Importance of Proper Posture
Aside from looking bad, an improper posture can lead to pain and other negative long term effects on your body. Maintaining a proper posture while standing, walking, or sitting is very important for the health of your bones, joints, ligaments, and muscles. Maintaining a proper posture during pregnancy can help avoid common aches and pains, as well as keep the mother and baby more comfortable. Proper Posture helps keep bones, joints, and ligaments aligned so that the muscles are able to work properly, and to avoid misuse, which can lead to pain.  Maintaining a proper posture prevents fatigue, strain, overuse, and muscular pain.
 
During pregnancy, a woman’s posture changes due to different factors:
-Growing belly shifts weight forward and alters center of gravity
            -This may cause undercorrection or overcorrection of posture
-Hormones cause joints and ligaments to loosen
            -This may cause incorrect posture due to end range changes
-Women may adapt different postures to offset pressure on other joints
-Various aches and pains alter how a woman stands and walks
            -Depending on where the pain is, women may adapt pain avoidance postures

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            The Pubic Symphysis is a cartilaginous joint in the middle of your pubic bones, it unites the superior rami of the right and left pubic bones. Normally, the joint has a small amount of movement, but this increases during pregnancy and childbirth.
            Symphysis Pubis Dysfunction happens when there is an excessive amount of movement of the pubic symphysis and pain due to either a misalignment of the pelvis and/or hormonal changes in your body loosening the joints around the pelvic area.  Very rarely, you can have a diastasis of the symphysis pubis, which is a separation that can cause intense pain in the hips, pelvis, groin, and buttocks, and can affect vaginal delivery.

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Diaphragmatic Breathing
-Diaphragmatic breathing is a natural and relaxed form of breathing, and is done by expanding and contracting the diaphragm. This allows you to maximize the amount of oxygen that goes into your bloodstream
-During diaphragmatic breathing, lung expansion happens lower in the body and is referred to as “deep breathing”
 
Diaphragmatic Breathing with Abdominal Activation
-Inhale slowly through the nose and allow air to fill your lungs, expanding the diaphragm
            -Your belly should expand
            -Do not let your shoulders or chest rise
-Exhale slowly through your mouth and let all of the air out
            -Contract your abdominals and bring your belly inward

What is a Belly Band
A Belly Band acts as a supportive garment (such as a Sports Bra) that women can wear during and after pregnancy.  Belly Bands offer slight compression; which helps stabilize the belly during activities, and could take some pressure off the abdominal and back muscles. Belly bands are designed to support the lower back and abdomen, as well as the pelvis (in some cases, depending on the type of band you get). A Belly Band can help cue women to engage their core muscles, but it does not replace the importance of strengthening your muscles through exercise.
Belly Bands can offer comfort during daily and physical activities, as well as reduce soreness in later stages of pregnancy as the belly gets bigger and the abdominal wall expands.
 
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One of the most common complaints I hear about from pregnant women is that they have back pain; especially during the later stages of pregnancy. Since there are many reasons as to why women can develop back pain during pregnancy, it is important to find the root of the problem before attempting to treat it.  Seeing a Physical Therapist to help assess and diagnose your back pain will help you find relief faster.

Causes of Back Pain during Pregnancy
Back pain can be caused by a variety of reasons, and the first step in treating pack pain is identifying why you have back pain and where it is coming from. Visiting a Physical Therapist for a thorough evaluation is usually a good idea when you cannot identify the cause of your back pain, or if it is affecting your daily life.
 
-Increasing weight gain during pregnancy
            - The increase in weight during your pregnancy means that your body has to support more weight than it is used to. This puts more pressure on your spine and the muscles, ligaments, joints, blood vessels, and nerves that surround it.
 
-Postural Changes/ Center of Gravity Changes during Pregnancy
            -As your pregnancy progresses and your belly becomes bigger, your center of gravity shifts (forward) to adjust for the change in weight and position of your belly. As your center of gravity shifts, you will begin to adjust your posture during sitting, standing, and moving. The change in posture may put strain on muscles, joints, and ligaments, causing back pain.
 
-Hormonal Changes during Pregnancy
            - During pregnancy, your body produces Relaxin; a hormone that allows the ligaments in your pelvic area to relax so that the joints become looser in preparation for delivery. Relaxin can also affect the ligaments in your spine, causing them to loosen and lead to instability and pain due to muscle strain.
 
-Stress during Pregnancy
            -Some believe that stress can accumulate in weaker areas of the body in the form of tension.  Muscle tension in your back during stressful periods in your pregnancy can lead to back pain, back strain, or back spasms.

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Sciatic Nerve Pain (Sciatica)
            The Sciatic nerve is a large nerve that runs from the lower spine, through the buttocks, into the back of the thigh, down through your leg and into the foot (you have 1 on each side).  The sciatic nerve provides motor and sensory input to the legs; it provides sensation to the back of the thigh, lower leg, and the sole of your foot.
            The sciatic nerve can be affected during pregnancy since it runs under your uterus as it goes to your legs.  The pressure from the growing uterus and developing baby can compress the nerve and cause sharp pain, tingling, burning, numbness, or electric-like pain. The pain usually starts in the low back or buttocks (depending where the nerve is compressed) and radiated into the back of the thigh and lower leg/ foot. Sciatic nerve pain is usually one sided.
       Sciatic nerve pain is usually worse when standing or sitting still (adding increased compression over time) and feels better when walking or lying on the side opposite of the one in pain

Exercises with Free Weights:
       *Free weights (dumbbells, barbells) are a great way to target specific muscle groups while also giving you the advantage of versatility in the way you move the weights, using more muscles to help stabilize the weights during various movements, and allowing you specificity your exercises to real life movements. You can perform various functional movements with dumbbells that will help you during pregnancy and afterward while taking care of yourself and your baby!
        *Safety Tip: Keep your torso straight as you perform the movements in each exercise, do not bend your spine forward or to the side as you lift your arms up, and do not swing your arms quickly (lower the weight if you cannot lift the dumbbells without using your torso for assistance)
 
Exercises in Standing:
        *When exercising in standing you need to make sure you are engaging your core by bringing your bellybutton up and in, tucking in your tailbone, and squeezing your glutes. If you feel that you are not able to control your abdominal muscles, your balance, or stability, then you should perform exercises in standing. Once you feel comfortable with your form, you can progress to tall kneel or physioball exercises.

Exercises in Tall Kneel:
       *When exercising in tall kneel, you are adding another element of balance, core stability, and pelvic strength to your exercise. Find your NEUTRAL SPINE in tall kneel by tucking your pelvis in, and ACTIVATE YOUR ABDOMINALS by pulling your bellybutton in toward your spine and up toward your nose.

Exercises with a Therapy Ball (Physioball):
        *When using a therapy ball, you add another element to your exercises. Sitting on a therapy ball while using free weights helps you work on your balance, stability, core strength, and pelvic strength. Make sure you are sitting on the ball with a NEUTRAL SPINE, your feet are shoulder width apart, and you ACTIVATE YOUR ABDOMINALS by pulling your bellybutton in toward your spine and up toward your nose.

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After the first trimester, it is recommended that pregnant women don't spend an extended amount of time on their back due to the pressure that the uterus can put on the Inferior Vena Cava. (The Inferior Vena Cava is the big vein in your belly that brings blood back to the heart)

Instead of giving up on doing all exercises that require you to be on your back, there are some modifications that can be used in order to reap the benefits of exercising in supine.  
-Place a wedge behind your head and shoulders so that you are in a reclined position where your heart is above your navel
-Prop yourself up on your arms so that your head and shoulders are off the floor and your heart is above your navel.

*Exercises in modified supine target your core (abdominals, pelvis, obliques), thighs, legs, buttocks.

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