Antenatal Exercises
Date issued: April 2022
For review: April 2024
Ref: C-393/SA/Physiotherapy/Antenatal Exercises v2
PDF: Antenatal Exercises final April 2020.pdf[pdf] 1MB
Introduction
This leaflet aims to provide you with exercises that are safe to do during any stage of your pregnancy. If at any time you feel dizzy, pain or unwell please stop and if symptoms continue speak to a health professional.
What can change during pregnancy?
Pregnancy hormones such as relaxin can cause increased elasticity (stretchiness) of the connective tissue (e.g. ligaments). As the baby grows, your posture and centre of gravity begins to change. This can affect ligaments and muscles. Your abdominals and your gluteal (bottom) muscles can get overstretched and become lengthened and ‘get lazy’.
What is a DRAM?
DRAM is a condition where the rectus abdominis (‘six-pack’) muscle spread apart at the stomach midline (linea alba) to allow room for the growth of your baby. This can happen in 90% of pregnancies during the third trimester and spontaneously recover within the first 6-8/52 postpartum.
Anatomy of your abdominal muscles
The main muscles involved in supporting your trunk especially during pregnancy are shown in the diagram below. You might hear us refer to them as the ‘core’ muscles or the primary/local sling.
Transverse Abdominis (Deep tummy muscle)
These muscles span from side-to-side and form the front part of your deep trunk muscles.
1) Sit, stand or 4-point kneeling
2) Gently draw your lower tummy muscles (below your belly button) in towards your spine, maintaining a relaxed normal breathing pattern
3) Hold the contraction 10-30 seconds and repeat up to 10 times
Pelvic Floor Muscle (PFM) exercises
It is important to train this muscle too as it works together with the transverse abdominis muscle. The pelvic floor muscle is like a sling/hammock that runs from inside the front of your pelvis to the coccyx. Like all muscles there are deep and superficial layers and fast and slow twitch muscle fibres that need to be worked differently.
Try these two ways of working the PFM, firstly trying in lying or sitting and then working towards standing.
1) Tighten the back passage, close around the vaginal exit and lift the muscles at the front, as if you are stopping the flow of urine or squeezing tight inside your vagina
2) Try to hold for as long as you can and then relax and repeat, aiming for 10 seconds and 10 repetitions
3) Now try squeezing quickly then relax, repeat 10 fast repetitions.
Neutral spine
Tilt your pelvis forward and then back. Establish where your natural midpoint is and maintain this whilst performing your exercises. During all exercises try to maintain activation of your transverse abdominis, pelvic floor muscles and keep a neutral pelvic alignment.
The following exercises aim to maintain your strength and mobility throughout your pregnancy, in order to reduce the incidence of back, pelvic pain and incontinence.
Hundreds
1) Find neutral spine on the ball
2) Inhale to prepare
3) Exhale and pulse arms up and down in a small arc or movement (Aim for 5 arm movements on inhale and 5 on exhale). Aim to get to 100 arm pulses in total
Spine Twist
1) Maintain neutral spine as you inhale to prepare
2) Exhale, rotate your spine to the left moving as one unit
3) Inhale and return to forward facing position
4) Repeat on the opposite side
Double leg stretch
1) Inhale to prepare
2) Exhale and raise your arms overhead whilst lifting one leg to hover off the floor
3) Lower and switch legs
Scissors
1) Inhale to prepare
2) Exhale and float your right knee upwards, brining your thigh parallel to the floor
3) Inhale to hold this balanced position
4) Exhale and slowly lower your leg to the floor
5) Repeat on the other leg
Wall squats with calf raises
1) Inhale to prepare, exhale and bend your hips and knees as far as you feel comfortable
2) Inhale and hold
3) Exhale and straighten back up the wall
Chest stretch with band
1) Hold band in front of chest
2) Inhale to prepare
3) Exhale, lift arms above head keeping band tight
4) Inhale, bend elbows to lower band behind head
5) Exhale, straighten elbows above head and then lower arms back to start position in front
Front row
1) Inhale to prepare
2) Exhale, extend the elbows and reach the arms upwards and forwards
Draw the sword
1) Inhale to prepare
2) Exhale, imagine you are drawing a ‘sword’ out of your pocket into the opposite side air
Airplane
1) Inhale to prepare
2) Exhale, and lift the shoulder up and forwards keeping the palms facing down
3) Inhale, take the arm to the side keeping it lifted, and then return it to the front
Triceps
1) Inhale to prepare
2) Exhale, straighten your elbow, keeping the shoulder still
Alternate arm/leg
1) 4-point kneeling, inhale to prepare
2) Exhale gently lift belly button to spine and squeeze pelvic floor muscles
You can make this exercise harder by following the pictures and lifting alternate arms, then alternate legs and finally trying opposite arm and leg lifts. If your wrists hurt in this position, then keep them in a neutral position by making a fist or leaning onto a chair.
Modified Press up
1) 4-point kneeling, arms slightly wider than shoulder width apart with soft elbows
2) Pelvis neutral alignment
3) Inhale and bend elbows sideways to lower chest to floor
4) Exhale to straight elbows and push back up
Side Leg Press
1) Side lying, neutral spine alignment
2) Inhale, bend top hip to hip height and bend towards chest
3) Exhale to extend in line with the trunk
Clam
1) Side lying with hips and knees bent
2) Inhale to prepare
3) Exhale and lift the top knee up towards the ceiling, keeping ankles together
Cat stretch
1) 4-point kneeling, exhale and arch spine
2) Inhale to hold position and stretch
3) Exhale to return to neutral
Thread the needle
1) Exhale and rotate one arm to the ceiling
2) Inhale and hold
3) Exhale to rotate and thread arm under body
Tail swish
1) Exhale and move tailbone horizontally to one side
2) Inhale to return to starting position
Mermaid (standing or on ball)
1) Inhale lift arm overhead
2) Exhale to lengthen curve of the spine maintaining neutral alignment
3) Inhale to return to starting position
Glut stretch on ball, avoid if you have pubic pain
1) Sit on the ball, cross one leg over the opposite knee
2) Lift chest and lean forward until you feel the stretch
Shell stretch on ball
1) Roll the gym ball forward, sink bottom back into feet to feel stretch
Final word
The importance of this treatment and exercise programme is to enable you to maintain strength and fitness throughout your pregnancy.
Further information
If you are continuing to have difficulties with the recovery after giving birth, please be aware you can self-refer to the physiotherapy department at Derriford Hospital
Physiotherapy Department
Derriford Hospital
Derriford Road
Plymouth
PL6 8DH
Tel: 01752 432233
www.plymouthhospitals.nhs.uk
Other sources of information:
www.pogp.csp.org.uk
images: www.dianneleephysio.com
www.completephysiotherapy.co.uk/core-muscles
