Exercise modifications during pregnancy
While there are modifications of exercises recommended during pregnancy and for postnatal women, there are often times that modifications within these exercises themselves need to be made. Each woman seen by a fitness or health professional needs individual attention at regular intervals during their pregnancy.
Often at the 20 – 24 week mark, the abdominal muscle wall changes as the baby inside the uterus moves up outside of the pelvis, and at this time, alterations to some exercises such as the plank may be needed. Some women however may need modification further, especially if they have a weaker or laxer abdominal wall or pelvic floor, which can be more likely when it is not their first pregnancy. Even when the plank is done on the knees there is pressure within the abdominal wall that can still push down on the pelvic floor or place stress on the abdominal muscles.
When feeling a client’s abdominal wall during the modified plank, her abdominal muscle separation increased with the length of hold of the exercise, as after 8-10 seconds she started to breathe hold. The bulge between her abdominal muscles, indicating a muscle separation, increased, meaning that this exercise could potentially increase the degree of abdominal muscle separation occurring during her pregnancy.
At this point we addressed changing her program, which included using a ball to lean on instead. However, for some women, a breath hold still occurs in this position and pressure down upon the pelvic floor may occur. Leaning over the ball for support or being on hands and knees and doing pregnancy abdominal bracing instead of the modified plank, may be more suitable for some women as their pregnancy progresses, although it is important to consider the amount of load suitable for each woman. Some may maintain control well with an alternate arm and leg lift for example, while others need to focus more on using a lower load with a single arm lift. Beginners or women in later stages of their pregnancy may need to use a stationary hands and knees position for appropriate deep abdominal and pelvic floor work to minimise strain on their abdominal wall and pelvic floor.
One client who was a regular exerciser with very good body awareness, in her second pregnancy, could feel the pressure changes within her abdomen with different variations of triceps extensions.
Triceps push backs, or using a band behind the back, loaded her upper abdominals and caused a breath hold more than when she used the single arm forward lean position for triceps extension. Initially there were a number of other exercises which she could do without breath hold using a Gymstick, and then as her pregnancy progressed, alterations needed to be made to prevent excess tension in her upper abdominals and a pattern of breath holding from putting pressure on her abdominal wall or pelvic floor.
So, if you are a Fitness Instructor remember:
- Each client is an individual and needs to be assessed at regular intervals to enable program changes to be made as her pregnancy progresses.
- For more information for Fitness Professionals refer to Fitness Australia’s Pregnancy and Postnatal Guidelines
Pelvic Floor First resources:
The pelvic floor and core exercises (download only)
10 step guide to putting your pelvic floor first (download only)
Written by Pelvic Floor First ambassador and physiotherapist Dianne Edmonds, July 2015