Anthony Gurule  00:00

Hey what’s up guys, welcome back to another episode of the Live LOUD Life podcast. My name is Dr. Antonio, I’m your host of the Live LOUD Life podcast. My wife and I, we co-own Live LOUD Chiropractic and Coaching here in Lafayette, Colorado. We are just outside of Boulder, Colorado in Boulder County. And our mission is to help families. We want to help make families stronger, so that we can build a stronger community. We want to help guide you to the adventurous life that you and your family were meant for. And we do this through chiropractic and coaching. chiropractic, obviously being more of a hands on approach, more of a clinical conversation, clinical diagnostics, but the coaching aspect is really what we believe is, you know, the foundation of what our system methodology, whatever you want to call it is, because a lot of this comes around through just coaching suggestions and recommendations. also, you know, obviously within that comes into clinical prescriptions of certain things to eat or supplements, so on and so forth. But it’s coaching a lifestyle, it’s coaching, it’s coaching a philosophy and a foundation about how to live an active healthy life as an individual, and setting an example of a healthy active life for your family, for your immediate family, for your friends, and more importantly for your community. So stronger families to make a stronger community as a whole would be a win win, right? And that’s what we want to be able to do. we want to be able to help fill in the gaps in the holes that you’re maybe not getting from, from other roles and conditions.

 

Anthony Gurule  01:43

And today that’s in particular where we’re going to talk about. it’s going to be a little bit more of a shorter episode because this is more of a quote unquote, you know, just discussion around how to lay out a framework and a better understanding of how to work out or what exercises are safe or maybe not safe during pregnancy. This is a very, very common question that we get.

 

Anthony Gurule  02:12

My wife Nichelle has created a mini course that has some workout ideas, recommendations, and prescriptions than laid out into a workout. She guides and  educates other clinicians on how to broach this topic as a chiropractor, how to better serve prenatal patients through chiropractic care, but also exercise recommendations and prescriptions, having recommendations with other personal trainers within the community whether that’s CrossFit whether that’s Orange Theory, chatting with coaches and owners and saying hey, if you have prenatal patients and they’re having these types of symptoms, or this has happened, here’s some better recommendations, not modifications. We call them lateralizations–you’re just you know, you’re doing something something different or something else we you know, we borrow that term from Charlie Weingroff, who’s a physical therapist and strength conditioning coach. But it also and also doulas, right, doulas and midwives and OBs who are directly involved with the prenatal process from nearly conception all the way through, having this conversation. we know that exercise is important during pregnancy,

 

Anthony Gurule  03:19

There are so many different studies that talk about the benefits of exercising during pregnancy, not only for the mom, but also for baby, which is quite interesting. They’re seeing increased cognitive-what’s the word I’m looking for? Excuse me, their cognitive output as a as an as a child through as they age is actually better from moms that actually worked out during pregnancy.

 

Anthony Gurule  03:50

Now this is tough, right? How do you define working out or exercise? it’s different for everybody. But we want to, and we encourage that, and yet we’re sympathetic to the different stages of life, aches and pains, so on and so forth, which obviously would limit what you can do from an exercise perspective. So you know, it’s a bit of a gray area on determining what is working out? what is exercise? What are the physical guidelines or recommendations for pregnancy? And without getting into the like, nitty gritty detail of every single thing. And obviously, every potential situation, if you had this versus this, what could happen? we’re not gonna be able to do that. What we just want to lay out is what is what are we trying to accomplish here, and we want to encourage you to stay as physically active as possible.

 

Anthony Gurule  04:41

And one of the things that constantly comes up is, well, should you add something in that you have not already been doing? Let’s say for instance, someone just through the stages of life with work and kids or whatever that is, they were not able to work out as much before they got pregnant, but now that they’re pregnant, whether they have more time or they understand the importance of exercises during pregnancy, well, would we say, “Well, you haven’t been exercising, so you shouldn’t do too much.” No, that doesn’t, that doesn’t really make sense. Now, we would encourage not to do too much, there’s obviously, you know, a too far swinging the pendulum of the other way. But we wouldn’t say “no, don’t exercise because you weren’t doing something before,” we just have to find those first few stepping stones to help them start to gain some momentum. and help hold their hand, if you will, So that their technique and they feel confident about lifting, or how far they’re walking or whatever that is. And that’s an important topic, because a lot of times people want to add things in, but they weren’t quite ready or weren’t doing them before. And they then assume that they’re not able to do them at all. So you do have to take that in consideration, there is a ton that you can do, and that you can still add, even though you weren’t doing them prior to pregnancy.

 

Anthony Gurule  05:54

Now on the big questions is, is it safe? you know, outside to contact sports, or different things like that the majority of what you’re going to do is safe for pregnancy, right? Rock climbing, we have pregnant patients that have been rock climbing before, obviously, there’s a certain inherent risk with certain sports or activities. You know, you could fall off riding your bike, you could fall over running, right, so we’re not encouraging any of these by any means. We’re just kind of, you know, setting some suggestions, if you will. And you have to take into consideration.

 

Anthony Gurule  06:31

Now, there are certain things to consider when you’re talking about like weightlifting, and how heavy and the intensity that you’re doing. And if you’re doing Valsalva movements, which is essentially holding your breath to maintain a more rigid or stiff torso, as you’re seeing changes in blood volume and blood pressure, you know, you do have to take that in consideration. And that is again, of course a conversation with your provider that is managing your, your pregnancy, but we recommend Mama’s weight lift, or do resistance training. During pregnancy, again, we talked about about load management and the intensity and things like that, but you can still lift and do fairly intense things. And it’s a fairly as a you know, as a scale and a wide range during pregnancy and see a ton of benefit from that. Now, are we trying to hit one rep maxes and PRs during pregnancy, I mean, some would argue yes, but I would argue, why, that’s not really an accurate representation of what your strength is anyways. So you know, you do have to to kind of keep manipulating the numbers and the weights and the intensity and the sets and reps in order to do it. But weightlifting and resistance training is safe, and it is effective. Now, outside of that, there’s not a lot of unsafe things to do, again, outside of contact sports, or things that would elicit, you know, potential trauma to you or baby based on impact we’ve had, again, not our recommendations, but some have tried very just easy scheme, because they’re in the winter months, and they wanted to and they felt very confident about not falling. So you know, you have those types of things.

 

Anthony Gurule  08:16

Overall, again, we’re talking about movement. You need to move, and it’s good to get your heart rate up. And it’s good to breathe hard. So that doesn’t mean just because you’re pregnant, you can’t do HIIT training or circuit training or CrossFit or Orange Theory. But you do have to listen to your body and understand certain signs that would indicate that things might be too much, right? Now those are going to be different for everyone, but a lot of this comes down to you know, lightheadedness, you know, breathing too hard. Certain aches and pains within lower extremity, chest, abdomen, so on and so forth would be obviously like your more extreme ones. If you’re becoming pale or anything like that, I mean, again, these are the same criteria, though, that would be if someone else was working out or training too hard. So it’s realistically the same thing. It’s just that your threshold level for all those most likely have gone down. And depending on what type of an athlete you were before, you’re going to be maybe a little frustrated that you’re not able to do the things you were able to do previously, which makes sense. But if you’re someone who wasn’t exercising before, you’re probably going to be a little bit more hyper aware of that, of just feeling that shortness of breath or that uneasiness. So again, we’re not saying you have to push through that because we’re not trying to set yourself up for a strength and conditioning program to increase your metabolic capacity to increase your strength and conditioning during pregnancy. We’re trying to help you maintain a healthy active pregnancy.

 

Anthony Gurule  09:54

Now, walking. walking is great. but in general, we encourage you to do something above and beyond walking. Obviously, again, certain things would dictate that you would not be able to do so. And this is again, any exercise. Any exercise that you do during pregnancy needs to be consulted with and work through and have a conversation with the primary physician who is managing your pregnancy, whether that’s your nurse practitioner, your midwife or your OB or obstetrician, right. But we would encourage more than just walking. walking is fantastic, but that’s kind of like your baseline minimum, right? Just like our activities, or recommendation activity guidelines. We want a few days a week of where we’re kind of just doing this steady state getting our steps in, you know, kind of pushing ourselves, we’re huffing and puffing, but still just kind of at that conversational level, but you’re not really getting a lot of benefits outside of that.

 

Anthony Gurule  10:55

So if you’re just walking, high five. kudos. can you do something more? Can you do some bodyweight squats? Can you do some bodyweight, you know, good mornings? can you do some walking lunges? do you have a suspension training, we’re able to do some bodyweight rows? Do you have some bands that you can do some rows with? You know, there’s a lot that you can do that allows you to get a little bit more out of that. Now, again, this all comes back down to preferences of exercises that you like to do, because that’s gonna allow you to maintain the most consistency, but then also the intensity that you like to do. And we do encourage having an open mind and at least being willing to try some high intensity things that allow you to still get your heart rate up a little bit. And it’s okay to lift more than five or 10 pounds. And not saying that that is a bad thing. There’s programs out there where it’s all directed around that where it’s lighter weight, high rep, but I just don’t want individuals and mamas to feel like they’re not able to do more and or being ashamed because other people are just saying they should back off because they’re pregnant. “why would you need a lift that much?” It fits within your strength, and your comfort, and your wheelhouse, that is totally fine.

 

Anthony Gurule  12:05

Again, you if you’ve been doing that enough, you understand the risk reward ratio and having a conversation with your practitioner has driven us to kind of help navigate and guide as you start to get further through pregnancies, what things maybe we need to change or manipulate. But that’s totally fine. Now outside of that, the question around safe also comes up around core exercises. diastasis recti, pelvic floor strength, so on and so forth, we want to enhance the capability of understanding how to control tension within your abdominal wall and your pelvic floor through pregnancy, because the pressure is increasing due to baby taking up more space. But we’re not we’re not necessarily we’re not gaining more strength, right.

 

Anthony Gurule  12:45

And so what a lot of people assume it’s when we’ve seen this, is “I don’t want diastasis. So I’m doing more core work to prevent diastasis from happening.” diastasis recti will happen in 100% of moms, it’s estimated at the week 35 Everyone will have some form of it. Now it is technically not a quote unquote diagnosis, though, until 12 weeks postpartum, because it is a normal thing that everyone will get. So you can’t diagnose someone with something that everyone will get–doesn’t make sense, right? So after that, though, if you still have weakness or spacing issues, then we can have a you know, a stronger conversation about putting a diagnosis on that.

 

Anthony Gurule  13:26

But what we’re trying to enhance and help is what exercises are quote unquote, not safe versus unsafe, but adding too much pressure or tension into the abdominal wall or the pelvic floor and creating more laxity. again, as that pressure for as baby’s growing starts to put more pressure on the pelvic floor and the abdominal wall. If you’re doing more things that increases the pressure within the within the abdominal cavity that’s going to push on that separation even more and/or push on that pelvic floor even more, creating potential incontinence or prolapse issues and/or more bulging and doming within the abdominal wall stretching out that separation or that gap even further, potentially making the recovery process more challenging or slightly longer. I’m not saying that it will but potentially, so we do have to take that in consideration. So we go through activation exercise of the pelvic floor, of the abdominal wall so that you better understand how to control those pressure increases while you’re lifting or exercising so that you simply can stay at a management level.

 

Anthony Gurule  14:28

And that in turn, helps you get through pregnancy of understanding how to lift up your older kiddo, having to lift up dog food or anything like that. It’s just managing and controlling pressure. So there’s really not anything that I would say that safe or unsafe. Now, things that we would advise against for core exercises is sit ups or crunches. You know a lot of those things that create like hanging knee raises and different things like that during pregnancy. A lot of those things that create a lot of intra abdominal pressure and tension. and especially during a flex position, that tends to put a lot more pressure on the abdominal wall, the separation where diastasis will occur as well as the pelvic floor.

 

Anthony Gurule  15:09

So, you know, while we never say never, there’s definitely a category of things that we definitely urge against because the risk/reward benefit and again, risk not being “injured,” But risk of potentially putting more pressure and making the recovery process  on the other side harder, is not is not something that we find to be as advantageous. But you can still get the benefits of quote unquote, core exercises through full body movements such as goblet squats, such as deadlifts, you know, depending on the phase that you’re in, push ups, which are, you know, a dynamic plank. or being able to do a TRX row, which is a reverse plank as you’re just lifting yourself up. three point rows where you’re on, you know, two hands or doing like a row on a bench, where you’re in a tabletop position that’s adding anti rotation exercises. So there’s a ton that you can do that still highlights and isolates, the core isolates, sorry. that highlights and will emphasize core activation, but through a full body compound movement. And what’s great about that is during pregnancy, depending on your energy levels, it’s hard to do all the little isolated accessory and all these separate exercises as it is. So it’s kind of nice being able to combine everything, so you get more bang for your buck, especially if you’re a parent and you’re on and you’re on baby number two or three, right?

 

Anthony Gurule  16:31

So what exercises are safe for pregnant women to do? All are. reduce or eliminate for sure contact activities, different things like that. the increased risk activities of you know, trauma and things like that. Outside of that you’re managing pressure, I would definitely encourage reducing anything that’s heavy lifting, that’s, that’s requiring you to do Valsalva moves, you’re having to hold your breath for an extended period of time. that changes blood pressure, so on and so forth. But outside of that, Pregnancy is a completely safe time to do all exercises. we definitely as we highlighted, urge and encourage, you know, certain things over other ones just for you know, added bang for your buck or full body movements, so on and so forth. And that, but outside of that you are free to do what you want.

 

Anthony Gurule  17:19

If you want guidance, though, you know, there are there are trainers out there that work specifically with prenatal patients. we would love to be able to have that conversation with you if that’s something you want to bounce back or navigate. Because we do want to encourage as much as we can. A very, very active pregnancy through exercise working out or however you want to describe that. So if you found this beneficial, please like share, subscribe. if you’re pregnant, I hope you can utilize this and take some of the information for you and yourself. If you have anyone else you know… a relative a family member, a friend who is pregnant and they’re unsure they’ve been you know asking this question what things I don’t know what things I can do. I don’t know if it’s safe for baby share this video with them. We’d love to be able to provide a better frame of reference and or context to be able to ask better questions so that they can find the workout program  or the movements that work best for them during their pregnancy. Until next time guys live loud .if you’re currently pregnant, Congratulations, and we look forward to helping and serving in the future.

Dr. Antonio: Welcome back to Live Loud Life podcast. I’m your host, Dr. Antonio Gurule and today I’m joined by Dr. Liz Turner. Dr. Liz and I co-manage a lot of patients, especially those that have tethered oral ties or tongue ties as they’re most commonly known. Actually, I’m going to see her myself soon, hopefully. My kids see her for some orthotropics which is where we want this conversation to go, kind of above and beyond tongue ties. Welcome, Dr. Liz. Please introduce yourself, give your social plugs, your websites right off the bat so people know who you are.

 

Meet Dr. Liz Turner

Dr. Liz: Hi, I’m Liz Turner, I’m so excited to be here. I am a dentist in Lakewood, Colorado, so I’m not too far from these guys. We work with a lot of families in the metro and surrounding areas and I have a couple of practices in one location–Fox Point Dental and Bloom Center for Sleep and Airway Health. I’m a general dentist, so I don’t just see pediatrics but I do see the manifestations of some of the issues that we can touch in the pediatric population in the whole lifespan. And so it’s really fun to put all the pieces together and start to really look at the root cause of a lot of health issues and how we can treat them from a dental perspective.

 

Dr. Antonio: That’s awesome and I want to segue right off of that. Before I knew this other side of dentistry, I guarantee the majority of people when they hear dentist, it’s cleaning cavities, so on and so forth. How does what you do differ? I know that could be a very loaded question, but differ from like the traditional dentistry that we know of cleaning cavities, so on and so forth.

 

General Dentistry vs Holistic Dentistry

Dr. Liz: Yeah, that kind of hops into my story a little bit. I was a general dentist for seven years, having had my own dental trauma and spent a lot of time in the dental chair. I grew up in a community in Maine where we didn’t have fluoridated water. And as dentists we are like, oh, fluoride this and fluoride that, and you have to have that in the water to be preventing decay. And so I just looked at dentistry as fixing teeth because cavities develop, and how do we prevent cavities? It took seven years for me to really look at, oh, my gosh, there’s so much more. I just thought I was in the wrong field.

 

So from Maine originally and then practiced kind of all over the place from Albuquerque to Minneapolis. I had my son born with an oral restriction (a tongue tie is the common name) and didn’t really know anything about it, just thought babies cried a lot. We ended up having him treated because I was able to find a dentist who had a laser. I didn’t have a great team in place, I didn’t really know anything about having a team, and it sounds weird to have a team for a tongue tie but we’ll get to that in a couple of minutes.

 

Shortly after I had him treated, my father-in-law had a heart attack because of years of undiagnosed sleep apnea, he had some AFib that developed and he threw a clot. And I’m just the dentist but I was like there seems to be a little bit more going on here. Then we started to look at his oral cavity. He’d had a stutter since he was four years old, he’s got his own oral restriction, a narrow arch, a high vaulted palate, real tall and lean so you never would think he’s got sleep apnea. It took a long time to get that diagnosis and at the end of the day, I mean, how many years does a heart attack take off somebody’s life? He arrested in the doors of the emergency room and was in a medically induced coma for six days.

 

It just makes me nervous that we’re not looking at trying to prevent these incidents from happening, we’re just looking to treat them when they’re happening. I started to connect the dots and looked at my own family and recognized, oh my goodness, as a dentist, we can see a whole lot of this sleep stuff. And at the end of the day, we need oxygen more than anything else and so these little tiny events early in life and through the lifespan, in the middle of the night when we’re not oxygenating properly, are really impacting our overall health. That’s a long, long answer of what do we look at, but as a general dentist, we’re trained to just look at the teeth and really we should be looking at the whole oral cavity and the health of the person as a whole.

 

Airway Assessments and What They Reveal

Dr. Antonio: I think that’s amazing, though, because I think something important you just said is “not properly oxygenated.” And what is the one thing that we do throughout the day more than anything? Is breathe, and that can be greatly affected by these things. One of the things that you were able to do (I wasn’t there during the consultation but my wife raved about) in your consultation of looking at our littles, is the airway passage. Can you walk through a little bit about what your assessment kind of looks like and what you’re looking for as far as how these developmental things are going?

 

Dr. Liz: Yeah. James Nestor put out this really cool book called Breath.

 

Dr. Antonio: That’s an amazing book, by the way. Sorry to interrupt. For anyone who’s listening, it’s not a clinical book. It’s very much a layman book, and he just talks about his journey so everyone should check that out.

 

Dr. Liz: He’s really funny. He takes his own airway deficiencies and like makes a big joke out of them but then fixes them and he references a lot of really great articles and things and so I think he breaks it down. It’s one thing to hear like me lecture about people’s airways all day long but it’s another thing to hear a journalist go on his own journey of plugging his nose and seeing how his sleep quality and exercise quality deteriorates. Because that’s another thing. From an athlete perspective, nasal breathing is at the end of the day what we should be doing.

 

Starting from infancy, babies are obligate nasal breathers so we really start to look at what the nasal passage is doing in our assessment. People come in for assessments and the first thing that I do is I just observe the person. Like are they sitting there really hyperactive? Especially the little kids, are they all over the place? And then I’m looking at are they just sitting with their lips kind of parted the whole time? Are they fogging up my mirror when I’m looking at them? Because if I’m seeing just this pattern of obligate mouth breathing, then I know that there’s something wrong from the beginning. And then we start to look at the shape of the palate, the narrowness of the arches. Because behind our dental arches is our nasal passage and our oral airway passage and if the nasal passage isn’t working well, then the oral passage will collapse and will cause these events in the middle of the night. So there’s all sorts of things that we see in the teeth and in the mouth that give us these indicators that there’s something wrong with the whole system.

 

Dr. Antonio: This obviously is a kind of “it depends” question, I think. The earlier the better for anything, but how early do you start to see those nasal passage and oral pathways really start to collapse and change? Do you see them in toddlers or is it more like it takes years and you don’t see that until adulthood?

 

Dr. Liz: We start seeing this stuff at birth. A lot of the things that we look at from infants is we’ll ask the family if they’re congested and they’ll say, oh, yeah, in the middle of the night. They’re like, you know, we’ve got to clear those boogers every morning. That’s a sign to me that there could be some aspiration into the nasal cavity that’s going to make it difficult for nasal breathing and the baby’s going to become more of a mouth breather. And once they become more of a mouth breather then the turbinates get inflamed and a lot of times the palate is going to form really high and vaulted and that’s going to restrict the nasal cavity even further.

 

Abnormalities in the Oral Pathway Can Be Corrected

We’ve all heard of the movie Napoleon Dynamite or the cartoon Beavis and Butt-Head, but we start to make a joke out of people’s anatomy and we start to normalize some of the patterns that we see in these obligate mouth breathers. The face will start to elongate because if we think about that, form is going to follow function. If we’re breathing through our mouth and our tongue is resting low, then the mouth is going to open and the face is going to develop in more of an elongated fashion and that’s just going to narrow the passages even further. It’s just this like cyclical growth pattern that happens because most of the cranial facial growth or the jaw growth happens before the age of six. If we don’t catch this stuff early in little kids, then we have some correcting to do later on that’s a whole lot harder, but can be done.

 

Dr. Antonio: I’m just thinking about myself being obviously older than six. What is it, 25 years old is when adults are pretty much skeletally mature, you’re not really growing at all? Are you able to make substantial changes in adults that are having these things or is it really kind of like we can improve things but we’re not going to really be able to make like profound changes within the bony structure, if you will?

 

Dr. Liz: Well, we can make changes in the bony structure. It differs male versus female, age dependent, but the cranial sutures don’t really fuse until the seventh decade. We have a lot of different appliances that can be used. Some of those have a minor surgery that goes with them to make that true sutural change. Other times, we can just increase the oral volume with things like Invisalign or teeth-uprighters to just make more room for the tongue. Because if we think about what the tongue is doing, it’s got to have room to live. If it doesn’t have any room to live, it’s going to live back in the airway and it’s going to essentially choke us or we’re going to open up our bite because we have to swallow and push our tongue forward. We start looking at this stuff early so that we can correct the foundation, so that we can build the house of the teeth, so we can line the teeth up on the right foundation, if that makes sense.

 

Dr. Antonio: Yeah, one hundred percent and we’ll make this alive for anyone who’s watching. I know I have it, my teeth in the front don’t close. The thing that was always like a joke for me is I could never eat ham and turkey sandwiches when I was little because I would just grab the bread and slide it off. I could not use my incisors the way they should be used and my palate is very high. I’ve worked hard on trying to improve nasal breathing, but I definitely know I’m someone who, at rest, I’m commonly just jaw mouth open. Like it just drops and it opens. Fortunately, I don’t have a lot of allergies or other things like that but it’s what you didn’t know, you didn’t know. When we were younger, this was never a conversation of anything that was happening.

 

Dr. Liz: You live a healthy life so you probably have a lower inflammatory diet that you prescribe by so you’re lower in some of those inflammatory proteins. What’s normal for you may be really sick for somebody else, if that makes sense. At the end of the day, it’s all about inflammatory processes and oxygenation.

 

Here’s Why Our Jaws Are Shrinking

The things that we look at early and what’s causing all of this stuff. In 2016, a study came out of Stanford that showed us that our jaws are essentially shrinking. And there’s another great book out there that’s written by an orthodontist, it’s called Jaws. It talks about how our genetic profile is really for 32 teeth but over time we’ve needed our wisdom teeth out and then there was a push to take out premolar teeth because there just wasn’t enough room for them. The introduction of the Western diet where we aren’t hunter gatherers anymore (we’re not like out killing our food and then cooking it over a fire and eating it, masticating as much as we used to) means that we’re not stimulating the stem cells around our teeth and so our jaws aren’t growing to the size that they should. Okay, that’s fine. I wouldn’t really change the fact that I have the conveniences of modern life but I do think it’s important for us to be aware that a lot of our children and ourselves are going to have some things we have to make up for and so a lot of that is the orthotropic stuff.

 

Dr. Antonio: For anyone, there’s the book.

 

Dr. Liz: Oh yeah, you’ve got it. Sandra Kahn, that’s a really good one, too.

 

Dr. Antonio: What was interesting, because I just had this conversation with a mom who brought their baby in for a consult for oral ties, it’s the same conversation and James Nestor talks about this in his book as well. He goes across multiple different civilizations and cultures, talking about diet and how the diet has also changed, and how essentially from that hunter gatherer perspective, but also just more palliative foods, just softer foods. When I was talking about it I was like when you think about it, what’s baby food? It’s just mashed up stuff. Whereas if we just were breastfed until then most cultures were just going to have some form of baby led weaning–softer foods still because they don’t necessarily have teeth–but they’re working on harder foods to actually develop more strength within that. But it’s hard because nowadays everything is semi processed, most things are just softer.

 

Dr. Liz: Yeah. And if you look at a lot of the marketing out there for some of the foods, it’s like “oh, melt in your mouth.” We don’t really want stuff to melt in our mouth! I understand that we need to do the early solids safely and there are ways to do that. There’s a lot of great feeding therapists that have recommendations for that and I do think that the baby led weaning approach is a really appropriate way. I’m not super strict about it because I do understand that we don’t want to force kids to do things that they can’t. Especially when we start to talk about the tethered oral tissue stuff, a lot of times they can’t safely form a bolus and so these kids are pegged as like picky eaters or they’ll hold food in their cheeks, they can only tolerate certain textures. But I do think it’s super important for us to introduce things that they have to masticate so that we can get the jaws to grow. That’s one piece of the puzzle.

 

Some Effects of Abnormal Facial Musculature

Another piece is what are the mechanics of the face doing? It’s funny because we think about the rest of our body and everybody’s like, oh, you’ve got to work out, you’ve got to tone, you’ve got to do squats to increase your glute strength. But nobody ever talks about the musculature of the face. Swallowing, we have to use eight different muscles and our tongue is made up of four muscles. If we’re not using those muscles appropriately, then we’re not going to develop the way that we’re supposed to. The lips and the cheeks essentially are supposed to be passive, they’re supposed to be nature’s braces, and the tongue is the one that’s supposed to be nature’s expander. It’s supposed to drive up to the palate and be able to effectively and efficiently breastfeed.

 

When we talk about breastfeeding medicine, at the end of the day, I want what anybody wants for their breastfeeding journey and that could be to not do it at all. But at the same time, I also want to know what the breastfeeding mechanics are and that they’re working really well. Because that shows me that the swallow pattern is developing well so that we can have appropriate swallowing pattern and retention and size of our jaws early on, and keep that going through the rest of their life. Like you pointed out, you have that anterior open bite, so likely you have what’s called a reverse swallow or a tongue thrust. And that’s just a retained reflex from the early childhood, so the first six months of life, because they have this infantile swallow pattern and a lot of times it just doesn’t go away. That’s not to say like bottles are bad or pacifiers are bad. There’s a starting point and a stopping point and I have opinions on all those things, because I have strong opinions on all this stuff, but we just want to know that we can get that swallow pattern corrected so that you don’t end up with that anterior open bite.

 

You’re a man, so women have lower levels of testosterone. Women that have that reverse swallow pattern, we see a ton and I’m sure you guys see this all the time in your practice. We see so much head and neck tension, forward head posture, tight muscles. And women will report, oh, I just hold my tension there. It’s not necessarily they hold their tension there; their tension just can’t go away. Because when we swallow 2000 times a day and we’re putting constant forward pressure on our hyoid bone (which is where our tongue attaches) and our hyoid bone is attached to all our strap muscles, we’re going to have so much of this head-neck shoulder tension traps. We see tons of migraines.

 

And it’s cool, because when we do some of these releases in conjunction with bodywork and proper therapy beforehand, what we hear six months later is that the tension just kind of like melted away. We’ll hear people just say, oh, yeah, it just doesn’t sit in my shoulders anymore and my tongue just sits in a different spot. I look at this tongue tie stuff as just one piece of airway puzzle. It’s really important for us to have the proper mechanics and the proper position but if we don’t have the proper foundation, then we can sometimes have some things we have to correct, if that makes sense.

 

Dr. Antonio: Yeah, that’s amazing. Based on what we knew at the time when I was younger, I went through speech therapy to try to assess the tongue thrust, all sorts of expanders and tried the things that help. And it helped but then once everything was taken away, it just reverted back to what it was. Because of what I know and what Nichelle has looked at me on, there’s just tension there that can’t really go away until something is actually done about it.

 

For these littles, we’ve seen co-management notes and certain things like that. We obviously look at a lot of the same things, but walk us through a little bit about the questions that you ask parents that would indicate a possible tongue tie or tethered oral tissue.

 

Diagnosing a Tongue Tie

Dr. Liz: Looking at babies before they’re even born, we can look at the familial pattern. A lot of the individuals that we treat have some type of an MTHFR mutation. We do know that there’s some type of a correlation between the MTHFR pathways and the methylation pathways and folic acid. People say, oh well, should I take a folic acid supplement? The reason we started supplementing with folic acid was to prevent things like spina bifida. We’re looking at a lot of the midline defect stuff. When I’m starting to talk to families about this stuff, they’ll walk themselves through and they’ll say, oh yeah, I know I have that MTHFR mutation or I know I have a family history of tethered oral tissues or tongue tie. I do think a lot of these are undiagnosed and so I think a lot of people don’t realize that they have it and a lot of times once we start looking at the baby, we start to realize that a lot of the family members do.

 

When we talk about the way that the midline forms, the tongue forms at 12 weeks in utero. It starts forming earlier than that but these tissues, the collagen frena, that are oftentimes too tight in these individuals, it starts to separate at 12 weeks in utero. And when it doesn’t separate completely, it’s kind of like the webbing in our fingers and our toes. If it doesn’t separate completely, they’ll go in and they’ll surgically correct it. The problem is we’re not really looking at these in the proper ways to diagnose them to know what to correct, unless you’re working with somebody trained to do so. I think a lot of the individuals that are able to diagnose–pediatricians, ENTs–they unfortunately can diagnose but they don’t have the ability to do it well because they were never trained. They get like an hour on the mouth. And even ENTs, I find that they’re not properly elevating the tongue to really look for the restriction.

 

The things that we look at in babies is body tension. We’ll look to see if they have like really tight balled fists or their feet are just flexed really tightly. We’ll see a lot of patterns of like torticollis or we’ll see plagiocephaly (flat spots on the head) and that just shows us there’s a lot of body tension. That’s what I work with you guys in conjunction with. Because if there’s tension in the mouth, which is kind of where we form from in these branchial arches, and it goes down through the rest of the body, then we’re going to have retained tension. What that’s going to do is it’s just going to mean that we’re never going to be able to relax the rest of our body to swallow appropriately.

 

And then we’ll also see a lot of cranial nerve restrictions. There are some cranial nerves that come out of the base of the skull and when those come out of the base of the skull and we have some birth trauma (whether it be like a vacuum assist or a C-section or just birth in general because it’s pretty traumatic), we can have some compression of the cranial nerves that can lead to some motor issues with the mechanics of the tongue. That’s why we like working with you guys because you guys rule that stuff out so we can really look for the true restriction.

 

When somebody comes into our office, what we do is we talk about all those symptoms and things we’re looking at are like colic-like descriptors. Some babies will be diagnosed with colic–which isn’t really a diagnosis, it’s just a descriptor of crying. And we’ll look for reflux, so aspiration in the nasal cavity, congestion. We’ll look for hiccups. A lot of times these babies will have had hiccups even in utero, because when they start swallowing at 30 weeks, they’re still not swallowing well.

 

Dr. Antonio: That’s interesting.

 

We Often Normalize Common Abnormalities

Dr. Liz: Yeah. I always ask, whenever somebody checks hiccups on our intake form, I’ll ask if they had them in utero, and they say “oh yeah, like four or five times a day.” And I didn’t want to believe it till my own kids, but yeah, every time. We’ll look for a central lip blister, so like a little blister in the middle, and that shows us sometimes the lip isn’t flipping to more neutral. We’ll look for cobblestoning of the lips which looks like little blisters, and they’re friction blisters. There was a post recently somebody pretty well known put out saying that they’re normal and common isn’t necessarily normal. So they’re common but I wouldn’t consider them normal. I would consider them a compensation that the lips are working way too hard and the tongue can’t really function.

 

Antonio: I had that exact same conversation this week. Just because we see it a lot doesn’t mean it’s necessarily normal.

 

Dr. Liz: Yeah. And that’s the thing with mouth breathing too, like we see it so much. So many kids right now are just underdeveloped and can’t breathe. And I’m super worried about what our population is going to be like in 15 years. Like we think we’re seeing illness now, we’re going to see a lot of illness in the future. Some of the illnesses, they’re big and they’re hard to treat. Like anxiety, depression, Alzheimer’s, dementia, cardiac disease, diabetes, obesity, all this stuff is related to like cortisol production and lack of oxygenation. It’s not just a breastfeeding issue that we look at but it’s so much more than that. Plus the aesthetic profile, like that big broad smile and the ability to show your teeth and keep them clean. Because when we mouth breathe, we have a lot of bad breath, we have more cavities, we have yellow teeth, so it’s like an aesthetic and confidence thing too. There’s a reason that a healthy smile is looked at as like nice looking.

 

Difficulties with Breastfeeding

Dr. Antonio: Which is definitely a much harder conversation to have when, first and foremost, breastfeeding is what’s challenging and they’re kind of on the fence about it. I don’t use the word invasive per se, but I’m like it’s definitely a procedure that’s not taken lightly. But when you’re looking at checking all those boxes and, you know, looks like a duck, walks like a duck, it’s probably a duck. But let’s look at beyond, right. Like I know a lot of this is newer and you can’t imagine what your kid is going to be like in 15 or 20 years, but we want to set them up for the best success as possible. And having this small little blip in their journey, of doing a revision, could mean the world of difference for certain things.

 

Dr. Liz: What I tell families is when we start talking about it all, they’ll really start to see the pieces in themselves. And they’ll say, oh, yeah, I had that small jaw and I had to go to speech therapy and I sucked my thumb and I didn’t like a lot of textures. And they kind of relate it to themselves and they realize that those things made them unhappy. And I say I don’t have a crystal ball and I can’t control every factor, but this is one thing that we have control over, and that’s developing the function early so that we can try to at least mitigate and lessen the severity of some of this stuff. Like you needed three expanders, maybe your kid will only need one. You needed jaw surgery, maybe your kid won’t need it.

 

At least if anything happens… Even in like removing tonsils and adenoids, because when we look at tonsils and adenoids, it’s all from mouth breathing. The family will say, oh yeah, I had the tonsils out. I’ll say, oh, how did that feel? And they’re like it was awful! And they’ll remember that stuff. When we look at like tonsils and adenoids, that’s just a filter. These are a filter and our nose is supposed to be the filter and we’re all obligate nasal breathers from the beginning. The turbinates are enlarged and so, on first latch, it distracts the baby so that they actually begin to breathe through their nose. And if we’re not able to get that latch for whatever reason… and ties are a big one.

 

Also, I hate to say, like some hospital support is not doing the service for our families that we need. They just say, okay, here’s that bottle. And I know there’s been a big push in hospitals to really try to promote breastfeeding, which is good as it is a big, big health thing. But yeah, so tonsils and adenoids, if we don’t correct the pattern of mouth breathing in conjunction with tonsils and adenoids, we’re still going to see snoring and sleep disordered breathing 12 years later. So we have studies on that.

 

Dr. Antonio: Two questions. I don’t know enough about the actual curriculum of becoming an IBCLC, but one of the main things is hospitals definitely are promoting it. Like, hey, go see the lactation consultant. But from the consensus, they are not able to actually diagnose these things.

 

Dr. Liz: Yeah. And I think that’s unfortunate because I do think that the training, just like dental training and speech training and lactation training, it’s a little backwards. We’re not looking at the beginning to the end. We look at the end, like there’s the speech problem. There’s the dental cavity and grinding. There are lactation issues, just give them a bottle. We don’t look at the reason that these things are happening and we’re not trained to. So I can’t fault somebody for not recognizing this stuff but I do think that there should be a subset of IBCLCs, who have a particular skill set and ability to assess the function that should be able to be diagnosed.

 

It’s fine, I feel like I have a relationship with IBCLCs I work with where we can really talk about the nuances from the functional and the structural things that we see and we can like co-diagnose, if that makes sense. They’re really careful to never diagnose. They say ultimately you have to do that, but they’re really forward in telling me these are the issues that I’m seeing and these are how I think that it’s being affected. But I do tell people your hospital-based lactation is great for the first couple of days of life and then you’re dismissed. I think as a country, we should have access to and really be pushed towards getting additional lactation support. Because our pediatricians can’t offer that. They say they can but they’re not feeding therapists, so we kind of do our moms and our families a disservice by not really advocating for that.

 

Working as a Team to Provide Patient-Centered Care

Dr. Antonio: I agree. We obviously work with a lot of the same people and you know when they say certain things that you’re like, alright, they think that’s what it is. Which is great because the people that we co-manage with are so thorough with their examination and the notes that they share. It’s like, yeah, I pretty much almost know what’s going on based on what that other person saw. Which makes life easy for everyone because then you’re not having to like recreate the wheel of the diagnostic procedure and you’re just piggybacking off that other provider, if you will.

 

Dr. Liz: Yeah. And I think it gives families a bit of confidence in the team that they’re working with if they’re saying the same things just because it is a hard decision to make when it’s for your kid. You have a hard job of being the consenting adult for a little one that doesn’t really have a voice and you just want to know you’re making the best decision for your family and doing something that’s absolutely necessary. And I think all of us are really good at helping the family navigate the difficulties of it, even though it is challenging.

 

Antonio: Definitely. I did want to circle back there. You had mentioned thumb sucking. Do you find a higher prevalence with thumb sucking with those that have the tongue ties and/or prolonged pacifier use, so on and so forth?

 

Tongue Ties and the Thumb Sucking Habit

Dr. Liz: Definitely. I look a lot at what this does from a perspective of releasing oxytocin from the brain. The tongue is supposed to sit up against the spot behind the front teeth and there is oxytocin that gets released by stimulation of the palate. When the tongue sits low and we have to use something non-nutritive to soothe ourselves or make ourselves feel better, we’re going to see a higher incidence of the need to thumb suck, pacifier use, clothing sucking, hair chewing on, and ultimately like nail biting and oral fixation stuff. We even have some adults that come in and they report, you know what, sometimes I wake up and my thumb is in my mouth. Those are oftentimes the people that we find their tongue is resting low and not stimulating that spot to get that feel good hormone to be released in our brain. So yeah, we do really work hard to try to build the function of the tongue beforehand so that if we need to do any type of release, the tongue sits right in that spot and we can try to reduce those habits as quick as possible.

 

Dr. Antonio: We know with habitual training that things as far as oxytocin and all those things can be retrained. But something as far as like oxytocin which just has such a profound effect on how someone feels, just releasing that and doing some exercises afterwards, are you actually able to see those things mitigate and go away?

 

Dr. Liz: I look at the little kids for a lot of it. Because if we can just put something else in their mouth, whether it be their tongue or a different type of appliance, kind of like these little orthotropic growth appliances or a habit appliance called a Myo Munchee, we can oftentimes get kids to stop using a pacifier because we stimulate the tongue to sit where it’s supposed to. We get the tongue resting high instead of low. Just as an example of one of the appliances we use, but it’s got a little spot right at the top that the tongue is supposed to be stimulated to. And sometimes people will take little gelatin spots and put it up behind their front teeth to try to get the tongue to sit there. It’s really interesting how some people will remember their own history. They’re like, oh yeah, I had this thing that they put in my mouth, like a little ball that my tongue was supposed to sit against. So this stuff isn’t new, we’ve been doing it for a long time. We just haven’t been doing it as cohesively, I think, as we could be.

 

Antonio: That’s fascinating, that’s really fascinating stuff. This has been amazing I guess because we talked about the differences between our traditional dentists and obviously the dentistry you’re doing, and I know you explained it very thoroughly and well. We’re kind of different from the traditional chiropractic model so when we talk about chiropractic and how we practice, we always try to say “hey, this is kind of how we’re different,” outside of like the general big lecture series, if you will. What are some of the things you really like to try to educate people on in really kind of differentiating yourself from other dentists as far as this stuff?

 

Parting Shot from Dr. Liz

Dr. Liz: We look at ourselves as a functional dentistry. Basically, we’ll treat a problem when it’s there but we’re always going to try to look for the root cause of it to try to prevent it from happening again. When we look at the function of the system, a lot of it comes down to nutrition, breathing patterns and ultimately the stuff we just talked about. Where’s your tongue sitting in your mouth? What are your lips doing at rest? Because if we can control those things, we can control a lot of the dental stuff we deal with–clenching and grinding, broken teeth, cavities, gum disease.

 

All the stuff that people hate dealing with, we can control if we can get to the root cause. We’re really big in just trying to educate people on what their current health status is and also try to help them find answers. If it’s not something that we can help with, we can try to help find them the right person, whether that be an ENT or sleep physician, a nutritionist, naturopath, things like that. Because there are definitely things that I would love to learn more about in terms of the nutritional stuff and I’d love to be able to offer more of those services on my own, but I just know there are people with way better knowledge than me. I’m more than fine farming stuff out to other individuals who I know can help my patients.

 

Antonio: Well, that’s amazing. I know I was sold before wanting to come and see you but I know I definitely need to come in because there were so many things that you said where I was like, yes, that is literally me to a tee. I will make it very soon.

 

Dr. Liz: Oh, anytime. I’m excited.

 

Antonio: I am too. It’s actually quite profound like literally how many things you just said which I had come across before but never took that perspective, so that’s pretty cool.

 

Dr. Liz: And I promise it’s not just for my patients. Every member of my family is in some phase of airway development.

 

Dr. Antonio: That’s awesome.

 

Dr. Liz: Little and big, so it’s kind of fun.

 

Dr. Antonio: That’s perfect. Anything else you wanted to add before we sign off?

 

Dr. Liz: No, I just appreciate all you guys do. It’s so fun working with your patients and I just think you guys do a great job in really educating people and encouraging people, and it’s just awesome.

 

Dr. Antonio: We appreciate the same. It’s been awesome connecting with you over the last year, year and a half or so, and thank you for taking care of our littles.

 

Dr. Liz: Of course, oh my gosh, they’re so fun. We have the best time.

 

Dr. Antonio: They love coming in.

 

Dr. Liz: We’ll be in touch and let me know if there’s anything I can do for you. My Instagram, I’ve got like eight accounts right now but probably the one that has the most information on it is @DrLizzzT.

 

Antonio: I’ll put it in the show notes and everything and link it over. Hopefully that makes it easier for people to find you.

 

Dr. Liz: Awesome. I’m so excited.

 

Antonio: Well, thanks again. I really appreciate the time, and have yourself a great weekend.

 

Dr. Liz: You too, talk to you soon.

Anthony Gurule  00:00

Hey what’s up guys, welcome back to another episode of the Live LOUD Life podcast. My name is Dr. Antonio, I’m your host of the Live LOUD Life podcast. My wife and I, we co-own Live LOUD Chiropractic and Coaching here in Lafayette, Colorado. We are just outside of Boulder, Colorado in Boulder County. And our mission is to help families. We want to help make families stronger, so that we can build a stronger community. We want to help guide you to the adventurous life that you and your family were meant for. And we do this through chiropractic and coaching. chiropractic, obviously being more of a hands on approach, more of a clinical conversation, clinical diagnostics, but the coaching aspect is really what we believe is, you know, the foundation of what our system methodology, whatever you want to call it is, because a lot of this comes around through just coaching suggestions and recommendations. also, you know, obviously within that comes into clinical prescriptions of certain things to eat or supplements, so on and so forth. But it’s coaching a lifestyle, it’s coaching, it’s coaching a philosophy and a foundation about how to live an active healthy life as an individual, and setting an example of a healthy active life for your family, for your immediate family, for your friends, and more importantly for your community. So stronger families to make a stronger community as a whole would be a win win, right? And that’s what we want to be able to do. we want to be able to help fill in the gaps in the holes that you’re maybe not getting from, from other roles and conditions.

 

Anthony Gurule  01:43

And today that’s in particular where we’re going to talk about. it’s going to be a little bit more of a shorter episode because this is more of a quote unquote, you know, just discussion around how to lay out a framework and a better understanding of how to work out or what exercises are safe or maybe not safe during pregnancy. This is a very, very common question that we get.

 

Anthony Gurule  02:12

My wife Nichelle has created a mini course that has some workout ideas, recommendations, and prescriptions than laid out into a workout. She guides and  educates other clinicians on how to broach this topic as a chiropractor, how to better serve prenatal patients through chiropractic care, but also exercise recommendations and prescriptions, having recommendations with other personal trainers within the community whether that’s CrossFit whether that’s Orange Theory, chatting with coaches and owners and saying hey, if you have prenatal patients and they’re having these types of symptoms, or this has happened, here’s some better recommendations, not modifications. We call them lateralizations–you’re just you know, you’re doing something something different or something else we you know, we borrow that term from Charlie Weingroff, who’s a physical therapist and strength conditioning coach. But it also and also doulas, right, doulas and midwives and OBs who are directly involved with the prenatal process from nearly conception all the way through, having this conversation. we know that exercise is important during pregnancy,

 

Anthony Gurule  03:19

There are so many different studies that talk about the benefits of exercising during pregnancy, not only for the mom, but also for baby, which is quite interesting. They’re seeing increased cognitive-what’s the word I’m looking for? Excuse me, their cognitive output as a as an as a child through as they age is actually better from moms that actually worked out during pregnancy.

 

Anthony Gurule  03:50

Now this is tough, right? How do you define working out or exercise? it’s different for everybody. But we want to, and we encourage that, and yet we’re sympathetic to the different stages of life, aches and pains, so on and so forth, which obviously would limit what you can do from an exercise perspective. So you know, it’s a bit of a gray area on determining what is working out? what is exercise? What are the physical guidelines or recommendations for pregnancy? And without getting into the like, nitty gritty detail of every single thing. And obviously, every potential situation, if you had this versus this, what could happen? we’re not gonna be able to do that. What we just want to lay out is what is what are we trying to accomplish here, and we want to encourage you to stay as physically active as possible.

 

Anthony Gurule  04:41

And one of the things that constantly comes up is, well, should you add something in that you have not already been doing? Let’s say for instance, someone just through the stages of life with work and kids or whatever that is, they were not able to work out as much before they got pregnant, but now that they’re pregnant, whether they have more time or they understand the importance of exercises during pregnancy, well, would we say, “Well, you haven’t been exercising, so you shouldn’t do too much.” No, that doesn’t, that doesn’t really make sense. Now, we would encourage not to do too much, there’s obviously, you know, a too far swinging the pendulum of the other way. But we wouldn’t say “no, don’t exercise because you weren’t doing something before,” we just have to find those first few stepping stones to help them start to gain some momentum. and help hold their hand, if you will, So that their technique and they feel confident about lifting, or how far they’re walking or whatever that is. And that’s an important topic, because a lot of times people want to add things in, but they weren’t quite ready or weren’t doing them before. And they then assume that they’re not able to do them at all. So you do have to take that in consideration, there is a ton that you can do, and that you can still add, even though you weren’t doing them prior to pregnancy.

 

Anthony Gurule  05:54

Now on the big questions is, is it safe? you know, outside to contact sports, or different things like that the majority of what you’re going to do is safe for pregnancy, right? Rock climbing, we have pregnant patients that have been rock climbing before, obviously, there’s a certain inherent risk with certain sports or activities. You know, you could fall off riding your bike, you could fall over running, right, so we’re not encouraging any of these by any means. We’re just kind of, you know, setting some suggestions, if you will. And you have to take into consideration.

 

Anthony Gurule  06:31

Now, there are certain things to consider when you’re talking about like weightlifting, and how heavy and the intensity that you’re doing. And if you’re doing Valsalva movements, which is essentially holding your breath to maintain a more rigid or stiff torso, as you’re seeing changes in blood volume and blood pressure, you know, you do have to take that in consideration. And that is again, of course a conversation with your provider that is managing your, your pregnancy, but we recommend Mama’s weight lift, or do resistance training. During pregnancy, again, we talked about about load management and the intensity and things like that, but you can still lift and do fairly intense things. And it’s a fairly as a you know, as a scale and a wide range during pregnancy and see a ton of benefit from that. Now, are we trying to hit one rep maxes and PRs during pregnancy, I mean, some would argue yes, but I would argue, why, that’s not really an accurate representation of what your strength is anyways. So you know, you do have to to kind of keep manipulating the numbers and the weights and the intensity and the sets and reps in order to do it. But weightlifting and resistance training is safe, and it is effective. Now, outside of that, there’s not a lot of unsafe things to do, again, outside of contact sports, or things that would elicit, you know, potential trauma to you or baby based on impact we’ve had, again, not our recommendations, but some have tried very just easy scheme, because they’re in the winter months, and they wanted to and they felt very confident about not falling. So you know, you have those types of things.

 

Anthony Gurule  08:16

Overall, again, we’re talking about movement. You need to move, and it’s good to get your heart rate up. And it’s good to breathe hard. So that doesn’t mean just because you’re pregnant, you can’t do HIIT training or circuit training or CrossFit or Orange Theory. But you do have to listen to your body and understand certain signs that would indicate that things might be too much, right? Now those are going to be different for everyone, but a lot of this comes down to you know, lightheadedness, you know, breathing too hard. Certain aches and pains within lower extremity, chest, abdomen, so on and so forth would be obviously like your more extreme ones. If you’re becoming pale or anything like that, I mean, again, these are the same criteria, though, that would be if someone else was working out or training too hard. So it’s realistically the same thing. It’s just that your threshold level for all those most likely have gone down. And depending on what type of an athlete you were before, you’re going to be maybe a little frustrated that you’re not able to do the things you were able to do previously, which makes sense. But if you’re someone who wasn’t exercising before, you’re probably going to be a little bit more hyper aware of that, of just feeling that shortness of breath or that uneasiness. So again, we’re not saying you have to push through that because we’re not trying to set yourself up for a strength and conditioning program to increase your metabolic capacity to increase your strength and conditioning during pregnancy. We’re trying to help you maintain a healthy active pregnancy.

 

Anthony Gurule  09:54

Now, walking. walking is great. but in general, we encourage you to do something above and beyond walking. Obviously, again, certain things would dictate that you would not be able to do so. And this is again, any exercise. Any exercise that you do during pregnancy needs to be consulted with and work through and have a conversation with the primary physician who is managing your pregnancy, whether that’s your nurse practitioner, your midwife or your OB or obstetrician, right. But we would encourage more than just walking. walking is fantastic, but that’s kind of like your baseline minimum, right? Just like our activities, or recommendation activity guidelines. We want a few days a week of where we’re kind of just doing this steady state getting our steps in, you know, kind of pushing ourselves, we’re huffing and puffing, but still just kind of at that conversational level, but you’re not really getting a lot of benefits outside of that.

 

Anthony Gurule  10:55

So if you’re just walking, high five. kudos. can you do something more? Can you do some bodyweight squats? Can you do some bodyweight, you know, good mornings? can you do some walking lunges? do you have a suspension training, we’re able to do some bodyweight rows? Do you have some bands that you can do some rows with? You know, there’s a lot that you can do that allows you to get a little bit more out of that. Now, again, this all comes back down to preferences of exercises that you like to do, because that’s gonna allow you to maintain the most consistency, but then also the intensity that you like to do. And we do encourage having an open mind and at least being willing to try some high intensity things that allow you to still get your heart rate up a little bit. And it’s okay to lift more than five or 10 pounds. And not saying that that is a bad thing. There’s programs out there where it’s all directed around that where it’s lighter weight, high rep, but I just don’t want individuals and mamas to feel like they’re not able to do more and or being ashamed because other people are just saying they should back off because they’re pregnant. “why would you need a lift that much?” It fits within your strength, and your comfort, and your wheelhouse, that is totally fine.

 

Anthony Gurule  12:05

Again, you if you’ve been doing that enough, you understand the risk reward ratio and having a conversation with your practitioner has driven us to kind of help navigate and guide as you start to get further through pregnancies, what things maybe we need to change or manipulate. But that’s totally fine. Now outside of that, the question around safe also comes up around core exercises. diastasis recti, pelvic floor strength, so on and so forth, we want to enhance the capability of understanding how to control tension within your abdominal wall and your pelvic floor through pregnancy, because the pressure is increasing due to baby taking up more space. But we’re not we’re not necessarily we’re not gaining more strength, right.

 

Anthony Gurule  12:45

And so what a lot of people assume it’s when we’ve seen this, is “I don’t want diastasis. So I’m doing more core work to prevent diastasis from happening.” diastasis recti will happen in 100% of moms, it’s estimated at the week 35 Everyone will have some form of it. Now it is technically not a quote unquote diagnosis, though, until 12 weeks postpartum, because it is a normal thing that everyone will get. So you can’t diagnose someone with something that everyone will get–doesn’t make sense, right? So after that, though, if you still have weakness or spacing issues, then we can have a you know, a stronger conversation about putting a diagnosis on that.

 

Anthony Gurule  13:26

But what we’re trying to enhance and help is what exercises are quote unquote, not safe versus unsafe, but adding too much pressure or tension into the abdominal wall or the pelvic floor and creating more laxity. again, as that pressure for as baby’s growing starts to put more pressure on the pelvic floor and the abdominal wall. If you’re doing more things that increases the pressure within the within the abdominal cavity that’s going to push on that separation even more and/or push on that pelvic floor even more, creating potential incontinence or prolapse issues and/or more bulging and doming within the abdominal wall stretching out that separation or that gap even further, potentially making the recovery process more challenging or slightly longer. I’m not saying that it will but potentially, so we do have to take that in consideration. So we go through activation exercise of the pelvic floor, of the abdominal wall so that you better understand how to control those pressure increases while you’re lifting or exercising so that you simply can stay at a management level.

 

Anthony Gurule  14:28

And that in turn, helps you get through pregnancy of understanding how to lift up your older kiddo, having to lift up dog food or anything like that. It’s just managing and controlling pressure. So there’s really not anything that I would say that safe or unsafe. Now, things that we would advise against for core exercises is sit ups or crunches. You know a lot of those things that create like hanging knee raises and different things like that during pregnancy. A lot of those things that create a lot of intra abdominal pressure and tension. and especially during a flex position, that tends to put a lot more pressure on the abdominal wall, the separation where diastasis will occur as well as the pelvic floor.

 

Anthony Gurule  15:09

So, you know, while we never say never, there’s definitely a category of things that we definitely urge against because the risk/reward benefit and again, risk not being “injured,” But risk of potentially putting more pressure and making the recovery process  on the other side harder, is not is not something that we find to be as advantageous. But you can still get the benefits of quote unquote, core exercises through full body movements such as goblet squats, such as deadlifts, you know, depending on the phase that you’re in, push ups, which are, you know, a dynamic plank. or being able to do a TRX row, which is a reverse plank as you’re just lifting yourself up. three point rows where you’re on, you know, two hands or doing like a row on a bench, where you’re in a tabletop position that’s adding anti rotation exercises. So there’s a ton that you can do that still highlights and isolates, the core isolates, sorry. that highlights and will emphasize core activation, but through a full body compound movement. And what’s great about that is during pregnancy, depending on your energy levels, it’s hard to do all the little isolated accessory and all these separate exercises as it is. So it’s kind of nice being able to combine everything, so you get more bang for your buck, especially if you’re a parent and you’re on and you’re on baby number two or three, right?

 

Anthony Gurule  16:31

So what exercises are safe for pregnant women to do? All are. reduce or eliminate for sure contact activities, different things like that. the increased risk activities of you know, trauma and things like that. Outside of that you’re managing pressure, I would definitely encourage reducing anything that’s heavy lifting, that’s, that’s requiring you to do Valsalva moves, you’re having to hold your breath for an extended period of time. that changes blood pressure, so on and so forth. But outside of that, Pregnancy is a completely safe time to do all exercises. we definitely as we highlighted, urge and encourage, you know, certain things over other ones just for you know, added bang for your buck or full body movements, so on and so forth. And that, but outside of that you are free to do what you want.

 

Anthony Gurule  17:19

If you want guidance, though, you know, there are there are trainers out there that work specifically with prenatal patients. we would love to be able to have that conversation with you if that’s something you want to bounce back or navigate. Because we do want to encourage as much as we can. A very, very active pregnancy through exercise working out or however you want to describe that. So if you found this beneficial, please like share, subscribe. if you’re pregnant, I hope you can utilize this and take some of the information for you and yourself. If you have anyone else you know… a relative a family member, a friend who is pregnant and they’re unsure they’ve been you know asking this question what things I don’t know what things I can do. I don’t know if it’s safe for baby share this video with them. We’d love to be able to provide a better frame of reference and or context to be able to ask better questions so that they can find the workout program  or the movements that work best for them during their pregnancy. Until next time guys live loud .if you’re currently pregnant, Congratulations, and we look forward to helping and serving in the future.