Pilates for

Core Strength and Better Body Alignment

for Recent Moms

Vilaykham Backes

BASI Comprehensive Teacher Training Course

Course start: July 2019

Paper submission: May 2020

Johannesburg, South Africa

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Abstract

Women’s bodies change after having children and, even with significant efforts, it can

take significant time to return to a pre-pregnancy state. This can depend on an individual’s

occupation, activities, level of fitness, as well as whether there were complications during

pregnancy, the number of pregnancies, and whether the births were natural or not.

For example, pregnancy stretches and weakens abdominal and pelvic floor muscles, and

the sacrum iliac joint (SIJ) widens ahead of childbirth. A pregnant woman may experience

lower back pain as the body bears more weight. The weakened core causes the shoulder

and neck muscles to overcompensate, causing neck and shoulder pain. Office work,

where much time is spent seated, can exacerbate these effects and extend recovery time.

Women that are active or exercise regularly will likely recover sooner than those who do

not, and a good diet additionally makes a big difference. However, even with these efforts,

which most women can understand and implement by themselves, it may not be enough

to return their bodies to their original pre-childbirth state. Fortunately, a targeted and

holistic Pilates workout routine, focused on specific muscle groups and joints, can

significantly speed up recovery, restore strength to pre-childbirth state, and overall body

strength and flexibility.

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Table of Contents

ABSTRACT ................................................................................................................................... 2

TABLE OF CONTENTS .............................................................................................................. 3

ANATOMICAL DESCRIPTION .................................................................................................. 4

CASE STUDY ............................................................................................................................... 8

CONDITIONING PROGRAM ...................................................................................................... 9

CONCLUSION ............................................................................................................................ 11

REFERENCES ............................................................................................................................ 11

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Anatomical Description Pilates can significantly assist a woman’s body recover from childbirth, so the question is

which parts of the body are the most affected, and what exercises can be done to achieve

again good posture and core strength, to result in a strong and healthy body? We can

start to answer this question by understanding the relevant anatomy. We will do this by

introducing the core muscles that support the functional health of the spine, followed by

a description of the main individual muscles.

The muscles of the core: The core muscles

are muscle group of the trunk of that help

stabilize our spine and pelvis during

movement, and thereby assist to ensure

good posture (see Figure 1). The core

muscles are not just those superficial “six packs” in the front of our body as seen in figure

1. There are four layers of abdominal muscles ranging from superficial to deep: rectus

abdominis (“six pack”), external obliques, internal obliques,

and transverse abdominis (TrA). The back muscles as see

later in Figure 5. The deep coreset consists of the diaphragm

at the top of the trunk, the pelvic floor muscles at the bottom

of the trunk, and transversus abdominals that wrap around

the front to the back of lumbar spine (see Figure 2). The

diaphragm and pelvic floor muscles work together with the

transverse abdominal and multifidus muscles to create a stable region in the lumber spine.

The diaphragm: This muscle is responsible for drawing air into the lungs – it keeps us

alive by drawing oxygen into the body. Whilst responsible for the breathing action, the

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diaphragm also contributes to core stability, stress control, sporting performance, and the

management of disorders like high blood pressure and others.

The diaphragm is a dome-shaped muscle that sits below the

lungs and above the abdominal cavity and is attached to the

lower ribs, sternum and lumbar spine (see Figure 3). It

contracts or relaxes based on the messages it receives from

the brain – these messages are sent subconsciously,

causing us to keep breathing. Stress, for example, can result

in “over” or “under” breathing, altered or sub-optimal breathing patterns that can vary

throughout the day and weaken the muscle, eventually leading to neck and shoulder

stiffness and pain. Conversely, controlling the breathing pattern can help reduce stress,

including related conditions, such as headaches, neck pain, high blood pressure, and so

on (Ehrer et al 2012).

When performing Pilates exercises, the lateral or intercostal breathing is used to facilitate

the abdominal traction to stabilize the trunk. During the inhalation of the lateral breathing,

the front and back of ribs case expand to keep abdominal contracted later then relaxing

it in the natural diaphragmatic breaching.

The pelvic floor muscles: The pelvic floor muscles provide a sling of support for the

inner viscera and adapt to the changes of internal pressure of the abdominal cavity. When

recruited, they increase intra-abdominal pressure and thus unloading the spine. The

pelvic floor muscles stretch like a muscular trampoline from the tailbone (coccyx) to the

pubic bone (front to back) and from one sitting bone to the other sitting bone (side to side)

(see Figure 4).

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The pelvic floor muscles become weakened after nine months of pregnancy and the

associated weight gain that

pushes down on these

muscles. This may result in

numerous problematic

conditions, including

incontinence, sexual

dysfunction, sensory and emptying abnormalities of the lower urinary tract, and chronic

pain syndromes.

Back Extensors - Multifidus: The back extensors consist of an erector spinae,

semispinalis, multifidus, and quadratus lumborum. As howing in Figure 5. This large

group of muscles works together to promote core

strength and stability and keeping the body

upright. For stability, however, the Multifidus are

directly responsible. They are attached to two to

three vertebrae for them to move efficiently. Thus,

weak multifidus leads to instability of the spine

and lower back pain, due to compensation of

muscles in that area.

The co-contraction of the diaphragm, abdominal muscles (TrA) and Multifidus and pelvic

floor increase the abdominal pressure, thus assisting in the spine’s mechanical

stabilization.

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Scapular Depressor: The primary muscles of scapular

depression consists of a lower trapezius and serratus

anterior. On page 27 of ‘Pilates for Rehabilitation by

Samantha Wood, paragraph one mentioned that “a

common issue seen in people with neck or shoulder pain

is excessive elevation of the scapula when raising arms

over head. [Figure 6]: strength and proper functioning of

the scapular depressors is necessary to prevent excessive

elevation of the scapula…”. They are deep muscles and

activating them requires mental focus and concentration, so the Pilates “mind-body”

approach works well in addressing this issue.

Quadratus Lumborum and Iliopsoas: These muscles are the link between the upper

body and the lower body. They are responsible for hips flexion in the sagittal plane as

well as helping spine lateral flexion and rotation (see Figure 7).

The quadratus lumborum as its name implies

is a quadrate muscle which means that it acts

as a stabilizer of the pelvis to the ribcage. The

psoas rotates the thigh and lifts the trunk off of

the floor from a supine position. As the spine

stack vertically above the pelvis, the psoas is

key to a healthy gait.

Pilates seeks to improve both stability and mobility of the above important group muscles

and spine for overall health.

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Case Study This case study is focused on my own experience of dealing with my body during and

after having given birth to my two children, and how Pilates has helped me get my body

back. I am a 42-year-old mother of two healthy children, born via natural births. My

daughter was born full term at 3.6kg and is now 7.5 years old; and my son was also born

full term at 4kg and is now 6 years old.

Before having kids, I was working as an accountant. Then, in 2012, whilst still being a

student, I became pregnant and 9 months later, a first-time mom. Today, I enjoy outdoor

activities with kids – we are very active as a family, and go walking or running in the park,

trail running and hiking. Indeed, I have now become a trail runner - for the past few years.

I have participated in organized trail races – the most known ones were “Run The Berg”

Challenge (2018, 30 km) and extreme (2019, 50 km) and “Run The Beast” (2019, 36 km)

Cape Town’s Tabletop mountain, and the “Otter Trail Run” (2019, 42 km) in one day. A

year prior joining the CTTC program I also did some gym work outs and Pilates sessions,

so I felt quite fit and strong by the time I started the CTTC.

However, my life before I became so active has still caught up with me – that old life was

one of working long hours in front of a laptop seated at a desk. This was my “weak”

starting point before getting pregnant and having children – it is no surprise that up until I

started seriously exercising, and especially doing Pilates, that I had serious tightness in

my shoulders and neck, leading inter alia to sporadic headaches; weak abdominals, tight

lower back, tight hips flexors and tight hamstrings. I often had neck and lower back pain.

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Conditioning Program Basi Pilates is a holistic approach. It is a very effective method as it looks at the whole-

body structure and function through blocks system.

BASI Block /Apparatus Repertoires Comments

Warm-up

(Mat)

Mat basic: Pelvic Curl, Spine Twist Supine, Chest Lift and Chest Lift with Rotation.

The basic series allowed abdominals and spine to gently warm up before starting more intense work out. The

Footwork (FW)

Reformer and Cadilac: Parallel heels, Parallel toes, Small V toes, Wide V heels, Wide V toes, Calves raises, Prances, Single leg heels and Single leg toes.

Progressing to Wunder Chair: Parallel heels, Parallel toes, Small V toes, Wide V heels, Wide V toes, Calves raises, Single leg heels and Single leg toes.

Reformers and Cadilac FW provides less loaded on joints as back is supported on the bed while focusing on strengthening foot and legs muscles. WuderChair add further strength as it performs in sitting in an upright position and the supporting leg is help up parallel to the floor. Its required co-contraction of back and abdominal muscles to maintain the trunk stability. Arms position changes according to the FW exercises, thus, it is almost like a full body work out.

Abdominals

(Mat and progressing to Reformer)

Mat: Hundred prep and roll up

Progressing to Reformer short box series (Round back, Flat back, Tilt, Twist, Roundabout and Climb a tree)

Mat works helped to gain abdominal and neck strength while arms were reaching away from ears parallel to the floor and in line with shoulders. The short box series on the reformer helped to strengthen the abdominals without added strain on the shoulders, neck and lumbar spine as knees are bent.

Hip Work

Reformer basic series: Frog, Circle up, Circle down and Opening.

Progressing to Cadilac Single leg side series: Changes, Scissors, Circles forward and back

The basic series allows full ranges of hip mobility with spine being supported on the bed.

Progression: The Cadilac focuse also use the co-contraction of back extensors and abdominals including obliques are required to stabilize the trunk while executing the exercises.

Spinal Articulation

Reformer: Bottom lift and Bottom lift with extension

Progression to Cadilac: Tower prep and Tower.

The reformer workouts performed toes the foot bar helped spine to articulate further and strengthened glutarals and hamstrings. The towers provides deeper spinal articulation, strengthening gluteal and

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hamstrings as well as shoulders and neck region.

Stretches

Upper body: Shoulder Stretch, Overhead Stretch, Side Stretch and Spine Twist (Pole Series). Lower body: Gluteals, Hamstrings, Adductors and Hip flexors (Ladder Barrel)

Shoulder stretches are especially great for flexibility and mobility as well as relieve some of the tightness in shoulders and upper back. The Ladder Barrel stretches helps greatly to increase the flexibility of hip flexors and hip extensors.

Full Body Integration I

Sitting forward and Side Reach (Cadilac). Progressing to Reformer Up Stretch Group: Up stretch 1, Elephan, Up stretch 2 and Long Stretch

These exercises here helps to improve the flexibility of lumbar spine, strengthen upper back and abdominals including obliques and hamstrings. The Up Stretch Group adds challenges to strengthen shoulder stability and deep flexion of hips joints.

Arms Work (Cadilac)

Arm Standing Series: Chest Expansion Biceps, Hug-A-Tree, Circles Up/Down, Punches and Biceps. Progressing: Push Through Group: Shoulder Adduction Double Arms and Sitting Side Prep / Side Sitting.

The standing series required co-contraction of back extensors and abdominal muscles to stabilize the trunk. By keeping shoulders wide to prevent tension in shoulders and neck. Push through group arms work help to improve shoulder adductor control, strengthened scapula adductors and abductors control.

Legs Work

Gluteal Side-lying Series on Mat: Side Leg Lift, Forward and Lift, Forward with Drops and Adductor Squeeze. Progressing to: Hamstring curl (Reformer Long box)

Strengthening gluteal along with pelvic lumbar stabilization and focus on engaging the TrA during movement. Progressing to increasing reformer resistance for extra hamstring workout to improve hip extensor and knee flexors.

Full Body Integration II (advanced)

Up stretch 3 and Tendon stretch

Progressing to Balance control front; Balance control back prep, or Balance control back.

These advance exercises required greater body strength to perform the front and back support with resistance in the Reformer. Thus, it further strengthening whole body muscles.

Lateral Flexion and Rotation

Side lift (push through series, Cadilac). Progressing to Side Overs Prep and Side Over (Ladder Barrel)

Focusing on abdominal with obliques, therefore it stretched and strengthened trunk lateral flexors.

Back Extension

Basic back extension (Mat)

Progressing to Swan Prep and swan (Ladder Barrel)

Improving back extensor strength and flexibility. It opens across upper back and shoulders while keeping my shoulders away from my ears.

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Conclusion After practicing the Pilates conditioning program over a year, I have learned to engage

and recruits the muscle focus to perform exercises and developed deep core strength

including the pelvic floor. My upper and lower body strength are much more balanced. I

have greater ranges of motion in my shoulders and hips and ankles joints. Overall

resulting in better posture and more in control of my body. Importantly, I don’t have much

shoulder, neck and lower back pain anymore. After many years of gradual deterioration

due to childbearing and office work, the Pilates program above has successfully brought

an important realignment to my body, improving core strength and a sustainability of

health, albeit, combined also with a healthy diet!

References Books:

• BASI Study Guide, Comprehensive Course, 2019

• Pilates Anatomy, Rael Isacowitz & Karen Clippinger; 2011

• Pilates for Rehabilitation, Samantha Wood, 2019

• Ehrer et al, (2012). Positive Effect of Abdominal Breathing Exercise on Gastroesophageal Reflux Disease: A Randomized, Controlled Study. American Journal of Gastroenterology. 107, 372-378.

Website:

• John Miller, Principal Physiotherapist, Web. Mar 23, 2020 <https://physioworks.com.au/FAQRetrieve.aspx?ID=31027>

• Chrissie Forbes, midwife and specialist pelvic health physiotherapist, Web. Mar 29, 2020 <https://www.allthingspelvicphysiotherapy.com/pelvic-floor-muscles>

• Continence Foundation of Australia, Pelvic Floor First, Web. March 29, 2020 <http://www.pelvicfloorfirst.org.au/news/595/how-your-weight-impacts-your-pelvic-floor>

• Jame Dunne, Sports Rehabilitation Therapist, Web. Mar 25, 2020 <https://www.kinetic-revolution.com/key-muscle-groups-for-stronger-running/>