FitnessMash

Training for Parenthood: Part 1 with Ilene Bergelson

If you missed our introductory Q & A with Ilene, be sure to check that out first here. Today, we talk with her about some specific lifting considerations for pregnant women and people with excess abdominal weight.

Q. Certain biomechanical changes occur as the fetus grows during pregnancy. How does this affect the pregnant woman’s lifting program? Would these same considerations apply if someone gains a lot of abdominal weight?

A. The extra load on joints (and lax ones at that) is a major consideration for pregnant exercisers, especially regarding their lifting programs. But it’s actually more the shape and location of the load relative to their center of gravity that must be taken into account, rather than the size of the load itself. The growing fetus creates a front load and changes the alignment of the spine, so it’s important to address this in the exercise program. It’s something you probably don’t think about unless you’ve been pregnant, but the impact of the weight distribution is quite dramatic.

The appropriate load depends on what the lifter is already accustomed to lifting, but modest loads are best for prenatal lifting programs. Pregnancy is not the time to lift your heaviest, and a pregnant woman should never train to exhaustion with any type of exercise. Temporary fatigue is the limit, not muscle failure.

Lifting considerations unique to pregnant exercisers include:

• Increased joint laxity (resulting in compromised balance, reaction time and joint stability)
• A distended abdominal wall with compromised recruitment
• An ever-changing center of gravity and intrinsic load
• Increased heating and cooling capacity (requiring extended warm-up and cooldown)
• Enlarged, sore breasts
• Pressure on the pelvic floor
• Additional cardiac output (adequate positioning and recovery are vital)
• Increase in size of the pelvis and altered hip mechanics
• Postural changes as the fetus grows

Some considerations apply to all exercisers with excessive abdominal weight, including:

• Increased risk of spreading and even herniating the fascia along the abdominal wall
• Lifting and carrying objects at some distance away from their base of support
• A shift in the center of gravity (forward and, in some cases, downward)
• Increased demand on the circulatory system
• Potential reduced field of vision (a partially obstructed view of the lower extremities)
• Change in muscle length-tension relationships

Q. You mentioned the risk of herniating the abdominal fascia and the need to consider this when creating lifting programs for individuals with excessive abdominal weight or moms-to be. How does this happen?

A. Pressure acted upon the abdomen can spread and even herniate the fascia along the abdominal wall. When we lift, there’s the pressure created by the lift itself (an external force acted upon the body), but we also create intra-abdominal pressure. Think of this as pressure created inside the body and directed outward into the abdomen.  It can cause the lifter to bear down, push the trunk muscles out and even hold the breath (Valsalva maneuver).

The combination of intra-abdominal pressure and the external forces of the lift increase the likelihood that the abdominal fascial wall will spread or tear (i.e., a hernia).

In both pregnant women and exercisers with substantial abdominal weight, the shape of the body is already causing additional tension on the abdominal wall (in the case of pregnancy, this happens as the baby grows bigger inside the uterus). The main difference is that in the case of pregnant women, the increased tension on the abdominal wall comes from the growing uterus, beneath the abdominal wall. In the case of the exerciser with a big belly, the tension can come from adipose underneath and on top of the muscle. This means a push into the abdominal wall from underneath, as well as a pull on the weight on top of the abdominal wall by the force of gravity when in upright positions (and additional pull in bent-over positions).

The intra-abdominal pressure created by a lift and the amount of torque that a certain position or movement places on the body must be within the limits of what the person is able to manage; the exerciser must be able to withstand the forces acting on the trunk. We can determine this by conducting a Diastasis check (a simple technique to check for widening of the Linea Alba), and avoid future damage by selecting exercises, positions, loads, planes and ranges of motion that are safe and appropriate. The key for trainers is observation and feedback: Look for signs of straining, nearing down and Valsalva maneuvers.

Lifting to a new level

Parenthood involves a lot of lifting! Take a look at the types of lifts parents do and consider how many of these movements occur in the lives of just about everyone else, too:

• Lifting load from beyond the base of support (over crib railings, changing tables, car seats, highchairs, playpens, bassinets, bathtubs, safety railings etc.)
• Lifting from the floor
• Lifting a load in motion
• Lifting and carrying an asymmetrical load

We can tailor any lift to be sport-specific; in this case, the sport just happens to be parenthood!.

Take this example:

Parenthood activity: Picking up baby from floor and lifting to shoulder

Base Exercise: Deadlift row

Modification options:

1) Load: medicine ball, small sandbag, gallon of water, free weight or cable

2) Stance: sumo, squat, staggered wide

3) ROM: floor to standing or any segment of that range

And the variations go on from there. Consider the grip, the trajectory of the lift, etc. These are just a few ways you can tailor the exercise for the sport-specific activity.

A word about outside help

In some cases, additional support (i.e., a brace) may be used, but only if needed to safely execute basic exercises. External braces are not tools to progress individuals into exercises they are not ready to perform. Start with modest loads and conservative ranges of motion, and ensure optimal alignment and absence of strain.

Stay tuned later this week for Part 2!

Filed under: exercise Q&A, interviews, strength training