I remember it like it was yesterday: I was 18 weeks into my first pregnancy. A little slower, but still bound and determined to run through all of it.
As I headed out on my first mile towards the Potomac River trails — I live in the DC Metro area — I had to stop every few minutes because of intense urinary urgency and excruciating pressure in the front of my pelvis. I had peed before I left but it didn’t make a difference, subsiding a little when I stopped running, but starting back up immediately with a run (I use the term running lightly — it was more like a loping waddle).
I reached a small parking lot along the river and sat down on a rock. I called my husband, and through the tears told him I was done running. He needed to come retrieve me as I couldn’t go any further or get back home. There was no way I could keep running anymore. I was defeated.
What had I done wrong? Why could other pregnant women seemingly prance through pregnancy and this rock was where my dreams would end?
(For my second pregnancy, I would love to tell you I put my big girl panties and ran entirely through with a devout sense of determination, due to my significant preparation, except that I don’t think I ever even ran during my second pregnancy — there’s something about the fatigue that comes with chasing after a never-sleeping 2-year-old boy that makes the joys of independent exercise a figment of one’s imagination.)
I still can’t go past that rock along the Potomac River without thinking of the day when my pregnancy running dream abruptly ended. I know the decision I made for my own training was what was right for me considering what I knew about my body and what I felt.
Many of you might be saying, “Well that’s not my story or my client’s story!”
To that, my response is, you might be right. You might also be wrong. As with everything I’ve learned about how women make our way through pregnancy, the answer is always “it depends.”
What the Research Says
I generally like to turn to the existing research, but here I’ll candidly admit that it’s not particularly helpful in guiding exercise programming during pregnancy. Why? Because it would be completely unethical to do a study on the premise that a specific intervention done in the context of that study will harm the baby.
Therefore, while there is a good amount of literature looking at high-intensity exercise (vs. high impact) and pregnancy in the context of health of the mother, delivery mode and health of the baby, most of this is retrospective research, like the recently published article in the CrossFit Journal about CrossFit training during pregnancy.1
Here are some examples that look specifically at high-impact exercise:
- “Women who exercise regularly and engage in high-impact exercises before the first pregnancy may have a reduced risk of pelvic girdle pain in pregnancy.” — British Journal of Sports Medicine2
- “Compared with non-exercisers, regular exercise and high-impact exercises during pregnancy are associated with reduced risk of having an acute Cesarean delivery in first-time mothers.” — American Journal of Obstetrics and Gynecology3
- “Skydiving is not recommended during pregnancy.” — Clinical Journal of Sport Medicine4
What this tells us is that:
- If you do high-impact exercise prior to pregnancy, you might have less pelvic pain during
- If it’s your first pregnancy, movement can reduce your risk of having to go straight to a C-section. (All bets are off after the first kid!)
- Don’t jump out of a plane when pregnant. (The good news is that there is a recommended lesser-risk alternative to skydiving: wind tunnel training. Totally sounds like a scaled activity!)
What This Means for Trainers and Coaches
Research aside, how do we choose to jump or not to jump? To go for impact or not? There are typically a few categories of pregnant clients:
- Moms-to-be who don’t want to do high-impact at all, and find brisk walking to be enough.
- Women who start to do high-impact early on, and then (like my own experience) find that their body is giving them signs to stop.
- Women who can perform most activities asymptomatically throughout their pregnancy, with or without scaling.
The question remains: where do we step in to regulate when the body isn’t showing signs of distress with high-impact activities? Do we have evidence to suggest that continuing high-impact during pregnancy will ultimately result in pelvic floor dysfunction or diastasis recti postpartum?
The answer is a cautious and thoughtful “No, but…” No, we don’t have the concrete evidence, but that doesn’t mean we shouldn’t be making educated, common-sense decisions during this impactful time (pun intended).
What we do know is that pressure control is important in pregnancy. With extra weight comes extra pressure (think outward on the belly and downward on the pelvic floor), and how our bodies manage that pressure can impact our muscle function after pregnancy. We also know that breath-holding increases intra-abdominal pressure, and that high-impact exercise requires above-average pressure management strategies.
Here’s some recommendations on how to provide better guidance to our moms-to-be with high-impact exercise:
Always Ask and Look
A wise 4-year-old once told me, “If you don’t ask, the answer is always no.”
Take the time to ask your client the following:
- Are you having leakage of any fluid during or after exercise?
- Do you have pressure in your pelvis, pubic bone or tailbone?
- Are you noticing any protrusion of organs outside your body? (This could be a sign of herniation or prolapse).
While it’s important to ask your client about what they’re experiencing, it’s also crucial to use your own powers of observation:
- Is there excessive doming or coning in the abdominals when your client is performing certain movements?
- Is breath-holding a primary strategy to during effort in exercise?
- Does their movement change to show signs of discomfort or favoring a body part?
Scale as Required
There is no reward for pushing beyond a client’s physiological capabilities, no matter what their Instagram says. Some women are simply more genetically predisposed in the biology department than others.
Genetically, some bodies and tissue types can withstand greater challenges and some bodies succumb to the influences of pregnancy hormones and weight gain. Some women may have enough training and movement background to be able to continue training with less scaling than others.
You may want to remind your client that there’s nothing inherently “wrong” with scaling movements, and that it’s not a sign of failure or of weakness.
Choose Teamwork
Teamwork with your client and their pregnancy team is vital. It’s imperative to have an open dialogue about your client’s expectations for movement in pregnancy as well as what they’re experiencing with each progressive week (or prior pregnancy history).
It’s also important to be well-versed in scaled movement options that are considerate of the challenges of progressing pregnancy as well as knowing when to refer to pelvic health experts for medical management in problem areas! It’s incredibly helpful to have resources who support your mutual goals!
You can find a pelvic physical therapist by using some of the resources listed below. Be sure to talk with them ahead of time to ensure a good fit for you and your client’s movement needs!
As movement experts, we’re best when we work with our clients using our knowledge and resources to help them make the best choice during their pregnancy experience.
Resources
To find a pelvic health physical therapist in your area, search one of the following websites.
If nothing comes up in your area, a general Internet search using one of the following terms: pelvic health, pelvic floor, women’s health physical therapist, or women’s health physiotherapist and the name of the city will provide some leads. In the U.S. use the term physical therapist. Outside of the U.S., use the term physiotherapist.
References
- Perkins C, Dewalt H, CrossFit Training During Pregnancy and Motherhood: A New Scientific Frontier, The CrossFit Journal, November 17, 2017. https://journal.crossfit.com/article/crossfit-training-during-pregnancy-and-motherhood
- Owe KM, Bielland EK, Stuge B, et al. Exercise level before pregnancy and engaging in high-impact sports reduce the risk of pelvic girdle pain: a population-based cohort study of 39184 women. Br J Sports Med. 2016. Jul;50(13)817-22. https://www.ncbi.nlm.nih.gov/pubmed/26435533
- Owe KM, Nystad W, Stigum H, Vangen S, Bo K. Exercise during pregnancy and risk of cesarean delivery in nulliparous women: a large population-based cohort study. Am J Obstet Gynecol. 2016 Dec; 215(6):791.e1-791.3.13. https://www.ncbi.nlm.nih.gov/pubmed/27555317
- Ebner F, Wockel A, Janni W, Paterson H. Parachuting and pregnancy: what do we know about pregnant skydivers and the risks they are taking? Clin J Sport Med. 2014 Nov;24(6):468-73. https://www.ncbi.nlm.nih.gov/pubmed/24637924