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When it comes to movement and exercise, women frequently have two concerns during and immediately following pregnancy – managing low back pain and performing the correct amount and type of exercises.

Managing low back pain
Physical therapists are educated to help patients overcome injuries to muscles, ligaments and bones. Many injuries can happen in these structures during and after pregnancy due to naturally occurring changes in the body.

• Weight gain from the pregnancy changes your posture by increasing the curve in your low back (lumbar lordosis). It also increases stress on your back, hip and knee joints.  Education regarding correct sitting and standing postures can help decrease stress on your neck, back, shoulders and legs, thus decreasing pain in these areas. It is much easier to achieve correct postural alignment for various activities around the house before the baby arrives than after he or she gets here!
• The increased curve in your low back contributes to the very high prevalence of low back pain in pregnant women (Borg-Stein & Dugan, 2007). Physical therapists have manual skills that can correct misaligned bones in the spine and pelvis during pregnancy and decrease lumbar and sacroiliac pain.
• Because of the hormonal changes involved in preparing the pelvic opening for delivery, ligaments and joints loosen during pregnancy. This decreases the stability of the pelvis and is a precursor for injury.  A physical therapist can instruct patients in exercises to improve pelvic stability.  
• Factors which may lead to persistent low back pain postpartum include; low endurance of stomach muscles, older age and pain in early pregnancy (Gutke, Ostgaard & Oberg, 2008).

Although most back and pelvic pain will disappear after one to three months, 37% of women continue to have pain that lasts beyond the post partum period, often developing into chronic pain (Rochetti, Vleeming & van Wingerden, 2008).  Addressing orthopedic problems with physical therapy early during pregnancy through exercise, education and manual skills may prevent development of long-term problems.

A study by Norman, Sherburn, Osborne and Galea (2012) found that physical therapy exercise and education prenatally also has been shown to improve the well being of new mothers. The participants in this study significantly improved in well being scores and depressive symptoms at eight weeks and this was maintained for four weeks after completion of the program.

Performing the correct amount and type of exercises
The recommendation is an accumulation of 30 minutes of exercise on most, if not all, days of the week. Pregnant women who were sedentary before pregnancy should follow a gradual progression up to 30 minutes a day.
Dynamic lumbar muscle stabilization exercises are used to strengthen the core and should be part of a home exercise program. Normal flexibility needs to be maintained, but exercises should be individualized and modified appropriately to accommodate for the increased looseness of structures that occur during pregnancy.

Water exercise has been found to be a safe activity with advantageous effects on swelling, body temperature and unweighting your body, otherwise known as buoyancy (Berry, Katz & McMurray, 1989). Unweighting your body in the water, thus decreasing stress on the joints, is a safe and enjoyable exercise option.  

As women get back into running post partum, we are learning that running patterns and pelvis movements may need to be evaluated and modified to be more efficient and less stressful on joints.

 
Additional exercise tips:

• Perceived exertion has been helpful in monitoring the intensity of exercise in pregnancy. Exertion should be described as “somewhat hard.”
• Exercise should be performed in a temperature-controlled environment (air conditioned in the summer).
• Dietary concerns and hydration always have to be considered during an exercise program, especially during pregnancy.  
• Exercising in 15-minute intervals has been recommended to prevent concerns about over heating with exercise during pregnancy.  
• Activities which increase the chance of falling should be avoided.  
• Always check with your obstetrician before beginning an exercise program if you are pregnant.  

A physical therapist can assist with making pregnancy and the transition to motherhood a more enjoyable experience. Pregnancy should not be a time of confinement and women with uncomplicated pregnancies are encouraged to continue to exercise for their mental and physical well being!   ■

For more information contact:
Deborah W. Marchese, PT, DPT
Sheltering Arms -  Hull Street
804.764.1001

Low back (or lumbar spine) pain is a common medical condition. In fact, it is inevitable that almost all of us will experience some type of lumbar region pain in our lifetime.
There are numerous causes of low back pain such as lumbar disc problem, degenerative arthritis, nerve impingement or a good old fashioned muscle spasm or strain. But are these conditions really the true causes of low back pain, or are they the consequence of things that we do to ourselves?

It’s true that traumatic injury to the lumbar spine is difficult to predict and to prevent. Fortunately for us, most of these issues resolve with time and conservative care.
Degenerative changes of the spine due to age related arthritis will naturally occur in all of us. We get shorter with time because the lumbar discs dehydrate and lose thickness, our spines get stiffer and bone changes occur.  At the same time, age-related changes to the lumbar spine can be self- managed with appropriate and regular exercise routines.

Disuse, or de-conditioning, is a sleeper injury of the lumbar spine system. Disuse injury occurs when people are relatively inactive, such as those with sedentary occupations (administrators, computer IT personnel, etc.) and those who travel by car or plane for a living. We were designed to move, not sit. Over time these folks tend to sink into poor postural habits, lose critical flexibility and strength of the trunk and legs, and generally de-condition themselves. Basically, if you don’t use it, you lose it.
The cumulative result of these sleeper factors sets up the lumbar spine system for further injury. When people suddenly decide to participate in physical activity such as gardening or a weekend warrior sporting activity, they wind up injuring themselves, flaring up an old injury or discovering an age-related change of the spine. Surprise!

A physical therapist can help you with recovery from these painful conditions. The key to preventing low back pain from the outset, however, is long-term dedication to a well-rounded physical activity program that includes flexibility and strengthening of the legs and trunk muscles and regular aerobic activity. ■

For more information contact:
Matt Wren, MSPT
Sheltering Arms -  PTWorks
804.764.1001