I have a new Pilates client who is 3 months pregnant and suffers from chronic back problems. She has a ripped disc between L5 and S1--an injury related to the wear and tear of being a former ice skater and basketball player. She is generally in very good shape, but she complains of back pain and low back "tightness." She is afraid her back pain will increase with the pregnancy. She would like me to build her a program that she can do at home, and she will see me for private, equipment-based studio sessions twice a month. Any suggestions about helping her have a relatively painless pregnancy? I have seen her once and she has extremely good body awareness and strong core support--she can access her core muscles and can stabilize her pelvis in supine fundamental mat exercises. Your input is appreciated.

Karla,

I think it would be great to start Pilates at this time as long as you take it slowly and adhere to the diastasis precautions, especially since you have been diagnosed with an umbilical hernia (i.e. no abdominal work in supine, no lifting the head and shoulders, no lifting double legs in the air, no plank pose...see my Pilates and Pregnancy: Safe Ab Exercises article). You should be focusing on lots of transversus abdominus strengthening, with an effort to approximate the rectus abdominus and close the diastasis. You can also work on upper and lower body strengthening, spine mobility, breathing and stretching.

Exercise can only be helpful for you. You will feel better, decrease stress, increase strength, increase flexibility, and improve respiratory function. Focused core stability work will help support the pregnancy and make the postpartum rehabilitation easier. It is NEVER too late to start exercising during pregnancy, but your workout may need to modified. After the birth, you will need to focus on abdominal rehab, being very careful to protect the hernia and not stress it. Wearing an abdominal binder or splint for the first few months can be very helpful. The pressure from the brace helps to physically approximate the abdominal muscles and can help them to heal more easily. It also provides a constant reminder to keep the transversus abdominus pulled in. I recommend the Tauts by Brooke Burke or a lighter weight splint by Julie Tupler.

Good luck!
Debbi

Hi Theresa,

I am by no means an expert on fertility but to my knowledge, I have never heard of any scientific research that indicates that exercise of any kind has an impact on fertility. I know that many women are instructed to “take it easy” while trying to conceive. However, I do not know if there is a real scientific basis to that recommendation. In fact, I would think that an exercise program like Pilates that incorporates breathing, stretching, and balancing of the body would actually be a positive step towards fertility. Pilates can help to increase energy and circulation through the pelvis which in my mind can only be a great thing. Pilates can also be a great way relieve stress which is a wonderful benefit while going through the fertility process. Fertility issues are very complex, and I think you should focus on doing things that make you feel happy and make your body feel good. Moderate intensity exercise should not impact fertility.

Again regarding how to generally work with pregnancy and postpartum clients, I'll just reiterate from previous posts that it is very difficult to answer such a general question. Working with this population, just like any special population requires special training. There are tons of exercises that can be great during pregnancy and postpartum. However, instructors need to be knowledgeable about the anatomy and physiology of pregnancy, the musculoskeletal changes, hormonal changes, changes in center of gravity, and precautions for working with this group. Working with any special population requires training and skill. This population in particular requires some extra training as the pregnant and postpartum body is quite different than a regular body. In my two-day workshop, I focus more on teaching instructors concepts rather than a list of exercises. My next course will be May 29-30 at Kinected Center in NYC. Most instructors feel very ready to work with this population after this course. Please also see my articles: Pilates and Pregnancy: Safe Abs and Postpartum Recovery for a general overview of working with this population, as well as the previous posts for more tips.

Best of luck,
Debbi

(Editor's note: Check out our May workshops page for more info on Debbi's course. Thanks! -Lauren)

Hi Jill,

There are tons of exercises that can be great during pregnancy and postpartum. However, instructors need to be knowledgeable about the anatomy and physiology of pregnancy, the musculoskeletal changes, hormonal changes, changes in center of gravity, and precautions for working with this group. Working with any special population requires training and skill. This population in particular requires some extra training as the pregnant and postpartum body is quite different than a regular body. In my two-day workshop, I focus more on teaching instructors concepts rather than a list of exercises. My next course will be May 29-30 at Kinected Center in NYC. Most instructors feel very ready to work with this population after this course.

The exercise focus is actually very similar during pregnancy and postpartum. During pregnancy, the main focus will be on TVA and pelvic floor strengthening. TVA strengthening during pregnancy is important for many reasons including: helping to support the growing uterus, prevention of low back pain, preparation for pushing, and diastasis recto control. Pelvic floor strengthening is also extremely important as this muscle group has the role of supporting the growing uterus from below. Both muscle groups become significantly stretched during the course of pregnancy especially during a vaginal birth. Strengthening these muscles during pregnancy will aide in the speed of the postpartum recovery process. My “prescription” is to design a program that has a heavy emphasis on TVA and pelvic floor stability as well as addressing the major postural changes brought on by pregnancy. Women should be taught how to close the diastasis by “drawing in,” and they should not perform any exercise in which they cannot keep the diastasis closed. Aggressive rectus abdominus strengthening should be avoided during pregnancy and early postpartum since the rectus has lost its integrity once the diastasis begins to open. Pilates practitioners should learn how to palpate the diastasis in order to make sure clients are able to keep it closed during exercise. Postpartum, women need to continue to focus on core stability with an emphasis on diastasis closure, rib cage closure, and pelvic balance.

C-section recovery is not much different than regular postpartum recovery except that there must be some attention paid to scar tissue mobilization. Women can begin to mobilize the scar as soon as it is healed which is generally by six weeks postpartum. Scar tissue mobilization is extremely important for prevention of adhesions. C-section scars are usually very thick and can create significant biomechanical issues if they are not addressed early on. Ways to mobilize the scar are to pinch it, lift it, and massage it. However, never apply pressure in a direction to pull it apart. Ultimately, we want the scar to behave like regular tissue.

It is common for women to have some mild stress incontinence during pregnancy due to the extreme pressure on the bladder, and it is also common for some women to have some stress incontinence issues initially postpartum. However, these symptoms should resolve by 12 weeks postpartum. In order to treat this problem, women may need to have manual therapy to balance the pelvis and pelvic floor following pregnancy and birth. Sometimes the pelvic floor can actually go into a rebound spasm after the extreme stretch during birth. Sometimes women are left very imbalanced in the pelvic floor after all the changes and pressure of pregnancy. Manual therapy can be necessary to help restore balance to the system. The manual therapy would have to be done by someone skilled in treatment of the pelvic floor. Then kegels, core stabilization, and hip stabilization will help to strengthen the system.

See my Safe Abs and Postpartum Recovery articles for more insight.

Thanks!
Debbi

Hi Jeffy,

The rib cage actually increases in diameter several centimeters during the course of the pregnancy. By the end of the pregnancy, the fetus and uterus have expanded into the abdominal cavity putting pressure on the rib cage.

Flexion is a movement, not an exercise. Flexion movements in general tend to be less comfortable as the pregnancy progresses due to the growth of the fetus/uterus into the abdominal cavity. Later on, flexion causes compression of the anterior diaphragm and the fundus of the uterus, which is not comfortable. Flexion movements also are not functional as the thoracic spine is becoming more kyphotic, and flexion tends to support that posture.

The difficulty with the leg exercises are due to hypermobility of the pelvis that occurs during pregnancy. Many pregnant women are uncomfortable doing any kind of abduction, adduction, or large leg movements due to excessive torque on the sacroiliac joints.

Postpartum, women should begin with neutral spine core stability work and kegels. TVA strengthening is extremely important. Emphasis should be placed on closing the diastasis. See my Safe Abs and Postpartum Recovery articles for more insight.

Thanks!
Debbi

Hi Rachel,

Just wanted to call attention to a couple of articles Debra has already written for us that should help with your questions. They are all linked in the main post above, under the 'Related Articles' heading. She includes a discussion of diastasis and provides a sample prenatal mat workout in Pilates and Pregnancy: Safe Ab Exercises. She also compiled The Pilates Bookshelf: Top Pregnancy Resources, which should be self-explanatory : ) Hopefully, it'll be easier for everyone to locate them now that I've added those links in a more obvious spot. Thanks for writing!

Best,
Lauren/Editor