Pilates for Imbalances due to Pregnancy and the Early Child Rearing Years

Transcription

1 Pilates for Imbalances due to Pregnancy and the Early Child Rearing Years Tove Aaronson 11/8/ Evolve Rehabilitation & Pilates

2 Abstract Page Taking a look at the postural deviations and imbalances that can occur on a woman s body due to the stresses of pregnancy and the early child- rearing years, we see how Pilates plays a key role in limiting those deviations and imbalances and working to correct them as they arise. Teaching the client body awareness and proper alignment, will allow them to catch the deviations and imbalances as they occur during their daily activities and to correct them so they do not become a habit. I have created an effective BASI Pilates program that is catered to my clients needs as a new mother and focusing on rebuilding her muscular strength and correcting her postural deviations and imbalances that have been caused during pregnancy as well as helping her to find the body awareness needed to promote a healthy and properly functioning body. 1

3 Table Of Contents Title Page Abstract Page 1 Table of Content 2 Anatomical Description of a women s body during and after pregnancy 3 Case Study 6 Conditioning Program 7 Conclusion 12 Bibliography 13 2

4 Anatomical description of a woman s body during and after pregnancy A women s body is built to go through pregnancy, childbirth and the nursing of a child. However, just because the body is built that way, doesn t mean that it doesn t place challenges and stresses on the body. Goodman explains that during the pregnancy there are many postural changes that occur throughout the spine, ribcage, as well as musculoskeletal changes such as diastasis recti. All of these changes are important when addressing the body during the post partum stage while the client is working towards regaining her pre- baby body (Goodman). The below images show the effects that pregnancies have on a woman s body.. Not only are there physical changes that the body undergoes during pregnancy but also psychological and hormonal changes. As you can see in the diagrams above, there are many stresses placed on the body to counter balance the shift of the added weight and postural changes. But it is also vital to take into consideration the psychological state of 3

5 each female as they progress through their pregnancy. They will be adjusting to their new body shape and their hormonal changes that affect their emotional wellbeing, as well as their energy levels. Hormones such as relaxin, progesterone, and estrogen are released during the pregnancy to allow the joints, ligaments and muscles to relax and allow the body to expand as needed. This is especially important for the hips so they can make room for the uterus and the baby during delivery (Dr. M.D. Mazumdar). However, with this being said, it is vital that after childbirth, there needs to be a great deal of focus on the correct posture to allow the spine to re- align itself into its normal curvatures (Dr. M.D. Maxumdar). Throughout the pregnancy and delivery, the body has been stretched and pushed to its max. However, there is little time for rest as there is now a child to care for around the clock. Here are images showing the incorrect and correct postures of daily activities that are done while caring for an infant. Many times we are nursing late at night or early in the morning when we are half awake and the last thing on our mind is our posture. But it is extremely important to take into consideration our posture. Allowing us to limit the likelihood of rounded shoulders, tight pecks and back muscles to occur. Picking up the child will be a constant activity throughout the day. While maintaining a neutral spine and lifting with the knees rather then the back, this will decrease the strain on the ligaments and muscles in the back and abdomen. 4

6 During the first year there will be hundreds of diapers changed and it will continue till the child is between ages 2 and 4. Changing the diaper in the upright position will limit the strain placed on the lower back. There are many aches and pains that can occur throughout the body and if we are not aware of the postures that we hold in our body during our daily activities, it will lead to musculature imbalances that can further aggravate and effect new moms. Creating a well- balanced and effective Pilates program is critical while working with new moms (Goodman). Just as a pregnancy, post partum recover has stages. The easiest way to break down the program is by three 6- week blocks. The first 6 weeks are going to be very light, intensity wise. Teaching the client to be aware of their postures and to notice if they are slumping, hiking a hip, and/or rounding their shoulders will help them to limit the imbalances that are likely to happen to a new mother. The focus during the sessions will be on the transverse abdominals, pelvis floor muscles, breathing exercises, as well as stretching the pectorals, gluteal, piriformis, and hip flexors (Goodman). The second stage is from 6-12 weeks post partum, will continue with the work on the abdominals and training the rectus abdominals to close nicely so that diastasis recti doesn t occur. The separation of the abdominals and the linea alba (connective tissue) is necessary during pregnancy to allow the abdominals to stretch by about 50% (Goodman). The muscles will most likely reconnect without trouble, however, that is not always the case. If a client does develop diastasis recti then the abdominal exercises will need to be adjusted and modified until she is able to perform the movements without her rectus opening, which could take up to a 5

7 year or longer (Goodman). The third stage begins on or after 12 weeks. However, each client is different and depending on her fitness level/health before and during the pregnancy, will play a role in her recovery time. During this stage the focus is on the abdominals, ribcage positioning, and maintaining correct posture. As the child gets older so does the weight bearing the body has to handle while caring for the child. Training the body during each session to feel the imbalances as they occur and to correct the postures will protect the muscular and skeletal imbalances that are likely to happen. Leah Stewart notes that when it comes to mothers, a meaningful Pilates practice can sometimes reset the confidence button in a woman who is struggling to accept, love and understand her changed body (Stewart). The focus of each session may change depending on the mental and emotional state of the client. It is not just about the physical benefits of Pilates but the psychological benefits as well. Gaining better body balance, control, harmony, resilience and awareness, can translate into a new kind of self- acceptance, and an appreciation for the individuality and uniqueness of their body (Stewart). All of these aspects need to be taken into consideration when working with new moms and creating a Pilates program that works for their individual needs. Case Study For my case study, my client is a 27- year- old mother of 2 boys whom has practiced Pilates on and off for 9 years. She is 5 4 and weigh 115lbs. Even through a healthy diet and an active lifestyle with daily exercise she gained 60lbs with each pregnancy. The recovery processes was relatively smooth but because of the expansion of her body during each pregnancy, it took a toll on her body as it returned to her normal size. With her abdominal wall expanding, hips opening, lordoic lower back, tight thorasic spine and chest, as well as 6

8 rounded shoulders developing during the pregnancy, there were many imbalances formed that were a constant goal during each session. During her post partum recovery, there were many more imbalances that arose. Nursing, rocking, holding, lifting, and sleeping created all new postural deviations and musculature imbalances. With these imbalances, she developed a hiked hip (baby hip) from carrying her child(ren) on one side, which caused imbalances in her oblique s, hamstrings, hip flexors, pictorials, and quadratus lumbordom. The exercise program that I have created is for her at 9 months post partum from her second delivery. She has worked with me before, during and immediately following her pregnancies, which allows me to have a thorough understanding of her bodies abilities and postural changes and deviations that have occurred over the course of the time since we started working together. I have created the below BASI blocking program with that in mind. However, with that being said, every day is different and depending on the week/day (s) she has had, the program will adjust to the needs of her body that she mentions to me or that I observe during the roll down as I begin the session. BASI Block System Program for Imbalances due to Pregnancy and Motherhood Block Exercise Equipment Notes Warm Up Roll Down Mat Pelvic Curl Spine Twist Supine Chest Lift Chest Lift with Rotation This is a great exercise to use as a tool to asses any asymmetries and imbalances within the body as well as giving the client time to focus the mind and tune in to the body. Creates focus and brings awareness to the abdominals as well as the pelvic floor- working to provide mobility and stability in the spine and pelvis through correct muscle activation. Aiming to maintain a neutral spine and avoiding hyperlordosis throughout the movement. Recruiting the use of the oblique s and healthy rotation of the spine Teaches the client how to effectively recruit the abdominals to build strength to be able to use for more challenging exercise. Working to build strength in abdominals with an emphasis on the oblique s. Focusing on trunk stability and building strength to help prevent lower back pain 7

9 Foot Work Abdominal Work Parallel Heels/Toes V Position Toes Wide V Heels/Toes Calf Raises Single Leg Heels/Toes Short Box Series Round Back Flat Back Tilt Wunda Chair Reformer The chair is very challenging and an unforgiving piece of equipment. Since there is nothing to use to help support the upper body during the footwork series, the trunk stabilizers have to be firing and working properly in order to maintain the correct posture and pelvic stability. Focusing on activating the abdominals before initiating the lowering of the legs will make the quadriceps and hamstrings fire allowing the hip flexors not to do all the work. Throughout the Parallel heels and toes, the focus for my client is to maintain the trunk stability as well as finding the control of the hip flexors. The knee extension ROM during the footwork on the chair is shorter then during the reformer or the Cadillac work, emphasizing the importance of the trunk stability to allow the hamstrings and the quadriceps to work. During the parallel toes position, maintain the ankle joint stability is key. Still focusing on the quadriceps and hamstrings, the small V position of the feet, allows the activation of the hip external rotators and adductors. As the client progresses- adding challenges with arm positions will be implemented. Continuing from the V position on the toes, the hip external rotators and adductors are still activated throughout the Wide V Heels and Toes. As the client works through the series, she may begin to fatigue, which will show in her trunk stability. Cueing to maintain her abdominal and back extensor activation and sitting tall on the chair will help her to maintain the proper postural alignment as well as keeping her from sinking into her hip joints and rounding her lumbar spine. This is a great exercise for the calf but also for trunk stability as well as simultaneously stretching the hip flexor and the calf on the opposite leg. Working with the client to maintain a level pelvis and not letting the hip hike will be a constant effort and getting her to find the symmetrical activation of the oblique s will be key in keeping the hips level. If the client has week hip flexors, this exercise will be very challenging. The goal is to get the leg that is lifted off the pedal parallel to the floor at hip height. If the client is unable to maintain the height of the leg while maintaining the trunk stability, using an assist such as a balancing ball will be used until we are able to maintain stability without. Fundamental/Intermediate - I am not including Round About or Climb- A- Tree as they are advanced level exercises that the client is not ready for yet. We may not get to the whole series at first, but will build up to the complete short box series. This is the essential exercise learned in the short box series. Allowing the client to create an elongated C curve through focusing on flexion of the lumbar spine before initiating the hinge from the hips will continue to help lay the foundation to many abdominal exercises throughout Pilates. Through the co- contraction of the abdominals and the back extensors, allowing for a neutral spine position to be maintained during the lifting and lowering phases of the exercise. This works on building the strength and muscle endurance that is needed as we continue to work on trunk and pelvis stability throughout the training session. This is a fundamental exercise that allows the client to form the correct alignment and muscle recruitment that is needed for more challenging lateral flexion exercise. 8

10 Hip Work Spinal Articulation Twist Frog Circles Down & Up Openings Extended Frog/ Reverse Short Spine Reformer Reformer This is an intermediate exercise focusing on the abdominals with an emphasis on the oblique s. Working to maintain a co- contraction between the abdominals and the back extensors to prevent hyperextending the back, which could cause excessive pressure on the lower back. The Hip Work is vital during our session because the hips play an instrumental roll in everyday life, such as the gait cycle, climbing up and down stairs, as well as coming up and down from a seated position. But more specifically for my client their hips have changed tremendously during pregnancy and post partum. The imbalances are even more prevalent from the postural alignment while carrying a child as well as many more daily activities that are involved while taking care of a young child. While focusing on the hip adductors, we are also focusing on the pelvic- lumbar stabilizers and working to build strength in the pelvic floor allowing for smooth movement through the work in the hip adductors, knee extensors and hip extensors during the exercise. This Block will help the client in strengthening her pelvic floor muscles and her abdominals as she works to stabilize her pelvis throughout the movements. Emphasizing on hip disassociation throughout the circles is not an easy task. Due to the imbalances of tight hip flexors, hamstrings and a weak pelvic floor; the hip work will be a challenge but is a great exercise for the pelvic floor muscles, focusing on strengthening the kegal as it was stretched and loosened greatly during pregnancy and delivery. Not only her abdominals will be working to maintain a neutral spine and pelvis but also the balance between the hamstrings and the adductors will be found. As the hamstrings will want to take over the work- the adductors have to fire correctly and equally with the hamstrings to perform the exercise properly. This is an ideal exercise for my client as it works to find her hip's functional range of motion without losing her neutral spine and pelvis. During pregnancy ligaments and tendons relax and individuals will be more flexible then usual, this is not always a good thing as they can over stretch past where they are available without knowing it, causing strains. As we retrain her abdominals and pelvic floor muscle finding her new ROM of her hips while maintaining her abdominals and pelvic floor contraction so the spine and pelvis is not compromised will be the focus. Adding on to the frog, circles and openings- this is an advanced exercise that will be added into my client s routine once she is able to maintain pelvic stability throughout the series. Extended Frog/Reverse requires a great deal of control and coordination, still focusing on the hip adductors- it also continues to develop hip adductor flexibility and the pelvic- lumbar stabilization. The is a great exercise for the client to feel a hamstring stretch when the carriage is all the way into the stopper as well as focusing on trunk stability and a lower back stretch during the roll down. If the client is having any neck or back sensitivities - skip the short spine and go to the bottom lift instead. 9

11 Stretch Standing Lunge Reformer Full Body Integration (F/I) Sitting Forward Side Reach Kneeling Cat Stretch Cadillac Arm work Arm standing Series Cadillac Chest Expansion Tight hamstrings and hip flexors are a consistent occurrence for pregnancy and post partum. Through the added weight and hyporlordoic curve of the spine during pregnancy to the adjustment as the body works to realign itself after delivery, followed by carrying and lifting of the newborn, stretching the hamstrings and the hip flexors is vital for my client. During the hip flexor stretch the pelvis will bias towards a posterior tilt allowing for the stretch of the hip flexor and also aids in releasing pressure in the lower back. During the hamstring stretch, the pelvis will bias towards an anterior tilt allowing a deep stretch in the hamstring as well as working on back extensor control. The use of the Push Through bar on the Cadillac during the sitting forward exercise focuses on the abdominals and back extensors as the client works from spinal flexion to spinal extension and vice versa but also allows a wonderful hamstring stretch. As my client has tight hamstrings, this exercises provides an added bonus with the stretch as she works on strengthening her abdominal wall and finding the co- contraction with her back extensors during the spinal extension phase of the exercise. Adding on from the sitting forward exercise, the side reach allows the oblique s to active while still focusing on pelvic- lumbar stability and working on the abdominal oblique control and flexibility as well as a nice stretch through the shoulder adductors. Finding the control through the trunk is the focus during this exercise. Working with my client to maintain a neutral spine position during the upright and the forward- leaning position is the key. The added shoulder stretch will be a challenge so working with my client on her range of motion during each stage is critical as well as working with her to maintain a neutral spine throughout the movement in order to protect the spine and shoulders from hyperextension. Incorporating the standing position during the session not only works the upper body during the arm standing series but also focuses on the abdominals and posture. There is no support or a tactile marker for the body's position to rest against. Working with my client in the standing position will allow her to focus on every muscle through her body to allow her to maintain proper postural alignment throughout the series which will help her to maintain that posture even after the session. As the client progresses more focus can be added to challenging her balance such as standing on one leg or adding accessories, such as balance boards or rotating discs. This will require deeper activation in her stabilizer muscles. As my client will be likely to develop imbalances in her shoulders, oblique s and hips- this will aid in the training of a balanced activation through both sides of the body. Focusing on the latissimus dorsi throughout the chest expansion, we are also developing the trunk stability and shoulder extensor and elbow extensor strength. My client will be more dominate on one side of her body from holding the child, which can lead to handedness postural deviation. Working with her to maintain a symmetrical connection throughout the lats while maintaining scapula stability without loosing the postural alignment is the goal. 10

12 Full Body Integration (A/M) Leg Work Lateral Flexion Back Extension Hug- A- Tree Circles Up & Down Punches Biceps Tendon Stretch Leg Press Standing Side Stretch Swan Basic Wunda Chair Wunda Chair Wunda Chair Wunda Chair Working to strengthen the pectoralis major is the goal of the exercise but for my client she will be tight in the pectoralis due to pregnancy and carrying her child (caused by rolling her shoulders forward), so the focus will also be on strengthening and increasing the flexibility of the shoulders horizontal adductors and to continue to work on the trunk and scapular stabilization. Adding another element to the series as the arms go overhead creates a deeper challenge on the trunk stabilizers as well as the shoulder flexibility. Working with my client to maintain trunk and scapular stability while incorporating shoulder flexibility and strength will be a challenge. If my client is tight in the shoulders or can not maintain the ideal postural alignment then a smaller ROM is necessary to begin and as the client progresses as we continue to work on the shoulder joint strength/ flexibility to increase her ROM. Adding work into the triceps as well as working the pectoralis major, the punches exercises require a deep abdominal connection to maintain trunk stabilization. The body will want to rotate the trunk with each punch so the work will be to maintain the trunk and shoulder stability as the arm reaches away on a horizontal line, allowing the triceps to work. By the end of the standing arm series the pectorials will be tight from all the work in the previous exercises so this forward- leaning position with the elbows reaching away from the rib cage will allow the chest to open and provide a nice release of the muscles as the biceps are activated. Due to my clients pregnancy- focusing on maintaining the connection of the abdominals and back extensors to maintain proper alignment and not releasing the ribcage and hyperextending the lumbar spine will be crucial during this exercise. This is an advanced level exercise and will not be done at this time. When the client is ready it will be added into the routine and will focus on the abdominals and shoulder flexor strength as well as stabilizing the scapula. For my client, the imbalances due to pregnancy and motherhood of a young child will make this exercise extremely difficult. The exercises will show all the imbalances, which will help me as the instructor, to work with her to fix those imbalances and create symmetry throughout the body. Balance, pelvis and truck stability, knee and hip muscle recruitment patterns, stability in the standing leg, and disassociation of the leg from the rest of the body will all be focused on during this exercise. The side stretch focuses on strengthening the oblique as well as stretching the opposite oblique, while maintaining the correct alignment throughout the body. As my client builds strength and stability, I can increase the challenge of this exercise by decreasing the spring resistance which will allow her oblique s to activate more to lift her torso back up to the diagonal line. Due to my client s hyperlordodic lumbar spine and weak abdominals, the range of motion may be smaller until the strength and correct muscle activation is built. The tendency will be to initiate the lift with the lumbar spine, which produces an excessive amount of pressure on the lower back and causes discomfort. Once the client is able to maintain pelvic stability and correct abdominal activation the range of motion will increase and as time goes on the load of the springs can decrease in order to make the exercise more challenging. 11

13 Roll Down to Finish The roll down is a great way to finish off the session. Giving the client time to re- group and take a moment to appreciate all the hard work they have done and what they have accomplished during their session. She will feel a stretch in her back extensors as well as the continued articulation of their spine during the roll down and up of the exercise. In conclusion, pregnancy and motherhood affect the body in more ways then one. There are many postural deviations and imbalances that occur that need to be addressed and corrected in order to maintain a healthy and functioning body. With the use of the pilates equipment, clients are able to experience hundreds of exercises that work towards conditioning the entire body and correcting the postural alignment and imbalances, allowing them to increase their bodies performance in everyday activities (Isacowitz). Creating a Pilates program that focuses on recruiting the correct muscles to activate when needed and postural alignment during daily activities will allow the client to protect her skeletal and muscular system that will allow her to stay active and healthy throughout the rest of her life. I myself, as a mother of 2, have experienced countless benefits from my Pilates practice and continue to work on correcting the imbalances that were caused during each pregnancy and through motherhood. 12

14 Bibliography Correct Posture in the Postpartum Period. Gynaonline.com. Dr. M.D.Mazumdar, MD. Getting new moms Confident and Back in Shape. Pilates.com. Leah Stewart. Spring 2012 Goodman, Debbie. Postpartum recover: Helping New Moms Get Their Bodies Back. Pilates- pro.com. Jan 16, pro.com Isacowitz, Rael. Pilates Second Edition. Champaign, Illinois. Human Kinetics, 2014 Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, 2013,