Pilates is an overall body fitness system that effectively addresses a pregnant woman's muscle imbalances. Pilates fully integrates the body so effectively that many of its exercises carry over to movements needed in daily life. This helps pregnant women better manage spine pain and keep an old injury from flaring up.
Pilates is a mindful exercise approach that takes concentration. I often have patients tell me, "I can do it, but I have to really concentrate." That's when I know they're getting the concept. This is not an exercise program that you can do on autopilot or just power through to get it done quickly.
The biggest benefit occurs when a person maintains focus to the point that 8-10 reps feel like a challenge. If a pregnant woman thinks Pilates is easy, she may need verbal and tactile cues to guide her away from overcompensating with the rectus abdominus, erector spinae, gluteals, and hip flexor muscles.
The weaker muscles of the pelvic floor - the transversus abdominus and multifidi - must be cued to recruit in an effort to help the body balance and maintain proper form. Pilates will tend to be more challenging over time, as the patient fine-tunes the movements to engage weak muscles more effectively.
Just about any pregnant woman can benefit from a good Pilates routine with modifications based on her individual needs. It can be completely safe throughout pregnancy.
Pilates is best known using a mat and props, but there are many pieces of equipment that aid in a more thorough repertoire of the work. Equipment can assist or destabilize the movement environment to perfectly match a pregnant woman's challenge point while maintaining good form.
Pilates works best when both mat and apparatus work are practiced. A physical therapist knowledgeable in Pilates principles applied to mat work and on the apparatus will give a pregnant woman the opportunity to successfully develop the groundwork for an effective Pilates program used in rehabilitation.
There are a number of ways Pilates-based rehabilitation can specifically help during pregnancy. Pregnancy creates many changes in a woman's body that can lead to an increased chance of injury.
Ligamentous laxity. Release in the relaxin hormone, causing laxity in all ligaments, is a big change that happens during pregnancy. This compromises the stability of the spine and pelvis. The excessive movement associated with this change can lead to pain and inflammation in the lumbar spine and pelvis. This can cause the piriformis, gluteals, erector spinae, rectus abdominus, and quadratus lumborum muscles to overcompensate for excessive movement. These muscles often go into spasm when they get overworked.
Ligamentous laxity increases the chance that the pelvis shifts out of alignment. You can educate your patient on how to self-correct this. The stabilization that a rehabilitative Pilates program provides can keep the pelvis from constantly getting out of alignment during pregnancy.
It's also important to educate your pregnant patients to avoid over-stretching and over-resisting the adductor musculature. This can reduce the risk of pubic symphysis separation.
Muscle imbalances. The Pilates focus on core and scapular stabilization helps manage pain and muscle imbalances associated with pregnancy. Pilates exercise can help strengthen the pelvic floor and transversus abdominus muscles surrounding the spine that become less efficient as they stretch during pregnancy.
The multifidi fire in conjunction with the transversus abdominus to help provide spinal stability. Together they are the core muscles that restore stability lost during pregnancy.
Pilates can train a pregnant woman to brace the spine while moving her arms and legs. When the spine does move, the focus is on maintaining an elongated spine by using core muscles surrounding the spine. These inner muscles protect the spine from compression that leads to degeneration of the disks or joints.
People with back pain do not effectively recruit the transversus abdominus and multifidi muscles, which are imperative to stabilizing the spine. The pain cycle makes it difficult to recruit these muscles without proper guidance to avoid common compensation strategies.
Often, the same exercises can make you better or worse, depending on your form. First, you may need to help a pregnant woman become more aware of how to recruit the core muscles that brace the spine. Many people have difficulty appropriately engaging these muscles. The focus on increasing hip joint mobility and hip-leg muscle flexibility often needs to be addressed as well. Pilates integrates all of these needs simultaneously.
The emphasis on stabilizing the transversus abdominus muscles that surround the spine helps prevent a diastasis rectus abdominus in the third trimester of pregnancy and the postpartum period. If a pregnant woman already has a diastasis rectus abdominus, the Pilates approach can help train her to control the separation to manage this dysfunction. The ability to control this separation helps reduce pain during pregnancy, promote an easier delivery, and provide a faster postpartum recovery.
Cervical pain is another common problem during pregnancy as the breasts enlarge and create more muscle imbalance between the pectorals and scapular stabilizers. Pilates focuses on engaging the scapular stabilizers while relaxing the upper trapezius that often spasm from overuse. This focus in combination with core control helps improve the poor postural habits associated with pregnancy.
Change in center of gravity. The changing center of gravity associated with weight gain puts pregnant women in a more vulnerable position that can be managed through a consistent Pilates program. To respond to changes, the mind-body connection must be strong to make the adjustments required to protect the spine and pelvis. Pilates helps restore balance.
Fluid retention. Body fluid retention must be managed to improve comfort. The increase in the relaxin hormone during pregnancy contributes to fluid retention, which increases the risk of carpal tunnel syndrome. Imbalanced muscles surrounding the neck and shoulders can also contribute to the numbness and tingling associated with carpal tunnel syndrome.
The legs are another common area for fluid retention. Pilates helps increase circulation by integrating the entire body during exercise, which can help better manage fluid retention.
Reduction in lung capacity. The focus on breath another benefit of Pilates during pregnancy. Women are more likely to become short of breath during the third trimester as the fetus grows. Being mindful of inhaling and exhaling slowly and deeply using diaphragmatic breathing during all Pilates exercises heightens the benefit while improving lung capacity.
This is particularly helpful during pregnancy, as the growing fetus pushes on the ribcage and diaphragm. Expanded lung capacity helps improve endurance during the first and third trimester. Diaphragmatic breathing also relaxes muscles that tighten up during pregnancy
Precautions During Pregnancy
Avoid teaching any inversion exercises in the third trimester and postpartum period to reduce the risk of embolism. The opening of the cervix during this period causes an increased risk of air embolism. Bridging and other exercises that place the buttocks higher than the head should be avoided.
Avoid supine exercises once the woman is in her second trimester. The pressure of the fetus pushing on the vena cava can obstruct blood flow to the fetus. This can cause shortness of breath and nausea. If a woman experiences these symptoms, she should stop the exercise.
In addition, any leakage of fluid or blood due to exercise should signal a stop to the program. High-impact exercise should be avoided to prevent pressure on the pelvic floor that can contribute to further weakness. This can lead to long-term problems of stress incontinence, a prolapsed uterus, and sexual dysfunction. Exercise that provokes cramping should also be avoided to reduce the chance of pre-term labor.
After many years of incorporating Pilates into physical therapy with pregnant women who have pain, I'm still amazed to see the number of women who eliminate pain simply by learning to effectively engage the core and scapular stabilizer muscles correctly with a solid Pilates program. Pilates gives pregnant women the control to manage pain without relying on medication.
Kim Gladfelter is owner of PhysioFit Physical Therapy and Wellness in Los Altos, Ca.