Pilates addressing the tolls of Motherhood

A BASI Pilates Program for Post-Partum Clients with Rounded Shoulder Syndrome, Diastasis

Recti, and Umbilical Hernias

Mia Melendez

February 27, 2019

Course date: January 2018 – September 2018

Location: Healthy Changes Pilates

Reading, Massachusetts, USA

Faculty: Ashley Caggiano

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Abstract

Child-bearing and rearing can cause significant postural deviations and abdominal injuries. These

deviations can cause abdominal and shoulder disfunction leading to Rounder Shoulder Syndrome

and limited core engagement. Through a Pilates Program with a whole-body approach, these

deviations can be addressed emphasizing correct scapulae placement and engagement as well as

pelvic stability and core engagement.

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Contents Abstract _________________________________________________2 Anatomical Description _____________________________________4 - 6 Case Study _______________________________________________7- 8 Pilates Program ___________________________________________9 - 11 Conclusion _______________________________________________12 Bibliography ______________________________________________13

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Anatomical Description

Motherhood can significantly impact the body of the child-bearing woman. “Mom Posture,”

commonly consists of rounded shoulders, a forward head position, and an anterior pelvic tilt. These postural

mal-alignments can be the result of pelvic deviations that occurred during pregnancy. Also, are repetitive

motions such as nursing an infant, carrying the baby, pushing a stroller, carrying car seats and even changing

an infant, all completed in a hunched position. These strains can be even further exacerbated by abdominal

injuries that occurred during a women’s pregnancy such as diastasis recti and umbilical hernias, which can

compromise core strength.

Rolled Shoulder Syndrome involves

shoulders that are rolled forward

anteriorly with excessive abduction of

the scapulae and internal rotation of

the humorous often accompanied with

kyphosis. This condition leads to weak

external rotators, scapulae adductors

and depressors. The weakness is

countered by tight internal rotators,

latissimus dorsi, anterior deltoids, and

pectoralis muscles.

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Diastasis recti is a separation of the right and left sides of the rectus abdominis muscle

(that is greater than 2.7 cm or about 2 finger widths) due to a thinning and weakening of

the linea alba tissue that connects the two sides. 32.6% of women experience diastasis recti, 1

year post-partum. A hernia may or may not accompany this issue. Specifically, an umbilical

The Transversus Abdominis pictured

here, is responsible for core

stabilization and protection of the

spine. The muscle can only fire

correctly when the pelvis is in a

neutral position. If a woman is

presenting an anterior tiled pelvis,

they will thus be unable to stabilize

their core and support their posture.

During pregnancy, as the center of

gravity shifts in the body, postural

changes occur. An anterior tilt of the

pelvis occurs and if not addressed, will

often remain after pregnancy.

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hernia occurs when part of the intestine protrudes through the umbilical opening in the

abdominal muscles.

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Case Study

Client A has carried and nursed a total of 10 children. She has a severe diastasis 4-5

finger width of separation along the linea alba line and an umbilical hernia. Client B has carried

and nursed a total of 3 children. Her diastasis is less severe with a 3 finger width separation

located just below the belly button. Both clients suffer from Rounded Shoulder Syndrome,

anteriorly tiled pelvis, poor abdominal engagement, and neck and shoulder pain including a

history of shoulder impingement. Client A and B are both athletic, play soccer recreationally and

enjoy the outdoors. Both have been treated with Physical Therapy in the last 2 years for

Shoulder Impingement or Abdominal Support but both clients felt that their acute symptoms

were addressed but not their chronic issues. A whole-body approach was not followed, and

postural deviations were not addressed.

Client A and B are both aware of the toll childbearing has had on their bodies. They are

keenly aware of the changes during their athletic activities. They feel a lack of total body

strength, pain in their shoulder girdles, and a fear of further injuring their abdominals. Both

clients suffer from “mom posture,” in addition to their abdominal injuries. Client A and B’s

diastasis and hernia have compromised their rectus abdominals. Both clients present an anterior

tilted pelvis commonly found in pregnancy. This pelvic placement is inhibiting their ability to

correctly fire their transverses, leading to core instability. The lack of support of their core has

put considerable strain on their Latissimus Dorsa which has been compensating to bear their

upper body weight leading to its strain and fatigue along with tight pectoralis major and anterior

deltoids. These overworking muscles have led to weak external rotators and shoulder adductors.

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I have taken a 3-prong approach for each of these clients. Our work will focus on

teaching correct pelvic alignment and strengthening their core specifically transverse abdominals

and obliques. We will also be addressing their shoulder complex, strengthening weak adductors,

depressors, and external rotators, while stretching their internal rotators, latissimus dorsi,

anterior deltoids, and pectoralis major. To aid with their kyphosis, spinal extensors will be

strengthened. It is very important that their diastasis and hernia be considered when developing

a whole-body program. Supine abdominal flexion and rotation is contraindicated, and

observation of correct pelvic alignment and proper core engagement is imperative to prevent

further injury, teach correct biomechanics, and improve functional strength.

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Pilate Program Block Apparatus Movement

Warm Up Mat Roll Down, Pelvic Curl,

Modified Spine Twist Supine

Modified Chest Lift, Leg Lifts,

Modified & Assisted Leg

Circles

Goal is warm up the body. Activate the deep abdominals and stabilizers. Work is modified to

ensure no strain on the abdominals. Modified work: Chest lift is done without flexion as client

engages transversus. Spine Twist Supine – feet on floor. Leg Circles completed with one bent

knee foot on floor with working leg supported with a band.

Leg Work Wunda Chair Parallel Heels, Parallel Toes, V

Position Toes, Open V Heels,

Open V Toes, Calf Raises

Selected in order to have clients support their upper body, engaging shoulder adductors and

external rotators with hands behind the trunk on sides of chair.

Abdominal Work Wunda Chair Standing Pike

Safe abdominal work for these clients with extra light weight, emphasizing the drawing in of

the abdominals and the scapular stabilization.

Hip Work Cadillac Single Leg Series

Double leg hip work could put too much strain on the abdominals, single leg is ideal here until

clients can build strength.

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Spinal Articulation Mat Spine Stretch

Emphasizing the deep abdominal engagement, use of spinal extensors and spinal articulation

with control.

Stretches Step Barrel Shoulder Stretch Lying Side

Emphasizing the stretch of the Latissimus Dorsi and Pectorals.

Full Body Integration (F/I) Reformer Scooter

Emphasizing trunk stabilization and shoulder stabilization and drawing in of abdominals.

Arm Work Wunda Chair

Reformer

Shrugs, Triceps Press Sit

Seated Arm Series

Emphasizing Shrugs to activate scapulae depressors and Rhomboids to strengthen scapulae

adductors. Also emphasizing trunk stabilization in all arm movements.

Full Body Integration (M/A) N/A N/A

Leg Work Mat Gluteals Side Lying Series and

Adductor Squeeze

Emphasizing pelvic lumbar stabilization.

Lateral Flexion / Rotation Mat Side Lifts

Emphasizing core stability and oblique strength.

Back Extension Mat Cat Stretch

Back Extension

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During Cat Stretch, emphasizing abdominal flexion and spinal extension as well as scapular

depression. During Back Extension, emphasizing spinal extension and abdominal engagement.

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Conclusion

I have had the pleasure of working with Client A and Client B weekly for 12 months. Both

have shown consider progress utilizing the Pilates program. They are now able to easily find a

neutral pelvis and maintain the position during our work. They can actively recruit their

transversus and stabilize through their core. We have worked on releasing their tight internal

rotators and chest muscles allowing them to have increased mobility and the opportunity for

balanced shoulder mechanics. Our work continues; as they grow in strength, new opportunities

to work deeper present themselves.

Both clients have made considerable progress and I believe they will continue to do so.

This Pilates program could benefit many mothers, as these conditions are quite prevalent in this

population. Acknowledging that 33% of women continue to have diastasis after 1 year post-

partum and that pregnancy often leaves women with an anterior tilted pelvis where the

transversus cannot engage efficiently, opens this population to injury and many muscle

imbalances. This is often compounded with the care of a newborn and family, where forward

flexion is repetitious. Pilates can aid in relieving “mom posture” and help in core stability post

child bearing.

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Bibliography

1. Sperstad, JB, Tennfjord, MK, Hilde, G, Ellström-Engh, M, Bø, K. Diastasis recti abdominis during

pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic

pain. Br J Sports Med. 2016 Sep;50(17):1096.

2. Isacowitz, Rael, Clippinger, Karen. Pilates Anatomy. Champaign, IL: Human Kinetics, 2011.

3. Clippinger, Karen. Dance Anatomy and Kinesiology. Champaign, IL: Human Kinetics, 2016.

4. Robinson, Lynne, Fernyhough, Kate. Pilates for Pregnancy. Beverly, MA: Fair Winds Press, 2013.

5. Brownstein, Bruce, Bronner, Shaw. Evaluation Treatment and Outcomes, Functional Movement

in Orthopaedic and Sports Physical Therapy. New York, New York: Churchill Livingstone, 1997.

6. What is Diastasis Recti? Mums@work. Nightingale Health Services. November, 2018.

7. “Ten tips on working with your pregnant clients.” Taube Pilates. Web. Feb. 2019

8. “My body after baby.” Lisa Druxman. ACE Fitness. Web. May 2013.