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Antenatal Pilates
nd
rd
Mike Smith
Jan 2012 (BASI CTTC)
Hobart , Tasmania
Abstract
This paper considers a case study of a pregnant client in the 3rd trimester and includes a pilates
conditioning program 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 pregnant clients.
The paper considers: should a new client start pilates when pregnant if they have never done pilates
before?
The paper concludes that:
As clients bodies will tend away from ideal alignment maintaining good posture should be a
primary goal.
Exercises should be modified as bodies alter during pregnancy.
Clients and instructors should be aware of conditions specific to pregnancy.
If pregnant clients are starting pilates for the first time routines should safe and very
controlled, and clients should probably get the all clear from a doctor first.
The BASI whole body approach to pilates should work well for pregnant clients, especially
with strong emphasis on individual needs and changes.
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Contents
Abstract ............................................................................................................................................... 2
1.
4.
Discussion.................................................................................................................................. 16
6.
Conclusion ................................................................................................................................. 18
7.
Bibliography/References........................................................................................................... 19
Table of Figures
Figure 1 - Diagram showing typical pregnant posture (Anthony 2005).................................................. 4
Figure 2 Pregnant client: deviation from good and bad alignment (Sullivan 2009) ............................ 5
Figure 3 - Good posture for a pregnant client (Robinson 2006) ............................................................ 6
Figure 4 - Diagram of Diastasis Recti (Powell 2013).............................................................................. 7
Appendices
Appendix A Studio photos showing some of the different modifications which can be used to
ensure the pregnant client is exercising in a safe position.
Appendix B Alexander Technique Photos showing some transitional movements.
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To limit the scope of the paper to a manageable focus, I have chosen the main topic of the paper to
be Trimester 2 leading to Trimester 3, and a client noted in the list above as type 2 i.e. Relatively
fit, with some pilates practice.
The BASI approach to pilates is a whole of body approach however, after researching the subject
area, the main topic and area of focus for this paper is posture. Secondary topics are stabilization
(specific strengthening and toning exercises) and lastly (but not least) breathing as a focus for
preparation for labour in the 3rd trimester.
Below in Fig 1 and 2 are two diagrams of a typical pregnant posture, noting the deviations away
from the ideal posture.
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Figure 2 Pregnant client: deviation from good and bad alignment (Sullivan 2009)
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Advice for new clients starting pilates for the first time, a selection of quotes from
different sources
It is not advised that you begin a pilates program or any form of exercise for the first time
after becoming pregnant Pilates Anytime website (Stewart 2012).
And also in the first trimester to allow the rectus muscles to lose tone and be able to expand.
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This same view (not to start pilates if not done it before) was taken during an entirely
separate discussion with Joleen Watson (BASI faculty, Qld , Australia) 29 Jan 2012.
If you are new to pilates we advise you to wait until you are at least 16 weeks pregnant
before you start the program (Robinson 2006).
If woman are at a higher risk of miscarriage2 it may be safer to begin classes after the 14th
week of pregnancy (weeks 8-14 are when miscarriage is most likely to occur - Teaching
Prenatal Dru Yoga: Teacher Training Notes 2012).
Unless already practicing yoga, do not begin during the first 3 months of pregnancy (Dru
Yoga: Teacher Training Notes 2012).
A review of the evidence suggests that, in most cases, exercise is safe for both mother and
foetus during pregnancy and women should therefore be encouraged to initiate or continue
exercise to derive the heath benefits associated with such activities. (RCOG 2006.)
All movement is good. It should be considered that for a client wishing to start pilates for the first
time when pregnant, this may be the only form exercise that she does, or will, do during her
pregnancy.
Contraindications
Exercise in the supine position should be avoided after 16 weeks of gestation.
Avoid magic circle between legs (use a ball of cushion instead).
Dont over stretch or bounce during pregnancy.
Avoid exercises that might force air into the vagina (such as exercises where you bring your
knee to your chest while on all fours).
Avoid exercises that cause the small of your back to curve inward (when loaded).
Avoid exercises that require bridging (bending over backwards).
Avoid exercises that involve deep flexion or extension of the joints (such as deep knee
bends), jumping, sudden changes of direction or jerky motions.
No loaded abdominal work (e.g. no chest lifts, hundreds etc.).
Extension of the torso is also not recommended if there is separation/diastisis.
Single legged work is contra indicated if any pain in pubic symphasis or hips.
No strong twisting.
No double leg float.
Nothing loaded on belly (not over ball, no rocking prep, swan dive etc.).
Because of instability around the pelvis, continue to avoid exercises with a wide range of
movements and/or long levers.
Do not use leg weights.
Specific recommendations and modifications:
Learn to release and control pelvic floor (PF) , have awareness.
Use active controlled stretching, not held, not pushing, with control.
Prone work is OK if still comfortable. Do not put load on belly, i.e. use props: c-cushion,
towel/mat supporting belly over an arc, triangular cushion, or in quadruped position.
Use ball or cushion for adductor gentle controlled squeezing - to replace MC between knees.
Can use arc on Reformer (fat end to lie against) to prop up clients for foot work.
2
You should also refer to medical practitioner if this is the case in order to confirm it is OK to start or continue
pilates.
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In supine position do a 1/2pelvic curl (just the pelvis to full ROM and back) not lifting off.
Footwork on wunda chair (good for posture).
Squatting on ped-a-pole or against wall using fit ball.
Include exercises for scapulae stability.
Include exercises that work the calf pump to improve circulation.
Include calf stretches to help prevent leg cramps.
Keep you limbs close to your bodyline and bend your knees when necessary.
Consider using a wedge or a rolled-up towel under sitting bones during sitting exercises.
Try to include some back extensions at each workout.
Encourage flexibility in hips, knees, ankles and shoulders.
Strengthen postural muscles (especially legs abdomen and lower back).
For relaxation adapt a side lying position on their left side, a cushion supporting the head,
and in later pregnancy a cushion supporting their belly.
Legs raised and supported (e.g. on fit ball) can be good for circulation.
For reformer footwork and hip work you can use a jump board resting on the shoulder rests
to elevate the head and torso of clients (to help avoid the supine position).
Pregnant cat good exercise to allow abdomen to release and stretch in a safe position and
take weight off the pelvic floor.
Where the placenta is attached to the lower half of the uterus, covering or partially covering the opening of
the cervix because exercise may exacerbate bleeding.
4
Where the neck of the womb opens prematurely due to the pressure on it of the uterus and the baby.
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Calf pain.
The above information in section (2) has been prcised and collated from a number of different
sources including: Anthony 2008, RCOG 2006, Isacowitz 2008, Cook 2009, Eisenberg et al 2000,
Teaching Prenatal Dru Yoga 2012, Donahue et al 2013, Robinson 2006, Stewart 2012, and Watson
2012.
The round ligament connects the front part of the womb to the groin. Symptoms, typically in the second
trimester due to the growing uterus, include a sharp spasm in the belly. The pain only lasts a few seconds.
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3. Case study
Client choice.
The client is my partner who went through pregnancy approximately 1 year ago. This made the
client choice very easy for me as I had a vested interest in establishing a good, healthy and safe
pilates practice for pregnant women in the 2nd and 3rd trimesters. This paper has been progressively
updated throughout the second and third trimesters as my client progressed through pregnancy, I
also taught pregnancy classes to the client (and 2 other pregnant friends) over several months
during the 2nd and 3rd trimesters.
Client particulars
Female, age 33, fairly fit, some pilates experience and some yoga experience, regular walking and
moderate exercise, very healthy diet, non-excessive caffeine intake, non-smoker and low alcohol
intake prior to pregnancy (negligible alcohol and caffeine intake during pregnancy). Weight gain in
the pregnancy was normal and well within recommended guidelines.
Pilates/yoga history
Some pilates practice over the last 2-3years. Some group sessions and some individual sessions with
BASI instructors. Started regular weekly pregnancy equipment pilates practice (group sessions of 3people) at end of 1st trimester. Yoga practice over a number of years (under instruction), started
regular twice weekly pregnancy yoga practice (group sessions) at end of 1st trimester. More regular
yoga practice than pilates practice over past 2 years until pregnant.
Physio/pilates physio assessment (and areas to focus on)
Slightly Kyphotic, focus on thoracic extension and work towards ideal neck position, Tendency
towards flat back needs to focus and trigger multifidous (especially in sitting). Some history of hip
misalignment prior to pregnancy (treated well with osteopathy and physiotherapy) long periods of
problem free movement, especially when practicing pilates and yoga under instruction.
Pilates Client Goals
Short-term
Posture (improve and maintain through pregnancy)
Pelvic floor (improve and maintain through pregnancy)
Keep current high fitness level as much as possible
Medium term
Improve specific fitness for pregnancy
Preparation for birth
Improve hip alignment
Long term
Improve chances of a swift recovery from birth (whether vaginal or caesarean)
Strength for the pregnancy (and post partum, e.g. holding baby, lifting baby etc.).
Prevention of future hip misalignment episodes.
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4. Conditioning program
Utilizing the block system two exercise routines are included below, one for the 2nd Trimester, the
other for the 3rd Trimester. The reasons for selecting the particular routines are based on taking into
account the contraindications, modifications and recommendations noted above. Some of the
exercises have specific notes next to them or refer to photos later in the text to explain the
modification.
First Trimester As noted earlier the main focus of this paper is the 2nd and 3rd trimesters.
Exercises in the first trimester should be based around establishing a routine, usually based around
exercises which the client is used to doing. Focus on: Neutral spine, extension of thoracic spine,
flexion on lumbar spine, transverse abdominus and oblique strengthening and stabilization (to
counteract loss of tone in the rectus), and pelvic floor toning. Breathing, practice learning different
breathing techniques.
Second Trimester Exercises in the 2nd trimester should be based around modifying a routine,
Neutral spine, lateral flexion, extension of thoracic spine, flexion on lumbar spine, transverse
abdominus strengthening and stabilization (to counteract loss of tone in the rectus). Gentle and
oblique exercises (as they will be getting more stretched now) pelvic floor toning and breathing to
stretch intercostals muscles.
Third Trimester Exercises in the 3rd trimester should be based around decreasing a routine.
Essential exercises include: Pelvic tilts, hip circles, stretching, pelvic floor work, squatting, breathing,
stability of the spine and pelvis. This is a good time to start the process of bulging (Anthony 2008)
of the pelvic floor (approx 3 weeks before due date).
Notes on Appendices
Appendix A includes a number of photos of modified exercises as identified in the pilates routines
described below. Some of these are to adjust the client so as to not be in a full supine position or
turn an exercise into a closed chain exercise.
Appendix B includes some pictures of transition movements during pregnancy using the Alexander
Technique movement principles (Machover et al 1993), it is suggested that these are very good for
the 3rd Trimester and post natal.
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Warm up
FBI 1
or
Flat Back (knee stretch series reformer)
Foot Work
Abdominal
Work
Hip Work
Additional
legs
Stretches
FBI 1
Lat flex/rot
FBI 2
Scooter (Reformer)
Mermaid (Reformer)
Thigh Stretch with RUB (Cadillac)
Arm work
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Back
Extension
Spinal
Articulation
Finish
Exercise
Equip/Notes
Warm up
Abdominal
Work
Stretches
Lat flex/rot
Due to the fact that there is no rectus abdominus work in this routine, FBI exercises which work the core
have been used instead.
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FBI 2
Scooter (Reformer)
Arm work
Back Extension
Spinal
Articulation
finish
#
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5. Discussion
It is probably not ideal to start new comprehensive pilates repertoire (or any new exercise) during
pregnancy if not experienced it before, however, the client could do a limited and safe routine (e.g.
a basic and simple routine focussing on breathing, stabilization and gentle stretching [Anthony
2008]). However it is worth noting that due to the many changes going throughout the pregnant
body it would be difficult to know what is normal/not normal for new exercises.
It is interesting to note that during pregnancy the fitness, mobility and endurance of clients will
reduce! This is different and opposite to the teaching of most other clients who, on the whole,
improve with a regular routine. This phenomenon needs to be considered and included within the
planned routines, the routines will need to be catered for each individual and progressively reduced
in difficulty, and the number of safe exercises as the pregnancy progresses.
In addition we should be looking for certain (potential) conditions, such as diastisis recti and
separation of the pubic symphasis, on a regular basis.
It is also worth noting that from week to week, day to day and even hour to hour, the way a
womens body can change is significant during pregnancy, much more so than expected fluctuations
in other clients. It is important for clients and instructors to be aware of this and make allowances.
A final observation of note was passed onto me be my osteopath who noted that structural changes
in the body can occur during pregnancy due to relaxin and the movement of bones, because of this
certain structural abnormalities or imbalances have the potential to be corrected during pregnancy
and soon after birth before the body changes back to normal. For example for the client in my case
study there is a chance that with good posture and some osteopathy/pilates treatment her hip
asymmetrical issues may be permanently resolved after pregnancy. It should be noted that the
bodies will be different than before pregnancy, so a new assessment and notes, and an approach to
pilates should be considered necessary for post partum sessions, almost treating them as a new
client.
Due to the possible problems that can occur during pregnancy it is prudent to seek assurance from
the client that they have seen their GP/Dr and have been given the all clear to start/continue a
pilates exercise routine during their pregnancy. This ensures that the client has been checked for
medical conditions, and would also cover you in the event that some problem did occur later during
the pregnancy which may be unrelated to pilates. Also it may highlight any areas you need to be
more aware of about your client, and help to ensure that the client has been told of certain physical
conditions that they should be aware of during any exercise routine especially with their changing
bodies.
Clients will lose their rectus abdominus tone! Do not focus on trying to keep or improve rectus
abdominus, in fact intentionally let it go. Focus on PF and other core muscles as they will need to do
more work than normal due to loss of muscles and the extra weight due to the baby, and the fact
that relaxin means that the hip/pelvic girdle complex can no longer be relied on to take all the
weight (it may separate) so other buttock muscles and hip muscles need to be able to help carry
the load. Fitter clients may be at more risk of diastisis due to tight abdominals, and may also have
more difficulty in learning to allow these to relax.
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As noted in the paper there are conditions which clients (and pilates instructors) need to be aware
of. Also the fact that these can change literally on a day to day basis, e.g. diastisis recti, issues with
pubic symphasis, blood pressure, and energy levels. Both clients and instructors should check in on
a regular basis for such conditions to allow exercise to continue in a safe and pain free zone at all
times.
At the Natural Balance Studio in Hobart, Tasmania, a detailed review of guidelines for instructing
pregnant clients was conducted during the course of the research for this paper. Pregnant clients are
only taught in specific pregnant classes. These guidelines (based on the research carried out for this
paper and professional development sessions at the centre including input for BASI instructors who
are also qualified physiotherapists and osteopaths) were amended so as to be safe for all trimesters
(i.e. if a client is pregnant it doesnt matter if in the 1st, 2nd or 3rd trimester). This approach does
mean that for fit clients in the earlier trimesters that the class may be a bit slower and easier that
could be conducted. However, interestingly, the feedback from these clients has been very positive,
in that they say it is enjoyable to slow down and focus on their pregnant bodies, rather than always
pushing to do the hardest exercise.
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6. Conclusion
6.1. During pregnancy changes will occur to the clients body which will tend to affect their
posture detrimentally, and tend to move it away from good alignment. A primary aim of
pilates exercises should be maintaining good posture.
6.2. Additional client goals include: pelvic floor conditioning, fitness for pregnancy (and
recovery from birth), and to improve hip alignment
6.3. During pregnancy there may be an opportunity to permanently alter alignment issues in a
positive way, due to relaxin flowing through the body.
6.4. Pilates routines can and should be modified, including assists, for pregnant clients as
suggested in the two routines included in this paper.
6.5. Should a new client start pilates when pregnant? the conclusion is that movement is good,
so yes, but to ensure that routines are safe and controlled. Also it is prudent to get the all
clear for exercise from their doctor.
6.6. Pregnant clients should recognise that they will (and need to) lose tone and definition of
their rectus abdominus.
6.7. There are a number of specific conditions that pregnant clients may encounter, clients and
pilates instructors should make themselves aware of them.
6.8. As the pregnancy progresses clients will become less able and need more control in their
movements (unlike most clients who you expect to improve in their performance week to
week).
6.9. The BASI whole body approach to pilates should work very well for pregnant clients in
maintaining pregnant bodies, preparing for birth and assisting in post birth recovery.
Especially when used with a strong emphasis on clients individual and changes to their
bodies, week to week.
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7. Bibliography/References
Anthony, C (2005), Pre/Post Natal Specialist Pilates Certification, Notes from pilates certification
course, The Centre For Womens Fitness, LCC, MI, USA.
Anthony, C (2008), The Pilates Way To Birth, Exercises for Mat, Cadillac, and Reformer, The Centre
For Womens Fitness, LCC, MI, USA.
Cook, K, (2009), Exercising in pregnancy, Up The Duff, Viking, Australia.
Donahue, C et al. (2013), Natural Balance Professional Development workshops (5/2/13, 29/2/13),
Hobart, Tasmania
Eisenberg A, Murkoff H, Hathaway S, (2000), The Fifth Month, What To Expect When Youre
Expecting, Angus & Robertson, NSW, Australia
Isacowitz, R (2008), Specific Populations, Module 12, BASI Comprehensive Course Study Guide
[Pilates Teacher Training notes], Body Arts and Science International, CA, USA.
Machover, I, Drake, a, Drake, J (1993), A guide to better pregnancy, natural birth and parenthood,
The Alexander Technique Birth Book, Frankfurt Germany
Noble, E (1988), Essential exercises for the childbearing year, Houghton Miffin, Boston, USA.
(NOTE- this book was referenced and recommended in the book Spiritual Midwifery by Inna May)
Pilates Anytime website ref: www. : Leah Stewart Prenatal & Postnatal weblink (8 Feb 2012)
RCOG (2006), Exercise in pregnancy, Summary of recommendations from a detailed literary review
of peer reviewed reliable database, Royal College of Obstetricians and Gynaecologists, Statement No
4, Jan 2006 , UK, http://www.rcog.org.uk/womens-health/clinical-guidance/exercise-
pregnancy
Robinson, L, (2006), Optimum Health and Fitness for Every stage of Pregnancy, Pilates Pregnancy
Guide, Firefly Books, NY, USA.
Stewart, L, (2012), Pilates Anytime Reformer prenatal video, BASI Faculty (pre and post natal
instruction) Feb 2012 on-line resource, www.pilatesanytime.com
Sullivan, K (2009) Introduction, Pregnancy and Birth, DK Publishing, Australia.
Teaching Prenatal Dru Yoga (an introduction, Book 12 Prenatal yoga), Teacher Training Notes 2012,
USA.
Watson, J (2012), Discussions/Q&A session during final module of BASI Pilates Comprehensive
Teacher Training, Hobart, Australia 29 Jan 2012.
Wood, S, (2012), Repertoire photos and examples, Pilates for Pathologies and Injuries [Notes],
BASI advanced education course 8-10 June 2012, Hobart, Tasmania, Australia.
Powell, W (2013), Google web search,5/11/13,
http://www.google.com.au/imgres?imgurl=http://mutusystem.com/wp-
content/uploads/2012/06/Diastasis-Recti-V3.jpg&imgrefurl=http://mutusystem.com/diastasis-recti-test-what-works-and-what-to
avoid.html&h=538&w=800&sz=170&tbnid=23iqhfpX2utQQM:&tbnh=105&tbnw=156&zoom=1&usg=__jMfOuNtAQ1_9ti0Mz128aF_aKn0=
&docid=lHDnnVOHrJKN-M&sa=X&ei=xrF4Us6DHoTHkQXizYGoAg&sqi=2&ved=0CEQQ9QEwAg
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Appendix A
Book openings
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Assisted Squats
cadillac
Hip opener
straddling WC
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Appendix B
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