Postnatal Pilates Roni Albrecht June 1, 2017 2016 Gig Harbor, WA
ABSTRACT During pregnancy the female body goes through many physiological and anatomical changes in order to adapt to the growing fetus. Some of these changes include the abdominal muscles stretching and separating to allow the fetus to grow, an increase in lumbar lordosis shifting the spine posteriorly and changing the center of gravity, and weight gain causing an increase of stress on the joints. Post pregnancy, women can experience diastasis recti, postural changes, and muscles imbalances due to these stressors and new habitual routines. Since the Pilates method focuses on functional exercises, it is a safe and effective way to rehabilitate and correct these post pregnancy conditions. With doctor approval many new moms can begin practicing exercises to strengthen the pelvic floor within days of giving birth. This paper will focus on utilizing functional exercises to help strengthen and re-educate the muscles post pregnancy. 2
Table of contents 1. Title page...1 2. Abstract...2 3. Table of Contents...3 4. Anatomical Description...4 5. Introduction.. 7 6. Case of Study...7 7. Conditioning program...9 8. Conclusion...10 9. Bibliography...12 3
Anatomical Description Diastasis Recti Diastasis Recti is the separation of the Rectus Abdominis muscles. The Rectus Abdominis muscles are the two long vertical muscles in the front of the stomach that are referred to as the 6 pack. The Linea Alba connects these two parallel muscles. During pregnancy Relaxin levels increase up to 10 times. These hormone changes allow the Linea Alba to stretch, separating the Rectus Abdominis muscles as the fetus grows in the womb. This separation inhibits the core from functioning properly. It can also cause lower back pain due to the lower back muscles and extensors over compensating for weak abdominals. In most cases, Diastasis Recti will heal on its own between 6 weeks and 3 months post pregnancy. In some, there is a noticeable lasting separation between the left and right abdominal that needs additional treatment to heal. Women who have more than one child are more likely to have this condition post pregnancy due to the Linea Alba stretching multiples times. There have been studies showing this condition is more common among women who do not exercise during pregnancy. The diagram below shows the difference between a normal abdomen and one that is suffering from Diastasis Recti. 4
Hyperlordosis Hyperlordosis is the increased lumbar curve of the spine with an anterior tilt of the pelvis. This faulty posture is caused by weak abdominals, tight hip flexors, and tight back extensors. To correct hyperlordosis the abdominals need to be strengthened, and the hip flexors and low back extensors need to be stretched. Specifically the transverse abdominals and multifidus need to be strengthened. This posture creates excess pressure on the lumbar spine and can cause lower back pain. The diagram below shows how the curvature of the lumbar spine increases throughout pregnancy. As the fetus grows in size the spine adapts by posteriorly shifting to give the fetus more room. 5
Transverse abdominals and Multifidus The transverse abdominals (also referred to as TrA) are the muscles surrounding either side of the back below the oblique muscles. The TrA muscles play a key role in stabilization specifically in stabilizing the lower back and pelvis. The Multifidus is a back extensor muscle running along the spine that plays a key roll in stabilizing the joints within the spine. Together the TrA and Multifidus help stabilize us through everyday activity and help protect the spine. Muscles Imbalances Mothers are prone to developing muscles imbalances due to new repetitive movement patterns and routines. Daily activities such has picking up and holding a child, breastfeeding, and carrying a diaper bag can overload unconditioned muscles causing stress and fatigue. There is a strong emphasis in Pilates to strive to achieve overall balance. In doing so muscles imbalances need to be addressed, and the appropriate muscles need to be stretched, strengthened, and conditioned. 6
Introduction Many new moms find it difficult to get their pre-pregnancy body back after 9 months of pregnancy. Pregnancy puts many stressors on the body and requires the body to go through many physiological and anatomical changes to accommodate the growing fetus. The Pilates Method is a safe an effective way for new moms to begin exercising and reconditioning their body soon after birth. Unlike other types of exercise programs, Pilates focuses on postural alignment, core strength, and overall muscle balance. This paper specifically focuses on how Pilates can help fatigued abdominal muscles post birth, postural changes caused by the growing womb, and muscular imbalances due to new habitual routines. Case Study Jennifer is 29 years old and is new to Pilates after having her third child. She started her bi-weekly sessions approximately 3 months after giving birth to her third child and cross trains 3 times a week to get back to her pre-pregnancy body. Her main objective is to lose the weight that she has gained from her pregnancy while focusing on regaining her abdominal strength and increasing her mobility. At three months post partum her abdominals are still very weak and there is a noticeable separation of the abdominals and relaxation of the stomach muscles. Her weak abdominals are also causing her lower back extensors to over execute causing lumbar hyperlordosis and lower back pain. She occasionally sees a chiropractor to relieve her lower back pain. Having three children, she also began her sessions with a muscular 7
imbalance in her right shoulder and scapula due to breastfeeding and favoring her right arm to hold her children. This muscle imbalance is noticeable in her work when she reaches both arms above her head. Her right shoulder stays down while her left arm and shoulder fully extends. Jennifer began her conditioning program with fundamental exercises to get her body familiar with the Pilates method. In her first few sessions it was noticeable that Jennifer s abdominals were very weak and would get fatigued after doing a few reps of the leg lifts and leg changes during the abdominal block. In her first 10 sessions exercises such as the Standing Arms Series was chosen to incorporate more core engagement without overloading the muscles. She continued this routine until she no longer fatigued then her repertoire was increased to include intermediate abdominal exercises like The Hundred. In the first sessions we also put emphasis on correcting her shoulder imbalance. She practiced the Pole Series in front of the mirror to visually see the pole tilting to one side as she reached both arms overhead. Within a few weeks she was able to keep the pole parallel to the floor throughout the exercises. Once she mastered the Pole Series we moved to the shoulder stretch to continually increase the mobility of her shoulder. After her underlining physical conditions were addressed and improved the repertoire in her sessions was expanded to include a wider range of muscles focuses to achieve total body balance. 8
Conditioning Program- BASI Block System BASI BLOCK Sessions 1-10 Sessions 11-20 Sessions 21+ WARM UP FOOT WORK AB WORK Hip Work Roll Down Pelvic Curl Spine Twist Supine Chest Lift Chest Lift w/ Rotation On Cadillac Parallel Heels Parallel Toes V Position Toes Open V-Heels Open V-Toes Calf Raises Prances Single Leg Heels Single Leg Toes Hip Opener On Cadillac (Mat) Single Leg Lift Leg Changes On Cadillac Basic Leg Springs Frog Circles (Down, Up) Walking Bicycles Roll Down Pelvic Curl Spine Twist Supine Chest Lift Chest Lift w/ Rotation On Cadillac Parallel Heels Parallel Toes V Position Toes Open V-Heels Open V-Toes Calf Raises Prances Single Leg Heels Single Leg Toes Hip Opener On Cadillac (Mat) Hundred prep Modified hundred w/ knees bent to table top On Cadillac Single Leg Supine Frog Circles (Down, Up) Hip Extension Bicycle Roll Down Pelvic Curl Spine Twist Supine Chest Lift Chest Lift w/ Rotation On Chair Parallel Heels Parallel Toes V Position Toes Open V-Heels Open V-Toes Calf Raises Single Leg Heels Single Leg Toes Hip Opener On Chair Standing Pike On Reformer Frog Circles (Down, Up) Openings Spinal Articulation Stretches N/A Pole Series Shoulder Stretch Overhead Stretch Side Stretch Spine Twist On Cadillac (Mat) Spine Stretch Ladder Barrel Shoulder Stretch 1 Shoulder Stretch 2 On Reformer Bottom Lift Bottom Lift w/ Extensions On Reformer Standing Lunge 9
FULL BODY INTEGRATION F/I ARM WORK FULL BODY INTEGRATION A/M LEG WORK LATERAL FLEXON/ ROTATION BACK EXTENSION N/A Cadillac Arms Standing Series Chest Expansion Hug-A-Tree Circles (Up and Down) Punches Biceps On Cadillac Sitting Forward Side Reach On Reformer Arms Supine Series Extension Adduction Up Circles Down Circles Triceps On Reformer Round Back Flat Back On Reformer Arms Kneeling Series Chest Expansion Up Circles Down Circles Triceps Biceps N/A N/A N/A Jennifer is still working towards this level of work Gluteals Kneeling Series Hip Extension Bent Knee Hip Abduction Bent Knee High Extension Straight Leg Wunda Chair Side Stretch Single Leg Skating Reformer Mermaid Jump Series Parallel V-Position Single Leg Changes Side Over Box Mat Reformer Cat Stretch Breastroke Prep Final Assessment Roll Down Roll Down Roll Down Reformer Pulling Straps 1 Conclusion Jennifer has seen much improvement in her work since beginning her conditioning program. She has regained strength in her abdominals and improved the mobility of her shoulders. Her husband has also noticed an improvement in her posture. Since beginning her program Jennifer has joined a coed softball team, and plays group volleyball once a week. She plans on continuing her conditioning program to compliment her new activities. 10
She also accredits practicing Pilates for helping her improve body awareness and recruit the correct muscles in everyday activities to reduce the risk of future injury and muscle imbalances. This case study shows how Pilates can help postnatal moms regain core strength and improve posture without putting excess stress on the joints and muscles allowing them to get back to normal activities. 11
Bibliography Diastasis Recti Abdominis. Physiotherapy & Functional Wellness, www.coreconcepts.com.sg/conditions/diastasis-recti-abdominis/. Paturel, Amy, Diastasis Recti. BabyCenter, 7 Feb. 2017, www.babycenter.com/0_diastasisrecti_10419293.bc. Postnatal Exercise: PTontheNet.com Online Education for Fitness Professionals, www.ptonethenet.com/articles/postnatal-exercise-2830. Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International, 2013. Reinold, Mike. The Role of the Transverse Abdominis in Low Back Pain. Mike Reinold, www.mikereinold.com/. Soma-Pillaty, Priva, et al. Physiological Changes in Pregnancy. Cardiovascular Journal of Africa, Clinics Cardive Publishing, Mar. 2016, www.ncbi.nlm.nih.gov/pnc/articles/pmc4928162/. Images Postural Changes During Pregnancy. https://static1.squarespace.com/static/54c8dbd9e4b00485f47ec653/t/57a04fa3893fc0a 066514316/1470124770548/pregnancypodiatrist.jpg Diastasis Recti Image. https://www.babycenter.com/0_diastasis-recti_10419293.bc Tranverse Abdominis Image. http://www.drdooleynoted.com/wpcontent/uploads/2015/11/img_4450.jpg 12