Pregnancy and agility – from a physiotherapy perspective

Bonny’s last blog both humbled and inspired me. In fact having had the honour of being close to her through out her pregnancy has had the same effect. It hasn’t been an easy ride for her. I thought it might be a good to follow on from Bonny’s blog and consider pregnancy from a physiotherapy perspective. Now this is not my area of specialism and I bow to other Physio’s who have far greater knowledge on this subject area but I think I can run through the basics for a start that may be useful for folk.

There are some key physiological things that happen to a woman’s body when she is pregnant. Most obviously the tummy gets bigger and the centre of gravity changes, this increases the lordosis, or curve of the lumbar spine. This increased curve will put more pressure on the joints of lower back and therefore may be a cause of low back pain. Another cause of musculo-skeletal pain is due to joints becoming increasing lax due to hormonal changes. This can effect the joints around the pelvis and can cause a condition called symphysis pubis dysfunction. This condition can be really painful and can limit activity, seeing a physiotherapist can help, they can prescribe you exercises, help you with some pain relieving strategies and also potentially consider a belt which can give the pelvis some compression and support which can be really useful. Other joints can become lax as well so care needs to be taken during exercise to not put joints at risk or push them out of their normal range. For example running a course or training on uneven ground may put stress on your ankles so considering the surface you train on and your footwear is important.

There are also haemodynamic changes that occur, haemodynamic relates to blood flow around the body. Heart rate increases, blood volume increases, stroke volume increases (the amount of blood pumped out by the left side of the heart during one contraction) and cardiac output increases (the amount of blood pumped around the body in one minute). Essentially all these complicated words mean that the heart is working harder and that the heart and the lungs need to work harder to maintain both mum and baby. This is the reason that some static positions such as some yoga positions and lying on your back for periods of time are not encouraged as it may reduce blood pressure and reduce the amount of blood returning to the heart (1).

Because there is a greater requirement on the body the lungs have to work much harder as well. During anaerobic exercise (exercise where you get out of breath quickly, your body is not using oxygen and lactate will form in your muscles) the lungs may struggle to pay back the oxygen quickly enough so caution is suggested with anaerobic exercise (2) This may mean that running flat out around a course may be not be a good idea but utilising some distance handling or holding your contacts for a few extra seconds may help you out. Aerobic exercise, exercise that is sustainable for a period of time and utilizes oxygen through out is generally thought to be safe and encouraged to both maintain and improve fitness through pregnancy (3,4). Types of exercise can include jogging, cycling, walking etc.
As a general rule exercising while pregnant is thought to benefit most woman who are going through an uncomplicated pregnancy (5). Obviously if there are any medical complications exercise advice should be given on an individual basis for each woman and by a fully qualified health care professional who specialises in obstetrics.

I think the key messages are to listen to your body, don’t ignore any warning signs and look after your nutrition, hydration, sleep and self care. All of these points become much more important when pregnant, for example making sure you drink before and after training or a competition to replenish lost fluid is vital when pregnant. Making sure your nutrition is on point, taking healthy and nutritious snacks out with you and making sure you eat before and after your runs or training. Try not to compare yourself to other people, we are all different and our bodies will all react differently. Pregnancy shouldn’t stop your agility journey, it may take it on a slightly different path but importantly keep having fun and stay safe.

1. Clark SL, Cotton DB, Pivarnik JM, Lee W, Hankins GD, Benedetti TJ, et al. Position change and central hemodynamic profile during normal third-trimester pregnancy and post partum [published erratum appears in Am J Obstet Gynecol 1991;165:241]. Am J Obstet Gynecol 1991;164:883–7.
2. Artal R, Wiswell R, Romem Y, Dorey F. Pulmonary responses to exercise in pregnancy. Am J Obstet Gynecol 1986;154:378–83. [PubMed] ⇦
3. de Oliveria Melo AS, Silva JL, Tavares JS, Barros VO, Leite DF, Amorim MM. Effect of a physical exercise program during pregnancy on uteroplacental and fetal blood flow and fetal growth: a randomized controlled trial. Obstet Gynecol 2012;120:302–10. [PubMed] [Obstetrics & Gynecology] ⇦
4. Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Med Sci Sports Exerc 2012;44:2263–9. [PubMed] [Full Text] ⇦

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