Bump Management and Modifications
Why talk about deadlifting during pregnancy? Have you ever reached across to a car seat to lift a baby or bend and reach over a crib? This motion of a hip hinge and lift is actually very functional for new moms and also can be very difficult. It requires strength and coordination of muscles that have been stressed and stretched during pregnancy. Also, some mommas love to lift weights as a part of their regular activity, so we need to know how to support and modify this movement for function and for fitness.
“I’m still deadlifting, but having upper left abdominal discomfort and cramping during the lift. I also feel like I need to change something up soon with my positioning, like going into sumo, as my bump gets bigger.”
Read more for how I work through these types of questions with clients
News flash! When working with an athlete who is also pregnant we have sooo much to take into consideration. It isn’t simply taking away one exercise and substituting another. If that were the case robots would have my job in 5 years and I can’t let that happen. So here is a peek into my brain for consideration for a pregnant client for deadlifting. Hint: there is more to it than dropping weight and turning your feet out.
The patient or client’s why?
As with any exercise modification during pregnancy, the questions are, “why do you need to do this exercise? Does she want to keep power in her glutes and hamstrings for another athletic activity, like running? Does she need to feel like she can still deadlift in the third trimester due to her identity as a power lifter? Does she want to keep the motion of hip hinge in her muscle memory to ease back into her competition lifts afterwards?” Her answer for all of these questions was, YES. And she wants to use her time in the gym to “prehab” for birth and postpartum, so is concerned about proper utilization of her “core,” hamstrings, and glutes.
The detective work begins…Why are her abdominals cramping?
Bottom line: At some part of the movement there is excessive pressure on the upper abdominals, or the structures that also live there, maybe the diaphragm or nerves coming from the thoracic spine. Excessive load or stress could be due to changes in the movement pattern, or frankly the load exceeding the new limits of the muscles needed to perform this lift – we need to spread the load evenly to all the muscular players.
Anatomy Lesson: The Abdominal Muscles
The anatomy facts: during pregnancy, there is a change in the length of the abdominals – all of them.
6 pack muscles that run up and down from your sternum down to your pubic bone. The linea alba is the strong connective tissue that connects both sides of your six pack and is what gets thinner with a growing belly. This is the tissue to take into consideration when talking about diastasis rectus abdominis (DRA) or abdominal separation. This tissue allows both sides of your abdominals to coordinate (talk to each other) or support you and transfer load from one leg to another, one arm to the other or diagonally from one leg to the opposite arm. So, you can see why continued separation after birth could complicate transferring load from the ground to overhead, side to side or even sitting up.
Muscles that run diagonally on either side of your trunk, with two layers intertwining like a basket weave from ribs to pelvis. We think of these as rotators, but they are also side benders and so many other organic movements like combined side bend and rotation. They also resist rotational forces to maintain your body in midline when you have unequal or unilateral load like a farmer’s carry or holding a car seat.
TRANSVERSE ABDOMINIS (TRA)
This muscle wraps around you like a corset from your low back, traces around your ribs and pelvis and also connects to the front tissue of the linea alba, under your six pack. This muscle is designed to “fire” or “activate” automatically before a movement of your arms, legs and body in order to allow support and tension around your pelvis to not only protect, but generate force from your lower body to your upper body and complete the movement efficiently. Yes, using your TrA can help improve performance!
*Every muscle in our body has an optimal length and range of motion at which it generates force –the abdominals may not be at optimal length to create optimal force right now – because you are growing a human! That is incredible! This may also change the coordination and speed of the muscles firing, so instead of the TrA supporting us first to stabilize, the other muscle may be turned on earlier or all the time to compensate. We call this “overactive” and overactive muscles may become tight and even painful.
Other movement modifications we can make to support your growing belly are the range of motion, amount of weight being lifted, or the mechanics of the movement itself. All of these will be addressed in the analysis of different parts of the movement. Other factors that are just as important and not addressed in this post are hormonal changes, energy level changes, ability for tissue to rebuild, and current and prior medical history.
Other Key Players
This dome of muscle sits up and under your rib cage separating the chest cavity from the abdomen. The diaphragm is vital in respiration, contracting down and flattening to pull air into the lungs as they expand and relaxing and recoiling up with exhalation. This muscles coordinates with the pelvic floor and TrA as described below in piston breathing.
THE PELVIC FLOOR
This group of muscles attaches from sit bone to sit bone (ischial tuberosity) and from pubic bone to tailbone forming a sling of support. Contraction of this complex group of muscles causes closure of sphincters for bowel and bladder control, lift for support of pelvic contents against gravity and further function for sexual appreciation and lymphatic circulation. These muscles have an intimate attachment to the interior wall of the hips and connective tissue that attaches to the hip muscles.
First, here is an important review of proper breathing technique to consciously utilize the diaphragm, pelvic floor and TrA together, as they are intended to support your body in a lift, push, pull, standing up and even jumping. Due to changes in pregnancy, cultural expectations of women to always suck in, and teaching women a male approach to holding your breath during lifting, this natural order of events may need to be practiced and re-learned. If you have mastered this move…onto the movement break down.
Foundation of Breathing and Lifting
With every movement we make, we can make the decision to either use our breath to support us and reduce pressure on our linea alba and pelvic floor or hold our breath which causes an increase in intra-abdominal pressure.
The first option is often referred to as piston breathing, but should really just be called breathing since it’s how we were built to function. This natural rhythm is necessary for proper function, reducing incidence of stress incontinence, prolapse and exacerbating diastasis recti. Piston breathing is; the diaphragm and pelvic floor muscles descending as
the transverse abdominals expand during an inhalation and then all recoil up towards the mouth and in towards the spine during exhale. This action of the diaphragm and pelvic floor lifting and the TrA hugging in to support the contents of the abdomen (baby) decreases stress and load on the other, outer, abdominal muscles which are being stressed already. Please see Julie Wiebe’s website and work for more great information as she is the mastermind behind “Piston Breathing.”
The alternative, holding your breath or bearing down, pushes the contents of the abdomen and pelvis (bladder, uterus and colon) down onto the pelvic floor and out against the linea alba. This pressure on an already stretched structure and vulnerable connective tissue could cause some pain and stretching and also some cramping of the overstretched muscles. This is the coordination you need to master, for everything from standing up, to lifting a car seat, to a deadlift.
But what about the Valsalva maneuver? We were taught to protect our spine during lifting heavy loads.
Filling your lungs and belly up and then holding your breath and closing your glottis (google it) to lift something is a Valsalva maneuver. The intention is to increase the intra-abaominal pressure to protect the spine. In research, this has only been found necessary to protect the joints in your low back if you are lifting 80% to 90% of your 1 rep max or lighter loads to failure.
The Valsalva maneuver (holding your breath with lifting) does increase your intraabdominal pressure and puts more stress on your linea alba, your pelvic floor and vascular structures. The question is, is it worth it?
I use the rule of thumb that if you have to hold your breath, grunt or bear down to lift or complete the movement during pregnancy it’s time to modify. Think long term here. I want you to be able to deadlift as many years as you would like instead of just taking a badass pictures during the third trimester.
Pregnancy may not be the best time to max out – it is up to you to know your limits based on these guidelines and be your own best advocate for long term health and function.
Let’s first break down the movement to its bare bones. It is a hip hinge, which requires length in your hamstrings, posterior and internal/external rotation of the femur within your hip socket, coordination of your transverse abdominis, pelvic floor and glutes to maintain position of your lower and mid back as your hips go from flexed to extended. And power of your glutes in multiple planes to drive the movement out of the hip hinge to extension, instead of pulling with your back. Whew! So, with a growing babe and belly living right in the middle of all this madness we can see why things may feel a little complicated or at least different. We will break down each component.
Getting Into Position
Not enough length in the hamstrings causing some rounding in the mid back.
Why is this a problem?
To raise up out of this position, you would need to reverse the rounding and hinge at your thoracic spine to lift up, putting excessive pull or force on your upper abdominals – also called a rib flare.
Self-assess: look in a mirror sideways with a slight bend in your knees and hinge forward with your butt reaching a wall, keeping your back flat. How far down can you bend? Not as far as you thought in order to reach the bar or kettlebells. Time to work on your hamstring flexibility. And possibly your hip joint’s ability to go back and down.
Also – who said you have to pull from the ground for it to be a deadlift? Raise the level the weight is sitting to reduce rounding in the spine.
- Kneeling hip flexor stretch with hamstring nerve glide
- Posterior Hip Mobilization with Band
- Hip Height Piriformis Stretch
- Hip Internal Rotation Hip Drives
Lack of extension in the thoracic spine: You don’t feel a stretch in your hamstrings but your upper back begins to round. (This is my personal problem – too much time at the computer) This may actually be a strength issue with the muscles in between your shoulder blades or a mobility issue with the joints in your upper back.
Self-assess: hold a yardstick between your shoulder blades on your back. Can you hinge with the yardstick staying in contact with the pelvis and the upper back?
- Bent over kettlebell rows (if you still feeling comfortable with your belly against gravity) or try seated or standing rows
- 3-D breathing training
- Gaining more mobility through your thoracic spine could decrease possible irritation of nerves traveling around your rib cage that could present as pain and muscle cramping in your abdomen.
Bump in the way and unable to reach full depth – the common thought and a great solution is toeing out, going into sumo or taking the hips into external rotation. This is a great solution to complete the lift, but brings up another topic of only performing glute exercises with your hips externally rotated. This is already the posture your body goes into during pregnancy, a common compensation to widen your base of support, and make room for growing belly, but in turn, shortens your glute muscles, decreases hip extension ability and exacerbating the pregnant waddle. Without getting too much in the weeds – we don’t want your glutes to always be in the same position. Letting your glutes go through the full range of motion allows them to strengthen functionally, possibly preventing nerve irritation like sciatica, and a strong set of glutes, leads to a better functioning pelvic floor.
Work your glutes in all planes of motion.
Without going into an additional post about hip rotation and pregnancy, if you choose the sumo position as your modification for deadlift, be sure to integrate stretches to maintain hip internal rotation. Also integrate glute strengthening exercises with toes pointed forward and (gasp) even internally rotated (obviously not loaded the same as externally rotated) such as lunges or body weight squats.
Summary: muscle strength in full hip rotation range of motion helps maintains pelvic floor muscle function, can prevent over shortening of piriformis muscle which could cause irritation of the sciatic nerve.
Prepping Muscular Support to Lift
Shallow chest breathing and holding your breath, not activating your piston breathing before the lift.
Self assess: use the previous description to learn the proper piston breathing rhythm and then feel for the muscle activation yourself. Feel for TrA activation with two fingers just inside your hip bones and you should feel a tightening of the muscle under your fingers. Remember that this muscle working properly is tightening around your abdomen, providing a secure hug, not moving any joints. You can also feel your pelvic floor just inside your thighs where the muscles attach to your pubic bone or just inside your “sits” bones. You should feel a lifting and tightening with exhaling. Now practice this in different positions leading up to walking through the movement without weight, against a wall, to ensure you get the natural rhythm down.
Possible solution: Practice Piston Breathing
Once you have incorporated piston breathing and feel like you have coordinated through the whole movement, but still feel like your pelvic floor activation or your glute activation is insufficient to stay activated through the whole movement try training a synergistic movement to improve muscle firing and possibly add stability to the pelvis via more muscles being engaged. (Sidenote: more is not always better. This is very individual)
Synergistic movements to add to Deadlift
Improve pelvic floor activation – right after the exhale and activation, isometrically activate your adductors (inner thighs) by drawing the arches of your feet and thighs together without actually moving or squeezing a ball if you have a narrow stance.
Improve glute activation – right after the exhale and activation, do the opposite, drive your feet outward without moving, like you are ripping a piece of paper apart the outsides of your feet.
Initiating with your back instead of hip drive. This may be a motor pattern problem (coordination) or this may also be that the load/weight has exceeded your abdominals ability to support your spine in neutral, at this time.
Dropping the weight or moving the weight closer to the axis of motion (your hips) will decrease the work of your abdominals and improve activation of glutes. We also know that women lose hip extension strength (glute strength) while they are pregnant and it remains decreased for up to 9 months if nothing is done about it. We can do something about it! So, yes, deadlifts are going to be more difficult now, but also very important to keep your function.
- Drop the weight
- Use Kettle Bell Deadlift or a Hex Bar to move the weight closer to the center of your body, where the power is!
- Use a Pulley System and just work on loading the hip hinge and drive instead of the lifting against gravity
- Deficit Lunge with Hip Hinge
*You will use piston breathing during all of these modified deadlift drills to engage TrA and pelvic floor coordination before the effort of the movement. Blow before you go!
The truth is there is no perfect set of exercises or movement modifications that will take your abdominal pain away. Human movement is more complex than that. The body is more beautifully complicated than that. These are ideas, rooted in evidence and knowledge and application of anatomy and function. Nothing can replace an individual analysis from a Pelvic Health PT who is willing to analyze your movement.
You’ve mastered piston breathing, shortened your range of motion, you’ve lightened the load, you’ve moved the force closer to your hips, but your upper abdomen is still sore at rest or with a deep breath.
Sometimes you need external support to give the abdominal muscles some slack, literally. I highly recommend support from the bottom up to support your pelvic floor, approximate your pelvis and wrap up to your ribs just like your transverse abdominis.
My favorite brands are SRC health and Bao Bei maternity. Kinesiotaping in a basket weave fashion can also help approximate the rectus abdominis and linea alba to offer some relief and offer a good reminder to your nervous system to utilize those muscles.
As with every type of internet education – this is all advice, not a formal evaluation or diagnosis or medical treatment which is recommended. A full evaluation from a pelvic health physical therapist and consultation with your medical provider is recommended before initiating any workout or movement changes.