Pilates in Pregnancy

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What is Pilates?
How does pregnancy affect the abdominal muscles, back and pelvic floor?
Is Pilates useful in pregnancy?
Is Pilates safe in pregnancy?
How do I modify Pilates during pregnancy?

What is Pilates?

Virtual Medical Centre Video

Pilates in pregnancy Pilates is an increasingly popular form of exercise for people of all ages and fitness levels. It is a low impact, versatile, and effective option for people wanting to improve their strength, posture, balance, flexibility and muscle tone. Pilates exercises focus on strengthening the lower abdominal muscles and pelvic floor, providing a 'stable core' that supports the back and allows efficient movement. Exercise programs can be extensively modified to focus on different body parts and accommodate individual needs. Resistance is provided through 'studio' Pilates equipment known as 'reformers' and 'trapeze tables', gravity, and other smaller equipment such as exercise balls and resistance bands.

How does pregnancy affect the abdominal muscles, back and pelvic floor?

During pregnancy, the abdominal (tummy) muscles are stretched to make room for the growing baby. This may weaken the muscles, particularly the deep abdominal muscles. Deep abdominal muscles are responsible for providing support to the back (working like a corset). Lack of support makes the back vulnerable to injury. This is made worse by the hormone relaxin, which is released in pregnant women to soften the ligaments and allow the pelvis to stretch during delivery. All ligaments are softened by relaxin, including the ones in the back. With reduced support from ligaments and abdominal muscles, many pregnant women experience back pain. Relaxin remains in the body for some time after the baby is born. It is therefore important to protect the back not only during pregnancy, but also after birth, particularly when lifting, bending, breastfeeding, etc.

The pelvic floor muscles are responsible for controlling the bladder and bowel. They are weakened as they stretch and hold the weight of the growing baby. Weak pelvic floor muscles can result in difficulty controlling the bladder or bowel (incontinence) and can impact on sexual function. For example, some women find they leak urine when they cough or sneeze (stress incontinence). Around 46% of pregnant women in Australia experience urinary incontinence, and 30% have ongoing problems after delivery.

Is Pilates useful in pregnancy?

Pilates is an ideal exercise during pregnancy as it is designed to strengthen the deep abdominal and pelvic floor muscles. Strength in these areas is known as 'core stability'. These exercises can be performed in positions that are suitable for women at all stages of pregnancy, such as on hands and knees. Such exercises may take the stress off the back and pelvic floor, and help position the baby for delivery. Pelvic floor exercises have been shown to reduce urine leakage in women with stress incontinence and women who have to rush to get to the toilet on time.

Pelvic floor exercises are an important part of Pilates, but may be carried out on their own (i.e. not as part of a Pilates program).

Is Pilates safe in pregnancy?

Pilates in pregnancy It is important to check with your doctor or midwife before starting any new exercise program during pregnancy. If you have not done Pilates before pregnancy, it is essential to receive input from a Pilates instructor or physiotherapist in a setting where you can receive individual attention. Do not attempt exercises on your own until a professional has assessed your performance.

To exercise safely in pregnancy, you should be able to perform an effective pelvic floor and deep abdominal contraction. Very basic Pilates exercises are designed to achieve this. If you cannot contract your pelvic floor or deep abdominals muscles effectively, more advanced exercises may place too much strain on your joints. This is why you need to be assessed by a Pilates instructor or physiotherapist before continuing with exercises.

Certain exercises are no longer appropriate from mid pregnancy onwards due to the positions they require (e.g. lying on your tummy or flat on your back). However, exercises on hands and knees, in sitting, and in kneeling positions are all likely to be safe. As your pregnancy progresses the muscles become more stretched, and it may become more difficult to achieve good contractions.

General Pilates classes may not be suitable for pregnant women because they may involve positions that are not appropriate or may progress too quickly. Clinical Pilates (in small groups of about four people, with a physiotherapist), or studio Pilates (in small groups) are generally more appropriate. These classes tend to be based on equipment, which will provide more variety in exercises, and will still be safe. Alternatively, some 'Pregnancy Pilates' classes are available, and are designed specifically to suit the needs of pregnant women.

How do I modify Pilates during pregnancy?

Food and water intake

As with all exercise, it is important to stay well hydrated. You may need to increase your intake of calories to make up for the energy and water you have lost while exercising. This may mean eating a small healthy snack (e.g. low fat yoghurt or a piece of fruit) and drinking an extra glass of water.

Monitor your energy levels

Pilates is a 'low impact' form of exercise, which means it is kind to your joints,. It can be modified so it is not too strenuous during pregnancy. However, you must monitor your energy levels. Don't 'overdo it' during class, or in general. Signs that you need to slow down include:

Being too winded to talk in a relaxed tone and rate
Dizziness
Uterine contractions
Bleeding or leaking fluid
Headache
Nausea
Feeling faint
Racing heartbeat

If you experience any of these symptoms during or after a Pilates session, stop exercise, inform your instructor and, if they feel it is necessary, seek medical advice.

Take care not to fall

As you get larger during pregnancy, your centre of gravity shifts forward, affecting your balance. Be cautious with activities such as getting on and off equipment, balancing exercises, and getting up and down from the floor.

Don't overstretch your joints

Due to the hormone relaxin, your joints are more flexible during pregnancy. It is important you do not overstretch, as this may cause injury. Working in a small range of movement, working on control and core strength is more appropriate.

As your tummy gets larger and the muscles stretch, it will become more difficult to achieve a good contraction. Continue to focus on achieving a sense of activating your abdominals and pelvic floor, and don't compensate by 'squeezing harder' and activating other muscle groups.

Avoid abdominal crunches and curls

Avoid abdominal crunches and curls throughout pregnancy. Using the rectus abdominis muscle (the 'six pack' muscle that runs down the front of the tummy), particularly as you grow larger with pregnancy, may increase the chance abdominal diastasis, where the connecting tissue that holds the two sides of the rectus abdominis muscle together is separated. Some degree of diastasis is common during pregnancy. If abdominal diastasis is present, have it assessed by your doctor or physiotherapist. They will check the way you are using your muscles to make sure it is not worsening the diastasis. Abdominal crunches also increase strain on the lower back, and may cause injury there.

First trimester

Don't overdo it, particularly if you are feeling exhausted or nauseous. These sensations often improve later in pregnancy, allowing you to do more.

Second trimester

Focus on:

Arm strengthening
Pelvic floor exercises
Squatting exercises
Pelvis and lower back stability
Spinal stretches (gentle)
Postural exercises

Avoid:

Exercises with legs wide apart (e.g. side stretches on the reformer). These may place strain on the joint at the front of your pelvis (symphysis pubis).
Lying flat. This may reduce the blood supply to you and your baby. If this occurs, you may feel dizzy or lightheaded.
Abdominal crunches
Extreme stretches
Unstable balance exercises
Unsupported back bends
Inversions (where your feet are higher than your heart, with your hips up too)
Sharp percussive movements
Jumping

Third trimester
Focus on:

Gentle stretches (these should feel good!)
Arm exercises
Supported back bends (such as over a bolster)
Stability exercises for your lower back and pelvis
Pelvic floor exercises
Breathing exercises
Thigh strengthening exercises (though not a deep squat in the last 4-6 weeks of pregnancy, as this may induce labour)

Avoid:

As per second trimester; also
Deep squats during the last 4-6 weeks of pregnancy (increases pressure on the cervix and may induce labour)
Exercises on one leg or with legs apart (lunges, splits)

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