The miracle of growing a human in your pregnant client's body, also comes with the miracle of just the right amount of changes. These changes may be accompanied by pain. 

As early as the first trimester of pregnancy, a woman may begin to feel pain in her sacrum (as I did).

As the fetus grows and the uterus expands, entering the second trimester, more pains may expand into the body, including the infamous pelvic and hip pain.

Walking, standing, sitting, rolling over in bed, can all be painful.

But research shows that lax ligaments are not the primary cause for pain! 

The loosening of the joints is preparing those hips to accompany a small human to enter the world, and is necessary during pregnancy! 

And research has found that pain:

• has more to do with how the sympathetic nervous system is responding to these changes.
• If mom has more stress in her life, is tired and depleted, she is more likely to have ongoing pain. 
  
  Towards the end of this post, we will go over how to help moms re-set their nervous system. 
  
  As Pilates teachers, our job is to teach movement., 

And we know that the right type of modified movement can be very healing. 

So we will start with anatomy, and Pilates-based movements. 

---

In this post we will go over:

• Anatomy and Physiology of the Pregnant Pelvis

• How Pilates can Help

  • Pelvic Floor Conditioning

    • Zipping and Unzipping

    • Pelvic Tilts

    • Dynamic Movement 

 

• Other Ways to Help
  • Healthy Sympathetic Nervous System
    • Rest
    • Uplifting Thoughts and Language

---

The Pregnant Pelvis: What's Happening to Your Pregnant Client's Body?!?!

Here is a short anatomy and physiology lesson on the pregnant pelvis:

Hormones Relaxin and Progesterone

These remarkable hormones are responsible for:

• the loosening of the joints and ligaments, particularly in the hips and pelvis-the sacroiliac joints and pubic symphysis joint (explained below). 

While this is absolutely necessary to accompany the growing fetus and expanding pregnant uterus, and ultimately the birth,

the expansion may contribute to mild pain in the hips and pelvis.

• These hormones also cause lax joints and ligaments in other areas of the body, resulting in issues such as a pregnant woman's susceptibility to sprained ankles.

---

Anatomy of the Core

Bone and Ligament Structures of the Core:

• The Pelvis
• Sacroiliac Joints
• Pubis Symphysis
• Lumbar vertebrae and supporting ligaments (Thoracolumbar Fascia)
• Uterus and Pelvic Ligaments

4 Primary Muscles of the Core -deepest core muscles

• Diaphragm
• Transverse Abdominals
• Pelvic Floor Muscles
• Multifidus

 

Secondary Muscles of the Core

• Gluteals (Butt Muscles)
• Hamstrings
• Adductors
• Latissimus Dorsi

 Myofascial Structures: 

The Deep Front Line (Anatomy Trains Theory) 

In addition to the above muscles, the core also involves our deepest structures from the bottom of the toes to the cheeks including the:

• Iliopsoas
• Thoracolumbar Fascia
• Pericardium (Heart)
• Mediastinum (Chest)
• Throat
• Tongue

Below is an image showing the DFL and the related structures. 

 

We are going to go over the anatomy of the pelvis.

Keep in mind that to relieve pain, the deep core muscles have to be involved, along with healthy everyday movement.

Our body parts work together! EVERYTHING is connected! 

---

 The Sacrum 

 This fused vertebrae, posterior (in the back of) of the pelvis, provides maximum support for the spine when positioned neutrally.

In pregnancy, the top of pelvis tends to tilt anteriorly (forward), causing sacrum to tilt up and the low back to sway into an exaggerated arch (lordosis).

This tilt actually SUPPORTS the pelvic floor, by decreasing the amount of downward intra-abdominal pressure. 

However, when the tilt is EXCESSIVE, and UNSUPPORTED, it can put unhealthy stress on the joints. 

 

Hugging the Baby, shown above in the second pic, can help mom-to-be have more control over her pelvis.

Pelvic tilts can help mom find length in the torso, and find a position for her pelvis that feels good to her unique body. 

 

Sacroiliac Joints

These joints attach the sacrum to the hip bones, normally allowing limited movement in the sacrum (nutation and counter-nutation). 

During pregnancy, these joints loosen (due to the hormones relaxin and progesterone) causing hyper mobility, which may contribute to the pelvic pain problem.

Pubic Symphysis Joint 

This is a normally a somewhat flexible band of cartilage that links the two halves of the pelvis together, allowing independent movement of the hip bones while walking.

In women, the pubic symphysis is created wider and more flexible than in men to allow the pelvis to stretch during child-birth.

Pelvic Floor

The pelvic floor is a group of small, long muscles that create a sling-like support in the pelvis.

These muscles connect to the joints of the sacrum, coccyx, and hip bones.

A strong, flexible, well-conditioned pelvic floor helps to:

• stabilize the upper torso and hip area,
• prevents incontinence (peeing when you laugh),
• supports the weight of the uterus, bladder, and bowels,
• and makes the bladder and bowels functional.

The pelvic floor works with the transverse abdominals to provide optimum stability of the core, helping to reduce the chance of diastasis recti.

 

Pelvic Floor Muscles

Notice how they attach to the sacrum

---

How Pilates can Help:

Deep Core with the Pelvic Floor Conditioning and Awareness 

Proper conditioning and awareness involves:

• Learning how to contract and release the pelvic floor muscles without involving the butt muscles, inner thighs, or abdominals.
• Learning how to stretch and release the pelvic floor. A tight iliococcygeus can actually open the the urethra. 
• Learning to isolate is just as important as learning to let the deep core muscles work together.

Try teaching the following Pelvic Floor Awareness Exercises: 

Zipping and Unzipping

1. Become aware of the pelvic floor by contracting and releasing.

Prepare your diaphragm by taking a few deep breaths, fully exhaling.

2. Imagine the front of the pelvis is a zipper.

Exhale all of the stale air and then: 

Inhale - Start at the bottom of the 'zip' and

Exhale - slowly contract the pelvic walls together as if zipping up a pair of jeans.

3. Once you have zipped to the top

Inhale - at the top of the zip

Exhale - slowly begin to 'unzip' the pelvic walls

Teach the same thing in the middle and in the back of the pelvic floor. 

The great thing about practicing pelvic floor exercises is your client can do them anywhere, and no one needs to know (so if you do end up practicing while standing in-line at the store, be aware of your facial expressions!  :-) 

This practice of contracting and releasing control is incredibly beneficial during all stages of pregnancy, before and after.

During the 3rd trimester, put emphasis on releasing the pelvic floor to prepare for the birth.

 

 Pelvic Tilts 

• The body attempts to counterbalance by creating an exaggerated curve in the low-back, called lordosis.  
• Lordosis is NECESSARY, however, can sometimes be exaggerated and contribute to discomfort in the low-back. 

Pelvic tilts along with a resilient pelvic floor (through relaxing and contracting) will:

• help keep the low back from feeling tight
• help mom-to-be feel more in-control of her pelvis.

 

How to Teach a Pelvic Tilt 

1. Have client stand or sit. 

And Cue The Following: 

2. Exhale all the air out, 

3. THEN Inhale to lengthen the spine (neutral)

4. Exhale - tilt the top of your pelvis back and the sacrum and tailbone under (posterior tilt) (like tucking)

5.  Inhale - Move through neutral (lengthened spine)

6. to a SUPPORTED arch (anterior tilt) (careful not to give into the arch), 

7. Repeat pelvic tilt 3-5 times. Can be done every day, multiple times a day.

 

! If it hurts your client, STOP! That is a great general rule to follow- if it hurts, don't do it. 

 

Dynamic Movement 

One of the primary Pilates principles is Whole-Body Health (Pilates Method Alliance).  Because everything is connected - body, mind, spirit - energizing movement throughout the day helps build resilience in all areas of life. 

From a fascia-focused and tensegrity training perspective, we want to move in a variety of ways (dynamic) reaching every micro-angle of the body. 

• Adding different angles to training in the studio helps to build a resilient pelvis, and body. 
• Training with both feet on the floor (rather than single leg) helps to reduce Sacroiliac Joint and Pubic Symphysis issues. 

 

Breathing 

Lateral Thoracic Breathing - making sure the exhale is complete. 

 

---

Vital Ingredients to a Pain-Free Pregnancy:

Rest

Encourage pre and postnatal women to pay special attention to the health of their sleep, to rest throughout the day, taking 'breathing breaks', silence breaks, anything that allows their mind to rest. (AKA meditation. However, the word 'meditation' had become some-what of a buzz word. So using other terms like 'breathing break', 'brain break', 'mind rest' may be a more effective way to describe meditation)

 

Nutrition 

Hydration and nutritious food. If you are not a nutritionist, consider partnering with one and getting some great recommendations for pre and postnatal. 

 

Positive, Uplifting Language and Thoughts

Research by Dr. Sinead Dufour, women's pelvic floor PT, found that just by changing the language around the pelvis to positive and empowering, women experience less pain. 

For example:

• instead of referring to the pelvis as dysfunctional or sensitive, use the terms resilient and healing

 

Self-Massage - Myofascial Release

Research shows that women who did their own myofascial release with a foam roller and a ball slept better, experienced less stress and fear, and had babies who experienced less stress. 

• Use a small, bouncy ball to massage the bottoms of the feet 
• Use a foam roller to massage the calves. 

Sunshine, Grounding, and Everyday Movement 

• Awareness of everyday movement postures.
• Walking in the park.
• Standing or walking without shoes (grounding), feeling the earth's energy. 

 

What other ideas can you think of? 

---

Body Patience During and After Pregnancy

Remind your client that her body will make drastic changes, and begin teaching her how to be patient and accepting of those changes. 

That is one the BEST things you can do for your clients. 

---

Click Here to Get A Ready-Made Guide on Teaching Hug the Baby Free the Baby for posture during and after pregnancy

---

Resources to learn more about: 

Research: Association Between Lumbo-pelvic Pain and Pelvic Floor Dysfunction

Relaxin

---

 Thank you for investing your time to learn at PregnancyPilatesImpact.com

I would love to hear from you! Questions? Comments?

E-Mail [email protected]

With Love and Gratitude,

Alison Marsh

- Founder of Pregnancy Pilates Impact: Helping Pilates Teachers to Create a Positive Impact in the Lives of Pre and Postnatal Women

 

Click here to learn more about The Pregnancy Pilates Impact Academy, and be the 1st to know when we open the doors.