There’s something in the water…

There’s something in the water in Camberwell at the moment…I have three pregnant colleagues and four pregnant friends who are each trying to navigate their way through the various stages of their pregnancies. I seem to be having similar conversations recently with these wonderful women about some things to be aware of, from a physiotherapy and Pilates perspective, while they are exercising. So I thought I’d jot down a few things to keep in mind for other women out there…

Pregnancy & Pilates

Pilates is a unique method of exercise, which requires concentration, control and precision. Pilates exercises are versatile and easily modified, so are ideal for pregnant women while your bodies change. However, like any mode of exercise, it must be practised correctly to ensure safety and effectiveness.

Hormonal Changes

The hormone ‘relaxin’ is released with one of its roles to relax connective tissue. This increases soft tissue laxity, affects joint stability, and potentially leads to conditions such as pelvic instability and pelvic girdle pain. Movements that challenge pelvic stability or involve asymmetrical forces around the pelvis should be practiced with caution, as they can provoke dysfunction in the pubic symphysis or sacro-iliac joints. Modify Pilates exercises to become bilateral and symmetrical, reduce twisting and rotational forces through the pelvis, and always promote correct activation of the pelvic floor muscles and lower abdominals. Repertoire involving gluteus maximus contraction is also beneficial in providing stability across the back of the pelvis.

Postural changes

Throughout the progression of your pregnancy, the natural spinal curvatures become exaggerated, with increased lumbar lordosis (sway back) due to the weight of the baby pulling forwards, and compensatory increased thoracic (upper back) kyphosis. Add to this, increases in spinal joint laxity and compression. The prevalence of reported lower back pain during pregnancy ranges from 35-61%. Pilates workouts need to focus on postural education and endurance, and encourage thoracic extension and lumbar flexion to elongate the spine.

Abdominal Musculature

As your baby grows, your abdominal muscles will be stretched in all dimensions. This altered length-tension relationship of the muscle fibres changes their ability to contract and dynamically support the spine. A diastasis (separation) of rectus abdominus is common, which can prevent optimal function of the core. In Pilates, ensure your deep abdominal muscle, the transversus abdominus, is activated prior to the superficial abdominals. Encourage a “drawing in” of the lower abdominals throughout, and discourage excessive outer abdominal loading by avoiding crunches and sit ups.

The Pelvic Floor

Increased weight in the pelvis places greater pressure down on pelvic floor muscles, leading to potential incontinence (loss of bladder or bowel control) during pregnancy and compromised intra-pelvic stability. Incorporating specific pelvic floor activation into the Pilates program will help condition the pelvic floor to manage incontinence symptoms and assist with pelvic stability. Strengthening has also been shown to promote a quicker 2^nd stage of labour and reduce the risk and severity of pelvic floor trauma during birth. When activating your pelvic floor, you should be able to feel a definitive squeeze and lift sensation.

Weight Gain

The recommended healthy weight gain during pregnancy is between 11kg and 16kg. It is influenced by many factors such as pre-pregnancy weight, baby weight, amniotic fluid, increased blood volume and increased breast size. This places increased stress on all joints, and allows less space for abdominal and pelvic organs. Sometimes women feel dizzy when lying on their back for extended periods as the pressure of the growing baby compresses pelvic veins and reduces blood flow back up to the heart, so you may be unable to exercise on your back after the first trimester. Take care with prolonged periods of supine lying; try propping the upper body on a wedge cushion, or change positions between exercises. Cushions can also be strategically placed around the pelvis and chest for prone work.

Cardiovascular & Respiratory Systems

The demand on your cardiovascular system escalates, with an increase in resting heart rate, cardiac output and total blood volume, and a decrease in blood pressure. Reduced venous return can produce swollen ankles and conditions such as carpal tunnel syndrome in the hands. Exercising in postures where the limbs are elevated in relation to the trunk will improve venous return to the heart. With available space in the abdomen at a premium, women must be aware of reduced lung volume and aerobic capacity during exercise. Pilates exercises should feature emphases on thoracic mobility, chest expansion and breathing techniques.

I’d love to hear your comments and answers to the following questions:

• Have you experienced any of the above changes?
• What modifications have you made to your Pilates program and exercise regime throughout your pregnancy?