懷孕媽媽體態大解析 Pregnancy and posture alterations
隨著懷孕週數的增加，身體體態也會有很大的變化。從體重的增長、賀爾蒙的影響、肚子體積增加以及日常習慣的改變，都會使姿勢與體態有所不同。此篇文章主要分析懷孕媽媽們從頭到腳哪些地方可能有潛在的受傷風險。
The body changes drastically at different pregnancy trimesters. Postural changes can be affected by the gravid uterus, hormones, increased body weight and lifestyle changes. This article focuses on what posture malalignment can be a potential harm to your body.
頸部前傾 烏龜脖子 頭向後仰 Neck forward tilting, elevated chin
懷孕後從第二個月開始，由於雌激素和黃體素的分泌量的增加，使得乳房增大。上半身的重心因此向前位移，相對的頸部容易被往前帶走。而為了平衡向前的力矩，容易出現下巴向前突出，頭向後仰的代償。可以用雙手摸摸看自己頸部後側靠近領口（大約在第6–7節頸椎）的位置，若有很明顯的骨突，則要注意是否長期處在於頸部向前凸，頭向後仰的姿勢。
Progesterone and estrogen levels elevate during the second pregnancy trimester, which increase breast size. The cervical shifts forward and the head compensates in an elevated (chin up) position due to the changes of the center of gravity. Palpate the back of the neck, approximately around the collar (6 or 7 segments of the cervical spine), there is a great chance that the head and neck is malaligned if there is an evident bone protrusion.
長期頸部姿勢不良容易導致慢性肩頸痠痛、偏頭痛，甚至手麻的症狀。
Neck forward tilting and elevated chin may cause pain around the neck and upper back, headache and even upper limb numbness.
駝背 胸椎過度前彎 Back slouching, thoracic kyphosis
乳房重量與體積的增加直接影響到胸椎的位置。在懷孕前若已經有駝背習慣的女性，在懷孕後駝背或胸椎過度前彎的問題會更加明顯。在過去的研究指出，懷孕比非懷孕的女性的背部挺直肌群(trunk extensors)較為活躍，目的是要抗衡乳房和肚子的重量。而駝背者背部肌群需要更出力才能平衡整個身體。
Increased size and weight of the breasts directly influences the position of the thoracic spine. The displacement of the thoracic spine would worsen during pregnancy if slouching is a habit before pregnant. According to a previous study, there is an increase of trunk extensor muscle activity in pregnant women compared to the nulliparous. This adaptive response is to compensate the increase of anterior loads during pregnancy. In addition, the back extensor muscles would be in a more active state in those who have thoracic kyphosis.
背部挺直肌群容易處於長期緊繃的狀態，衍伸肩胛骨中間疼痛（俗稱膏肓痛）或上背痛的問題。
Pregnant moms may have problems with upper back muscle tightness and pain in the middle of the scapula.
肋骨向上翻 Ribs out flare
以前長輩常常會提醒我們『不要駝背，抬頭挺胸』，而我們也乖乖照做。但這『挺胸』是否做對，還是我們其實都在『把肋骨向前、向上挺』？懷孕期間由於身體前方的重量增加，為了要矯正駝背姿勢，容易不小心將肋骨也向前挺了出去。外加上女性長期穿著內衣，使得胸椎與肋骨動彈不得，全部緊縮在一起，加劇了肋骨外翻的現象。胸椎與肋骨活動欠佳時，易導致肺部擴張不易，核心肌群排列不良。
In order to ‘correct’ thoracic kyphosis or slouched spine, some might have doubts about the right way of posture adjustment. Some often find themselves flaring the ribs instead of straightening the thoracic spine. This is due to the decreased mobility of the ribs which is related to wearing bra since puberty and poor postures. Malalignment of the ribs may change the placement of the diaphragm, which is crucial to normal breathing patterns and spinal stability.
媽媽們容易感到胸悶、呼吸不順暢、長期缺氧想睡、核心肌群無力、身體直立力量變差等。
Moms may experience chest tightness, hypoxia, drowsy, core muscle weakness and difficulty in maintaining your body in an upright position for a long time.
腰椎前凸 Accentuated low back curvature, lumbar lordosis
現代女性大多數在懷孕後仍在職場就業，避免不了久站、久坐或搬重物。如家中已經有其他小孩需要照顧，免不了需要抱小孩、背小孩物品等需求。在身體有負重的狀態下外加上肚子重量，容易使得腰椎過度前凸。從身體側邊觀察，可發現腰部明顯向前移位。腰椎過度前凸是核心無力的表徵之一，表肌肉無法支撐身體與外部的重量，而用腰椎的韌帶、骨頭直接性的支撐。如此使施予腰部的壓力非常大，衍伸出下背痛的問題，也是懷孕媽媽最常遇到的困擾。
Most women still work during pregnant, prolonged sitting, standing and carry weights are necessary in certain situations. Those who have small ones to care at home, holding children and carrying their necessities are needed. The increased anterior loads and external weight accentuate the low back curvature (lumbar lordosis), which place pressure on the lumbar spine. Core muscle, a trunk stabilizer, is weak in those with exaggerated lumbar lordosis. Without the help of core muscle providing support to the spine, ligaments and joints on the spine is compensated to act as stabilizers.
過度腰椎前凸易導致腰部酸痛或容易拉傷，嚴重者可能有腿麻、腿部脹痛等問題。
Low back pain is highly related to excessive lumbar lordosis. In worse conditions, some might suffer from lower limb numbness and heat due to nerve compression.
骨盆前旋（傾）Pelvis forward tilting
隨著胎兒的重量增加，骨盆腔需要承受的壓力更大，若沒有足夠的肌肉力量或穩定性，骨盆易前旋。此現象通常從第二孕期開始變明顯。易使得骨盆底肌肌群的排列位置較差，臀部肌群與腿部肌群較難使力。骨盆底肌肌群若無法好好發揮其功能偶會出現漏尿症狀。研究指出，懷孕婦女在撿東西或綁鞋帶時，會減少膝蓋的彎曲反讓腰部向前彎，容易造成腰部受傷。此現象可能來自於臀部與腿部肌肉出不了力，而腰部使用不當而造成。
The gravid uterus rotates the pelvis sagittally which puts the pelvic floor muscles, gluteal muscles and muscles around the thighs in a stretched position. The muscles may decrease in function and normal muscle tone. Urinary incontinence is highly associated with pelvic muscle weakness, while decreased gluteal muscles and thigh muscles is related to low back injuries. A previous study indicated that the trunk was more bent and knee flexion was significantly less for pregnant women during lifting objects up from a stool. This is possibly due to the weakened gluteal muscles and thigh muscles that do not provide proper function during activities.
長時間骨盆前旋（傾）的懷孕女性們，容易有漏尿、腰部不適、臀腿部肌群減弱的症狀。
Prolonged pelvic forward tilting result in problems such as incontinence, low back pain and thigh muscle weakness.
膝蓋向後頂 Back knee, genu recurvatum
懷孕後膝蓋韌帶會變得比較鬆弛，有時會感到不穩定或呈現向後過度伸直。從側邊觀察，會發現大腿與小腿不在同一直線上。膝蓋向後頂時，大多數使用骨頭、軟骨與韌帶結構支撐身體重量，而非大腿肌群。通常一開始不太會有症狀，但膝蓋長期受到壓迫而大腿肌群無法正常發揮時，容易引發膝蓋痛與膝關節相關的問題。若想要在懷孕期間運動的媽媽們，容易在運動量增加時膝蓋受傷。
Ligaments in the knees become loose during pregnancy, which induce hyperextended knees. In anatomy, it is thought as malalignment of the femur and the tibia. The knee joint, ligaments and cartilages are put under stress in this situation, while the muscles that support the knee joint decrease in function. This induces knee pain during increased physical activity or exercise.
髕骨痛、髕腱痛、膝蓋內外側疼痛是此族群容易遇到的困擾。尤其是在蹲站、上下樓梯、蹲馬桶等姿勢下，疼痛最明顯。
Patellofemoral pain, patella tendon pain, medial/ lateral knee pain are the most common problems in those with back knee. Especially during squatting down and going up and down the stairs.
足部外翻 Flat feet, pronated feet
懷孕女性足部外翻程度平均比非懷孕女性較高。這是由於足底的筋膜、肌肉、韌帶等不足以支撐日漸增加的體重所造成。站著足部外翻時，容易連帶膝蓋向內位移，使得足踝與膝蓋排列形變。從正面或後方觀察可看到兩側膝蓋距離減小，大腿與小腿形成一個Ｘ，俗稱Ｘ型腿。這樣的膝蓋腳踝排列組合容易造增加膝蓋及足弓的壓力。若工作需長期站立或走動的女性，有較大的機會足底、小腿與膝蓋不適。
Flat feet during pregnancy is caused when the arch of the foot flattens out upon weight bearing or walking. Thus causing stress on the plantar fascia, ligaments and foot muscles leading to significant pain. When flat feet appears, there is a greater chance of altering knee alignment — knock knees. When standing up straight, the knees are close together but the foot stay apart. This adds stress to the knees, calf and ankle causing unwanted pain.
足部外翻者通常會有小腿內側疼痛、膝蓋內側痛、髕骨外翻、足底壓力不平均與足底筋膜炎等問題。
Pregnant moms may have symptoms such as medial calf pain, medial knee pain, patellofemoral pain, uneven foot pressure and plantar fasciitis.
上述懷孕時7個不良姿勢，您有幾個符合現況？
如果您因為有這些現象而導致疼痛或痠痛，建議尋求醫師或物理治療師的幫忙。Please seek medical help if you have pain or problems related to the faulty postures mentioned above.
藉由整體性的姿勢評估，才能了解哪些地方需要被矯正。
將身體擺在較佳的位置，可以使肌肉筋膜發揮支撐的功能，減少關節韌帶被壓迫的不適感！
若有興趣，歡迎參考之前的文章
Other articles you might be interested in…
懷孕期間可以 運動嗎？物理治療師提供幾招小撇步讓孕媽咪動起來！
Physiotherapist’s guide on exercise do and don’ts during pregnancy懷孕時我的身體會如何變化，運動會不會有風險？
How does my body change during pregnancy?
Reference:
Danna A, Magalhães AT, Silva BS, Duarte BS, Barros GL, Silva M, et al. Upright Balance Control Strategies During Pregnancy. Gait Posture. 2018 Oct;66:7–12.
Pardo F, Amo A, Rios MP, Gijon-Nogueron G, Yuste CC. Changes in Foot Posture During Pregnancy and Their Relation With Musculoskeletal Pain: A Longitudinal Cohort Study. Women Birth. 2018 Apr;31(2):e84-8.
Biviá-Roig G, Lisón JF, Sánchez-Zuriaga D. Changes in Trunk Posture and Muscle Responses in Standing During Pregnancy and Postpartum. PLoS One. 2018 Mar 27;13(3):e0194853.
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