Journal Article Excerpts RE: Exercise During Pregnancy and Postpartum
(1)Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period.”
MUSCULOSKELETAL ADAPTATIONS Anatomical and physiological changes during pregnancy have the potential to affect the musculoskeletal system at rest and during exercise. The most obvious of these is weight gain. The increased weight in pregnancy may significantly increase the forces across joints such as the hips and knees by as much as 100% during weight bearing exercise such as running. Such large forces may cause discomfort to normal joints and increase damage to arthritic or previously unstable joints. “Despite a lack of clear evidence that musculoskeletal injuries are increased during pregnancy, these possibilities should nevertheless be considered when prescribing exercise in pregnancy.” Data on the effects of increased weight of pregnancy on joint injury and pathology are lacking (emphasis mine). Because of anatomical changes, pregnant women typically develop lumbar lordosis, which contributes to the very high prevalence (50%) of low back pain in pregnant women. Balance may be affected by changes in posture, predisposing pregnant women to loss of balance and increased risk of falling. However, increased incidence of falling during pregnancy has not been reported. Another musculoskeletal change during pregnancy is increased ligamentous laxity (emphasis mine) thought to be secondary to the influence of the increased levels of oestrogen and relaxin. Theoretically, this would predispose pregnant women to increased incidence of strains and sprains. This hypothesis has been substantiated by objective data on the metacarpophalangeal joints (see study #2 below by Calguneri and Wright). Despite a lack of clear evidence that musculoskeletal injuries are increased during pregnancy, these possibilities should nevertheless be considered when prescribing exercise in pregnancy. EXERCISE IN THE POSTPARTUM PERIOD Many of the physiological and morphological changes of pregnancy persist for four to six weeks postpartum. Thus, exercise routines may be resumed only gradually after pregnancy and should be individualized. Physical activity can thus be resumed as soon as physically and medically safe. This will certainly vary from one woman to another, with some being capable of engaging in an exercise routine within days of delivery. There are no published studies to indicate that, in the absence of medical complications, rapid resumption of activities will result in adverse effects. Undoubtedly, having undergone detraining, resumption of activities should be gradual. No known maternal complications are associated with resumption of training. Moderate weight reduction while nursing is safe and does not compromise neonatal weight gain. Failure to gain weight is associated with decreased milk production, which may be secondary to inadequate fluid or nutritional intake to balance training induced outputs. Nursing women should consider feeding their infants before exercising in order to avoid the discomfort of engorged breasts. In addition, nursing before exercise avoids the potential problems associated with increased acidity of milk secondary to any build up of lactic acid. Finally, a return to physical activity after pregnancy has been associated with decreased postpartum depression, but only if the exercise is stress relieving and not stress provoking. ABSTRACT We have studied changes in peripheral joint laxity occurring during pregnancy in 68 females using both the finger hyperextensometer to quantify laxity at the metacarpophalangeal joint of the index finger and Beighton et al.’s modification of the Carter and Wilkinson scoring system. Although the latter system recorded no change, the more sensitive hyperextensometer demonstrated a significant increase in joint laxity during the last trimester of pregnancy (0.02 greater than p greater than 0.01) over the readings from the same individuals after parturition. When primigravidae and multigravidae were compared, a highly significant increase in laxity was found in women having their second baby over those having their first (0.01 greater than p greater than 0.001), though no further increase in laxity occurred in subsequent pregnancies.
(2) Changes in joint laxity occurring during pregnancy [Abstact].”