Exercise During Pregnancy

diastasis recti exercise in pregnancy exercise pregnancy first trimester pregnancy pregnant Feb 13, 2023

Orthopaedic and Pelvic Health Physiotherapist Brittany Klingmann and Melissa Dessaulles, Mommy Berries Founder BScPT, BScKin, Pelvic Health, discuss the latest evidence around exercise during pregnancy, including what do the guidelines say, the benefits of exercise during pregnancy, what type of exercise is recommended, and reasons why it may not be recommended in certain situations.



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[00:00:00] This episode is a collaboration between Melissa Dessaulles of Mommy Berries Physiotherapy and the Pelvic Floor Project.


[00:00:56] Melissa Dessaulles: How many of you have questions about exercise during pregnancy? [00:01:00] Can it harm the baby? Are there risks to mom? What are the benefits? Are there certain exercises that are better than others, any that need to be avoided altogether? How vigorous can the exercise be? How do you know how to modify?

[00:01:16] It is hard to find answers to these questions on social media or Google. What if I told you there are evidence-based guidelines that not only dispel many of the exercise during pregnancy myths, but also outline the numerous benefits to being active while you grow a baby? Joining me today to break down the guidelines for you is fellow physiotherapist from Halifax, Nova Scotia, Brittany Klingmann. Brittany is not only a bright and energetic personality, has a brain full of knowledge, but she also lifts very heavy weights herself. If you haven't already listened to episode 13 where we discuss CrossFit and weightlifting during pregnancy and postpartum recovery, [00:02:00] I recommend you listen after this one.

[00:02:03] Our goal today to help provide you with motivation and confidence to be active in your pregnancy, and of course, plug Pelvic Health Physiotherapy because we do not just teach kegels. We're also here to help you better understand your pregnant body and know how to support it as it grows and recovers. If you haven't already heard, I facilitate small group guidance to pregnant and postpartum moms. We meet regularly to discuss hot topics that you're wondering about, like prolapse, leaking, the core, and diastasis, but we also try exercises together and learn ways to modify if needed. You deserve to feel confident through it all. Now, without further ado, grab your walking shoes, your dumbbells or your yoga mat. Let's discuss exercise during pregnancy. Alright, Britt, I'm happy to have you back to talk similar to our last episode where we talked more about, [00:03:00] CrossFit and weightlifting during pregnancy and postpartum. I wanted to bring it out a little bit and talk generally about exercise during pregnancy because both of us see a lot of women during pregnancy come in and have different questions. I thought this would be a great opportunity to help clarify some things and answer some questions that I know a lot of people have. So thank you so much for joining me all the way from Halifax.

[00:03:24] Brittany Klingmann: Yes, thanks for having me, Mel. I look forward to our chat.

[00:03:28] Melissa Dessaulles: Will you just start off by anyone that doesn't know who you are? Will you talk a little bit about who you are, where you are, and your passions when it comes to pelvic health?

[00:03:40] Brittany Klingmann: Sure. Yeah. My name's Brittany Klingmann. I'm a physiotherapist orthopedic and pelvic health. I am currently located in Halifax, Nova Scotia although originally from the west coast. Spent the first, oh gosh, at least seven years of my practice in BC and then now we're out on the other side of the country. And it [00:04:00] was really my personal journey. I would say postpartum, specifically in my scenarios, specifically returning to fitness after my two C-section deliveries, that sparked my passion working with individuals who are pregnant and wanting to continue exercising through pregnancy and, helping them navigate that journey postpartum as well.

[00:04:30] So I think this is gonna be a fun conversation today because I do think time and time again in the clinic I'm having conversations a lot of conversations on helping individuals understand or dispel myths, maybe is a better way to say around exercise in pregnancy.

[00:04:50] Melissa Dessaulles: Now, please don't downplay all your successes with what you do in your spare time. Will you tell everybody your area of specialty and what do you do for [00:05:00] activity in your spare time?

[00:05:01] Brittany Klingmann: Sure. Yeah. Over the last, I guess it's been close to six years now, I first found CrossFit so fell in love with CrossFit and then through CrossFit, fell in love with weightlifting. I spend the majority of my free time now weightlifting So the true Olympic lifting, which would be the snatch and the clean and jerk. So I like to move heavy weight and oddly enough, depending on when perhaps when you received your training in pelvic health, the world of pelvic health, a lot of times the narrative was around potentially like protection guidance and avoidance guidance. And I wanted to play a little bit of devil's advocate cause I didn't truly believe that these things were inherently bad for you, . And if anything, I now feel stronger and better than I ever have physically, and that would include my pelvic health as a piece of that [00:06:00] puzzle.

[00:06:01] Melissa Dessaulles: Go further into your recent accomplishments.

[00:06:04] Brittany Klingmann: Oh, I did qualify for the World Masters Games. Unfortunately, due to Covid, they've been canceled for this time around. But that is more than Okay. I have my target set on qualifying for actually I have the qualifying total numbers to compete at the World Championships and weightlifting for masters in Orlando at the end of this year.

[00:06:27] Melissa Dessaulles: Good for you. I'm proud of you. Yeah. Thank you, . So I thought I wanna talk through kind of very practical things today and I thought, if we talk through how we approach some of the questions that our clients have when it comes to our role as a physiotherapist, I thought we could start there. And so I picture every single new client that comes in to see me if they're pregnant. I always wanna know, a little bit about their goals, what's bringing them in. But I always ask if they don't bring it up, what kind of activity do you get right now, besides survival, I often say if they have a [00:07:00] child or if they're pregnant. What kinds of things do you like to do for physical activity? And are you doing everything that you want to do because, lots of times people will say well, I used to do this, and so I want to know, okay, are you not doing the things that you want to do because of time, because of the pregnancy, because of covid? Or because maybe some there's been some sort of messaging in your head that you're leery to do certain activities. So first I just wanna find out, are you doing everything you want to do? Do you feel comfortable in what you're doing or what's holding you back? So I wonder if we talk a little bit about. you know, Because when we talk to our clients about exercise and how to be as active as they can, we're not really necessarily pulling this information out of a hat or or just pulling it off of social media. There's actually some new guidelines that we can use in our back pocket. Most recent, like 2019 Canadian guidelines for physical activity throughout pregnancy that help us to guide our [00:08:00] clients. I just wanna know that the information we're talking about today is based on those guidelines and helping you be able to integrate those guidelines into what you want to do for activity. Brit, what if we start a little bit about why, like, why is it that we want to help our clients be active during pregnancy? I mean, there's several benefits to being active. Mm-hmm. And so what if we just start listing some of those so people know why it's so important to us?

Benefits to Being Active

[00:08:28] Brittany Klingmann: Yeah, absolutely. So in general, the guidelines, like usually when we think of physical activity, we think of physical benefits to one one's own wellness. And these guidelines, while yes, it has a multitude of physical benefits, maternal benefits, there are also fetal and neonatal benefits to continuing exercise. So this is a unique point in time where you're not only influencing your own physical [00:09:00] health, but also the wellness of the developing fetus or baby. So in general, there are fewer newborn complications when the expectant mother is maintaining physical activity throughout their pregnancy. As well as the maternal benefits to get into some maybe like medical terminology, it does decrease risk of preeclampsia. Gestational diabetes, it does decrease the risk of c-section rates. While although that's potentially not a kind of a main focus it is found supported in the literature, it does decrease risk of instrumented deliveries. And so from our lens, Mel, as we would know from a pelvic health perspective, there is a increased incidence of tearing or higher degrees of tears with instrumented deliveries. It can reduce the incidence of urinary incontinence or that [00:10:00] bladder leakage during pregnancy and potentially even influence incidents postpartum, it can decrease gestational weight gain, and it has a multitude of positive mental health benefits as well as decreasing complaints of kind of lumbopelvic discomforts or pain. So those are, that's a, this is actually a long list of benefits. The other thing I think is really important to state clearly, or talk about is to dispel the myths that in the literature exercise is not associated with increased risk of miscarriage, increased risk of stillbirth or neonatal death or preterm birth or complications around preterm birth.

[00:10:49] So I know there's a lot of moms that come in scared of I don't know. I've heard that I shouldn't exercise in the first trimester and I don't want to do harm, [00:11:00] essentially. I don't want to do harm. Or they've been told by their primary healthcare provider that actually I I wasn't active before I got pregnant, so I shouldn't start something new. And these guidelines, which we can talk in detail here in a second. They will they actually say no. Like start unless you have a specific contraindication, they encourage you to become active.

[00:11:27] Melissa Dessaulles: Yeah, I was actually listening to like one of the lead researchers Margie Davenport on the, At Your Cervix podcast, which I'll link in the show notes, and she was one of the lead researchers that helped put together these guidelines and, she was saying that kind of one of their, one of their main goals with putting together these guidelines were to help people understand that is outdated information that's circling around there for the most part that you need to scale back on exercise because it might be harmful. Cause you said, we actually found no [00:12:00] risks as you just mentioned to the fetus. And so I, and then I think when you look at, when you think, okay so there actually aren't that all of those risks that we thought that there were mm-hmm. wow. Actually look at that long list of benefits and I couldn't, the one I was drawn to the most, and I can't remember the stat that she gave, I wanna say it was like 60 or 70% decrease in depression, that, that, I think that's such a big thing. You stop exercising because you have these, these nervous feelings or these hesitations and you don't, you just don't know. So you'd rather not do it, but then stopping the activity or not being, active in any type of activity, if anything might start that cycle, you start worrying about those things even more. So I thought that was really interesting to think about, wow like unfortunately there's just so much fear out there that isn't found in any of the research, but more than anything, like we should be active for so many reasons.

[00:12:55] Brittany Klingmann: Yeah, absolutely.

[00:12:57] Melissa Dessaulles: And I also think too, like one of the things [00:13:00] that some of the other things I bring up to my clients is I explain to them all of the benefits, but then also too, I say postpartum is such a time of needing to be strong. Like you're lugging around a weight all the time. So just yeah, thinking about establishing that routine or feeling like you have a strong body before all of the physical demands of being a new mom start. And let's face it, I mean, look at how much the body changes during pregnancy to be able to keep up with those changes is helpful.

[00:13:26] Brittany Klingmann: Yeah, absolutely.

[00:13:28] Melissa Dessaulles: What if we talk about then, obviously the benefits are huge, what about, okay, so the other thing that, she mentioned as far as these guidelines go is that there used to be a recommendation that you needed to get approval from your care provider before you were active and now they're saying you do not need your care, given that we know that there's no risk you don't need your care provider in that first trimester, especially cuz so many women are not seeing their care provider until several weeks or even a couple months into their pregnancy. You don't need your care provider's blessing before you go for [00:14:00] a walk or before you do moderate activity. So I wonder then though, in the guidelines, they also list the contraindications, like there would be some medical issues. Yes. That exist, that, that would suggest that you not be active. And these would be ones that your care provider would bring up to you. And do you wanna share some of those, Britt?

[00:14:21] Brittany Klingmann: Sure. Yeah. Yeah. So absolute contraindications can include ruptured membranes, premature labor, unexplained persistent vaginal bleeding, placenta previa after 28 weeks gestation, preeclampsia, incompetent cervix, intrauterine growth restriction, higher order multiples. So the example that they include is triplets or beyond, uncontrolled type one diabetes, uncontrolled hypertension, uncontrolled thyroid disease and then other serious cardiovascular, respiratory or systemic disorder. So that, the individuals [00:15:00] generally would be well informed by their primary care provider in those circumstances. So then the other thing they do talk about in the guidelines is that it can be a sliding scale of, for example, with the placenta previa. Like they can be, they can start as no contraindications to exercise and in that third trimester that the recommendations for them may change. So just flex flexibility to a sliding scale?

[00:15:35] Melissa Dessaulles: Yeah. And then I think just trusting that, your care provider will tell you if you have any of those issues. Mm-hmm, like it won't, that won't go undetected. They're using all their, the ultrasounds and all the other information they're gathering to be able to tell you about that. Yeah. But basically unless you know that about yourself, the benefits of exercise far outweight a ny risks. Yes. What about so what if we talk about, then before we go into the specifics, like what is [00:16:00] recommended? What, let's talk about the recommendations when, sure, it's when it comes to exercise. So basically if you don't have those contraindications, you should be active. Yes. Um, And then, so yeah, go ahead. Let's start.

Recommendations around Exercise

[00:16:12] Brittany Klingmann: So accumulating at least 150 minutes of moderate intensity physical activity each week. They say that should be acquired over a at least three days, but being active daily is encouraged.

[00:16:28] Melissa Dessaulles: And then on that note too, Britt sorry, what? Yeah, I'm just trying to think of some of the clients that come in. And so when you hear that 150 minutes, like I think a lot of people will be like, oh my gosh, like I don't have, my gym membership because of Covid and it's icy out. But I always like just walk people through what does your day look like? Do you walk your older kid to school? Are you walk like lots of people have dogs that they're taking out for work. And they don't even count that as an exercise, right? Yeah. Or they don't realize that, oh yeah, I actually have to take stairs at work. [00:17:00] Like all of that counts and Yeah. Like it doesn't have to be that you need to be in a prenatal class or you need to be enrolled in prenatal yoga or that you need to have a gym membership. Like any physical activity counts in this 150 minutes.

[00:17:15] Brittany Klingmann: Exactly. In the clinic I usually use perceived exertion or get helping them know what what is moderate intensity anyways, right? And a really user-friendly guide that you can use is the talk test. So I would say if you're out walking with your partner with a friend that you should, a moderate intensity would be add an intensity that you're getting a sentence or two out, and then you need to redirect to focus on your breath and then you resume the conversation, but you're not getting a word or two out and needing to stop to catch your breath. If you're maintaining that type of effort, they would, you would be deemed as exercising in that [00:18:00] moderate intensity range. And if you're keen and want to wear a heart rate monitor, the guidelines also do give heart rate ranges as well. So I, we don't need to necessarily share those details of exact numbers, but for people that are wanting to track that, it is another tool that can be used. But I think more those subjective resources are just really easy to use.

[00:18:24] Melissa Dessaulles: Absolutely. And also too, I think knowing that a lot of the limitations with the guidelines are because of a lack of research. I mean, that's one of the things is that they don't do a lot of research on pregnant women, especially elite athletes or high intensity exercise. I know that they have to draw their recommendations based on a lack of data, so I think, like what I, I know that they're starting to be more and more research out there looking at high intensity exercise for pregnant women. Yeah. But right now, some of those limitations are in place because we don't know. But I [00:19:00] think that's something too, to keep in mind on an individual basis. These guidelines are in place, but you know, how you feel as an individual when you're exercising is very important too. I think we have to often just encourage people to listen to their bodies, right?

[00:19:14] Brittany Klingmann: Yeah. Yeah. Exactly. What's another one? So coming back to 150 minutes minimum of three days encouraged most. Also, combination of aerobic and strength-based activities was another one of their recommendations.

[00:19:32] Melissa Dessaulles: So what kinds of things so then if you're talking to someone Brit, that's that, you're talking to someone in, in front of you, then that's, wanting to know what that means. So like examples. Let's talk about examples then of aerobic exercise

[00:19:47] Brittany Klingmann: Aerobic exercises are exercises that would elevate the heart rate per, like a sustained duration. So activities could include walking, hiking, cycling,[00:20:00] running. They could be in, in a gym context, any of the equipment that you might use, elliptical trainers, rowing machines, those types of scenarios would be your aerobic swimming would be another excellent example of aerobic activities. So finding the things that you enjoy doing first and foremost. And that would, but that would constitute under that I'm sure for you, Mel speaking to that, skiing and biking, like maybe not necessarily the downhill stuff, but cross country, very much an aerobic based activity that depending on how you interpret the guidelines would be also maybe an activity that they flag as, should we be careful with this if there's an innate risk of falling or that like trauma to the belly, so to speak. How do [00:21:00] you manage those scenarios? Cuz I, I know I have conver, like this is one that I very much take as a person to person, totally, topic.

[00:21:11] Melissa Dessaulles: I would say. I would say for me I think like someone that runs think there used to be a lot of talk about you shouldn't run during pregnancy, but actually now I feel like we're changing to, if it feels good to run, you should run. And so if someone is out getting a lot of pain and it doesn't feel good then maybe it's not for them at that time. That's not the way that they should be exercising. I find too that there's a certain, like for example, downhill skiing. Some people are very accomplished skiers and have grown up skiing and they don't feel nervous. Yeah. I remember feeling a sense of nervousness when I was skiing pretty early on, so it wasn't for me. But other people wouldn't bat an eye at it. And I think it depends on their, generally. I think that's where we have to be a bit intuitive. Yeah. And I think that we shouldn't be, we should be careful that we're not saying don't do that [00:22:00] if it feels good. Because we we don't have any evidence to say it's bad. Yeah. But also helping them feel confident to, to trust their bodies if they do feel good. Cause I think sometimes a lot of the advice they get is, oh you should only be walking and doing prenatal yoga. I think a lot of women hear. Mm-hmm. So I think it's our job to help them, feel confident in the things that they want to do. Cuz isn't that the biggest goal is that they do what they want to. Yeah. Maybe let's touch on then the strength aspect because, I think like this, the benefits of strength training is huge and, like I said, we did an episode where we talk about how you can make modifications as your belly grows and as your body changes for some of the sports that you participate in. So I think people should ref refer to that episode. But I think, generally thinking about whole body strengthening is very important right.

[00:22:48] Brittany Klingmann: Absolutely. Yes. Like obviously with the demographic that I work with I have the, I'm gonna, I'm gonna call it a luxury cause I absolutely love it, but I have the opportunity [00:23:00] to work closely with individuals helping them navigate continuing strength training to the way, the capacity that they desire throughout their pregnancy. Now, I think the biggest variable there is again the modification piece that comes alongside that as you progress through your pregnancy, there's still an infinite number of options of types of exercises that can elicit the desired effect that you're looking for. But the changes or the tweaks that you might make will vary on for each in individual. As far as like when that occurs. There's general timelines that I modify certain aspects of lifting, especially with the barbell, if it's, if it's naturally going to say, make contact with the pelvis or in and around the pelvis and the baby bump starts to get in the way, like that's, those occur at very [00:24:00] similar time points. So there's, there are certain types of modifications that would occur at similar time points of a pregnancy, but one exercise that feels good for someone at 30 weeks may not feel good for someone else. And those would be where the kind of individualized tweaks happen. Absolutely. Yeah, and then I guess maybe thinking about more general recommendations that I do make when it relates to strength training is moving away from what we call using a Valsalva technique for bracing. So that is closing off the throat and holding our breath through a lift in order to increase intrabdominal pressure. I do change their strategies so that they're breathing throughout the lift. That, and that's one kind of general change that I encourage when it relates to strength training.

[00:24:59] Melissa Dessaulles: Awesome. [00:25:00] Yeah, I think, like you said it's just, I think figuring out what people want to do. And it's not like you would suggest someone that doesn't do any strength training. It's not like, well, let's, we need to get you Olympic lifting during your pregnancy. But just respecting that everyone comes at it from a different angle and that I think in the past we've been quick to say, you must stop all hard things. Yeah. Can we just touch on yoga quickly, cuz I know that yoga, stretching can all be very beneficial. Sure. Sometimes there's some question around whether yoga is safe during pregnancy. And as a general rule, I love yoga during pregnancy. Yeah. I think I love that. It, it encourages mind, body connection, presence and awareness of the body. Breath. It really focuses on breath Mm-hmm. , and we know how valuable that is for birth. But what do you tend to tell people when they ask you, should I do yoga or can I do yoga? Anything specific that you talk about?

[00:25:52] Brittany Klingmann: Yeah. I, again, I'm, I say I fall very much in line with what you just said Mel, [00:26:00] as far as the benefits of it. In general, maybe one thing that I do discuss is just starting to watch or listen to the body as far as how it's feeling in certain poses and if certain poses going deeper into a pose doesn't feel good, then that is potentially just an indication that we wanna back off. How deep of range of motion we're maybe asking of our bodies, especially in and around the like lumbopelvic region. If it doesn't feel right.

[00:26:34] Melissa Dessaulles: Yeah, exactly. I think if it feels good, it must be great. If it doesn't feel good, is it certain poses or maybe is it just not the type of exercise you need? Because everybody has a different body. Yeah. Okay, so just talking a little bit about getting variety. So basically try to find variety in those 150 minutes. What else? Yeah, can you think of any of the other guidelines or the recommendations I should say?

[00:26:58] Brittany Klingmann: Yeah. The other [00:27:00] recommendation was, and this is another one that I speak of a lot with women, is the exercising, don't stop exercising on your back. So I think there's a lot of fear-based messaging around that, and women believe that I just, I can't do it. I shouldn't be on my back. It's not good. There's too much risk. And really the risk is risk to you if you become symptomatic. So if on your back you start to feel lightheaded or nauseous or unwell then that's an indication that for you, exercise on your back at that point is not a great idea, and it doesn't mean you have to discontinue exercise on your back completely, but maybe just elevating your your shoulders, your upper body just a little bit. So if we think of a, like a traditional gym environment where the bench is like flat, we just choose the incline bench instead. And we can still do all of our exercises if it resolves [00:28:00] that kind of feeling of lightheadedness or dizziness or just feeling a little bit unwell.

[00:28:05] Melissa Dessaulles: Okay. And knowing that could last a moment in time and that later in the day, it's fine. It's just exactly. Yeah. And just just, yeah. Your body won't just all of a sudden shut down. You will have warning signs. Yes. That baby's position is just not favorable to that at that moment.

[00:28:19] Brittany Klingmann: Yeah, that's right. That's I do discuss that one with. Basically everyone I see. Cuz it's usually a question that comes up what can I do? I'm not supposed to exercise on my back. That's not entirely true.

[00:28:31] Melissa Dessaulles: Yeah, exactly. Yeah. Yeah. The other recommendation that I was really happy to see is that they do suggest pelvic floor muscle training and, I don't wanna use this episode to go into detail, but that pelvic floor muscle training does not involve just kegels. That's that's right. In general, just like working on coordination and movement and awareness of your pelvic floor, because these muscles are going through a lot, we just wanna maximize their movement, their strength, their ability to relax and a beneficial group of muscles to get [00:29:00] to know before your postpartum.

[00:29:04] Brittany Klingmann: Yep. I agree.

Example Case Studies

[00:29:05] Melissa Dessaulles: I was thinking, Brittany what might be helpful is I wrote down a couple ideas of sample clients that I feel, some of the questions that they have and if we could talk through some of the listeners will be listening to this and say, oh my God, I totally am that person. What about the mom that comes in and says, I have been way too exhausted and nauseated in my first trimester to do anything and I am so feel terrible and I'm failing. What are we gonna say to this woman?

[00:29:33] Brittany Klingmann: Yeah. Generally where I meet that one is fatigue is real in the first trimester. And meet that with self compassion and truly give your body what it needs. And if what your body needs is to come home after work and lay on the couch and have nap, you go ahead and do that.

[00:29:52] Melissa Dessaulles: Absolutely. And that I, sometimes I find that 150 minutes sounds daunting. And just knowing that even if you get half of that, that's [00:30:00] a score, right? That's a win. And Yeah. You do you have your journey, understand the benefits but be go easy on yourself, right?

[00:30:09] Brittany Klingmann: Yeah. And I think that what I like to reinforce in those particular clients or that, that example is that, in most case scenarios that does not persist through your entire pregnancy, that the fog will lift and you will see this new light of some renewed energy and feel a little bit different where at that point in time it is absolutely okay to resume back towards those guidelines, so to speak, or whatever your goals are. And in that scenario, to just know that we want a gradual approach back to what you were doing. So your body has a chance to adapt and accommodate to that.

[00:30:51] Melissa Dessaulles: Absolutely. And I often tell that woman that's oh my gosh, now I'm out of the habit and I just feel so ugh. And I [00:31:00] always think, I wonder if you could, just try a different time of day or just for a couple days, experiment with before you lie on the couch, go for a walk just around the block or five minutes and just see because you actually might feel better. Just getting some fresh air and getting out. If it doesn't work, great, you've tried it. But a lot of women will say I actually found I felt better if I just went for a short walk. And that five minutes turned into 10 minutes and it made a big difference. So I always just say just try it and see, especially if it's getting outside. So you already touched on the woman that maybe has been off for a while and is returning gradual entry. But what about the one that's do you know what, I'm actually a pretty sedentary person. And they've heard the messaging around, there used to be messaging saying, don't start anything new in pregnancy. It used, yes, used to have been some. So a lot of these women that would consider themselves sedentary are like, I guess I shouldn't exercise till after. I know the guidelines say, actually no. Anytime. Anytime you're ready to start is a perfect time, but you're [00:32:00] just not gonna go pedal to the metal. You're not gonna start running when you, yeah, you're not even walking or you're not gonna start lifting weights if you're not even moving your body. So anything else for that person that would consider their themselves inactive?

[00:32:14] Brittany Klingmann: Yeah, I mean, for those people obviously reinforcing the benefits of the activity that we kind of listed in the beginning can help sometimes be a motivator for change. And then, like you said, I would say finding little snippets of something that they think they would enjoy and trying just get small doses of it interspersed throughout the day might be a easier approach to digest. Creating change. And then with them, I would definitely look at kind of habit change strategies of, incorporating that with something that they already do or already enjoy so that it doesn't feel like a chore of something new to make that [00:33:00] seem a little easier.

[00:33:02] Melissa Dessaulles: Absolutely. Yeah. What about the one that something hurts? So if I go way back to the initial question, when I ask them. Okay. Why do you think you're not active? Is it that something about your body stopping you from being active? And this is where I think a lot of people say I'm getting this crazy rib pain, or my pelvis hurts. I'm getting the shooting, stabbing feeling in the front of my pelvis. My SI joints hurt, my low back hurts, so therefore I'm not being active. What? What are we gonna, what are some suggestions for this listener?

[00:33:31] Brittany Klingmann: I would in the that case, I might say it'll depend to give you a really vague answer, but it'll depend on what was the activity that they were doing that was provoking those discomforts? And is there something about the strategy or like how they're doing the activity that can maybe be tweaked and in those scenarios, if it's someone that I'm seeing in clinic, it would be like an immediate test, retest. Show [00:34:00] me, let's try it. Okay, let's tweak something. How does that feel? And in those scenarios, it's either it's like it's a light switch. It's oh, that's better. Oh, that's not. And if it's oh, that's better. Okay, we go with a strategy change. If we try and tweak a few things and it's still, I don't know. No. Then it's let's just, what else do we wanna do? And find a new activity? Cause, there's like an infinite list of options, right?

[00:34:26] Melissa Dessaulles: Absolutely. And I think, again, a lot of the information used to just be like, if it hurts, it's bad. But I always explain to my clients think about the pregnant body as a friend in need. I say that all the time. Although we're all changing in very similar ways, our bodies all have a history and a previous story and so many other things playing a role into the body that we're gonna feel things differently. And sore doesn't mean broken. The pregnant body is not fragile, it's still stable. It's just really different. And sometimes that's where the individuality comes in. And I think like one of the biggest things I [00:35:00] wanted to get across it, and this point is, that this is why you'd go see someone. This is our expertise, right? Is we can give you some ideas, we can give you some thoughts, but you have a different body than your neighbor or your friend. Yeah. And having someone take a look and help you. Breakdown, like you said, some of the reasons they might be having those aches and pains, because there's quite a bit that, yeah, I think that, we can offer as physios as far as, will a support band be helpful? Will a certain stretch or a certain strengthening exercise or like you said, change the strategy in how they're doing it. Yeah.

[00:35:33] Brittany Klingmann: Yeah. Yeah, I agree. That one is just context specific. I guess.

[00:35:37] Melissa Dessaulles: Absolutely. Absolutely. Yeah. What about the all of messaging around, I'm scared I'm gonna damage something. So I think the big ones are we already talked about there's nothing saying that your fetus is at risk I think just being able to understand that's old information and old beliefs, but when it comes to your body, I think a lot of women [00:36:00] are worried they're gonna damage their pelvic floor is one thing. Yeah. Let's talk about that to start with. What do women need to know about their pelvic floor during pregnancy and exercise?

[00:36:12] Brittany Klingmann: Yeah. Generally the conversation that I would have with clients with regards to this is that, I mean, the pelvic floor is working for us all of the time, right? So it's a group of muscles that never gets a break. And then in the context of pregnancy, they're undergoing so much change that in general I find that they're a group of muscles that if anything, hold too much tension when they're overtime, right? Yeah. They're overtime, they're getting tired and they, they function to be able to support the pelvic organs and they really should act more like a trampoline to absorb the impacts of day-to-day rather than be this kind of like rigid floor, so to speak. That is like [00:37:00] on all the time. And so I usually have conversations more around like that, let's just get to know our pelvic floor and know what it feels like to intentionally contract it or intentionally relax it and feel what it might do in certain movements, for example. And just become in tune with it rather than feeling like we need to be activating it all the time. And so then, depending on what they experience there might be tips or tricks to intentionally activate more at certain times that maybe you have those like increased pressure moments in your day-to-day activities, like you're lifting your toddler and you feel like heaviness or you leak a little when you sneeze. Like then we can bring that, how does the pelvic floor function in those types of things? With regards to exercise, [00:38:00] I usually say this system is automatic and reflexive. And if we don't have a previous history or trauma or a reason to know about it, we don't need to know about it. And so if you're exercising and you're not experiencing pain, heaviness, leaking, any of those symptoms that would indicate your pelvic floor is having trouble, then I think things are okay.

[00:38:23] Melissa Dessaulles: Exactly. Exactly. Yeah. And I think that, yeah, you hear a lot of like do's and don'ts with exercise, and I think that was one of the biggest things I wanted to convey in this. There's not, there are no black and white exercises. There's no good versus bad, there's no black and white, and it again feeds into this body that's changing rapidly and that you just have to work with it because it doesn't, I think a lot of times people get the messaging that during pregnancy the pelvic floor is loose and floppy and you've gotta engage it all the time and that you've gotta be careful or it, you'll blow it out or something. I don't like the images around people's descriptions are like that, but [00:39:00] just yet our body's very resilient are like, our body's always a few steps ahead of what you think you're doing? So it won't just lay down and fail on you, but I think just learning how to help this situation that's changing, this changing environment moving target as you grow in pregnancy and just knowing how to facilitate it or help it. And yeah. But yeah, I mean, some exercises like that kind of leads me to things like running where we used to think, that there was too much pressure on the pelvic floor. But at the end of the day maybe you feel good when you're running, or maybe you feel like doing some focused pelvic floor exercises helps you run. There's so many different pieces of the puzzle to influence. And at the end of the day, if you're feeling good, running's not a bad activity. Yeah. Yeah. I agree. I think, I would think I often tell people think less about creating damage and more just how to help support.

[00:39:54] Brittany Klingmann: Yeah. I agree.

Diastasis Recti

[00:39:55] Melissa Dessaulles: I think the other big topic people are worried about damaging as far as [00:40:00] diastasis goes and that I must protect my core. I must stop engaging any core muscles so that I don't pull my abs apart. Can we talk a little bit about way back, one of the first episodes I did, I can't remember, four or five talks about diastasis and yeah, if you haven't listened to that one, take a listen cuz it we talk through what diastasis is, why you shouldn't be afraid of it, helping you to understand it. But at the end of the day, by the end of our pregnancy, everyone will experience some stretch between their their rectus muscles or their six pack muscles. We need to create space. So the tissue between our six pack muscles stretches, and that is what's known as diastasis. So all women will experience that towards their end of their pregnancy. But what, so if we talk about exercise as it relates to diastasis, what do you say, if someone says to you what do I need to be mindful of in my exercise? Or [00:41:00] what kinds of things do I have to be careful of so that I can be on top of my diastasis? I realize that's a really big question.

[00:41:07] Brittany Klingmann: It is a big question. And to be honest, I'd say perhaps I follow a little bit on the conservative side here when it comes to, in pregnancy with it generally speaking, like I do say that once we get that, like later in the second trimester, for sure when the belly starts to pop, it I, I say there's a lot of ways to exercise your core specifically. If people are wanting, say, core work, like a traditional crunch, might not need to be one of them in that particular situation. But in the run of a day or like just generally speaking if people start to notice they have the diastasis, so that kind of bulge or coning at the midline when they're doing an exercise that requires that abdominal activation. [00:42:00] I usually say let's see about a different exercise for you or whether we just modify that particular exercise to make it easier so that your core wins, right? Because the belly as it grows, the rectus, like the rectus muscles are just, they're becoming stretched and they're like less in their less advantageous position to function well. And so we may just start to notice less capacity for some of those higher level exercises. It absolutely doesn't mean that if you just, sit up off the floor once that, that that stretch is going, you're going to tear those abdominals apart more. I think that's one thing. I like to definitely reassure individuals that, that linea alba, that connective tissue is like like a leather belt type consistency. It's very strong and resilient and so...

[00:42:57] Melissa Dessaulles: To try and just tear it open.

[00:42:59] Brittany Klingmann: Yeah, that's [00:43:00] right. Dispel some of that.

[00:43:01] Melissa Dessaulles: You can still target those core muscles, but perhaps in, in positions that don't lead to, like you said, as much coning or doming or vulnerability or pain. Right? Knowing, like you don't need to be scared, but just need to understand your body's changing. And some modifications need to be made, but overall, maintaining strength is valuable in your abdomen. You don't need to stop using all your core muscles. You just might need to use them in a different way.

[00:43:27] Brittany Klingmann: I'll reference the postpartum period where I think you used the example, which I really like, cuz when you're growing, although our body does change right over course of nearly 10 months, which is a short interval of time, however, in the context of birth is quite a long time for our body to get used to those changes and navigating that birth is like popping the balloon. Right? Totally. Whereas if we've maintained that kind of sense of support or learned how to [00:44:00] maintain that connection with our abdominal wall, even when the belly was bigger, it will help us reference that in that postpartum period when then life like, it's not like work right, right away?

[00:44:13] Melissa Dessaulles: Absolutely. And you think about how like as a postpartum woman, like your body also feels different. It's a different difference because like as soon as that baby comes out it, everything feels very different. And generally, like you've touched on the muscles of the pelvic floor and some of it's core teammates are not muscles we're used to thinking about. So to have to figure those muscles out in a different body and in a depleted time of your life and you're not getting much sleep, you can just see sometimes those women will look at you like what? Whereas I think that's one of the benefits to feeling aware of those muscles during pregnancy is like, oh, okay, I was expecting this to feel different after. I need to get those muscles feeling a little bit stronger again. I know how to connect with those cuz I worked on that before, yeah. Yeah. Yeah, exactly. Like kinda [00:45:00] body awareness and knowing how to work with your muscles is very valuable and I then, I always tell people, once you learn about those muscles and how to feel in control of them, the world is your oyster. Like you don't have to be limited to good and bad. You can start to notice and modify on your own. Yeah. But I wonder if we could flip into just really highlighting what kinds of things we would do as physios if you came to see us. Cuz I do see a lot of women during pregnancy come in and they'll say, Mel, I was referred by my, all my friends told me that I should come in, but I don't really I don't know if it's too early for me to come or if I should have waited till after I had my baby. So I think just to summarize some of the things we look at is we'll help you understand what the guidelines are, what the recommendations are, and apply it to you because I think that sometimes can be really daunting for people to be like, okay, what am I supposed to do? Cuz my friends are doing something different. But we will help you become active and confident in that activity based on what you want to do, right?

[00:45:59] Brittany Klingmann: [00:46:00] Absolutely. Yeah. Yeah. We will help you sort out some of the aches and pains that you're having so that you can be active. Yep. Great. That's a big one. Like generally speaking, I don't know about you Mel. Like I, I know you're booked quite in advance. So you probably do see people later on. I'll have people really keen in that first trimester booking in with me asking, lots of questions and generally I do a brief overview and then say, okay, now go away in the second trimester will be the time that we may start troubleshooting some of these, specific changes with exercise. Or you might start to have a little niggle or have an a acre pain that we can then manage. So I think it's good for them to know that, yeah, being, having discomforts and being pregnant doesn't just mean I live with this. Yeah, there's a lot that can be done as far as giving people information, education, tips and tricks to self-manage, or occasionally, maybe it's hands-on techniques that we're helping [00:47:00] them get some relief as well.

[00:47:02] Melissa Dessaulles: Yeah, absolutely. And I think just too, like that, another thing that, that is within our wheelhouse is to help you come up with a plan to get back to exercise postpartum too.

[00:47:12] Brittany Klingmann: Yeah. Oh, I agree. I think like he helping, especially with the internet, right? And all of the fear mongering that's out there or mislabeled information. I like to help people set like realistic expectations in the postpartum period in particular, right? Because there's a lot of images out there of get your pre-pregnancy body back in six weeks or that six week check with your care provider, green light back to fitness and not really understanding the implications of what changes your body went through in pregnancy, what changes may have occurred in labor. And then six weeks of essentially not doing a [00:48:00] whole lot. Deconditioning happens in that point in time too. So just helping them with the logical steps so that when they get back to the things that they love, that they can do it in a way that feels good, that they're not feeling then frustrated by having setbacks of new aches and pains or injury or whatever that might be.

[00:48:19] Melissa Dessaulles: Totally. Yeah. What about some kind of last minute words of advice if we were to summarize some, take home messages and let's just go back and forth, but my first thought was like, start small. Cause I, I picture the women that come in. They're like, oh my God. You've talked about yoga, you've talked about strength training, you've talked about cardiovascular training. Oh my gosh, I feel like I don't have time. I'm like, listen, what's feasible to you? You do not need to get a gym membership. You do not need to sign up for prenatal yoga. Yes. Just start small because often once you start you start to notice the benefits and all of a sudden five minutes turns into 10. Yeah.

[00:48:54] Brittany Klingmann: I like that one. Start small and probably think go slow [00:49:00] as far as, not slow as in speed, but if we think of maybe a progression, right? Like you describe someone might start with five minutes and then it turns into 10. Let's just keep on with those, that incremental progress rather than thinking five minutes needs to turn into 60. Because if we change too quickly, then our body sometimes doesn't have that ability to catch up with that change in demand.

[00:49:24] Melissa Dessaulles: What about, and I always say too what do you like? There's so many things floating, okay, I'm supposed to do this, and this. Just disregard what you've heard and just what do you really like? Oh, I love to hike. Perfect. Let's figure that out. Or, I love to dance. Perfect. That's great physical activity. And so I think that, you're way more likely to get into something and enjoy it if it's something you like. It doesn't matter what other people are doing.

[00:49:46] Brittany Klingmann: I'd say embrace the change. So being flexible and adaptable, like embrace this period of change in that, to try not to have a rigid approach of, oh, I need to stick [00:50:00] to my five days a week. I need to stick to these exercises. I need to stick to my weights that I'm moving, whatever that whatever it is. Being flexible and adaptable will definitely facilitate kind of enjoyment through the process.

[00:50:13] Melissa Dessaulles: Totally. I have another one I think is big, is accountability. I think a lot of people are finding not having that gym membership or not being part of a class is hard for them. So I think sometimes you have to be creative, whether it be an online group you can join or, reach out to a friend once a week. I actually recently started these small group sessions where I go through pregnancy and postpartum recovery with a small group of women and I, because I heard so many women were saying need someone to be able to help pull me along. We talk about exercise and different ways they can incorporate it and we talk about diastasis in the pelvic floor and preparing for birth, but I added, I add everybody into a WhatsApp group and I try to go in there regularly to say what did everybody do today? Or motivate one another. [00:51:00] Yeah. And this weekend I asked, how's everybody's weekend? And it was amazing how many of them posted. I was feeling so like I was fixated on some of my aches and pains, or I was feeling really stressed. I incorporated what we talked about and I went out for some exercise and I feel so much better. And then they all started doing the same. Like you could see that they all pull each other along.

[00:51:20] Brittany Klingmann: Yeah. That's a great great one.

[00:51:22] Melissa Dessaulles: It just, all of a sudden it popped into my head that I think just that, again, I can't say enough that the recommendations are 150 minutes, but like half of that is still valuable. I think that, yeah, it's, we have this all or none feeling all the time, but all of those benefits we listed for mom and baby are not wasted with less time being physically active.

[00:51:44] Brittany Klingmann: That's right. Yeah. I think that's a great one.

[00:51:49] Melissa Dessaulles: I think we've covered the main basics. Do you have anything else?

[00:51:52] Brittany Klingmann: Yeah. No, I mean, it can become a little bit of a wormhole on the internet, or depending on you may be left with not a lot of information[00:52:00] from your healthcare provider too. I've definitely had scenarios there where we can act as a collaborating agent between healthcare provider and patient where I know the system's overrun right now, right? And physicians or primary healthcare providers may not have time, whereas we can dedicate more, more of that time to help break down that information for people to help them, reassure them, and get them feeling comfortable and encouraged to do more.

[00:52:33] Melissa Dessaulles: Absolutely. And I think on that note too, if you are seeing a care provider anyone that you're seeing during your pregnancy and you are getting messages that you should be careful and there's all sorts of red flags they're giving you and you're suggested to not exercise, then I, do you need a second opinion? Cuz there, there is still some old information circling out there. And if you find that at any point you're feeling nervous or held back then reach out to someone at both Brittany and I [00:53:00] offer online appointments. I will link the ways to connect with us in the show notes. But at the end of the day, I think everyone will get outta this. We, we are we promote physical activity in pregnancy. We're here to have to be physically active in pregnancy. Thank you so much, Brittany.

[00:53:16] Brittany Klingmann: Hey, thanks for having me. I always appreciate fun, appreciate your words of wisdom, and that's a wrap.


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