Rib and Chest Pain During Pregnancy (Week 30)

A week ago I started getting pain in my chest whenever I laid down to sleep either on my side or my back. I ended up having to sleep in my recliner upright for a few days for the pain to go away. Thank goodness I had an airplane neck pillow and a extremely comfy chair to get me through that time. The pain in my chest started just a few minutes after laying down, and radiated from my sternum (chest bone) and through my rib muscles on each side of it. The pain would make breathing more difficult, and the only thing that I could do to alleviate the pain the next day would be to have my partner stretch my chest muscles a few times throughout the day.

Although I have had this pain before I was pregnant, it would be rare. I would wake up in the morning with a stiffness in my chest, but shortly after getting out of bed and moving around the pain would subside.

Topical Pain Relief Creams a "No-Go"
A visit to the pharmacy for some topical muscle relief cream proved fruitless. I'm not allowed to take any anti-inflammatories, whether orally or topically, while pregnant. Not good. Fearing the worst--that the pain would last for the remaining two months of my pregnancy--I did some research online to see what was going on: why was the pain so severe, and why was it so consistent? The results I found were unsatisfying.

Is it Heartburn?
If you Google "chest pain during pregnancy" or "sternum pain during pregnancy", the results overwhelmingly tell you that what you have is heartburn. That's' baloney, I say. Here's what the symptoms are for heartburn:

• A burning sensation in the chest
• A burning feeling in the throat
• Feeling of food "sticking" in the middle of the chest or throat
• Sour or bitter taste in the mouth
• Difficulty swallowing

I know what heartburn feels like. It has visited me sporadically throughout my pregnancy. It's not fun, but it's not the kind of pain I was feeling. So what is it, then?

No One Really Knows What Causes It

The sobering truth is, there's no clearcut explanation for why this happens to pregnant women. There is a condition, known as Costochondritis, which is an inflammation of the cartilage that connects a rib to the breastbone (sternum). It causes sharp pain where your ribs and breastbone join....Hmmm, okay, this sounds a lot more like what I've been going through. My sternum and the muscles on either side of it are sore to the touch. Having said this, I'm not into self-diagnosis, so I'm also not about to jump to the conclusion that this is what I have.

Pain in the ribs and sternum is not uncommon to pregnant women. As the baby grows, the uterus expands and can put pressure on your ribs. The Intercostal muscles, which are located between ribs, can become strained. Rib pain can make movements and even breathing painful. During pregnancy, it may be difficult to find a position which isn't painful, which seems to complicate the situation. 

Okay, so the question remains: what can I do about the pain?

How to Ease Rib and Chest Pain During Pregnancy

Pain Medication. Before taking any medication, confirm that it is okay to do so with your doctor. Tylenol is generally considered safe during pregnancy, and more severe rib pain may take a stronger pain medicine. Many different types of pain medication can be prescribed during pregnancy for rib pain, but your doctor will need to decide which medicine is best for your pregnancy. 

Open up the chest. Sit upright in a comfortable chair and place a small pillow in the small of your back creating an arch. This will take some of the pressure off your rib pain and make it easier to breathe again. You will know when you find the angle that works best for you, some pregnant women need more of an arch than others.

Stretch the chest. Follow this link to find instructions on how to do an assisted chest stretch. Being pregnant, it is easier if you are seated in a chair. Your partner will have to raise his or her knee to place it between your shoulder blades. This stretch was my lifesaver--it immediately reduced the pain to almost nothing, and by the end of the day I'd have no pain at all.

Use ice to reduce inflammation. Place a bag of ice or a chilled gel pack on your ribs where the most pain is. If you have rib pain on both sides, place ice over each. It is generally considered best to have a thin layer of cloth between ice and skin, so you may be most comfortable by placing your ice pack right over your clothing. 

Raise your arms above your head. While seated, either with the ice packs or without, raise your arms above your head. I have a high back recliner, and I can grab the back of the seat with my hands to prevent my arms from getting tired. It's a great way to take the pressure of my uterus off my lower ribs. Hold this position as long as is comfortable, and repeat as needed.

Work that Pelvic Floor (week 28)

Crunches don't really seem to be happening for me any more. I'm at the seven-month mark, and my belly is  big enough now that it gets in the way. I have a hard enough time getting off the couch once I sit down. I have quickly learned that either I sit down on the edge, or I sit in a firm chair.

On top of which, I've realized that my inability to lift the weights I used to lift before I was pregnant is a direct result of the loss of strength in my core. One of the principles I learned early on as a personal trainer was that a strong core helps you lift heavier weights, which in turn makes for stronger arms and legs.  In some cases it takes the scenario "you don't know what you got until you lose it" to make you realize how true that really is.

The loss of strength in my core is directly a result of the stretching of my rectus abdominus over my uterus. In its stretched-out state, it simply can't contract with the same strength it had before. So, how do you strengthen a core that just doesn't work the same way it used to? You need change your focus to the deeper muscles in your core and pelvis. And you can forget about looking for that familiar "burn" when you do an intense ab routine; instead, you need to visualize the muscles that are working and focus on contracting them to their maximum ability.

What to Work On

Pelvic Floor: This includes the group of muscles that support and help control the action of the vagina, the uterus, the bladder, the urethra, and the rectum. Contracting the pelvic floor muscles prevents the flow of urine when you are peeing, and causes the vagina to tighten. Giving birth puts a lot of stress on these muscles, and can weaken and damage them. This can result in stress incontinence (a.k.a. "mommy bladder") and decreased satisfaction during intercourse. Stress incontinence means that you might leak small amounts of urine while coughing, sneezing, laughing or exercising. 

Strong pelvic floor muscles can support the extra weight of pregnancy and help you push during the second stage of labour. When done regularly, these exercises can help to prevent stress incontinence and improve your healing time after birth. Another bonus of the exercises is that women with strengthened pelvic floor muscles are more likely to be orgasmic and have a more satisfying sex life.

Transverse abdominus: it's a muscle I've talked about in my earlier blog entitled How to Train Your Abs During Pregnancy. For those of you who don't know, your transverse abdominus is a muscle that runs underneath the more visible rectus abdominus (the muscle that shows when people have 6-pack abs), and acts as your stomach girdle.

How to Work on Your Pelvic Floor
I'm sure you've heard of the term "kegels", but you may not be aware of how to do them. First of all, they're the easiest exercise to do because you can do them pretty much any time, anywhere. You can be lying down, sitting in the car driving, or standing in line at the bank.

Finding them: First of all, you need to figure out how to contract your pelvic floor muscles. The easiest way to do this is to try and stop the flow of urine while you're peeing. If you succeed, you've got the basic move.

Perfecting your technique: Once you've identified your pelvic floor muscles, empty your bladder and sit or lie down. Contract your pelvic floor muscles, hold the contraction for five seconds, then relax for five seconds. Try it four or five times in a row. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

Repeat 3 times a day: Aim for 3 sets of 10 per day.

How to Work Your Core
Pelvic Tilts: They can be done lying on the floor or standing with the back to a wall. The standing version is a bit more difficult, but it is a good option for women who are not comfortable on their backs.


1. Lie on your back with the knees bent and the soles of the feet on the floor (or you can stand with your back against a wall). This is your neutral position, with the natural curve of the lumbar spine causing the low back to be slightly elevated.

2. On an exhale, gently squeeze your glutes (butt muscles) and pull your hip bone towards your lower ribs. Your butt will not actually leave the floor, but you will feel your low back press into the floor (or wall).  You are essentially taking the curve out of the low back.

3. After a few seconds, inhale and return to your neutral position.

4. Repeat this movement 5 to 10 times.

Click here for an animated version of this exercise.


Tail Wagging

Starting Position: Kneel on a mat and assume the "all-four's" position. Keep your head in a neutral position by looking down at the floor.

Action: Keeping your shoulders still, move your right hip toward your right shoulder as far as you can. Slowly return to the starting position then move your left hip toward your left shoulder as far as you can

Bird Dog
There's no sense in re-inventing the wheel. Here's a great link on how to do the bird dog exercise.

Mental Health and Pregnancy (Week 26)

I've been feeling great during these past few weeks of my pregnancy. My belly is ever expanding, and I've gained a total of 20lbs so far. Even though my thighs slightly rub together now when I walk (gack!), the doctor says I'm right where I need to be in terms of weight gain.

My baby is healthy and active (he kicked my Obstetrician's Doppler microphone 3 times during my last visit), which I guess isn't a surprise given how active mommy tries to be. I've been keeping active with a combination of swimming twice a week, walking twice a week, and doing various 20-minute exercise videos to work on muscle maintenance.

My mood has also been pretty good. Although I alternate days between feeling tired and energetic, overall my spirits are pretty high. I'm very glad for that. Not everyone is so lucky. It is just as easy to feel depressed and anxious as it is to feel happy and joyous when you're pregnant. I am ever aware of the possibility that I may get depressive symptoms during and/or after my pregnancy.

The Link Between Mental and Physical Health
Mental health has always been a prevalent issue in my life for two reasons: a) depression and anxiety runs in my family, and b) I have a BA in Psychology, which increases my awareness and sensitivity to the topic. One of the reasons I maintain such an active lifestyle is because I'm convinced it is one of the reasons I am in such a good mood to begin with. When I don't exercise for a while, I get lethargic and generally feel "blah".

There is a large body of research on the link between mental health and exercise. Put simply, when depressed and anxious people exercise over a set period of time, many feel better. Furthermore, if they maintain an active lifestyle, they are less likely to relapse.

Other research has shown that women who exercise during pregnancy are less likely to develop Postpartum Depression. This is great news, particularly for those mothers who want to avoid taking anti-depressants during and after pregnancy.

My quick and dirty advice to those of you who are not pregnant but one day plan to be: start exercising before you become pregnant, and maintain an active lifestyle throughout your pregnancy. If you are pregnant now, it's never too late to start exercising and begin reaping the rewards.

How to Recognize Symptoms of Depression
Depression can spring up on any one of us at any point in our lives. It can be particularly distressing when you have a baby, and you feel that you should be feeling happy and motivated to take care of this new life, but you feel the opposite instead. An estimated 14 to 23 percent of moms-to-be experience clinical depression, and about 40 percent have some symptoms. That's a lot of sad pregnant women.

Symptoms of depression include: feeling sad for several weeks; loss of interest in activities you normally enjoy; feelings of guilt or hopelessness; and/or difficulty concentrating. If you recognize any of these symptoms in yourself, talk to your doctor or midwife.

How to Recognize Symptoms of Anxiety
Pregnancy is listed as a significant stressful life event. t is normal to be somewhat preoccupied with "doing all the right things" to ensure your unborn child has the best chance for a normal development. However, for some women this preoccupation can get blown out of proportion to the point that it affects how they live their lives.

Earlier this year, one of my clients was on her fourth pregnancy, and was well-aware that her anxiety levels increased during pregnancy. During our exercise sessions, she would get nervous about how high her heart rate felt to her when she did anything aerobic. Even though her doctor told her she was fine, and we used a heart rate monitor to make sure her heart rate wasn't elevated to a dangerous level, it was hard for her to not feel a sense of panic over it. The biggest thing that helped her control her anxiety was simply her awareness of what it was caused by, and that her feelings were not rational.

If you are suffering from anxiety that is persistent, intrusive or out-of-proportion; irritability; inability to sleep because of your fears; waking up with a racing heart; or have difficulty concentrating, talk to your doctor or midwife.

Pre-Natal Fitness Exercise Videos...Cheap and Cheerful Fitness! (Week 24)

I just hit my sixth month this week, and I have to say, I really have no complaints. Since my tummy now protrudes further than my chest, my hip pain is still gone, I'm sleeping well (apparently, not for long), and my energy is moderate to high (thanks to the iron supplements), I'm feeling pretty darn good. I am still training clients, walking, hiking, swimming, and now have added prenatal workout videos to my repertoire. I've also done a bit more reading on how to work on concerns about diastasis rectii (see my Sept 7th, 2010 entry on how to train your abs for pregnancy).

Why Exercise Videos Instead of the Gym?
As a personal trainer, it makes a lot of sense that I should visit the gym and train using a prenatal fitness program. So why am I not going? It's simply the psychology of it: when I go to the gym, I go there to work hard. It's what I've been doing for years. The problem is, I shouldn't be working hard now. It has taken me months to come to terms with the changes my body has undergone, and that I can't train the way I used to. Looking back, I'm pretty sure that the hip pain I had a month ago was because I pushed my body a bit too hard.

By following exercise videos, I am relinquishing control over the intensity and duration of my workouts to someone else. Frankly, it's a nice feeling. Heck, if that woman on the screen says I only need to do 15 reps of squats with no weights, then I will!

Exercise videos for pregnancy also introduced new exercises to me, and made my workouts more interesting. When you exercise for any length of time, it's important to keep things interesting so that you keep doing them.

Training Abs to Reduce Diastasis
When you are further along in your pregnancy, it becomes a good idea to use a device to support your abs while you do crunches. Whether it be a belly band, a tummy splint, or a towel, a device that wraps around your tummy while you perform a crunch will decrease the lateral force on your rectus abdominus. The least expensive tool is the towel. (see picture)

Although the woman above is clearly not pregnant, this is how you would use it to do crunches. You can increase the intensity of the crunch by lying on a stability ball. Whenever you do a crunch, make sure to pull in your belly button to engage your transverse abdominus. This will also reduce the lateral force on your tummy.

Great Pregnancy Exercise: Swimming (Week 21)

I am pleased to say I am feeling less breathless and dizzy since my post last week. For one, I doubled my iron dosage, which has helped elevate my daily energy as well as my capacity to climb stairs. I also have started to take it easier in general: I walk, climb stairs, and do everything a bit more slowly than I used to. But what I'm most pleased about is that I've gotten back into the pool and have started a swimming regimen again. This is after  finding a new bathing suit that fit me.

How I Found a Swimsuit in the Fall
Given that it is the fall season and swimsuits in general are harder to come by, I found it difficult to find a maternity store that sold bathing suits. There is a specialty bra and swimsuit shop in Toronto called Melmira that not only offers a great selection of maternity bras, but also maternity swimsuits. Although I did go there to buy two maternity bras a few months ago, they cost me $250. Given the high prices of their bras, I assumed their swimsuits would likewise be expensive.

So instead I paid a visit to Bikini Village, who doesn't sell maternity swimsuits at all. I asked the clerk if there was any way I could find a regular suit that would fit my new body, and she said "of course!". I tried on two swimsuits before deciding on a simple Roots one-piece that was a few sizes larger than what I normally wear. Easy peasy!

Why I Love Swimming Right Now
Although walking is also great exercise when you're pregnant, when I walk for an extended period of time, I tend to feel pressure from the weight of the baby  in my lower abdomen, which is a bit uncomfortable. When I swim, I feel completely comfortable moving around in the water. In fact, it's a easier to move slowly while I'm swimming because I'm so buoyant now!

The Benefits of Swimming During Pregnancy
Swimming is great exercise because it uses both large muscle groups (arms and legs). It is both low-impact (reducing the risk of injury) and it is a great aerobic workout. In general aerobic exercise

• improves circulation
• increases muscle tone and strength
• allows you to sleep better at night
• improves your energy
• helps you cool down from the emotionality caused by pregnancy hormones

Swimming Tips

• If you are new to exercise, check with your doctor or midwife before starting any exercise 
• Drink plenty of water to stay hydrated (swimming in a pool of water doesn't count!)
• If you're in your first trimester
• Try to swim for at least 30 minutes daily (if you have the energy). 
• Swimming first thing in the morning may counteract nausea and energize you for the rest of the day
• If you're in your second trimester
• You don't have to change anything that you were doing in your first trimester--except you might need a new swimsuit
• If you're in your third trimester
• The breast stroke is particularly beneficial in the third trimester, because it lengthens the chest muscles and shortens the back muscles, two areas that typically become misaligned as your body changes during pregnancy

Breathless and Dizzy...and Not in a Good Way (Week 21)

Being a (self-acclaimed) superfit mom, I went into this pregnancy pretty confident that I would be able to maintain a level of fitness that I could be proud of. Of course, life has a funny way of cutting me down to size once-in-a-while--even though I'm short enough as it is.

My Near-Faint Experience

Late last week I experienced something I had never felt before. I was walking with a client around their neighbourhood for our weekly one-hour walk, at our usual moderate pace, when I started to feel out of breath. At first I thought it was funny because a walk like that never used to make me feel like I had just done a 30-second sprint. "Ah, the joys of pregnancy," I thought. Soon enough, it became apparent that my heavy breathing was not subsiding, and I was starting to feel dizzy. I began to feel faint. To my minor embarrassment, I quickly reached a point where if I didn't sit down, I was going to collapse. My poor client, who had no idea what was going on with me, was understandably concerned. I was having a hard time breathing, and my heartbeat was pounding in my ears. Without having much choice, I sat down on the curb to try and recover. It took all of 30 seconds to feel normal again. Without skipping a beat, I got back up and we completed our walk. I had no idea what to make of what had happened, and what was worse was that I couldn't explain it to my client. 

The very next day, I walked home from the cinema with my partner--it's all of a 10 minute walk. We reached our building and headed up the four flights of stairs to our apartment. By the time I had reached the hallway, a huge wave of dizziness came over me. I was breathless yet again, and my heart was going a hundred miles a minute. I needed my partner to help me through the apartment door. I was starting to see stars, and I realized I was close to passing out. After collapsing on the couch, I panted for another 30 seconds, during which time my breathing and heart rate quickly subsided. It was at this point I decided that I should figure out what the heck was going on with me. Thankfully I could easily find out what the problem was--and that it was nothing serious. 

Pregnancy and Breathlessness

In pregnancy, your ribcage widens to allow for an increase in lung capacity. This works to offset the problem that the growing uterus plays in constricting your breathing. As your uterus expands, it pushes up into your diaphragm, making it harder to pull in your usual-sized breaths of air. Moreover, with all those pregnancy hormones that cause your muscles and ligaments to relax, your diaphragm is on a mini vacation, not working as hard to pull air into your lungs. 

To make things worse, the increasing progesterone in your body makes you more sensitive to the carbon dioxide your muscles produce as a waste product when you move. The resulting breathlessness is caused by your body trying to get rid of the carbon dioxide and replace it with oxygen as quickly as it can.  

Breathlessness can also be caused by low blood iron levels, which I am prone to.

Pregnancy and Dizziness

By now, if you've been following my blogs, you've learned that there's a lot of hormone-induced relaxing going on in the body. One of the other parts of the body that are relaxing as your pregnancy progresses are your blood vessels. They are widening to help increase blood flow to your baby. This causes your blood pressure to be lower than usual, which can reduce the blood flow to your brain, temporarily causing dizziness.

Dizziness is also caused by low blood sugar levels that may occur as your body adapts to changes in your metabolism. Women who are anemic or who have varicose veins may be more susceptible to dizziness than others (not only do I have low blood iron levels, I also have varicose veins, which explains the severity of my symptoms).

When you Need to Worry About Breathlessness and Dizziness 

There are not always benign explanations for why you may feel breathless and dizzy during pregnancy. You should contact your health care provider immediately if your dizziness is accompanied by vaginal bleeding and/or pain in your abdomen. This could be a sign of an ectopic pregnancy, a low-lying placenta, or placental abruption.

You should also contact your health care provider immediately if you have persistent dizziness or dizziness accompanied by blurred vision, headaches, or palpitations; this may be a symptom of severe anemia or some other illness that could have a negative effect on your pregnancy.

If you are feeling breathless and you get the feeling that your heart beat is racing, irregular or missing a beat, or if you feel chest pain--especially if it starts when you exert yourself--or if you have difficulty breathing when you're lying down or at night, see your doctor.

Pain in the Hip! (Week 20)

So, remember that article I wrote not-too-long ago about how the back and pelvis slowly may go out of whack as your pregnancy progresses? Well, it couldn't have been more aptly timed. For the past few weeks I have been experiencing pain in my lower back and hip. It first started pretty mildly, and would only hurt if I moved a certain way, like turning or bending over. It was a sharp stabbing pain that would go away whenever I stopped the particular movement I was doing.

As the weeks progressed, I maintained my toned-down exercise regimen that I've implemented since getting into my second trimester. However, the pain became more frequent and more movements became difficult to do. My clients would notice me limping about and would offer to help me do the normal tasks I would do while training them. Hmmm, not cool. It's one thing thing to endure some discomfort, it's another to let it affect my job. On top of which, it became increasingly difficult to exercise.

Katrina Kulhay to the Rescue
Fortunately, one of my clients referred me to a Toronto Chiropractor that specializes in pregnancy, Katrina Kulhay. I met her for the first time today. She is a positive, energetic woman who sincerely got excited over the news that I was pregnant, and began spouting words of advice on nutrition and exercise. Aside from telling me a lot of what I already know, she also told me to tone down the impact of the exercise I've been doing (which is something an active person hates to hear). This is because as my pregnancy progresses, the levels of relaxin (the joint-loosening hormone) will increase to a point where too much impact could cause my joints to slip around "like a banana". Eeesh.

When it came to the treatment, she obviously knew what she was doing. She was quick, efficient, and actually took the time to explain what she was doing to me as she was doing it. Since that single treatment this morning, I have progressively felt better throughout the day. In fact, as I write this, I am fully mobile again and almost completely pain-free.

Changing my Exercise Routine
Dr. Kulhay advised me to perform special exercises to help strengthen my pelvic floor. This will prevent future pain, as well as make it easier to push out my baby during delivery. These exercises included kegels, supine pelvic tilts, and assisted squats.

Assisted squats can be done with two chairs on either side of you. Holding the back of each chair in each hand, slowly lower yourself down into a squat position. Return to standing. While you complete the movement, use your hands to help slow you down as you lower your body, and help push you up as you raise your body.

Kegels and supine pelvic tilts can be done every day. Do 3 sets of 15-20 reps. For squats, do 3 sets of 15-20 reps every other day.

As far as working my abs and upper body, she said I could continue as I had been before. If you are suffering from lower back pain and discomfort like I am, I would recommend performing upper body exercises that are seated or lying down, so as to not stress your back.