PilatesDuringPregnancy

FionaBitmead25thSeptember2018CourseYear:2017/18RituelsStudio,Paris

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Abstract

The female foregoesextremephysical andpsychological changesduringpregnancyas

intensepressureisplacedonthebody.Itisvitaltounderstandchangesthattakeplace

during pregnancy to construct a safe Pilates programmewhilst selecting appropriate

repertoire for each individual depending on their stage of the pregnancy and their

particularbodytore-establishahealthybodyandmind.

Pregnancy is divided into three trimesters, physical changes associated with each

trimester will be discussed to understand the limitations of the female body as

pregnancy progresses. Examining and addressing how essential correct postural

alignmentisduringandafterpregnancythusavoidingpainanddiscomfortonthebody.

Acasestudyispresentedtoillustrateaclasstailoredfor20weekspregnantCharlotte.G

usingtheBASIblocksystemandrepertoire.

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TableofContents

Abstract…………………….…………………….…………………2

TableofContents…………………………………………………3

Anatomicaldescription………………………………………...4

Trimesters……………..…………………………………………….5

CaseStudy…………………….…………………….……………….7

Conclusion…………………….…………………….……………..10

Diagrams………………………….…………………….…………..11

Bibliography…………………….…………………….…………..12

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AnatomicalDescription

During pregnancy the musculoskeletal system, joints, ligaments and organs are

stretched and pushed to their maximum especially in the pelvic and lumber spine

region. Diastasis recti will occur as a result of the fetus expanding where the rectus

abdominusmusclesandconnectivetissue(lineaalba)separate(SeeFig.1,Diagrams2&

3).Withallthesephysicalchangesthewoman’scentreofgravityshiftscausingpostural

deviations.Maintaining goodpostureduring andafterpregnancy is vital for releasing

muscletension,reducingstrainsonjoints, ligamentsandmusclesaswellasimproving

bloodsupplyaroundthebody.Itwillenabletheautonomicnervoussystemtofunction

efficiently,whichinturnimprovesthereproductiveorgans.

Thepelvic floor isresponsible formaintainingurinarycontinence,supporting internal

organsandsustainingthefunctioningofthereproductivesystem.Theexpandinguterus

placesalargeamountofweightonthepelvicfloorandimmensestretchingatchildbirth

weakensthemuscles.Exercisesforthepelvicfloor(seeFig.3)improvesstrength,helps

preventurinarystressincontinence,misalignmentinthehipsandsacroiliacjoint,pelvic

organprolapseandmusclespasmsthatcausepaininthepelvicarea.

The change in the psychological state must also be taken into consideration as the

womanadjuststoanewbodyshapewhilsthormonalchangesandenergylevelsallhave

theiraffectonmentalwellbeing.ThePilatesphilosophynourishesboththebodyandthe

mind. It requires intense concentration designed to move consciously in perfect

alignment,whichactslikeaformofmeditation,clearingthemindasonefocusespurely

ontheprecisionofmovement.

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Trimesters

1stTrimester (0 -13weeks):hormone levels changeasoestrogen,progesteroneand

relaxinarereleasedintothebody,nourishingthefetusalongwithlooseningligaments,

musclesandconnectivetissuebetweenthebonesforthepelvistosoftenandtheuterus

to expand. Although the bodywill experience greatermobility and flexibility this can

lead to unstable joints, therefore the range of movementmust be limited to prevent

weakeninganddamage.

Theeffectsoftherelaxinhormoneismostconcentratedaroundthepelvisrelaxingthe

muscles, jointsandligamentsmakingroomforthegrowingfetus,whichisresponsible

fordestabilisingthepelvisthatcancausesciaticpain.Strengtheningthehipflexorsand

extensorswillaidbalancingthepelvisandrelievepressure.

The surge of hormonal change can cause fatigue, dizziness and nausea so only light

stretching isadvised,avoidingstrenuousexercisesandany inversionse.g.shortspine,

jackknife and the tower. Focus should be placed more on postural improvement,

strengtheningthepelvicfloor,breathingandrelaxation.

2ndTrimester(14-27weeks):asthebodysettles,boththefatigueandnauseausually

disappear leaving the mother feeling physically and emotionally healthier. It is

importanttofindexercisestoprotectandstrengthenthebodyastheweightofthebaby

becomesheavier.Workingonposturalalignmentinanuprightpositionwhereaneutral

pelvis is established will reinforce muscles around the lumbar, thoracic and cervical

spine as the uterus and breasts develop. Avoid exercises where the abdominals are

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strongly contracted to prevent the rectus abdominus spreading further apart e.g.

exclude:Hundreds,roll–up,singleanddoublelegstretch.

3rdTrimester(28-40weeks):Thebodywillfeeltheburdenofthisextraweightinthe

uterus and breasts, creating postural imbalances and deviations that can be highly

uncomfortableanddestabilisebalance. Asthebabyincreasesinsizethepelviscanbe

pressured intoananterior tilt, changing thecentreofgravityandnaturalcurveof the

spine (lumbarsacral region) promoting hyperlordosis as the body tries to counter-

balance(illustratedinFig2).

Weight of developing breasts can increase curvature through the thoracic spine

(Kyphoticposture).Awarenessofposturaldeviationswillhelpfocuswhatexerciseswill

be most beneficial e.g. working the pelvis back into neutral position, chest opening

exercises,strengtheningtheupperbackandpromotingscapulastablilisationpreventing

roundingintheshoulders.Lyinginsupinewillputalotofpressureonthespineandcan

compressveinsandarterieslimitingbloodflowandoxygentothebaby(Fig4.Depicts

ligamentsandorgansas theuterusexpands thatwillplacepressureon thespine).To

take thisweight off the spine and vital organs exercises shouldbe executed standing,

sittingorkneelingonallfourstoreleasetensionandstrainbeingplacedonthebody.

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Casestudy

CharlotteG.is34yearold,20weekspregnantwithherfirstchildandtheoutwardsign

of the baby is still very compact. Charlotte sustained a long professional career as a

dancer and as a resultmaintains a naturally fit and very able body. She has no pre-

existing injuries or anymedical problems. During the first trimester she experienced

fatigueandmildmorningsickness.Herhormonessettledduringthissecondtrimester

butsheissufferingfrompaininherupperbackespeciallywhenshehasbeensittingfor

toolongwithhunchedshoulders.Nolumbarspinediscomfortisbeingexperiencedbut

shouldbemonitored.

Charlotte has a basic knowledge of Pilates fundamentals, each week we modified

exercisesdependingonherphysicalandmentalstate.The followingpages illustratea

class I designed using the BASI block system and repertoire specifically tailored for

Charlotte in her second trimester. The desired results are to create a progressive

programme which will maintain Charlotte’s all-over muscle tone, correct postural

deviationsthatcouldleadtodiscomfortespeciallyinthethoracicregion(wheresheis

alreadyexperiencingpain)and fortifyingmusclesaroundthepelvicregionthatwould

facilitateherduringchildbirthandthroughoutthepregnancy.

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BLOCK EXERCISE Apparatus NOTES

WarmUp RolldownPelvicCurlSpinetwistSupine

Mat Focusingonbreath isapriorityduringsessionswithCharlotte.AsshedevelopsIwilltakeoutanyexercisesin supine and spine flexion. Instead I will haveCharlottewarmingupstandingusingaballetbarre.

Footwork ParallelHeelsParallelToesV-PositionToesOpenVheelsOpenVToesCalfraisesSingleLegHeelsSingleLegToes

Wunda

Chair

Footwork on the wunda chair requires strong trunkstabilisation to maintain correct posture and pelvicalignment.Itisagreatoptionforpregnantwomentohave them sitting upright as the baby becomesheavier and more challenging on the body. We canplace thechairagainstawallallowingher touse thewallforextrastability.

Abdominal StandingPike Wunda

Chair

It is advised not to do inversions but as Charlotte isnot suffering fromnausea this is a goodexercisenottoplaceadditionalpressureontheabdominals,whendiastasisrectiisoccurring.Towards theendof the2nd trimester Iwouldnotdoany rectus abdominal flexion work but ratherincorporate the use of abdominals as stabilisersduringotherexercises.

Hipwork FrogCirclesdownCircleupOpeningsORSidesinglelegseries

Reformer

OR

Cadillac

Being a dancer Charlotte has a great ROM, to avoidoverstretching I concentrated on limiting her ROMandfocusmoreoncontrolandstability.Ashersizeincreaseswewillavoidherlyinginsupine.Choosing the side single leg series on the Cadillac,putting a pad under her belly to not put too muchstrainontotheobliques.

Spinal

Articulation

SpineStretch

Mat

This exercise does not place excess pressure on thespine or risk compressing veins and arteries. It iscurrently possible for Charlotte as her baby is verycompact.Alternativelywhenshe increases insizewecanusetheKneelingCatstretchontheCadillac.

Stretch Gluteals,hipflexorsORPoleseries:ShoulderstretchOverheadstretchSidestretchSpinetwiststanding

Ladder

Barrel

OR

Pole

Fittingeverything intoanhoursession ischallengingbut if possible I want Charlotte to do two stretches,oneforthepelvisandsecondlyforthethoracicspine.OpeningupthechestisapleasantfeelingforCharlottewhosedevelopingbreastspullhershouldersforwardinto a Kyphotic posture. I encourage her to stretchlightlybutavoid forcing,which canbe commonwithdancers.

FBI ThighStretch Cadillac Whilst challenging trunk stability and abdominalcontrol it is also gives Charlotte a nice hip flexorstretch.

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ArmWork Armsstandingseries:ChestexpansionHugatreeCirclesupCirclesdownPunchesBiceps

Cadillac Working in a standing position is comfortable forCharlotte andenablesme to see clearly anyposturaldeviation she is experiencing. This particular armseriescontainsexercisestoencourageopeningoutthechest through the thoracic spine which helping torelievethepainsheisexperiencinginherupperback.

LegWork Squats

Cadillac I designed a class thatwould not jump around fromonemachinetothenextbutcomplete2or3blocksoneach piece of equipment to avoid loss of balancewhilstkeepingCharlotte’smindandbodystimulated.Squats gave Charlotte the opportunity to work onstrengtheningherquadriceps&knee stablisation, allkey components when balancing out the muscles asthebabyincreasesinsizeanddestabilisesthebody.

Lateral

Flexion

SpineTwist Mat Requiring a Lateral flexion exercise thatwouldmostbenefit Charlotte without putting excessive pressureon her spine (as the weight of the baby increases),wouldbethespinetwist.Itengagestheobliquesandback extensors. Usually performed seated on a matwith straight legs but at this stage it is better to gethersittingonaboxwithherthighsinaV–position.

Extension CatStretch Mat Anexcellent exercise to finish the class,wherebeingonallfoursdistributesherweightevenly&takestheload off the back. This particular exercise allows forthat lovely extension through the thoracic spine andflexionintothelumbarspine(bothareasthatbecometighter during pregnancy) at the same time muchfocus is required onbreathing combining themind -bodyholisticapproachthatweaspiretoinPilates.

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Conclusion

Pilatesisextremelybeneficialforwomenduringpregnancyasitworksonstrengthening

muscles thatwill protect joints and ligaments,which undergo great stress and strain

placedonthebodyduringpregnancy.Pilatesprovidesnumerouspsychologicalbenefits

that can be very advantageous in reducing stress and anxiety during this demanding

timeasmuchemphasisisplacedonbreathing,connectingthemindandthebodyduring

exercises.

Constructingaconditioningprogrammemustbespecificallydesignedaccordingtoeach

client, depending on their stage of the pregnancy. Understanding each trimester will

help awareness of the pregnant woman’s limitation and determinemodifications the

teacherwillberequiredtomakesuchasavoidingexercisesinproneandsupineduring

thelatterpartofthepregnancy.

Pilates classes made Charlotte aware of her postural deviation as a result of her

pregnancy,usingthisconditioningprogramwewereableto findexercisesto improve

andstrengthenareasofweaknessthathasrelievedherbackdiscomfortandimproved

hergeneralwellbeing.

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Diagrams

Fig.1:DiastasisRecti

Fig.2:

Postural

Deviations

Fig.3:ExercisingthePelvicFloor Fig.4:

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Bibliography

Book:Selby,Anna.“PilatesforPregnancy”Hammersmith,London:Thorsons,HarperCollinsPublishers,2002.

Book:King,Michael&Green,Yolande.“PilatesforPregnancytoningexercisesforthemother–to–be”HeronQuays,London:OctopusPublishingGroup,MitchellBeazley,2002

Book:Isacowitz,Rael.“StudyGuide:ComprehensiveCourse”CostaMesa,California:BodyArtsandScienceInternational,2013.

Website:”Pilatesinteractive”copyright2015PilatesInteractivehttps://www.pilatesinteractive.com

Website:”Glown”TheGloballibraryofwomen’sMedicine,Shrock,PGlob.Libr.Women’smed2008https://www.glowm.com/section_view/heading/Exercise%20and%20Physical%20Activity%20During%20Pregnancy/item/98

Website:“WhattoExpect”2018https://www.whattoexpect.com/pregnancy/exercises-for-pregnant-women