Pregnancy: postural changes

It goes without saying that your body undergoes dramatic changes during pregnancy. One of those changes is your posture. But don’t go thinking it will happen overnight because it doesn’t, the changes are gradual and creep on you as you gain weight and your body adjusts to the various developments of pregnancy. Because of the weight you will gain your body experiences more aches and pains than it usually would. It’s a given, but what you do about it could help provide relief, I’ll return to that later.

As your abdomen and breasts enlarge your centre of gravity changes and your body does its best to hold you upright. The extra weight tends to pull you forwards and downwards (it’s like that moment when you’re starting to lean forward and pick something up), this affects the pelvis by tipping it forward and in turn leads to increased curve in your lower back (the lumbar region). Hey presto – you’ve got lower back ache!  You may also get sciatica as a result of the pelvis tilting forwards (anterior tilt) – causing compression of the sciatic nerve.

Try this now – stand up – tilt your pelvis so your bum sticks out, your abdomen pokes forwards – can you feel the subtle shift in your centre of gravity? Feel how the curve of your lower back has become exaggerated. You might notice your toes need to grip on the floor a little harder? Now imagine how all of these changes will increase and intensify as pregnancy progresses.  Men too should try this, so they can get a sense of what the woman goes through.

As a knock on effect of the pelvic shift and increased lumbar curve, muscles and joints higher up the spine and around your shoulder blades (thoracic area) and your neck (cervical area) will be put under increasing strain and before you know it you could end up with back ache higher up, maybe neck ache, stiffness, headaches and maybe sinus problems. A further effect of the increased lumbar curve (and breast enlargement) is that your shoulders tend to round forwards and your head and chin poke forwards. As we’ve said elsewhere, everything is linked and connected. Everything affects you elsewhere in your body. If one thing changes in your posture it will affect other areas of your body.

Lower down in your body your knees may have a tendency to lock backwards as they try to stabilise your body position, and your feet are constantly being challenged as the weight moves forwards and your toes take the strain.

Breathing changes in pregnancy too, firstly because of the internal organs, including lungs, being squashed and repositioned as your baby grows. But also the diaphragm (the major muscle involved in breathing and which separates the abdominal and thoraxic cavities) is also being repositioned. The diaphragm attaches in many places, including the upper two or three lower back (lumbar) vertebrae. As we’ve already mentioned, the lumbar curve becomes exagerated in pregnancy, and this will clearly affect how the diaphragm works and lead to a decrease in lung capacity. You would notice this as shortness of breath.

Returning to the spine, because of the change in the spinal curves the ligaments that hold your vertebrae and other joints together are subjected to additional strain – it’s not just the muscles. If you’ve not already heard of relaxin then you need to know about it. This is a hormone which causes joint laxity because of how it acts on ligaments. In certain parts of the body during pregnancy this is very useful – such as the birth canal which needs to accommodate your baby during birth – the pelvis needs some flexibility to cope. However, relaxin doesn’t just affect ligaments and joints which need some flexibility for birth – it affects all ligaments and therefore all joints. One effect can be the onset of symphysis pubis dysfunction (SPD), defined in the Illustrated Dictionary of Midwifery (Winson & McDonald, 2005) as “excessive softening of the cartilage with softening of the pubic bones and destabilisation of the joint”. Note the word excessive; not every woman who gets pregnant is affected by SPD. So it’s good that your pelvis becomes more flexible, but you need to bear in mind that your pelvic bones may not be aligned, and that you may need to adjust the way you lift items or walk, particularly up/down stairs. Thinking about feet again, they’re at risk of collapsing arches as the ligaments become lax and strain under the extra weight you’re carrying.

When bones become misaligned the muscles will have to adjust in some way. That could be either by lengthening or shortening. Neither of these are great, but the good news is that tension in muscles caused by short muscles can be helped with focussed massage. In SPD the gluts (bum muscles) and lateral rotators (small and deep muscles in your bum) are often found to be short as the pelvis starts to open up and expand slightly. Shortness in these muscles can also be linked to sciatic pain.

As a consequence of the realigning of the pelvis, extra weight-bearing and postural adjustments, some muscles can also become weak through what could be termed overuse or by being strained. Fluid retention is also common during pregnancy, and this too can cause strain on joints. A common complaint in the wrists is carpal tunnel syndrome, where the nerve (medial nerve if you’re interested) that goes to your thumb and some of your fingers is literally compressed in a tunnel of bone at the wrist. You might experience numbness or tingling, pain or loss of function. With this syndrome caused by fluid retention, lymphatic drainage massage can help disperse the accumulated fluids and ease the pain.

What can you do to help alleviate pain and discomfort caused by postural changes during pregnancy? Pilates or yoga are excellent for keeping your posture in the correct alignment. A specialist pregnancy class is invaluable because the instructor will have the knowledge about correct alignment of your posture, and know how to instruct you towards the optimal posture for your individual pregnancy. Swimming is also good because the water takes your weight – see my post on this in May here. Finally, it goes without saying, that massage is immensely beneficial for soothing the aches and pains that do crop up. The therapist can identify shortened tight muscles which need relaxing. If you have water retention then lymphatic drainage techniques can be employed with the aim of improving your circulation and reducing the swelling. By easing muscle tension and reducing swelling there should be a reduction in joint stress, particularly important for those weight-bearing joints like knees and pelvis which are subject to ever increasing pressure as pregnancy progresses.I hope you are now more aware of the way your posture may change during pregnancy (and afterwards, as your body will need time to readjust back to its normal posture after giving birth), and that I’ve given you a few ideas how to have a more comfortable time. I always think it is better to know what may be coming and have the knowledge to deal with it. Let me know if you have any other suggestions or want to share your experiences.

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