by Trish Gipson RPT
While for some of us pregnancy can be a glorious time where we feel better than we have ever felt, for the majority of us it is a time of back pain, calf cramps, rib pain, difficulty breathing, and the dreaded pregnancy waddle. Because of our growing bellies, we tend to shift our ribcage back in space to counterbalance the change in our center of mass. This causes increased muscle tension in the back and hip muscles, which can lead to back pain, rib pain, and sacroiliac joint pain. But by focusing on our posture and maintaining mobility in our muscles and joints, we can help to minimize the aches and pains associated with being pregnant.
It is important to be aware of our posture and alignment throughout our pregnancy. Try to keep your weight evenly distributed between your toes and your heels, keep the knees soft (ie: don’t lock them in hyperextension), carry your pelvis over your heels and stack your ribcage over your pelvis. Also think of floating your shoulders up very slightly (I cue people to imagine a helium balloon under their armpits; this prevents the shoulder blades from getting pulled down and back which can contribute to back and rib pain as well as neck pain and tingling in the hands). And last but not least, lengthen the back of your neck so that the head hovers at the top of your spine rather than poking your chin forward (I cue people to imagine strings attached to their ears pulling them up). In this position, you should be able to take an unrestricted, deep breath into your abdomen and lower ribs.
Here are a few stretches that can be helpful to release some of the tension that builds up from pregnancy-related posture changes:
laying on your back on the floor with a rolled up bath towel underneath you along your spine (you can also do this laying against a yoga ball if laying flat on your back is uncomfortable). Open your arms out to the sides to feel a gentle stretch across your chest. Relax in this position for a few minutes each day.
Deep hip stretch
lay on your back, knees bent, feet flat on the floor. Cross your right ankle over your left knee. Pull your right knee towards your left shoulder with the left hand; stop at the midline. Allow your left knee to fall out, causing a greater rotation at the right hip, therefore a bigger stretch. Hold 30 seconds. Repeat on the other side.
Hip flexor stretch plus overhead reach
kneel with your left knee down in a low lunge position, right leg forward. Activate abdominals so that your low back doesn’t arch. Press the hips forward to feel a stretch in the front of your left hip. Reach the left arm up overhead and lean slightly toward the right side, to feel increased lengthening along the left side of your torso and the front of the hip. Hold 30 seconds and repeat other side.
Standing in front of a chair, bring the chin down to the chest and flex the thoracic spine vertebrae by vertebrae. When your hands can reach the chair, support yourself and “pour” yourself into your hands. Return to starting position, moving vertebra by vertebra. Repeat 10 times.
Lay on your back, feet in the air, knees bent. Loop a belt around your feet and pull your feet towards you. Relax your tailbone down to the floor to feel a stretch in the hips and pelvic floor. Hold for up to a minute.
Supported Deep Squat
Come down into a deep squat, with a small stool or roll under your buttocks for support. Keep the knees over your toes (don’t let the knees fall in). Press out gently into the knees with your elbows. Rest in this position for a minute or so.
As our posture changes our diaphragm tends to adopt a more flattened position, and the lower ribcage widens or is held in an “open” position. This position makes it more difficult to get air into the lower lungs and is tied to increased tension in our backs in the kidney area. It is a good idea to take a few minutes throughout the day to practice diaphragmatic breathing (I call it umbrella breathing), to help release tension in the back and obliques, to maintain mobility in the ribcage, and to move air into the lower lobes of the lungs.
Laying on your back, knees bent and feet flat on the floor (prop yourself up with 2-3 pillows if laying on your back is uncomfortable). Breathe in through your nose and feel the belly rise and your ribcage widen in the front, back and sides (imagine an umbrella opening at the bottom of your ribcage). Exhale passively without squeezing the air out. Practice this for a few minutes each day.
As we near the end of the pregnancy, the joints of the pelvis starts to widen, stretching the ligaments of the pubic symphysis (where the pelvis meets in the front) and sacroiliac joints (where the pelvis meets the base of the spine in the back) which can contribute to pelvic pain. Sometimes a pelvic torsion or twist (often what people describe as their pelvis being “out”) can result from muscle imbalances and asymmetrical standing posture.
It is very important to get in the habit of standing with weight equal on both feet. Shifting to one side and jutting the hip out contributes to muscle imbalance and can force the pelvis into a torsion.
If you do feel that your pelvis is “out” or you are getting severe pain in the hip or SI joint with weightbearing, the following is a self-mobilization exercise that you can do to correct the torsion.
Self-correction for Pelvic Torsion
Laying on your back, knees bent, feet flat on the ground (if laying on your back is uncomfortable, prop yourself up with 2-3 pillows). Press the heel of the painful leg/hip/SI joint into the floor as if you are trying to pull your heel toward your buttock (but there should be no movement). Hold for 3 seconds then relax. Repeat 5 times then stand up and walk around and see if the pain is improved. Repeat again as needed.
If your aches and pains are minor you can try these above exercises. However, if your pain is severe and cannot be managed with exercise, it is important to seek the help of a physiotherapist. Sometimes manual release, massage, or other hands-on techniques are necessary to restore proper movement to the joints and tissues which will then allow you to use these exercises to manage the discomfort.
You can find a women’s health physiotherapist in your area by clicking on the “Find A Physio” tab on the Physiotherapy Association of BC website (http://bcphysio.org/) or feel free to contact myself at firstname.lastname@example.org.
Trish Gipson graduated from SFU with a Bachelors Degree in Kinesiology, and from McMaster University with a Masters Degree in Rehabilitation Sciences (Physiotherapy). She completed her Advanced Diploma of Manual and Manipulative therapy, and has taken post-graduate courses in manual therapy, acupuncture, pre- and post-natal care, pelvic and perineal re-education, and running injuries, and is a trained Pilates instructor. She has experience working with people of all ages and fitness abilities but has a special interest in treating pelvic floor disorders and working with new moms and moms-to-be. Trish has completed numerous half and full marathons, and has also laced up her hiking boots to walk the Inca Trail in Peru and climb Mount Kilimanjaro in Tanzania.