Forty percent (1,120) of the participants in the 2014 Winter Olympic Games were female. That number grew during the 2018 Winter Olympics to 1,242. The International Olympic Committee (IOC) realized that this growing population of female athletes competes during the most fertile period of their lives. Therefore, they’ve spent the last few years evaluating exercise and pregnancy in the recreational and elite female athlete. They found that having a child no longer means female athletes must step away from their sport. In fact, baring any complications, the athlete may continue to exercise at a moderate level during the entire pregnancy. If able to keep up with their training, most will still demonstrate a VO2maxafter child birth near their pre-pregnancy level(1).
This level of fitness, while possibly helpful with some aspects of pregnancy, does not prevent them from experiencing the same musculoskeletal issues as other pregnant women. Therefore, in today’s feature article, physiotherapist, athlete, and new mom Tracy Ward reviews some of the ways to manage the common musculoskeletal issues that arise. These include back, hip, and pelvic pain.
An uncomplicated pregnancy means an athlete should be able to do most activities with minor adjustments. However, certain conditions require pregnant athletes to avoid exercise altogether (see table 1). Others, while not absolute contraindications for exercise, necessitate close monitoring of both the mother and child (see table 2). Though cleared for exercise, athletes should avoid activities that increase their risk of falling or abdominal trauma. This means they may need to stop specific sport participation and focus on cross training activities. Stop exercise immediately if the athlete experiences any of the following:
Vaginal bleeding;
Regular painful contractions;
Leaking amniotic fluid;
Shortness of breath before exercise;
Dizziness or lightheadedness.
Fear avoidance
Despite a thorough rehabilitation process, athletes may still develop fear avoidance. This is their brain’s protective mechanism to ensure no further injury occursBr J Sports Med. 2016; 50:990-996. The brain will remember the feeling of pain from the original injury and will induce hesitancy, caution, and reduced confidence. A gradual rehabilitation programme that progresses each aspect of training is essential, with the final result being tasks within the sports environment and mimicking the exact sports drills. This will build confidence and a liking to the actual return to sport situation. This can often take time, and as explained above, the neural adaptations that can aid clinical rehabilitation of the brain need to occur. However, this cannot be rushed, and it is not the athlete’s ‘fault’ for being under confident.
History of prior pregnancy complicated by fetal growth restriction, miscarriage, preterm birth or labor
Enlarged cervix
Unstable arrhythmia
Chronic respiratory issues
Uncontrolled diabetes
Seizures
Underweight
Headache
Chest pain
Weakness
Swollen or painful calf muscles
Musculoskeletal concerns
Without anything to compare childbirth to except an acute injury, the IOC borrowed the return to sport guidelines from the 2016 World Congress in Sports Physical Therapy consensus statement(1). They divide the post-partum progression into three phases:
Return to participation – engaging in cross training activities at a lesser intensity than prior to pregnancy;
Return to sport – participating in actual sport and sports specific drills but still restricting intensity and duration;
Return to performance – executing their specific sport at or better than their pre-pregnancy status.
While ‘uncommon’, the incidence of pregnancy in female athletes should continue to rise as the numbers of women in sport increases. For now, sports scientists base current recommendations and guidelines on the scant research and the consensus of experts. While exercise is usually safe, pregnancy is not the time to push the envelope and make performance gains. Assure athletes that they will be able to return to sport and advocate for the best training goal of all: a healthy mother and child.
Alicia Filley, PT, MS is the former editor and a long-time contributor to Sports Injury Bulletin and its sister publication Sports Performance Bulletin, she has 30 years’ experience working in rehabilitation, sports injury, and sports performance. Alicia holds a bachelor's and a master's degree in physical therapy. She is a practicing physical therapist and avid hiker, runner, and cyclist. When not writing and researching, Alicia can be found putting our findings to the test outside on the ...
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Dr. Alexandra Fandetti-Robin, Back & Body Chiropractic
"The articles are well researched, and immediately applicable the next morning in the clinic. Great bang for your buck in terms of quality and content. I love the work the SIB team is doing and am always looking forward to the next issue."
Elspeth Cowell MSCh DpodM SRCh HCPC reg
"Keeps me ahead of the game and is so relevant. The case studies are great and it just gives me that edge when treating my own clients, giving them a better treatment."
William Hunter, Nuffield Health
"I always look forward to the next month’s articles... Thank you for all the work that goes into supplying this CPD resource - great stuff"
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