The second trimester of pregnancy may contain a lot of variables from client to client but in general you will want to continue to focus on increasing her overall strength with a large emphasis on building upon her deep core connection; all while encouraging good posture and creating workouts that empower her. This article builds upon the guidelines for trimester one (detailed in First Trimester Pregnancy Guidelines); which I recommend reading regardless of the trimester your prenatal client is experiencing.

Learning Objectives:

1. Learn tips for helping to prevent or minimize diastasis recti.
2. Understand what to expect for a prenatal client in her second trimester and review exercise modifications.
3. Discover recommended exercises that should (and should not) be included in a prenatal client's exercise program during her second trimester.

1st Trimester: Week 1 through Week 12

2nd Trimester: Week 13 through Week 26

3rd Trimester: Week 27 through Week 40

2nd Trimester Focus Points

Yes, she can start exercising in her 2nd trimester.

Many pregnant women may not feel like exercising during the first trimester or may have had reasoning from their physician to avoid or limit first trimester activity. Once she is in her second trimester of pregnancy and her physician has given her the okay to begin or resume physical activity it’s safe and good for her to get started on a regular prenatal workout routine. After educating yourself on the proper exercise guidelines and modifications that are best for your client, gradually progress and modify her exercises as you see fit for her current level of fitness - and review common questions and guidelines you should follow each session.

Create workouts for her that include both resistance and aerobic exercises which could greatly decrease her risk for pregnancy health concerns. Even if she is just starting an exercise program in her second trimester the benefits can be tremendous. A study by R. Ramirez-Velez (2013), that looked at the effect of exercise during the second half of pregnancy and it’s effects on the placenta, found a positive correlation between exercise and improved “fetal oxygenation and in turn potentially reduced risk of gestational disorders associated with impaired endothelial function.”

The “Golden Trimester”

For some expecting women the second trimester is their “golden trimester,” the trimester when she feels her best and has more energy. That may not be the case for many, and for those women, encouraging her to move her body regularly may be the last thing she wants to do, but what could actually help her feel better. If your pregnant client is experiencing that “golden trimester” and she feels like increasing her workouts slightly from her first trimester, it can be okay to do so. Most important is to continue using the “talk test” to be sure she isn’t overdoing her cardiovascular activity, to confirm that her form is still spot on if you increase any weights, and encourage her to “listen to her body.”

Minimizing Back Pain

Back pain, specifically low back, for many pregnant women is all to common, but it doesn’t have to be or at least you can help her minimize pain and prevent it from getting worse as her pregnancy progresses. In a newer study by Yan et al., (2014), found that “stability ball exercises during pregnancy may reduce pregnancy low back pain and boost daily life functions.” I couldn’t agree more! Encouraging her to move daily, even at home by giving her one or two simple exercises she can do on her own can make a vast difference in how she feels. Plus, teach her how to activate her deep core muscles, which help give her low back support. “Forward Rolls” (demonstrated below), are a wonderful at-home exercise that can help your clients prevent or manage any back pain - even those with scoliosis.

Encourage Good Posture

Encouraging good posture and proper lifting go hand-in-hand with preventing and minimizing back pain, especially if she already has another young child or two at home that she is carrying along with her growing baby bump.

Tips for Encouraging Good Posture:

• Ask her how she spends her days sitting, standing, slouched over. Then encourage her to change positions often, get up from sitting and do a couple squats or walk around.
• Remind her to lightly activate her deep core throughout the day, to stand tall (lifting through the top of her head) and avoid locking her knees. 
• Remind her to properly pick things up off the ground and avoid lifting with her back. Lunges and squats are good exercises for teaching her proper techniques for picking up her children (see the video below for a brief demonstration proper lifting technique with lunges).

Diastasis Recti

Diastasis recti is the separation of the rectus abdominals. There are many factors that can contribute to diastasis recti in pregnant clients, such as genetics, having twins/triplets/etc., multiple pregnancies, and exercise. In my professional opinion, having trained many pregnant and new moms, there is a lot of prevention and minimizing of abdominal separation you can do for your clients.

The second trimester is when her belly begins to expand; although this varies depending on her body and whether this is a first pregnancy vs. a third pregnancy. With each pregnancy she is going to have more stress on her abdominals because her uterus expands sooner with each pregnancy. If she had any separation with a previous pregnancy she will likely experience separation again. These suggestions can help you to minimize further separation during her pregnancy and decrease the separation in her postpartum phase. In the postpartum article I will discuss more about repairing diastasis.

Tips for Preventing/Minimizing Diastasis Recti during Pregnancy:

• Avoid supine forward flexion (any crunch-type exercises) in her second trimester or sooner if any “coning” of her belly is noticed. This holds true for any exercise that creates any “coning” effect of her belly. The pregnant belly should be smooth and round in the center; “coning” is when you see a slight “bulging” in the middle of the belly, as this indicates there is some separation or at least widening and thinning of the linea alba.
• Focus on strengthening her deep core muscles, along with good posture for each exercise.
• If she mentions her belly feels "really tight" (most common with first pregnancies) have her practice relaxing her belly with some deep breathing or Cat Cows to allow the abdominal muscles and skin to stretch.
• When she's getting up from bed or in a position where she's on her back, teach her to roll to her side before getting up. This can greatly decrease the intra-abdominal pressure. 

To Plank or Not to Plank?

It’s a two-part answer and you must be able to answer “yes” to both. This is also a good general guideline if you aren’t sure of any other exercise for your prenatal clients. If you answer “no” to either, then see the general guideline for planking modifications.

1. Can she connect her deep core well enough to avoid that “coning” effect of her belly? If yes, then she can safely continue performing planks during her second trimester as long as that holds true each session.
2. Was she performing full planks during her first trimester with proper form? If yes, then she can continue as long as each session you can still answer “yes” to question #1.

General guidelines for planking progressions, from more challenging to safer options:

1. Full Planks – toes on mat
2. Modified Planks – knees on mat
3. Modified Side Planks – see trimester one exercises
4. Side Reaches – see exercise demos below
5. Exercises on all 4’s – such as Cat Cows (more on that to come in the trimester three article)

Can She Lay on Her Back?

ACOG (American College of Obstetrics and Gynecology) recommends avoiding supine position after the first trimester of pregnancy. This I find to be true for only a small amount of pregnant women. That said, you absolutely should minimize her time in the supine position - typically 5 minutes is a safe limitation. The main exercise I recommend with her in the supine position are hip rolls as they can help her back tremendously. Symptoms that she may experience, which indicate she should avoid supine position are: feeling dizzy, lightheaded, nausea, contractions, anything that just doesn’t feel "right." For those clients that don’t feel comfortable on their back or just don’t want to get in the position, you will need to avoid supine position all together for the remainder of her pregnancy.

“Short periods on your back are generally fine. It is only a problem if a pregnant uterus inhibits return of blood to the heart. If so, a patient may feel nausea, etc. Once they adjust their position, the symptoms resolve. There are no long-term harmful effects to mom or baby.” – Dr. Gigi Kroll Ob/Gyn

Round Ligament Pain

Round ligament pain can be very uncomfortable and is one of the more common pains your pregnant client may deal with, especially if this is her first pregnancy. The pain is usually experienced as a sharp or jabbing pain in the lower belly or groan area. As her baby grows, the round ligament (which attaches from her uterus to her groin) stretches and can cause pain for some or all of her pregnancy.

Movements that may be bothersome and should be avoided during the time she is experiencing round ligament pain are:

• Lunges – I recommend replacing lunges with squats.
• Running – if she is experiencing this type of pain with running I recommend walking instead.
• Walking – if walking is bothersome she may be best to focus on strength exercises until the pain subsides.

Recommended Exercises for the 2nd Trimester of Pregnancy

Note: Any exercise that is recommended for the second trimester of pregnancy is also a good option for first trimester.

Forward Rolls

Forward Rolls allows her body to be in a position to safely stretch her back muscles. Remind her to only move through a range of motion that feels good for her body, which may change as her pregnancy progresses. Perform 3 sets of 6 repetitions.

1. Kneeling with the ball positioned close, exhale to initiate movement by tucking her chin to slowly articulate her spine and roll the ball out. Inhale to hold this position, breathing deep into her belly while gently drawing her shoulders away from her ears and allowing her low back to arch into a comfortable position.
2. Exhale to initiate movement by rounding her spine at her pelvis and gently pressing hands into the ball; focus on articulating her spine back to starting position - all while continuing to “hug her baby.”

Side Reaches

Side reaches are a safe and effective exercise she can perform her entire pregnancy. She can also continue modified side planks from her first trimester as long as she can connect her deep core and avoid any “coning” of her belly. Perform 10 to 20 repetitions, then switch sides.

1. In a side kneeling position, reach the top arm over her body and extend the top leg out and away. Inhale to prepare to move.
2. On the start of the exhale, instruct her to slowly round her spine drawing her top elbow and knee towards each other (they do not have to touch, the goal is to get her to round her back).
3. Inhale when lengthening to starting position.

Hamstring Curls with Small Ball

Hamstring Curls using a small ball, for tactile purposes, is a wonderful exercise to keep the hamstring and glutes strong all while in a safe and comfortable position during the second trimester. This exercise is also a recommended third trimester exercise. Perform 2 to 3 sets (of the 20 + 20 repetitions described below) before alternating sides.

1. On all 4’s, place a small ball between her calf and hamstring on one leg. Have her find a comfortable starting position to hold her leg bent that also keeps her spine in as close to a neutral position as possible (you want to avoid over-arching the lower back).
2. Holding the ball, perform 20 small slow pulses squeezing the ball, then continue with 20 slow presses upward, while flexing her foot. Then release and switch legs.

Full Lunges

Lunges, specifically Full Lunges are recommended also for deep core strength. But be sure to follow the modification if full range of motion is too challenging. If she is experiencing any round ligament pain, replace any lunges with squats. Perform in sets of 10 to 15 reps, and it's optional to add light 2 to 5 lbs. dumbbells to increase the challenge.

1. Starting in a forward lunge position, keep the weight on the heel of her front leg while reaching her arms up into a “V” position or keep them to shoulder height, if needed.
2. Exhale to bring her back leg through to standing. Then instruct her to use her deep core to bring her back leg through and lift, or modify and just bring her back leg to tap by her standing leg.
3. Inhale as she moves back into her forward lunge.

Squat + Lat Pull + Rotation

This combo exercise is wonderful to strengthen her deep core, improve posture, strengthen mid back muscles, and keep glutes and hamstring strong. Plus, it opens up her hips. This exercise is a good option during the third trimester for many; just take note that you may need to decrease her range of rotation as her pregnancy progresses. Perform in sets of 20 repetitions, alternating sides.

1. Standing in a wide squat and feet slightly rotated out, hold the band about shoulder-width apart overhead.
2. Exhale to stand while pulling the band to her chest, rotating towards her right and allowing her hips to turn with her torso and back heel to lift and pivot. This is very important that her hips turn with her torso during pregnancy.
3. Inhale as she returns to center and lowers into a squat.
4. Reach her arms upward, keeping tension in the exercise band.
5. Exhale to stand and rotate to the opposite side pulling the band towards her chest, allowing her hips and back heel to pivot with her torso.

Conclusion

Now you understand what modifications you need to make once your prenatal clients are their second trimester - specifically core modifications and exercises for prevention or minimizing  of diastasis recti and common back pain due to her changes in posture. Continue encouraging her to move daily, even if it’s only a couple exercises or a short walk, because regular movement really can help her to feel her best.

References

American College of Obstetrics and Gynecology. (2015) ACOG.org

Betsch, M. Wehrle, R. Dor, L. Rapp, W. Jungbluth, P. Wild, M. Spinal posture and pelvic position during pregnancy: a prospective rasterstereographic pilot study. 2014 Aug 26.

Ramirez-Velez R. Bustamante J. Czernicyzniec A. Aguilar de Plata AC. Lores-Arnais S. Effect of exercise training on eNOS expression, NO production and oxygen metabolism in human placenta. 2013 Nov 14;8(11):e80225

Yan, CF. Hung, YC. Gau, ML. Lin, KC. Effects of stability ball exercise programme on low back pain and daily life interference during pregnancy. 2014 Apri;30 (4):41209