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Modified Pilates during Pregnancy

& Post Pregnancy

During pregnancy, the predominant aim should be to maintain pre-pregnancy fitness levels rather than improve fitness levels. Once pregnant, some women who may have followed a more sedentary lifestyle become more health conscious and are keen to start an exercise programme to improve their fitness. Others who are used to exercising and maintaining a high level of fitness may wish to continue exercising throughout their pregnancy.

As long as the mum-to-be has no medical complications or pre-existing conditions such as a history of miscarriages, medical and fitness professionals agree that exercise is safe during pregnancy.

If you suspect you may be pregnant, you should cease all exercise until your pregnancy is confirmed. Once your pregnancy is medically confirmed and you have medical clearance to exercise, you may participate in Modified Pilates' exercise whether or not you have done Pilates before. You will need to complete a Physical Activity Readiness Questionnaire (PARQ) and a PARQ relating to pregnancy.

If you are worried about exercising too soon, wait until the start of the 2nd trimester. We would advise anyone considering starting Pilates’ exercise during the 3rd trimester to wait until after pregnancy before they commence Pilates.

Mums to be without any prior experience of Pilates, irrespective of how active or sedentary their lifestyle was before pregnancy, may attend an induction or beginner level lesson. Mums-to-be who already participate in group mat work lessons may continue to attend their usual lesson level during the 1st trimester. They may continue to attend the same lesson level after the 1st trimester but should perform modified movements or attend a lower level lesson.

 

Pregnancy as a Result of IVF Treatment

We do NOT recommend Pilates’ exercise at any level for those who may become pregnant as a result of IVF treatment. However, if the mum-to-be wishes to commence or continue to do Pilates, we recommend that she seek medical guidance and attend induction level lesson only as long as she has obtained medical clearance to participate in Pilates' exercise.

 

If any complications or health issues arise during pregnancy, all exercise including Pilates' activities should be stopped until you have received medical clearance from your GP or midwife that it is safe to return.

 

Warning Signs

You should stop exercising immediately and contact your GP or midwife if you experience any of the following:

  • Vaginal bleeding or excessive discharge from vagina
  • Abdominal or chest pain
  • Heart palpitations or shortness of breath
  • Sudden swelling of hands, feet or face
  • Severe, persistent headaches, dizziness or feeling faint
  • Raised blood pressure
  • Severe pain in pubic area or hips
  • Severe nausea or vomiting
  • Placenta Praevia (placenta too low or too close to cervix)
  • Severe anaemia or exhaustion
  • High temperature (over 100°F or 38°C)
  • Uterine contractions or breaking of waters
  • Baby small for date

 

The Benefits of Modified Pilates during Pregnancy

Pilates’ exercise is extremely beneficial as it provides an ideal preparation for labour and is of benefit during the time of recovery afterwards (post pregnancy). It offers both mental and physical training and differs from other forms of fitness in that it targets the deep postural muscles building strength from the inside out, a vital aspect considering the effects pregnancy has on the body and the noticeable changes in posture occur.

Better Posture

As the foetus grows in the uterus, the abdominal muscles weaken causing the pelvis to tilt forwards. This affects the shape of the spine causing the lumbar curve to increase which often leads to back ache. Pilates’ exercises that lengthen the tight lumbar curve will help to strengthen the abdominal muscles and maintain better lumbar alignment. Pelvic tilting is ideal and can be done in a seated position, lying down face up or kneeling on hands and knees. The position may have to be modified as the pregnancy progresses.

As the breasts enlarge, the upper back and shoulders round forwards and weaken the upper back and shoulder blade area. The muscles across the chest tighten. The head and chin move forwards resulting in the muscles down the back of the neck tightening, a common cause of tension and headaches. The muscles down the front of the neck lose tone as they weaken. Neck stretches and education of ideal spine and joint alignment will address these issues.

Improved Functional Strength and Stamina

Improving shoulder and arm strength will be helpful after giving birth when holding and carrying the baby, especially when carrying the baby in a car seat, placing a car seat and baby in and out of a car and as the baby grows bigger.

Improving abdominal strength is helpful during labour and after childbirth. The risk of separation of the linea alba ligament is reduced, the ligament that runs down the centre of the abdominal muscles and forms the navel. If it stretches more than 3cm a condition known as diastasis recti occurs. Sometimes the abdominal muscles may appear taut and toned as the abdomen enlarges to take the weight of the uterus but this impression can be false. Separation is more likely to happen if the abdominal muscles are weak, if excess weight is gained during the pregnancy, if pregnancies occur close together, if the baby is large or in the case of multiple births. However, some abdominal strengthening exercises such as rolling movements should be avoided to reduce the risk of diastasis recti occurring (refer to Exercise Limitations during Pregnancy).

Pilates’ exercise will strengthen the pelvic floor muscles. Strong pelvic floor muscles will contract strongly and quickly which may aid childbirth. Weak pelvic floor muscles that are overstretched may not return to normal length afterwards, increasing the likelihood of pro-lapse and continence issues later. Activating pelvic floor muscles whilst performing Pilates’ exercises during pregnancy should be encouraged as an alternative to activating the TA muscle. This is especially helpful if the linea alba ligament does separate as the TA muscle will be inhibited until the ligament repairs itself.

Efficient Breathing & Improved Circulation

The Pilates’ breathing technique can alleviate feelings of breathlessness caused by the diaphragm moving upwards to accommodate the growing foetus. Improved circulation will reduce the likelihood of swollen legs and ankles, leg cramps, varicose veins and/or haemorrhoids.

Aids Relaxation

Improved sleep patterns and increased energy levels will speed up postnatal recovery.


Exercise Limitations during Pregnancy

You should avoid the following:-

  • Running.
  • Lifting heavy weights.
  • Head lifting movements whilst in a lying down face up position.
  • Rolling movements.
  • Lying down face up after week 16 as oxygen is reduced to the foetus in this position and venous return is impaired as a result of the heart increasing in size to cope with the extra volume of blood during pregnancy. Exercises should be performed in a seated position instead.
  • Standing for long periods of time.
  • Overstretching right from the start of pregnancy, for at least 3-5 months after giving birth if not breast feeding and until at least 12 months after stopping breast feeding. The effect of the hormone relaxin will make mums-to-be feel that they have a greater range of joint movement and over-stretching may cause long-term joint damage. Therefore, anyone who was extremely flexible before pregnancy should not stretch to their new range of movement and should keep to the range of movement they performed pre-pregnancy. They should place their legs no more than hip-width apart when sitting on the floor. The effect of relaxin affects the whole body and not just the pelvic girdle. However, much damage can be done to the pelvic area during pregnancy. The sacroiliac joint may widen causing inflammation and pain or the pubic bones may separate, also causing inflammation and pain and increasing the risk of pubic symphysis syndrome resulting in pain when walking or climbing stairs and in extreme cases the only cure is immobilisation and bed rest.
  • Performing the movement called One Leg Circle with a straight leg even if the movement was performed like this before pregnancy. Again, due to the effect of relaxin on the body’s joints, the movement should only be performed with a bent leg.
  • Performing arm exercises with both arms together towards the later stages of pregnancy (3rd trimester). Perform movements with single arms instead.
  • Lying face down will be inappropriate during the latter stages of pregnancy. Exercises should be performed kneeling on hands and knees instead (as long as carpal tunnel syndrome is not present in which case it may be best to perform modified exercises sitting on a chair or stability ball), or in a side-lying position instead (with bottom leg bent for balance).

Take care when standing up from lying down. A ligament that connects the uterus to the front of the pelvis can be affected resulting in cramp being felt if the enlarged uterus shifts suddenly (sharp stabbing pain in the lower and outer quadrant of the abdomen either on the right or the left). Another ligament may cause a tight or dull pain in the sacrum area may be experienced if the pelvis tilts forwards overly.

 

Post Pregnancy

Before returning to Pilates, anyone irrespective of whether they attended Pilates or not during pregnancy may re-start or start as long as they have obtained medical clearance to participate in physical exercise at the 6 week check-up (8-10 weeks for Caesarean Section). This timescale allows time for the abdominal muscles to close and re-align. Completion of a Physical Activity Readiness Questionnaire (PARQ) relating to post-pregnancy will be required before restarting Pilates' activities.

Ideally, those who are re-starting Pilates after pregnancy should attend an induction level lesson initially and progression to higher level classes should not be rushed. If attending a higher level class, similar modifications as those performed during pregnancy should be performed to begin with.

Anyone who has not done Pilates before should attend an induction lesson level initially.

Waiting until the 6 week check-up (8-10 weeks C-Section) does not mean you cannot exercise at all.

  • Daily walking complimented by posture education at this stage is an excellent form of exercise. Considerations should be taken into account when buying a pram to make sure that the handle height allows the mother to walk with correct alignment.
  • Pelvic floor exercise accompanied by thoracic breathing can be started as soon as the mother is ready and within days of childbirth.
  • Gentle pelvic tilting can be introduced 3-4 days after childbirth and may be performed standing, lying or kneeling on hands and knees.
  • Advice should be sought from a doctor or midwife before starting swimming as there is a chance of infection.
  • During this time clients should limit their range of movement considerably when stretching and movements that were restricted after the 1st trimester will remain restricted post pregnancy, especially if there has been a separation of the linea alba ligament.


Using a Stability Ball during Pregnancy

Whilst using a stability ball may be encouraged during pregnancy, please note the following:-

  • Balancing on a suitably inflated stability ball is extremely challenging and is advisable only for those who already possess a high level of core strength and balance. Those who do not possess sufficient core strength or balance would be advised to use a chair or stool initially as this will facilitate an upright spine alignment and a more stable surface, both essential when strengthening the core muscles.
  • Choose a stability ball that is the correct size for your height and ensures that your hips are slightly higher than your knees when it is inflated to its maximum (for most women 50cm is about right). A soft stability ball offers little challenge and may result in poor spine and/or hip/knee alignment.

 

 

Client Feedback

I am so glad that I kept up my Pilates’ classes throughout my pregnancy and was able to progress through my pregnancy without any lower back pain.  (HK)