Athletes, whether elite or recreational, should aim to continue with certain aspects of their rehabilitation throughout pregnancy to prevent issues either during the pregnancy or when they resume training after the birth.
Achilles tendon loading and calf strengthening should be implemented to maintain the tensile strength of the tendon (its ability to accept load), and the strength of the calf muscles. This can be in the form of calf raises or using a leg press machine. Proprioceptive work (balance and foot placement) and drills are also important to help to enable the feet to work well, despite any ligament changes that maybe occurring, and which would make the feet less stable. Drills are also important for maintenance of neuro muscular control, and retaining and maintaining movement patterns, especially as the body changes.
Muscular condition and range should be maintained by stretching. Ideally training during the months when it is possible should include a degree of impact to help with bone health. It is possible to do weights on machines as long as they are not done isometrically (holding the weight) and that the mother is able to breathe throughout. It is very important to prevent a Valsalva manoeuvre during training (holding the breath and pushing down and thereby increasing abdominal pressure). It is also important to maintain pelvic alignment if exercising to minimise the likelihood of pelvic injuries and pubic symphysis pain. We would recommend the following stretches to maintain pelvic and spinal alignment, and to alleviate stress on the upper body.
Temperature regulation is important. Ideally pool temperatures should be below 32 degrees and, if exercising on land and indoors, thin layers of clothes and fans should be used to maintain a lower body temperature. Pregnant women sweat more, which will help with termperature regulation. Hydrotherapy pools should be no higher than 35 degrees for pregnant women.
It is possible to generally maintain aerobic fitness throughout pregnancy, health of both mother and bay allowing, with a loss of anaerobic conditioning, as this becomes less of a priority throughout the pregnancy.
Musculoskeletal changes also include reduced thoracic and lumbar rotation and counter rotation, which will affect walking, running and exercising. It is important for this to return to normal ranges before increasing training, as there are a number of potential injuries than can arise from reduced rotation.
Effects on the viscera (organs) can include kidney ptosis (kidneys staying lower in the abdomen), posterior adhesions of the kidneys (from being squashed), uterus, bladder issues, reduced liver immobility (from having reduced space during the pregnancy). The problem with reduced mobility in the viscera is that there can be an associated effect on back and pelvis mobility, on muscle flexibility, and can result in neural symptoms and altered breathing. It can take up to 6 weeks for the uterus to involute (return to normal size), and 4-6 weeks for kidneys to involute.
Therefore six weeks, after the first post partum check, is advised as the earliest time for resumption of training, with exception of low level core, gluts and foot/calf strengthening which can be done earlier. Within the next six to twelve weeks, it should be possible to resume training as able, incorporating tendon loading without going into excessive dorsiflexion, core work, drill work, and movement pattern work.
Pelvic realignment work and thoracic rotation work by a physio, should be brought in within first 6 weeks and maintained so that, as issues return to normal over next five months, they are in the correct alignment.
Click here to download additional exercises and stretches recommended to help maintain strength and flexibility. It is also recommended that gluts are kept strong and you can download our glut program here.