Injury Prevention For Pregnant Athletes
Injury prevention and training for athletes
Athletes, whether elite or recreational, should aim to continue with certain aspects of their rehabilitation throughout pregnancy to prevent issues either during the pregnancy or when they resume training after the birth.
Feet and achilles tendons
Achilles tendon loading and calf strengthening should be implemented to maintain the tensile strength of the tendon (it’s ability to accept load), and the strength of the calf muscles. This can be in the form of calf raises or using a leg press machine. Proprioceptive work (balance and foot placement) and drills are also important to help to enable the feet to work well, despite any ligament changes that may be occurring, and which would make the feet less stable. Drills are also important for maintenance of neuromuscular control, and retaining and maintaining movement patterns, especially as the body changes.
Stretching and strengthening
Muscular condition and range should be maintained by stretching and strengthening. The correct stretching exercises can help maintain good pelvic alignment and minimise postural changes and pain. It is also useful to maintain strength in the abdominal and gluteal (buttock) muscles to help with pelvic stability, reducing stress on the ligaments in the pelvis, sacro-iliac joints and pubic symphysis.
Bone health and weight training
If you are used to exercising, it should be possible to maintain some training, making adaptations when necessary. During the months when it is possible, training should include some impact to help with bone health. This may be in the form of jogging/running if you are a runner. If you are used to doing strength training with weights, it is usually possible to continue with this, as long as good postures are maintained, you can breathe throughout, and the weight is adapted into the pregnancy. It is possible to do weights on machines as long as they are not done isometrically (holding the weight) and that the mother is able to breathe throughout. It is very important to prevent a Valsalva manoeuvre during training (holding the breath and pushing down and thereby increasing abdominal pressure). You should avoid exercising on your back after 16 weeks.
Please note that every pregnancy is different, and it is important to listen to your body.
Temperature regulation
Temperature regulation is important in pregnancy. Ideally swimming pool temperatures should be below 32 degrees and, if exercising on land and indoors, thin layers of clothes and fans should be used to help maintain a lower body temperature. Pregnant women sweat more, which will help with temperature regulation, and it is important to stay hydrated. Hydrotherapy pools should be no higher than 35 degrees for pregnant women.
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Maintaining fitness
It is possible to generally maintain aerobic fitness throughout pregnancy, health of both mother and baby allowing, with a loss of anaerobic conditioning, as this becomes less of a priority throughout the pregnancy. As your shape changes, it will become necessary to adapt or manage training.
Musculoskeletal changes
Musculoskeletal changes also include reduced thoracic and lumbar rotation and counter rotation, which will affect walking, running and exercising. After the baby is born, it is important for this to return to normal ranges before resuming and increasing training, as there are a number of potential injuries than can arise from reduced rotation. A pelvic realignment and thoracic rotation assessment should ideally be done by a physio in the first 6- 8 weeks, and monitored as athletes start to get back into training.
Abdominal strength
It is really important to get some guidance to regain abdominal strength. The abdominal muscles are stretched throughout the pregnancy, and lose strength, function and tone. The muscles need to be retrained to work properly once the baby arrives. The external oblique muscles in particular work at a completely different angle during the latter stages of the pregnancy and need to be retrained to work in the correct way. There will also be a normal split in the tendon vertically down the middle of the abdominal muscles (diastasis recti, or rectus diastasis), which means care will need to be taken in the rehabilitation of the abdominal muscles after pregnancy, so that as the muscles work, they draw the abdominal muscles together in a strong, functional way, narrowing the gap. All sports have different requirements for abdominal function and it is so important to get this area right.
You should avoid things like sit-ups, planks, press ups and leg raises until you are ready- one thing that will catch you out will be getting out of bed without rolling onto your side!
Please see the section on rectus diastasis/abdominal separation. The rectus diastasis test can be used to check you are doing your exercises correctly and monitor if you are ready to progress them.
Caesarean sections
If you have had a Caesarean section (C-Section), it is important to take things easier than if you have had a vaginal birth. You doctor should be able to advise you, but generally you will be advised to wait for 8 weeks, before starting to think about doing any exercise.
Pelvic floor
Pelvic floor training should start during the pregnancy and continue after the birth, until normal function is achieved.
Returning to training
Six weeks, after the first postpartum check, would be an advisable earliest time for resumption of training, with exception of low level core, glutes, and foot/ calf strengthening.
Within the next six to twelve weeks, it should be possible to resume training as able, incorporating tendon loading without going into excessive dorsiflexion, core work, drill work, movement pattern work. Your physiotherapist should be able to advise you on getting back into training after your baby arrives.
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