Pilates in pregnancy

THIS IS IN NO WAY A SUBSTITUTE FOR MEDICAL COUNCELING
The Pilates method emphasises the importance of beginning movements from a central core of stability, combined with appropriate breathing control. Pilates focuses on lateral chest breathing as opposed to the stomach breathing advocated in yoga. This breathing technique utilises four sets of muscles, namely, the diaphragm, the transverses abdominus (inner abdominal muscle), multifidus (part of the erector spinae muscles) and the pelvic floor muscles. These muscles have been termed the ‘cylinder of stability’ and contracting them together leads to an increased intra-abdominal pressure.

This tenses the thoracolumbar fascia (membrane which covers the deep muscles of the back of the trunk) and has been proposed to be one mechanism of increasing the stability of the lumbar spine region (Hodges and Richardson, 1997). Learning the correct method of breathing is vital, but one of the most difficult principles for beginners to grasp. Once the mother has stabilised her pelvis and lumbar spine, gradual arm and leg movements are introduced to challenge this core stability. Exercise during pregnancy offers many physical and emotional benefits (Artal and O’Toole, 2003) and because of the gentle nature of many of the exercises in Pilates, mothers are increasingly seeking it during and after pregnancy. In particular, many of the exercises can be performed on the side or while sitting, and hence are safe during the second and third trimester when a supine position is contraindicated.

Pilates is now a mainstream exercise and although the basis for the exercises have been well researched (Hodges and Richardson, 1997; Richardson et al, 2002), very little has been published on Pilates in the academic literature, largely as a result of Pilates activities being outside of academic institutions. I am unaware of any published studies looking at the effects of Pilates on pregnancy or indeed whether exercises to focus on the transverses abdominus during pregnancy can reduce the incidence of diastasis recti (also known as abdominal separation). Such studies are therefore much needed. In the hands of the right instructor, Pilates can be enjoyable and a highly effective form of therapy. It is important to caveat this by saying that Pilates in the UK is not well governed, and it is therefore important that anyone considering seeing a therapist check their credentials carefully and preferably seek references from other patients.

(See more at: http://www.rcm.org.uk/midwives/features/pilates-and-pregnancy)

Pelvic floor
Pelvic floor muscles play an important part in our pelvic spinal stability, but have other important functions, such as supporting the pelvic organs and ensuring resistance to sudden rises of intra-abdominal pressure (during sneezing and coughing) and control of continence. After birth, the pelvic floor muscles have the ability to be retrained. When the individual starts the retraining of pelvic floor muscles, it is important first to identify and isolate the correct muscles. In the Pilates studio, we start this process in positions where there is the lowest load on the pelvic floor muscle, such as side-lying or supine positions and progress to seated and standing exercises thereafter.

Mothers are then encouraged to incorporate their exercises into their daily functional activities. Pelvic floor exercises should ideally be performed throughout pregnancy, although if a woman has not been educated during the antenatal period, then she must begin as soon as possible after birth. If she does not, the muscles remain stretched and weakened and recovery is prolonged.

Summary
Pregnancy is associated with a number of musculosketal problems. It is important to educate all mothers, as well as those involved in ante- and postnatal care with advice on bras and exercises that are safe in pregnancy (in particular pelvic floor exercises). There is not much that can be done to alter the inevitable physiological and hormonal changes of pregnancy. However, by strengthening the core stabilising muscles around the pelvis and spine, and improving the breathing pattern, it is hoped that one can optimise the body for the challenges it may face. Pilates is based on the principle that a central core is developed and then movements are introduced to challenge this core stability. This philosophy is clearly applicable in pregnancy – a significant test both mentally and physically on the mother’s body. By maximising the mother’s core stability before and during pregnancy, it should be possible to limit any potential harm. Returning to exercise soon after the birth is important for the mother’s physical and mental wellbeing – she looks after her baby’s body for nine months, who cares for hers?

Can anyone practice Pilates during Pregnancy?
If you have never done Pilates before you are advised to wait until you are in your 2^nd trimester. If you are generally fit and health and have been participating in sport prior to your pregnancy you can choose when you wish to start Pilates.  You will be asked to seek verbal medical clearance from your GP/midwife if you’re generally in good health. However, if you have previously had complications during this or other pregnancies such as miscarriages, continual bleeding or have undergone IVF treatment you will need written consent.
If you are expecting twins you will need written consent to start classes and may find that you cannot continue for as long as some of the other ladies. Those ladies expecting triplets or more 1:1 sessions are advised. 

Contraindications to exercise
If you have been told you have any of the following unfortunately taking up group exercise is not suitable as this time however, on discuss with your GP/midwife 1:1 sessions maybe suitable:

• Haemodynamically significant heart disease
• Restrictive lung disease (COPD)
• Incompetent cervix
• Persistent second or third trimester bleeding
• Placenta previa after 26 weeks gestation
• Premature labour during current pregnancy
• Ruptured membranes
• Preeclampsia (Pregnancy induced hypertension)

Are there any warning signs to terminate Pilates exercises?
If you experience any of the following during a Pilates class or when exercising in general please stop, alert the instructor and discuss continuing exercising with your GP/midwife before returning to class:

• Vaginal bleeding
• Shortness of before exertion
• Dizziness
• Headache (sign of dehydration)
• Chest pain or palpitations
• Muscle weakness
• Calf pain or swelling
• Pre-term labour
• Decreased fetal movement (less than 6-8 movements per hour for more than 4hours)
• Abdominal pain, especially back or pubic
• Excessive fatigue
• Pelvic girdle pain
• Amniotic fluid leakage

(see more at: http://www.pilateswithrachel.co.uk/page11.htm)

Exercise Guidelines
The American College of Obstetricians and Gynecologists (ACOG) guidelines for exercising while pregnant include:

• In the absence of contraindications, pregnant women are encouraged to engage in 30 minutes or more of mild to moderate exercise on most, if not all, days of the week.
• During the second and third trimesters, pregnant women should avoid standing motionless for too long and exercising while supine (lying on their backs).
• Supine positions can decrease the blood flow to the uterus.
• Less oxygen is available for aerobic exercise so modify the intensity of your routine accordingly.
• Stop exercising when fatigued and do not exercise to exhaustion.
• Participation in a wide range of recreational activities appears to be safe. However, activities with a high risk of falling or abdominal trauma should be avoided.
• Do not become overheated and monitor your heart rate while exercising to be sure it does not exceed 140 beats per minute. The target heart rate will vary by your level of fitness.
• Avoid positions and movements that present a challenge to balance in order to prevent falls. Remember, since the extra baby weight is carried in front of the body and not equally distributed, a woman’s centre of gravity changes.
• Avoid bouncing on a ball as this may cause dilation.
• Always check with your doctor before continuing to exercise or start a new exercise program especially if you are a high-risk pregnancy.
• Listen to your body and do not do anything that does not feel “right.” Stay in touch with your body’s new needs and experiences. Slow down and rest as needed.
  

Pilates and Pregnancy
Since Pilates is non-weight bearing, the exercises are ideal for pregnant women. Pilates works by strengthening the core of the body as well as the postural muscles that support the weight of the baby. Strengthening the back and improving posture makes carrying the baby easier, with less risk of pain and injury. Also, exercises can be modified to your current condition during any stage of the pregnancy. As the size of the belly increases, more leg, arm and shoulder exercises should be added. Pregnant women have plenty to do on the ‘chair’ – a piece of equipment that usually doesn’t get as much attention as others. The chair offers lots of exercises in the standing or seated position. Pilates breathing techniques encourages extra oxygen to flow to the unborn child and can also contribute to a smoother delivery.

www.phillyfitmagazine.com Certification Program also makes the following recommendations:

• Refrain from movements that take the pelvis above the head as this can cause air to enter the uterus, which can be dangerous (i.e. jackknife). The hip bones should stay anchored onto the ground although the legs can lift (i.e. single leg circle).
• Avoid EXTREME rotational, twisting and side bend movements of the spine because of the (small) chance of the placenta tearing away from the uterus.

Postpartum Guidelines
Pilates makes sense for postpartum women because stronger abdominal muscles create a body that can return quicker to pre-pregnancy condition. The ACOG says you can resume your pre-pregnancy routine based upon your personal physical capability, although your obstetrician may ask you to wait until your six week postpartum checkup. Joints and ligaments remain relatively loose for approximately three to five months, so you’ll want to ease back into your Pilates routine with care. Also, most women develop a gap in their abdominal muscles as their belly expands during pregnancy and labor. This gap takes about 4-8 weeks to close, so you want to avoid strenuous abdominal exercises until then. If you had a normal vaginal delivery and exercised throughout your pregnancy you can probably start with light exercises within days of giving birth.

If you stopped exercising during your pregnancy or are a newcomer to fitness, you’ll need to take it slow the first month. If you had a C-section, expect to wait longer, usually about six weeks.

Pilates and Beyond
After birth, women can continue to experience the benefits of Pilates. Pilates helps get the abdominal muscles and pelvic floor muscles back into shape. Many mothers experience lower back, hip and shoulder pain as they carry their babies without sufficient core strength. Constantly carrying your baby on one side of the body can also contribute to misalignment where one hip and shoulder may sit higher than the other. Pilates bilateral work helps bring the hips, shoulders and spine back into balance so mothers can fulfil the hectic needs of the new baby and participation in daily activities. The realignment reduces pain and the stress often experienced in a new mother’s daily life and helps restore the body’s natural harmony.

Lenore states “After giving birth by C-section, I was back in the Pilates studio in four weeks. It was difficult initially to retrain my abdominals but after a few weeks of regular practice, I was back to where I left off and my muscles definitely remembered where they had been pre-pregnancy.”