Key Moments
Pelvic Health, Lifting During and After Pregnancy, and More with Marika Hart (Episode 43)
Stronger By ScienceKey Moments
Experts discuss pelvic health, pregnancy lifting, and postpartum recovery for women.
Key Insights
Pelvic floor dysfunction, including incontinence and prolapse, is more common among female exercisers than often realized.
Training during pregnancy is generally safe and beneficial, but requires careful consideration of intensity and contraindicated activities.
Postpartum recovery is highly individual, with guidelines suggesting a phased return to exercise over many months.
Coaches and trainers need to be aware of female-specific health considerations, including cyclical changes and potential long-term effects of pregnancy.
Pelvic pain can stem from overactive as well as weak pelvic floor muscles.
Understanding and open communication are crucial for supporting female clients through their unique health and training journeys.
UNDERSTANDING PELVIC HEALTH IN ATHLETES
Pelvic health is a critical, often overlooked, aspect for female lifters and their coaches. Symptoms like stress urinary incontinence (leaking urine during exertion) are surprisingly prevalent, affecting nearly half of regular gym-goers. Pelvic organ prolapse, a descent of pelvic organs, and pelvic pain, often linked to conditions like endometriosis, are also common. Understanding these issues is vital for coaches to recognize potential problems and know when to refer to specialists, even if direct treatment falls outside their scope of practice.
SCREENING AND REFERRAL NETWORKS ARE ESSENTIAL
Fitness professionals should implement targeted screening questions about pelvic health concerns. Developing a strong referral network with pelvic health physical therapists, OB/GYNs, and other specialists is crucial. While coaches cannot diagnose or treat, they can help clients manage symptoms through exercise modifications and by facilitating access to appropriate healthcare professionals, ensuring clients feel supported and understood.
GUIDELINES FOR EXERCISING DURING PREGNANCY
Training during pregnancy offers numerous benefits but requires careful management. While pregnant women are resilient, not fragile, it's essential to have medical clearance and consider contraindications. Starting exercise during pregnancy is acceptable with moderate intensity if previously sedentary. High-intensity interval training (HIIT) is generally contraindicated. Perceived exertion is a better guide than heart rate alone, though monitoring both is advisable, especially at higher intensities. Maintaining hydration and avoiding overheating are paramount.
ADAPTING TRAINING ACROSS TRIMESTERS
As pregnancy progresses, training modifications become necessary. Barbell Olympic lifting is now contraindicated due to the risk of fetal impact. Lying flat on the back might need to be avoided after the first trimester, or with symptom onset. Diastasis recti (abdominal muscle separation) becomes more common and may necessitate avoiding exercises that excessively stress the linea alba. Balance and reduced blood pressure can affect stability, making fall prevention and modified movements important, especially with the increasing size of the belly.
POSTPARTUM RECOVERY AND RETURN TO TRAINING
Postpartum recovery is a lengthy, individual process, often taking 9-12 months. The type of birth (vaginal with or without complications, or cesarean section) significantly impacts recovery timelines and initial exercise considerations. Even six weeks postpartum, scar tissue strength is reduced, and a phased return to activity, starting with gentle movements and breathing exercises, is recommended. Coaches should facilitate this gradual progression, prioritizing tissue healing and symptom management over strict timelines, and understanding that a mother's body has fundamentally changed.
LONG-TERM CONSIDERATIONS AND COACHING BLIND SPOTS
The concept of 'once postnatal, always postnatal' emphasizes that pregnancy and childbirth cause lasting anatomical and physiological changes that can manifest years later as pelvic floor dysfunction or other issues, especially during menopause. Male coaches may have blind spots regarding female-specific experiences like body image struggles, disordered eating, and the impact of trauma or harassment. Recognizing that pelvic floor muscles can be overactive, not just weak, and understanding the psychological benefits of supportive coaching are vital for creating safe and effective training environments for women.
Mentioned in This Episode
●Software & Apps
●Organizations
●Books
●Drugs & Medications
●Concepts
●People Referenced
Coaching Pregnant and Postpartum Women: Key Considerations
Practical takeaways from this episode
Do This
Avoid This
Prevalence of Stress Urinary Incontinence in Female Athletes
Data extracted from this episode
| Sport/Activity | Prevalence (%) |
|---|---|
| Regular Gym-goers | 49 |
| Volleyball | 66 |
| Endurance Runners | 50 |
| Triathletes | 37 |
| Gymnastics | 70 |
| Trampolining | 90 |
| Powerlifters | 40 |
Abdominal Fascia Strength Post C-Section
Data extracted from this episode
| Time Post C-Section | Strength of Abdominal Fascia (%) |
|---|---|
| 6 weeks | 50-60 |
| 6-7 months | 70-90 |
Women's Body Image Dissatisfaction & Disordered Eating
Data extracted from this episode
| Demographic | Experience | Prevalence (%) |
|---|---|---|
| Women in Canada & US | Dissatisfied with body | 80-81 |
| 10-year-old girls | Afraid of being fat | 80 |
| Young girls | Opting out of life events due to body image | 79 |
| Women - study 2014 | Engaging in some form of disordered eating | 75 |
Common Questions
Pelvic organ prolapse is when pelvic organs descend due to weakened pelvic integrity, described as heaviness or a bulge. It's often highly prevalent structurally (50%+), especially after childbirth, but is only a problem when symptomatic. It's even found in women without childbirth experience, like paratroopers.
Topics
Mentioned in this video
A common symptom of pelvic floor dysfunction where urine leaks during activities like coughing, sneezing, jumping, or laughing. It's often considered 'normal' by many women, but it is treatable.
The separation of abdominal muscles during pregnancy to accommodate a growing baby, which is totally normal and experienced by up to 100% of women.
A high-intensity fitness regimen that has, in some instances, unintentionally glorified stress urinary incontinence during workouts, sparking discussions about normalizing symptoms versus seeking treatment.
A condition causing pelvic pain and painful periods, statistically common in about 10% of the population, often taking years to diagnose.
Occurs when one or more pelvic organs (bladder, bowel, uterus) descend due to loss of myofascial integrity in the pelvis, often described as a sensation of heaviness or a bulge. While common, it becomes problematic when symptomatic.
A training method involving short bursts of maximum effort, which is contraindicated during pregnancy due to potential risks to the baby from reduced blood flow at very high VO2 max levels.
A breathing technique involving a breath hold, often used for heavy lifting, but contraindicated in pregnancy due to increased blood pressure spikes and intra-abdominal pressure that could affect the baby and pelvic floor.
A colleague of Marika Hart who works with powerlifters and CrossFitters, providing tips on using lifting belts to manage incontinence.
Pelvic health physiotherapist, co-founder of Girls Gone Strong, and expert on pelvic health, pregnancy, and postpartum recovery.
Co-founder of Girls Gone Strong, strength and conditioning coach, and speaker on female-specific lifting topics.
A free, supportive Facebook group for health and fitness professionals to ask questions and share experiences related to coaching and training women, with access to experts and community members.
A comprehensive, evidence-based, interdisciplinary certification covering coaching psychology, female anatomy and physiology, nutrition, exercise, rest, recovery, programming, and the birth process, all specific to pre- and postnatal women.
An organization dedicated to providing education and resources for women's health, fitness, and nutrition, particularly for female lifters and coaches who work with them.
A research review or publication which the guests are subscribed to and appreciate for its in-depth research and articles.
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