During pregnancy many physiological changes occur to your body including increased blood volume and flow (it is common to see a 50% increase!), increased resting heart rate, and certain muscular changes, in particularly the abdominal wall which spreads to accommodate growth but consequently becomes weaker. It is also common to see some forward tilt of the pelvis from the 2nd trimester onwards which can compress the vertebrae of your lower spine and this combined with weaker abdominals (particularly the transverse abdominus) can be a major cause of back pain. Compensatory curvature of the upper back can cause muscles in this area to become long and weak and conversely chest and front of shoulders, short and tight. Both of which should be addressed. So, with all of this in mind, should focus on the following areas:
– Strengthen lower abdominal region and pelvic floor
– Strengthen upper back
– Strengthen glutes
– Stretch chest and front of shoulders
Below I have outlined some simple yet effective exercises that will help strengthen and release the necessary areas outlined above. From the 3rd trimester you should be aware that your ligaments will be slightly looser than normal due to the release of a hormone called “relaxin” (which can remain in your body for up to 5mths post pregnancy) so be careful not to push any stretches too far.
- Pelvic tilts-Stand with your back against a flat wall with your arms by your sides and feet 6 inches off the wall, adopt a nice relaxed position. Take a deep breath in and as you exhale, pull your tummy button in towards your spine, “tilt” your pelvis backwards as if pushing your lower back into the wall, and waistband in an up. Breathe in again and relax, out and tighten. Repeat for 10 “deep” breaths. This same movement can be practised sitting on a Swiss Ball.
- Side hip external rotations-Lying on your side with heade rested on your arm,place your other hand just in front of your chest with fingertips on the floor (just for stability). Bend both hips and knees to 90 degrees with knees and ankles both together. Hold that position, engage your core to stay stable and rotate your top leg outwards, lifting the knees as far apart as possible and keeping contact between the feet at all times. Perform 10 repetitions per side and really try to think about the outside of your hip and glute as you externally rotate the leg.
- Ball stability-this one will utilise the Swiss ball. Sitting on the ball with feet flat on the floor and arms by your sides. Adopt an upright posture, pull tummy in with a slight backward pelvic tilt. Lift your right leg 1 inch of the floor and hold for 10 seconds aiming to keep the ball a still as possible. Change legs and repeat 5 times for each side. This can be progressed to holding weights / bottles of water in one hand and passing over head to the other to alter centre of gravity and require slightly more core stability.
- Superman-adopt a”horse stance”on hands and knees. Hands should be directly under shoulders and knee under hips and spine should be neutral. Breathe in and as you exhale, draw your naval up towards your spine, engage pelvic floor and perform a slight backward tilt of the pelvis. Breathe in and return the start position. Repeat for 5 repetitions, sit back on to your heels to take the pressure off your wrists, then repeat for another 5. This can can be progressed – on exhalation lift one hand 1 inch off the floor, alternate hand with each breath. With one less point of contact on the floor, you will be slightly less balanced meaning more stability required to maintain the neutral position.
- Shoulder rotations – Using either a long piece of string, broom stick or elastic exercise
band, adopt a grip that is roughly twice that of shoulder width. Relax your arms but keep them straight and SLOWLY raise them up maintaining a small amount of pull on the elastic, and rotate all the way over your head until the elastic is behind you touching your lower back. Slowly bring the elastic back over to the start position and repeat for 10 repetitions. It is very important not to push through any pain or discomfort on this exercise. If it feels too hard, widen your grip. This is not really a strengthening exercise but more to maintain good shoulder movement and mobility.
- Reverse Fly – Standing upright hold your arms directly out in front of you with thumbs pointed upwards, feet hip width apart. Breathe in and as you breathe out engage core and move your arms out to the side (as if trying to make a cross shape), at the same time rotate so that your thumbs are now pointing back behind you. Bring your arms as far back as possible and really try to squeeze your shoulder blades down and together. Be sure not to “hunch” your shoulders up. Breathe in and return to the start position, repeat for 10 repetitions. This exercise is great for your upper back but is most effective when you really think about that shoulder blade squeeze. Imagine you are trying to squeeze a ping pong ball between them!
- One last muscle group to work AS MUCH AS POSSIBLE is the pelvic floor group. On all of the above if you really try to squeeze those muscles (as if you are trying to stop yourself going to the toilet) you will see even more benefit.
Complete this circuit 3 times and remember to concentrate! That is the key. Without engaging the correct muscles these exercises are pointless and should not be rushed. Done correctly and at least once per week should help with back pain and ensure as easy a birth as possible!