What are some safe abdominal exercises for pregnant participants that will help get their bodies ready for labor and delivery?

Strong core muscles are vital for helping prenatal participants offset pregnancy-related postural changes that can cause back pain and other discomforts. The following basic exercises are appropriate for virtually all prenatal and postpartum women. The moves are also excellent for nonpregnant class members who need to learn how to engage their core muscles. Prenatal women should master these exercises before they do any other core or abdominal exercises. Keep the following in mind:

* As with all prenatal exercise, participants must get a physician’s approval before they start.
* Class members should empty their bladders before beginning.
* It is important to maintain neutral spinal alignment (except during the pelvic rock-and-roll). “Neutral” is different for every person and may change as pregnancy progresses.
* If a participant feels discomfort or pain during an exercise, she should stop and be encouraged to discuss her condition with her healthcare provider.

Abdominal Compressions. Perform these moves in seated, standing or quadruped ( all fours) position. In seated or standing position: With spine in neutral alignment and shoulders relaxed, place hands on lower abdomen and let abdomen relax completely. Keeping hands where they are, pull navel toward spine and away from hands while exhaling slowly. Hold contraction, exhale fully, inhale and allow abs to relax back to hands. Do this slowly with the breath, or more quickly, using various music tempos. In quadruped position, perform same maneuver, but work against gravity as abdomen lifts away from floor. Keep shoulders and upper back as still as possible.

Opposite-Arm-and-Leg Horizontal Reach. In quadruped position, tighten abdominal and squeeze glutes. Simultaneously extend one leg and opposite arm parallel to floor. Try to hold body in still, planklike position from fingertips to toes, spine in neutral. Hold for 15–60 seconds and switch sides. In addition to transversus abdominis and obliques, this exercise engages glutes, hamstrings, back extensors and shoulders.

Pelvic Rock-and-Roll. On stability ball, sit up tall and rock hips side to side, causing ball to roll slightly. Do this with control. Continue rocking motion for 30–60 seconds, then tilt pelvis anteriorly and posteriorly, rolling ball front to back for another 30–60 seconds. Shoulders and ribs remain mostly stable without much movement. Adventurous exercisers can also roll ball in a circle, first clockwise then counterclockwise.

Is your you-know-what bothering you? Do you experience discomfort when you, um, well, you know? These women-focused health practitioners know exactly what you mean, and they can help you find relief.
When something’s not right “down there,” it affects how we feel everywhere else. Fortunately, there’s a growing field of medicine devoted to treating these unique complications. Practitioners of women’s health physical therapy help women (and some men) who have problems with sexual intercourse, urination, fertility, pregnancy preparedness, postpartum recovery and cancer recovery. They deal with the stuff we’re too embarrassed to talk about, and because they’ve seen it all, they can reassure patients that their issues are at least treatable, if not always curable.

This specialty started in 1995, when a group of orthopedic physical therapists recognized that their clinics were filling up with women whose concerns weren’t being addressed. Women’s heath physical therapists (WHPT) are often the problem solvers that gynecologists, obstetricians, urologists and other doctors call when confronted with a gender-specific medical mystery, like discomfort during sex, after childbirth or while going to the bathroom. All WHPTs (find one near you by going to the American Physical Therapy Association locator) have stories about patients who were told by a former doctor that their problem was just “part of being a woman.”

Like other types of physical therapists, they specialize in treating functional problems, but they say they also offer proactive services, like helping pregnant women prepare for an easier delivery and preventing complications like C-sections. Here are six situations where a women’s health PT might be able to help you.

Incontinence

“Fifty percent of adult women will have incontinence at some point,” says Jennifer Klestinski, MPT, communications director for the Section on Women’s Health of the American Physical Therapy Association, who has a private practice in Madison, Wisconsin. “Because of anatomic differences, the effects of pregnancy and childbirth, and the effects of decreasing estrogen, women leak far more often than men. But with proper strengthening, the data shows there’s an 85-percent chance of complete resolution.”

The regimen: Weak pelvic muscles are a major factor in incontinence, so in addition to Kegel exercises, Klestinski recommends doubling up: “Engage the pelvic floor muscles while doing other daily core exercises—like Pilates—to strengthen the abs, back and hips.” Another surprising cause is osteoporosis, because a rounded back causes our thoracic cavity and abdomen to press on the bladder. A WHPT would recognize this during an evaluation and could prescribe appropriate exercises for bone density loss.

Make sure you’re practicing Kegels correctly and learn the other pelvic workout you should be doing

Organ Prolapse

Think of prolapse as a hernia that mostly affects women. When the muscles that hold the pelvic organs become weak or stretched, the organs—the bladder, uterus, small bowel, rectum—can drop from their normal spot and push against the wall of the vagina. As many new mothers know, pregnancy is the most common cause of prolapse. However, it’s not just the trauma of the childbirth that’s a factor—it’s also the extra pounds. “There could be 15 to 25 pounds plus the weight of a baby pushing on the perineum,” says Klestinski. This means that excessive weight gain (no baby necessary) can also put you at risk. Weight maintenance is key to avoid risk of prolapse.

The regimen: Klestinski explains how a WHPT would take a holistic approach to address organ prolapse. “We work from the top down and from the bottom up. From above you may have extra body weight and extra downward pressure from poor posture, dysfunctional bladder habits or from adhesions due to prior surgeries or injuries. From the bottom up, we have the pelvic floor muscles, which act as a supportive hammock to the pelvic organs.” Many WHPTs can help women work on weight management through exercise. To further improve the “top down” issues, the therapist would use manual techniques, patient education and posture training. At the other end of the, um, spectrum, she’d put the patient through workouts to strengthen and tone the pelvic muscles. This gives us yet another reason to do those darn Kegels.

Pregnancy and Recovery

Pregnancy causes profound anatomical and hormonal changes to our bodies. “Some women’s bodies accommodate those changes quite well, and some women require a fair amount of work and assistance,” says Jill Boissonnault, WCS, PT, PhD, past president and founder of the International Organization of Physical Therapists in Women’s Health.

The prenatal regimen: Pushing out a baby is never going to be easy, but some WHPTs say that massaging the perineum with a lubricant, as well as stretching the hip and pelvic muscles, can help a woman “open up” during delivery, which could make her less likely to tear. There’s also evidence that pregnant women can be taught how to bulge and flex their pelvic muscles correctly during labor, which can help avoid C-sections.

The postpartum regimen: “There are things a woman can do to mitigate some of the risk for future dysfunction, like strengthening her pelvic floor with Kegels throughout her pregnancy and after she delivers,” says Boissonnault. She adds that in France, where postpartum wellness visits are included under national health coverage, new mothers are likely to be advised by a WHPT about strengthening their pelvic floor muscles, their abs and their posture.

Pelvic Pain

Because many women avoid talking about this with their friends, family members and even their sexual partners, pelvic pain can be emotionally exhausting as well as physically unbearable.

Vulvodynia: An excruciating affliction of the vulva which affects an estimated 16 percent of women at some point in their lives, vulvodynia is described in this video from the Dr. Oz show as feeling like “acid burning the skin” or a “constant, knife-like pain.” It can be caused by trauma to the pelvis, which may result from chronic yeast or bacterial infections, physical force, accidents, surgery, or physical or sexual abuse.

I know a woman in her mid-20s who has suffered from vulvodynia since childhood. She suspects the cause may have had something to do with an ill-fitting waist harness on a forceful carnival ride. In her quest for relief, she was referred to gynecologists, dermatologists and psychologists, and tried topical anesthesia, antidepressants, talk therapy and the patronizing advice to “have a glass of wine and you’ll be fine.” She was finally told that pain-free sex would require surgery, and her doctor advised her to visit a women’s health physical therapist to prepare for the procedure.

“Many doctors assume that women’s health physical therapy can only take you to a certain point,” says my friend’s therapist, Gopi Jhaveri, PT, DPT, co-owner of Brooklyn Health Physical Therapy, “but we know it can take you all the way to recovery.” Jhaveri discouraged the surgery and instead worked with my friend to develop a rehab program. Four months later, my friend joyfully credits Jhaveri with her “cure.”

The regimen: This varies depending on the patient’s anatomy and type and severity of symptoms, but treatment often includes regular in-office manual therapy, at-home stretching using dilators, exercising daily to strengthen the pelvic muscles, avoiding harsh cleansers like soap in favor of sweet almond oil, and using a local anesthetic like lidocaine during sex.

Vaginismus: A 2010 episode of MTV’s True Life featured three women in their 20s whose pelvic conditions prevented them from having intercourse. Tali, an aspiring singer, had a condition called vaginismus, which involves painful, involuntary spasms and tightening of the vagina. As part of Tali’s treatment, Isa Herrera, MSPT, clinical director of Renew Physical Therapy in Manhattan, showed Tali and her boyfriend how to manually stretch Tali’s vagina (it was more clinical than kinky).

Herrera specializes in intra-vaginal massages to release tight or uncooperative muscles, and also in teaching patients and their partners to do this as home. “One out of three women has some sort of pelvic pain,” says Herrera, who is also the author of Ending Female Pain: A Woman’s Manual. However, she says, many women don’t admit it. “I’ve heard excuses like ‘it hurts unless I keep changing positions’ or ‘it hurts because my partner is so big.’ But the vagina is a wonderful thing and should be able to accommodate just about any man.” Herrera says WHPTs empower women to recognize and alleviate their physical discomfort.

The regimen: Techniques vary, but Herrera says she often follows a full pelvic muscle evaluation with manual massage, including trigger-point release technique to “release knots.” Herrera stressed that although the pain may occur in the pelvic area, the most successful approaches are holistic and involve the entire body. “Pain during sex can cause enormous anxiety, which results in the tensing up of different muscles groups, from the pelvis and the legs to the neck and back.” An important aspect of treatment includes diaphragmatic breathing and relaxation techniques to help the patient deal with the anxiety as well as the pain.

The Two Exercises Every Woman Should Be Doing
By Corrie Pikul
Oprah.com | August 03, 2011

Women’s health physical therapists swear these pelvic workouts help forestall all kinds of female-specific problems. One’s a classic, and the other will forever change how you look at your watch.

If you have never felt pelvic pain, a “little spritz” (thank you, Whoopi Goldberg, for that phrase), or organ prolapse, you probably want to keep it that way. The best strategy for shaping up “down there”? Yep, that old standby, the Kegel. We know you’ve heard this before, but that’s because experts agree that Kegels are the most effective exercise to improve the muscle tone of the pelvic floor. “After the age of 35, we lose 5 percent of our muscle mass every 10 years,” says women’s health physical therapist Kristi Latham. This reduction occurs in muscles everywhere in the body—including those in our most private regions. Here’s a full pelvic workout, including Kegels and “pelvic clocks.”

Keep in mind: Just like you wouldn’t run sprints with a sprained ankle, you shouldn’t do these exercises if you have a painful pelvic condition (like vaginismus) without first checking with a women’s health physical therapist.

A Kegel Refresher Course

These wonder clenches can increase sexual arousal, improve your ability to reach orgasm, help you master control of your bladder and, says Latham, support your pelvic organs in avoiding dreaded conditions like prolapse.

Fitness instructor: Kristi Latham, PT, CLT, is the pelvic health and lymphedema program director at Metro SportsMed Physical Therapy in Brooklyn, New York.

Warm-up: When you’re just starting out, it’s best to lie down so that you can concentrate solely on your pelvic floor.

The exercise: Squeeze the muscles around your vagina and anus. These are the muscles you use to prevent gas from passing, stop the flow of urine and the muscles that contract during orgasm. Think about trying to pull the muscles up and in (if your pelvic floor is weak, you will only faintly feel this contraction). You’ll know you’re doing these exercises correctly if you feel the muscles tightening but don’t have movement in your abs or buttocks. Isolate your pelvic floor so if somebody looked at you while you were doing the exercise, they wouldn’t think you were moving at all.

The routine: For healthy women without symptoms of pelvic floor impairment, do the following three times per week: 5-second squeeze followed by a 10-second rest period, 10 times, 3 times per day (30 total). With practice, you should be able to do them while sitting at your desk or driving.

Advanced:
Endurance training: Increase hold time and decrease rest time: 10-second squeeze followed by a 3-second rest period.
Sprints: Add in what Latham calls “quick flicks”: Squeeze and relax 5 times, as fast as you can, followed by a 5-second rest period. Do 30 per day, 3 times per week (as above).
Form drills: Try any of the above routines while standing up.

Note: You’ve probably heard that you should practice Kegels by stopping the flow of urine while going to the bathroom. Using Kegels to frequently stop or slow the flow of urine can cause backflow, which creates infection, and can also disrupt your pelvic muscle coordination. Most WHPTs discourage practicing Kegels while urinating. Latham suggests paying attention to how your muscles feel just after urination, then follow up later with a Kegel to feel the difference between relaxed and contracted.

Pelvic Clocks
These exercises can improve circulation to the pelvic organs; decrease tightness, stiffness or congestion from prolonged sitting or standing; increase pelvic flexibility; improve balance and—not enough for you?—help you gain a better awareness of spinal stability.

Fitness instructor: Gail Wetzler, PT, EDO, is the owner of Wetzler Integrative Physical Therapy Center in Newport Beach, California, and instructor of pelvic physical health courses for the American Society of Physical Therapists.

Warm-up: Lie on your back to be sure that the back side of the pelvis has a full range of movement. Bend your knees and keep your feet flat on the floor. Keep your spine in a neutral position. Imagine that there is a clock on your lower abdomen, where 12 o’clock is at the bellybutton, 6 o’clock is at the top of the pubic bone and your hip bones are at 9 and 3.

The exercise: Bring the bellybutton down to the spine. This will make the “clock” tilt, down at the 12 position (bellybutton) and up at the 6 (pubic bone). Move your hip and pubic bones to rotate your clock to the side so that 3 o’clock hip is lower. Move around the clock, tilting the pelvis until the 6 o’clock position is lowest. Continue around the clock, hitting every number, until the 12 position is again the lowest position. Repeat two or three times, then reverse to repeat the cycle in the opposite direction, two or three times.

The routine: For healthy women without symptoms of pelvic floor impairment, the clocks should be done once per day to keep the pelvic girdle in shape. Those experiencing movement restrictions can try these two times per day (a.m. and p.m.).

Advanced: Vary up the routine each day: Try going from 1 o’clock to neutral, then 2 o’clock to neutral, and continuing like that around the clock. Wetzler suggests repeating one movement, such as 4 o’clock to 5 o’clock, five to six times “to really feel the pelvic activity.”