Pilates in the Second Trimester of Pregnancy

Transcription

1 Pilates in the Second Trimester of Pregnancy Alice B. Roby December 16, 2016 BASI CTTC (2015) Chicago/Denver/Whitefish

2 Abstract A primary goal of a Pilates exercise regime during the second trimester of pregnancy is to prepare the woman s body for the additional weight of her rapidly growing uterus and fetus. Research shows that strengthening a pregnant woman s abdominal and pelvic floor muscles will help her maintain a healthy lumbar spine to avoid developing hyperlordosis, promotes proper alignment and posture as her center of gravity shifts forward, reduces her risk of developing diastasis recti, will aid her in safely performing all of her daily movements and activities, and will prepare her for a successful childbirth. Due to their crucial role in preventing hyperlordosis and diastasis recti, and in aiding functional daily movement and successful childbirth, the primary anatomical focus of this research is the abdominal and pelvic floor muscles, with special mention of the role of the gluteals in total pelvic floor health. 1

3 Table of Contents 1. Abstract 1 2. Table of Contents.2 3. Anatomical Description...3 Figure 3.1: The Pregnant Spine..3 Figure 3.2: The Abdominal Muscles...4 Figure 3.3: Diastasis Recti..5 Figure 3.4: Variations of Diastasis Recti 5 Figure 3.5: The Pelvic Floor Introduction Case Study Conditioning Program Conclusion Bibliography..14 2

4 Anatomical Description Figure 3.1: The Pregnant Spine The pregnant spine in the second trimester tends towards hyperlordosis, or an increase in the natural curve of the lumbar spine, and is typically accompanied by an anterior, or forward, tilt of the pelvis. This condition is commonly caused by the additional weight a woman carries as the uterus and fetus rapidly grow, and the relaxing of ligaments and joints due to hormones. Muscles in the erector spinae, hip flexors and quadriceps are typically shortened and tight, thus pulling the pelvis further forward. The muscles in the abdominals, gluteals and hamstrings are typically stretched and weak, thus not assisting in counterbalancing the gravitational pull forward of the pelvis. The result is often low back pain. 3

5 Figure 3.2: The Abdominal Muscles There are four connected abdominal muscle pairs: the rectus abdominis, the internal obliques, the external obliques, and the transversus abdominis. The two most superficial abdominals are the rectus abdominis and the external oblique muscles. The rectus abdominis (RA) muscles run vertically up and down the center of the abdomen. The external obliques are on the sides of the RA, and run diagonally downward towards the center of the abdomen. The two deeper abdominal muscles are the internal obliques and the transversus abdominis muscles. The internal obliques are beneath the external obliques, along the sides of the RA. The internal obliques have both upper fibers that run upwards towards the center of the abdomen, and lower fibers that run downwards towards the center of the abdomen. The RA muscles, in conjunction with the internal and external oblique muscles, are responsible for flexion (including lateral flexion) of the spine. The deepest of the abdominal muscles is the transversus abdominis (TA) muscle, which runs horizontally and wraps around the abdomen like a corset, narrowing and flattening the abdomen. The TA muscle s primary function is postural and protective; the contraction of the TA stabilizes the spine and pelvis before movement of the lower or upper limbs. http-//womenfitness.net/img2016/artimg/march/abdominal-muscles/ 4

6 Figure 3.3: Diastasis Recti Diastasis means separation, and recti refers to the rectus abdominis (RA) muscles. The linea alba, Latin for white line, is connective tissue that runs vertically down the midline of the abdomen, between the RA muscles. The linea alba can become stretched as the fetus grows, causing the RA to widen laterally and separate. Figure 3.4: Variations of Diastasis Recti Diastasis recti can occur at any point along the linea alba; the separation can be complete, running along the length of the linea alba, or more pronounced either above, below, or at the navel. 5

7 cdn.wellnessmama.com/wp-content/uploads/diastasis_v2.png Figure 3.5: The Pelvic Floor Muscles The pelvic floor is a group of muscles that attach from the pubic symphysis to the coccyx and sacrum. This group of muscles is often referred to as a hammock, or a sling, providing essential support to the pelvic organs such as the bladder, uterus and bowels. Pelvic floor muscles contribute to healthy functionings including sexual response, bladder control, and guiding the baby s head down the birth canal. Strengthening the pelvic floor muscles increases flexibility and control, which will aid in the childbirth process, and also prevent incontinence issues during the post-natal period. 6

8 Introduction Pilates can be an excellent form of exercise during all stages of a woman s pregnancy. This paper focuses on the benefits of pilates during the second trimester of pregnancy, when the uterus and fetus begin to grow rapidly. As the woman s body undergoes rapid weight gain and expansion in the uterus, a separation of the abdominal muscles called diastasis recti can occur, weakening a woman s core. As her midsection grows and weakens, her center of gravity changes and pulls her pelvis forward into an anterior tilt, creating lordosis in the lower lumbar spine and causing low back pain. Hormones such as relaxin loosen her ligaments and joints, which can cause further pain and instability. A pilates conditioning program can be instrumental in preventing a pregnant woman from developing diastasis recti, anterior pelvic tilting and hyperlordosis, and much of the subsequent pain that can accompany such pregnancy conditions. 7

9 Strengthening a pregnant woman s abdominals without putting her into deep flexion is key to avoiding diastasis recti. Exercises with deep flexion, including excessive lateral flexion using the obliques, can exacerbate the stretching of the linea alba and the separating of the RA muscles by pulling them apart further. Focusing on contracting and strengthening the TA muscle without flexion is a crucial element to a pilates program during the second trimester of pregnancy. A strong TA muscle, along with intact RA muscles and obliques, will help prevent the pelvis from tilting forward and the lumbar spine from overly curving because the woman will be able to hug the baby by contracting her muscles and pulling into her core. This ability to support the weight of the baby will promote proper posture and alignment, and will aid in daily functional movements. Often when hyperlordosis and an anterior pelvic tilt are present, it signals that not only are the abdominals weak and lengthened, but so are the hamstrings and gluteals. And, the erector spinae and hip flexor muscles are typically tight and shortened in this scenario. Therefore, it is important to incorporate exercises into the conditioning program that target the strengthening hamstrings and gluteals, while stretching the hip flexors and low back muscles. The pelvic floor muscles are another group of muscles essential to the overall health of the pregnant woman. These muscles play a vital role in successful childbirth, and also prevent incontinence in the post-natal months. Strong pelvic floor muscles that a woman knows how to contract and release means that she will be able to use them on command during labor, guiding the baby s head through the birth canal. Performing Kegel exercises help condition the pelvic floor muscles to contract and release. However, research shows that repeated tightening and contracting of the pelvic floor muscles via Kegels will does not equal strong pelvic muscles. A tight muscle is not a strong muscle. A healthy muscle needs to have the ability to contract, but 8

10 also to lengthen and stretch. Further, constant tightening via Kegels results in pulling the coccyx inward towards the pubic bone, thus making the birth canal smaller. In order to strengthen the pelvic floor muscles and simultaneously open, lengthen and stretch the pelvis out, is to strengthen the gluteal muscles. Strong gluteals will counter the inward, shortening pull on the pelvic floor muscles, and create a balanced, toned, and more lengthened pelvic floor. This will allow the baby to pass through the birth canal more easily. Case Study My client, Katie K., is a 42 year old woman in the second trimester of her first pregnancy. Katie is an experienced pilates devotee, and has enjoyed BASI pilates workouts for over a decade. She has been cleared by her doctor to continue with her pilates regimen, keeping in mind to make certain modifications for pregnancy. Katie has no injuries, is not showing any signs of diastasis recti, and at 24 weeks still feels fine lying supine for short periods of time. I have structured a program for Katie using the BASI Block System, with the desired results being: strengthening Katie s abdominals while minimizing her chances of developing diastasis recti; promoting healthy posture to prevent low back pain; and maximizing pelvic floor health to prepare Katie for childbirth and post-natal recovery. *NOTE: Katie and I meet for two sessions per week, and in the conditioning program below I have noted more than one set of exercises per block, to show how our sessions can vary. She does not perform all of the exercises each session. BASI Block System Conditioning Program for Katie in her 2nd Trimester: Warm Up BLOCK EXERCISES REASON & NOTES Pelvic tilts on Ball Pelvic Curls (x3) Spine Twist Supine -Katie feels good on her back for 5 minute intervals, and her doctor says this is fine. 9

11 Warm-Up (cont ) Foot Work Abdominal Work Leg Lifts Leg Changes *Reformer or Wunda Chair: Parallel Heels Parallel Toes V Position Toes Open V Heels Open V Toes Calf Raises Prances (Reformer Only) Prehensile (Reformer Only) Single Leg Heel Single Leg Toes Chair: Torso Press Sit Standing Pike Reverse Cadillac: Sitting Forward -Spine Twist Supine is kept controlled with a small range of motion (ROM), as a lot of rotation in the obliques can potentially contribute to diastasis recti (DR). 1. *Reformer with modifications (Ball, or jumpboard behind back to sit upright, or Wedge to lie on carriage on a diagonal) 2. Wunda Chair Foot Work (no modifications necessary) -Torso Press Sit does not require deep flexion, thus is good when preventing DR -Although Standing Pike reverse has flexion, it is light resistance and therefore puts minimal strain on the rectus abdominis (RA). It also offers safe back extension and a hamstring stretch. -Sitting Forward also has a lighter resistance and minimal strain on the RA, and offers a hamstring stretch. Hip Work (Strap Work) *Reformer: Supine Leg Series Frog Circles Down/Up Openings Variation: Circles Down/Up Extended Frog Extended Frog Reverse *Reformer Wedge placed on carriage so Katie is lying upright on a diagonal 10

12 Spinal Articulation Stretches *Reformer: Bottom Lift Bottom Lift with Extensions Reformer: Standing Lunge *Kneeling Lunge Ladder Barrel: Gluteals Hamstrings Adductors Hip Flexors *Katie is currently OK being on her back for short periods of time and has doctor OK; if this changes, we will no longer perform this exercise * Consideration is given to not overstretch Katie, as relaxin in the body can lead to pregnant women overstretching *If/when Katie s belly starts to get in the way, we will discontinue Kneeling Lunge Full Body Integration (Fundamental/ Intermediate) Arm Work Reformer: Long Stretch *Scooter Ped-A Pul: Arms Standing Series Extension Adduction Circles Up/Down Triceps *Reformer: Arms Sitting Series Chest Expansion Biceps Rhomboids Hug-A-Tree Salute Cadillac: Arms Standing Series Chest Expansion Hug-A-Tree Circles Up/Down Punching Biceps Arm Work Series (Magic *Scooter has flexion, but not with heavy resistance or strain on the RA, and therefore should be OK *Only one series is performed each session *Arms Sitting Series on the Reformer can be done seated on the box for added comfort and to avoid tensing the hip flexors These series are chosen because they can be performed in an upright position and strengthen the latissimus dorsi muscles, which are important to functional daily movement and activities, and overall strength of a pregnant woman. 11

13 Arm Work (cont.) Full Body Integration (Advanced/ Master) Leg Work Lateral Flexion/Rotation Circle): Arms bent Arms Straight Arms Overhead Single Arm Side Press Single Arm Bicep None Wunda Chair: *Leg Press Standing Frog Front *Cadillac: Squats Lying Side Single Leg Series Changes Scissors Circles Forward/Back *Mat: Gluteal Side Lying Series Side Leg Lift Forward and Lift Forward with Drops *Reformer: Jumping Series Parallel Position V-Position Single Leg Parallel Leg Changes Reformer: Mermaid None-- FBI II is too strenuous for Katie at this stage of her pregnancy. *Only one series is performed each session *Leg Press Standing can be done holding poles for assistance with balance *Squats are an excellent exercise to prepare Katie for childbirth: opening the hips and strengthening the glutes. *Friends who have recently completed their BASI training tell me that Lying Side Single Leg Series is now part of the Hip Work Block. When I went through my training, this series was in the Leg Block. *Gluteal Side Lying Series is especially important for Katie, because strengthening the gluteals, in conjunction with Kegels, help strengthen the pelvic floor muscles, thus preparing for childbirth and recovery. *Reformer Wedge placed on carriage so Katie is lying upright on a diagonal Both of these exercises are gentle enough flexion and rotation for the 2nd trimester 12

14 Lateral Flexion/Rotation (cont.) Chair: Side Stretch of pregnancy. Care is given not to overstretch Katie on Side Stretch. If Katie s belly gets too large for Mermaid to be performed comfortably, we will discontinue this exercise. Back Extension Mat: Cat Stretch Lying prone is not comfortable or safe for the fetus during the 2nd trimester of pregnancy. Cat Stretch is safe and effective. Conclusion A pregnant woman can avoid the painful pitfalls of pregnancy by strengthening and stretching her body in a safe, effective manner via pilates. By strengthening her abdominals, especially her TA, while avoiding deep flexion exercises, she may be able to prevent diastasis recti. Strong abdominals in conjunction with stretching (but not overstretching) her hip flexors and erector spinae muscles will help prevent the pregnancy posture known as hyperlordosis with an anterior pelvic tilt. With proper alignment she will enjoy pain-free functional movement in her daily life. By strengthening her pelvic floor and gluteal muscles, she will be preparing for childbirth and recovery. The BASI Pilates Block System and a trained BASI Pilates instructor can help a pregnant woman achieve exceptional results in her body that will carry her beyond her second trimester of pregnancy into a healthy delivery and life with her baby. 13

15 Bibliography Books Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael. Wunda Chair & Ladder Barrel: Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael. Reformer: Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael. Cadillac: Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael. Mat: Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael. Auxiliary: Movement Analysis Workbook. Costa Mesa, California: Body Arts and Science International, Isacowitz, Rael and Clippinger, Karen. Pilates Anatomy. Champaign, Illinois: Human Kintetics,

16 Bond, Mary. The New Rules of Posture: How to Sit, Stand, and Move in the Modern World. Rochester, Vermont: Healing Arts Press, Calais-Germain, Blandine. Anatomy of Movement, Revised Edition. Seattle, Washington: Eastland Press, Inc, Bowman, Katy. Diastasis Recti: The Whole-Body Solution to Abdominal Weakness and Separation. USA: Propriometrics Press, Websites 5 Simple Exercises for Correcting Anterior Pelvic Tilt. Inhumexperiment.blogspot.com. 25 Nov Your center of gravity shifts during pregnancy, the best ways to avoid pain are. The Training Fix. 29 April You Tube Aligned and Well Down There For Women - Pelvic Floor Exercise. Bowman, Katy. 28 May

17 Pelvic Floor Health. Midwifery Traditions: Home and Hospital Birth Gynecology. Midwifery Traditions and Associates, Your Pelvic Floor. BeFit- Mom. BeFit-Mom, Ready, Set, Push! Fit Pregnancy.com. Meredith Corporation, What are the Pelvic Floor Muscles and what do they do. The Pregnancy Centre Demac Resources Pty Ltd. Images Figure 3.1: The Pregnant Spine Figure 3.2: The Abdominal Muscles 16

18 Figure 3.3: Diastasis Recti Figure 3.4: Variations of Diastasis Recti cdn.wellnessmama.com/wp-content/uploads/diastasis_v2.png Figure 3.5: The Pelvic Floor 17