Pilates For The Mother Runner Emma Wagenvelt July 2018 Comprehensive Teacher Training Certification The Woodlands, TX. 1
Abstract Running as a form of exercise has numerous health benefits, including cardiovascular endurance, increased bone density, weight management and mental wellbeing. New mothers are often eager to resume their running routine quickly to regain a sense of self and manage the stress of early motherhood. However, pregnancy and delivery place a heavy demand on the body, and returning running too quickly can leave postpartum women susceptible to injury and fatigue. This paper will examine the ways in which a Pilates program can help a new mother restore optimal physical condition, so that she may find joy in running once more. 2
Table of Contents Title Page...1 Abstract..2 Table of Contents.3 Anatomical Description...4-7 Case Study...8-9 Program & Discussion...10-15 Conclusion.16 Bibliography...17 3
Anatomical Description Figure 1 Image from drlib.info As a pregnancy progresses, a woman's body will undergo significant postural change. The weight of the growing baby will cause her center of gravity to shift and pull the pelvis out of neutral alignment (figure 1a), which will have compensatory effects on spinal alignment. Loss of strength in the abdominal muscles can pull the pelvis into an anterior tilt (figure 1b), resulting in increased lumbar lordosis. Alternatively, the pelvis may be pulled into a posterior tilt (figure 1c), resulting in a flat lumbar spine and a fatigued or sway back posture. The first year of motherhood places further demand on the thoracic spine, as most 4
new mothers spend hours in a rounded or hunched position nursing, rocking, and cradling their new infant. As a result, many new mothers present with thoracic kyphosis- rounded thoracic spine and shoulders, weak pectoral muscles, and cervical lordosis (DiFiore 2010). In a high-impact sport such as running, the spine acts as a shock absorber, so correct alignment is key for injury prevention. Therefore, identifying and working in a neutral pelvis and spine will not only be beneficial to posture, it will encourage correct muscle recruitment, and improve efficiency in breathing. The hormone relaxin specifically targets the ligaments of the pelvis to prepare a mother's body for birth, but all joints in the body are affected to some degree. Increased joint laxity during pregnancy (and beyond, if breastfeeding), can compromise joint stability and support, making joints susceptible to injury. The stress on the joints is exacerbated by pregnancy weight gain, and the weight of the growing baby (DiFiore 2010). As running places strain on the ankles, knees, pelvis and spine, lumbar-pelvic stability should be restored before a running program is resumed. 5
Figure 2 Image from mutusystem.com The four muscles of the abdomen (transverse abdominals, rectus abdominals, internal oblique, external oblique) work together in conjunction to form a muscular corset that provides support for the abdominal and pelvic organs, and stabilizes and supports the pelvis and lumbar spine. During pregnancy the abdominal muscles stretch to accommodate the growing baby. Relaxin increases the elasticity of connective tissue which allows the linea alba to stretch, and the rectus abdominals to separate. Muscle length will reduce naturally following birth, but this process can be enhanced with Pilates exercises (DiFiore 2010). Strength in the abdominals is important for a runners posture, balance, endurance, and stability. 6
Figure 3 Image from www.goread.com The pelvic floor muscles at the base of the pelvis work in conjunction with the transverse abdominals, obliques, and multifidus to maintain intra-abdominal pressure, and stabilize the pelvis and lumbar spine. During pregnancy the increasing weight of the baby, coupled with lax ligaments can cause the pelvic floor to weaken. As running increases intra-abdominal pressure, a weak pelvic floor could lead to a number of issues including lower back pain, incontinence, or even pelvic organ prolapse. 7
Case Study My case study client is a 32-year-old mother of two. She practiced Pilates, running, walking, and yoga consistently throughout pregnancy. We started our sessions when she was 5 months postpartum, and she had been practicing mat Pilates for two months prior to that. She is in good physical health, but still presents with some common postpartum conditions that she would like to address before resuming her regular running program. Anterior Pelvic Tilt- identifying and working from a neutral pelvis will be crucial to remedy other postural imbalances Lumbar Hyperlordosis- tight lower back extensors causing some lower back pain, tight hip flexors and hamstrings. Working in a neutral spine and pelvis, plus improving lumbar pelvic stability and abdominal strength, and stretching the hip flexors, hamstrings, and lower back extensors will help to correct Thoracic Kyphosis- tight pectorals and weaker upper back extensors. Focus on strengthening the thoracic extensors, and the pectoral muscles. Teach good body awareness whilst nursing and caring for infant. Weakened Abdominals- a lack of abdominal strength causing a lack of support in the internal organs and spine, and contributing to lower back pain. Focus on activating the TA, and strengthening the rectus abdominals and obliques Joint Instability- She is still breastfeeding, so joint instability caused by the hormone relaxin is a concern. Special care that exercises are performed 8
within the appropriate range of motion for the joint, with correct alignment, and close attention to technical detail to prevent injury 9
Program & Discussion Block Sessions 1-10 Sessions 10-20 Sessions 20+ Notes Warm Up (Fundamental Mat) (Fundamental Mat) (Fundamental Mat) Roll Down Roll Down Roll Down Pelvic Curl Supine Spine Twist Chest Lift Chest Lift with Rotation Pelvic Curl Supine Spine Twist Chest Lift Chest Lift with Rotation Pelvic Curl Supine Spine Twist Chest Lift Chest Lift with Rotation Footwork Cadillac Cadillac Cadillac Performing footwork on the Cadillac provides a beneficial stretch through the hamstrings as well as building strength through the legs. The limited range of knee flexion means we are training in the power range, a more functional range of motion, and reducing stress on the knee. Another benefit of footwork on the Cadillac is pelvic-lumbar stabilization. Abdominals Cadillac Bottom Lift with Roll Up Hundred Prep Hundred Hundred Prep Hundred Bottom Lift with the Roll Up Bar was initially 10
Bar Coordination Coordination selected to regain pelviclumbar stability. After ten sessions the client was ready to progress onto The Hundred Prep, The Hundred, and Coordination on the Hip work Cadillac Basic Leg Springs Frog Circles (Down/Up) Walking Bicycles Single Leg Supine Frog Circles (Down/up) Hip Extension Bicycle The benefits of performing hip work on the Cadillac include hip adductor strength and control, hip extensor strength and control, and pelvic-lumbar stabilization. The Single Leg supine exercises provide the opportunity to address imbalances between the two sides of the body. Spinal Articulation Bottom Lift Bottom Lift with Extensions (after 5 sessions) Cadillac Tower Prep Tower Cadillac Tower Prep Tower In the first 10 sessions, the client was still building abdominal strength and regaining confidence with the Pilates repertoire. 11
Bottom Lift on the reformer was selected to facilitate hamstring control, pelvic stabilization, and abdominal strength. After 5 sessions, extensions were added to increase the challenge. From session 10, the client was ready to progress to a more advanced exercise. Tower prep and tower were selected, which had the added benefit of a hamstring stretch. Stretch Standing Lunge Kneeling Lunge Kneeling Lunge Performing the standing lunge provided an excellent stretch for the hip flexors and hamstrings. Progressing to the Kneeling Lunge after 10 sessions increased the intensity of the stretch. Full Body Integration Reverse Knee Stretch Reverse Knee Stretch Up stretch 1 Up stretch 2 Reverse Knee Stretch was selected to develop abdominals and 12
hip flexors strength, and trunk stabilization. After 20 sessions Up Stretch 1, 2, and 3 were selected to stretch hamstrings and shoulders while still developing strength and stabilization through the core. Arm Work Arms Sitting Series Arms Sitting Series Arms Kneeling Series The Arms Sitting Series was selected to challenge trunk stability. After 20 sessions, the client had sufficient trunk stability to progress to Arms Kneeling series on the. Leg Work Wunda Chair Hamstring Curl Hip Opener Wunda Chair Hamstring Curl Hip Opener Wunda Chair Forward Lunge Backwards Step Down The hamstring curl was selected so that the leg strength could be developed in a very safe and stable position. Hip Opener on the chair was selected to improve pelviclumbar stabilization, hamstring 13
Full Body A/M N/A N/A Balance Control Front control, and so that the client could benefit from stretching and opening up her tight hips. After 20 sessions the client was ready to progress onto the advanced exercises Forward Lunge and Backwards Step Down to increase leg strength, power, control, and also add a balance challenge. For the first twenty sessions we didn t include an exercise in this block. After session 20 Balance control front was selected to further develop core strength. Lateral Flexion Wunda Chair Side Stretch Wunda Chair Side Stretch Side Over On Box Side Stretch on the Wunda chair was selected to regain oblique strength in a safe and stable position. After session 20 the client had sufficient oblique stretch to do the Side Over on the 14
Back Extension Wunda Chair Swan Basic Wunda Chair Swan Basic Pulling Straps 1 Pulling Straps 2 Swan Basic on the Wunda Chair was selected to practice back extension from a safe and supported position. After 20 sessions Pulling Straps 1 & 2 were selected to strengthen the back and shoulder extensors Additional Stretches Pole Series Pole Series Pole Series The Pole Series was added at the end of sessions or for Homework to stretch the shoulders and chest, and ultimately improve posture 15
Conclusion My client began running 3-4 miles, 2-3 times per week after about ten Pilates sessions. By twenty sessions, she was up to 4-5 miles, 3-4 times a week. She reports a noticeable difference in her endurance, and a sense of lightness and freedom during her runs, as well as quicker recovery time between runs. I feel that her stronger core and improved posture have improved the quality of her running form and her efficiency as a runner. She also reports increased body awareness in her everyday activities when caring for her infant daughter, and she is no longer suffering from lower back pain. In our sessions, her strength has developed quickly, and her flexibility continues to improve. She plans to continue with Pilates as a form of cross training as she trains for her next marathon. 16
Bibliography Books Angell, H. (2017) Pilates for Runners, Bloomsbury, UK. DiFiore, J. (2010) The Complete Guide to Postnatal Fitness, A & C Black, London. Isacowitz, R. (2013) BASI Comprehensive Course Study Guide, Body Arts and Science International, CA, USA. Isacowitz, R. (2006) Pilates. Your Guide to Mat and Apparatus Exercises, Human Kinetics. USA. Isacowitz, R. Clippinger, K. (2011) Pilates Anatomy, Human Kinetics, USA. Puleo, J. Milroy, P. (2010) Running Anatomy, Human Kinetics, USA. Websites Pelvic Floor Tutorial with Leah Stewart www.pilatesanytime.com Pelvic Organ Prolapse https://www.nafc.org/pelvic-organ-prolapse/ Pilates Running Mojo with Myriam Kane www.pilatesanytime.com 17