Why Modifying Exercise for Pregnant and Postpartum Women is Mandatory and How to Do It - FITNESS PAIN FREE

Why Modifying Exercise for Pregnant and Postpartum Women is Mandatory and How to Do It

Working with pregnant and postpartum women is similar to working with any other population. They face specific problems due to the nature of being pregnant and delivering a baby afterwards.

If you have an athlete with knee or shoulder pain it’s up to you to make the exercise modifications necessary to ensure they continue to train safely and don’t get hurt further. The same things goes for pregnant and postpartum women. Sometimes they’ll need modifications in order to continue exercising safely and to avoid future problems.

Being pregnant or in the postpartum period (after delivery) can make you more prone to a variety of issues including:

  • Diastasis Recti or Doming (separation of abdominal muscles)
  • Prolapse (uterus and other pelvic organs protruding out of the vagina)
  • Umbilical Hernia (Stomach contents protruding out of the stomach wall typically above the navel)
  • Urinary Incontinence (leaking)
  • Hip, SI joint and Lower Back Pain

As a coach we really need to be aware of these problems and know how to handle these situations if they pop up. On top of this we also need to make sure our training is appropriate so we don’t cause any of these issues (or worsen them if they’re pre-existing).

Fortunately for us, if we understand a few basic principles and are on the lookout for these problems throughout the course of pregnancy and afterwards we can prevent quite a few problems and help these women stay safe and strong.

First and foremost, success between the coach and athlete is going to revolve around great communication.

Obviously as a coach we need to know whether or not your athlete is pregnant. A lot of this will revolve around creating a gym culture that is open and accepting toward pregnant and postpartum women’s needs. If your athletes know you work with pregnant women frequently, chances are they’ll feel comfortable discussing this with you (and also comfortable being led through their exercise journey as pregnancy continues).

Cialis is one name just for this generic drug; under this name it employed for treating ED and benign prostatic hypertrophy (BPH) in USA, also referred to as an enlarged prostate.

It’s important to understand that if your athletes are experiencing any number of key symptoms during training, the immediate exercise needs to be modified right away to find a more suitable alternate exercise. We need to be aware of this as coaches but athletes also need to be on the watch for these symptoms and report anything back to the coach they may be experiencing:

  1. “A sense of heaviness”
  2. “A feeling of bearing down”
  3. “Abnormal sensations down below”
  4. Contractions (Go see your doctor if felt)
  5. Leaking
  6. Pain

Any of these symptoms can signify the start of prolapse, pelvic floor or other orthopedic issues. If your athlete is experiencing any of these issues their training should be modified immediately to find a variation that causes no symptoms.

As a coach we also have to be on the lookout for specific issues and not just being mindful of symptoms. One major issue both during pregnancy and after is diastasis recti or doming. This is basically separation of the abdominal muscles:

Image courtesy of Sarah Duvall of https://www.coreexercisesolutions.com/

Doming and diastasis recti can be present with any exercise that challenges the core (which is most movements really). This means that as a a coach we have to be on the look out for this problem during pretty much all movements in the gym with special attention towards core exercises.

For more information on how to check for diastasis recti and more tips for correcting it check out my colleague Sarah Duvall’s article on the subject HERE:

Next I wanted to provide an example of how we would go about modifying a very common exercise you’d see in the gym. We’re going to be talking about squatting. Squatting can create any of the symptoms mentioned above and if spotted the movement needs to be modified.

First and foremost, several factors influence how stressful the squat is on the core in pregnant and postpartum women. If we understand these principles it becomes pretty easy to figure out how we can modify the squat for our athletes:

  1. Total Load – Increased weight on the bar will increase demand on the core and pelvic floor
  2. Torso Inclination – The more the torso is pitched forward in the squat the greater the demands are on the core
  3. Postural Demands – Different squat variations are more or less challenging to maintain a neutral position of the spine, ribcage and pelvis.  For example, a back squat is most challenging to stay neutral, followed by a front squat and finally a goblet variation would be easiest
  4. Depth of Squatting – Deeper squats will stretch the pelvic floor to a greater degree and increase demands on those muscles
  5. Squat Stance Width – Just as in depth of squatting, wider stance squats will stretch the pelvic floor to a greater degree and increase demands on those muscles
  6. Postures – Excessive rib flair, lumbar extension (arching) or anterior pelvic tilt all decrease our ability to brace appropriately and can increase stress on the core and pelvic floor
  7. Mobility Restrictions – Limited ankle, hip or thoracic spine mobility may reduce the ability to perform the squat with a neutral pelvic, spine and ribcage position, thus increasing stress to the core and pelvic floor

With these principles in mind we can start to develop some strategies for our athletes that experience symptoms while squatting. Let’s say we have an athlete that reports she’s feeling a lot of pressure down under during the squat. Let’s say you also notice she’s sitting in a lot of anterior pelvic tilt (low back arch) and is using a pretty wide stance.

Based on this information you decide to give her a few cues to bring her stance a little more narrow and adopt a more neutral pelvic position. From there you coach her on breathing and bracing through the squat and voila, no more bearing down.

Now, this process worked in this case but you’ll definitely find that everyone is an individual and a strategy for one woman may not work for another. Based on the principles described above, here are some more tips:

6 Tips For Reducing Stress in the Squat for Pregnant and Postpartum Women

1: Reduce Torso Inclination During Squats

  • Stay more upright during squats
  • Choose an exercise variation that reduces torso inclination: For Example – Back squat > Front squat > Goblet squat

2: Reduce Load on the Bar

  • Take some weight off the barbell
  • Consider using tempos and paused reps to get a training effect (which in effect will reduce load on the bar)

3: Choose Easier Exercises Based on Postural Demands

  • Back squat > Front squat > Goblet squat

4: Reduce Squat Depth or Stance Width

  • Either or which reduce stretch / stress to the pelvic floor muscles

5: Fix Exercise Technique

  • Squat with a neutral spine position avoiding excessive anterior pelvic tilt and rib flair

6: Correct Mobility Limitations

  • Correct underlying mobility limitations in the hips, ankles and thoracic spine
  • Consider adding a heel lift or wearing olympic weightlifting shoes to improve squatting position when mobility issues are present

Now you’re armed with a whole battery of tools if you’re faced with an athlete who experiences symptoms. It doesn’t have to be this complex but either one of these principles may be all you need to keep your athletes safe during the squat.

Lastly, to expand on principle #1 and #3 a bit more, when altering exercise technique and load doesn’t get the job done, we can completely change the movement to help with symptoms. I’ve created some nice and easy infographics to help you out with the process. These modifications take into account all of the principles I’ve outlined earlier in the article:

Basically if a back squat is creating symptoms you can try front squats instead. If that doesn’t correct the issue we keep modifying to the right until we find a variation that doesn’t create symptoms.

So there you have it! Now you know just how important it is to modify exercise for pregnant and postpartum women to keep them safe and happy. We went over the specific problems these women face, when modifications need to occur and lastly several ideas for how to modify the squat.

If you’re interested in learning more about how to work safely with pregnant and postpartum women myself and pelvic floor physical therapist Sarah Duvall have teamed up to create a great mini course on the topic.

In the mini course we cover several essentials for working with pregnant and postpartum women including:

  • Why you need modifications throughout pregnancy and how to implement them (webinar format)
  • The common mistakes trainers make when getting women back to training after pregnancy
  • What are the major concerns both during pregnancy and after and how to be on the lookout for them
  • How long does it take to get back to full training after pregnancy?
  • The importance of breathing for pregnant and postpartum women and how to use it to prevent and solve problems
  • 1 week of modifications for a pregnant athlete, so you can see exactly how it’s done

All you need to do is fill out your information below and you’ll receive instant access:

Leave a Comment: