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Biomechanical Adaptations of Gait in Pregnancy: Implications for Physical Activity and Exercise

  • Rita Santos-RochaEmail author
  • Marco Branco
  • Liliana Aguiar
  • Filomena Vieira
  • António Prieto Veloso
Chapter

Abstract

During pregnancy, women experience several changes in the body’s physiology, morphology, and hormonal system. These changes may affect the balance and body stability and can cause discomfort and pain. The adaptations of the musculoskeletal system due to morphological changes during pregnancy are not fully understood. Few studies clarify the biomechanical changes of gait that occur during pregnancy and in postpartum. The purpose of this chapter is to analyze the available evidence on the biomechanical adaptations of gait that occur throughout pregnancy and in postpartum, specifically with regard to the temporal, spatial, kinematic, and kinetic parameters of gait and balance.

The highlights of this chapter are the following: (1) Pregnancy requires biomechanical adjustments as shown by several publications in the last 20 years. (2) Adaptations due to pregnancy are recognized to provide safety and stability. (3) Most studies performed a temporal, spatial, and kinematic analysis, and few studies performed a kinetic analysis. (4) There is lack of consistency in the results of biomechanical studies due to different methodological approaches. (5) The adaptation strategies to the anatomical and physiological changes throughout pregnancy are still unclear, particularly in a longitudinal perspective and regarding kinetic parameters. (6) The main biomechanical adaptations during pregnancy are gait speed reduction, longer double-support time, and increased step width, and ground reaction forces decrease. (7) There is lack of information regarding the effects of physical activity and exercise, risk of falls, and low back pain on the biomechanical adjustments. (8) Exercise adaptations can be provided in order to increase adherence, safety, and effectiveness.

Keywords

Pregnancy Postpartum Biomechanics Loading Gait Balance Exercise 

References

  1. 1.
    Paisley TS, Joy EA, Price RJ Jr. Exercise during pregnancy: a practical approach. Curr Sports Med Rep. 2003;2(6):325–30.CrossRefGoogle Scholar
  2. 2.
    ACOG. Your pregnancy and childbirth: month to month. 5th ed. Washington, DC: American College of Obstetricians and Gynecologists; 2010. p. xiv, 467.Google Scholar
  3. 3.
    Bø K, Artal R, Barakat R, Brown W, Davies GAL, Dooley M, et al. Exercise and pregnancy in recreational and elite athletes: 2016 evidence summary from the IOC expert group meeting, Lausanne. Part 1—exercise in women planning pregnancy and those who are pregnant. Br J Sport Med. 2016;50(10):571.CrossRefGoogle Scholar
  4. 4.
    Oken E, Ning Y, Rifas-Shiman SL, Radesky JS, Rich-Edwards JW, Gillman MW. Associations of physical activity and inactivity before and during pregnancy with glucose tolerance. Obstet Gynecol. 2006;108(5):1200–7.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Foxcroft KF, Callaway LK, Byrne NM, Webster J. Development and validation of a pregnancy symptoms inventory. BMC Pregnancy Childbirth. 2013;13(1):3.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Borg-Stein J, Dugan SA, Gruber J. Musculoskeletal aspects of pregnancy. Am J Phys Med Rehabil. 2005;84(3):180–92.CrossRefGoogle Scholar
  7. 7.
    Domingues MR, Barros AJ. Leisure-time physical activity during pregnancy in the 2004 Pelotas Birth Cohort Study. Rev Saude Publica. 2007;41(2):173–80.CrossRefGoogle Scholar
  8. 8.
    Pereira MA, Rifas-Shiman SL, Kleinman KP, Rich-Edwards JW, Peterson KE, Gillman MW. Predictors of change in physical activity during and after pregnancy: Project Viva. Am J Prev Med. 2007;32(4):312–9.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Borodulin K, Evenson KR, Monda K, Wen F, Herring AH, Dole N. Physical activity and sleep among pregnant women. Paediatr Perinat Epidemiol. 2010;24(1):45–52.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    DiNallo JM, Williams NI, Downs DS, Le Masurier GC. Walking for health in pregnancy. Res Q Exerc Sport. 2008;79(1):28–35.Google Scholar
  11. 11.
    Owe KM, Nystad W, Bø K. Correlates of regular exercise during pregnancy: the Norwegian Mother and Child Cohort Study. Scand J Med Sci Spor. 2009;19(5):637–45.CrossRefGoogle Scholar
  12. 12.
    Evenson KR, Wen F. National trends in self-reported physical activity and sedentary behaviors among pregnant women: NHANES 1999–2006. Prev Med. 2010;50(3):123–8.CrossRefGoogle Scholar
  13. 13.
    Walsh JM, McGowan CA, Mahony R, Foley ME, McAuliffe FM. Low glycaemic index diet in pregnancy to prevent macrosomia (ROLO study): randomised control trial. BMJ. 2012;345:e5605.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Hegaard HK, Damm P, Hedegaard M, Henriksen TB, Ottesen B, Dykes A-K, et al. Sports and leisure time physical activity during pregnancy in nulliparous women. Matern Child Health J. 2011;15(6):806–13.CrossRefGoogle Scholar
  15. 15.
    Tinloy J, Chuang CH, Zhu J, Pauli J, Kraschnewski JL, Kjerulff KH. Exercise during pregnancy and risk of late preterm birth, cesarean delivery, and hospitalizations. Womens Health Issues. 2014;24(1):e99–e104.PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Liu L, Su H, Yu M. Full-term delivery in a pregnant breast cancer patient. Acta Obstet Gyn Scan. 2011;90(12):1454.CrossRefGoogle Scholar
  17. 17.
    Segal NA, Chu SR. Musculoskeletal anatomic, gait, and balance changes in pregnancy and risk for falls. In: Fitzgerald CM, Segal NA, editors. Musculoskeletal health in pregnancy and postpartum: an evidence-based guide for clinicians. Cham: Springer; 2015. p. 1–18.Google Scholar
  18. 18.
    Barakat R, Perales M, Garatachea N, Ruiz JR, Lucia A. Exercise during pregnancy. A narrative review asking: what do we know? Br J Sports Med. 2015;49(21):1377–81.CrossRefGoogle Scholar
  19. 19.
    Reese ME, Casey E. Hormonal influence on the neuromusculoskeletal system in pregnancy. In: Fitzgerald CM, Segal NA, editors. Musculoskeletal health in pregnancy and postpartum: an evidence-based guide for clinicians. Cham: Springer; 2015. p. 19–39.Google Scholar
  20. 20.
    Rasmussen KM, Yaktine AL, Institute of Medicine and National Research Council of the National Academies. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: The National Academies Press; 2009.Google Scholar
  21. 21.
    Wang TW, Apgar BS. Exercise during pregnancy. Am Fam Physician. 1998;57(8):1846–52. 57Google Scholar
  22. 22.
    Whitcome KK, Shapiro LJ, Lieberman DE. Fetal load and the evolution of lumbar lordosis in bipedal hominins. Nature. 2007;450(7172):1075–U11.CrossRefGoogle Scholar
  23. 23.
    Ostgaard HC, Andersson GB, Schultz AB, Miller JA. Influence of some biomechanical factors on low-back pain in pregnancy. Spine (Phila Pa 1976). 1993;18(1):61–5.CrossRefGoogle Scholar
  24. 24.
    Gilleard WL, Brown JM. Structure and function of the abdominal muscles in primigravid subjects during pregnancy and the immediate postbirth period. Phys Ther. 1996;76(7):750–62.CrossRefGoogle Scholar
  25. 25.
    Foti T, Davids JR, Bagley A. A biomechanical analysis of gait during pregnancy. J Bone Joint Surg Am. 2000;82A(5):625–32.CrossRefGoogle Scholar
  26. 26.
    Gutke A, Ostgaard HC, Oberg B. Predicting persistent pregnancy-related low back pain. Spine (Phila Pa 1976). 2008;33(12):E386–93.CrossRefGoogle Scholar
  27. 27.
    Wang SM, Dezinno P, Maranets I, Berman MR, Caldwell-Andrews AA, Kain ZN. Low back pain during pregnancy: prevalence, risk factors, and outcomes. Obstet Gynecol. 2004;104(1):65–70.CrossRefGoogle Scholar
  28. 28.
    Aldabe D, Milosavljevic S, Bussey MD. Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review. Eur Spine J. 2012;21(9):1777–87.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Monteiro M, Gabriel R, Aranha J, Neves e Castro M, Sousa M, Moreira M. Influence of obesity and sarcopenic obesity on plantar pressure of postmenopausal women. Clin Biomech (Bristol, Avon). 2010;25(5):461–7.CrossRefGoogle Scholar
  30. 30.
    Woo J, Leung J, Kwok T. BMI, body composition, and physical functioning in older adults. Obesity. 2007;15(7):1886–94.CrossRefGoogle Scholar
  31. 31.
    Bosch K, Nagel A, Weigend L, Rosenbaum D. From “first” to “last” steps in life – pressure patterns of three generations. Clin Biomech. 2009;24(8):676–81.CrossRefGoogle Scholar
  32. 32.
    Butler EE, Druzin M, Sullivan EV. Gait adaptations in adulthood: pregnancy, aging, and alcoholism. In: Rose J, Gamble JG, editors. Human walking. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2006. p. 131–48.Google Scholar
  33. 33.
    Hong Y, Bartlett R. Routledge handbook of biomechanics and human movement science. London: Routledge; 2010. p. xi, 606.Google Scholar
  34. 34.
    American College of Sports Medicine, Riebe D, Ehrman JK, Liguori G, Magal M. ACSM’s guidelines for exercise testing and prescription. 10th ed. Philadelphia, PA: Wolters Kluwer; 2018. p. xxx, 472.Google Scholar
  35. 35.
    Nigg BM, Herzog W. Biomechanics of the musculo-skeletal system. 3rd ed. Hoboken, NJ: John Wiley & Sons; 2007. p. xiii, 672.Google Scholar
  36. 36.
    Elliott B. Biomechanics: an integral part of sport science and sport medicine. J Sci Med Sport. 1999;2(4):299–310.CrossRefGoogle Scholar
  37. 37.
    Brüggemann G-P, Potthast W, Braunstein B, Niehoff A. Effect of increased mechanical stimuli on foot muscles functional capacity. In: Cavanagh PR, Crago PE, editors. XXth congress of the international society of biomechanics and 29th annual meeting of the American Society of Biomechanics. Cleveland, OH: International Society of Biomechanics; 2005.Google Scholar
  38. 38.
    Nicholls JA, Grieve DW. Performance of physical tasks in pregnancy. Ergonomics. 1992;35(3):301–11.CrossRefGoogle Scholar
  39. 39.
    Perry J. Gait analysis: normal and pathological function. Thorofare, NJ: SLACK; 1992. p. xxxii, 524.Google Scholar
  40. 40.
    Forczek W, Staszkiewicz R. Changes of kinematic gait parameters due to pregnancy. Acta Bioeng Biomech. 2012;14(4):113–9.PubMedPubMedCentralGoogle Scholar
  41. 41.
    Lymbery JK, Gilleard W. The stance phase of walking during late pregnancy – temporospatial and ground reaction force variables. J Am Podiat Med Assn. 2005;95(3):247–53.CrossRefGoogle Scholar
  42. 42.
    Gilleard WL. Trunk motion and gait characteristics of pregnant women when walking: report of a longitudinal study with a control group. BMC Pregnancy Childbirth. 2013;13:71.PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Branco M, Santos-Rocha R, Vieira F, Aguiar L, Veloso AP. Three-dimensional kinematic adaptations of gait throughout pregnancy and postpartum. Acta Bioeng Biomech. 2016;18(2):153–62.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Abdel-Aziz YI, Karara HM, Hauck M. Direct linear transformation from comparator coordinates into object space coordinates in close-range photogrammetry*. Photogramm Eng Remote Sens. 2015;81(2):103–7.CrossRefGoogle Scholar
  45. 45.
    Bartlett R. Introduction to sports biomechanics : analysing human movement patterns. 2nd ed. New York, NY: Routledge; 2007.CrossRefGoogle Scholar
  46. 46.
    Richards J. Biomechanics in clinic and research : an interactive teaching and learning course. New York, NY: Churchill Livingstone; 2008. p. xvii, 207.Google Scholar
  47. 47.
    Robertson DGE, Caldwell GE, Hamill J, Kamen G, Whittlesey SN. Research methods in biomechanics. 2nd ed. Human Kinetics: Champaign, IL, USA; 2014.Google Scholar
  48. 48.
    Winter DA. Biomechanics and motor control of human movement. 4th ed. Hoboken, NJ: Wiley; 2009. p. xiv, 370.CrossRefGoogle Scholar
  49. 49.
    Nigg BM, Liu W. The effect of muscle stiffness and damping on simulated impact force peaks during running. J Biomech. 1999;32(8):849–56.CrossRefGoogle Scholar
  50. 50.
    Miller D. Ground reaction forces in distance running. In: Cavanagh PR, editor. Biomechanics of distance running [Internet]. Champaign, IL: Human Kinetics; 1990.Google Scholar
  51. 51.
    Peterson DR, Bronzino JD. Biomechanics : principles and applications. Boca Raton, FL: CRC; 2008.Google Scholar
  52. 52.
    Whittle M. Gait analysis: an introduction. 4th ed. New York, NY: Butterworth-Heinemann; 2007.Google Scholar
  53. 53.
    Inman DJ, Soutas-Little R. Engineering mechanics: dynamics. Upper Saddle River, NJ: Prentice Hall; 1998. p. 702.Google Scholar
  54. 54.
    Nigg BM, MacIntosh BR, Mester J. Biomechanics and biology of movement. Champaign, IL: Human Kinetics; 2000. p. xvii, 465.Google Scholar
  55. 55.
    Watkins J. Structure and function of the musculoskeletal system. 2nd ed. Champaign, IL: Human Kinetics; 2010. p. viii, 399.Google Scholar
  56. 56.
    Turner CH, Robling AG. Designing exercise regimens to increase bone strength. Exerc Sport Sci Rev. 2003;31(1):45–50.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Witzke KA, Snow CM. Effects of plyometric jump training on bone mass in adolescent girls. Med Sci Sports Exerc. 2000;32(6):1051–7.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Hohmann E, Reaburn P, Tetsworth K, Imhoff A. Plantar pressures during long distance running: an investigation of 10 marathon runners. J Sports Sci Med. 2016;15(2):254–62.PubMedCentralPubMedGoogle Scholar
  59. 59.
    Hennig EM, Milani TL. In-shoe pressure distribution for running in various types of footwear. J Appl Biomech. 1995;11(3):299–310.CrossRefGoogle Scholar
  60. 60.
    Hughes J, Pratt L, Linge K, Clark P, Klenerman L. Reliability of pressure measurements: the EM ED F system. Clin Biomech. 1991;6(1):14–8.CrossRefGoogle Scholar
  61. 61.
    Santos-Rocha R, Veloso A. Comparative study of plantar pressure during step exercise in different floor conditions. J Appl Biomech. 2007;23(2):162–8.CrossRefGoogle Scholar
  62. 62.
    Abdul Razak AH, Zayegh A, Begg RK, Wahab Y. Foot plantar pressure measurement system: a review. Sensors Basel. 2012;12(7):9884.CrossRefGoogle Scholar
  63. 63.
    Robinson CC, Balbinot LF, Silva MF, Achaval M, Zaro MA. Plantar pressure distribution patterns of individuals with prediabetes in comparison with healthy individuals and individuals with diabetes. J Diabetes Sci Technol. 2013;7(5):1113–21.PubMedCentralCrossRefPubMedGoogle Scholar
  64. 64.
    Keijsers NLW, Stolwijk NM, Louwerens JWK, Duysens J. Classification of forefoot pain based on plantar pressure measurements. Clin Biomech. 2013;28(3):350–6.CrossRefGoogle Scholar
  65. 65.
    Amemiya A, Noguchi H, Oe M, Ohashi Y, Ueki K, Kadowaki T, et al. Elevated plantar pressure in diabetic patients and its relationship with their gait features. Gait Posture. 2014;40(3):408–14.CrossRefGoogle Scholar
  66. 66.
    Butterworth PA, Landorf KB, Gilleard W, Urquhart DM, Menz HB. The association between body composition and foot structure and function: a systematic review. Obes Rev. 2014;15(4):348–57.CrossRefGoogle Scholar
  67. 67.
    O'Brien DL, Tyndyk M. Effect of arch type and Body Mass Index on plantar pressure distribution during stance phase of gait. Acta Bioeng Biomech. 2014;16(2):131–5.Google Scholar
  68. 68.
    Mickle KJ, Munro BJ, Lord SR, Menz HB, Steele JR. Foot pain, plantar pressures, and falls in older people: a prospective study. J Am Geriatr Soc. 2010;58(10):1936–40.CrossRefGoogle Scholar
  69. 69.
    Fernando M, Crowther R, Lazzarini P, Sangla K, Cunningham M, Buttner P, et al. Biomechanical characteristics of peripheral diabetic neuropathy: a systematic review and meta-analysis of findings from the gait cycle, muscle activity and dynamic barefoot plantar pressure. Clin Biomech (Bristol, Avon). 2013;28(8):831–45.CrossRefGoogle Scholar
  70. 70.
    Justin S, Joshua B, Roger A, Evangelos P, Jack C. Musculoskeletal and activity-related factors associated with plantar heel pain. Foot Ankle Int. 2014;36(1):37–45.Google Scholar
  71. 71.
    Ramalho F, Santos-Rocha R, Branco M, Moniz-Pereira V, André HI, Veloso AP, et al. Effect of 6-month community-based exercise interventions on gait and functional fitness of an older population: a quasi-experimental study. Clin Interv Aging. 2018;13:595–606.PubMedCentralCrossRefPubMedGoogle Scholar
  72. 72.
    Branco M, Santos-Rocha R, Vieira F. Biomechanics of gait during pregnancy. Sci World J. 2014;2014:5.CrossRefGoogle Scholar
  73. 73.
    Ribeiro AP, Joao SM, Sacco IC. Static and dynamic biomechanical adaptations of the lower limbs and gait pattern changes during pregnancy. Women’s Health (Lond Engl). 2013;9(1):99–108.CrossRefGoogle Scholar
  74. 74.
    Anselmo DS, Love E, Tango DN, Robinson L. Musculoskeletal effects of pregnancy on the lower extremity. A literature review. J Am Podiatr Med Assoc. 2017;107(1):60–4.CrossRefGoogle Scholar
  75. 75.
    Nyska M, Sofer D, Porat A, Howard CB, Levi A, Meizner I. Planter foot pressures in pregnant women. Israel J Med Sci. 1997;33(2):139–46.Google Scholar
  76. 76.
    Goldberg J, Besser MP, Selby-Silverstein L. Changes in foot function throughout pregnancy. Obstet Gynecol. 2001;97(4):S39.Google Scholar
  77. 77.
    Huang T-H, Lin S-C, Ho C-S, Yu C-Y, Chou Y-L. The gait analysis of pregnant women. Biomed Eng Appl Basis Commun. 2002;14(2):4.CrossRefGoogle Scholar
  78. 78.
    Ribas SI, Guirro ECO. Analysis of plantar pressure and postural balance during different phases of pregnancy. Rev Bras Fisioter. 2007;11(5):391–6.CrossRefGoogle Scholar
  79. 79.
    Carpes F, Griebeler D, Kleinpaul J, Mann L, Mota C. Women able-bodied gait kinematics during and post pregnancy period. Braz J Biomech. 2008;9(16):33–9.Google Scholar
  80. 80.
    Gaymer C, Whalley H, Achten J, Vatish M, Costa ML. Midfoot plantar pressure significantly increases during late gestation. Foot. 2009;19(2):114–6.CrossRefGoogle Scholar
  81. 81.
    Karadag-Saygi E, Unlu-Ozkan F, Basgul A. Plantar pressure and foot pain in the last trimester of pregnancy. Foot Ankle Int. 2010;31(2):153–7.CrossRefGoogle Scholar
  82. 82.
    Hagan L, Wong CK. Gait in pregnant women: spinal and lower extremity changes from pre- to postpartum. J Women’s Health Phys Ther. 2010;34(2):46–56.CrossRefGoogle Scholar
  83. 83.
    Ribeiro AP, Trombini-Souza F, Sacco IDN, Ruano R, Zugaib M, Joao SMA. Changes in the plantar pressure distribution during gait throughout gestation. J Am Podiat Med Assn. 2011;101(5):415–23.CrossRefGoogle Scholar
  84. 84.
    McCrory JL, Chambers AJ, Daftary A, Redfern MS. Ground reaction forces during gait in pregnant fallers and non-fallers. Gait Posture. 2011;34(4):524–8.CrossRefGoogle Scholar
  85. 85.
    Moccellin AS, Driusso P. Adjustments in static and dynamic postural control during pregnancy and their relationship with quality of life: a descriptive study. Fisioterapia. 2012;34(5):196–202.CrossRefGoogle Scholar
  86. 86.
    Branco M, Santos-Rocha R, Aguiar L, Vieira F, Veloso AP. Kinematic analysis of gait in the second and third trimesters of pregnancy. J Pregnancy. 2013;2013:718095.PubMedCentralCrossRefPubMedGoogle Scholar
  87. 87.
    Aguiar L, Santos-Rocha R, Vieira F, Branco M, Andrade C, Veloso A. Comparison between overweight due to pregnancy and due to added weight to simulate body mass distribution in pregnancy. Gait Posture. 2015;42(4):511–7.CrossRefGoogle Scholar
  88. 88.
    Branco M, Santos-Rocha R, Vieira F, Aguiar L, Veloso AP. Three-dimensional kinetic adaptations of gait throughout pregnancy and postpartum. Scientifica (Cairo). 2015;2015(2015):580374.Google Scholar
  89. 89.
    Yoo H, Shin D, Song C. Changes in the spinal curvature, degree of pain, balance ability, and gait ability according to pregnancy period in pregnant and nonpregnant women. J Phys Ther Sci. 2015;27(1):279–84.PubMedCentralCrossRefPubMedGoogle Scholar
  90. 90.
    Gimunova M, Kasović M, Zvonar M, Turčínek P, Matković B, Ventruba P, et al. Analysis of ground reaction force in gait during different phases of pregnancy. Kinesiology (Zagreb). 2015;47(2):236–41.Google Scholar
  91. 91.
    Bertuit J, Leyh C, Rooze M, Feipel V. Plantar pressure during gait in pregnant women. J Am Podiat Med Assn. 2016;106(6):398–405.CrossRefGoogle Scholar
  92. 92.
    Branco M, Santos-Rocha R, Aguiar L, Vieira F, Veloso AP. Kinetic analysis of gait in the second and third trimesters of pregnancy. J Mech Med Biol. 2016;16(4):1–12.CrossRefGoogle Scholar
  93. 93.
    Blaszczyk JW, Opala-Berdzik A, Plewa M. Adaptive changes in spatiotemporal gait characteristics in women during pregnancy. Gait Posture. 2016;43:160–4.CrossRefGoogle Scholar
  94. 94.
    Ramachandra P, Kumar P, Kamath A, Maiya AG. Do structural changes of the foot influence plantar pressure patterns during various stages of pregnancy and postpartum? Foot Ankle Spec. 2017;10(6):513–9.CrossRefGoogle Scholar
  95. 95.
    Elsayed E, Devreux I, Embaby H, Alsayed A, Alshehri M. Changes in foot plantar pressure in pregnant women. J Back Musculoskelet Rehabil. 2017;30(4):863–7.CrossRefGoogle Scholar
  96. 96.
    Sunaga Y, Anan M, Shinkoda K. Biomechanics of rising from a chair and walking in pregnant women. Appl Ergon. 2013;44(5):792–8.CrossRefGoogle Scholar
  97. 97.
    Aguiar L, Andrade C, Branco M, Santos-Rocha R, Vieira F, Veloso A. Global optimization method applied to the kinematics of gait in pregnant women. J Mech Med Biol. 2016;16(6):1650084.CrossRefGoogle Scholar
  98. 98.
    Aguiar L, Santos-Rocha R, Branco M, Vieira F, Veloso A. Biomechanical model for kinetic and kinematic description of gait during second trimester of pregnancy to study the effects of biomechanical load on the musculoskeletal system. J Mech Med Biol. 2014;14(1):1450004.CrossRefGoogle Scholar
  99. 99.
    Rodacki CL, Fowler NE, Rodacki AL, Birch K. Stature loss and recovery in pregnant women with and without low back pain. Arch Phys Med Rehabil. 2003;84(4):507–12.CrossRefGoogle Scholar
  100. 100.
    Fries EC, Hellebrandt FA. The influence of pregnancy on the location of the center of gravity, postural stability, and body alignment. Am J Obstet Gynecol. 1943;46:374–80.CrossRefGoogle Scholar
  101. 101.
    Calguneri M, Bird HA, Wright V. Changes in joint laxity occurring during pregnancy. Ann Rheum Dis. 1982;41(2):126–8.PubMedCentralCrossRefPubMedGoogle Scholar
  102. 102.
    Schauberger CW, Rooney BL, Goldsmith L, Shenton D, Silva PD, Schaper A. Peripheral joint laxity increases in pregnancy but does not correlate with serum relaxin levels. Am J Obstet Gynecol. 1996;174(2):667–71.CrossRefGoogle Scholar
  103. 103.
    Jang J, Hsiao KT, Hsiao-Wecksler ET. Balance (perceived and actual) and preferred stance width during pregnancy. Clin Biomech. 2008;23(4):468–76.CrossRefGoogle Scholar
  104. 104.
    Paisley JE, Mellion MB. Exercise during Pregnancy. Am Fam Physician. 1988;38(5):143–50.Google Scholar
  105. 105.
    Gilleard W, Crosbie J, Smith R. Effect of pregnancy on trunk range of motion when sitting and standing. Acta Obstet Gyn Scan. 2002;81(11):1011–20.CrossRefGoogle Scholar
  106. 106.
    Vullo VJ, Richardson JK, Hurvitz EA. Hip, knee, and foot pain during pregnancy and the postpartum period. J Fam Pract. 1996;43:63.Google Scholar
  107. 107.
    Albino MA, Moccellin AS, Firmento Bda S, Driusso P. Gait force propulsion modifications during pregnancy: effects of changes in feet's dimensions. Rev Bras Ginecol. 2011;33(7):164–9.CrossRefGoogle Scholar
  108. 108.
    Inanir A, Cakmak B, Hisim Y, Demirturk F. Evaluation of postural equilibrium and fall risk during pregnancy. Gait Posture. 2014;39(4):1122–5.CrossRefGoogle Scholar
  109. 109.
    Gottschall JS, Sheehan RC, Downs DS. Pregnant women exaggerate cautious gait patterns during the transition between level and hill surfaces. J Electromyogr Kinesiol. 2013;23(5):1237–42.CrossRefGoogle Scholar
  110. 110.
    McCrory JL, Chambers AJ, Daftary A, Redfern MS. Ground reaction forces during stair locomotion in pregnancy. Gait Posture. 2013;38(4):684–90.CrossRefGoogle Scholar
  111. 111.
    Ersal T, McCrory JL, Sienko KH. Theoretical and experimental indicators of falls during pregnancy as assessed by postural perturbations. Gait Posture. 2014;39(1):218–23.CrossRefGoogle Scholar
  112. 112.
    McCrory JL, Chambers AJ, Daftary A. Redfern MS. Ground reaction forces during stair locomotion in pregnant fallers and non-fallers. Clin Biomech (Bristol, Avon). 2014;29(2):143–8.CrossRefGoogle Scholar
  113. 113.
    Sawa R, Doi T, Asai T, Watanabe K, Taniguchi T, Ono R. Differences in trunk control between early and late pregnancy during gait. Gait Posture. 2015;42(4):455–9.CrossRefGoogle Scholar
  114. 114.
    Wu WH, Meijer OG, Lamoth CJC, Uegaki K, van Dieen JH, Wuisman PIJM, et al. Gait coordination in pregnancy: transverse pelvic and thoracic rotations and their relative phase. Clin Biomech. 2004;19(5):480–8.CrossRefGoogle Scholar
  115. 115.
    A.C.O.G. Exercise during pregnancy and the postpartum period (Reprinted from American College of Obstetricians and Gynecologists.). Clin Obstet Gynecol. 2003;46(2):496–9.CrossRefGoogle Scholar
  116. 116.
    Kluge J, Hall D, Louw Q, Theron G, Grove D. Specific exercises to treat pregnancy-related low back pain in a South African population. Int J Gynaecol Obstet. 2011;113(3):187–91.CrossRefGoogle Scholar
  117. 117.
    Shim MJ, Lee YS, Oh HE, Kim JS. Effects of a back-pain-reducing program during pregnancy for Korean women: a non-equivalent control-group pretest-posttest study. Int J Nurs Stud. 2007;44(1):19–28.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Rita Santos-Rocha
    • 1
    • 2
    Email author
  • Marco Branco
    • 1
    • 2
  • Liliana Aguiar
    • 2
    • 3
  • Filomena Vieira
    • 2
  • António Prieto Veloso
    • 2
  1. 1.Sport Sciences School of Rio MaiorPolytechnic Institute of SantarémRio MaiorPortugal
  2. 2.Laboratory of Biomechanics and Functional Morphology, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human KineticsUniversity of LisbonCruz Quebrada-DafundoPortugal
  3. 3.Universidade Europeia LisbonLisbonPortugal

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