Pilates for New Mothers

Angela Wright May 2014 November 2013 (BASI CTTC) Hobart, Tasmania

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Abstract This paper considers the changes that occur to a woman during pregnancy and includes a Pilates conditioning program for a new mother based on the BASI Block System. It includes an anatomical description and notes changes away from ideal posture. It also includes details of contraindications and specific issues associated with new mothers returning to a Pilates program. Clients and instructors should be aware of conditions following pregnancy such as diastasis recti and pelvic floor laxity. They should also be familiar with the physiological and psychological changes that occur during pregnancy and the symptoms and discomforts from pregnancy, delivery and looking after a newborn. Recommencing Pilates clients should have medical clearance and the repertoire and movements should be safe and controlled.

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Contents Abstract ................................................................................................................................................ 2 Anatomical Description ......................................................................................................................... 4 Figure 1 ............................................................................................................................................. 4 Discussion ............................................................................................................................................. 5 Figure 2 ............................................................................................................................................. 7 Conditioning Program ........................................................................................................................... 8 Program template ............................................................................................................................... 11 Conclusion .......................................................................................................................................... 13 Bibliography. ....................................................................................................................................... 14

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Anatomical Description Common postural issues evident in pregnant women can include: forward rotation of the shoulders, lax abdominal muscles, head in a forward position, kyphosis of thoracic spine, lordosis of lumbar spine, anterior tilt of the pelvis, shortened hamstrings and extended knees.

Figure 1 Diagram showing correct and incorrect pregnant posture (Pregnancy Posture 2014)

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Discussion Although pregnancy is a normal, natural condition it does change a woman’s body with the effects varying between each individual. Pregnancy can substantially affect a woman’s posture, a change which often remains once the baby is born. In an ideal posture the forces of gravity are evenly distributed throughout the body. However during pregnancy the uterus grows larger and causes the centre of gravity to shift forward. This can lead to tightness of the muscles of the lower back, hip flexors and in the back of the neck due to an anterior head carriage position. The extra weight of the breasts also leads to tight chest muscles, rounding of the shoulders and neck tension. The altered posture leaves women vulnerable to an array of conditions, such as lower back pain and knee pain, which were not present before conception (Levy 2012). Weight gain from a growing baby also means women tend to decrease their activity levels in the second and third trimester which affects mobility and flexibility and can in turn create poor posture (Long 2012). Following childbirth usual discomforts for new mothers can include such things as sore neck and shoulders from breastfeeding and tight, fatigued lower back pain from rocking, bouncing and holding newborns (Stewart 2012). Lower back pain can be due to many factors a prominent one being reduced tone of the abdominal muscles. In fact, following pregnancy the Tranversus Abdominis can become lazy or even ‘switched off’(Laughlin 2001). This is more likely to occur if the woman has had a caesarean section. There may also be lingering tightness in the lower back muscles and residual tension in hip flexors Sacroiliac joint pain is also not uncommon following childbirth. During childbirth the sacrum and the ilia (the large bones that make up the bulk of the pelvis) move significantly in 5

relation to one another, to allow the baby’s head to pass through. (Isacowitz and Clippinger 2011). One source of joint pain might be an incomplete return of these bones to their previous positions (Laughlin 2001). The presence of relaxin, a hormone present in the woman’s body from the moment of conception until six (6) weeks after she stops nursing, causes connective tissue such as ligaments to soften and therefore joints to become hypermobile and less supportive. (Levy 2012). Throughout pregnancy the pelvic muscles must withstand a greater degree of downward pressure due to weight gain and the growth of the baby. During childbirth the pelvic floor muscles are greatly overstretched and weakened (Kalisiak 2012). This can lead to pelvic floor laxity and potential prolapse which can persist for many months after birth. Diastasis Recti is a complication of pregnancy, and although not affecting all women is reasonably commonplace. This occurs when women experience separation of their rectus abdominis muscles, causing poor core strength which can lead to low back pain issues, digestive issues and a ‘jelly belly’. The linea alba becomes stretched and the two rectus abdominis muscles move away from each other, creating a diastasis. (www.PassionChiropractic.com.au 2014) (www.Wikipedia.org 2014).

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Figure 2 Diagram showing the diastasis-recti condition (Diastasis Recti 2014)

Typically the degree of separation of the abdominal muscles will lessen within the first year following childbirth; however it is possible to remain after this time. The weakening of these abdominal muscles may also make it difficult to lift objects and cause lower back pain. Additional complications may manifest themselves in weakened pelvic alignment and poor posture which can result in chronic back pain (www.Wikipedia.org 2014). Aside from the physical symptoms of pregnancy new mothers (particularly first time mothers) are often sleep-deprived, stressed and unsure of themselves. They also often feel pressured to immediately get back their pre pregnancy bodies (Stewart 2012). In summary, changes to posture, the birth process and lifting, carrying and caring for a baby produces a variety of strains and pain affecting muscles and joints. Together with potential problems of pelvic floor laxity or diastasis recti there are many considerations for Pilate’s instructors when working with a new mother returning to Pilates.

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Conditioning Program “The foundation of the Pilates method is working with the whole body in mind. The body is the most intricate of instruments and imbalance in one area will inevitably cause imbalances in other areas. Therefore Pilate’s programs should be comprehensive, regardless of the persons’ age, fitness or ability level” (Isacowitz 2006). Having said that, clients returning to Pilates following the birth of a baby need to adopt a safe approach to workouts. Ideally they should have their doctor’s consent and should be no less than 6 weeks post-partum. The BASI approach is well suited as an individualised program which can be adjusted to the client’s individual needs. As each woman is unique and each pregnancy different, the most important aspect may be that the woman listens to her own body. “The program should be conducted with compassion and sensitivity to the client to ensure that the program experience is a positive one” (Isacowitz 2013). The following Pilates program example is generally based on an intermediate level with adaptations to accommodate the body changes as outlined above. The program should also be individualised according to the client’s history and state of wellbeing on the day. Most women will know their own limits and the repertoire should be adapted accordingly. The program goals for a new mother returning to Pilates are to: 1. prevent any further diastasis recti separation or strain on the pelvic floor; 2. Improve pelvic stability, pelvic floor and Transversus Abdominis condition; 3. assist the client’s awareness and understanding of the changes to the body that may have occurred during pregnancy; 4. improve posture misalignment;

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5. focus on tight shoulders, neck and lower back caused by breastfeeding, lifting and carrying the baby; 6. restore flexibility and mobility; 7. encourage whole body conditioning; and 8. increase confidence . The following program has been chosen to emphasise movements which helps to maintain and strengthen parts of the body in order to improve or maintain good posture. The program has also been created to reactivate and strengthen muscles in the abdomen, spine and pelvis whilst ensuring safety is paramount to reduce any risk of further diastasis or pelvic floor issues. Reconnecting abdominal walls with the pelvic floor should be a priority in the early stages of motherhood (Nurse Together 1970). If the client has suffered diastasis recti (the separation of the muscles from the linea alba) trunk flexion should be avoided at first. The stress that trunk flexion with abdominal load places on the body could exacerbate a diastasis recti (Stewart 2012). As the client has been more inactive than usual, the program is designed to facilitate mobility and flexibility. It includes stretching hip flexors, tight hamstrings, chest expansion for rounded shoulders, the thoracic spine (kyphosis) and the lumbar spine (lordosis) and strengthening the pelvic and abdominal muscles. The additional benefits of the program are improved balance and proprioception that may have been lost as a result of the change in shape and size of the body during pregnancy, plus enhanced energy levels. 9

A well-constructed Pilates practice will benefit and assist the physical changes and awareness a mother has of her post-natal body. A meaningful practice can also sometimes reset the confidence button in a woman who is struggling to accept, and understand her changed body as she navigates her new role as a mother (Stewart 2012). A conditioning program utilising the Block System from the BASI approach highlighting exercises for a new mother is detailed in the following program.

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Example Program for New Mothers

BLOCK 1

Rolldown and Warm Up

Pelvic curl Supine spine twist (feet on fit ball if required) Chest lift (may need support under back at chest level) Cat stretch to replace chest lift with rotation

Equip

Comments

Mat

The fundamental warm-up is initially recommended for clients returning after a break from Pilates. Remind clients of core contraction of the TA – slowly contract abdominal muscles pulling them straight back towards the spine along with lifting pelvic floor and lateral breathing. Be sensitive to the Client’s ability and wellbeing.

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Foot Work

Footwork series

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Abdominal Work

Leg Circles with theraband

Wunda Chair Mat

Up and Down Circles (care with the height and width of legs)

Reformer

Extended Frog Extended Frog Reverse Bottom Lift and Bottom Lift with Extension

Reformer

Allows the hip flexors to relax and assists tight hamstrings and relaxes muscles of the hip joint. Uses abdominal muscles as stabilizers rather than as movers. Focus is on hip disassociation while stability of the pelvis is maintained to encourage balanced use of hip muscles. Adapt weight of springs as required. The TA is required for effective spinal articulation.

Kneeling lunge

Reformer

Maximising stretch to hip flexors and hamstrings.

Leg changes maintaining one foot in contact with the floor 4

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Hip Work (strap work)

Spinal Articulation Stretches

Cue core contraction and lifting pelvic floor for prevention of further diastasis. Form is important! Emphasise good posture and use of trunk stabilisers

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Cue for chest open and sternum forward for optimum shoulder posture. 7

Full Body Integration 1

Push Through Series: Sitting Forward Side Reach Kneeling Cat Stretch

Cadillac Strengthens abdominal muscles, extends shoulders and improves flexibility of hamstrings.

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Arm Work

Standing Arm Series

Cadillac

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Additional Leg Work Full Body Integration 2

Squat

Cadillac

This block would most likely be excluded. Tendon Stretch may be suitable for some clients.

Wunda Chair

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Lateral Flexion / Rotation

Side Kneeling Stretch

Wunda Chair

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Back Extension

Swan Basic Back Extension Single Arm

Wunda Chair

Improves spinal articulation, shoulder flexibility and trunk stabilisation Develops arm and shoulder strength, and flexibility. Demands core strength and good posture. Cue the core. Great for core strength. Timed for flow of the session. Encourages focus on lifting pelvic floor and TA contraction. Use heavier spring to reduce risk. Focus is on abdominal obliques Cue to maintain scapular control and avoid rotation of the pelvis Strengthens back extensors Develops scapular control Emphasises abdominal control

Rolldown to finish

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Conclusion Mothers typically return to exercise after a six week post natal checkup (or later if the baby was delivered by Caesarean section) and should only recommence Pilates after a medical clearance. Pregnancy is a natural condition but changes occur to a woman’s body which can be detrimental to good posture. Instructors must also be aware that some women may experience conditions such as pelvic floor laxity and Diastasis Recti. The instructor has a duty to facilitate balanced sessions which provide a whole body workout. In saying this, the Pilates repertoire ought to be modified in choreography or with the use of assists, being sensitive at all times to the individual’s condition. The Pilates sessions detailed in this paper supports these goals as well as maintaining/improving posture and the client’s understanding of the changes that have occurred to her body, focusing on relaxing tight muscles, strengthening weak muscles and improving abdominal and pelvic floor strength. The paper also reminds instructors of the other benefits that a well-constructed Pilates program can deliver benefits such as balance, body awareness and a ‘reset’ of the confidence button and energy levels of a new mother.

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Bibliography. Books Isacowitz, R. (2013) “Specific Populations Module 12”, BASI Comprehensive Course Study Guide, Body Arts and Science International, CA, USA. Isacowitz, R. (2006) Pilates. Your Guide to Mat and Apparatus Exercises. Human Kinetics. USA. Isacowitz, R. Clippinger, K. Pilates Anatomy (2011). Human Kinetics, USA. Laughlin, K. with Cristaudo, J. (2001) Stretching and Pregnancy, Simon and Schuster, Australia. Websites/Newsletters/Journals Diastasis Recti, accessed on 12 May 2014 (http://www.diastasisrecti.com) Diastasis Recti, accessed on 20 April 2014 (http://www.Passionchiropractic.com.au) Diastasis Recti, accessed on 20 April 2014 (http://www.wikipedia.org/wiki/diastasis_recti) Newsletter 2013,Leah Stewart.(www.basipilates.com) Newsletter Lessons for Health. 2012, B, Kalisiak. (www.legacytherapystl.com) Pilates: Great Exercise for New Mothers 1970 (www.NurseTogether.com) Pilates and Getting Moms Confident and Back in Shape 2012, Leah Stewart (www.pilates.com) Pilates exercises for New Moms (part 1) 2012, Robin Long. (www.thebalancedlifeonline.com)

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Perinatal Fitness 2012,Lesly Levy, (www.pilates-pro.com) Pregnancy Posture, accessed on 11 May 2014 (http://www.google.com.au) Other Interview with Tessa McDonald – New Mother, Wednesday 21 May 2014. Menezes Pilates for Pregnancy Video, 2011. Pilates Institute of Australasia Pty Ltd. Chatswood, Australia.

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