Considerations when teaching post-natal Pilates By Sophie Contreras, Physiotherapist, APPI Educator and Unite Health Management Education Manager APPI Pilates is a fantastic form of exercise that everyone can benefit from, including post-natal women from the first few weeks after delivery, right up to returning to pre-pregnancy exercise levels. The APPI Pilates method is designed to be easily adapted for many special populations, ensuring that prescribed exercise is always safe and effective and meeting the specific needs of your clients. Following pregnancy and birth, with regards to Pilates in general terms, women should address deep abdominals and core strength, postural awareness & endurance as well as global strength to meet the physical demands of caring for a baby. Strengthening the pelvic floor and addressing any related dysfunction is of key importance, but it's important that pelvic floor strengthening is specifically addressed rather than assuming "engaging the centre" in a Pilates exercise is adequate. This should be the realm of the Women's Health Physiotherapist, so please refer on if unsure. Each client will have a different history, a different pregnancy, a different labour etc, so it's important to assess clients individually to ascertain their specific needs rather than giving generic post-natal exercises. A group class can be a good option to encourage exercise participation and socialisation at this time, but women should be assessed individually and deemed suitable to enter the group setting. In general terms, pelvic floor exercises and isolated transversus abdominis
activation can usually be encouraged as soon as comfort allow, along with following other important post-natal advice. Following on from this, simple Pilates exercises focussing on lumbopelvic stability and limb dissociation can be incorporated to build a base to work from. Once an adequate level of pelvic floor strength and lumbopelvic control has been re-gained and diastasis rectus (if present) has resolved (generally after the 6 week mark) you can start to gradually incorporate more loaded abdominal exercises as long as control allows. It's important to observe for compensations and ensure good control at all stages. If doming is observed during Pilates exercises, it's important to address it, as this kind of imbalance in the abdominals can have significant implications for the pelvic floor.
Along with abdominal and core strengthening, thoracic mobility and postural exercises should be encouraged, especially if the mother is breastfeeding. These exercises can be combined with teaching soft tissue self-release techniques with the foam roller and massage balls to relieve common musculoskeletal discomfort. Exercises such as breast stroke preparations and swan dive level 1-3 are extremely valuable to address upper thoracic extensor strength and deep neck flexors, which are of key importance when considering cervico-thoracic dysfunction and posture. Incorporating the foam roller into a Pilates programme is a great add on postnatally, it's an easy way to increase challenge to core control without loading the global abdominals too much. It can also be used for a variety of thoracic mobility exercises to relieve discomfort and address general tightness, commonly seen due to feeding posture, increased workload and general fatigue.
Physiotherapists and allied health professionals trained in Pilates are best placed to educate women with regards to effective, graduated and safe exercise to help them return to their pre-pregnancy state. If you are interested in learning more about pregnancy and post natal Pilates - you can find our more by attending APPI's Ante & Post natal Pilates course.