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Structural changes during pregnancy

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Lesson objective

• Explain correct posture and how to transfer safely and effectively between different postural positions and during different daily activities

• Explain the structure and detail the structural changes that occur in the spine and pelvis

• Explain the muscle, ligament and bone density implications of the ante state

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Weight Gain

• Average total gain: 12-13 kg / 27-30 lbs

Activity 1• In small groups label the weight distribution

diagram given to you by your tutor• 5 minutes

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Activity 1 • Group 1 - Explain what is meant by correct

posture and consider the effect pregnancy may have on correct posture?

• Group 2 - What effect does pregnancy have on the pelvis and what effect does gravity have on pregnancy?

• Group 3 - What effect does pregnancy have on muscles, which lengthen, which shorten?

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Posture

• Feet approx hip distance apart• Feet comfortably placed, distributing weight

evenly between feet• Knees slightly bent• Locate a neutral pelvic position• Bring shoulder blades down and closer

together, lifting rib cage away from hips• Lengthen back of neck, chin at right angles to

shoulders & looking straight ahead

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Effects of Pregnancy on the Spine

• Centre of gravity changes• Abdonimal muscles Lengthen

& weaken• Reduced support for the

spine• Increased ligament &

intervertebral disc elasticity• Increased lordosis• Increased kyphosis

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Effects of Pregnancy on Posture

• Centre of gravity shifts downwards & outwards • Lumbar lordosis increases• Thoracic kyphosis increases

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Correct Posture

Dependent on:– Flexibility in:

hip flexors

hamstrings

pectorals

lower back– Strength in:

gluteals

abdominals

upper back

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The Pelvis

• 4 bones:

2 hip bones

sacrum

coccyx• Each hip bone consists

of 3 fused bones:

ilium

ischium

pubis

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Joints of the Pelvis

• All fixed (fibrous) joints• Front - symphysis pubis (pain)

• gap 4mm pre-pregnancy (up to9mm during pregnancy)

• Back - sacroiliac allows for slight forwards, backwards &

sideways movements when spine flexes or extends

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Muscle, Ligament & Bone Adaptations to Exercise (non pregnant population)

• Muscle mass increases

• Force & velocity of contraction increases

• Improved muscle co-ordination

• Increased ligament strength

• Increased bone density

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Muscle Adaptation when Pregnant

• No research to suggest force or speed of muscle contraction is any different throughout pregnancy.

• Muscle mass & strength increase in response to weight gain. Specific increase to lower body muscles

• Abdominal muscles become stretched, thinned and weaker as a result.

• Other postural muscles may become shortened as a result of poor postural adaptation.

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Effects of Pregnancy on the Rectus Abdominus

• Muscle lengthens width ways & separates• Muscles ability to contract weakens• Can separate at the linea alba (diastasis recti)

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Ligament Adaptation to Pregnancy

• Centre of gravity changes stretches ligaments supporting pelvis, hips and lower back leading to decreased mobility & increased mechanical stress.

• Release of relaxin loosens ligaments throughout pregnancy & up to 6 months postnatal.

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Bone Adaptations when Pregnant

• Maternal bone mineral density is maintained

• Maternal bone turnover increases

• Calcium absorption through intestinal walls increases

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Muscle, ligament & bone adaptations to exercise during pregnancy

Results do not appear to be additive with respect to:•lean muscle mass•remodeling•bone density

• Regular weight bearing exercise should have positive effect on:

•muscle strength & tone•improve posture, abs & back strength•mechanical stress from centre of gravity changes & back pain

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Summary

• Postural awareness and correction can be the single most important skill a pregnant woman can learn.

• Discomfort and pain around the pelvis should be addressed through alternative positions, exercises and referral to health professionals when persistent

• Muscle function and bone density remains unaltered, whilst ligaments loosen during pregnancy