Stability exercises to soothe pregnancy aches and pains!

A woman’s body undergoes significant changes throughout pregnancy. In our previous article, we outlined some of the musculoskeletal issues faced by pregnant women. This post will detail the importance of working the core, transverse abdominal, and pelvic floor muscles in order to reduce pain and prevent lower back problems.

The role of core muscles

These muscles keep the skeleton in place and are located in the trunk, abdomen, and pelvic floor.

• The multifidus: these are deep paravertebral muscles that originate in the lumbar, thoracic, and cervical vertebrae, and act as major stabilizers for the lower back.
• The transverse abdominal: the deepest of the muscles that form the abdominal wall, it serves to stiffen the lumbar spine, thus increasing the stability of this area.
• The pelvic floor: this term refers to the muscle group located at the base of the pelvis. In women, these muscles play a vital role in supporting the bladder, intestines, and uterus. Due to their shape, pelvic floor muscles are often compared to a trampoline. During pregnancy, these muscles must support additional weight, which frequently leads to stretching and a loss of effectiveness.

The benefits of exercise

Before childbirth:

50% of pregnant women will experience lower back or pelvic pain severe enough to affect their quality of life. A physiotherapist can offer treatments to reduce this pain, i.e. core exercises for the lower back and pelvis, massages, and orthopedic manual therapy.

Post-partum:

The benefits of exercising after childbirth – commonly known as the post-partum period – are well-understood and recognized, and an exercise program will improve the new mother’s overall health. A number of musculoskeletal issues can arise in recently post-partum women, including diastasis recti and symphysis pubis dysfunction.

Diastasis recti is characterized by a separation of the large muscle bands in the abdomen – secondary to stretching caused by pregnancy – and can cause abdominal and pelvic pain. Fortunately, core stability exercises  may help decrease pain.

Symphysis pubis dysfunction (SPD) arises from a relaxation in the pelvic ligaments as well as increased joint movement during pregnancy. Pain can range from moderate to severe and is concentrated in the pubis, or can progress to radiating pain in the back and legs. Once again, exercise can be effective in relieving pain.

Basic exercise program

Certain specific exercises can help you:

• Develop / maintain core muscle strength
• Avoid pain during pregnancy
• Improve recovery after childbirth

Core stability

This exercise works to strengthen the transverse abdominal muscle:

1. Lying on your back with your knees bent, tighten your stomach as though you were trying to push your belly button into the floor.
2. Hold the contraction for 10 seconds.
3. After a few repetitions, try to hold the contraction while moving your arms and legs.

Multifidus activation

1. On your hands and knees, rotate your pelvis to ensure your back is straight.
2. Tighten your back muscles as though you were trying to push them into your spine.
3. Hold for 10 seconds.
4. Once you have mastered this exercise, hold the contraction while stretching out your arm or leg.

The plank

This exercise contracts the abdominal, lumbar, and pelvic wall:

1. Lie on your stomach, with your hands and elbows tucked beneath your shoulders.
2. Repeat. As this exercise becomes easier, hold it longer. You can also execute it on your side.

Kegel exercises

These exercises are designed to strengthen pelvic muscles:

1. Lying on your back with your knees bent, contract your pelvic muscles, as though stopping a flow of urine.
2. Hold this contraction for 10 seconds.
3. Once you have mastered this, attempt the exercise in various positions (seated, standing, etc.)

If you have any questions, contact one of our physiotherapists.

By Guillaume Desroches and Andrée-Anne Lorrain, Physiotherapists

References :

• Norris, C. M. (2008). Back stability: integrating science and therapy. Human Kinetics.

• Hodges, P. W., & Richardson, C. A. (1996). Inefficient muscular stabilization of the lumbar spine associated with low back pain: a motor control evaluation of transversus abdominis. Spine.

• Stuge, B., Hilde, G., & Vøllestad, N. (2003). Physical therapy for pregnancy‐related low back and pelvic pain: a systematic review. Acta obstetricia et gynecologica Scandinavica.

• Borg-Stein, J., & Dugan, S. A. (2007). Musculoskeletal disorders of pregnancy, delivery and postpartum. Physical medicine and rehabilitation clinics of North America.

• Mota, P., Gil Pascoal, A., & Bo, K. (2015). Diastasis Recti Abdominis in Pregnancy and Postpartum Period. Risk Factors, Functional Implications and Resolution. Current Women’s Health Reviews.

• Acharry, N., & Kutty, R. K. (2015). Abdominal Exercise with Bracing, A Therapeutic Efficacy in Reducing Diastasis-Recti Among Postpartal Females.Int J Physiother Res.

• Leadbetter, R. E., Mawer, D., & Lindow, S. W. (2004). Symphysis pubis dysfunction: a review of the literature. The Journal of Maternal-Fetal & Neonatal Medicine.

• Nilsson-Wikmar, L., Holm, K., Öijerstedt, R., & Harms-Ringdahl, K. (2005). Effect of three different physical therapy treatments on pain and activity in pregnant women with pelvic girdle pain: a randomized clinical trial with 3, 6, and 12 months follow-up postpartum. Spine.