A Physiotherapist’s Secrets for the Second Trimester
By Andrea Meade, Reg. PT
Pregnancies are a lot like snowflakes – each one is unique in its own special way. Some make it through the first trimester without so much as a dry heave or a hiccup, while others really struggle to keep up with their normal daily routines. There are, however, many commonalities that make it possible to draw strong scientific conclusions and develop guidelines around exercise and activity in the pregnancy and postpartum period.
Outward signs of pregnancy include a more prominent belly, and a dark line extending vertically toward the pubic bone known as the linea nigra. Posture also changes as the center of mass moves forward and downward into the chest, abdomen and pelvis. Movement is more effortful and muscles in the midsection begin to stretch to what may seem like impossible lengths, creating a challenge for any activities requiring core strength and stability. There is a lot going on behind the scene, too. Physiological changes include an increase in overall blood volume, higher resting heart rate, a boosted cardiac output, and adjustments in the ability of blood vessels to bring nutrients to the tissues. Rate of breathing increases. The blood becomes less efficient at regulating temperature and dissipating heat. 1
The benefits of exercise in pregnancy are well documented, however, and supported by sound research 1, 2. Physiotherapists (PT’s) tend to take an even more proactive and restorative approach to exercise. given that we regularly come into contact with individuals who are not tolerating exercise well – either due to pain, incontinence, or other physical or physiological limitations – we have a special interest in addressing physical complaints early on. Those aches and pains that are often dismissed as ‘normal’ or ‘expected’ in pregnancy are a big deal to us, because we understand the impact of disability on daily life.
For pregnant women the capacity to exercise and stay in shape is affected by normal physiological changes, as described earlier. As well, for a certain segment of the population, day-to-day movements and tasks may also become difficult. This can be due, in part, to mechanical pain which is experienced in the region between the top of the hip to the crease of the buttock, known as pelvic girdle pain (PGP). In fact, 20% of pregnant women with PGP experience significant pain, disability and loss of function, resulting in socio-economic consequences. 3
What do physical therapists know about movement that can be helpful when PGP arises? And for the rest of us lucky ladies, what is a rehab-friendly approach to minimizing pain and maintaining functional fitness until ‘labor day’? As someone who is reasonably fit and somewhat knowledgeable on this topic, allow me to share a few of my experiences, observations and adventures from my own pregnancy thus far.
1. Simple tasks, like rolling over in bed, require a little more time, energy and planning than before
I’ve noticed that the sacroiliac joint (the connection to my pelvis, at the base of my spine) on my left side has been sore. There is a mild tug in this area when I change positions during the night. I’m blaming this on normal pregnancy-related changes that affect the ligaments stability of this joint. This is not a catastrophe; I know that this particular pain can be managed without too much effort. Luckily I happen to know a few little tricks to help minimize the strain at this joint during everyday activities (think pelvic floor!). Keeping my body weight balanced over both legs definitely helps, as does sleeping in symmetrical positions. The discomfort also serves to remind me that I need to work on keeping my hip and thigh muscles strong so that forces are absorbed by my lower limbs first, and not higher up the chain.
2. These days, brisk walking takes an awful lot of willpower.
My pre-pregnancy routine included 30-40 minutes of moderate intensity cardiovascular activity and interval training, followed by 10-15 minutes of weight-training, about 3 days a week. My current routine? I’ve started to give myself silent pep talks before climbing a flight of stairs! Knowing that my exercise capacity is on the downslide, I have temporarily scaled down the intensity and duration of my workouts so that I’m dewy-yet-comfortable by the end of each session. I would love to be able to ‘push’ – that’s what has always energized me in the past – but I know that I would have difficulty sustaining a high-intensity session. Besides, I just don’t feel like it! Reminding myself that pregnancy, labour and postpartum recovery require a decent level of phsical endurance is what motivates me to be consistent while also being patient with myself.
3. The standard equipment at my gym is beginning to look (and feel) like a military grade obstacle course.
Oh, the crazy things I have done in the name of fitness. Haven’t we all? Steering clear of “extreme” fitness routines is easy when I really pay attention to how my body feels. Lately I’m much more attracted to no-frills, middle of the road endeavors such as walking…and…well, just walking! And some basic strengthening to help support my load-bearing joints and spine (my resistance band is my new best friend). And some gentle stretching. This is exactly what is recommended by obstetricians and exercise physiology experts. 1,2 Nothing fancy. Just basic principles of strengthening and conditioning.
My conclusion so far, at 21 weeks along: Booty Bootcamp and Hot-Hot-Hot yoga can wait until after labor day (which for me, will be sometime around January 9th).
References:
Physical Activity and Exercise During Pregnancy and the Postpartum Period. ACOG Committee Opinion No. 650. American College of Obstetricians and Gynecologists. Obstet Gynecol 2015;126: e135-42.
Exercise in Pregnancy and the Postpartum Period. Joint SOGC/CSEP Clinical Practice Guideline No. 129. J of Obstet Gynaecol Can 2003;25(6):516-22.
Pelvic Girdle Pain During or After Pregnancy: a review of recent evidence and a clinical care path proposal. Verstraeten, EH, Vanderstraeten, G, and Parewijck, W. Facts Views Vis Obgyn. 2013; 5(1):33-43.