Pregnancy is one of the most meaningful and remarkable experiences in a woman’s life. Physical radiance, the surge of endorphins, and excitement about becoming a mother for the first time or again are among the most enjoyable benefits. However, pregnancy is also a physically and emotionally taxing experience because of the pain and discomfort that can go hand in hand with anatomical changes. In fact, pregnant women typically develop lumbar lordosis, which contributes to a very high prevalence of lower-back pain (Artal & O'Toole 2003), and it is pregnancy rather than childbirth itself that has the greatest effect on the pelvic-floor muscles, with 64% of women developing incontinence symptoms during this time (DiFiore 2003).
Research suggests that women with uncomplicated pregnancies should continue exercising at mild- to moderate-intensity levels to help offset some of these discomforts and to prepare for the birth ahead. Provided they receive clearance and special instructions from a physician, expectant mothers will benefit immensely from staying active throughout their pregnancy (Dawson 2003).
How Pilates Exercise Programs Can Help
Offering a mind-body approach that balances strength and flexibility training, Pilates exercise is perfectly suited to preparing women for labor and a speedy recovery postpartum. A no-impact regime, it places special emphasis on restoring the spine’s natural curves (postural alignment) and on improving stability and mobility in the lumbopelvic and shoulder girdles—all important factors during pregnancy and beyond.
Postural Alignment. Throughout the gestation period, postural alignment alters, and many muscles become imbalanced, which can put mechanical stress on the lower back, pelvis, hips and feet. The shoulders and upper back begin to round forward, and the cervical spine pulls the head forward as well. The thoracic extensors and scapular stabilizers lengthen to create a greater thoracic kyphosis (convex posterior curve) and protracted scapulae, while the neck extensors and pectoralis muscles shorten. Lumbar lordosis may also increase, causing tightness and contributing to lower-back pain. Improving postural alignment is therefore a key benefit of Pilates training during pregnancy.
Lumbopelvic Region. As the baby grows, the woman’s center of gravity shifts, affecting coordination and balance. Pilates exercises can enhance these skills without compromising safety. In addition, the hormone relaxin affects the joints and connective-tissue collagen fibers in the pelvis, particularly the sacroiliac and symphysis pubis (DiFiore 2003). Relaxin, while essential for the expulsion of the infant during birth, can produce the negative side effect of increasing instability in the pelvis. Strengthening the lumbar region helps stabilize the lumbopelvic girdle.
Shoulder Girdle. The physical demands of lifting and carrying a newborn require upper-body strength and stability. A Pilates exercise program will strengthen the rhomboids, middle and lower trapezius, rotator cuff muscles, middle and posterior deltoids, biceps, triceps, serratus anterior and latissimis dorsi.
Pilates Programs and Exercise Recommendations
Clients should be encouraged to take private Pilates classes to ensure exercises are properly modified and adapted as pregnancy progresses. If you teach group Pilates classes, communicate with clients beforehand about how to perform the exercises and what small equipment to use.
Available guidelines on Pilates and pregnancy can be unclear and even contradictory, so Pilates instructors should always respect the guidelines set by professional organizations such as the American College of Obstetricians and Gynecologists (ACOG).
Follow these general programming tips when working with a pregnant client:
Periodically Check for Diastasis Recti. A common occurrence, diastasis recti is the stretching and separation in the rectus abdominis that can happen any time during pregnancy. To check for this condition, have the client lie supine, place two of your fingers just above her navel and ask her to raise her head to activate the rectus abdominis muscle. If there is a separation, you will feel complete hollowness. In this case, always keep one of both of the client’s feet supported during Pilates exercise, decrease the load on the abdominals (stay away from open-kinetic-chain exercises) and avoid shearing forces across the torso, as would occur in oblique curl-ups (Dawson 2003). (Note: Before you touch the client, ask for her permission.)
Teach the Proper Way to Get Up From the Floor. This is essential. Cue your client to roll onto her side and then push, using her hands and arms, to come to an upright position. Once this becomes awkward or uncomfortable, use a raised mat or mat converter on a reformer instead of the floor.
Be Sure to Warm Up and Cool Down Adequately. Also, vary the Pilates workout to challenge and encourage your client.
Concentrate on Pilates Exercise Programs for the Pelvic Floor, Spinal Stability and Joint Stability, as well as on Balancing the Entire Musculoskeletal System. Focus on strengthening the thoracic extensors, lengthening the anterior chest muscles and stabilizing the lumbopelvic region and shoulder girdle. Throughout the workout, promote either a neutral spine or a slight posterior tilt with slight lumbar flexion (imprinted); emphasize the deep stabilizing muscles (transversus abdominis, multifidus, diaphragm and pelvic-floor muscles).
Avoid Large Ranges of Motion, Overextension and Overflexion of Joints. Support positions using a small pillow, spine supporter or small barrel, and ensure submaximal connection (25%) with the pelvic-floor and transversus muscles. Resistance equipment, stability balls, small barrels and spine supporters are great tools. Larger pieces of exercise equipment—like the Pilates reformer, stability chair and Cadillac—are also easy to work into programming because many Pilates exercises can be performed kneeling, standing, sitting and four-point kneeling.
Adjust for Joint Laxity. Increased laxity makes pregnant women more vulnerable to sprains and strains. Therefore, avoid long-lever adduction and refrain from keeping your client in the same position for too long, especially while standing.
Pilates is ideal for pregnancy for the same reason it has been labeled an exercise program for a lifetime. Its mind-body connection and no-impact, custom approach to exercise ensure that every client reaps the benefits from a workout tailored to her fitness level and her body’s unique intricacies. Programming properly and creating a safe and pleasant atmosphere will encourage clients to practice their Pilates exercises regularly during pregnancy and draw them back to reach their personal fitness goals afterward.