Pregnancy is associated with a number of musculoskeletal problems. Some changes are hormonally induced. The release of relaxin is responsible for the softening of the ligaments that can lead to joint instability and back pain. Women who exercise during pregnancy tend to experience back pain less often than those who don’t. Some women may experience pubis symphysis pain, which occurs when the pelvic expands to facilitate the growing foetus. Exercises that increase core strength can help to stabilise the pelvis and potentially prevent the separation of the pubis symphysis (Baker, C. (2006) pregnancy and fitness).
Another common problem that may occur during pregnancy can be symptoms of urinary incontinence. This is also due to the effects of relaxin and the increased weight of the growing baby. The pelvic floor muscles and urethra stretch under pressure causing stress incontinence. Pelvic floor exercises can help to alleviate stress incontinence and strengthen the pelvic floor muscles (Baker, C. - Pregnancy and Fitness 2006). During pregnancy the abdominal muscles stretch in all directions to provide elasticity within the muscle. The two bands of muscle can stretch away from the midline of the body (linea alba) to allow more space for the expanding uterus. This is known as diastasis recti. For around two thirds of women, diastasis recti may occur in the second or third trimester of pregnancy and this can lead to back pain due to the decreased spinal support from the abdominal muscles. As Pilates focuses on strengthening the deep postural muscles such as the transverses abdominus and pelvic floor muscles, there will be minimal chance of doming as less stress will be placed across diastasis recti.
Exercise during pregnancy is aimed at maintaining fitness levels rather than reaching peak fitness. If a client has been active before pregnancy then generally she can continue her exercise programme without any major changes (The American College of Sports Medicine’s guidelines for exercising testing and prescription 7th edition, Lipponcott, Williams and Wilkins, Philadelphia 2006). However, they should not exceed pre pregnancy intensity levels. As a Pilates session does not incorporate CV work, it should be advised that CV training is incorporated into their programmes. Strengthening of the deep core muscles will help to stabilise the spine and improve posture. This will help to prevent or alleviate back pain, joint pain and stress incontinence. It will also help to support the weight of the growing baby. The Pilates programme will need to be adapted and modified across all three trimesters to accommodate the changes that occur, taking into consideration any contraindications to exercise. Body positions in Pilates need to be considered.
During the first trimester all body positions are acceptable providing that the client feels comfortable and is not dizzy. During the second and third trimesters they should avoid exercise in the supine or prone positions. As most Pilates exercises are in these positions you would need to consider how you can adapt these exercises to a seated or standing position, still ensuring a balanced and effective workout. You could also offer modification to the programme as the pregnancy develops such as using a chair for support, or maybe a Swiss ball for some exercises.
The closing phase is also an important component of Pilates. You should stretch all muscles worked in the main phase and return the muscles back to their pre exercised state. It will also help to stretch out the muscles that have become tight due to postural changes. However, only maintenance stretches should be performed and the client should be encouraged to stretch to a comfortable range of movement. Relaxation is an important element and the client should be made to feel comfortable and at ease. The relaxation technique could be passive or guided active relaxation. This could be varied from class to class and will help to relieve tension and stress. There is also a lot of focus on breathing in Pilates, which can have a very positive effect during labour. You should breathe at an easy and comfortable pace, being careful not to over-breathe as this could cause dizziness. Lateral thoracic breathing is performed during Pilates exercise but should not be forced as this will become harder as the uterus grows.
By practising Pilates during pregnancy you can prepare the body for the many challenges that may face the expectant mother. A strong core will help to stabilise the spine and prevent injury as well as help to realign muscular imbalances due to postural changes. Regular Pilates exercise will promote general wellbeing and relaxation, which will be very welcoming to the pregnant client.
You can find out more with our Pre- and Post-natal Exercise CPD course here
Written by Jo Curran.