Guidelines for Working Out and Staying Active through Pregnancy from a Pelvic Floor Physical Therapist

Being currently in my second trimester of pregnancy, it has been an eye opening and humbling experience navigating working out and staying active as my body changes and the baby gets bigger. As pelvic floor physical therapists, we specialize in guiding clients throughout their pregnancy and postpartum journey in how to safely stay active. However, now going through this experience personally it has given me some extra insight on some ways to know when to modify and how to deal with that “athlete brain” mind set. Below I’ve answered some common questions we get as pelvic floor physical therapists that I hope will help guide you throughout your own pregnancy if you are trying to stay active.

How can I safely train during my pregnancy?

According to the American College of Obstetricians and Gynecologists, “Pregnant women should do 150 minutes of moderate intensity aerobic activity per week, such as brisk walking, during their pregnancy. Women who already do vigorous intensity aerobic physical activity, can continue doing so during their pregnancy.” This means that if you were participating in running or CrossFit or a HIIT program prior to getting pregnant, you can continue to do that activity during your pregnancy. I will say there are certain conditions in pregnancy in which activity is NOT recommended so you need to make sure and clear it with your medical provider prior to continuing. If you haven’t been active or regularly doing an exercise routine, it is NOT recommended to begin a new program during pregnancy but instead start a walking program. Start with a 10 minute walk and progress from there depending on how you are feeling. Some other things to consider:

Stay hydrated and keep yourself cool when possible (workout in the shade/early morning or in front of a fan/in AC)

Monitor how hard you are breathing. You should still be able to have a conversation with someone; remember your baby needs oxygen too!

If a movement doesn’t “feel right” or causes pain/pelvic pressure/urinary leakage it’s time to modify that movement

What can I NOT do?

This is a “it depends” question and the answer varies from person to person. Some women are running or working out until their water breaks but some women have to modify early in their pregnancy due to abdominal coning or pelvic discomfort. The question that every pregnant person should always be asking themselves when thinking about an exercise is not “can I do this” but “should I do this”? Yes, you can probably run faster or lift heavier than what you are doing but it’s important to remember you need to train for the season of life that you are in and during pregnancy this goal is remaining healthy and preparing for labor and delivery! High impact activities like running/jumping and lifting heavy weights puts extra pressure on your pelvic floor because of the extra weight of the baby/uterus. If this is not managed properly it can lead to issues during pregnancy and postpartum that can include urinary leakage, prolapse, and pelvic/back pain. Movements like running or jumping or core intensive movements like pull ups, sit ups, and other gymnastic movements need to be assessed on risk vs benefit scale. The risk of injury or pelvic issues is NOT worth the potential benefit of some of these exercises, especially during the second and third trimester when you can easily substitute the movement out for a less intense exercise.

*My own experience with this so far as someone who does CrossFit: During my first trimester I felt pretty good, only a few instances of nausea and fatigue but overall still motivated to workout. I didn’t modify anything during my first trimester EXCEPT crunches and toes to bar right around the end of my 1st trimester due to feeling some vulvar pressure. I modified these with other core exercises like planks, side planks, and half kneeling chops. Since being in my second trimester and getting bigger I have had to modify a lot because I get out of breath so much more quickly and I’ve experienced some pulling sensation in my lower abdominals when I try to do pull ups or double-unders. So now I have decided to take out jumping movements and any movement hanging on the bar because of the discomfort I am feeling. I’ve also substituted barbell cleans and snatches with dumbbells because of my growing belly. Can I still jump and do double-unders? Yes, BUT I’m feeling some discomfort and this is the sign we look for to modify!

When should I modify a movement?

Again this is a “it depends” question. If you have urinary leakage, pelvic or abdominal pressure/pulling, pelvic pain (including hip pain), back pain, or feeling vulvar heaviness with your movements this is a sign to stop the movement and modify. Most people do not have to modify their movements within the first trimester, however definitely within the 2nd and 3rd trimester core intensive and high impact exercises should be modified! I personally recommend substituting jumping or running within the 3rd trimester especially because of the size of the baby and uterus during that stage.

When should I see a pelvic floor physical therapist?

First, I’d say every woman should come in to see a pelvic floor physical therapist, regardless of symptoms, especially within their pregnancy. This will help you connect to your pelvic floor and prep as much as you can for labor and delivery. Plus, we can give you great exercises to maintain strength and flexibility that will feel good and help ease the postpartum recovery.

However, it is definitely recommended to see a pelvic floor physical therapist if you are continuing to have pelvic pressure, pain, or urinary leakage despite modifying or changing a movement.

Other symptoms during pregnancy (and when not pregnant for that matter) that pelvic floor physical therapists can help with include leakage with coughing/sneezing, pain with intercourse, constipation, and low back/hip/pelvic pain.

I’ll end this by saying staying active during pregnancy should always be about how you feel! It’s so hard to step back from an activity you love BUT remember you will benefit so much more from modifying or changing your idea of what working out looks like, especially when you return to that activity postpartum!

Dr. Katie Ihlenfeldt, PT, DPT