Pilates in the Second Trimester of Pregnancy

Alice B. Roby

December 16, 2016

BASI CTTC (2015)

Chicago/Denver/Whitefish

1

Abstract

A primary goal of a Pilates exercise regime during the second trimester of pregnancy is to

prepare the woman’s body for the additional weight of her rapidly growing uterus and fetus.

Research shows that strengthening a pregnant woman’s abdominal and pelvic floor muscles will

help her maintain a healthy lumbar spine to avoid developing hyperlordosis, promotes proper

alignment and posture as her center of gravity shifts forward, reduces her risk of developing

diastasis recti, will aid her in safely performing all of her daily movements and activities, and

will prepare her for a successful childbirth. Due to their crucial role in preventing hyperlordosis

and diastasis recti, and in aiding functional daily movement and successful childbirth, the

primary anatomical focus of this research is the abdominal and pelvic floor muscles, with special

mention of the role of the gluteals in total pelvic floor health.

2

Table of Contents

1. Abstract…………………………………………………………………………1

2. Table of Contents……………………………………………………………….2

3. Anatomical Description………………………………………………………...3

Figure 3.1: The Pregnant Spine………………………………………………..3

Figure 3.2: The Abdominal Muscles……………………………………….…..4

Figure 3.3: Diastasis Recti……………………………………………………..5

Figure 3.4: Variations of Diastasis Recti………………………………………5

Figure 3.5: The Pelvic Floor………………………………………….………..6

4. Introduction…………………………………………………………….………7

5. Case Study………………………………………………………………..…….9

6. Conditioning Program…………………………………………………….…….9

7. Conclusion………………………………………………………………….…13

8. Bibliography……………………………………………………………….….14

3

Anatomical Description

Figure 3.1: The Pregnant Spine

The pregnant spine in the second trimester tends towards hyperlordosis, or an increase in the

natural curve of the lumbar spine, and is typically accompanied by an anterior, or forward, tilt of

the pelvis. This condition is commonly caused by the additional weight a woman carries as the

uterus and fetus rapidly grow, and the relaxing of ligaments and joints due to hormones. Muscles

in the erector spinae, hip flexors and quadriceps are typically shortened and tight, thus pulling

the pelvis further forward. The muscles in the abdominals, gluteals and hamstrings are typically

stretched and weak, thus not assisting in counterbalancing the gravitational pull forward of the

pelvis. The result is often low back pain.

http://www.thetrainingfix.com/your-center-of-gravity-shifts-during-pregnancy-the-best-ways-to-avoid-pain-are/

4

Figure 3.2: The Abdominal Muscles

There are four connected abdominal muscle pairs: the rectus abdominis, the internal obliques, the

external obliques, and the transversus abdominis. The two most superficial abdominals are the

rectus abdominis and the external oblique muscles. The rectus abdominis (RA) muscles run

vertically up and down the center of the abdomen. The external obliques are on the sides of the

RA, and run diagonally downward towards the center of the abdomen.

The two deeper abdominal muscles are the internal obliques and the transversus abdominis

muscles. The internal obliques are beneath the external obliques, along the sides of the RA. The

internal obliques have both upper fibers that run upwards towards the center of the abdomen, and

lower fibers that run downwards towards the center of the abdomen. The RA muscles, in

conjunction with the internal and external oblique muscles, are responsible for flexion (including

lateral flexion) of the spine.

The deepest of the abdominal muscles is the transversus abdominis (TA) muscle, which runs

horizontally and wraps around the abdomen like a corset, narrowing and flattening the abdomen.

The TA muscle’s primary function is postural and protective; the contraction of the TA stabilizes

the spine and pelvis before movement of the lower or upper limbs.

http-//womenfitness.net/img2016/artimg/march/abdominal-muscles/

5

Figure 3.3: Diastasis Recti

“Diastasis” means separation, and “recti” refers to the rectus abdominis (RA) muscles. The linea

alba, Latin for white line, is connective tissue that runs vertically down the midline of the

abdomen, between the RA muscles. The linea alba can become stretched as the fetus grows,

causing the RA to widen laterally and separate.

https://readysetmamas.com/diastasis-recti/

Figure 3.4: Variations of Diastasis Recti

Diastasis recti can occur at any point along the linea alba; the separation can be complete,

running along the length of the linea alba, or more pronounced either above, below, or at the

navel.

6

cdn.wellnessmama.com/wp-content/uploads/diastasis_V2.png

Figure 3.5: The Pelvic Floor Muscles

The pelvic floor is a group of muscles that attach from the pubic symphysis to the coccyx and

sacrum. This group of muscles is often referred to as a hammock, or a sling, providing essential

support to the pelvic organs such as the bladder, uterus and bowels. Pelvic floor muscles

contribute to healthy functionings including sexual response, bladder control, and guiding the

baby’s head down the birth canal. Strengthening the pelvic floor muscles increases flexibility and

control, which will aid in the childbirth process, and also prevent incontinence issues during the

post-natal period.

7

https://midwiferytraditions.com/2015/11/18/pelvic-floor-health/

Introduction

Pilates can be an excellent form of exercise during all stages of a woman’s pregnancy. This

paper focuses on the benefits of pilates during the second trimester of pregnancy, when the

uterus and fetus begin to grow rapidly. As the woman’s body undergoes rapid weight gain and

expansion in the uterus, a separation of the abdominal muscles called diastasis recti can occur,

weakening a woman’s core. As her midsection grows and weakens, her center of gravity changes

and pulls her pelvis forward into an anterior tilt, creating lordosis in the lower lumbar spine and

causing low back pain. Hormones such as relaxin loosen her ligaments and joints, which can

cause further pain and instability. A pilates conditioning program can be instrumental in

preventing a pregnant woman from developing diastasis recti, anterior pelvic tilting and

hyperlordosis, and much of the subsequent pain that can accompany such pregnancy conditions.

8

Strengthening a pregnant woman’s abdominals without putting her into deep flexion is key to

avoiding diastasis recti. Exercises with deep flexion, including excessive lateral flexion using the

obliques, can exacerbate the stretching of the linea alba and the separating of the RA muscles by

pulling them apart further. Focusing on contracting and strengthening the TA muscle without

flexion is a crucial element to a pilates program during the second trimester of pregnancy.

A strong TA muscle, along with intact RA muscles and obliques, will help prevent the pelvis

from tilting forward and the lumbar spine from overly curving because the woman will be able to

“hug the baby” by contracting her muscles and pulling into her core. This ability to support the

weight of the baby will promote proper posture and alignment, and will aid in daily functional

movements.

Often when hyperlordosis and an anterior pelvic tilt are present, it signals that not only are the

abdominals weak and lengthened, but so are the hamstrings and gluteals. And, the erector spinae

and hip flexor muscles are typically tight and shortened in this scenario. Therefore, it is

important to incorporate exercises into the conditioning program that target the strengthening

hamstrings and gluteals, while stretching the hip flexors and low back muscles.

The pelvic floor muscles are another group of muscles essential to the overall health of the

pregnant woman. These muscles play a vital role in successful childbirth, and also prevent

incontinence in the post-natal months. Strong pelvic floor muscles that a woman knows how to

contract and release means that she will be able to use them on command during labor, guiding

the baby’s head through the birth canal. Performing Kegel exercises help condition the pelvic

floor muscles to contract and release. However, research shows that repeated tightening and

contracting of the pelvic floor muscles via Kegels will does not equal strong pelvic muscles. A

tight muscle is not a strong muscle. A healthy muscle needs to have the ability to contract, but

9

also to lengthen and stretch. Further, constant tightening via Kegels results in pulling the coccyx

inward towards the pubic bone, thus making the birth canal smaller. In order to strengthen the

pelvic floor muscles and simultaneously open, lengthen and stretch the pelvis out, is to

strengthen the gluteal muscles. Strong gluteals will counter the inward, shortening pull on the

pelvic floor muscles, and create a balanced, toned, and more lengthened pelvic floor. This will

allow the baby to pass through the birth canal more easily.

Case Study

My client, Katie K., is a 42 year old woman in the second trimester of her first pregnancy. Katie

is an experienced pilates devotee, and has enjoyed BASI pilates workouts for over a decade. She

has been cleared by her doctor to continue with her pilates regimen, keeping in mind to make

certain modifications for pregnancy. Katie has no injuries, is not showing any signs of diastasis

recti, and at 24 weeks still feels fine lying supine for short periods of time. I have structured a

program for Katie using the BASI Block System, with the desired results being: strengthening

Katie’s abdominals while minimizing her chances of developing diastasis recti; promoting

healthy posture to prevent low back pain; and maximizing pelvic floor health to prepare Katie for

childbirth and post-natal recovery.

*NOTE: Katie and I meet for two sessions per week, and in the conditioning program below I

have noted more than one set of exercises per block, to show how our sessions can vary. She

does not perform all of the exercises each session.

BASI Block System Conditioning Program for Katie in her 2nd Trimester:

BLOCK EXERCISES REASON & NOTES

Warm Up

Pelvic tilts on Ball

Pelvic Curls (x3)

Spine Twist Supine

-Katie feels good on her back

for 5 minute intervals, and her

doctor says this is fine.

10

Warm-Up (cont’) Leg Lifts

Leg Changes

-Spine Twist Supine is kept

controlled with a small range

of motion (ROM), as a lot of

rotation in the obliques can

potentially contribute to

diastasis recti (DR).

Foot Work

*Reformer or Wunda

Chair:

Parallel Heels

Parallel Toes

V Position Toes

Open V Heels

Open V Toes

Calf Raises

Prances (Reformer Only)

Prehensile (Reformer Only)

Single Leg Heel

Single Leg Toes

1. *Reformer with

modifications (Ball, or

jumpboard behind

back to sit upright, or

Wedge to lie on

carriage on a

diagonal)

2. Wunda Chair Foot

Work (no

modifications

necessary)

Abdominal Work Chair:

Torso Press Sit

Standing Pike Reverse

Cadillac: Sitting Forward

-Torso Press Sit does not

require deep flexion, thus is

good when preventing DR

-Although Standing Pike

reverse has flexion, it is light

resistance and therefore puts

minimal strain on the rectus

abdominis (RA). It also offers

safe back extension and a

hamstring stretch.

-Sitting Forward also has a

lighter resistance and minimal

strain on the RA, and offers a

hamstring stretch.

Hip Work (Strap Work)

*Reformer:

Supine Leg Series

Frog

Circles Down/Up

Openings

Variation:

Circles Down/Up

Extended Frog

Extended Frog Reverse

*Reformer Wedge placed on

carriage so Katie is lying

upright on a diagonal

11

Spinal Articulation *Reformer:

Bottom Lift

Bottom Lift with Extensions

*Katie is currently OK being

on her back for short periods

of time and has doctor OK; if

this changes, we will no

longer perform this exercise

Stretches

Reformer:

Standing Lunge

*Kneeling Lunge

Ladder Barrel:

Gluteals

Hamstrings

Adductors

Hip Flexors

* Consideration is given to

not overstretch Katie, as

relaxin in the body can lead to

pregnant women

overstretching

*If/when Katie’s belly starts

to get in the way, we will

discontinue Kneeling Lunge

Full Body Integration

(Fundamental/

Intermediate)

Reformer:

Long Stretch

*Scooter

*Scooter has flexion, but not

with heavy resistance or strain

on the RA, and therefore

should be OK

Arm Work

Ped-A Pul:

Arms Standing Series

Extension

Adduction

Circles Up/Down

Triceps

*Reformer:

Arms Sitting Series

Chest Expansion

Biceps

Rhomboids

Hug-A-Tree

Salute

Cadillac:

Arms Standing Series

Chest Expansion

Hug-A-Tree

Circles Up/Down

Punching

Biceps

Arm Work Series (Magic

*Only one series is performed

each session

*Arms Sitting Series on the

Reformer can be done seated

on the box for added comfort

and to avoid tensing the hip

flexors

These series are chosen

because they can be

performed in an upright

position and strengthen the

latissimus dorsi muscles,

which are important to

functional daily movement

and activities, and overall

strength of a pregnant

woman.

12

Arm Work (cont.) Circle):

Arms bent

Arms Straight

Arms Overhead

Single Arm Side Press

Single Arm Bicep

Full Body Integration

(Advanced/ Master)

None None-- FBI II is too strenuous

for Katie at this stage of her

pregnancy.

Leg Work

Wunda Chair:

*Leg Press Standing

Frog Front

*Cadillac:

Squats

Lying Side Single Leg Series

Changes

Scissors

Circles Forward/Back

*Mat:

Gluteal Side Lying Series

Side Leg Lift

Forward and Lift

Forward with Drops

*Reformer: Jumping Series

Parallel Position

V-Position

Single Leg Parallel

Leg Changes

*Only one series is performed

each session

*Leg Press Standing can be

done holding poles for

assistance with balance

*Squats are an excellent

exercise to prepare Katie for

childbirth: opening the hips

and strengthening the glutes.

*Friends who have recently

completed their BASI training

tell me that Lying Side Single

Leg Series is now part of the

Hip Work Block. When I

went through my training, this

series was in the Leg Block.

*Gluteal Side Lying Series is

especially important for

Katie, because strengthening

the gluteals, in conjunction

with Kegels, help strengthen

the pelvic floor muscles, thus

preparing for childbirth and

recovery.

*Reformer Wedge placed on

carriage so Katie is lying

upright on a diagonal

Lateral Flexion/Rotation

Reformer:

Mermaid

Both of these exercises are

gentle enough flexion and

rotation for the 2nd trimester

13

Lateral Flexion/Rotation

(cont.)

Chair: Side Stretch

of pregnancy.

Care is given not to

overstretch Katie on Side

Stretch.

If Katie’s belly gets too large

for Mermaid to be performed

comfortably, we will

discontinue this exercise.

Back Extension Mat: Cat Stretch

Lying prone is not

comfortable or safe for the

fetus during the 2nd trimester

of pregnancy. Cat Stretch is

safe and effective.

Conclusion

A pregnant woman can avoid the painful pitfalls of pregnancy by strengthening and stretching

her body in a safe, effective manner via pilates. By strengthening her abdominals, especially her

TA, while avoiding deep flexion exercises, she may be able to prevent diastasis recti. Strong

abdominals in conjunction with stretching (but not overstretching) her hip flexors and erector

spinae muscles will help prevent the pregnancy posture known as hyperlordosis with an anterior

pelvic tilt. With proper alignment she will enjoy pain-free functional movement in her daily life.

By strengthening her pelvic floor and gluteal muscles, she will be preparing for childbirth and

recovery. The BASI Pilates Block System and a trained BASI Pilates instructor can help a

pregnant woman achieve exceptional results in her body that will carry her beyond her second

trimester of pregnancy into a healthy delivery and life with her baby.

14

Bibliography

Books

Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and

Science International, 2000-2014.

Isacowitz, Rael. Wunda Chair & Ladder Barrel: Movement Analysis Workbook. Costa Mesa,

California: Body Arts and Science International, 2000-2014.

Isacowitz, Rael. Reformer: Movement Analysis Workbook. Costa Mesa, California: Body Arts

and Science International, 2000-2014.

Isacowitz, Rael. Cadillac: Movement Analysis Workbook. Costa Mesa, California: Body Arts

and Science International, 2000-2014.

Isacowitz, Rael. Mat: Movement Analysis Workbook. Costa Mesa, California: Body Arts and

Science International, 2000-2014.

Isacowitz, Rael. Auxiliary: Movement Analysis Workbook. Costa Mesa, California: Body Arts

and Science International, 2000-2014.

Isacowitz, Rael and Clippinger, Karen. Pilates Anatomy. Champaign, Illinois: Human Kintetics,

2011.

15

Bond, Mary. The New Rules of Posture: How to Sit, Stand, and Move in the Modern World.

Rochester, Vermont: Healing Arts Press, 2007.

Calais-Germain, Blandine. Anatomy of Movement, Revised Edition. Seattle, Washington:

Eastland Press, Inc, 2014.

Bowman, Katy. Diastasis Recti: The Whole-Body Solution to Abdominal Weakness and

Separation. USA: Propriometrics Press, 2016.

Websites

“5 Simple Exercises for Correcting Anterior Pelvic Tilt.” Inhumexperiment.blogspot.com.

25 Nov 2009

http://inhumanexperiment.blogspot.com/2009/11/5-simple-exercises-for-correcting.html

“Your center of gravity shifts during pregnancy, the best ways to avoid pain are…”. The

Training Fix. 29 April 2014.

http://www.thetrainingfix.com/your-center-of-gravity-shifts-during-pregnancy-the-best-ways-to-

avoid-pain-are/

You Tube

“Aligned and Well Down There For Women - Pelvic Floor Exercise”. Bowman, Katy. 28 May

2012.

https://www.youtube.com/watch?v=WR7C-

fQkkOY&index=13&list=PLcZNlKUGp4_btouVTvM5rirVx6_HdpQC-

16

“What are the Pelvic Floor Muscles and what do they do.” The Pregnancy Centre. 2011 - 2016.

Demac Resources Pty Ltd.

http://www.thepregnancycentre.com.au/pregnancy/exercise/what-are-the-pelvic-floor-muscles-

and-what-do-they

“Pelvic Floor Health”. Midwifery Traditions: Home and Hospital Birth Gynecology. Midwifery

Traditions and Associates, 2015.

https://midwiferytraditions.com/2015/11/18/pelvic-floor-health/

“Your Pelvic Floor.” BeFit- Mom. BeFit-Mom, 2006-2014.

http://www.befitmom.com/pelvic-floor-in-pregnancy.php

“Ready, Set, Push!” Fit Pregnancy.com. Meredith Corporation, 2016.

http://www.fitpregnancy.com/exercise/prenatal-workouts/ready-set-push

Images

Figure 3.1: The Pregnant Spine

http://www.thetrainingfix.com/your-center-of-gravity-shifts-during-pregnancy-the-best-ways-to-

avoid-pain-are/

Figure 3.2: The Abdominal Muscles

http://www.womenfitness.net/top10/flat-abs/

17

Figure 3.3: Diastasis Recti

https://readysetmamas.com/diastasis-recti/

Figure 3.4: Variations of Diastasis Recti

cdn.wellnessmama.com/wp-content/uploads/diastasis_V2.png

Figure 3.5: The Pelvic Floor

https://midwiferytraditions.com/2015/11/18/pelvic-floor-health/