Solstice Physiotherapy

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CrossFit & Pregnancy

Kara Mortifoglio

Before becoming pregnant, I wondered if I could do CrossFit with a big belly. It would be a lot of pressure and honestly, really hard to do.  Then I became pregnant, took some CrossFit classes and found out that it was not as bad as I thought it would be. Why? Because CrossFit is totally modifiable and scalable.  Instead of running, I did the assault bike. Instead of box- jumps, I did step-ups.  I took it slow and it worked well. My CrossFit coach was great, providing effective modifications. And given the fact that I am a PT, and I am knowledgeable about exercise modifications as well.  

For women whose coaches are not knowledgeable, and who are not PT’s, participating in CrossFit when pregnant may be uncomfortable.  With this in mind, let me provide a guide to modifications. First, I will review the literature and what research exists. 

In 2015 the American College of Gynecology and Obstetrics (ACOG) issued a Committee Opinion on physical activity and exercise during pregnancy and postpartum period. It lists these as reasons not to engage in exercise:

 Contraindications: 

  • Hemodynamically significant heart disease

  • Restrictive lung disease

  • Incompetent cervix or cerclage

  • Multiple gestation at risk of premature labor

  • Persistent second or third trimester bleeding

  • Placenta previa after 26 weeks of gestation

  • Premature labor during current pregnancy

  • Ruptured membranes

  • Preeclampsia or pregnancy-induced hypertension

  • Severe anemia

Relative Contraindications (meaning, you might be able to exercise but you should ask your doctor, and monitor how you respond to exercise): 

  • Anemia

  • Unevaluated maternal cardiac arrhythmia

  • Chronic bronchitis

  • Poorly controlled type 1 diabetes

  • Extreme morbid obesity

  • Extreme underweight (BMI less than 12)

  • History of extremely sedentary lifestyle

  • Intrauterine growth restriction in current pregnancy

  • Poorly controlled hypertension

  • Orthopedic limitations

  • Poorly controlled seizure disorder

  • Poorly controlled hyperthyroidism

  • Heavy smoking

The opinion lists activities, recommended by the ACOG, to avoid during pregnancy:

  • Contact sports like ice hockey, boxing, soccer, and basketball

  • Activities with high risk of falling like downhill skiing, water skiing, surfing, off-road cycling, gymnastics and horseback riding

  • Scuba diving

  • Sky diving

  • Hot yoga or Pilates (I disagree with this)

Since heart rate changes rapidly during pregnancy, it is recommended to use the Borg Scale of Perceived Exertion (6-20). Pregnant women should register between 13-14.  One study noted that they found no negative effects to the fetus as the result of exercising. The study actually showed a lower rate of GDM (gestational diabetes), lower rate of preeclampsia, and improved recovery after delivery and post-partum.

Recommendations for lifting:

Many CrossFit exercises involve lifting. Many OB’s provide their patients with lifting guidelines from a paper published in 1984. I located a more recent study that summarizes all studies to-date regarding lifting. (Note: the study focus is in occupational settings.) This fantastic diagram provides very specific recommendations for lifting – it notes that if you are under 20 weeks gestation, your max lift is 36 pounds, after 20 weeks it is 26 pounds.  It makes me think about real life.  Let’s say you already have a child – a baby or toddler– that weighs more than 26 pounds. A young baby in a car seat. which weighs 10 pounds, – lifting them, you’d be surpassing the recommended lift-limit. The Royal College of  Physicians says that there’s minimal risk, finding that less than 1 per 100 pregnant women who do heavy lifting at work, have pre-term deliveries. 

In my research, I found a resource directly related to CrossFit and Pregnancy. It lists guidelines for each trimester and notes some common post-partum issues including: 

  • Joint laxity

  • Rectus diastasis

  • Urinary incontinence

  • Pelvic floor muscle injury

  • Pelvic organ prolapse 

One of their recommendations to deal with prolapse is to perform Kegels. As a pelvic floor PT, I disagree with this recommendation. Here are my personal, professional recommendations for CrossFit by trimester:

  • First Trimester (Weeks 0-12): You will probably be tired and nauseous, so if you get to class at all, it’s is a win! Do what you usually do, if anything feels weird then slow down. Handstand push-ups, might not feel good, so you could try handstands or cut them out altogether.  GHD sit ups might also feel uncomfortable, so try switching to regular sit-up or planks

  • Second Trimester (Weeks 13-27): Your abdomen will be getting bigger.  I recommend avoiding a lot of extensions so skip the GHD sit-ups.  Running might start to feel uncomfortable, so switch to the bike or rower (rower may pull on your stomach,).  AMRAP (as many reps as possible) workouts should be avoided, instead an EMOM (every minute on the minute) is preferable to allow for a rest period and not rush through exercise.  Overhead lifting should be reduced in frequency and weight.  Finally, pull ups will get more challenging, so switch to ring rows. 

  • Third Trimester (Weeks 27-40): It will start to be harder to breathe as you grow. Make sure you are able to speak while working out. This ensures that your heart rate is in the correct range. Box jumps should be modified to step ups, burpees can be performed on a box or elevated surface. Sit ups should be avoided, but planks are OK.  If something is uncomfortable, skip it or ask your coach for a modification. 

  • Fourth Trimester (Post-partum period, birth-3 months): High-impact activity should be avoided until week 12 post-partum. There is a lot of research that supports 12 weeks as the best time to start adding high-impact activities.  After delivery, it is important to slowly build back strength. Pilates/yoga type activities are great to start with. 

I strongly recommend that women, regardless of C-section or vaginal delivery, be fully evaluated by a physical therapist that specializes in women’s health. During the evaluation session, we will look at the pelvic floor muscles and vaginal canal to check for strength, scarring and function.  We will fully evaluate for prolapse, diastasis of the abdominals, as well as strength and functional movements.  Kegels alone may not “fix” the dysfunction that often occurs from childbirth. And depending on the symptoms the patient presents, Kegels may actually make the situation worse.

 

If you have any questions or want to come in for a session, please email us at info@solsticept.com or call us at 929 269 2505.  If preferable, we can do a telehealth session in lieu of coming in.