5 Tips for Training Pregnant Women!
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On December 20, 2013, freelance writer, Megan Senger, interviewed CEO and Founder of Fit For Birth, Inc., James Goodlatte, for an article that would be published in the May issue of IDEA Fitness Journal, Volume 11, Number 5. James was one of several industry experts interviewed for the article titled “Functional Fitness for Pregnancy.” His progressive and unique views helped shape the article, particularly concerning exercise selection and objectives. His views also gave a unique perspective on what it means to select exercises based upon Trimesters. What follows are the transcripts of the complete interview…
Background by Megan Senger:
This article will discuss functional fitness as it relates to the different stages/trimesters of pregnancy. Note that this article is NOT a review of exercise guidelines during pregnancy, cardiovascular or nutrition concerns, or general tips about working with pregnant clients. Instead, it will focus exclusively on functional fitness for activities of daily living during pregnancy, i.e. what exercises should a pregnant client perform during her 1st, 2nd, and 3rd trimester so she can comfortably perform ADLs during her pregnancy, prepare for the birth experience (“fit for birth”), and her immediately post-partum ADLs (e.g. sitting in a chair nursing/feeding her baby for hours, etc).
Top Functional Exercises for first trimester:
With the understanding that addressing dysfunction is generally a higher priority than addressing trimesters, the top functional exercises during the first trimester would include:
1) Deep diaphragmatic belly breathing–Chances are that her Diaphragm doesn’t function optimally. Diaphragmatic breathing is the single most important exercise that will ever be instructed for the modern pregnant woman. It is the starting place or foundational component behind nearly all muscle imbalances. Besides breathing, it is the primary pump regulator for digestive motility (effecting nutrient dissemination, toxin removal, and can alleviate constipation), lymph (affecting immunity), and cerebrospinal fluid; it plays a role in one’s pH balance, overall chemistry, emotions. Very importantly, it is the pregnant body’s primary physical access to relieving stress and dissipating cortisol production. Modern pregnant women are stressed and their cortisol levels are too high. A simple way to view cortisol is as the opposite of growth hormone. It should be made very clear to every prenatal specialist on the planet that stress and cortisol are seriously hurting the vitality of our children while they are in the womb.
If you are a fitness or health professional, the starting exercise, the exercise you return to, and the exercise you end with is diaphragmatic breathing. Proper coaching of diaphragmatic breathing will look like filling the belly, ribs, and lower back first. Only with a very deep breath would the chest/neck raise, and if it does it should be only the last one-third of the inhale.
Progressions for diaphragmatic breathing may include and are not limited to:
b) supine with a weight on belly
c) supine with alternating leg raises (knees bent at first…can progress to straighten legs)
d) supine with double leg raises (knees bent at first…can progress to straighten legs)
(Preventing excessive lordosis is usually a key point in the above exercises)
e) seated (can she perform the breath without straining the neck/chest accessory breathing muscles?)
f) standing (can she perform the breath without straining the neck/chest accessory breathing muscles?)
g) during exercise
h) during all ADL!!
2) The second most important exercise is to activate the pelvic floor musculature, famously known as Kegels, after the therapist that made them famous in his practice. Remembering that the human body is a system of pumps will frame the context for this muscle as well. References suggest that the pelvic floor (PF) mirrors the diaphragm in movement. In practice, to keep from over-complexity and “stressing” the client with too many thought-tasks, I will simply ask her to activate and relax the PF in her own natural rhythm….and then apply this to her exercises, similar to breathing.
Progressions for pelvic floor activation may include and are not limited to:
a) 1sec ON, 1sec OFF (20+ reps)
b) 20sec On, 5sec OFF (3+ reps)
c) “elevators”: vary intensity for several seconds each: low-medium-high-medium-low
a) Kegels applied to each breath cycle
b) Kegels applied to rhythmic functional exercises and then any exercise
c) Kegels applied to ADL
Although the majority of pregnant women will have an under-activated PF, some will have the opposite muscle imbalance. I do not know if there is a statistic on this, but i have found this to be the case for about one in ten women. In these cases, the prenatal fitness professional must coach the woman to relax her PF, or risk driving her into some serious problems when delivery time arrives. If you and your client determine that she has an over-facilitated PF, the learning phase listed above can simply be reversed in terms of time and intensity practice (for example: 20sec OFF, 5sec ON). Just make sure your reminders are centered on relaxing the PF musculature.
If all a fitness or health professional does in the first trimester is coach proper diaphragmatic breathing and PF activation, we would have far fewer birth complications, let alone muscle imbalances, dysfunctions and a myriad of pregnancy-related discomforts. To be exceedingly clear, however, the difference is made in HOW you coach them to do the exercises.
Before moving on, I will address the TVA. This extremely important muscle generally is under-activated and needs to be activated. For two reasons, I leave it to be specifically addressed only after proper diaphragm and PF function are understood by the client. First, women in the fitness world are increasingly showing up with a permanent “draw-in” syndrome that they’ve adopted thanks to well-intentioned fitness professionals. The danger of holding in one’s abs too much, however, is often the shut-down of the Diaphragm. Holding ones abs in all day should in no way be considered good function. The inner unit is a pump. Proper function should be cyclic. Second, i have found that as a woman achieves proper function of the diaphragm and PF, the TVA will follow right along in good function, with really no additional coaching involved. The explanation may be that the PF musculature is highly connected to the lower abdominal and TVA musculature.
Assuming we have successfully activated the core via diaphragmatic breathing and PF exercises, we can move to the next most important topic: hip loading. Pregnant women have glutes that are under-activated. How can a pregnant woman avoid SIJ dysfunction, pubic symphysis separation, any of the pelvic girdle pain syndromes (PGP, etc), and any musculo-skeletal pregnancy related pain problem if her glutes do not load when they are supposed to load? It’s a losing proposition. (I could have said the same thing, by the way, for diaphragm & PF function.)
Let’s revisit what a functional exercise is. Should it be considered “functional” to perform wobble-board exercise with a distended TVA, lack of diaphragmatic breathing and a pelvic floor completely turned off?
Should it be considered “functional” to have your pregnant client perform a squat that has no glute activation while her PF is under-activated and her TVA hangs distended?
My suggested answer to both questions is an overwhelming “no.” As far as I am concerned, a “functional exercise” must have “corrective” components. Again, it’s HOW you do it.
Having said that, if a pregnant woman has been coached on proper core loading and hip loading mechanics, my next six most important exercises will incorporate the “Primal Movement Pattens” identified by Paul Chek. (Squat, lunge, bend, twist, pull, push).
The following is an example. Note that diaphragmatic breathing and PF activation is a presumed prerequisite:
1) BEND: Deadlift (progress from 2-legged to 1-legged…never straight-legged)
Tip: A new mom is going to find herself bending at the changing table, at the car seat, and just about everywhere else until her kid is old enough to no longer be carried everywhere. I progress women to hold one Dumbell (DB) at their shoulder in a manner that often reflects what she will be dong with her newborn all day long.
Note: The “bend” of a deadlift indicates hinging at the hip, not the spine. Before bending the spine and hip together, a proficiency of hip loading must be coached to ensure that a synergy between the hip and back exists. This is important because a big belly does not grant the abdominal muscles great leverage, leaving a pregnant woman at higher risk of diastasis recti, for example. The reality, of course, is that pregnant woman is going to bend to tie her shoe laces and other ADL. The question becomes: What is the most important use of our one hour in the gym with these women? Usually the answer is hip loading, not spine rounding.
In theory, a highly functioning pregnant athlete should be able to perform spinal bends in the first and second trimesters. In fact, a truly functional pregnant woman should be able to perform spinal bends through to her third trimester as well, but we do not live in a world of good function. Because of this, Fit For Birth coaches our instructors to generally remove spinal bends like crunches and side flexion as the woman begins showing and therefore has less abdominal leverage.
2) SQUAT: (progress from 2-legged to 1-legged, and incorporate 1DB at the shoulder)
Tip: In order to be considered a functional pregnant woman or soon-to-be mom, it is mandatory to achieve mastery over the 1-legged squat. How often will she be on one leg? Every step she takes! It is imperative that she has the proper core loading and hip loading sequences in place.
I also encourage women to achieve the deep squat position, as it represents the shortest and widest opening for the birth canal. I call this the foundational position of birthing, and I work with every client to correct whatever imbalances may be preventing her from reaching this position comfortably, if any.
3) LUNGE: (progress from static split squats to stepping into different planes)
Tip: stepping laterally or opening the legs rotationally are often considered no-no’s considering the hormones of laxity and possibility of pelvic separation. The question is: should we fitness professionals avoid the movements altogether or teach our clients how do perform them safely? I coach Fit For Birth professionals to teach safely. In short, the pre-requisites would include proper core loading and hip loading mechanics. Once those are in place, standard safe progressions can be used. The reason why I don’t leave exercises like “lateral lunges” off completely is because I choose to empower my clients to have awareness and access to the correct muscles. I do this in preparation for that rare day that she steps off the curb unexpectedly sideways, and needs to access those muscles. Out in the world of surprise is where the injury is likely to occur. Thats where great training pays off.
To be clear, I do not coach Fit For Birth professionals to perform dynamic lateral or rotational exercises with a dysfunctional pregnant woman who has no glute or core activation.
4) PULL: DB Bent Row (progress to 1-arm, possibly 1-leg varieties)
Tip: For most pregnant women, the primary focus should remain on the hip loading and core-diaphragm-PF activation. Third in line would be Scapular Loading. The bent row is a necessary exercise for a soon-to-be-mom who will soon be bending over in so many new places. Coaching her how to maintain proper hip and core loads while moving the arms will save her from lots of back pains and more.
5) TWIST: Plank + 1-limb lift (activating the rotational stabilizers without performing an official twist pattern)
Due to the overwhelming dysfunction present in our modern population, Fit For Birth generally coaches our professionals to remove formal twist patterns like Oblique crunches as the pregnant woman begins to show, which is usually sometime in the second and third trimester. Similar to the spinal bend pattern, the reason is because a big belly does not grant the abdominal muscles great leverage, leaving a pregnant woman at higher risk of diastasis recti, for example. The same possibilities exist, of course, for highly trained athletes with extraordinary muscle balance: a functional pregnant woman should be quite capable…that’s just not the world we live in right now.
6) PUSH: push-up (start on knees, progress to lift one knee from ground, and possibly to full push-up)
Tip: Soon-to-be-mom is going to find herself on the floor a lot, laying and playing with her newborn and emerging toddler. She is going to be performing one sided and other strange varieties of “pushing up” off the floor. She must learn this pattern to be a functional mom. As usual, core loading is the priority. However, now Pec loading (rather than front deltoid and upper trap) is the key. And the belly really doesn’t get in the way like you might think, leaving this as an exercise I use in any trimester. Another tip is that lifting one knee/leg allows for a great progression as well as a way to challenge the rotational “twist pattern” stabilizers.
Top Functional Exercises for second trimester:
As you can probably tell by now, Fit For Birth does not classify our exercises according to trimester. We classify exercises according to function.
As such, we assess our clients with a basic primal movement assessment, looking for function/dysfunction in four major categories:
Top Functional Exercises for third trimester:
If a woman arrived to train in the third trimester, we would choose exercises based more upon her current level of function, rather than her current trimester.
Clearly, if she has a big belly, we don’t place her face down for exercises. Nor do we choose exercises like ballistic leg swings or plyometrics, etc., considering the laxity factor.
Having said that, a First Trimester exercise to work on before the belly grows is the prone cobra. While she can still lie prone on the floor or a ball, make use of the time to coach her on scapular adduction and shoulder external rotation.
Fit For Birth’s protocol postpartum is to jump right into inner unit core activations like diaphragmatic breathing, PF, and TVA. These exercises can be done while in the hospital, lying in bed with her baby, sitting on the couch, and anywhere that new mom will find herself in the first days postpartum. This “inner unit rehab” works unbelievably well for getting a woman back in shape, returning her to a “flat” stomach and re-establishing her foundational musculoskeletal-skeletal concerns.
As her initial postpartum period subsides and she feels ready to get back into more exercise, we move to what Fit For Birth calls Belly Training exercises like planks, side planks, prone cobras, etc. When ready, we progress to the primal movement patterns.
Read more from the interview here:
James Goodlatte is a Pre & Post Natal Holistic Health Coach whose passion is to heal families by inspiring the use of natural methods and by building a global team of fitness & health professionals to reduce infertility, avoid mechanized childbirth, and lower chronic disease in our infants. As the founder of Fit For Birth, Inc., he is a driving force for providing Continuing Education Credits for the Pre and Post Natal World. As a writer, his articles have been published in a dozen languages and have inspired contact from Pre & Post Natal women as well as health professionals in over 150 countries.
James Goodlatte is a Holistic Health Coach, corrective exercise practitioner, speaker, author, and professional educator. His passion is to heal families by inspiring the use of natural methods and by building a global team of fitness & health professionals to reduce infertility, avoid mechanized childbirth, and reduce chronic disease in our infants.