You Are Only As Strong As Your Core: Ab Modification For Pregnancy

Written by Ives Hot, ACE-Certified Group Fitness Instructor

Wow it's been a minute since we shared a post.  A lot has happened in the past couple of months.  Kaila Jae is turning ONE this month, we have both ran and PR'd races, and I am joining the FIERCE club of mamas in May 2020.  Oh yes, pregnant and THRIVING.  Thrive is my word for 2020 and my goal is to be a resource for women in Seattle that are embarking on this journey, are thinking of pregnancy in the future, or are post-partum.  

Let me preface this by saying that as a fitness instructor one of the first concerns I had when I found out I was pregnant was how will I need to adapt my workouts.  I was in the peak of my marathon training cycle and initially my worry was how do I need to adjust my training and nutrition to run a successful race.  As I started my web search for pregnancy and running, I quickly realized that I would also need to adjust my HIIT strength training.  My goal here is to share helpful modifications to make other women feel comfortable in strength training classes as they embark on this wild pregnancy journey!  I am going to talk about some of the science behind what is happening in your body, break down moves by trimester, and give you confidence to keep showing up in class for YOURSELF and that BABE.  

This post serves as a guide based on expert opinions and guidelines that are available.  However, you should always check in with your OB/GYN and listen to their advice about exercise and pregnancy.  Pregnancy is also not the time to suddenly become a workout fiend, if you weren't active at baseline.  

‍

WHY SHOULD I MODIFY MY CORE EXERCISES?

If you're new to pregnancy, you may be wondering why you should change what you're doing before you have a big old belly in the way.  Even if you aren't showing, in the first trimester your uterus starts to grow and expand to make room for baby -- this means your abs start to stretch.  Towards the end of your first trimester, beginning of the second trimester you will want to check for diastasis recti (DR).  

Diastasis = separation
Recti = abs

DR describes the abnormal separation of your left and right abdominal wall, which appears as a gap between the two sides. It is normal for your abs to separate slightly during pregnancy to make room for baby, but a separation greater than 2 centimeters is thought to be abnormal.  When you have DR and crunch up, you may notice "coning" or a ridge that occurs in the center of your belly.  But why is DR bad?  Generally, DR is bothersome because it can cause lower back pain, urinary incontinence, constipation, and at times makes vaginal delivery more difficult.  In rare cases DR can lead to hernia formation due to there being a thinner layer of tissue allowing the organs to poke out.  

DR can happen with any pregnancy, but is more common when women carry twins, have had multiple pregnancies, or are shorter in stature.  Based on "What to Expect," if you develop a 3 finger width separation between your abs, you definitely need to modify your core exercises.  Modify does not equate to STOP exercising.  A strong core supports a strong pelvic floor and you definitely want that for delivery.  

‍

FIRST TRIMESTER
You may be one of the lucky mamas and not feel any symptoms (nausea, aversions, fatigue) until halfway through the first trimester.  If you are experiencing those symptoms --it's okay, you aren't alone and hopefully that all improves in the second trimester.   In regards to adjusting exercises this early on there are lots of expert and not-so expert opinions.  Again, please be aware that most of the articles that are available are written based on expert opinion and don't necessarily have strong data supporting them.

There is a camp of individuals that feels strongly that you should not "do crunches."  The reasoning behind this strong stance is that a "sit-up" or crunch motion places more pressure on the rectus abdominus (left and right more surface layer ab muscles).  There is also some conflicting data from the Journal of Orthopaedic and Sports Physical Therapy, that demonstrated how abdominal crunch exercises performed during pregnancy actually shortened the inter-rectus distance from gestational week 35-41 through 14 weeks post-partum. If you don't want to stop traditional ab exercises, you can modify them by placing a wedge or ball behind your back for additional support.  Ultimately, unless any exercises are causing discomfort or pain you do not need to modify during the first trimester.  However, if you are more apprehensive about developing DR, you can focus more on oblique and transverse abdominus strengthening exercises.  

Example 1: Side Plank

• You can do this exercise with your palm flat on the ground or on your forearm for less shoulder strain and more balance.  
• Stack your feet, so that your hip are aligned.  Lift your hip off the ground and continue to drive up, while holding in your core.  
• Modification: Pyramid kickstand your lower leg, by bending your lower knee 90 degrees so both legs are not lengthened.
• You can perform this exercise for time.  Beginners start at 30 seconds and build up time from there.

Example 2: Bird Dog

• Start in table top position on your hands and knees with a neutral spine.  Belly breathe so that you are zipping you abs together (visualize pulling a string from your belly button up toward your spine).
• Inhale then extend to lengthen opposite arm and leg.  Exhale and contract to bring thigh to meet elbow.  Extend back out.  Perform 3x and alternate sides.  
• You can do this exercise for a set period of time i.e. 60 seconds or repetitions.  

‍

SECOND TRIMESTER
By now you may be starting to look pregnant, especially if you are having twins or this is your second or third (or more) babe.  If your bump seems small, don't stress either.  We all grow and show differently in this phase of pregnancy and it can be hard to hear comments from friends, family or strangers about your body.  For Christy and I, we both did not show until later into our second trimester.  Try not to compare yourself to other mamas or if you aren't pregnant yet, try not to mom shame.  Whether you outwardly look preggers or not, chances are that YOU have noticed a change in your abdomen by now.  It's wild to think of everything going on inside your body.  Your uterus has grown much larger to make room for baby, amniotic fluid, and the placenta and clothes feel tighter (hello stretchy pants #BLESS).  

Because your body is changing, you may start to feel differently about your typical exercises and in turn need more modifications.  Personally, at about 18 weeks is when I started to modify my abdominal exercises.  I am now at 22 weeks and continue to exercise 6 days per week, including running, cycling, HIIT, and strength work.  I still do Barry's classes about 4x per week and although I am a bit more breathless, I continue to hit sprints on that treadmill albeit a bit slower.  (For perspective: My baseline is an endurance athlete and I ran the NYC Marathon at 13 weeks pregnant.)

I no longer perform abdominal exercises that involve a full range sit up, v-up, jack knife, or bicycle crunch.  Basically, any fast tempo or quick diagonal ab exercise I view as off limits and I rather focus on slow-controlled exercises that allow for breath to be connected to movement.  You can also continue traditional or side planks and the bird dog mentioned above if it feels good.  

Exercise 1: Knee Hover or Mountain Climber March

• Start in table top position on your hands and knees with a neutral spine.  Belly breathe so that you are zipping you abs together (visualize pulling a string from your belly button up toward your spine).
• As you inhale, lift your knees an inch off the ground and have a static hold.  As you exhale, keep your abs contracted and slowly release knees down.  Repeat for 10-15 reps.  
• ADVANCED: You can belly breathe as above and start in a plank position.  Slowly draw your right knee to below your hip then return to a plank.  Switch and draw your left knee in.  As you exhale, keep your abs contracted.  If you cannot keep your belly button drawn up to your spine drop down to table top and rest before re-attempting.  
• Modification: Complete the Mountain Climber March on an elevated surface, i.e. hands on a bench and feet on the ground.  

Exercise 2: Deadbug or Heel March

• If your OB/GYN cleared you to lie on your back this is a nice slow exercise.  As you enter the third trimester or become less comfortable, you can do this exercise with pillows or a wedge propped against your back. If you ever feel dizzy when lying on your back, skip this exercise.
• Start lying on your back with your arms and legs straight up in the air.
• Belly breathe in to contract your abs (as above), focus on lowering the opposite arm and leg to the floor, then lift them back to the starting position.  Take your time, the slower the better.  I am for 3-5 seconds in each direction.  Repeat 10-15 reps per side.  
• Modification: If straight legs are too difficult, bend your knees 90-degree or rest the non-working foot on the ground. ​

Exercise 3: Heavy Lifting Moves i.e. Deadlift, Squat, Lunge

• Not going to walk through these moves but HELLO just a friendly reminder that strength work of any kind relies on strong core.  In each of these exercises and lots of other heavy lifting, your breath needs to be controlled and your abs engaged to perform the exercise effectively and safely.   Deadlifts are and will always be my favorite exercise because they target legs, glutes, lats, abs, and so much more!

THIRD TRIMESTER

You are in the final stretch mama! Things are feeling really REAL as you feel baby moving daily, don't sleep as comfortably, and probably start to move a bit slower.  You are not alone in how you feel and can always reach out to Christy and I with questions, concerns, or stories.  There is no such thing as TMI when you're growing a human!  

This is also when you really start modifying exercises to feel more comfortable and to try to reduce DR.   The pressure from intra-abdominal flexion can cause that "coning" or ridge to appear.  You are going to want to avoid traditional ab exercises by this point if you have been hanging on to them.

Exercise 1: Plank

• Start with legs lengthened and forearms on the ground.  Make sure your shoulders are in line with your elbows.
• Breathe belly button in toward your spine and lift your knees off the ground.  As you exhale, keep your abs engaged and contracted.  Hold for 10-30 sec and repeat with rest in child's pose between repetitions.  
• Modification: Push Up position for the plank or elevate your arms on a step or bench to relieve pressure.  Additional modification, you can perform the plank with knees resting on the ground but focusing on the breathing.  

Exercise 2: Modified Bird Dog

• Start in table top position on your hands and knees with a neutral spine.  Belly breathe so that you are zipping you abs together (visualize pulling a string from your belly button up toward your spine).
• Inhale then extend one arm and hold out for 3-5 seconds.  Exhale and contract to bring arm back to resting position.  Now perform with your opposite arm, then each leg.

​Exercise 3: Heavy Lifting Moves i.e. Deadlift, Squat, Lunge

• You aren't hallucinating, yes the heavy lifting is here again.  Deadlifts are a great alternative to traditional ab exercises and should still be doable.  Yo may not be able to hinge forward as far and you can progress to sumo squat deadlift as your bump grows, but key is to continue to condition that body with this awesome move along with other lower body focused exercises.
• For upper body lifts consider performing a row from a supported hinged position or table top.  You can also combine bicep curls, rows, or snatches with squat movements.  

​

Alright we have covered A LOT. I hope you feel empowerd to show up for yourself and that babe in the gym or your next group fitness class and have some tools to adjust ab exercises when they come up.  Don't worry you're not alone on this journey.  Just remember to notify the instructor that you are pregnant and will be modifying! This post is based off literature searches on PubMed, Lexicomp, as well as opinions from fitness experts that wrote for Shape Magazine, Parents website, What to Expect, and Bump.  Another great resource I found in my research was the Pregnancy Guide from Expecting and Empowered.  

CONQUER YOUR SUMMIT,

Ives

‍