Zager Chiropractic Services

Dr. Zager has successfully treated and adjusted her pregnant patients throughout their pregnancies – even up until the delivery. As you move through the different trimesters of pregnancy, there are different techniques that Dr. Zager will use. The information below will just remind you of important things to keep in mind while you are pregnant.

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Exercises:

            Kegals: Tighten your pelvic floor (try to stop your flow of urine), hold for a count of three and then relax. Do this exercise at least 5 reps, 3 different times a day. After you have delivered your baby, you should continue this exercise to help reset the muscle tone in the pelvic floor.

            This is one of the most important exercises you can do during your pregnancy and afterwards. By strengthening the floor of the pelvis (this is what the baby will be sitting on as it gets larger) you will be giving your enlarging uterus the support it needs and it will help you to maintain your own pelvic stability.

            Pelvic tilts – laying on your back, slightly tilt your hips up toward the ceiling, then relax, then arch your stomach up. If you want to go to the next level, tighten your abdominals and buttocks while doing this stretch. The next level is to raise your pelvis off the floor while doing this exercise.

            Cats – get on all fours. Arch your back up and then sink your stomach to the floor.

            Half Sit-ups/Crunches: lying on your back with your knees bent, support your head with your hands. Slightly raise your head and shoulders off the ground. Start at only 5 or 10 per half. The second half is to sit on the floor with your knees bent. Place your hands on top of your knees. Lean back about 6 “ and then come forward. This half works the lower abdominals. Obviously as your progress through your pregnancy, you will not be able to perform the second half of this exercise.

            Shoulder wings – Standing with your arms to your side. Wing your shoulders back and hold it for a count of three, squeezing as hard as you can.

            Shoulder shrugs – Standing, shrug your shoulders up and hold it for a count of three. Then actively push them down toward your hips for a count of three.

            Walking/Swimming: Both are great exercises to keep you in cardiovascular shape. Do one or both daily. Swimming is particularly good for taking the baby’s extra weight off of you for a little while. Remember – no hot tubs or baths that are very hot.

            After your delivery, continue to do your exercises. Walking (or strolling) and your shoulder wings/shrugs will be very helpful for you, as will pelvic tilts and kegals.

Nutrition:

            Eat healthy – lots of vegetables for their vitamins/minerals and for their sugar leveling components. Make sure you do eat protein (peanut butter is great as is chicken/turkey) since your baby will need those building blocks. Look at taking a good children’s vitamin with iron or a prenatal vitamin recommended by your OB/GYN. Also, make sure to drink plenty of fluids. Water (you can squeeze some lemon juice or lime juice in your glass), milk, orange juice, and cranberry juice (helps keep yeast infections down) are all very nutritious and healthy for you.     

The information below is what the American Pregnancy Association recommends.

• Three to four servings of fruits and vegetables
• Nine servings of whole-grain or enriched bread, cereal, rice, or pasta for energy
• Three servings of milk, yogurt, and cheese for calcium
• Three servings of meat, poultry, fish, eggs, nuts, dried beans, and peas for protein

If you are breastfeeding, make sure that you continue to eat well and that you drink plenty of fluids (you are still supporting two people).

Sleep:

            Make sure you get good sleep. You not only need it, but your baby needs you to have it. When you sleep is when the body rebuilds and repairs itself. As you progress through your pregnancy you will want to start sleeping on your side – preferably your left side. Make sure your pillow is big enough to fit between your shoulder and your neck without tilting your neck. Also you might want to use a pillow behind your back to help give you some support.

            Get as much sleep as you can now to build up your reserves, because after your baby is born you will be awake every 2 hours or so. If you take some naps during the first couple of months after your baby is born, you can help reduce some of the sleep deprivation symptoms you may experience.

Body Changes:

            As you go through pregnancy your body undergoes significant changes.

Your biggest change is that your center of gravity changes, because of the extra weight in front of you. You will be leaning back and your low back and midback can get tired/stressed. (There are some good pregnancy braces that can help with low back pain if you need them.) Try to keep a good posture, and make sure that you get to get up and move around (don’t sit all day long). You will have to adjust to this new center of gravity and be aware of your balance as you progress.

            Also, as your breasts enlarge, you will have more stress pulling on your shoulders and neck. Do your shoulder exercises (Shoulder Shrugs and Shoulder Wings) to help relieve some of this stress.

            As you get closer to your due date, your ligaments will start loosen up (ultimately preparing for delivery), this means that you may get some hip pain, and your bones may be easier to move out of place. You may need to be adjusted more frequently as you get closer to delivery.

After Delivery:

            Your body is going to go through another major change (you just lost 20 – 30 pounds over night) and your center of gravity will go through another change. You will be getting less sleep, your breasts will enlarge – and with feeding and holding your new baby all your work will be pulling your shoulders forward. You still need to do your shoulder and midback exercises to help relieve some of the stress in the midback

(lift, carry and run)

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1. How mommy injuries occur:
   1. Lifting, bending, twisting, and reaching. Moving those big diaper bags, toddlers, and baby car seats. Bending over incorrectly and pulling pants up, tying shoes, giving baths and just in general picking things up. Twisting to put the kids in car seats and buckling them in. You name it, we do it.
   2. You can prevent many injuries by having good posture, using good body mechanics, stretching and strengthening your muscles, and by knowing your limits. Do not continue to do something that HURTS!
2. Posture.
   1. Head up – looking over the horizon
   2. Chest with a balloon attached
   3. Hips over the knees
3. Stretches to help you in the morning and after naptime. Typically hold a stretch for a count of three and then relax. Never bounce on a stretch.
   1. Ranges of motion – always do pure movements in the neck and back. Also do not whip your head in doing these. Never go past a point of pain.

i.      Neck – look up, then down; look to the right, then left; bend your right ear to your right shoulder, then your left ear to your left shoulder. Great exercise to do in the shower.

                           ii.      Back – lean forward with your hands on your thighs. Lean slightly backwards (don’t over extend). Turn to the right, then the left. Lean to the right and then the left.

                          iii.      Shoulders –

1.      Roll your shoulders back and then front.  Your arms can be at your sides, or with your arms at shoulder height.

2.      Then leaning over with your arm hanging straight down, draw small circles in one direction, making the circles larger. The reverse direction.

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   1. Back stretches

                            i.      Cats – get on all fours. Arch your back up and then sink your stomach to the floor.

                          ii.      Back rocks – Lying on your back, bring one knee up to your chest and rock it back and forth. Then do the other leg. Then bring both legs up to your chest and rock them back and forth. This exercise specifically puts motion into sacrum and your low back.

                         iii.      Pelvic tilts – laying on your back, slightly tilt your hips up toward the ceiling, then relax, then arch your stomach up. If you want to go to the next level, tighten your abdominals and buttocks while doing this stretch. The next level is to raise your pelvis off the floor while doing this exercise.

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   1. Arm and leg stretches

                           i.      Arm pulls – take one hand and grab the other arm just above the wrist. Pull forward and across the body. This stretches out the shoulder and mid back area.

                         ii.      Hamstring stretch – put one foot up on a low stool or step. Lean forward over the leg until you feel the stretch behind your knee and thigh.

1. Exercises to help strengthen your muscles and joints.
   1. Sit ups – Crunches – lying on your back with your knees bent, support your head with your hands. Slightly raise your head and shoulders off the ground. Start at only 5 or 10 per half. The second half is to sit on the floor with your knees bent. Place your hands on top of your knees. Lean back about 6 “ and then come forward. This half works the lower abdominals.
   2. Shoulders and mid back

                           i.      Shoulder wings – Standing with your arms to your side. Wing your shoulders back and hold it for a count of three, squeezing as hard as you can.

                          ii.      Shoulder shrugs – Standing, shrug your shoulders up and hold it for a count of three. Then actively push them down toward your hips for a count of three.

                        iii.      Reverse flys – holding lightweight dumbbells, bring your back just as in the shoulder wings. Do a set of ten.

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   1. Lat pull downs – Using a pair of lightweight dumbbells, bring your hands above and in front of your head. Then bring them out and slightly in back of your shoulders.
   2. Biceps/triceps – Biceps – using a light pair of dumbbells, with your arms at your side and bent at 90-degree angle, palms up. Bring your hand up to your shoulder. 

                           i.      Triceps- holding the dumbbell by the bell. I have to show you.

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   1. Lunges – Standing, take a small step forward, bending your knee and keeping your back straight.

                           i.      Reverse lunge – Standing, take a small step backwards, bending the knee and keeping your back straight.

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   1. Walking, swimming (not butterfly)
2. What to do when you hurt yourself.
   1. Assessment

                           i.      Overuse vs. acute injury: Acute injuries are typically ones with sharp pain versus overuse or chronic ones, which are more of an aching pain.

                          ii.      Ligament vs. muscle injury

1.      Ligaments hold the bones together. Ligament injuries are sprains. They are typically worse than strains. If someone else moves your joint (you are not using your muscles to move the joint) and there is pain, it is most likely a sprain.

2.      Tendons hook the muscle to the bone and are a part of the muscle. Tendon or muscle injuries are strains.

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   1. RICE – rest, ice, compression, elevation
   2. Stretches
   3. Heat/ice alternating  – always end with ice. The first couple of days should be ice first. Five to ten minutes at a time. Make sure you don’t get frostbite! A frozen bag of peas works well, as does a wet dishtowel placed in the freezer for 15 minutes.
   4. Mineral ice/icy-hot etc. These products can be used to help relieve sore muscles. You must be careful not to think that because the muscles feel better temporarily that you can overuse them again. Do not use these products with a heating pad or if you are diabetic.
2. How to do things correctly: Take breaks, walk around and stretch!
   1. Lifting

                           i.      Face the thing you are picking up

                         ii.      Bend at the knees to pick things up.

                        iii.      Keep things close to your body, near your center of gravity.

                        iv.      When picking up larger toddlers, sit down and have them climb into your lap. Then stand up with them. Have them stay close to your body.

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   1. Bathing:

                           i.      For small babies, use your kitchen sink so you don’t have to lean over.

                         ii.      When you are bathing in the tub, get on your knees and brace yourself with your forearms on the side of the tub.