Pregnancy, Pain & Posture: a video progression to restore movement

As I write this post, my wife is 32 weeks pregnant with our third child in three years, so I dedicate this one to Katie….you, and your body, have endured more than most can imagine.


Our boys

I will concede right off the bat that I am not a woman and have not been pregnant, but I have worked with and treated women at all stages of pregnancy, including immediately after C-sections and women 20 years later that are still trying to get their bodies back.  From what I have seen, there is no other experience a person can go through that is both physically and mentally more challenging on your body than getting pregnant, having the baby, and making it through the first five years in one piece.

Medicine has come a long way in making sure that the mother and baby are physiologically OK from conception through to the birth, but there still remains a significant lack of proper support and education for women when it comes to pain, posture, movement and physical function both during and after pregnancy.  The most important factor to consider is that most women don’t have great posture, movement mechanics or strength before they get pregnant, so this issue it not solely created by pregnancy, but merely exposed by it.  Most women are not used to carrying 10-30lbs around all day, or having to bend and pick things up off the floor sixty times a day, or hunching over breast feeding time and time again.  These are physical demands that would be hard on anyone, but particularly hard on someone whose body has changed so dramatically in a relatively short period of time and is functioning on very little sleep.

If you haven’t already please read everything your mother taught you about posture is wrong or how to stand.  They will help give you a better context to understand this post.

Ideally to move well to prevent pain and dysfunction, you are able to vertically stack your body in good posture as you stand, sit, push, pull, walk and lift.  The strength and stability in your muscles and joints, combined with your body awareness are the main factors to help you maintain good posture throughout the day.  As you get more and more pregnant, your abdominals get progressively more stretched and proportionately weaker.  At the same time, you are getting heavier and your joints are getting looser and looser due to hormonal factors.  The strategy your body used to use to keep you vertical will fundamentally start to change because you now have a weak, heavy belly pulling you forward- other muscle groups are going to have to pick up the slack.

As a woman’s center of gravity gets shifted forward during pregnancy, her back and glute muscles should have to work much harder to keep her vertical and walking relatively normally, but her body will be fantastic at cheating to do whatever feels easiest to move at the time.  The result is usually to lean most of the torso backward and to place both hands on the low back and hips for support.  The trouble is that when you stand or walk around with your pelvis in front of your feet, instead of over top of them, your glutes cannot function properly and the deep muscles in your hips and groin will get really tight, overworked and sore.  This is the primary cause to women getting SI joint pain, pubic bone pain and sciatica during and after pregnancy.

The best thing a woman can do to prepare herself physically for pregnancy is to create body awareness of how to stand, sit, walk and lift mechanically well before her body starts to change.  It is much easier to find your way back after pregnancy if you know where you started from- most women don’t.  Most new moms turn into what Diane Lee would call a butt gripper or back gripper.  Their bodies have been so stretched out that they will subconsciously grip and clench certain muscle groups just to hold everything together while trying to perform the physical job of being a mom.  The trouble is that the muscles they are gripping and clenching are suppose to be moving muscles and when you ask a big moving muscle to be both a passive stabilizer and a mover at the same time, something inevitably breaks down- this is where body awareness becomes the most important factor as it relates to life tasks like standing, breathing and bending.

You cannot move well if you tend to brace major muscle groups during light load activities and you cannot be functionally very strong if you cannot move well.  The best preventative tool and the first rehabilitative step should be to learn how to turn some muscles off before you attempt to turn a whole bunch of new ones on.  The post pregnancy education for women tends to overly focus on practicing pelvic floor exercises like kegels.  These exercises are useful to help restore and activate these important muscles, but they are only a small piece of the puzzle when it comes to restoring women’s posture, movement and physiques.  A woman can diligently do kegels every day, all day and still end up with pelvic pain, weakness and/or incontinence if she doesn’t learn to stop squeezing and bracing muscles in her trunk and bum when she stands up.

The trunk and pelvis create a cavity inside for all your organs to function and move.  This cavity is a system under pressure and if you squeeze it, the contents are going to look for the easiest place to escape.  In pregnant women and new moms the two places the contents are going to push on are the center line of the stomach muscles called the linea alba and the pelvic floor.  If enough pressure is exerted on the linea alba it can tear, creating a diastasis which is effectively an abdominal hernia splitting your six pack muscle down the middle.  If enough pressure is pushed downward on your pelvic floor and bladder you can become incontinent and even develop a prolapsed uterus.  Just doing kegels and creating a heroically strong pelvic floor won’t hold all this together.  You need to learn how to stop squeezing your pelvis and trunk like a tube of toothpaste as your support strategy and start moving with your hips, legs and abdominals.  Good functional strength requires developing movement skill with a balance of stability and mobility.  If you end up consciously or subconsciously choosing rigidity to stabilize an area of your body, you may develop strength, but should be walking around with a sticker on your forehead that says “Warning Contents Under Pressure- May Explode at Any Time.”

Contents
Many women can’t wait to get back to the gym after pregnancy to try and tone up their stretched out bodies.  I would recommend treating the process as rehabilitation and not fitness, regardless if you had a vaginal or C-section birth- either way muscles have been damaged and need a chance to recover.  The time frame for soft tissue healing is 4-6 weeks and most of that will happen in the first three weeks, but you should still be cautious in weeks 3-6 because even though you may be feeling better your body is still trying to remodel tissues back to their strong and functional states.

Here is a list of videos in order that you should watch to learn about pain, posture and movement.  The first few videos will teach you what is “normal” and the rest will demonstrate exercises to help you restore normal movement.  Start at the beginning and work down.  Once you can complete these movements well, you should be ready to take what you have learned to the gym.

Learning:

  1. Everything your mother taught you about posture is WRONG
  2. What is my Core? Depends who you ask?
  3. Core training: when less is more
  4. Movement: your body is the car and you are the driver
  5. Breathing: more than just keeping you alive

Doing: (Exercise Progressions)

  1. How to stand
  2. How to sit
  3. Breathing as an exercise
  4. The Deep Inner Unit: Light Core
  5. 4 Point Neutral Spine
  6. Rib Shimmy
  7. 4 Point Rock Backs
  8. Bridges
  9. Kneeling Squats
  10. Weight Bearing Tripod
  11. Ankle Skewer Forward Lean
  12. Squats
  13. One leg stand
  14. Thirsty Birds
  15. Reaching Up 11
  16. Vacuums
  17. Passive Chest Stretch
  18. Passive Lat Stretch
  19. Hang & Dangle

Once you have made your way through this list, you can progress to jumping, running, pushing and twisting exercises that will be posted on this site soon.  Please use your Dashboard to take notes, save your exercises and keep track of your progress.  If you build a foundation of strong movement, you will learn to make life as a mom a good physical workout instead of a harmful one.  Good luck…have fun!

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