Pilates in Pregnancy

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Can you still practice Pilates with a baby on board? Absolutely, but we do have to make a few modifications to adapt to the changes in a pregnant woman’s body. Many of our clients continue to practice right up to their due date, much to the admiration of their fellow class members! This blog will look at the many benefits of continuing Pilates practice during pregnancy as well as giving some ideas for exercising safely during pregnancy.

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There are some reasons not to exercise during pregnancy and it is always a good idea to check with your physiotherapist or midwife if you have any concerns. See the full list of signs to stop exercising at the bottom of this article.

Exercising during pregnancy is known to benefit both mother and baby – and can have long lasting health effects for the baby long after it is born. Studies have shown that if the mother’s heart rate is raised, the fetus’s heart rate also goes up. So by keeping yourself fit, you are giving your baby a wee workout!

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In general, it is advised to keep the intensity you exercise at to a moderate level. Make sure you can still speak in sentences while working out. You are recommended to continue an exercise programme from before pregnancy and stop any exercise where there is a risk of impact. If you were totally inactive before pregnancy, then it is advised to start some form of gentle exercise. Pilates is a great gentle exercise and can be adapted to any level, even if you have not done it before pregnancy, to exercise the muscles effectively and safely.

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Antenatal Pilates helps to maintain posture, strength and flexibility to reduce/prevent pregnancy-related discomfort and a class taught by a specialist antenatal Pilates instructor will teach awareness of correct body biomechanics and postural alignment while adjusting to the changes in the body – increased weight and the change in centre of gravity with a growing bump.

The pelvic floor has additional pressure placed on it from early in pregnancy. It is a good idea to start pelvic floor exercises before you even get pregnant, but if you’ve missed that opportunity, it’s definitely better to start before the birth than after the birth. Pilates during pregnancy can help you get best function from your pelvic floor while performing the exercises.

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There is a fairly common misconception that a strong pelvic floor is also tight and can cause problems during the birth. Actually, problems of tightness in the pelvic floor, as in any other muscle, tend to arise when there is weakness in some areas of the muscle – the weak muscle fibres build up tension to compensate. A well functioning pelvic floor which is both strong and mobile can actually aid the delivery by encouraging the baby to turn effectively as it is being born. If the pelvic floor is in good condition prior to the birth, it can really speed recovery and limit effects of continence problems after the birth.

An antenatal Pilates class will also focus on the upper back and arms to help prepare the body for caring for your baby. Good control around the shoulder blades will be essential when you spend hours leaning over and carrying baby. When you go to a pregnancy Pilates class you might wonder why you do so many squats! Think ahead, how many times a day will you be picking up baby and getting on and off the floor? If you train this movement prior to the birth, you will be able to maintain better leg and spine alignment when this is probably not at the forefront of your mind!

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It is important to know that you shouldn’t do sit up type exercises after the first trimester of pregnancy. This is because the long stomach muscles which run from the sternum down to the pubic bone stretch to almost double their original length in pregnancy and will split apart in two thirds of women. This split (rectus diastasis) is not a problem in itself – it is a natural part of pregnancy. But any sit-up type movements that strengthens the muscle in the split position can make it more difficult to rehab postnatally. You still want to maintain the control of the deep abdominal muscles and obliques, but this can be done in sitting and standing positions as well as on hands and knees (4 point kneeling) and will not create an intense pull on the muscles.

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The antenatal classes will also give the added benefits of allowing you time to focus on yourself and your developing baby in a relaxed class which is small enough to allow you personal attention when required. You will meet like-minded mums-to-be and get to exercise in a supportive environment where everyone in the class is experiencing similar changes to their bodies and benefiting from the instructor’s expert advice and experience.

As an antenatal class is suitable for all stages of pregnancy, please be aware there might be people in your class in their first trimester. If you know someone in the class who is in the early stages of pregnancy, please help them keep their big secret until they have made their pregnancy public!

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Stop exercising and seek advice if you experience any of the following:

  • Ligament pain
  • Pubic/sacroiliac/pelvic girdle pain
  • Low back pain
  • Leg pain or cramps
  • Varicose veins
  • Swelling in hands and feet
  • Carpal tunnel syndrome
  • Vaginal bleeding
  • Abdominal cramping
  • Feeling faint/short of breath
  • Decreased fetal movement
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Women’s Health Physiotherapy and Pilates

It is not commonly known that Physiotherapists can specialise in problems of the pelvic floor and bladder. This may be a small area of Physio, but it can make a huge difference to those who are struggling with a little (or a lot of) leakage and a loss of continence. This problem can seriously impact on quality of life for many women, and some men too.

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The more accurate term for the service is Pelvic Obstetric and Gynaecological Physiotherapist, however, Women’s Health Physiotherapist (WH Physio) is still in wide use so will also be used here. Specialist Physiotherapists specifically deal with pelvic floor issues, but also with associated problems of prolapse and weakened abdominal muscles post-childbirth. A WH Physio can also look at patterns of drinking and toilet visits and help make practical changes to reduce symptoms of urgency. WH Physios also specialise in the ante- and post-natal period, and can help with pregnancy related back, hip and pelvis pain. Then in the postnatal period we can help you return to function if abdominal muscles have split during pregnancy or if you have any aches and pains following childbirth, or repetitive strains from looking after your new baby.

‘Women’s’ health can be misleading, because everyone has a pelvic floor. Continence issues due to a weakened pelvic floor affect one in three women and one in ten men – as it affects many women after childbirth it is more of a women’s problem. A series of simple exercises and some straightforward lifestyle changes can make a huge difference. The exercises, as in most cases, do not work overnight and ask at least 3 months of commitment 3 times a day from you. However, each set should only take a couple of minutes and can be done anywhere (I do mine on the bus!) so it is just a case of remembering or setting and alarm on your phone. Compared to the alternatives – either a worsening problem that needs to be dealt with by using more and more pads, increasing strength medication; or even surgery which has been the subject of controversy recently – a few moments of your day is really a small price to pay.

Image from Advanced Uro-Gynaecology for Physiotherapists: Michelle Lyons

Unfortunately, it has been found that one third of women with weakened pelvic floor are doing the exercises incorrectly and could make their problems worse. Assessment of the pelvic floor by a specialist Women’s Health Physiotherapist can help you ensure you are performing the exercises correctly. You can also be taught different ways to check for yourself that you are doing it right once this has been established. When the exercises are done correctly with other lifestyle changes alongside them, they can be incredibly effective and give you a fantastic way to look after yourself and help prevent any problems arising in future. There are plenty of descriptions of pelvic floor exercise programmes online, however, nothing can match having this assessed individually, especially if you are having persistent problems.

Much rarer than a weakened pelvic floor is a pelvic floor which goes into spasm, due to an imbalance of different fibres of the muscles. This can be incredibly painful, so it important to learn how to completely relax the pelvic floor as well as how to contract it effectively and to be able to do both under conscious control.

In Pilates we talk about the ‘centre’ – this comprises the deep abdominal muscles which wrap around the abdomen like a corset, the diaphragm at the top and the pelvic floor at the bottom. These 3 sets of muscles which form a ‘cylinder’ work together to provide active support for the low back, mid back and pelvis. If you learn to engage the pelvic floor correctly this will lead to the deep abdominals switching on at the same time (keep breathing deep and wide into the ribcage to get the full cylinder working together!). Unfortunately it doesn’t work the other way – if you contract the deep abdominal muscles, the pelvic floor does not switch on automatically.

In any Pilates exercise where you lift up your head, this can push the abdominal contents down on the pelvic floor, which can put undue stress on the pelvic floor, especially when adding in the additional work on the abdominal muscles. It is necessary with any head up position to engage the pelvic floor before performing the lift of head and shoulders; this prevents any downwards pressure on the pelvic floor and helps it to strengthen and improve control at the same time. I bet you’ve never been told to pre-contract your pelvic floor before lifting something heavy, but you want to do that too for the same reason!

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There is research that Pilates is effective for those with mild continence issues as it teaches you to contract your pelvic floor effectively and this carries over into everyday life.

So, next time you’re in your Pilates class and the instructor advises you to think about engaging through the pelvic floor, really add this into the exercise! You will be making a big difference to helping your pelvic floor work effectively as part of the whole core system.

If you are not sure if you are contracting your pelvic floor correctly, please come and see me in the clinic to check this for you as well as provide you with a personalised programme and advice.