Pilates with Kierstin! Bridges with Stability Ball

Kierstin Elliot

Exercise: Bridges with Stability Ball

Set Up: Lie on your back with knees bent, with left foot flat on the mat, and stability ball under the right foot. Arms resting by your sides. Neutral pelvis.

Execution: Inhale to prep. Exhale to lift pelvis off the mat into bridge position while pressing left foot firmly into the mat and right foot firmly into the stability ball. Hold bridge for one breath, then lower with control maintaining a neutral pelvis. Repeat 5-10 times on this side and then switch to the other leg.

Focus: Keep pelvis completely level throughout the entire exercise. Be sure to not overuse or arch the lower back. Ribs should be flush with abdomen and the knees should be reaching over the toes.

Importance: Key muscles targeted in this exercise are the glutes and hamstrings! Pelvic and core stability are also challenged due to the stability ball. If you feel only your hamstrings engaging as you bridge, move heels closer to sits bones. This should help the glutes turn on.

Modifications: If you find adding the stability ball too challenging, don’t continue using it with faulty form. Try marching slowly in a bridge position- hold the right leg up for 5 counts, then slowly transfer to left leg lifting for five counts. Keep alternating legs being sure the pelvis stays level and glutes and hamstrings are engaged. If you find you pelvis dropping on one side as you do this, then do fewer repetitions to start.

Pilates with Kierstin! Kneeling Side Twist

Kierstin Elliot

Exercise: Kneeling Side Twist

Set Up: Kneel on the reformer facing either right or left side of the room with a strap held in both hands. Hands should be directly in front of the sternum, and arms rounded as if holding a big beach ball. Shoulders relaxed, lats slightly engaged, lower abs lifting up and glutes engaged for stability.

Execution: Inhale to prep. Exhale to twist from waist towards foot bar while maintaining fixed upper body posture. Inhale to return back to starting position. Imagine wringing out your waist.

Focus: Obliques and TA, spinal rotation, and pelvic stability. Be sure to keep the pelvis still while twisting from your waist. Your range of motion should only be about a quarter of a pie. Initiate movement with the ribcage, not the arms.

Importance: Core strengthening, spinal mobility, pelvic stability, and overall coordination.

Modifications: If dealing with bad knees, perform the exercise while sitting on the long box. This can also be done standing on the floor with a theraband attached to a doorknob, or standing with free weights.

 

Pilates with Kierstin! Slingshot Lunges on the Reformer

Just in time for your New Year’s Resolutions, here’s another awesome exercise from Kierstin Elliot, Pilates Teacher at Beyond Basics Physical Therapy!

Goal: Strengthen the glutes and balance 

Exercise: Slingshot Lunges on the Reformer

Set Up: Standing on the floor with right foot near foot bar and left foot against the shoulder rest. Keep left knee straight and tilt upper body forward creating one long diagonal line from head to back toes. Use one blue spring as resistance. Belly button and chin are tucked in with neck lengthened and shoulders rounded back.

Execution: Inhale to send pelvis back into lunge bending the front knee 90 degrees while reaching arms forward and keeping the pelvis level and squared off to the front. Keep shoulders away from ears. Exhale to straighten the front knee, lower arms to sides, and return to your starting position.

Focus: Be sure to keep proper alignment throughout the spine. Lumbar spine should be elongated and supported throughout the entire exercise. Maintain core connection by dropping bottom ribs towards the top of your hips bones. Hips should also be level and squared off to the front- make sure there’s no pelvic rotation during lunges.

Importance: One of the best exercises for strengthening your glutes! This exercise also enhances your ability to stabilize the pelvis and lower back while connecting to the core for improved balance.

Modifications: Limit the range of motion in standard position, or drop back knee to the carriage. Dropping the back knee may draw more focus to the quad, making the exercise feel more like a stretch, however, the focus should still be held on standing glute. For an added challenge, grab a set of 3 pound free weights for your arms for added core control.

Pilates Move of The Month with Kierstin! Lat Pull and Triceps

Kierstin Elliot

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Goal: To IMPROVE Posture!

Exercise: Lat Pulls and Triceps

Set up: Lie facedown on the box with naval pulled up towards the spine, chin tucked in with neck lengthened (as if you are holding a tangerine under your chin), glutes engaged, and legs extended. Pull yourself to back bars of the reformer and hold onto the poles with both hands. Use one blue spring for resistance.

Execution: Inhale to lengthen elbows, exhale to bend elbows.

Focus: The main muscle group targeted here are the lats. Think about pulling down from the armpits while the elbows bend and extend. This action will help stabilize the shoulders, keeping them out of the ears. Also, focus on releasing the upper traps and lengthening the back of the neck. The more work we can get from underneath the shoulder blades, rather than above, the better!

Importance: Improves posture! Strong back extensors lead to better posture, especially in this day in age where phones and computers are constantly pulling our shoulders forward and weakening our backs. Incorporate a few lat pulls into your routine and feel taller almost instantly!

Modifications: To make it easier, drop tension to one yellow spring. To make it harder, place a squishy ball between ankles and add hamstring curls or pulses between lat pull sets!

Here I am, demonstrating the lat pull!

Mind the Gap: Diastasis Recti Abdominis and What We Don’t Know: Part I

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Joanna Hess, PT, DPT, PRC, WCS

Summer holidays are approaching. You’re lounging at the beach and feeling quite proud of the ruffled swimsuit that guards the battle marks of the mom bod—the wrinkly and poochy belly. On the horizon, a woman in string bikini framing her flat tummy joins the four children sitting next to you. She must be their nanny, or maybe the children were adopted, or she probably had a surrogate. But after a short conversation, she reveals that in fact is the biological mother of these children and that she carried to full term. And when you awkwardly compliment her on the restoration of her college-era body, she nonchalantly shrugs and says, “Genetics? Maybe the coconut oil that we brought back from Bali?”

As the power of airbrushed social media images expand, the Cinderella stories of mummy tummy to model abs give hope to the many moms scrolling mindlessly on our phones passing the wee hours of childcare. These stories are powerful and inspiring, but do not reflect most of our situations, nor answer many elusive questions about diastasis recti abdominus.

What is Diastasis recti abdominis and why do we care?

Diastais recti abominis (DRA) is the excessive separation between the two sides of the rectus abdominis (the six pack muscle), which creates a pooching of the belly, particularly with difficult tasks. For this blog, the background information focuses on pregnancy related DRA while the application of the information can be used for any one with DRA. During the third trimester 100% of women have a DRA, defined as a separation >2 cm below the umbilicus (1). One answer to why we care about DRA is that we want our stomachs to look normal if not flat. The wrinkly skin stomach has not reached mass popularity on the runways. Another reason we care is because DRA has been assumed to predispose a long term sequelae of breakdown in the body. The cosmetic appearance associated with DRA improves as the inter-recti distance (IRD), the width between the bellies of the rectus abdominis, decreases.

As physical therapists, we screen for DRA in order to gain a larger understanding of how the body is working together. Many of us assume that the lack of stability in the front of the body will lead to compensations in other parts of the body—primarily the diaphragm, pelvic floor, and back. Dysfunction in these areas have been documented to be higher during pregnancy and the post-partum period (2). Physical therapists regularly address DRA when patients present with low back pain (LBP), pelvic floor dysfunction, pelvic pain, and urinary incontinence (3). A couple of studies looking at post-partum women seeking medical care for abdominal pain and pelvic floor dysfunction show a higher incidence of DRA in this populations (4,5). However, this is not to say that the DRA causes or predicts these conditions.

In recent prospective studies using ultrasound assessment, the assumption that DRA correlates to pelvic floor dysfunction and low back pain (LBP) is challenged. The findings suggest no relationship but even a possible protective mechanism of DRA during pregnancy, with no difference in LBP symptoms at one year postpartum regardless of DRA status. Of course, this is a statement of generalization to a study population and does not reflect the outliers, individual predispositions and presentation.

DRA During Pregnancy

No differences were found in pelvic floor function or in urinary incontinence between women regardless of DRA status, during or after pregnancy. Women presenting with DRA in their 2nd trimester were more likely to have higher vaginal resting pressures, strong pelvic floor muscles strength, and better endurance of pelvic floor muscles. The set of women with 2nd trimester DRA had lower BMI before pregnancy and during pregnancy with trend increased general physical activity (6)

DRA Post-Partum

Interestingly, women who at 6 weeks postpartum did not have a DRA were more likely to have a pelvic organ prolapse > Stage 2 (6). DRA status (none or mild) had no relationship with low back pain at 6 months (1) and 12 months postpartum (7). This corroborates another study showing no difference for DRA in women reporting LBP and that severity of DRA does not predict intensity of LBP when present (5). Heavy lifting >20x/week was shown to be a risk factor for postpartum DRA, but not age, pre-pregnancy BMI, 2nd trimester BMI, weight gain, caesarean or vaginal delivery, abdominal circumference at 35 weeks, hypermobility (p – 0.06), cardio and strength exercise, general abdominal and pelvic floor exercise (1). From the research available, we cannot predict from a group of postpartum women with DRA who will have symptoms that affect their daily living.

Looking a Little Deeper at Diastasis Recti Abdominis

As assumptions about DRA and its relationship to long term dysfunction start to shift, what is important to identify in a DRA presentation is also changing. The literature and clinical practice related to DRA mainly looks at the IRD, or the separation between the right and left muscle bellies of the rectus abdominis However, the focus on the widening of the linea alba may be less important than the ability of the linea alba to transfer forces and contribute to the stability of the abdominal muscles (8). A wide linea alba that holds tension and stabilizes the front of the abdomen with increased intra-abdominal pressures through functional task may be more desirable than a narrow linea alba with distortions that loses force and allows abdominal pressure to push forward through functional task. A pulled-apart and taut rubber band hold tension better than a relaxed and crumpled band. The width and depth of the linea alba need to be contextualized within the individual’s posture, daily movement, and functional core adaptability. The literature has yet to identify subgroups that would likely explain why some people have DRA that self-resolve and among those who don’t, why it impacts cosmetics and function in some people and not in others, why it seems to be a protective mechanism for some pelvic floor and low back conditions and exacerbating in others.

The linea alba is often connected to the rectus abdominis because of the focus of the IRD as a marker of DRA. However, the linea alba actually is the anatomical and functional intersection of all the abdominal muscles—the rectus abdominis, the internal and external obliques, and transverse abdominis, which is seen at a microscopic level with different angles of fibers in the linea alba. In a cadaver study looking at the collagen of the linea alba without DRA, previously pregnant women had thinner linea alba, but greater widths. Females who were previously pregnant had higher ratio transverse to oblique fibers—60% for females and 37.5% for males. The female cadaver that had never been pregnant had infraumbilical fibers more similar to males (9). The small size of this study limits its application, but perhaps an increase of transverse abdominis muscle activity in the lower abdominals is represented in the higher number fibers, and that this adapted activity resolved the DRA for these women.

Hormones may possibly play a role of the development of DRA for some women, but because DRA persist well after post-partum hormones return to normal. In men, hormones are unlikely to be the primary driving cause of persistent DRAs. Women who are breastfeeding do have a higher relationship with unresolved DRA until breastfeeding is concluded (5). However, no research has been conducted on this relationship and may add to another subgroup to explain the variance of women who spontaneously resolve and others who never resolved their DRAs.

 

Joanna is a treating therapist at our downtown location. Stay tuned for the next installment on this topic, Mind the Gap Part II: Diastasis Recti Abdominis: What we Can do About it.

To call and make an appointment with our expert PTs call:

212- 354- 2622 (Midtown)

212-267-0240 ( Downtown)

 

References:

1. da Mota PG, Pascoal AG, Carita AI, Bø K. Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain. Manual therapy. 2015 Feb 1; 20(1):200-5.

2. Lee DG, Lee LJ, McLaughlin L. Stability, continence and breathing: the role of fascia following pregnancy and delivery. Journal of bodywork and movement therapies. 2008 Oct 1; 12(4):333-48.

3. Keeler J, Albrecht M, Eberhardt L, Horn L, Donnelly C, Lowe D. Diastasis recti abdominis: a survey of women’s health specialists for current physical therapy clinical practice for postpartum women. Journal of Women’s Health Physical Therapy. 2012 Sep 1; 36

4. Spitznagle TM, Leong FC, Van Dillen LR. Prevalence of diastasis recti abdominis in a urogynecological patient population. International Urogynecology Journal. 2007 Mar 1; 18(3):321-8

5. Parker MA, Millar LA, Dugan SA. Diastasis Rectus Abdominis and Lumbo‐Pelvic Pain and Dysfunction‐Are They Related?. Journal of Women’s Health Physical Therapy. 2009 Jul 1; 33(2):15-22.

6. Bø K, Hilde G, Tennfjord MK, Sperstad JB, Engh ME. Pelvic floor muscle function, pelvic floor dysfunction and diastasis recti abdominis: Prospective cohort study. Neurourology and urodynamics. 2017 Mar 1; 36(3):716-21.

7. Sperstad JB, Tennfjord MK, Hilde G, Ellström-Engh M, Bø K. Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. Br J Sports Med. 2016 Jun 20:bjsports-2016.

8. Lee D, Hodges PW. Behavior of the linea alba during a curl-up task in diastasis rectus abdominis: an observational study. journal of orthopaedic & sports physical therapy. 2016 Jul; 46(7):580-9.

9. Axer H, Keyserlingk DG, Prescher A. Collagen fibers in linea alba and rectus sheaths: II. Variability and biomechanical aspects. Journal of Surgical Research. 2001 Apr 1; 96(2):239-45.

10. Liaw LJ, Hsu MJ, Liao CF, Liu MF, Hsu AT. The relationships between inter-recti distance measured by ultrasound imaging and abdominal muscle function in postpartum women: a 6-month follow-up study. journal of orthopaedic & sports physical therapy. 2011 July.

11. Coldron Y, Stokes MJ, Newham DJ, Cook K. Postpartum characteristics of rectus abdominis on ultrasound imaging. Manual therapy. 2008 Apr 1;13(2):112-21.

12. Boissonnault JS, Blaschak MJ. Incidence of diastasis recti abdominis during the childbearing year. Physical therapy. 1988; 68(7):1082-6

13. Chiarello CM, Falzone LA, McCaslin KE, Patel MN, Ulery KR. The effects of an exercise program on diastasis recti abdominis in pregnant women. Journal of Women’s Health Physical Therapy. 2005 Apr 1; 29(1):11-6.

14. Benjamin DR, Van de Water AT, Peiris CL. Effects of exercise on diastasis of the rectus abdominis muscle in the antenatal and postnatal periods: a systematic review. Physiotherapy. 2014 Mar 1; 100(1):1-8.

15. Pascoal AG, Dionisio S, Cordeiro F, Mota P. Inter-rectus distance in postpartum women can be reduced by isometric contraction of the abdominal muscles: a preliminary case–control study. Physiotherapy. 2014 Dec 1; 100(4):344-8.

16. Sancho MF, Pascoal AG, Mota P, Bø K. Abdominal exercises affect inter-rectus distance in postpartum women: a two-dimensional ultrasound study. Physiotherapy. 2015 Sep 1; 101(3):286-91.

17. Litos K. Progressive therapeutic exercise program for successful treatment of a postpartum woman with a severe diastasis recti abdominis. Journal of Women’s Health Physical Therapy. 2014; 38(2):58-73.

18. Gillard S, Ryan CG, Stokes M, Warner M, Dixon J. Effects of posture and anatomical location on inter-recti distance measured using ultrasound imaging in parous women. Musculoskeletal Science and Practice. 2018 Apr 1; 34:1-7.

19. Kirk B, Elliott-Burke T. The Effect of Visceral Manipulation on Diastasis Recti Abdominis (DRA): A Case Series.

Lace up or Feet up? Running During Pregnancy

Running and exerciseJoanna Hess PT, DPT, PRC, WCS

Exercise in ever tightening spandex while making frequent public toilet stops, or binge on Netflix and cronuts? Pregnancy is a great equalizer. Not even Kate Middleton can escape the hormones that can cause pregnant women to suffer from mood swings, fatigue, nausea, and achiness. Those symptoms—and modern culture—frequently encourage pregnant women to decrease movement and everyday activities. However, there is resounding support in academic literature that recreational physical activity during pregnancy is beneficial to both mother and baby.

While the pregnant woman is best suited to monitor what is beneficial for her body and baby during pregnancy, adequate information to make that decision is not always readily available. Yet around 600 studies published between the mid-1980s and mid-1990s corroborate that exercise during pregnancy is not harmful by measure of fetal birth weight, mode of delivery, preterm delivery, Apgar scores, and acute fetal well-being (1-3). What’s more, the American College of Obstetricians and Gynecologists (4) removed the limitations for intense exercises back in 1985 (5) and a literature review showed that bed rest was not beneficial for pregnancy complications. Still, 95% of ob-gyns continue to prescribe activity restrictions to certain pregnant mothers (6).

Clearer guidelines are needed for how pregnant women can decrease injury while maintaining performance and the well-being of mother and baby. While running is only one mode of boosting fetal and maternal health, many women, especially here in New York, embrace it as a key part of their overall wellness. As a recreational runner myself, I was disappointed during my first pregnancy with the foggy information regarding how to run safely during pregnancy. I found myself as a self-case study, correlating the physiological and biomechanical pregnancy changes with a shift in running mechanics. At the third trimester, I had a suspicion that I should replace running with the elliptical and restorative yoga.

The scientific literature specific to running during pregnancy is extremely limited, and in its absence, I’ve used findings for “moderate to strenuous” physical activity, in addition to clinical knowledge of pregnancy related changes in the body and running patterns to develop the recommendations below. Recently, a group of researchers published a series of five papers and combined recent literature about higher level physical activity during pregnancy for application in appropriate populations (7-8).

Pregnancy and exercise:

Pregnancy may seem like a counter-intuitive time to start an exercise program. However, research shows that 150 minutes/week of moderate exercise (9) for inactive and relatively sedentary women, and moderate to strenuous exercise for active women, has strong health benefits for both fetus and mother. Moderate exercise is recognized as 5-6 on the Rate of Perceived Exertion (RPE), 40-59% HRR (Heart Rate Reserve = Heart rate max – Heart rate resting). Moderate to strenuous is described as 7-8 RPE, 60-84% HRR (1). So while growing a baby is not a good time to start a running program, it is a good time to increase an appropriate level of physical activity or continue an established running program. Some of the benefits of appropriately prescribed exercise are correlated to (10-16):

· Improved cardiovascular function

· Lower risk for gestational diabetes

· Improved strength and lean muscle mass

· Improved sense of wellbeing

· Improved sleep

· Decreased bone density loss

· Decreased physical discomfort – low back pain, pelvic girdle pain

· Healthier gestational weight gain, which protects against complications like cesarean delivery, hypertension, preeclampsia, and gestational diabetes

· Improved general healthy behaviors

· Improved psychological wellbeing – reduction in depression and anxiety, improved self-esteem, particularly for women who were previously inactive

· Improved ability of the placenta to deliver oxygen

· Increased amniotic fluid

· Healthier fetal birth weights that correlate to changes in leptin levels that continue to correlate with a healthier body fat and muscle ratio at the age of 5

· Increased gestational age

· Decreased rate of pregnancy complications, although one study showed higher use of physician assisted delivery (10)

· Faster delivery and decreased chance of Cesarean delivery in a setting that supports natural birth (11)

· Higher Apgar scores

· Lower fetal heart rate and increased fetal heart-rate variability

· Improved neonatal orientation

· Higher general intelligence and oral language skills at the age of 5

· Improved ability of baby to self-soothe after birth, (i.e. longer stretches of night sleep)

Precautions:

Strenuous activity is correlated to a higher rate of miscarriage during the implantation phase of pregnancy—about 20-23 days after the last menstrual cycle. Elevated body core temperature (above 103 degrees Fahrenheit), which can be caused by strenuous activities like marathon running or exercising in hot and humid weather, can increase the risk of fetal neural tube abnormalities during its development, 35-42 days after last menstrual period. Exercising for 60 minutes in a comfortable environment will not raise core temperature above 100 degrees Fahrenheit.

The pregnant woman’s heart rate should not exceed 90% of her maximal heart rate. Because of physiological changes, the pregnant runner will underestimate her heart rate based on the typical rate of perceived exertion or talk test. For this reason, the pregnant runner should modify the run intensity knowing that her heart is working harder than she perceives or wear a heart rate monitor using the HRmax = 220-age, unless she has access to laboratory equipment that can calculate HRmax without full exhaustion.

The American College of Obstetrics and Gynecology, (ACOG) has set absolute and relative contraindications to aerobic exercise during pregnancy (4).

Absolute contraindications:

· Hemodynamically significant heart disease

· Restrictive lung disease

· Incompetent cervix or cerclage

· Multiple gestation at risk of premature labor

· Persistent second or third trimester bleeding

· Placenta previa after 26 weeks of gestation

· Premature labor during the current pregnancy

· Ruptured membranes

· Preeclampsia or pregnancy-induced hypertension

· Severe anemia (different than mild anemia)

Relative contraindications:

· Anemia

· Unevaluated maternal cardiac arrhythmia

· Chronic bronchitis

· Poorly controlled type 1 diabetes

· Extreme morbid obesity

· Extreme underweight (BMI <12)

· History of extremely sedentary lifestyle

· Intrauterine growth restriction in current pregnancy

· Poorly controlled hypertension

· Orthopedic limitations

· Poorly controlled seizure disorder

· Poorly controlled hyperthyroidism

· Heavy smoker

Warning signs:

Low back and pelvic girdle pain/instability, knee/hip pain, pelvic heaviness, sharp pains in the pelvic floor, urinary leakage, and regular ankle sprains are all signs that it may be time to modify running as exercise. In the clinic, I am often asked about pelvic floor symptoms, particularly urinary leakage during pregnancy, and specifically with running.

I like to think of these warning signs as a force transfer problem—something in the system is not working well. For stress incontinence and pelvic heaviness, it’s the inability of the pelvic floor to generate enough force to keep things up against the up-chain forces of running (2.5x while accepting weight after the flight phase) and down-chain forces of steadily increasing body weight + baby’s weight (around 20% of pre-pregnancy weight). But post-partum is not as simple as the forces that are generated from running or the ability to do a Kegel. Elite athletes and non-exercisers have about the same rate of post-partum incontinence. However, postpartum symptoms are more likely if exercise also caused urinary leakage during pregnancy (16).

The pregnant body is a little more complicated:

It needs to taken into account, that the 10-fold increase of relaxin and progesterone that might be responsible for more instability as forces from the ground traveling up into the falling arches of the feet, adduction of the knee, internal rotation of the hip, through the pelvic floor and gapping of the sacroiliac joint. As the fetus and breasts grow, the body’s center of gravity shifts forward, the ribs flare, and the pelvis tilts forward. While the gluteus maximus and calf muscles are getting stronger to propel the pregnant body forward, the front of the body gains significantly more mass. When this happens, the front of the diaphragm and the front of the pelvic floor are positioned so more forces are going through the front of the pelvic floor than the back. This requires more support of the bladder through the pelvic floor. As the pelvis widens, foot step width increases in walking (17), but decreases in running during the single stance phase, requiring more pelvic control. In other words, the pregnant runner’s leg strength, particularly the hip stabilizing muscles, gluteus medius and minimus, need to be exponentially stronger than in the non-pregnant runner to account for additional weight, forward weight shift, and ligamentous laxity. I primarily talk about the deficit of the gluteus group because of what I see clinically, but depending on when the woman is experiencing pain or pelvic floor instability symptoms, other muscles may also need attention.

The usual period of pain experienced by pregnant runner’s initial strike to single stance, corresponds with the biomechanical gapping of the sacroiliac joint. Alleviating such issues will require force absorption and muscle activation through the quadriceps, medial hamstrings, calf muscles, tibialis anterior, TFL, adductor magnus, iliopsoas, and gluteus medius/minimus. Symptoms of lower extremity and lumbopelvic pain, pelvic heaviness, or sharp pains in the pelvic floor have similar biomechanical and physiological causes as urinary leakage. They should be treated in a similar manner whether controlling the upward and downward loads by:

· decreasing speed of running – correlated to double flight phase, which increases upward pressures

· decreasing vertical displacement

· landing with a midfoot strike to increase shock absorption (18)

· increasing arm swing/thoracic movement – dispersing upward forces and facilitating the respiratory and pelvic floor piston

· decreasing daily physical exertion that causes increased abdominal pressure

· increasing external support with (sacroiliac joint) SIJ belts or foot orthotics – decreasing the body’s instability

· improving glute strength in functional positions – tandem lunges, close chained glute isometrics

· improving dynamic single leg pelvic stability – star excursion

· maintaining hip flexor mobility – controlling forward pelvic tilt, movement throughout the day out of sitting posture, hip flexor stretches, shifting weight back through heels, diaphragmatic vs. back breathing

An orthopedic physical therapist specializing in pelvic floor dysfunction and in prenatal and postpartum care will be able to give more specific recommendations, since each woman’s symptoms are a little different.

Expected running changes in pregnancy:

For previous recreational to elite runners, about 70% will continue to run at some point in the pregnancy with only 1/3 continuing into the third trimester. They usually cut the running volume and intensity by 50% compared to non-pregnancy training. For those who stopped running during pregnancy, over half elected to do so because of self-monitoring symptoms of wellness, about one quarter stopped due to physician’s advice, and the remainder stopped for fear of a miscarriage. Whether choosing to continue or stop running during pregnancy, most women had returned to running by 2 months postpartum, and without negative impact on breastfeeding (19).

Speed will decline as instability increases, so that the body has less time with both feet off the ground. Ankle sprains may happen intermittently because of changes in foot position, possible increased swelling, and laxity in the ankle ligaments. Resting heart rate increases 15-20%. Breathing might be more labored during running because of increased sensitivity to carbon dioxide (particularly in early pregnancy) and decreased lung capacity/rib excursion (in late pregnancy). Pregnancy-related mild anemia, which decreases available blood oxygen, affects more than 40% of pregnant women and may show up as accelerated fatigue and increased respiratory rate during running. Be sure that fatigue is not related to severe anemia or hypothyroidism, particularly in persistent symptoms. The pregnant body will improve its ability to thermoregulate with increased sweating to dissipate more heat.

Clothes won’t fit like they once did, especially the spandex. Find some appropriately fitting, breathable, loose exercise clothing that does not excessively compress around the stomach. Urinary urgency and frequency are common limitations in running as the pregnancy progresses, which requires some planning and increased water intake.

Running during pregnancy presents an opportunity to do something overwhelmingly beneficial for both mother and baby, with the added incentive of tuning into the body’s remarkable capacities. While physical activity, running or otherwise, will look different during pregnancy, the goals are similar for a healthy lifestyle. Be kind to yourself—body, mind, and spirit. You and your baby will be thankful. Happy trails. Please leave any comments or questions here!

Joanna is currently taking new patients at our downtown office.

Irene &amp; Joanna treatment 4
Joanna keeping fit with personal trainer, Irene Donahue at our Downtown location

Phone: (212)- 267- 0240

 

 

1. Szymanski LM, Satin AJ. Exercise during pregnancy: fetal responses to current public health guidelines. Obstetrics and gynecology. 2012 Mar;119(3):603.

2. Physical Activity Guidelines Advisory Committee. Physical Guidelines Advisory Committee Report, 2008. Wasington, DC: U.S. Department of Health and Human Services: 2008.

3. Barakat R, Stirling JR, Lucia A. Does exercise training during pregnancy affect gestational age? A randomised controlled trial. British Journal of Sports Medicine. 2008 Aug 1;42(8):674-8.

4. American College of Obstetricians and Gynecologists. Physical activity and exercise during pregnancy and the postpartum period. Committee Opinion No. 650. Obstet Gynecol. 2015;126(6):e135-142.

5. Artal R, O’toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. British journal of sports medicine. 2003 Feb 1;37(1):6-12.

6. Bigelow C, Stone J. Bed rest in pregnancy. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine. 2011 Mar 1;78(2):291-302.

7. Bø K, Artal R, Barakat R, Brown W, Davies GA, Dooley M, Evenson KR, Haakstad LA, Henriksson-Larsen K, Kayser B, Kinnunen TI. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1—exercise in women planning pregnancy and those who are pregnant. Br J Sports Med. 2016 May 1;50(10):571-89.

8. Bø K, Artal R, Barakat R, Brown W, Dooley M, Evenson KR, Haakstad LA, Larsen K, Kayser B, Kinnunen TI, Mottola MF. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 2—the effect of exercise on the fetus, labour and birth. Br J Sports Med. 2016 Sep 22:bjsports-2016.

9. US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Department of Health and Human Services. Washington, DC: 2008.

10. Kuhrt K, Harmon M, Hezelgrave NL, Seed PT, Shennan AH. Is recreational running associated with earlier delivery and lower birth weight in women who continue to run during pregnancy? An international retrospective cohort study of running habits of 1293 female runners during pregnancy. BMJ open sport & exercise medicine. 2018 Mar 1;4(1):e000296.

11. Erdelyi GJ. Gynecology survey of female atheletes. J Sports Med Phys Fitness. 1962;2:174-179.

12. Prather H, Spitznagle T, Hunt D. Benefits of exercise during pregnancy. PM&R. 2012 Nov 1;4(11):845-50.[Ine

13. Hoeg TB. Baby on Board: Long Distance Running During Pregnancy – iRunFar.com [Internet]. iRunFar.com. 2017 [cited 2018May7]. Available from: https://www.irunfar.com/2017/12/baby-on-board-long-distance-running-during-pregnancy.html

14. Clapp JH, Capeless E. The VO2max of recreational atheletes before and after pregnancy. Med Sci Sports Exerci. 1991;23:1128-33

15. Gjestland K, Bø K, Owe KM, Eberhard-Gran M. Do pregnant women follow exercise guidelines? Prevalence data among 3482 women, and prediction of low-back pain, pelvic girdle pain and depression. Br J Sports Med. 2012 Aug 1:bjsports-2012.

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Pilates Versus Yoga

Pilates vs. Yoga Kierstin Elliott, Certified in Stott Pilates

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As a pilates instructor, I am often asked the question, “How is pilates different from yoga?” Although there are many similarities between the two practices, such as developing strength and flexibility, the differences are quite substantial.

Yoga is an ancient practice that has long been established throughout Indian culture. One major factor that sets yoga apart from pilates is the spiritual element. For many, yoga promotes an environment of self awareness in mind, body, and spirit. Although there are various styles of yoga, ranging from the lively flow of Vinyasa to the meditative holds of Yin, you have the freedom to explore and evolve the limitations of your body and mind within the practice.

Pilates is a more recent method of movement created by Joseph Pilates as a form of rehabilitation and was introduced to the States in 1920. Pilates wanted to create a practice in which injured soldiers could quickly rehab with bio-mechanics. Therefore, the apparatus’ used in the practice such as the Cadillac and Reformer, closely resemble hospital beds with springs, pulleys, and slings. Pilates is focused primarily on restoring the natural curves of the spine using these 8 founding principles: breath, concentration, control, centering, flow, alignment, precision and relaxation.

Both pilates and yoga offer numerous health benefits for the mind and body in addition to complimenting each other quite well. If you are looking for a more spiritual or meditative connection through movement, yoga is the choice for you. If you are looking to strengthen your core and improve posture, pilates will be right up your alley. Give them both a try and see what makes the most sense for your body. Finding a practice that not only feels good, but one that you also enjoy, is important for maintaining consistency and progress. Only with commitment and dedication to your practice will you discover the stronger, healthier, and happier version of you!

 

kierstinbbpt_smKierstin Elliot currently teaches Pilates at Beyond Basics Physical, Flex, Kinespirit, and offers in home training. Call the office at Beyond Basics at 212-354-2622 for more information on Kierstin!