Pilates & 2 nd Trimester Pregnancy

Pilates & 2nd Trimester Pregnancy Jodi Goldberg 7/20/08 Las Vegas, NV 2008 ABSTRACT Pilates is a safe and effective exercise approach in maintainin...
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Pilates & 2nd Trimester Pregnancy

Jodi Goldberg 7/20/08 Las Vegas, NV 2008

ABSTRACT Pilates is a safe and effective exercise approach in maintaining health and fitness for pregnant women throughout the entire pregnancy. The research indicates that Pilates exercises enable the expectant mother to maintain good posture, strength, alleviate recurrent aches and pains, and improve the mother’s awareness of her changing body to avoid musculoskeletal dysfunction and injury. Pilates is appropriate to begin at any stage of pregnancy and it does not matter if one has never had any previous experience. Modifications are an essential component of a Pilates program to allow the pregnant client to exercise in a comfortable and safe environment while keeping the intent of the given exercise. Barring any contraindications, pregnant women can benefit greatly from building core strength to support a more comfortable pregnancy and delivery.

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CONTENTS

Anatomical description of structures involving pregnancy…………………………4-5 Introduction of Pilates and pregnancy………………………………………………6-7 Case Study…………………………………………………………………………..7-9 Conditioning program utilizing the BASI Block System…………………………...8 Conclusion…………………………………………………………………………...9-10 Bibliography…………………………………………………………………………10

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Although pregnancy affects several areas of a woman’s body, anatomical description will be focused on the abdominals, associated ligaments, and the pelvic floor. The round ligaments are on either side of the uterus and connect to the pelvis. During exercise, slight discomfort in the groin or vaginal area can arise if the enlarged uterus shifts and pulls on these ligaments. The broad ligament attaches to the lumbar spine and the uterus sac. (See Figure 1). As the size of the baby increases, the abdominal wall stretches and the weight of the uterus is placed on this ligament which may cause low back discomfort. (Green & King, 2002). The abdominal muscles have to stretch in width and length to accommodate the growing uterus. This expansion is facilitated by a fibrous connection called the linea alba. The two sides of the rectus abdominis, obliques, and transversus abdominis (TA) expand and, in some cases, may separate by 3-6 inches. The TA muscle runs around the lower part of the abdominals and links into the linea alba. With strengthening of TA, one can prevent the abdominals from separating too far. (See Figure 3). (Green & King, 2002).

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The pelvic floor is a hammock of muscles that passes from the pubic bones in the front of the pelvis to the coccyx. These muscles are important because of their ability to stretch during the delivery process. If lacking in strength, they become overstretched and weak which can lead to incontinence. Instruction in relaxation and contraction of the pelvic floor is an integral part of the Pilates exercise regimen for pregnant women.

(Green & King, 2002)

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Exercise is an essential component in maintaining health and fitness as well as reducing possible injury for pregnant women. The American College of Obstetricians and Gynecologists recommend 30 minutes of moderate exercise a day for healthy pregnant women. (Wilusz, 2008). It is suggested that expectant mothers gain an average of 25-35 pounds during pregnancy. This weight gain creates excess stress on the feet and lower back. As the center of gravity shifts forward due to the growing fetus and the mother’s breasts, the base of support increases. This imbalance creates lumbar lordosis which causes a shortening of the spinal extensors, lengthening of the abdominals and hip flexors and, thus, added stress to the gastrocnemius and soleus to maintain standing balance. (Wilusz, 2008). Due to all of these changes in posture, weight, and center of balance, the core requires greater stabilization. Creating strength in the core muscles will help decrease excessive pressure on the surrounding joints, muscles and bones. Because Pilates is so focused on building core strength, it is one of the best exercises pregnant women can use both during and after their pregnancy. Comfort and safety are key factors in the design of a Pilates-based exercise program for pregnant women. Modifications, therefore, are essential and help to maintain the integrity of the desired exercise. The focus of the program is on postural changes, muscle training and physical training in preparation for childbirth. (Green & King, 2002). There is often increased concern about the pregnant client lying supine during pregnancy due to potential “supine hypotensive syndrome.” This occurs when the weight of the baby lies on the vena cava of the mother’s heart preventing normal circulation of blood back to the heart. This syndrome can affect the oxygen levels of the baby and the mother

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and, therefore, the client should not exceed 5 minutes in the supine position. (Green & King, 2002). Benefits of Pilates exercises during pregnancy include: •

Increase of abdominal strength provides support of the weight of the baby and uterus and acts as a splint for the spine by helping to keep it in neutral. (Green & King, 2002).



Aids childbirth by making pelvic floor muscles stronger and giving the mother an increased body awareness. (Green & King, 2002).



Increases stamina



Increases relaxation which impacts sleeping patterns and energy levels



Increases circulation to help decrease leg cramps and varicose veins



Enhances breathing in preparation for labor and delivery



Decreases weight gain and assists with weight loss following pregnancy



Decreases urinary incontinence due to pelvic floor muscle weakness and dysfunction



Relieves or prevents low back pain



Reduces risk of a separation at the rectus abdominis (Diastasis recti) CASE STUDY

The subject is Francine S., a 33 year old pregnant female at the end of her second trimester (27 weeks). Her past medical history is unremarkable and she has no limitations. Francine was exercising regularly before she became pregnant and reduced frequency and intensity of exercise since she found out she was pregnant. Francine had

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some familiarity with Pilates exercises on the Reformer as it was the choice apparatus pre, during, and post her first pregnancy. WARM UP

Lateral rib cage breathing seated on Swiss ball Pelvic Curl Spine Twist Supine

FOOTWORK

(using c-shaped cushion for assist on Reformer) Parallel heels/toes; Open V heels/toes; Calf Raises; Prances; ** Deferred single leg footwork due to complaints of discomfort at pubic symphysis for the past 1-2 days.

ABDOMINALS HIP WORK SPINAL ARTICULATION STRETCHES FBI 1 ARM WORK FBI 2 ADDITIONAL LEG WORK LATERAL FLEXION/ROTATION BACK EXTENSION

(used BOSU® for head support with each exercise) Cadillac: Mini Roll-Ups; Mini Roll-Ups Oblique; Roll up w/ RUB (long yellow springs; BOSU® for head support) Cadillac Basic Leg Springs: Frog; Circles (down/up); Walking; Bicycles (2 directions) n/a Standing Lunge on the Reformer n/a Arms Sitting Series on Reformer Chest expansion; biceps; rhomboids; Hug-A-Tree; Salute n/a Gluteals Side Lying Series (w/o weight) Side Leg Lift; Forward and Lift; Forward with Drops; Adductor Squeeze w/ Pilates ring Side lifts Cat Stretch

Due to the restrictions in time with lying supine, limited exercises were performed in that position. The BOSU® acted as an assist for several exercises to keep Francine comfortable on her back. FBI and spinal articulation exercises were not integrated as the positions necessary would involve either too much spinal flexion or physical exertion. Since Francine had not performed Pilates exercises over the past year, it was important to keep the program at a fundamental level. Because the goals of this program involve 8

maintaining strength, increasing body awareness and posture, and preparing for childbirth, the development of the conditioning program would be based on Francine’s tolerance and response to exercise. Some additional exercises that may be considered are: WUNDA CHAIR: Footwork; Side Kneeling Arm; Side Kneeling Stretch; Hamstring Curl; Hip Opener with head support. CADILLAC: Pelvic tilts seated on Cadillac while holding the RUB or PTB; Arms Standing Series (w/o Butterfly); Components of the Push Through Series such as Shoulder adduction sitting forward and Sitting Side; Thigh Stretch with RUB. REFORMER: Hip work (Frog; circles; openings); Arms Supine Series with support of cshaped cushion; Flat Back from the Knee Stretch Series. AUXILIARY: Gluteals Kneeling Series; Arm work using the magic circle; Sitting Series using the magic circle. Special attention would also be directed towards Francine’s flexibility during exercise by controlling any excessive range of motion. This can occur because pregnant women produce a hormone called relaxin. This is to relax ligaments of the pelvis and allow separation of the joint surfaces allowing for more space to accommodate a growing baby. This hormone also affects the fibrous tissue of the pelvic floor as it enables it to stretch during childbirth. (Green & King, 2002). In conclusion, Pilates is an exercise method that is gentle enough to perform during pregnancy, yet challenging enough to assist with maintaining muscular strength, endurance, flexibility, posture, and most importantly balance. It is advantageous as it can be started at any time during a woman’s pregnancy, and it focuses on some of the most

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important muscle groups involved in pregnancy. With attention directed towards the Pilates principles, pregnant women can develop body awareness, control, and create whole body balance so that the physical changes experienced during pregnancy do not negatively impact their lives, rather enhance the quality of life while pregnant and postnatally. BIBLIOGRAPHY Green, Y., King, M. (2002). Pilates workbook for pregnancy. Berkeley, CA: Ulysses Press. Ogle, M. (November 21, 2006). How to use Pilates to support pregnancy. About.com [On-line]. Available: http://pilates.about.com/od/pilatesforeverybody/a/pregnancyBasics.htm. Wilusz, A. (2008, June 16). Working out for two. Advance for Physical Therapists and PT Assistants, 19, 26-27.

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