A gestational diabetes workout plan!

A client told me tonight that she has been newly diagnosed with gestational diabetes. NOOOOOOOOO!!!

She has been attending my class for the last few months, although because of her busy schedule hasn’t been coming every week.  So, for her, and for all the women of the world who have been diagnosed with gestational diabetes, I’ve developed a great workout plan that you can do at home, to help you control your diabetes and hopefully avoid this….

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19 pound baby at birth!

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Hammer time – don’t touch it!

Hammer toes… what the?

Here is a medical drawing of hammer toes…

Have you really looked at your feet, I mean, really looked at them.  What are your toes doing?  This is a scary endevor, but one we must all embark upon if we are to venture through life pain free…

So, drum roll please…. Here is a picture of my feet (well, my left foot)

and I wonder why I’m having foot pain??!! The bottom of my feet (my metatarsals) are really sore, and my toes number 2 and 3 are numb, and have been for more than a year.

The saddest part of these hammer toes is that I only just realized that I have hammer toes (among other issues with my feet), and they have been sore for over 2 years now!

You will also notice the scratch on my big toe. That is a love scratch from my new kitten, Mittens, ahhh, she is so cute!  Anyway…

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Insulin resistance, pregnancy, and gestational diabetes – a short explanation

This blog post explains the role of insulin and glucose in our bodies.

But what about pregnancy and insulin?  Something pretty amazing happens when you become pregnant (besides the facts that you are growing eye balls, and finger nails, oh and that a heart starts beating inside you that isn’t your own… besides those small details).

In a normal pregnancy, insulin resistance increases at the level of the muscle (1, 2).

Don’t you think that is amazing??  Ok… let me describe why that is so cool.

by J I N N e e Răng Thỏ :x on flickr
mmmmm, sugar!

Pregnancy is so special, that even your muscle cells know that your baby is the priority now, and sacrifices glucose for the baby! Having an increase in insulin resistance means it is harder for insulin to bring glucose into muscles when you are pregnant. In other words, not as much glucose is hopping out of your arteries and into your muscles.   This is what you and your baby want, as more glucose in your blood goes directly to your placenta, as a yummy food for your baby.  Your baby needs glucose to grow properly. Continue reading

The physiology of insulin – a little pictorial explanation. It’s funny!

Have you ever wondered, really wondered, why there is so much fuss about insulin in pregnancy?  I mean, why is it so important, and what does it do anyway?

Here is my little pictorial explanation of insulin and its pathway with muscles.

But first, what is insulin?  In Angie’s words (that’s me), insulin is the substance that takes sugar out of your blood and allows it to enter your muscles (and other places, like fat). But don’t take my word for it, click here for more explanation about that.

Imagine insulin is like the cool guy, cruising along streets (arteries),

Insulin = cool guy

by matt512 on flickr
Cool Guy

Um, no, not so cool, let’s try that again…

Insulin = cool guy

by Iomo54 on flickr
Cool guy take 2

that’s a bit better… Continue reading

Perineal Massage: There’s the rub!

by Ko:(char *)hook on flikr

Top gift for expectant mothers??!! I know, I know… you think it is a massage or a spa day, but you are WRONG! How about this… a perineum massage handout with perineal oil to boot.  Oooh, oooh, sign me up!

What exactly is a perineum, anyway, and why should you be massaging it when you are pregnant?

The perineum is the skin, muscle and tissues that lie between your vagina and your anus.  It is the place where doctors cut you if you are going to have an episiotomy, and it is also the most likely place a woman tears if she gives birth vaginally without an episiotomy.  And yes, you want to tear, rather than be cut, but more on that later.  But yes, you want to be intact, rather than tear, and that is where perineal massage comes in.

A Cochrane review, which is “internationally recognised as the highest standard in evidence-based health care” investigated “the effect of antenatal perineal massage on the incidence of perineal trauma at birth and subsequent morbidity.”  Whoa.  Say what?  Basically, they wanted to know if massaging your va-gi-gi when you were pregnant helped with tearing, episiotomies and pain after birth.  And what did they conclude, these gurus?

Antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain, and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.


Did you hear my cue?  Provide with information!  Hey, I’ve got the information… let’s talk about it, and better yet, my mission is to ensure every pregnant woman is massaging at 36 weeks pregnant onwards… let’s get down to business! Continue reading

Preeclampsia, exercise and pregnancy: A systematic review

by comedy_nose on flikr

Preeclampsia is a fancy way of saying high-blood pressure in pregnancy.  But what is all the fuss about?  Why do providers check your blood pressure at every prenatal visit (and if they are not, they should be!) and what is happening if you do have preeclampsia?  Basically, preeclampsia is the leading cause of maternal morbidity and death, especially in developing countries (1), which kind of sucks, because when you are having a baby, you want to be around to see the baby.  So, pretty important topic, right?

Well, some researchey dudes in Brazil (1) decided they wanted to know once and for all if exercise can help reduce the risk of preeclampsia in pregnancy.  So, they got their little fingers typing into all sorts of databases, and started searching all the pregnancy and exercise literature in all the world… that is to say, they did a systematic review.  They found 231 articles, 217 which were excluded because the articles didn’t address the topic they were interested in, so world wide, they had 17 research papers to examine. Continue reading

A closer look: Glucose tolerance at 24-28 weeks pregnant is improved in women who exercise

Everybody knows that gestational diabetes is not a good thing to have when you are pregnant.  It isn’t good for mama, it isn’t good for baby.  Basically, it means BOO for everyone. (And if you want to learn more about the pathways of insulin, which is responsible for the glucose in the blood in gestational diabetes, through a funny pictorial I created, click here)

By Joint Base Lewis McChord on flickr

Let’s take a closer look at a trial that was published last year. Then maybe after you know the facts, pregnant ladies who are exercising may look a little more excited than the women exercising in this photo, because you will know how awesome it is for you and your baby… but HEY, at least they are doing it!


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Running in early pregnancy

I heard a fabulous pod cast by Another Mother Runner (awesome website and community… whoop, whoop to Sarah and Dimity), called Lady Doc.  The obstetrician speaking stated that at about 28-29 weeks many runners stop running due to the relaxin levels and the growing baby.

I just wanted to clarify one little point for all the newly pregnant mamas out there, trying to run…the thing is… before you even obtain “large and in charge” status with a huge mama tummy…before your jeans are even getting a little tighter on you… before ANY of that happens, in fact, more or less at conception, your hormones go CRAZY! (and that IS official medical language!)  Most importantly for running, relaxin is SURGING.

Relaxin in pregnancy peaks at around 12 weeks. This hormone is responsible for making all your ligaments nice and loose, so your baby can move through your pelvis during labor. 12 weeks is before the baby even starts to move out of your pelvic region, so before you start showing.  Due to these high relaxin levels, you may actually feel uncomfortable running, despite not even physically being able to see that you are pregnant.

You need to listen to your body, it is that simple.

NYC running mama

Here is a BAMR (bad ass mother runner, and I mean, really bad ass, with a marathon personal best of 3 hours and 20 some minutes. Hello?!) blogger, NYC running mama, (pictured).  She blogged her whole pregnancy running experience, which is awesome because now we can all learn from it!  Check out this quote regarding her experience at about 8 weeks pregnant (and this is someone who was running 6x/week, up to 50 miles a week):

But by week 8, I started to feel extremely tired, out of breath, and achy when I was running.  I constantly felt like I needed to stop and walk – so despite not wanting to, this is what I did.  I began doing a run/walk interval (running 1-2 miles, then walking 1/2 mile). I’ve never been a walker so I was surprised to find I actually enjoyed it! However, I was extremely discouraged – I really missed being able to run for more than 10-15 at a time and was worried that my plans to run throughout pregnancy were lost.

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Running and pregnancy – a physical therapist’s point of view

by simply bike on flickr

Should you, or shouldn’t you, run in pregnancy?

(For another blog entry on running in early pregnancy, go here)

You are probably already doing what you should be doing.  Researchers have found that often pregnant women will modify their goals and decrease training on their own, by listening to their bodies (1)


Bottom line… if you have been running before you were pregnant, and your body feels good when you run, absolutely, keep running!  Whoop, whoop!  It is, however, not the time to increase your intensity, whether by increasing your speed or increasing your distance.  The key to running in pregnancy is to listen to your body.  And if you feel fine when you are running, but a day or two later you have an increase in pain ANYWHERE, but especially in your pelvic region, then this is called latent pain and is probably caused by your running.  This pain, (to me, as a physical therapist), would be a reason to stop running and start looking for the huge range of alternative sporting options available to you.

Amber Miller after running a marathon!

What about the marathon?  Many of you may have seen this video of Amber Miller, the woman who ran a marathon at 38 weeks pregnant and then delivered her baby.  If you are mid marathon training, and discover you are pregnant, my advice would be to not continue with the marathon training.  Stay at the longest distance you have run, and don’t go any longer than that.  If you are already at 15 miles in your long runs, maybe switch the marathon plan to a half marathon.

What about… drip, drip… my leaking? There is always the question of running and leaking.  If you notice that there is leaking while you are running and pregnant, then I would also advise you to switch to a lower impact sport, or run shorter distances.  Your pelvic floor is under a great deal more stress with pregnancy, and adding the impact of running may exacerbate your pelvic floor weakness.

For an interesting, although not entirely accurate, discussion on running and pregnancy, go to this podcast series, and go to number 19, Lady Doc, from my favorite running bloggers  Sarah and Dimity


1) Beilock SL, Feltz DL, Pivarnik JM.  Training patterns of athletes during pregnancy and postpartum.  Research Quarterly for Exercise and Sport. Mar 2001; 72(1):39-46.