paleolates

courtesy of Pilates Style

Courtesy of Huffpost

One doesn’t have to look far to find many testaments to the value of Pilates during pregnancy. Though it has not received a specific endorsement from any UK health authority (RCOG for example), I doubt that there are many Pilates teachers who would tell a mum-to-be that Pilates wasn’t a good idea. Searching for ‘risks of Pilates during pregnancy’ doesn’t yield many results.

Equally, though perhaps less numerous, there are a number of women who will attest to the value of (appropriately scaled) CrossFit during pregnancy. Indeed there is a website, and social media pages and websites for ‘CrossFit Moms’. In this instance the doubters are a bit more vocal. While they may be largely lay people, photos of a heavily pregnant CrossFitter doing weighted squats caused a storm of controversy, with commentators declaring that she was endangering her baby, and that this activity should be regarded as child abuse.

I am an enthusiast for both of these exercise modalities, but recently I’ve had cause to reconsider my beliefs around pregnancy and exercise.

I’ve also had cause to wonder, prompted by social media threads in particular, about the prevalence of pre- and post-natal sacroiliac joint problems and symphysis-pubis dysfunction. Of course, the release of relaxin, not to mention hyper mobility, will have an impact on joint stability. We know that relaxin is released for a reason, yet it seems a very inefficient (thus unlikely) natural response if it causes lasting problems. I don’t believe in the ‘we just spontaneously break’ model of health that we generally adopt in the developed world. Something about our inputs, or our environment causes ill health – whether it’s joint problems or heart problems, for example. If we are (symptomatically) hyper mobile I suspect it’s because something in our diets, or parents diets (inputs) led to changes in collagen structure leading to lax connective tissues. There appears to have been a variety of research around the subject of diet and collagen (a protein), particularly in relation to caloric, protein, or cholesterol restriction – here’s a study on rats, if you fancy it. Thus, pelvic instability is not a random luck of the draw occurrence, but has an underlying cause. This is not an attempt to lay blame on anyone who has suffered with this problem – rather, to suggest that they have been unfortunate in their genetic inheritance and expression; or have not received the best guidance.

To get back to comparing exercise, first off, what are the most important exercises, or important muscles to be worked during pregnancy? Pelvic floor, right? You’ve got to do your pelvic floor exercises, for heaven’s sake! I’ve certainly done my fair share of teaching PF contractions to pregnant clients.

And then, last year, I watched Jill Miller’s webinar on CreativeLive, which featured the excellent Katy Bowman, as she put it, ‘dropping the Kegel bomb’ (Kegels is the term used in the US). She asserts that the most effective, and balanced way of keeping one’s pelvic floor toned during pregnancy is to squat, and to walk. We might say ‘practice natural human movement patterns’….Her argument is that, while they may be appropriate for some women, isolated pelvic floor exercises may lead to excessive pull on the inside of the sacroiliac joint and consequent imbalance/instability. Squatting would give more balancing posterior support, and both walking and squatting would help to keep tone in pelvic floor muscles.

And what are the issues around Pilates and pregnancy? We encourage pregnant clients at our studio to work with the apparatus, rather than doing mat classes. We’ve had great results and have had plenty of women coming to class right up to the end of their pregnancy. That said, during their second, and especially in their third trimester, a lot of their class doesn’t look much like classical Pilates. We don’t encourage participation in mat classes largely because of the restrictions in lying down (though I’d be the first to agree that guidelines on this are heavy handed, and that a woman’s body will most likely have a way of telling her to stop if lying down is causing vena cava compression), and herein lies one of the fundamental drawbacks of Pilates, especially in the classical practice – there’s a lot of lying down. I know of Pilates teachers who have had terrible problems of pelvic instability during pregnancy. There was a heated debated on a Facebook forum recently about the rights and wrongs of allowing a pregnant woman to participate in a Pilates mat class. Another recent post on the same forum was from a Pilates teacher in her third trimester, unhappy that her workouts feel incomplete because she can no longer follow the sequence that she’s used to. Advice from her responding peers ranged from suggestions for standing (Pilates) work, to taking walks and enjoying nature. Great suggestions, yet I fear that they may fail to address the problem of the lady’s frustration – her workout has to change completely. Is there an issue with the scalability of Pilates? Or the scalability of a ‘classical’ approach to Pilates? Mari Winsor’s book, ‘The Pilates Pregnancy’ is a case in point, with a number of reviews on Amazon commenting that the sequence of exercises varies little from one trimester to the next, and that she doesn’t offer much in the way of modification. In the third trimester she suggests the Hundred with bent knees and feet on the floor, or kneeling up if lying down is too uncomfortable.

Lying down isn’t just a problem from the point of view of possible restriction of blood flow, but also because it doesn’t train the muscles and soft tissues around the hip joints and pelvis to handle to take the increasing load of the growing baby. Indeed, would it not be better to be loading these joints (hip & SI) before conception, and in the early stages of pregnancy, in order to have a strong/stable foundation for the certainty of increasing load?

Here’s where the CrossFit mums-to-be that I know of step in. (Firstly, let’s be clear – I’m sure that many women have had happy and healthy pregnancies and deliveries with Pilates as their exercise companion). The wife of my first CrossFit coach is due in a matter of days, and still doing pull-ups. Another lady that my current coach is training, who is expecting twins in three months, is still deadlifting and squatting with weight – and maintaining that her back has never felt better. The beauty of the exercise methodology that they are following is that it can be scaled to fit their changing needs, without having to change the exercises themselves, and there are articles, in addition to the website mentioned above, to guide mums-to-be and coaches alike. In other words, they can squat throughout their pregnancy – the load and the range needs to change but the activity remains the same. High intensity workouts can be left ’til later, so there’s no need for any stopwatches, but there’s lots of scope for strength work (indeed, it doesn’t matter whether it’s called CrossFit or strength & conditioning). A lot has been written about the community aspect of CrossFit, and one of the benefits of this scaleability is that it means that pregnant women do not have to miss out on their fitness community, and the potential disempowerment of ‘I can’t do what I used to’.

I’m not really advocating that everyone pregnant gives up Pilates and signs up at their nearest CrossFit gym. I just wonder if there isn’t (sometimes) something missing from Pilates that needn’t be. Or maybe there’s a middle ground. I’ve never seen film or photographs of Joseph teaching a pregnant woman, and I don’t remember any reference to pregnancy in his writing. Perhaps he never intended pregnant women to use his method. If, like me, you believe that Pilates is about moving well then many activities can be approached with a Pilates sensibility, perhaps to the significant benefit of women both pre-conception and during their pregnancies.