Problem 1: Low Back Pain is probably the most typical complaint of women during pregnancy (besides excessive weight gain that is).

Contributing Factors: Ligaments are more lax (loose) during pregnancy, which can contribute to instability and also increase the stress to the spine and its supporting muscles. An increase and re-distribution of body weight as well as the resultant change in center of gravity also create more stress to the lower back.

Low Back Solutions: Prevent low back pain with attentiveness to posture – stand erectly and engage your abdominal muscles to avoid excessive arching of your low back. Bend and lift with care and with attentiveness to form – bending from your hips and knees rather than your back. Sleep on your side and, consider positioning a pillow between your knees or try cuddling up to a body pillow, resting your top arm and leg forward. If you experience low back symptoms, ask your doctor about a lumbo-sacral belt to provide additional support and avoid activities that reproduce symptoms. Consult with a physical therapist if your pain is debilitating – there are treatments and exercises that can help!

After the big day: Even once the baby is born, take care to continue the good habits outlined above.

A few more helpful hints: When lifting the baby from the crib, first move him/her close to where you are standing to avoid lifting while reaching forward. To lift a toddler from the floor, bend into a squat and lift from your legs or, if you have pain, have your young child climb onto a sofa and lift him up from that higher position. Switch off from one hip to the other when carrying a baby for a longer period and opt for one of the great carriers on the market if you will be holding the baby for an extended time (or better yet, use a stroller). To rise from bed, when lying on your back, roll to your side and push from your hands to reach a sitting position to avoid rising using an old-fashioned sit-up motion. Most importantly, get back on track with your fitness program once you’ve received your OB’s OK.

Problem 2: Abdominal Diastasis. Not every pregnant woman winds up with this problem and it is essentially impossible to prevent.

Contributing Factor: The abdominal diastasis is essentially a separation of the right and left sides of the front abdominal muscle (rectus abdominus) from their central attachment (the linea alba). Most often noted in the third trimester, the separation is a result of weakened connective tissue (from hormonal changes) coupled with the uterus pushing against the abdominal wall. This separation can be felt as you do a partial crunch, lifting your head and shoulders while you palpate.

Solutions: There are no solutions during pregnancy except not to let the diastasis worry you. In most cases it will resolve after the baby is born.

After the big day: Brace your abdominal muscles with your hands, pushing both the right and left sides toward the center if you have to cough. This will keep the sides of the muscle from pulling apart while it contracts more violently. When resuming your exercise program, begin by strengthening the more interior abdominal muscles (transverse abdominus) before focusing on the weakened rectus abdominus, avoiding crunches at the outset. Consult a resource on pregnancy and exercise for specific instructions.

Problem 3: Fatigue. Most women experience fatigue, especially during the first trimester.

Easy solution, sleep! Enjoy it too because down the road, sleep may be harder to come by!

Contributing Factor: Your body is undergoing significant hormone adjustments.

Solution: Don’t fight it! And it may seem counterintuitive, but consider beginning a low-level exercise program; a good walk, may help you to sleep better. As long as you don’t push your limits, there’s no time like the present…

After the big day: Once the baby is born sleep may really be at a premium. Try to rest when the baby naps and listen to your body. You are also burning a lot of energy/calories, particularly if you are nursing. The weight will come off if you eat sensibly – avoid going overboard counting calories – be sure to eat a sufficient amount and eat healthy calories to address your own nutritional needs.

Problem 4: General Fitness Concerns. The general rule is that if you’ve already been doing it, you can continue to do it – that goes for weight training, running, sports and sex. However, there are a few notable exceptions and rules to follow:

• Avoid exercises on your back after the first trimester (continue to work your abdominals in safer/recommended ways rather than crunches or the like).
• Lighten up! Pregnancy is not a time to set personal bests. Go easier on yourself.
• Don’t worry too much about your heart rate, but monitor your perceived exertion (RPE). If you feel like an activity is too strenuous, it is. STOP! If you experience light-headedness or dizziness, discuss it with your physician.
• Work to strengthen your pelvic floor muscles (the famous Kegel exercises).
• Avoid sports and activities that challenge your balance after the fourth month because during pregnancy balance tends to be more of an issue. You don’t want to fall.
• Listen to your body – even if you are doing an activity you’ve been doing all along, if it begins to feel awkward or uncomfortable, stop.

Enjoy your pregnancy and all that will follow. The time, as they all say, will go by so fast.

First, my recommendations are offered as a general scientific based suggestion to succeed as one training design may work for one runner, but may be a huge mistake for another.  We are all different.  Runners come in all shapes and sizes and our body mass, aerobic capacity, muscle strength, frequency of training availability, surfaces we run on, cross-training background, and general nutrition are all variables that will enable us to run with a smile, or make us vulnerable to ‘break down’, resulting in injury.  Many problems can be prevented if identified early and adjustments made.  Your program may only need to be tweaked and alternatively, it may need to be tailored a great deal.

Let’s start with rest, a subject one doesn’t think about when considering running 26.2 miles.  Admit it, runners are an obsessive group and you have to be somewhat to do this.  No one wants to stop running, but sometimes this is needed.  Do you run everyday, every other day, do slow long runs on weekends?  The thing to keep in mind is that your runs need to be of a specific intensity (speed), frequency, and duration to promote a physiological change. 

You may have started slow (hopefully approximately four month ago for your first marathon), but too tentatively.  Eventually, but gradually, you are going to have to get out and do some more ’substantial’ runs to build you aerobic capacity and anaerobic threshold.  It doesn’t mean you have to run a marathon distance before as I’ve met many runners who trained at distances no greater than 16 miles before their first marathon. (I did however have the experience of meeting an experienced runner in the starting line medical tent of a marathon who had run a marathon the day before.  He was attempting to run a marathon in every state in one year.  Surprisingly, he was complaining of shinsplints and it’s not something I would recommend.) 

It is possible to run without completing a 22 mile run before, but you need to set realistic goals and give yourself time to make these changes.  Sometimes, these shorter training runs may be beneficial as your body type may not allow you to complete the run without risk.  Make the changes in training first and give your body time to adapt.  This includes rest periods when you’re tired, ill, or are suffering from injuries.  Physiological changes actually occur during the rest periods and you need to give your body ample rest to promote this. 

Questions to ask yourself may be, “Am I so exhausted towards the end of a run that I am compensating or losing form?”  Are you developing pain or experiencing pain that is beyond the common muscle fatigue you get with running? This is different than being ’stale’ or bored with the training, that can occur also.  You shouldn’t be doing only hills or interval runs and you may need to consult with a professional.  All marathons of notoriety offer links to groups or lectures way in advance that provide specific recommendations to help.  Some have groups that are charity based, but also train together, insuring consistency and will counsel you how to finish and enjoy the experience. 

Generally, you should be running about 40 miles per week about one month prior to the race.  You also need to taper this distance as you approach the last week.  Try running the last 10 miles of the course about two weeks before to familiarize you with it.  You can study the elevation on most websites to prepare for hills.  Along those lines, you can train on hills, but this should not be the only route you do.  Vary the pattern you run and avoid the pitch of a road.  Hard cement, the pitch of a road, and uneven surfaces can all lead to bio mechanical errors that may irritate structures in the legs.  Running just 1/2 mile on an irregular path can lead to tendinitis, strains, sprains, or poor form, leading up to stress reactions over time.  I will talk more in the future about specific problems you may encounter from dehydration to black toe-nails, Yucchh!   Have a good day and enjoy the nice weather.

 Types of Stretching

• Static (passive)
• Active Isolation (static)
• Active (dynamic)
• Contract – Relax (PNF)
• Strain – Counterstrain – Positional Release

 Static Stretching (Passive)
Static stretching is the most traditional way to stretch and remains a viable and popular option.  A muscle is put in a position of stretch over its entire length and held in its lengthened position (hence the name static) for a period of 30 seconds.  Research has demonstrated that the best results are achieved by repeating a static stretch four times.   Static stretches can be performed independently or with a partner.  There are a variety of positions in which muscles can be put on stretch, and some are more desirable than others.  For example, the hamstrings (in the back of the thigh) connect to the pelvis (at the ischial tuberosity – often referred to as the sit bone) and to the lower leg (just below both sides of the back of the knee).  The actions of the hamstring (when it contracts) are to extend the hip and flex (bend) the knee.  Therefore, to stretch the hamstring over its entire length, one must do the opposite – flex the hip and extend (straighten) the knee.  A good way to do this is to lie on your back and use your hands to draw your leg toward your chest, keeping the knee as straight as possible.  After you’ve taken up all the slack in the muscle and feel a stretch, hold the position for 30 seconds.  You will likely stretch a little further with each subsequent repetition.  

Not every passive stretch is a good one however.  Hamstring stretching positions that cause you to round your back as you lean forward go beyond the slack in the hamstring and stress the low back.  These are not advisable unless the forward bending comes exclusively from the hips and your back remains in a neutral position.  That also rules out hoisting your foot onto a very high surface and bending forward.  Try elevating your foot on a low stool instead (or sitting on the edge of a chair with your leg stretched in front of you) and bend forward from the hip with a straight back.  The result?  Less effort, better stretch, reduced potential for injury.

Studies have shown that a short-term effect of static stretching is the diminished force output of the stretched muscle.  This is one reason that some now eschew it as a warm-up prior to strenuous activity. 

Active Isolation Stretching – Static
Active Isolation stretching is exactly what its name implies – a muscle is stretched by actively contracting its opposing muscle.  Studies have demonstrated that the result of contracting one muscle (termed the agonist) is the relaxation of that muscle’s opposite, or antagonist.  Let’s use the hamstrings as an example once again.  Contracting your quadriceps (the muscle group in the front of the thigh whose action is to straighten your knee and assist in flexing your hip), will result in the relaxation of your hamstrings (in the back of your thigh).  Proponents of Active Isolation recommend holding the end position for only a few seconds.  Many athletes endorse this type of stretching and it has been shown to be very effective.

Active Stretching – Dynamic
Active Dynamic Stretching entails movements that put muscles on stretch.  Because they involve movement, these stretches are said to increase muscle temperature and prepare muscles for activity.  Dynamic stretches are also said to put joints through their full ranges of motion, though that is not likely because a joint can only be moved to its end range when the muscles crossing that joint are on slack (relaxed) rather than on stretch.   Examples of active/dynamic stretches include motions such as a lunge, which puts the hip flexors (in front of the hip/groin) on stretch, and the Inch Worm in which one creeps forward while maintaining a Downward Facing Dog yoga position (on the hands and feet with the butt high), which stretches the hamstrings.

If you like Active Dynamic Stretches I would not rely on them as the sole means of increasing your flexibility.  Because muscles are stretched in combination – for instance the calf along with the hamstring in the Inch Worm exercise – if one of those muscles is particularly tight, it will limit your ability to stretch the other.  Also, as with ballistic stretching, care must be taken to avoid setting off a stretch reflex due to the quick stretch that movement may elicit.

Contract – Relax (PNF)
PNF stands for Proprioceptive Neuromuscular Facilitation.  This is a broad classification that includes both strengthening and flexibility exercises.  PNF strengthening entails a variety of effective exercises that involve multiple muscle groups working in combination in functional cross-planar motions (working in diagonal patterns rather than strengthening individual muscles in isolation). 

PNF stretching is better known as Contract – Relax (C-R) and it has long been employed by physical therapists and athletic trainers to assist clients in developing increased flexibility.  Contract – Relax has both active and static components.  This type of stretching is based on research demonstrating that tension in a muscle is relaxed in the aftermath of contracting that same muscle.  This is quite different than the principle already described for active isolation stretching which shows that a muscle also relaxes with the contraction of its opposing muscle. 

C-R is most easily performed with a partner.  Using the hamstrings to illustrate once again: the hamstrings are held in a position of mild stretch (with the knee extended – straight – and the hip maintained in flexion) and are asked to contract gently.  This contraction is sub-maximal (only a mild force is exerted) and it is isometric (no movement is allowed).  This isometric hamstring contraction (to extend the hip) is held for several seconds, while the position of end range hip flexion with the knee straight is maintained with the aid of a partner.  Following the contraction there is a relax phase, during which the partner attempts to move the hip into greater flexion, thereby further stretching the hamstring.  The sequence is: contract (actively) – hold the contraction – relax/stretch (passively).  Several repetitions are performed with the ending position of each rep becoming the starting position of the next.  As a result, significant gains can be seen.

Strain – Counterstrain (Positional Release)
Another staple in physical therapy clinics, Strain – Counterstrain (S-CS) is a technique to release a muscle rather than stretch it, but the end result is more flexibility.  By passively maintaining a muscle in its fully contracted position for 90 seconds it has been shown that the muscle will relax, subsequently allowing it to stretch further.  Though often done with the assistance of a partner or health professional, Strain – Counterstrain positions can be maintained independently (as with holding the knees to the chest for the hip flexors) or with the help of pillows (as when releasing the hip abductors (outer thigh) in side-lying by elevating the upper thigh on pillows).  You may want to follow Strain – Counterstrain positioning with static stretching to capitalize on newly gained flexibility.

Conclusion
Just as we work to achieve balance in our lives, we also benefit from working toward a balance within our bodies.   Having normal flexibility is an important component of this balanced ideal and one that will help to prevent the stresses and strains that result in overuse injuries.