mental health with short and long-term exercise. These improvements include reduced fatigue, improved body image, decreased symptoms of negative mood and increased vigour.
The current guidelines suggest that during a non-complicated pregnancy exercise can be safely performed for 30-90 minutes, 3-4 times per week. This should include aerobic and strengthening exercises. The intensity and duration of exercise you can safely tolerate during pregnancy will depend on your activity levels prior to pregnancy. If you do not exercise regularly, you should wait until 12 weeks to start a gentle exercise regime. You should aim for 15 minutes of basic exercise 3 times a week initially and gradually progress to 30 minute sessions. If you are already active on a regular basis you should aim to maintain that level of fitness and continue with both aerobic and strength exercises at a moderate level. You may need to adapt to incorporate more low impact exercise as the pregnancy progresses. Due to decrease in joint stability you should avoid excessive stretching and sports with rapid changes of direction or high impact. Contact sports should also be avoided due to risk of direct injury to the foetus.
What changes should we be aware of during pregnancy? Cardiovascular changes – Due to increased heart rate and increased blood volume, you may experience low blood pressure when exercising. This can cause fatigue or dizziness. Therefore, you should avoid standing completely still for prolonged periods and be cautious of exercising in the supine position (lying on your back). This is also what causes your feet and ankles to swell!
Hormonal changes – The hormone relaxin modifies the collagen in ligaments during pregnancy, resulting in increased laxity of ligaments and reduced joint stability. Therefore, high impact exercises and sports involving sudden changes of direction should be reduced to limit risk of injury.
Postural changes – As the foetus grows, your centre of gravity moves forwards. This leads to an increase in lumbar lordosis (curve of the lower back) and forward tilt of the pelvis to avoid falling forwards. During the second and third trimester abdominal muscles will stretch and elongate and there will be inhibition of the gluteal (buttock) muscles. Exercise can help improve your balance and reactions to reduce risk of falls.
Temperature control is often affected during the first trimester, but this improves as the pregnancy develops. Exercising at a moderate intensity for up to 60 minutes in a controlled environment should not raise the core temperature above 39 degrees. The recommendations are to avoid hot or humid conditions during exercise, have water available and be aware of clothing choices.
If you experience any of the following during exercise you should stop and seek further advice: Vaginal bleeding, Breathlessness before exertion, Dizziness, Headache, Chest pain, Muscle weakness, Calf pain or swelling, Pre-term labour, Decreased foetal movement, Abdominal or pelvic pain, Excessive fatigue, Amniotic fluid leakage.
If you would like to arrange an assessment with one of our physiotherapists to discuss a current issue or for advice on how to increase or maintain activity levels during pregnancy, please contact CoActive Physio on 07919 411845 or email firstname.lastname@example.org
American College of Obstetricians and Gynaecologists (ACOG). Exercise during pregnancy and the postpartum period, 2009.
Bo K, Artal R, Barakat R, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. British Journal of Sports Medicine, 2016.
Pelvic, Obstetrics and Gynaecological Physiotherapy (POGP). Fit and safe to exercise in the childbearing year, 2013.
Pivarnik J et al. Impact of Physical Activity during Pregnancy and Postpartum on Chronic Disease Risk. Medicine & Science in Sports & Exercise, 2006.