and neck off the bed/mat, while palpating the join between the rectus abdominis muscles (RA). A normal separation is 2-3 cm for 2-5 cm of the length of the muscle. The separation, if identified, should be measured, recorded and checked on subsequent visits. Walking, even post Caesarean, can also be commenced immediately. Swimming should wait until the post-natal bleeding has stopped (usually around 6 weeks) and if a Caesarean has been performed time for wound healing should be allowed. Comfort, fitness and strength levels should also be the deciding factor with running although it is essential to have good TA/PF control, good single leg balance and small knee bend ability to cope with its physical demands. An exercise programme can begin similarly to where the ante-natal program left off. The obvious change now however is that a client may feel comfortable exercising prone and supine again (commonly a lovely sensation!). Helping clients to get back in touch with good TA and PF is vital. Once TA control is good, if the RA separation is >2cm, oblique retraining can begin. RA retraining should begin only when the separation is <2cm.

Conclusion Exercise pre and post-pregnancy, if permitted, should be an integral part of a woman’s approach to a healthy lifestyle for her and her baby. The choices of what and when should take into consideration past history, personal skill and preference and the presence of pain or other complications. If you wish to take specialist pre and post-natal classes you will need to take a REPs recognised pre and post-natal course. Details of these can be found via the REPs training portal on the REPs website.

References 1. American College of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 267. (2002) American College of Obstetricians and Gynecologists. Obstet Gynaecol 2002; 99: 171—173 2, 10, 13 & 14. Royal College of Obstetrics and Gynaecology (RCOG 2006). Statement No. 4. January 2006 3. Borodulin KM, Evenson KR, Wen F, Herring AM, Benson AM (2008) Physical Activity Patterns during Pregnancy. Medicine & Science in Sports & Exercise, Official Journal of the American College of Sports Medicine. 2008; Nov; 40 (11):1901-1908 4. Duncombe D, Wertheim EH, Skouteris H, Paxton SJ, Kelly L (2009) Factors related to exercise over the course of pregnancy including women’s beliefs about the safety of exercised during pregnancy. Midwifery- Elsevier. 2009 5. Lumsden M.A, Hickey M. Royal College of Obstetricians and gynaecologists Complete Women’s Health. Thorsons. United Kingdom, London Hammersmith. 2000 6. Stables D, Rankin J.(Eds) (2005). Physiology in Childbearing: with anatomy & related biosciences (2nd ed). Edinburgh: Elsevier 7. Kristiansson P, Svardsudd K, Schoultz B (1996) Serum relaxin, symphyseal pain, and back pain during pregnancy. Journal of

Obstetrics and Gynaecology. 1996 Nov (5): 1342-7 8. Selby, A. Pilates for Pregnancy. Thorsons. United Kingdom, London, Hammersmith. 2002 9. Vleeming A, Snijders C, Stoeckart R, Mens J (1997) The role of the sacro-iliac joint in coupling between spine, pelvis, legs and arms, in Vleeming A, Mooney V, Dorman T, Snijders C, Stoekart R (eds) ‘Movement, stability and low back pain’ Churchill Livingstone, Edinburgh Chap 3:53-73 12. Horns PN, Ratcliffe LP, Leggett JC, Swanson MS (1996) Pregnancy Outcomes among active and sedentary primiparous women. Journal of Obstetric, Gynaecological and Neonatal nursing 25(1):49-54 11. Kardel KR (2004) Effects of intense training during and after pregnancy in top level Athletes. Scand J Med Sci Sports. 2005 Apr;15(2):79-86 15. Sports Medicine Australia. Women in Sport. Fact sheet No. 2 2002 Sports Medicine Australia. Exercise and well being after pregnancy. Fact sheet. 2005.

ANSWER THE FOLLOWING QUESTIONS ONLINE TO EARN CPD POINTS Please login to the members area of the REPs website to give your answers

Q1 Q2

Q3

What physiological change do the hormones relaxin and progesterone cause? Is it: a. Cartilage softening b. Smooth muscle relaxation c. Lumbar extension

What is the suggested heart rate percentage of age adjusted maximum that pregnant women should keep to? Is it: a. 40-50 per cent b. 50-60 per cent c. 60-70 per cent of their age adjusted maximum

What is the normal width to length ratio of a post-partum rectus diastisis? Is it: a. 1-2cm width to 2-5cm length b. 2-3cm width to 2-5cm length c. 3-4cm width to 2-5cm length

NB. Do not attempt to answer the questions in the interactive version of this magazine

THE AUTHOR

Rachele Quested is a physiotherapist who trained at the University of Queensland and has subsequently completed a Masters in sports physiotherapy. Rachele is also a

senior presenter for the Australian Physiotherapy & Pilates Institute (APPI), and regularly presents courses for the APPI throughout the UK. She has also trained with Body Control Pilates. For more details visit: www.ausphysio.com

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20 Arriba1_12.indd 1 14/7/10 08:12:04 Freephone 0800 612 6096 www.myarribaclub.com The The REPS Journal 2009;00(Month):00-00 REPs Journal 2010;18(September):18-20