Staying Active and Safe: 4 Essential Injury Prevention Tips for Your Second and Third Trimesters
The second and third trimesters are a period of incredible transformation. As your baby grows, your centre of gravity shifts, your ligaments loosen due to hormonal changes like relaxin, and your body undergoes significant biomechanical adjustments.
As a Doctor of Physical Therapy and a Pilates instructor, I often see expectant mothers who are eager to maintain their fitness but aren't quite sure how to adapt their movement to these changes. My journey from studying bodywork to specialising in pelvic health has shown me that exercise during pregnancy isn't just about "staying in shape"—it’s about preparing your body for the marathon of birth and the physical demands of postpartum recovery.
Maintaining an active lifestyle is wonderful for both you and your baby, but the goal during the later stages of pregnancy shifts from "performance" to "functional stability." To help you navigate this, I’ve outlined four foundational tips to prevent injury and support your pelvic health as you move through your second and third trimesters.
1. Never Skip the Warm-Up: Preparing the Joints
When I’m out on a wilderness search and rescue mission or practicing Wing Chun, I know that my body cannot perform without a proper primer. During the second and third trimesters, a warm-up is even more critical than it was pre-pregnancy.
Because of the increased presence of relaxin, your joints are naturally more mobile—and consequently, less stable. A focused warm-up helps "wake up" the proprioceptors (the sensors in your joints that tell your brain where your body is in space), which is vital for preventing rolled ankles or strained backs.
Focus on Mobility, Not Just Stretching
Rather than static stretching, focus on gentle joint nourishment:
Hip and Shoulder Circles: Use slow, controlled circular motions to lubricate the ball-and-socket joints.
Spinal Articulation: Move your spine through its full range—flexion, extension, side-bending, and rotation. However, keep these movements to a "mid-range." Avoid pushing to your absolute end-range of motion, as your ligaments are more vulnerable to over-stretching right now.
The Mind-Body Connection: Give yourself five to ten minutes to really feel the effects of the blood flow increasing. In my Zen tea ceremony practice, we value the transition into the task; treat your warm-up as your transition into honouring your body’s current state.
2. Use Breath as Your Engine: The Power of the Exhale
In the world of pelvic health, we have a saying: "Exhale on exertion." Your breath is the most powerful tool you have to manage intra-abdominal pressure and protect your pelvic floor.
Your Exhale is Your Engine
Think of your exhale as the ignition switch for your deep core. When you breathe out during the most difficult part of a movement—such as standing up from a squat or lifting a grocery bag—you naturally encourage the diaphragm to lift. This, in turn, helps the pelvic floor lift and the transverse abdominis (your "corset" muscle) to contract.
Supporting the Pelvis and Spine
Activating these deep core muscles creates a natural internal brace. This support is crucial for decreasing the pelvic girdle pain (PGP) and lower back irritation that many women experience as their bump grows. When you use your breath to power your movement, you aren't just working out; you are actively protecting your spine and reducing the risk of long-term pelvic floor dysfunction.
3. Prioritise Single-Plane Movements
During my time earning my DPT in Colorado, I spent a lot of time studying how the body adapts to stress. During pregnancy, your body needs significantly more time to adapt to "higher-level" demands. While multi-plane movements (like a lunge with a twist and a pivot) are great for athletes, they can be a bit too much for the pregnant pelvis to manage safely in the third trimester.
Simplifying the Demand
I recommend starting your workouts with single-plane movements before even considering a transition to multi-plane exercises.
Single Plane: Moving forward and back (like a standard lunge) or side to side (a side squat).
The Pivot Risk: Think about the difference between a rotation in place versus a rotation with a pivot. A pivot adds a shearing force to the SI joints and the pubic symphysis, which are already under strain.
By keeping movements simpler and more linear, you allow your nervous system and your connective tissues to manage the load without the risk of "tripping up" or over-straining a specific area.
4. Monitor for "Tenting" and Manage Pressure
One of the most common questions I get in the clinic and the Pilates studio is about abdominal separation, or Diastasis Recti Abdominis (DRA). To prevent worsening this condition, it is vital to limit or eliminate exercises that create "tenting" or "coning" along the midline of your stomach.
The Problem with Planks
While planks are a gold-standard core exercise for many, the downward pressure of the baby against the abdominal wall during a plank can be too much in the second and third trimesters. This pressure often manifests as:
Tenting: A visible ridge or "coning" down the centre of your belly.
Pelvic Floor Symptoms: A feeling of heaviness, pressure, or accidental leakage.
The "Pull" Effect
Tenting is a sign that the intra-abdominal pressure is not being managed correctly and is pushing against the linea alba (the connective tissue between your six-pack muscles). This create a "pull" effect that may worsen DRA symptoms and make postpartum recovery more difficult.
What to do instead: Swap planks for bird-dogs, side planks (if no coning is present), or seated core activations. There are countless ways to strengthen your core that don't involve the high-risk "all-fours" or prone positions that gravity makes so difficult during late pregnancy.
Final Thoughts: Moving with Intention
As someone who loves the intensity of climbing and the endurance of running, I know it can be frustrating to "scale back." However, I invite you to view this not as a regression, but as a different kind of training. You are training for the most athletic event of your life.
By focusing on joint stability, intentional breathing, simplified movement patterns, and pressure management, you are setting yourself up for a much smoother postpartum recovery. Your body is doing something incredible—treat it with the same respect and care you would give to any elite athlete.
If you are experiencing persistent pain or are unsure if your form is correct, I highly recommend seeing a pelvic health physical therapist. We are here to help you move with confidence, from the trail to the nursery.
Stay active, stay safe, and listen to the wisdom of your body.
About the Author: Jess, DPT, NCPT
Jess is a Bay Area-based Doctor of Physical Therapy and Nationally Certified Pilates Teacher specializing in pelvic health and orthopaedics. When she isn't in the clinic, you can find her volunteering for wilderness search and rescue, practicing Wing Chun, or enjoying a quiet Japanese tea ceremony.