One of the most common exercise-related questions that arises during pregnancy is whether it is safe to “twist.” In fact, the concern about twisting has made many pregnant people fearful of turning in bed, cracking their backs, or performing everyday tasks that require a little rotation.
First, let us be clear. You are not a robot. Nor should you try to move like one.
While some movements definitely need to be altered as pregnancy progresses, many types of rotation are safe — and beneficial — during pregnancy.
Read on to learn:
- Why pregnancy creates concern around twisting in the first place
- The difference between rotation and twisting
- Guidance on twisting during pregnancy (what’s safe and what to avoid)
- Beneficial rotational exercises to focus on
Quick Answer: When it comes to twisting during pregnancy, the most important distinction is whether you are loaded or unloaded. Unloaded twisting — like turning in bed, cracking your back, or reaching for a seatbelt — is safe throughout pregnancy. During loaded (strengthening) exercises, avoid twisting with dissociation, where your shoulders rotate farther than your hips. Instead, focus on neutral trunk rotation, where your hips and shoulders move together as one unit, which is both safe and beneficial.
Why is Twisting a Concern During Pregnancy?
Before we get into what to focus on vs. avoid, it’s important to understand two anatomical changes that occur during pregnancy that increase the pressure within your core (and therefore affect guidance on twisting).
1. Increased Intra-Abdominal Pressure
As the belly grows, it increases the pressure in the abdominal cavity, or intra-abdominal pressure (IAP). This increased pressure pushes outward onto the abdominal wall, which thins and weakens the connective tissue that runs in between the left and right sides of the rectus abdominis (“6-pack”) muscle, called the linea alba.
In the photo above, you can see the linea alba in a non-pregnant individual on the left (a very thin line down the center of the abdomen). Then, see how it stretches during pregnancy in the image on the right. This stretching of the linea alba tissue leads to a widening of the gap between the left and right sides of the rectus abdominis muscle, otherwise known as diastasis recti (DR). Therefore, some degree of DR is normal and necessary during pregnancy to create space for baby to grow.
2. Alignment Shifts
As the belly grows, it not only increases IAP, but it also tends to tip the pelvis forward, as you can see in the image below. This not only compresses the tissues in the low back (no wonder low back pain is so common!), but it also further increases the stress on the linea alba connective tissue.
Because these two changes are already placing significant stress on the linea alba, it’s important to avoid exercises that add further pressure beyond what the growing belly creates. This is exactly why certain types of twisting during loaded movements become a concern during pregnancy.
Guidance on Twisting During Pregnancy
First, let’s clarify what “twisting” means.
Twisting = rotation with dissociation of hips and shoulders.
So, twisting is any type of rotational movement where the hips and shoulders do not move together in the same direction, as shown in the left image below. Notice how the shoulders are turned directly to the side wall, but the hips did not move the same amount. This type of rotation, or twisting, places excess stress on the linea alba tissue. Therefore, it’s best to avoid exercises involving twisting once you develop a belly.
That said, not ALL forms of rotation are bad! In fact, exercises that involve rotation in which the hips and shoulders move together as a unit are safe and beneficial throughout pregnancy. You can see an example of this in the right image below. Notice how the shoulders and hips moved in the same direction as one cohesive unit. This type of rotation does not add any further stress to the linea alba tissue.
Beneficial Rotation Exercises
Any time you are rotating, but working to keep your trunk in neutral alignment (hips and shoulders in line), this is beneficial because you are utilizing your deep core muscles to preserve this alignment (which strengthens them) while avoiding placing any additional stress on the outer abdominal wall. Below are a few examples of rotation with a neutral trunk:
Important Technique Points
When performing the exercises above, keep in mind the following two important technique points to ensure you are practicing safe and beneficial rotation:
- Initiate the turn with your rear foot: It may seem surprising, but twisting actually begins at ground level. Specifically, your turn is a result of how well you pivot off of your rear foot. If you look at the photos above again, you’ll notice the difference in the rear foot positions. Therefore, you want to think about initiating your turn by swiveling your back foot (like you are putting out a cigarette butt!). The more you pivot your foot, the more efficient your turn, and the better able you’ll be to preserve the “slice,” as discussed next.
- Preserve the “slice”: All these exercises have you hold out your arms in front and clasp your hands together (same as illustrated in the photos above). Notice that when you do this, your arms and trunk form a triangle. Think of this triangle as your pizza, or pie, “slice” (whichever one you find tastier😊). The goal with rotation is to preserve the shape of the slice as you move the trunk as one cohesive unit. If you find that your arms want to bend, focus harder on pivoting your rear foot to generate a stronger turn.
One Type of Twisting That’s Perfectly Fine
We do want to add one important clarification to the guidance above to allay any unnecessary fears. While it is important to avoid twisting during “loaded movements” (or strengthening exercises), it is perfectly safe to twist during pregnancy when unloaded. This means that you can perform stretches (like the cover image of this blog post!), reach for a seatbelt in the backseat, turn in bed, crack your back, and perform any other daily task that requires you to move your shoulders farther than your hips. You will be fine, and your baby will be fine. The goal is not to move through life like a robot. You can do “normal” things without fear, because our bodies were built for this.
Frequently Asked Questions
Is twisting safe during pregnancy?
It depends on the type of twisting. Unloaded twisting — like turning in bed, cracking your back, or reaching for a seatbelt — is safe throughout pregnancy. During strengthening exercises, avoid rotation with dissociation (where your shoulders rotate farther than your hips) and focus instead on neutral trunk rotation, where your hips and shoulders move together as one unit.
What is the difference between twisting and rotation during pregnancy?
Rotation is the broader term for any movement that involves turning the body. Not all rotation is problematic during pregnancy. In fact, some rotation is necessary and beneficial. Twisting is a specific type of rotation that involves dissociation of the hips and shoulders, where one moves farther than the other. Unloaded twisting (like stretching, cracking your back, or turning in bed) is perfectly safe throughout pregnancy. Loaded twisting (strengthening exercises) should be avoided once you develop a belly. Neutral trunk rotation, where the hips and shoulders move together as one unit, places no additional stress on the core and is safe and beneficial throughout pregnancy.
Why is it necessary to avoid twisting exercises during pregnancy?
As the belly grows, it increases the pressure within the core (intra-abdominal pressure). This leads to diastasis recti (DR), a widening of the gap between the left and the right sides of the rectus abdominis (“6-pack”) muscle. While some degree of DR is a normal and necessary part of pregnancy to allow baby space to grow, it’s important to avoid exercises that create additional pressure beyond that caused by the growing belly. This is why it is necessary to avoid loaded movements (or strengthening exercises) that involve twisting. However, rotation in which the hips and shoulders move together as a unit does not place additional stress on the outer abdominal wall and is therefore safe and beneficial throughout pregnancy.
Can twisting cause diastasis recti during pregnancy?
First, it’s important to understand that some degree of diastasis recti (DR) is normal and necessary during pregnancy to create space for the baby to grow. DR will naturally occur as the belly grows. However, it’s important to avoid movements and exercises that further increase the pressure in the core (beyond that caused by the growing belly), as this could worsen DR and make it more difficult to heal in the postpartum period. This is why loaded twisting — strengthening exercises involving dissociation of hips and shoulders — should be avoided once you develop a belly because it places too much pressure on the outer abdominal wall. However, unloaded twisting (like stretching or cracking your back) is perfectly safe throughout pregnancy.
Is it safe to crack your back during pregnancy?
Yes. Cracking your back is an unloaded movement, which means it does not place the same stress on your core as loaded exercises do. Unloaded twisting of any kind (stretching, cracking your back, putting on a seatbelt) is safe throughout pregnancy.