Pregnancy exercise prescription

Currently I’m helping a 36-year-old mum who’s 33 weeks pregnant with her second baby. At 20 weeks she developed pain around her pubic symphysis (front pelvic joint) along with a sensation of vaginal heaviness.

Pain is slowing her down when she moves and stronger when she stands from a chair or turns in bed. She has not regained full closure of the split in her abdominals from the first pregnancy.

Examination showed

  • She was sucking in her upper abdomen to do a PFM lift; her PF was not lifting at the same time
  • Her pelvic floor bulged down when she coughed
  • She had no awareness of contraction between the pelvic floor and the deep abdominal cylinder of core muscles

It was obvious her PF and abdominal muscles were not providing support to pelvic organs or pelvic joints when she was active. The lack of muscular support not only led to pubic symphysis movement but put her at risk of pelvic organ prolapse.

Lack of automatic PFM contraction and/or PFM descent on exertion are red flags for PF dysfunction. In a healthy PF, muscles lift and hold early to support the pelvic organs (prevent prolapse) and close sphincters (contain urine/wind). When the overextended abdominals and non-responsive PF combined with a heavy uterus, postural changes and looser pelvic joint connections, painful shearing developed at the pubic joint when she moved.

Recognising the PF lifting action (with lower abdominal tightening) progressed to lifting her PF before sit to stand and cough. She was eager to practice the exercises in different positions to improve PFM responsiveness and strength. The next step will be to integrate this action into everyday movements  and other functional exercises. Fitting compression shorts gave pelvic girdle support and reduced pubic pain when standing from sitting. Combined with improved PF/deep abdominal strength she hopes to reduce shearing movement at the pubic joint as pregnancy progresses.

Her first birth involved lying on her back with an epidural, forced pushing, suction, episiotomy and stitches. When labour starts this time around she will follow strategies for active birthing to minimize trauma to the abdominals and pelvic floor (contained in Hold It Mama).

This study has identified factors during pregnancy and postpartum, which are predictors for ongoing pelvic girdle pain.