Physiotherapy and safe movement in pregnancy 

Pregnancy is a period which brings a number of considerate changes in the woman’s body: change of posture, weight increase, shift in the gravity centre, hormonal changes, growth of blood volume, increased flexibility of joints etc. Physical activity can provide you with energy and strength and rid you of excessive fatigue. It relieves backache, calf cramps and nausea. It will help you feel better, prepare you for the labour and speed up the recovery to your original shape.

What happens to your body in pregnancy?

As soon as your pregnancy has started, the volume of the blood flowing through your bloodstream (by 40%)increases; this makes your heart beat faster, your breathing accelerates. From approximately the 6th month of your pregnancy, the growing baby pushes your diaphragm upwards, thus pressing on the inferior part of your lungs. Your breathing becomes more superficial. By the end of the pregnancy, the diaphragm has shifted by 4 cm or even more - so it is difficult to breathe deeply. Training the correct breathing techniques is an important part of pregnancy exercise and of your preparation for labour. To keep your abdomen muscles in a good shape, you can utilize active exhalation.

pregravidic and during pregnancy

Due to the growing uterus, the chest opens up (see picture) and the tissue between ribs stretches. This could cause rib pains, reminiscent of burning or solidification. The ribs and surrounding tissue can be relaxed by targeted exercise. It is also important to wear the right size bra in pregnancy.

Anaemia (decreased level of blood haemoglobin) in pregnancy is rather frequent. This is the main cause of overall tiredness, which occurs from the beginning of the pregnancy and it is perfectly natural in this period. It is recommended to get sufficient rest and to exercise suitable physical activities - See Physical activity and pregnancy.

Hormonal changes in pregnancy also affect the blood circulation. Your veins become “lazier”, the blood circulation is slower and less efficient. In advanced pregnancy, the weight of the baby presses on the veins of the lesser pelvis; this makes the return of the venous blood to heart more difficult. Circulation problems can occur, such as swellings, varicose veins on legs and external genitals, haemorrhoids. To prevent formation or aggravation of the varicose veins, avoid long and stationary standing and sitting with your legs crossed. While reclining on your back, place your legs above your body (i.e., the feet are above the level of your heart). This eases the return of the blood through the veins back into the heart. Exercise frequently to boost your blood circulation: lying down on your back, with your legs elevated, turn your ankles in both directions for 2 - 5 minutes. Alternatively, you can in turns pull and push your feet with an ankle movement (as if you were pedalling an old sewing-machine). Massaging your legs and arms also helps; the motion is from the toes/fingers towards the heart. As soon as you wake up, wear supportive pregnancy tights. To support your blood circulation of the perineum (prevention or alleviation of varicose veins on external genitals and of haemorrhoids), perform the so-called “pumping” - tightening and relaxing of the pelvic floor muscles for 2 - 5 minutes.

Exercising the pelvic floor muscles is a story of its own; it is a very important activity not only during pregnancy and after the birth; a healthy and active pelvic floor is … (sentence by Dr Figurová). During the pregnancy and labour, the pelvic floor muscles are weakened. This might result in leaks of urine, flatuses, descent of organs or lowering of sexual satisfaction. During pregnancy, the growing weight of the uterus presses on the pelvic floor muscles; this results in its considerable weakening. Moreover, the hormonal changes cause impairment of the pelvic floor muscles contraction. Around 50% of the women suffer from leaks of urine and flatuses during pregnancy; this is, more often than not, only temporary. To alleviate these problems during pregnancy and to prevent their persistence after the birth (around 10% of women), exercise aimed at strengthening of the pelvic floor muscles should be conducted, as well as exercises to prevent constipation (abdominal respiration) and exercise (and, from 34th week of pregnancy, also a massage) to relax the perineum. To avoid extensive overloading of the pelvic floor muscles, refrain from running, jumping, carrying of heavy load and long standing. The exercises of pelvic floor muscles should be consulted with a physiotherapist to make sure the correct technique is used.

Abdominal muscles serve mainly as a support of the abdomen; their tonus holds the internal organs in correct position. They also form a part of the supportive spinal system and help its stability. The muscles of the abdomen are, during pregnancy, gradually protracted and, thus, weakened. The centre of gravity is shifted forward and the curvature in the lower back (lordosis) increases. 49% of women suffer from back pains.  For prevention, it is essential to master and keep the correct posture. It is also important to strengthen the deep muscles, especially those of the back and abdomen which stabilize the spine. It is good to stretch and, if needed, massage the muscles of the lower back. If the pain is too intense and it persists, consult your doctor or contact your physiotherapist.

Relaxin - the pregnancy hormone softens ligaments and makes the joints more flexible. These changes are most prominent on the pelvis. The pelvis diameter grows to ease the passing of the baby at delivery. As a result of this higher flexibility of the pelvic junctions, pains in public bone area, groin area, buttocks and sciatic nerve appear. To balance instability of pelvic ligaments at every movement at which you shift, straddle your legs, etc., activate the pelvic-stabilizing muscles, especially the pelvic floor muscles and the deep abdominal muscle. Try avoiding positions in which the body weight is concentrated on one side only (walking on a slope, standing on one leg). When standing, do not bend your back forward. When getting up from bed or from your car, try to keep both legs together and move them simultaneously, to prevent pressure or drawing on the pubic symphysis when spreading your legs. To facilitate the movement, you can use a small pillow or over-ball inserted between your knees.

Growing breast volume and their growing weight cause increased strain on the muscles of the thoracic spinal area. This area must therefore also be given the appropriate attention; the overloaded spinal muscles should be relaxed and the muscles that fix the correct position of the shoulder-blade have to be strengthened.

Sports in pregnancy:

If you have practiced sports before you got pregnant (in case of physiological pregnancy without any complications), you can continue but the intensity of the exercise should gradually lessen. The exercise intensity is established according to the heart/pulse rate (HR); HR should not exceed the value equal to the sum of the resting pulse rate and 60% of the difference between resting HR and estimated maximum HR (i.e. 220 – age). (For example, a 30-year old woman with the rest HR of 70: 220 – 30=190, 190-70=120, out of which 60% = 72. 72+70=142: This woman should therefore not exceed HR of 142/min in her pregnancy). The pulse rate should fully recover within 15 minutes after the exercise. The sports activity should take place regularly, no more than 3 times a week, for 30 - 45 minutes. Ideal sports in pregnancy are swimming and aqua-aerobics. Any sport that requires fast reaction (this is extended up to a double in pregnancy) and balance (change in centre of gravity and impaired stability in advanced stages of pregnancy) is unsuitable, just like any contact sport with a risk of injury (ball games etc.). Overheating must also be avoided; the bodily temperature should not exceed 38°C. You should therefore refrain from visiting a sun parlour or sauna.

If you were not on friendly terms with sport before you got pregnant, it is not recommended getting started now with intensity. You can, however, use the natural possibility of movement, especially outdoors, such as walking. You can also try swimming or aqua-aerobics, pregnancy exercise under supervision of an expert instructor or yoga for the pregnant. The exercise will boost your energy and reduce your fatigue. It will also slow down excessive weight gain in your pregnancy. It reduces incidence of muscle cramps and retards the development of varicose veins. Moreover, it also levels down anxiety and depressions in pregnancy.