Corrective Exercises Post-pregnancy

Report
Corrective Exercises
Post-Pregnancy Physical Issues
Lisbeth Geertsen, CMT, CES
The Many Joys of Pregnancy
20-45
years
Exercised
before and
during
pregnancy
Postural
imbalances
developed during
pregnancy
Prone to
injury
Started exercising
after the birth of
your first or second
child
Compensations
patterns have
developed
The Many Joys of Pregnancy
Physiological Changes during Pregnancy
• Cardiovascular System
• Respiratory System
• Hormonal and Metabolic
Changes
• Musculoskeletal System
The Many Joys of Pregnancy
Hormonal and Metabolic Changes
Hormones
released to
widen the
birth canal by
increasing
ligamentous
laxity.
Relaxin
Progesterone
The Many Joys of Pregnancy
Musculoskeletal System
Average weight gain during pregnancy:
27.5 pounds (12.4kg).
• The influence of this
additional weight on the
skeleton, coupled with the
effects of relaxin and
progesterone, increases
ligamentous laxity.
• Loosening of joints decreases
joint stability in the hips,
pelvis, and lumbosacral
spine.
The Many Joys of Pregnancy
Baby grows and
abdomen enlarges (abs
stretch & diastasis
recti), postural
alignment is altered
due to change in COG.
Pelvis shifts
anteriorly increasing
the lordotic curve of
the lower back
Upper back posture
becomes rounded as
the back
compensates for the
increase in the
lumbar lordosis.
Shoulders become
rounded and the
head juts forward on
the neck.
The chest and
shoulder are pulled
forward and inward,
increasing the
kyphotic curve.
Exaggerated Scurve of the spine
(kyphotic lordotic
postural
alignment).
The Many Joys of Pregnancy
Musculoskeletal System
The postural changes will eventually create muscular imbalances:
Abdominal wall is
stretched and
weakened, and
opposing muscles in
the low back are
forced to remain in a
shortened position.
Upper back muscles
are elongated and
weakened, and the
chest and anterior
shoulder muscles
become chronically
tight.
The muscular activity
in the posterior neck is
also greatly increased
as the head shifts
forward.
The Many Joys of Pregnancy
Musculoskeletal System
Laxity and weight
gain can cause
changes in the
knees, feet, and
ankles.
The knees may be
slightly hyperextended.
Pregnancy can induce
a drop in the arches
and increase
pronation of the foot,
which may change the
biomechanics of the
lower kinetic chain.
The Many Joys of Pregnancy
Common
conditions
associated with
pregnancy
• Round
ligament pain
• Diastasis Recti
• Pubic pain
• Low-back pain
• Leg cramps
• Carpal Tunnel
Syndrome
• Varicose veins
Muscular Imbalances related to
Pregnancy
• Lack of pelvic floor strength – which is ”the center of the
universe” because it supports so many organs and bones (Dr.
Linda Brubaker).
• Internal scars an adhere to other parts of the body while
healing, hampering muscle movement or causing pain years
later (Debra Goodman, PT).
• If a postpartum woman has weak core muscles or a large
diastasis recti, running or other pounding exercises can be
problematic. Hold off until you know you have stable core
strength (Marianne Ryan).
• Unresolved injuries during childbirth can show up later in life
as pelvic floor disorder such as incontinence, and pelvic organ
prolapse (Journal of the American Medical Association).
Muscular Imbalances related to
Pregnancy
• Ask your doctor at the 4-6 week postpartum checkup to check
strength of pelvic floor.
• Exercising too hard too soon can lead to problems including
pelvic pain. Women can exercise as they normally would
during pregnancy and after their 4-6 week postpartum
checkup as long as don’t have pain.
• Risk factors: the more children the more like to have
symptoms, and obesity.
Muscular Imbalances related to
Pregnancy
• Postural changes during pregnancy creates certain “trained
imbalances” between muscle groups than can lead to
discomfort, pain, and in some cases, injury.
• It’s important to counterbalance the natural tendency during
pregnancy to become either ‘tight’ or ‘weak’ in specific areas,
because the ‘trained imbalances’ will most likely sustain after
pregnancy as well.
• If muscle imbalances or poor flexibility has altered movement,
then they may also have altered the way the core muscles
react and stabilize.
Muscular Imbalances related to
Pregnancy
•
•
Tight/overactive muscles:
– Scapula protractors (pecs, ant.
deltoid) & levator scapula
– thoracolumbar area (latissimus
dorsi)
– hip flexors, ITB, piriformis,
hamstrings & hip adductors
– gastrocnemius & soleus
Weak/underactive muscles:
– Scapula retractors (rhomboids,
middle/lower trap)
– Abdominals (rectus abdominis,
transverse abdominis, int/ext
obliques)
– lumbar paravertebral
– pelvis floor, gluteus maximus ,
gluteus medius & quads
•
Instead of only focusing on each of
these areas in isolation,
incorporate functional movement
exercises.
•
Conventional view: if tight calves
=> incorporate stretches for the
calves.
•
Functional view: What movements
are limited because of my tight
calves? Ex.: Squatting =>
incorporate functional stretches
and specific exercise progressions
that can improve squatting.
Identifying Muscular Imbalances
Movement
Patterns
–
–
–
–
Squat
Hurdle Step
Lunge
Shoulder
mobilization
– Active Straight Leg
Raise
– Rotational
Identifying Muscular Imbalances
• Posture
– Poor posture due to weakened abdominal muscles
• Muscle strains or misaligned bones
– Annoying at first but can develop into debilitating disorder
years or decades later.
• Age
– Many women in the US are older when having babies and
in some cases spacing pregnancies closer together giving
the body less time to recover.
• Multiple birth
– Increase in fertility treatment leads to more twin
pregnancies which add to the physical strain on the
women’s bodies.
Focus on the CORE
CORE
CORE TRAINING
Torso & Hip
Stability &
Coordination
Your core is your power
house, it should be
from your core you
generate force to move
your extremities.
FOCUS ON STABILITY!
“Stability is the act of
controlling force”
(Athletic Body in
Balance, 2010)
Corrective Exercises
• Abdominal Exercise
– The rectus abdominis muscle is the focus in most
traditional abdominal exercises e.g., crunches, but it’s even
more important to strengthen the transverse abdominis ,
as it plays a key role in spinal stabillization. Also, its fibers
are horizontally aligned, so when the belly expands, it can
better adapt than rectus abdominis, and a stronger
transverse abdominis may help prevent diastasis recti
• Kegel Exercise
– Push up and in to strengthen pelvic floor after pregnancy.
Corrective Exercises
• Pelvic Floor Exercise
– The five layers of muscle and fascia attached to the bony ring of
the pelvis are commonly referred to as the pelvic floor. They
extend from the pubic bone to the tailbone and support the
internal organs. They affect bladder, bowel, and sexual function.
The weight gain and mechanical stress of the growing uterus
creates a stretch weakness in the muscles of the pelvic floor.
– Hormonal influences cause a softening of these tisues that further
aggravates the weakness as does the birth process itself.
– Maintaining the strength and integrity of these muscles during
and after pregnancy is important to help prevent urinary stress
incontinence, pelvis organ prolapse, pelvis pain from muscle
spasm, and misalignment in the hip and sacroiliac joints.
Corrective Exercises
• The Better Balancer
– To work core muscles, with the body in a line over the
knee, hold the pelvis steady, breathe and circle the arms.
• The Posture Promoter
– For better alignment, stand with good posture and using
your breath to engage your core muscles, lift arms
overhead, which trains the body to move safely in
everyday activity. Use theraband – anchor under feet and
lift over head.
• The Anti-Huncher.
– To prevent rounded shoulders and hunching, sit on a
balance ball and draw the shoulder blades down an back.
Reference
Beyond Baby Weight: What to Expect After You’re Expecting.

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