The likelihood is, this is an experience of the third trimester you will never, or have never, experienced in your life. The Coronavirus lockdown has had a huge impact on how we live, who we see and how we move. As you enter the 3rd trimester you are already faced with a the most significant changes to your movement as it is. Add to this limited access to physio, trainers and face to face health support can make it tricky to get the specific help you are looking for. Whilst you may not be able to go to what you had planned there are still lots you can do to keep moving well and staying strong.

One big advantage our new lifestyles bring is a change to our daily habits. Many women find that by the 3rd trimester that any symptoms of discomfort or more severe issues such as back or pelvic girdle pain (PGP) that can be triggered (Wu et al 2004). A significant issue reported is related to the repeated postures or positions that you must perform to do your job or care for other children. These are dictated to you buy the desk you sit at, the commute you must take or the hours you work. Working remotely or different hours provides the opportunity to break this cycle, thus managing the provocation of your symptoms. If your symptoms are more severe and you are waiting to see a health professional, the pelvic partnership and The POGP have reliable information to help you understand and address your condition.

Next Steps: Log your symptoms: When are they worse? Is there a pattern? Try varying your positions and take time is standing as well as in a comfortable rest position to minimise the aches creeping. Feeling safe is as important as actually doing the exercises.

What is safe in the 3rd trimester?

By now you have exceeded the time when it is appropriate to exercise laid on your back to exercise or sleep (IOC 2016). The intensity at which you can exercise may also start to reduce and you should rely on how intense you feel each time rather than relying on heart rate monitors or ‘your normal’. This is the time for intuitive movement and activity, identifying when your body feels capable and not forcing your body to keep going- You can use a simple test called the ‘talk test’ (Recommended by the ROCG) to guide you. Try to use pregnancy safe exercises like modified Pilates, yoga, or walking. Unfortunately, swimming is now off limits due to social distancing but when these restrictions are lifted you can utilise this right up to your birth for a great cardiovascular non-impact form of exercise. ROCG & PHE are key governing bodies guiding us in how to keep healthy and safe during this pandemic. Now you are in the third trimester it is important that you maintain an active and healthy lifestyle whilst following the social distancing guidelines. (You can find updates on their websites listed below). It is recommended by the Chief Medical Officer (2017) to participate in 150 minutes of exercise per week including the activities listed above.

Physical Activity for Pregnant Women

Next Steps: Plan your exercise in using home workouts and daily walks. Set yourself a goal 150 minutes per week of exercise and movement that makes you feel better physically and emotionally. There are lots of online classes you can join like Jennis Pregnancy app which was developed in conjunction with Chartered Physiotherapists.

Jennis Pregnancy App

How to maintain and improve strength and relieve muscle tension?

The most common need I see in clinic is the need for strength. Massage and stretches are helpful relief tools. Massage brings circulation and changes the tone (tight or gripping) of the muscles that are giving you the symptoms you feel. This not only helps to take the muscles out of this pattern but can change the way the muscles work.  Muscles are encased by sheaths of connective tissue that can become sticky and reduce the glide and action of your muscles. Spikey ball massage and foam rollers are a great home practice to help free up those muscle actions. This is great for symptoms release and helping the muscles get ready to function better, but they must be followed up with strength exercises. Even though your symptoms might be coming from spasm or tightness in the muscles it is the weakness of the muscles that cause these symptoms to present.

Next Steps: Try some gentle movements first to see which are limited or aggravate your symptoms. Now try doing some massage with your ball or roller, followed by strength exercises. If you really want to play detective retest the limited or aggravated movement after each release and strength exercise. You might be surprised to see that one or two have significant impact on improving your symptoms. If you do find that lower back massage and hamstring curls have the biggest reduction on your symptoms, then that is exactly what you should be doing to help balance your body’s movements. Look at our YouTube page for some examples of exercises or workouts

Pelvic floor exercises are so simple, convenient to do and can be used during movements such as lifting or bending yet these are the exercises that women find challenging to get into their daily routine. Supervised pelvic floor programme have the best outcomes and symptom reduction, even reducing the likelihood of requiring further, more invasive, treatment in the future (NICE 2015). Add to this that Pelvic Floor exercises improve the support of the Pelvis (Vleeming 2012) Back (Lee 2014 & 2008) and reduces postnatal risk of incontinence (Reilly et al., 2002) giving you a desirable list of reasons for making this a priority. I teach women the ‘Wink & Zip’ which helps you use all the muscles correctly, getting an effective pelvic floor squeeze every time. First, relax your tummy and pelvic floor, then focus just on your back passage. Imagine you squeeze, as if holding onto wind, feeling a slight lift like a ‘wink’. Next time you try the wink imagining extending the movement by drawing your back-passage forwards as if trying to ‘zip’ close the gap between your back and front passage. Finally coordinate it with your breath by starting your squeeze as you start you out breath, then progress by holding gently whilst taking a normal in breath then relax. You can vary this by trying short squeezes, as if just switching on then letting go. Nice (2015) recommend doing x8 ‘holds’ and ‘shorts’ three time per day to improve your pelvic floor function.

Next Steps: Keeping up with this program can be hard by yourself. You could download squeezy app or join our ‘Pelvic floor, Core and More’ program for a 6-week guided plan, to not only get your pelvic floor exercises going but also improve your overall pelvic health. For more details contact the team on hello@katiebellphysio.com.

Supporting Resources

https://www.gov.uk/government/publications/covid-19-guidance-on-social-distancing-and-for-vulnerable-people/guidance-on-social-distancing-for-everyone-in-the-uk-and-protecting-older-people-and-vulnerable-adults

https://www.rcog.org.uk/en/guidelines-research-services/guidelines/coronavirus-pregnancy/covid-19-virus-infection-and-pregnancy/

Lee DG (2004) Stress Urinary Incontinence- A Consequence of Failed Load Transfer Through the Pelvis? Hermann Wallace

Lee DG, Lee LJ, Mclaughlin J (2008) Stability, continence and breathing: the role of fascia following pregnancy and delivery. Journal of Bodywork and Movement Therapies (12), pp. 333-348

Nice Guidelines (2015) Urinary Incontinence in Women (Statement 4)

Reilly et al (2002) Prevention of Postpartum stress incontinence in primigravidae with increased bladder neck mobility: A randomized controlled trail of antenatal pelvic floor exercises. Intern Journal of Obstetrics and Gynaecology (109), pp. 68-76

Vleeming et al., (2012) Sacroiliac joint Overview, Journal of Anatomy 221(6), pp. 537–567

Wu W.H. et al., (2004) Pregnancy related pelvic girdle pain, terminology, clinical presentation and prevalence.  Eur Spine Journal (13) pp 575-589.