Avoiding yoga poses during pregnancy

Q. I’m pregnant and I love to do yoga. Is it still OK to do inverted postures? 

A. Opinions vary greatly regarding pregnancy and inverted postures—from they shouldn’t be done, to do what feels good, to limit time spent in them. While some experts believe that certain inverted postures can help turn a breech baby, others also feel that once the baby s turned head down, inversions should be avoided. "Inverted positions are fine in pregnancy up until week 30 or 32 when the baby turns head down," says Birgitta Gallo, author of Expecting Fitness (Renaissance Books, 1999). "While the baby is still turning and rotating in the uterus, it doesn’t matter what position you are in. However, when the head goes down into the birth canal, you want it to stay there. If a pregnant woman over 32 weeks gestation bends over, the baby’s head could in effect dislodge, and as it is still continuously kicking, it can rotate itself again and end up in breech."

Many experts agree that one of the most crucial times to avoid inversions is postpartum. "Air embolism is a potential hazard during the postpartum period," explains Elizabeth Noble, P.T., author of Essential Exercises for the Childbearing Year (New Life Images, 1995). "There have been several cases in the literature of maternal death. An air bubble enters the unhealed placental site when a negative vacuum is created, and while this is rare, it’s also preventable." Noble also notes that during pregnancy "women are protected against air embolism by a closed cervix, amnion and chorion." She does warn, however, that unless you are accustomed to yoga postures, you should avoid poses during pregnancy that require balancing, as injury may occur. 

Ease side aches through breathing

Q. What can I do when I get a side ache while running? How are side aches caused, and how can I avoid getting one to begin with?

A. Experts aren’t clear as to the exact reasons for side aches, also known as side stitches, which seem to typically occur on the right side. Some experts believe it has something to do with the organs ligaments becoming strained due to being jostled up and down from the running motion. Others feel it’s related to the muscles in the area, particularly the diaphragm, going into spasm or cramping. Still others feel it has more to do with a runner’s breathing, even going so far as to relate it to the rhythm of the breathing in relation to the timing of the right foot hitting the ground. Whatever the reason, as a runner, you know that it can be a real, well, pain! 

Cathy Cox, M.Ed., M.S.W., a yoga instructor at the Sports Club LA in Washington, D.C., believes the main cause of side stitches while running has to do with the diaphragm going into spasm, and that by learning proper breathing you can help prevent the problem. "The yoga practice of Ujjayi breathing brings the breath into the lowest part of the lungs more completely," she explains. "This expands the diaphragm or inhalation and reduces the incidence of spasm or side aches."

Cox explains that in Ujjayi breathing "you breathe through the nose and bring the breath into the sides and the back of the body, deep into the lungs." Contract the lower abs slightly to support the lower back. "The `whispering’ muscles of the throat are also slightly contracted to create a rushing ocean-like sound in the throat while you inhale and exhale—sometimes called Darth Vader breathing." 

She adds that the practice of yoga stretching works to "elongate muscles in the torso, making it easier to expand the rib cage more fully." 

For more tips on preventing and easing side stitches while running, log onto www.trailrunningusa.com, www.coolrunning.com or www.nyrrc.org. 

Exercising with a heart murmur

Q. I just found out I have mitral valve prolapse or a heart murmur. Should I limit my workouts? 

A. Mitral valve prolapse (MVP) is a common malady affecting millions of people—anywhere from 4 percent to 18 percent of the population (no, that’s not a typo! Reports of MVP vary that much). Also referred to as a floppy valve or heart murmur, it affects more women than men: 7.6 percent of women compared to 2.5 percent of men, according to the Framingham Heart Study. Other sources cite that there are up to 18 percent of women with MVP. 

MVP is often associated with a plethora of corresponding symptoms, including chest pain, fatigue, heart palpitations, shortness of breath, anxiety, panic attacks, headaches, low exercise tolerance and mood swings. But, says Kristine A. Scordo, Ph.D., R.N., author of Taking Control: Living with the Mitral Valve Prolapse Syndrome (Kardinal Publishing, 1996), regular aerobic activity can help ease symptoms. "Those who regularly exercise have [fewer] symptoms and more endurance than those who do not," Scordo says. "The most important type of exercise for people with Mitral Valve Prolapse Syndrome (MVPS) is aerobic exercise. This form of exercise produces the physiological adaptations tha reduce the frequency and intensity of MVPS symptoms." 

Dr. Scordo explains that it’s important for people with MVP to incorporate a warm-up and cool-down (as we all should), and to not necessarily rely on heart rate response. MVPers often have inappropriate heart rate responses to physical activity, she says, so a better gauge of intensity may be to use the Borg or Rate of Perceived Exertion Scale (RPE). On the 1 to 10 scale, Dr. Scordo recommends being around 5, or "somewhat hard."

Other tips for MVPers include to slowly work into an exercise routine, especially if you’re new to it, and do it regularly (versus sporadically). Strength training is also OK. "Remember to start with weights that are easy to lift," Scordo says, "and never hold your breath—slowly exhale as you lift a weight to prevent a spike in blood pressure." Above all, she recommends consulting your healthcare provider before beginning any new exercise program. "He or she knows your health history [the best] and can properly advise you."