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Workshop #794

Pre and Postnatal Pilates

2 hrs 25 min - Workshop


The Truth about Abdominal Exercises for Pre and Post Pregnancy: Minimize the uncertainty when it comes to Pre and Postnatal Pilates with this practical workshop taught by returning PA instructor Leah Stewart (a new mother herself).

What really happens to the abdominals during pregnancy? What are the best exercise choices during Pregnancy? What if my client has Diastasis Recti? These and other important questions are addressed in this 10 chapter workshop.

Pregnant women, new mothers, and Pilates professionals are all sure to find this information invaluable to their practice of Pilates.

Watch the videos all at once or chapter by chapter and return to it as often as you like.

To view and print the handout click here: Workshop handout

For more helpful pre and postnatal tips check out Leah's series here on Pilates Anytime.
What You'll Need: Reformer w/Box, Mat

About This Video

(Pace N/A)
Aug 29, 2012
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Chapter 1

Hi everybody, welcome to the truth about abdominal exercises pre and post pregnancy. I wanna make sure I got the title exactly right. So I'm Leah Stewart, and you guys have know me here on Pilates Anytime as the pre and postnatal girl, I still call myself a girl, or am I a woman now? (all giggling) What's that? Specialist.

I'm a specialist yes exactly. So I'm very excited to bring this workshop to you for a couple of different reasons. First of all, just being that working with pre and postnatal women is just a large, huge passion of mine. Before I went through the experience myself, but definitely after I went through experience just, you know, the fire was even more if you will. And second is I chose, Christie and I rather, we chose to focus on abdominals because it is probably the biggest part of pre and postnatal Pilates that everybody's so confused about and so afraid of.

What do we do, what do we not do, and how can we keep people safe but still keep them challenged? Do you guys agree with that? So that's probably the biggest reason why. Now this section that I'm gonna teach you guys today, is actually a lot of the abdominal section that I have in the BASI Pilates three day pre and postnatal course that I've developed for BASI Pilates. So I'm BASI Pilates, senior faculty, and also their pre and postnatal Pilates associate faculty.

So this is kind of just a little teaser to that whole comprehensive pre and postnatal programming. So that's why we just wanted to narrow it down to one little part here, sound good? Sound good out there, alright, here we go. So obviously, like I stated before there's so much confusion about the abdominal exercises during pregnancy, and how labor affects the abdominals, how pregnancy adopts the abdominals and what do we do? And why is this so confusing, because let's face it, a large part of the Pilates repertoire is emphasized and bases around abdominal work.

That doesn't always mean crunches or chest lifts or 100, that means stabilization, that means abdominals doing side flexion and rotation, you know, all of these different ranges of motion, the abdominals are such a big part of the practice and of the method, and so we have to be able to address the changes, the physiological changes, and the anatomical changes that a woman goes through during pregnancy, and how we can still keep that root of the Pilates work alive for these women. I think there's a lot of misunderstanding about the abdominals, I think you'll find two extremes out there. You'll find the people that say, do not do any abdominals whatsoever. Don't even think about abdominal exercises and there's other people that are like, ah, you're fine, just keep doing the 100 and keep doing this, and keep doing that, and I've seen both extremes. Now that might be a little bit outdated, because now people are finally starting to come to the middle, but it doesn't take much if you just Google a little bit on the internet and you start reading blog posts, or you start reading even like science, you know, medical groups or something like that, you're gonna start to see both of those views.

Well, my approach obviously is to fall somewhere in the middle, to keep safety and integrity intact but also to still keep the woman moving and utilizing and helping instructors or teachers like me and like you, and the pregnant clients themselves, understanding how wonderful abdominal work can actually help them. And we'll go through all those details during pregnancy, during labor and after. Yeah, so we got to stop this confusion no more. Because that confusion all it does is it really limits what Pilates is able to do for a woman during pregnancy, and for a woman after pregnancy. I love prenatal Pilates, but I have a little soft spot in my heart for postnatal Pilates, because I think that women after they have babies are they kind of, not that they get forgotten about, but that programming isn't as solid, it isn't as strong as the prenatal one.

I think people, Oh, she's with her baby, now she's not gonna have any time, she's too busy, she's too tired, you know, all of those types of things, it should be the exact opposite, this is when we should really be honing in with women and really using Pilates as a tool to help them heal. So what we're gonna accomplish today in our workshop is we're going to explain exactly what happens to the abdominal muscles during pregnancy, looking at the anatomy of the abdominal muscles and how it shifts as the belly grows. And as the belly deflates after the baby is born, and we're gonna look at analysis of a diastasis recti and kind of it's cause and effect on our pre and postnatal exercise choices. We're going to look just briefly do like a little list of the importance of continued abdominal training during and after pregnancy, and then we're gonna go into some of our kind of interactive part of the workshop. We're gonna start doing some movement exploration where I'm gonna give you some just traditional abdominal exercises Pilates not working reform our work, we're gonna focus on today, and then together we're gonna kind of create some modifications for them based on the information that I told you.

And then at the end, when we have some extra time I'll do a couple of little short math sequences, I'm gonna try to do one little short math sequence abdominal sequence for prenatal, and one for postnatal. Does that sound good? Awesome, okay, so before we start, what I'd like you to do the ladies that are here and of course all of you there as well, I'd love for you to write down maybe a list of three to five of your biggest fears and or apprehensions or concerns about doing abdominal work. Let's just keep it during pregnancy for this question. So go ahead and jot those down for me.

So what are some of the things that have held you back in your own practice with teaching your prenatal clients? What is the fear of, do you fear you're going to cause damage or injury, do you fear you're going to the mom or to the baby? Like, just be really honest and what have been some of your fears, and those of you two out there at home taking this workshop, be writing those down as well, and just be really honest with yourself, and really try to dig deep and understand what those concerns and fears are. Okay, so I'm gonna have you women kind of share a couple of your fears, and I'm gonna go ahead and repeat them so that we can have the people at home here as well. So we'll start with you, Emily Overstressing the abdominals that it might've endanger the pregnancy.

So Emily expressing a fear of overstressing the abdominals so that it might endanger the actual pregnancy itself, so the safety of the baby. Okay, so the safety of the baby. So I'm gonna write these down too. Okay, so overstress safety of baby, okay Laurie. Basically the same thing, I'm not trying to injure the client when things are an exercise, what exercise can I do with them?

Okay, so Laurie expressed what exercises she actually can do so that she's not running the risk of injuring the woman. Yes, so your concern is woman, wouldn't want to injure her. Okay, wonderful, did I say everything you said? Okay. Okay Marta.

I am unconcerned, obviously safety from the mother and the baby, but we not to push too hard. That client back is hard for her to begin with. When do you tell him you know, what got to stop a little bit or when you do relax a little bit on this and that have been not be disappointed and they're still getting a really good workout program. So much gets taken away from them. Yeah, so Marta, it expresses how far to take women with abdominal work and when to back off, and kind of along with that what I'm hearing also from Marta is how to ensure especially those clients that we have that are maybe really hard workers or they're like, you know, the gym rat kind of mentality is you know, how the transfer the way we do abdominal work and how it still is very effective although they might not feel the same sort of challenge that maybe they desire, in case that's an important one as well, okay, Candace.

When would you quit lying on your stomach? Lying on your stomach, okay. So Candace asks, when do you quit lying on your stomach, which doesn't really have to do with will abdominal exercises but absolutely. I can address that somewhere in there. Just tell me if I don't like supine like lying prone for back extensions and things like that.

Yeah, that would be one of my fears. Would you know when to stop or be stopping the first time? Yeah, yeah. (indistinct chattering) So a question of, when do you stop lying supine and when do you stop lying prone? Because of the growing uterus and the growing belly which is going to affect the choices that we make for our exercise selections In the last trimester can you do partial roll downs at all?

Partial like standing roll downs or like sit like roll-ups kind of? Yep, okay. And then the other question was when does it become too late to do things like straight stretch on the reformer? Where you pause and lean, you get so big you know. You're talking about like a hamstring stretch, like okay.

Long stretch, like a plank position. Okay, okay, I know, depending on your certification. Okay, so our last question is how long can you do like seated partial rollbacks or roll downs and how long can you do plank positions? Great, these are fantastic questions. Now, for those of you out there who are watching this maybe you had some of the same fears and questions and concerns.

But if there isn't one in here that we're gonna address go ahead and in the comments box below type it in, and then I'll try to answer it for you there. Okay fantastic, so first so we're gonna maybe get some of these things answered, I'm not gonna go through and answer them all right now. Let's see if they kind of get answered for you, but I have these down so that there's a good, you know, I can keep track of them. So the first thing I wanted to do today

Chapter 2

was explain what happens to the abdominals during pregnancy. So the obvious thing is they're gonna get stretched, right?

So as the uterus and the baby grows, the abdominal muscles have to stretch, and they're designed to stretch not only the abdominal muscles themselves particularly the rectus abdominis but also all of the connective tissue and our one connected tissue that we're primarily concerned with when it comes to the abdominals is the linea alba, right? The linea alba is the connected tissue that runs straight down the center of the torso, and the right and left sides of the abdominals are joined at the linea alba particularly again, that of the rectus of abdominis. So you guys knew all of this information based off of your anatomy, basic anatomy that you guys learned with your certification. The thing that I think a lot of people fear is that that is actually a natural process that thinning and stretching and even separating, which we'll get into more detail, that's a natural process that has to happen. So there's no way that we're gonna keep the abdominals in and taught and toned and tight.

It's just not gonna happen, no we don't want that to happen either, we want those abdominals to stretch and expand with the growing belly, so that's the first thing now, why do they stretch and expand. Hormones other than the physical or the anatomical changes, hormones have a huge part to play with that as well, so the hormones, progesterone and relaxin are going to soften those connected tissue. And they're also gonna decrease the muscle tone, throughout the entire body. But one of the areas that's big is in the abdominals, and so thank goodness that happens that those hormones are released through the body, and that that growth happens gradually over time because then the muscles have time to respond to that stretch into that stress of the growing uterus. Okay, so what we wanna emphasize is abdominal exercises that are going to keep that stretch healthy and natural and keep them abdominals able-bodied if you will, or strong for support.

But that aren't gonna place too much stress on the abdominals exercises, aren't gonna play so much stress in the abdominals so that we exacerbate or encourage more of that separation, that's not necessary, does that make sense? Yeah, so it said it has to be, the idea is to have strong, supportive abdominals, not tone and tight and six pack abs. Yeah, does that make sense? Women think it's so fearful that, Oh my gosh I'm gonna lose my tummy when you get pregnant. Yeah you are, and it's for a very beautiful and worthwhile reason, but yes you are.

Your abdominal muscles are going to stretch by 115% past their normal lanes. By 38 weeks, 40 weeks gestation, that's how they're gonna stretch and you want that to happen and it has to happen. Okay, so again, I stated here in the notes, we want abdominal exercise that strive to obtain adequate abdominal support and strength for postural control and childbirth, rather than those that emphasize tight muscles. But on the other hand, and is the other extreme for people that are like, don't do any ab exercises at all. Now we know that abdominal exercises are much more than doing trunk flexion.

We know that in Pilates, although I think it's hard for us sometimes to let go of that notion that if we're gonna do abs, we have to be doing the a 100, we have to be doing the double-leg stretch the single-leg stretch, do you guys agree with me on that? It's hard to let go that notion but there's so many different ways that we can do it. If a woman doesn't have adequate support and strength in her abdominal muscles then we have the complete opposite problem, it's gonna really affect your postural control, it's gonna lead to possible lower back pain. Pelvic pain is going to maybe alter the baby's position in the uterus, you know, there's all sorts of different things, it's gonna make recovery that much more challenging after labor. So we have to have the perfect balance in the abdominals, making my point clear?

Okay, yeah, any questions up to this point, ladies? Okay, so we're gonna get more into that explanation first, but you know I'm a big proponent of scientific study as well as experiential work and unfortunately, up to my knowledge and to my resources that I have access to scientific journals and, you know, studies and reviews and things like that, there just, isn't a lot of studies that have been done on diastasis recti or abdominals during pregnancy and definitely ones that not have been done on exercise and Pilates and how it affects the abdominals during and after pregnancy. If there are studies out there, some of them are very poorly done, some of them are good, so we have to just take that information, and kind of use it as some sort of a resource as best as we can, but it's not absolutely reliable, it's not the be all and end all of things. And then a lot of what we talk about, you know, again comes off of our experiences of working with clients or what we felt on our own body or, you know, things like that. So, you know, that's kind of what I hope to bring into this workshop today, and certainly into the full course is kind of that marriage of scientific study interviews with doctors and physicians and PTs, and also just a combination of what we in the Pilates world know to be true 'cause we've seen it on 100s and thousands of bodies happen.

Yeah, so just wanna kind of state that as well. So to review the abdominal muscles again this is a very basic review, we have the abdominal wall is comprised of four muscles that are paired on the right and left side. So each one has a pair, and together they're gonna cover the entire abdominal cavity of the abdominal wall all the way up from xiphoid process and the ribcage all the way down to the pubic synthesis and to the ridge of the pelvis. The most superficial or considered to be the most superficial is the rectus abdominis. And this is the one that we become primarily concerned with splitting or opening or stretching during pregnancy.

And this runs up and down vertically along the abdomen which you guys know is considered the six pack. And it's the primary exercise for trunk flexion, that's his primary job, and of course when it's concentrically concocted it will help with stabilization as well. So that's the big one, and when I refer to this kind of the diastasis to separation that's generally the exercise that we're primarily speaking of. The next we have the external and internal obliques, I kind of just paired them together, but they're two separate muscles, and they run diagonally from the size of the abdomen toward the midline. So you have the internal obliques which lie under the external obliques, the internal obliques connecting more lower to the pelvis external obliques, connecting more up into the rib cage and they run diagonally and they're responsible for we know, rotation and lateral flexion, and the internal obliques also assist the transverse abdominis and creating that sense of stabilization, intraabdominal pressure, et cetera.

I know this is a quick review, but, just to kind of have that in there. And then lastly, we have the transverse abdominis which is often considered the deepest layer of the abdominal muscles and often considered the most important muscle when it comes to core stabilization and Pilates and even pre and postnatal work is that transgressive abdominis. The transmissive abdominis is near is responsible for narrowing the ways, so when we draw it in, it kind of cinches the waist in, so it looks like we have that belt on, so that's where we get that image of the cuing a lot of, you know, pretend like you have a corset or a belt top wrapping around your waist, that's why we use that image. And along with the obliques, it'll help to compress the abdominal wall as well to create that sense of that sensation of flattening the abdominal wall. And of course, core stabilization and vital for functional movement, postural control, alignment and healthy back care.

Again, that's functional movement, postural control alignment, and healthy back care. And when you look at that, we want functional movement for our pre and postnatal clients. We want postural control. We want good alignment and we want healthy back care. So that would say, Ooh, transmissive abdominis that's important, that's the one we should be focusing on.

Woo, woo, woo. Yes and no, you know, we want a marriage of all of the abdominal muscles, we want to bring them all in together in order to maintain optimum utilization of those muscles during pregnancy optimum... Thank you, control and resource of them as well. So yes, we can work the rectus abdominis. We can work the old links, we can work the transverse abdominis and we should, it's just gonna be in a different matter.

And we're gonna get into that a little bit more as well. Any questions up to this point? Ah, ah, okay, good feeling good? Nice okay, so just all the basics there. So I have this a little diagram here I'm showing you but you can see in the photograph here, you can see the you know, the linea alba that runs straight out to center.

You can see the vertical pull of the practice of dominance. You can see the fibers run vertically and then you can see how the external and internal obliques run diagonally. And you can see how the transverse abdominis runs horizontally, so all of that has to come together in this beautiful blend to create that support for our body for our lower back for stabilization of our pelvis. Now with all the hormones that are surging through a woman's body that job is even harder because now we have abdominal muscles that are being stretched and weekends more or less, if you want to consider it that way, you have hormones well that's happening because of the growing uterus and the baby, you have hormones that are also adding to that stress and stretch and all of that instability. So all of that comes together and making it really difficult for a pregnant woman to feel like she has control of her midsection, to feel like she has control of her pelvis.

And then to add on top of that, you don't want them to go they're carrying around this extra weight and depending on the woman, how much weight they gain depending on their body proportions, long torso, short torso, pelvises naturally anteriorly childhood narrow pelvis wide pelvis. You know, there's so many different things that come in, that's why they say each pregnancy is completely individual and completely different, all of those come into play, of why it's so important that although we're not trying to keep the shape of the abdominals the same, does that make sense? We want them to respond to the growing belly, those hormones are gonna happen if we like it or not, and thank God they do when we go into labor, but what we wanna do is we want to encourage those muscles and I'm repeating myself, but I just wanna get the point across is to just have enough work in them, to keep that support, to keep that strength and to keep the comfort in the body. And the strength is gonna come in so vitally for labor. Okay, we're gonna get into that a little bit more later but those abdominal muscles are utilized very much so during labor, and the ability to keep a sense of awareness throughout the entire term of pregnancy, keep that sense of awareness throughout the process of labor and then keep that sense of awareness while we're rehabilitating and healing postpartum is what becomes really important.

So it's not so much about working those abs, it's about keeping the sense of awareness and control in those abdominals, does that clarify any sort of confusion that there might be? Okay, so that's why we continue abdominal work, if we didn't have that goal, and we thought well, we're not gonna be able to keep the same amount of tone in them, then yeah I would say why even bother doing abdominal work. But no, we have a very functional reason of why we continue to do our safe abdominal work, and feel free at any point, ladies, to just pop your hand up too.

Chapter 3

So we want to talk about next as pregnancy progresses the dimensions and the growing weight of the uterus inevitably will influence the musculoskeletal morphology of the pregnant woman, so we're gonna talk about this and this is where some interesting facts kind of come in, it's a little bit more physiological talk that kind of comes in, that kind of brings the why we're going to adapt and modify the abdominal work the way he does into a lot of perspective. I know for me, it certainly did, 'cause you can be told, you know, don't do flexion don't do fluxing with rotation, you know, you're like, okay great, but really why, why what's happening anatomically that really makes that important.

So hopefully I'll give a little bit more insight, we could go into a really detailed thing here, but I think for the scope of our role as teachers, we just seem to have a good function, you know foundational, fundamental understanding of this process. So first of all, as we know, when the uterus grows the rib cage expands, the lower aspect of the rib cage really expands and gets wide. And as that happens, the spatial relationship of the superior, the above and the inferior abdominal muscle attachments are going to shift, does that make sense? So because the abdominals are attached to the xiphoid process and attached up into the rib cage as the rib cage expands that attachments from the upper and the lower are going to shift. And so that inevitably we'll get into more is gonna alter the line of pull, or the line of action when those muscle fibers contract, and try those muscles try to shorten in order to move the bones in a certain way.

Okay, so that's clue number one. Haha, okay, clue number two is, there's an increase and I mentioned this already in overall muscle length, particularly that of the rectus abdominis seem to the changes in the anterior and lateral dimensions during pregnancy. So what we mean by anterior and lateral is growing forward and growing sideways, okay? So as the belly grows forward and as it expands out to the side and as the rib cage expands, those rectus abdominis muscles are gonna go from being just like this to curving over. So those muscle fibers have to lengthen as they go, and again, it happens slowly over time, but there's all that going on in the body on a cellular level to get those muscle fibers nice and long so that they can stretch over the belly or what we'll learn later actually not quite over, but more on the side of the belly, okay?

So that lane has a big role to do as well. Because of the increasing anterior abdominal dimensions, it's gonna alter the angle of the abdominal wall muscle attachments in the sagittal and coronal plane. Okay, so I'm getting, I'm just expanding, I'm kind of being a little redundant but just reviewing at the same time. So again, the increasing anterior dimension so what's gonna happen is, and you'll see in this picture is the rectus abdominal muscles move laterally rather than vertically across the torso. Now we think about that like, yeah, duh, it makes sense right?

That you would think that that happens, but if you really think about that, the rectus runs straight down and now it's running this way. So it's not that it's the same diagonal pull as the obliques, but it definitely is more of a lateral pull than a vertical pull at that point. Can you guys see that from that image that's in there it definitely has a more lateral pull, now that space in the middle, it's just that stretched and thinned linea alba. So the changes in those muscle attachments and the bony attachments changes the line of pull and can possibly affect those rectus abdominal muscles ability to produce any torque when you do movement. So the biggest one is gonna be flexion, okay.

So it is going to alter the ability to produce flexion not only that, but by producing flexion, the weight of the uterus is going to press up because we have a big belly here it causes a big restriction if you will, obstacle that actually pushes up into that already expanded linea alba and rectus abdominis exacerbating more separation. So that's the biggest reason why we say stay away from flexion after a certain point. Okay, so that's gonna be it. Now what I found in, Oh, actually I'm gonna go into this later, sorry, I'm jumping ahead getting ahead of myself, I did put this in here. Is that making sense to you guys at all?

We're gonna keep repeating this, so how do these changes in the musculoskeletal part of the body affect our movement choices, so then I created another list for you here. So again what I wanna emphasize is it's important to recognize that this change in pregnancy happens very slowly and it happens over times. So our modifications are going to happen slowly and over time. Now what Marta had asked me for is or actually Candace it as when do we stop doing ab work? When do we start making our modifications?

Well, truth be told it's going to be slightly different for every woman, because some women pop out and show sooner than others. So we can give you guidelines, some studies show that like at 14 weeks there's not showing any of that separation or stretch happening again. You know, then of course, obviously that stretch progresses over time. A nice general rule of thumb is gonna be second trimester, you're done with flexion. Okay, so after 12 weeks, now that's playing it on the safe side, because some women don't really start to show until 14, 15, 16 weeks where they start really getting a nice little baby bump.

But what, what sort of, you know, 'cause that's 12 weeks you know, the baby's still the size of your finger you know if even that, you know, very, a little lipstick too very small still, so is there gonna be any sort of you know, pressure that's really happening from a uterus or from that's still fairly small at that point? Who's to say, if you wanna play it on the safe side you could say second trimester I'm done. General rule is during the first trimester, you can keep things fine, because what in kind of, as I go back to your question Emily is doing abdominal work and flexing the trunk isn't gonna hurt the baby at all, what we're concerned about is mom, and we're not concerned about mom's health or safety. we're concerned with exacerbating the stretch and pull of the abdominals that is already happening. So, you know, why would you make it more when you don't have to, you're you're adding to the quote unquote problem rather than, you know just letting it kind of do it run its natural course.

Will we get into other things like, you know, putting yourself in balance things where you could potentially fall or even the argument of lying supine for a long time, that's when we start to get into baby safety. But this as far as just doing flexion is just for mama, and not that it's going to you know, be fatal or anything like that to her, it's just more of a safety precaution to keep her dominant muscles as healthy as possible. Because if the more and more and more they stretch, and the more and more they separate, if that diastasis is greater and greater, and she keeps going, going, going, going, going the worst the more pumps she's gonna have possibly during labor, then we can turn into some serious issues or even recovery after labor, does that make sense? So we'll clear that out of the way right now. Okay, so abdominal flexion, isn't going to hurt baby, it's just an issue for mama's safety and mama's wellbeing.

Yeah, okay, the separation of the abdominal muscles and the widening of the linea alba, again, like I said began to occur some time in the second trimester. So again, I kind of started to state this one study shows that separation with in its subjects was at 14, was not an excuse me at 14 weeks, gestation began to show by week 26 at the umbilicus so right at the belly button site, above the umbilicus about 30 weeks and below about 34 weeks. So basically what I'm showing there is it's the separation starts to show kind of the apex of that belly bump, and then we'll kind of like gradually go up and gradually go down as the belly keeps expanding, and it keeps pressure going down and pressure going up at the same time. So stopping abdominal work, like I said, on the safe side you could do more second trimester, or you could wait when there really is a little baby bump that's starts to be evident, then maybe it's time to start incorporating some of the gentle modifications. Does that sound like a reasonable time?

I can't tell you 14 weeks, 15 weeks, 16 weeks, that's just impossible because it is so different for everybody, and I think it's not that you're going to I'm gonna stop everything, is now you're gonna start adding those modifications nice and slow. Because the lengthening of the abdominals particularly the rectus abdominis occurs over time, there's a theory that some scientists have studied is is it in physiology, we know the muscle fibers you know, they cross over each other, right? And that's going to affect how they contract and the kind of torque that they produce. So the theory is, is that, well, we know that if muscles are overstretched and they're pulled apart the muscle fibers, that they're not able to cross over each other enough when they can do those contractile properties happen in order to create that torque to produce movement. The other theory is when muscles are too tight they have again, nowhere to go.

So that's the history of a tight muscle it doesn't necessarily mean as a strong muscle. So we want that balance between muscle length relationship. Does that make sense? So one theory holds that because the abdominals are so overstretched during the course of pregnancy, is it in fact that alteration and that link tension relationship that's lessening their strength and their ability to produce torque? Well, along with this theory goes, well not necessarily because that happens over time happens such a long in over nine months or 40 weeks.

However you wanna think about it, that it actually has more to do with that alteration in the line of pull that we described, you know, the rectus abdominis actually going more lateral than vertical, that actually will alter that rectus abdominis and the abdominals as a whole ability to produce the same amount of torque and power that it maybe could in a normal state. Does that make sense? So this is all just kind of theoretical talk but it does pose some very interesting ideas, as far as what is actually, what changes are actually affecting how we do abdominal work when we're pregnant or when we're working, you know, with pregnant women. There definitely needs to be more research done on this, I think the line of pull, the line of action alteration is really fascinating, because if you think, if we're trying to produce flexion here, there's nothing in front of the trunk, there's no muscle there, the muscles have been shifted to the side, so they more appropriately use for our rotation and lateral flexion things like that. And again that uterus pushing up against the abdominal wall that's going to just push more pressure, there's already so much pressure there, so with movement we're just pushing more pressure up against that abdominal wall, which is going to create more of that separation, what are your thoughts on this so far?

You kind of go look at me like, hmm, any thoughts? Makes sense right? Okay, and just seeing kind of little fact here

Chapter 4

is there was a study that found the torque production of the rectus abdominis may be reduced by 30 weeks gestation. So by 30 weeks, so you only have 10 weeks left at that point, so you're well into your pregnancy because of the altered line of pull, some of these women that they tested were not able to do flexion at all. Yeah, they just, obviously there's a big obstruction there at that point, but they weren't able to do, there was no ability for the muscles to create that.

And they attributed that against that line of pull, and we've already this next point talks about the significant physical obstruction, not only the safety factor, but it's uncomfortable. All of a sudden, you know this space you have between your ribcage and your pelvis, feels very shortened and you have something in there that moves, and it's super uncomfortable. So why do we even wanna go there with flexion? We just don't need to, and so that's why we don't. And the biggest, another big factor here is because the abdominal inferior attachments go to the pubic symphysis and they go down onto the iliac crest of the pelvis, they obviously play a huge role in pelvic stabilization.

And because of the altar line of pull, because again of the hormones surging through the body relaxing and stretching and lengthening out the connective tissue and the muscles, the ability to stabilize the pelvis is very much so altered. And with saying that, you know, we know that pregnant women because of the weight of the uterus coming forward their pelvis goes into an anterior tilt. It's inevitable, and there's no way to not have that happen. In fact, it has to happen in order for them not to feel like they're gonna fall down and that they can walk in their body, whole body shifts for that changing center of gravity. But along with that in all that instability that's going on, we can still keep particularly those lower fibers of the rectus, the lower fibers of the internal oblique, the lower fibers of the transfers of abdominals, we can still keep those nice, and we can move them and keep them nice and strong and keep them supple if you will as well, you know, keep moving in and out of the essential contents or contractions isometric contractions to work all of the different ways that we can contract our muscles, we can still do that late into pregnancy to help guarantee a little bit more of that sense of pelvic control and stability.

It's such a fine line, and I think it's really fascinating because you really have to fall somewhere in the middle. And, you know, in my three day course we go way into detail of the pelvic floor 'cause that's obviously a whole other big thing that comes with pregnancy, but it's this beautiful balance of strength and mobility, of strong and flexible. And you know, it has to be this really nice marriage of those two concepts, and that really comes very important when we talk about the pelvic floor, but even does apply again, to the sense of the abdominals. And so again, and it can't be either extreme, it can't be strong, strong, strong, work, work, work but it can't be forget it, just let them go loose let them stretch, it has to be somewhere in the middle. So that's what happens before birth or during pregnancy, in a nutshell.

(laughing) How does that sound? Good, okay, so after birth, so again you've heard this, it takes nine months to get there and a matter of depending on how long your labor is, a couple hours you know, even if you had a labor that was let's say 24 hours, you know, a very long labor process or even longer than that, that's still relatively short by comparison to how long it takes the abdominal stretch. So you have birth, you give birth, okay? The abdominals, particularly the upper fibers of the abdominals are contracting along with the uterus to help press the baby down and out through the birth canal. By opposite, the pelvic floor muscles are trying to open an open and open and open and open and open in order to accommodate that.

(all laughing) So we want, again, it all the more reason I didn't include birth in here, I just thought I talked about it, but in the notes, all the more reason to have that sense of when the pushing starts to happen of being able to not, it's not the idea of bearing down, but being able to kind of just feel that contraction and those images of pressing down kind of in and down, if you will, if we don't have abdominal muscles and again, this is just what some studies are finding or theorizing is that if we have that xx push you like that, that push up kinda like how we're told not to push the abdominal muscles out when we do Pilates exercises, if you kind of have some theorize that that action, that forceful action of overstretched abdominals can actually cause a more of a separation or even severe cases like a herniation or something like that. So again all the more reason to feel how to engage those muscles and that action of the abdominals, helping with that pressing process during the contractions to expel the baby down in through the birth canal and out. So yeah, they come into play there. So then after the baby's born there's a sudden release of that uterine stretch, okay? But now, I mean, suddenly you don't have this little being in your body anymore, your uterus is still big obviously, and that's gonna take a few weeks to shrink down, back down to its pre pregnancy state, but it doesn't have the pressure there anymore, that it did from the baby, from the physical form elbows head and every of the baby in there.

And use a lot of water and you lose a lot of fluid and you lose blood and you give birth to the placenta. So all of this excess stuff, and weight just comes out of your body, in the matter of you give birth to the baby in the matter of half hour, minutes to a half hour to an hour later you've birthed the placenta, you know, all of that happens really, really fast. So boom, all of that is gone, so what's happening to your abdominals now? Yes, the right, instead of being like a stretch that's tight you know, like, I'm like pulling canvas like a artist pulls canvas across like the wood there. It's just like flip, it's just flopping there.

I know that's like, let's just say in lay terms, okay? But so now we have these over lengthened abdominal muscles that don't have any pull on them. So now their ability to create any sort of contraction now that at this point instead of the lot alter line of pull, that now has to do with that length tension relationship, does that make sense? So now they're overstretched and now the muscles fibers aren't able to pull across each other in order to create that enough power to create that sort of movement or torque, does that make sense? So it kind of switches on us, well, theoretically it kind of switches on us. But it makes sense, so not only that, but because of that pull and that sudden release, they're very tender, you know, there might be a little bit of damage to the abdominal muscles, especially I mean seriously, and those of you have babies can attest this, it's like the most gnarly ab workout you've ever done right?

'Cause it's just so involved, and not only that, it's just the abdominals but again, just the action of the uterus, the construction deep within the uterus, what happens to the pelvic floor, all of that kind of comes together, the muscles of the back, all of that kind of comes together, so there's just this fatigue and this soreness that happens after birth, not only that but the muscles are in such a state that they're not adequately prepared to bounce back into exercise, well, traditional like, okay, you have your baby last week, let's get on the reformer and do coordination. You know that's just not gonna happen nor should it happen. One statistics states that the separation and widening of the abdominal muscles in the linea alba after birth returns to that of 22 to 26 weeks gestation. So that's when, after you give birth there's still a nice little round belly there. And so the abdominal muscles go from that 40 weeks of stretch and separation back down to that 20 to 26 weeks which is still fairly significant.

Okay and so it's not like that vertical pull is gonna go right back or the linea alba is gonna go right back, it's all gonna take some time. It's all gonna take some time. So how do these anatomical musculoskeletal changes of the early postpartum period affect movement? So again, because of the alter, like I said before, because of the altered, excuse me here because of the altered link tension relationship we're not gonna be able to produce the same amount of force or torque, especially in certain ranges of motion and certain exercises we're not gonna be able to do that, and it now, again, same thing as in prenatal there's an inability to provide a sufficient stabilization as well. A support of the pelvis, and of the abdominal walls.

So after birth, and I hope this clarifies some things for you. So after birth, we don't have that uterine pressure and stress on the linea alba the abdominals like we did in pregnancy, so that's one of the main reasons we don't wanna do flexion to exacerbate that separation. After birth we don't have that stretch or that stress anymore of the baby and of the uterus, not in the same way, so technically, are we safe to go into flexion? I don't know, that's a yes or no answer Maybe yes because we don't have the uterine pressure there anymore, but no, again, because the abdominals are in such a state of pull and length and stress and fatigue, there's no way that they are adequately able to contract in the way they are needed to produce good traditional flexion of the torso. They just can't, it's not that it's unsafe in the sense of when we had a big belly, or it's that they just aren't in the place they aren't healed properly, they don't have the ability that the correct contractile abilities to get us there in a place of integrity with integrity, with control, with proper placement with proper stabilization, it's just not gonna happen.

So that's why, and it doesn't feel good, it hurts, it's sore, it's tender, so that's why we wait, and we do gradual adding a flexion because if we do that and we try to do all this flexion and our abdominals are still slightly on altered a line of pull, and our linea alba is still stretched out. And our muscle fibers are overly lengthened, and we're trying to do all this contraction and we're not stabilizing, we're not recruiting our TA the right way that we should, again, all we're doing is possibly pulling apart pulling apart, pulling apart, pulling apart, yes. (indistinct) Yes exactly, exactly. Yeah and we don't have enough time to go into full C-section explanation, but you're absolutely right then you're healing from major abdominal surgeries, so exactly. So Emily asks, you're good Christie, Emily asked the same effect after birth, if you had a C-section you know, not being able to do any abdominal exercises without being in pain, without hurting, and she's absolutely right, and that goes a little bit beyond the scope of of this workshop in particular and something that we do get into and larger workshops or courses but you're absolutely right that the effects of the incisions and the layers that they cut through and all of that greatly affects.

And to put on top of that women that have had C-section they also have not only to deal with surgery and incisions and scar tissue and healing from that, they still have to also heal from stretch abdominals, stretch linea alba that even if they had an unplanned C-section maybe they pushed for a while before they went into C-section, they still have to also heal from that process of labor as well. So you're absolutely, absolutely right, so we have to take that into consideration. So it's not, so with all of this being said,

Chapter 5

all of this kind of anatomical explanation it's not so much about, it's unsafe to do abdominal work, it's bad to do abdominal work, if it's unsafe to do certain type of abdominal work but it's vital to do a certain type of abdominal work. It's unsafe to do exercises that I call traditional Pilates exercises, supine, head, neck and chest comes off the mat. Boom, we're done, we're not gonna do that.

But that's just one little compartment now, that compartment happens to have a ton of exercises in it, ones that we know, you know we can list them off, go over and over and over on all the different apparatus. But over here is this whole vast repertoire that we can do, here's what we can't do, here's what we can do, but this just requires creativity, trial and error, thinking about it, exploring the movement, all of those types of things, so what we can do is we can say what aspects of these exercises that are off limits to us at this point or for our clients, do we like abdominal strengthening spinal movement, whatever those objectives might be. Okay, how can we take that incorporate those objectives into this realm of exercises that are safe for us to do? Isn't that something fabulous. So instead of focusing on the can't, we go, okay, we acknowledge that we can't, but here we can, yeah good.

So before we get into that which is the fun part, you can see, I get all excited. We're gonna talk a little bit more about diastasis recti. Any questions up to this point? Okay, did the anatomy lesson make sense to you guys? Good, okay.

Okay, so again, we should repeat ourself a little bit a diastasis recti okay? Is a condition where the rectus abdominal muscles separates in the middle at the linea alba. The linea alba again, it's the piece of the connective tissue that runs directly down the center of the torso, from the xiphoid process down to the pubic synthesis. So it's a long piece of connective tissue. During pregnancy the linea alba widens and thins due to the pressure intention of the expanding uterus and the pregnancy hormones that softeners.

And this predisposes it to separation to large separation to micro tears, all of those types of things, it predisposes it to that again, the abdominals and the linea alba have to stretch, they have to open during pregnancy. It's gonna be a different degree, here's why it's gonna be different degree for women. Is it their first pregnancy? If it's not their first pregnancy, if it's their second to their third how close back, how back to back where those pregnancies, how much recovery time did they give their body in between pregnancies? Multiple bursts, twins, triplets, okay?

Age, genetic factors, state of the abdominals beforehand, were you an exerciser, were you not an exerciser, were you obese, were you not obese? All of these things are to come into play, they're gonna affect the severity of a diastasis recti. Okay, it's more common than I think we recognize the diastasis, and I think so many women that I've heard get hung up in this oh my gosh, I have of two fingertips separation, or I have this, I have that. And everybody's probably gonna I mean, it's a very small percentage of women that they say do not get a diastasis at all. And again that has, again, the lovely thing about science it has to do with what are their measurements of what a diastasis is, some people say one to two fingertips.

Some people say one, some, you know, it's different, it differs. So depending on who's measuring you, but we can't get so hung up on whether we got one that we did something wrong, because we have a diastasis recti, it's gonna happen, that separation, that opening, that lengthening is gonna happen, it might be very small moment, it might be half a fingertip to fingertip and they're blessed and that's wonderful. And that's gonna probably just come back together naturally. But where it comes into what the fear is, is that we don't want to do exercise choices or encourage our clients to do things that, aren't gonna make it bigger than it probably naturally was gonna be. Okay, that's where it gets troublesome.

And calm and obviously as pregnancy progresses and it stays during the postpartum period, it stays for months sometimes, is it depending on the diastasis, you know, some people may never get rid of their diastasis but they have very high functioning strong, beautifully, usable abdominal muscles but if you were to test them, they might have that little bit of that diastasis still present. And then we'll get a little bit more into that later. So again, I put another image up for you here that shows just directly the abdominal the rectus abdominis, abdominal muscle, and then it shows on the right side, the separation the diastasis recti. Does that happen to everyone? You know, it's so hard for me to say yes and no, because it depends on the Marta asks does it happen to everybody, does the diastasis happen to every single person and as such, I think some people will say definitive yes and some people will say definitive no.

I'm gonna say, I don't know, yes and no. Again, it depends on those measurements, from my understanding of my experience is that from I've asked my midwife, I've asked OBGYN from studies that I've read, from books that I've read. It is normal to have a one to two fingertip with early postpartum meaning the fourth trimester they call it the first 12 weeks after you've given birth. And they also say that just naturally as the muscles retone and regain their normal length, through that postpartum period, that diastasis will start to close. Now, if you have wider than two fingertips, and it's not uncommon for some women to have three, four even five, and you can put your hand down to their belly, if that's the case, then yes.

You know, they have a severe diastasis and we need to use exercises to help or sometimes even surgery to help pull that back together. So isn't normal for all women to have that little bit of that separation? Who's measuring, what are their measurings? They might measure you and say, you don't have a diastasis because you have one fingertip or two, does that make sense? Or they might say yes, you have a very small diastasis, but it's going to heal naturally over time.

Or they might measure and be like, there's just not enough of that, now keep in mind. and I'll answer your question kind of to keep in mind that when they palpate the right and left sides of the rectus abdominis, you can feel that they're separated naturally by the linea alba, but you can feel the two sides of the muscular band, so those two right and left side muscles never joined together, they're connected by that linea alba. So there naturally is, if you wanna argue that distance between them, it's just how large is that linea alba that's connecting them, and that's what we wanna try to help to bring back together and to encourage coming back together. And we know that connective tissue takes longer to do those types of things, the muscle does the muscle tissue does. Yeah, Candace.

I think you've answered my question. I would ask what separates from what? but really it's not necessarily a separation is kind of a spreading of the linea alba. Some people's alba is wider... Yes, yes exactly, so Candice says what defines the separation and the separation is just that it's the widening of the linea alba, and the widening of the rectus abdominis.

How far laterally does those two bands of the right and left side of the rectus get because how far does the linea alba get? In some cases though severe cases, there actually will be a tear of the linea alba, and actually a herniation of the contents of the abdominal wall there. So that's a very severe case, so that actually can happen. Now, in some cases, are they gonna find some micro tears and things like that, maybe, but it's more defined, it's just that opening that spreading of that linea alba, how far has that spread exactly? Great question, great question.

So I know I've said a lot of my things in here, so I'll try and not repeat too much since we're getting I'm to try to wrap up here in the next 10 minutes, so how does the diastasis recti affect movement? So overall, a diastasis recti, or one that's made larger by poor exercise choices affect overall integrity of the functionality of the abdominal muscles by altering the role in postural support and control, trunk and pelvic stability, delivery rather of the baby, preventing lower back pain, it could affect respiration, and their ability to produce flexion rotation then lateral flexion of the trunk. So that's what a diastasis alters, a diastasis again is not like a physical condition that is harmful to the woman's health, it is a condition that is harmful to their functional ability. We know that the abdominal muscles and the abdominal wall working as a whole is what keeps our trunk and our pelvis and our lower back functional and feeling good and feeling healthy and feeling strong, when those muscles aren't able to behave and act in the way that they're meant to, because of the altered line of pull, the altered tension or excuse me, ability to produce torque, the opening or the stretching out of the linea alba, all of that comes together to where we now have a major problem in functional movement and functionality, and that's what becomes an issue. And then layer on top of that, for women who have a diastasis after or who you know, still have a pretty prevalent diastasis after postpartum, let's say after the initial 12 weeks, then you're adding the pressure of carrying a baby that's growing wait, wait, wait each passing week, let's just face it, picking up, constantly bending over, picking up all of this stuff that requires good functional core mechanics and stability and control, isn't gonna get any easier as the baby gets older and heavier and more active, yeah, so all of those things come into play as the dialysis is created during labor or excuse me, during pregnancy and can remain a problem after 'cause mother diastasis that separation happens during pregnancy and can remain a problem after if we don't do the correct type of exercises.

I already talked about the herniation there, and that's because we could create, if we do something really forceful just in everyday movement, we pick up something too heavy or we do flexion, we're doing the wrong exercises. Again, there's no muscle there at that point, it's just some connective tissue and some skin, and that's it, so we're adding more stress to something that's already so stressed and predisposed to injury again, because even after you give birth you still have tons of hormones that are surging through your body, particularly the hormone relaxing if you're still breastfeeding. So you're still vulnerable to that, what am I looking for? Laxity and your ligaments and laxity and your joints. There are certain movements that should be avoided during a diastasis when you have a diastasis because they're not able to support again, I said, it's not that it's dangerous to do these it's just that the abdominals are in the place to support these ranges of motion.

Traditional spinal flexion where the head, neck and chest lift off the mat, big one. So she says, Oh my gosh, I have this mommy, tell me and I'm poochie and I need to do a ton of ab exercises to get it flat again and be like, okay great, so let's just do the 100. No, we're not gonna do that. We're not gonna do that for a long time. Okay, until you can show me that you have this support and the control.

Abdominal exercises with traditional flexion and rotation, chest lifts, criss-cross, hamstring pull three, those types of exercises we're not gonna do. Again, because of that flexion meets rotation, we're just adding a lot of stress and strain, and it's challenging on the abdominals, and they're not ready to support that. Exercises where straight legs lower toward the floor. So anything on the back, you know, flying here, you know where we do kind of scissor actions of the legs or something bicycles or something like that. Those we're not going to do, a little sweaty there.

Those are not gonna do yet, because again, the support isn't there, we're not doing flexion, oh, we think, okay, that's safe, but now we're adding these long leavers and we're trying to move and what's gonna happen to the abdominal wall, right? Because there is not strong enough yet to support that. Could we do modified versions of the things? Absolutely, but we're not gonna be doing those straight leg kind of exercises.

Chapter 6

You could even argue plank positions at that point.

Maybe not, there's a lot full body concentric contraction that has to happen, what's one of the biggest things that release is, just in a normal person, their belly sticks out, right? Because of that positioning. Quadruped positions you know, modified quadruped positions, those are going to be actually great tools to use to facilitate and feel like you're gonna draw up the abdominal wall, but full plank like pushup type positions, there has to be a good amount of regaining strength and regaining control in those. I didn't put that on the list. (indistinct) Well, so she's asking if we would do seated roll downs and guess we wouldn't, I'm gonna get into what exercises are safe and just a little bit yeah.

It's important to note that the recti diastasis can be observed at the umbilicus, right at the side of the belly button, above a couple of centimeters, or right below, most often is gonna be found right around the side of the belly button or just slightly above, and sometimes you'll find it below, but this kind of centered around the belly button is gonna be the most prominent place. And I'm going to show you how to test for diastasis but we're gonna have to bring the mats out for that, so let me just finish this next little part and then we'll go into our movement aspect and we'll add the testing for the diastasis into that, sound good? Okay, so the big question here, okay, why should we continue to do abdominal exercises during and after pregnancy? So we've learned what happens during pregnancy, we've learned the dangers that are involved, or the problems that we've created, we've learned what a diastasis recti exactly is. So again, other than I saying you know, keeping the abdominals nice and strong what are some other reasons that we're going to continue with abdominals?

So number one is before pregnancy helping a woman maintain ideal posture alignment during pregnancy, proper stability positioning of the pelvics and the lumber spine, to help to ensure correct positioning of the baby, okay within the abdominal wall, so that cause those abdominals and that skin and all that is helping to support the uterus as well okay, that's within that, when the baby obviously is housed in the uterus. Assisting labor and the pushing the process, and the prevention of unnecessary or excessive lower back pain, which is a huge complaint among pregnant women, why do we need the abdominals after pregnancy? Why do we use abdominal exercises to need for the proper reconditioning after pregnancy, help facilitate the shortening of the overlength and abdominal muscle fibers, so that they can properly regain strength for movement and support, is a big one. To help a woman established ideal postural alignment after pregnancy, so many new mothers have very poor posture and it's a combination of the muscles that have been stretched and work the abdominals, the pelvic floor, but one of the biggest things is the other combination is this posture that we have, that's so involved with caring for our new baby. It's forward, it's rounded, it's either fatigued posture or it's still anterior tilt the pelvis, the abdominals are lax, so you get this forward belly hanging out kind of forward head look.

And it's other than the fact that it's not very attractive aesthetically it's just wreaking havoc on the body. Okay, so we wanna try to help them to have that ideal posture. Helping a woman establish good body mechanics when caring for her newborn child, picking up holding nursing, et cetera. So we wanna use those abdominal exercises to help that now. Re-establishing strength with the abdominals through some of the exercises that I'll show you and then pulling those that queuing into things like squats or footwork or things like that, that they can do, and actually pulling in some of the cues of, you know, picking up and holding a baby or, you know all those types of things that's gonna come into play here.

So the abdominal exercises are gonna set the foundation for that postural control and that mechanical oxygen, a proper alignment for those things. And the prevention or lessening of common pelvic and lower back pain, that often occurs in the initial postpartum period. Abdominal muscles are gonna help to relieve the lower back tightness, the lower back discomfort, the lower back fatigue, they're also gonna help the type of abdominals that we do, inevitably are gonna bring in a lot of pelvic floor work which is gonna help to bring blood flow and circulation down into the pelvis, down into the abdominals, which is gonna help just quicken that healing process as well. And the same goes for C-section, you know, to kind of help facilitate that the healing of those incision sites. So that's why we do pull up abdominal exercises.

So we don't say, forget it, we say, let's do it, let's just do it this way, sound good? Any questions? Good, wonderful, so our next section we're going to show how to test for diastasis, okay? We'll kind of play with each other, and then we're gonna go into what ranges of motion are safe and which ranges emotions are good. And I'm gonna go into a little bit of a movement exploration together, sound good?

Fantastic wonderful, let's take a quick break. Okay, so ladies, we're going to move on into showing you

Chapter 7

how to test for a diastasis recti and we're going to show you how to self test, so for those of you out there, how to self testing yourself and then you're kind of, and then I'm gonna show you how to test on somebody else just to kind of mimic the same thing. So it's very simple and it's very quick, so you wanna just join me? Let's just do it together, okay? So you're gonna lie down on your back in a supine position with your feet on the floor.

So just like you're gonna go into a chest lift or something of that nature. Place one hand behind your head that you're supporting your neck. Yes, now the important thing is you're gonna take your fingertips and you're gonna point them straight down, just about maybe like, I don't know, a few centimeters right below the belly button. Yeah, so you don't want the fingertips vertical, you know into the center, you want it perpendicular to that linea alba line, exactly. So you're gonna take up, sorry, not below.

Did I say below? A little bit above, thank you sorry. Just a little bit above your belly button. Now take your breath in, now don't think of doing like a chest lift or an abdominal contraction, all I want you to do is just lift your head. Now you should feel, that you can sink your fingertips down like if you can sink your fingertips down, and wiggle them back and forth.

In between the space, do you feel space there? You do feel space? No, it'll feel like your fingertips are sinking down like deep. You can't do it, you don't have one. You will might feel the two bands of your abdominal right and left side, but if you can sink your fingertips down and really wiggle from side to side or shift from side to side, that is a diastasis.

Okay, so let's try it again, one more time, we're gonna start down again, so whenever you don't want to flex your abdominals you want to just lift your head neck and chest up. Don't think about flexing your abdominals, okay, so take your breath in and lift up. (indistinct) Yeah about an inch above your belly button. Yeah, so yeah, you probably might have your baby have it. Does anybody think they might?

Okay, we're gonna test you Emily. So you want that, so now come back down and go right below your belly button, as it was gonna be that other spot we were gonna test, you're gonna test the below a books with me above the belly button and right below, so lift up and you want the same thing, you want to see if you can push any amount of your fingertip down into that. Good, go back down, and then you can do it just right at the side of the belly button and lift up, and that might be where you feel a little bit more and come back down. Okay, so let's see on Emily, anybody else feel anything? I don't have one.

No, you don't have one. Okay, so come on up here. So we're gonna show, we showed how to do a little self test on yourself, and now we're gonna show on Emily, but Marta asked a great question she said, is it possible to have a diastasis recti if you're not pregnant or before you're pregnant? And the answer is yes. It actually is common in men, men who have big bellies you know, those big, hard, like middle aged man belly, sometimes they have a diastasis, if you do incorrect abdominal work, you can give yourself a diastasis.

If you are maybe like laborers that are lifting heavy objects or working like that and they're not recruiting or stabilizing the correct way they can have diastasis as well. So it is very possible, it's not only pregnant women and post pregnant women that have diastasis recti. Okay so Emily, go ahead and lie down for me. Let's go ahead that way, actually yeah. So how you wanna test your client, is the same way that you essentially tested yourself.

So you can have them put one hand behind their head, Yeah, some instances they'll have both hands down and they'll lift up, but I'm going to take better, I can fill up your belly battery. So I'm gonna take my fingertips and it always start right at the belly button, and then I just walk a couple centimeters, a few centimeters up above her belly button. So take your breath in and just lift your head and chest. So here, so if you guys wanna come up close, do you feel that little bit of that ridge there? Yeah, so here you can see I mean, but look, I can get one fingertip down there.

But you can see the sides of her two bands of her abdominis rectus abdominis here. So that would be considered like a fingertip with, of her separation, so go back down. So that would be a really small one, not one that you're gonna be too worried about but that you still want to make sure she's recruiting now. Here's the interesting part, is come back up now try to engage your TA, it goes away completely. Do you guys see how I can't push down now?

I'll go back down and just relax and come back up without engaging, and there's that little bit of that separation and I can feel it right around her belly button too. But when she engages her TA and recruits properly, it completely goes away, so this is good, thank you. So this is the instance and did anybody absolutely not feel any on themselves? Did you not feel one on yourself? Yeah, I did it right when I was doing it wrong.

When I was trying to do engage calculate then I did it did, but when I was just lifting my head and shoulders I didn't. You didn't. I didn't, yeah I must have... Yeah no, let me test you too. So good and then I'll explain what I was gonna explain right there too.

But did you guys see that little bit? Now when you have more severe, you can get two fingertips down there the same way, three fingertips down there even four with, and I'll still feel that space, could you guys imagine the severity of the difference between one and two and three and four? Yeah, so that's when it becomes a problem, so same thing here at belly button, there it is. Okay, good, so come on up. No, so see how nothing, there's no sinking of my fingertip.

I could fill the bands of her muscle, but there's no, there's none of that, did just see how far my fingertips sunk into between her two Emily's two and right side of her rectus abdominis, I don't get any of that here so go back down, good so again don't try to contract, just lift the head, neck and chest. Yeah, so this it's completely flat here, there's no little ridge, if you will, like a little canyon and that's how you know you have the diastasis good, thank you. So is that actually when it doesn't come all the way back together after pregnancy? So that's a great question. Okay, so now we have two questions to answer here.

Well, actually it comes up with your question is, is it okay if you still have that little fingertip separation and the answer is yes, okay? So when you have a wider than two, three, it will be interesting, I know you Emily said your children, your youngest is eight now. So, you know, interesting to see what first year after you gave birth, what that separation was. But if the separation is two, three, four finger width apart you're gonna do exercises that are gonna promote that again, that shortening of the rectus abdominis and that kind of that naturally and with the help of exercises, the rectus is gonna realign in its right vertical position, and that linea alba tissue is gonna start to close. That's gonna happen naturally to some degree, but we're going to encourage that process with proper exercise choices.

Yes, so all the decrease of that separation is, is a shortening of the linea alba, and the shortening of the abdominals and the re-pulling of the abdominals back into their correct aligning. Now, Emily had a little bit of that separation and so she's not gonna leave her being like Oh my gosh, I have a diastasis and it was terrible. Okay, so she is fine, and what you may not be able to see is well they're watching this online is that when she, when I cued her to contract her abdominals the way that she would if she were doing like a good Pilates chest lift that separation completely went away. There was that wrapping of the transverses and everything kind of came in and pulled them together. And the connected tissue was really strong.

The other problem with the diastasis, during pregnancy and post-pregnancy is that stretched tissue is so weak and so fragile. So even if somebody never technically closes their diastasis if they can get it as small as possible, and that fingertip was very small, but it's still very strong and solid. And all of the other the muscles around it can engage to support it and everything draws in together, everything's recruiting properly, then it's a very functional, safe, healthy position and she's fine, does that make sense? So this obsession that I hear women with, Oh my gosh, I have to close this, you wanna close it as much as possible, but it's still is very possible to have a one even maybe a two fingertip with diastasis and still have very strong functioning solid, supportive, wonderful, fabulous, great abdominals. Yeah so that's the point here, so the goal is to get it rehabilitated as strong as you can.

Yeah, I know that was a quick little lesson in how to do that, but again, starting the belly button just walk up and then you can feel that. And when you feel somebody with two or three or four you'll know it, you'll see how my fingertip again went down, but it'll be wide, and you can like, almost slide your hands in between those two ridges of the rectus abdominis. Yeah, okay, let's move on.

Chapter 8

So I wanted to show you how to, or tips or ways to create creative, safe, and effective pre and postnatal abdominal exercise modifications. So not all Pilates exercises are created equal, okay?

Because so many of them are going to do that trunk flexion or that trunk function with rotation or those unsupported positions like full planks or, you know, lying supine, those heavy just like leg lift type exercises. Those are the ones that we want to avoid but we have so many different options for good exercises. So I'm gonna give you six examples of ranges of motion or type of position, you can work your abdominal exercises in. And this is hopefully just gonna give you a launching pad from where you can create all sorts of different modifications and experiment with your clients. So the first is the seated roll down slash pelvic tilt exercises.

Now, exactly what you had asked earlier, is can we do these half rollback exercises? And the answer is yes, we can, but we have to keep it to a certain range of motion, and that's what becomes really important. So these seated roll down exercises or pelvic tilt exercises are actually a huge part of my personal and the repertoire show with my clients prenatal and postnatal, when you get into like the ab work that you're gonna do your third trimester and some of the ab work you're gonna do early postpartum, there's a lot of overlapping there, 'cause it's kind of the same restrictive range, even though you don't have the belly anymore you still want to treat those abs just as sensitively. So what we refer to a seated roll down to, you can try this with me, it's feet are gonna be on the mat, hands behind the thighs, and essentially it's like a pelvic tilt, okay? Now you can do pelvic tilts and right after you have baby years, no more risk of lying on your back.

Okay, I'll answer that question now. The reason that we don't lie in our back, and I'm gonna say 20 weeks is for that is because the baby gets so big, that the weight of the baby presses down on the descending vein, and it stops, it interrupts the blood flow and the oxygen that flows through the body to the uterus. So mom, so it could potentially harm baby, but here's the thing, this is why it's like, we can't like be like Oh, you know, Oh my gosh, I can't do two pelvic curls, yes you can because you have to be lying down for a significant period of time. 10 minutes, 15 minutes, 20 minutes. And mom is gonna feel dizzy, nauseous, disoriented way before baby ever feels it.

So mom will feel funky, she sit up and you'll feel better because of the weight is stopping that circulation. So they're not getting the same amount of oxygen and blood into back up into the brain and all of that, so that's where that dizzy kind of feeling comes from. So sitting up, so that's where the supine rule comes in. But if you wanna lie supine for a minute, two minutes, 30 seconds to do a couple of pelvic tilts, that's gonna be fine, so that's where the supine role comes in, does that make sense? Great, fantastic, so the sitting exercise is hands behind the thighs, and imagine if you had your third trimester belly you would just open your legs wider okay, to accommodate for that.

And you're gonna take your breath in, and you're gonna thread the belly button and think about flexing the lumbar spine first and then letting the pelvis roll into the posterior tilt second. Now this is about how far you're gonna go during pregnancy. Because when I start to get down to this range of motion, all of a sudden boom, that pressure of the rectus is up and I'm using too much of those abdominals for that trunk flexion. But when I stay in this range my trunk is still vertical and I'm pulling the lower, I'm connecting the lower fibers of the muscle of trunk to pull the pubic bone up toward the sternum, I'm up toward the belly. So I'm engaging this part up against gravity, but it's yeah.

And it's in a really nice, safe way, really focusing on these lower fibers here. By pulling my rib cage down, to meet my rib cage or excuse me to beat my hip bones, I'm accessing the obliques here as well. Okay, and a little bit of that rectus abdominis, but in a nice, safe way, it's not like you're going so much against gravity or against resistance there, you're kind of going with it if you will, does that make sense? So this is an example of the seated rollback, seated pelvic curl or pelvic tilt exercises. And the variations are endless leg lifts, arms, rotation here, I mean the variations come and there's tons of them there, so that's an example of a very safe way, so when you guys said that, did you feel your abdominals, right?

One comment I've gotten on my classes my prenatal classes here on Pilates anytime it's been like, Oh, I thought it would be really easy on the abs, and whoa, I felt my abdominals and I felt my pelvic floor. And that's exactly the point, you can still massage those deep muscles and work that spine, and work that back, and work the abdominals and work the pelvic floor, and still feel that that challenge if you will, but in a very safe way, so that's one example. Supine, pelvic tilt exercises, so again, we all know our pelvic tilts, and this is gonna be before 20 weeks, gestation and immediately after birth. So going in to these pelvic tilt exercises, so just rocking back and forth from a neutral, even a slightly anterior through neutral, through to the poster your tilt, now hold the posterior tilt for me. And I want to think about the rectus abdominis attaches to the pubic synthesis really shortening those lower fibers of the rectus really shortening to pull that pubic synthesis up.

And think about the obliques drawing the hipbones ASIS, up toward the rib cage. And then think about the transverse hollowing and narrowing the waist, can you guys feel that? Yes and then release it inhale. And again, so we're using these pelvic tilts in this workshop to facilitate the abdominal work but these are also fantastic exercises for pelvic floor work as well. And really, so there's a lot of different variations you can do on this, you can go into the pelvic tilt and you could rotate from one side to the other.

I mean, you could do some pelvic rotations, you could do pelvic clocks, yeah. So you're getting more of the oblique action, you can add leg lifts with it to get a little more so as a little bit more unilateral work for the obliques and draw leg lifts into. So I'm just gonna give you a couple of examples of starting points, but this is your basic recipe is that supine pelvic tilt, which is gonna work. And then from there, you guys have the knowledge and the creativity to go and experiment from there. Number three if so, make sure you're taking notes down through this tool, number three is going to be non supine trunk flexion exercises.

I thought long and hard about what to call that. And that's what I came up with. So what do I mean by non-supine trunk flexion, trunk flexion meaning folding of the spine is not a bad thing for abdominals. It's when we do the trunk flexion that comes from a supine position and up there. That's when it becomes problematic.

So what I mean by supine, sorry non-supine trunk flexion exercises are things as simple as coming forward into a fold here and inhale, articulate in the spine up. And coming forward, now when you do that, try that with me, is I want you to think about hollowing the abdominal wall in and drawing the trunk forward. Now hollowing tight and feel the pelvic floor muscles shortening and squeezing, do you guys feel that? And then inhale, restock it up. Now let's try a little bit different, rotate toward me so I can see you.

Yeah, and you're gonna try to access the obliques on that same side towards the internal obliques. And then of course we know the external obliques on the opposite side, so now fold over and inhale come up and fold over hollowing, and inhale, do you guys feel that oblique connection? So there you have safe abdominal exercises, now are these gonna build the same amount of strength that like a chest with rotation would? No, but that's not what we're looking for. We're looking for that drawing in that supportive quality.

So a lot of times we hear the cue when you do exercises like that, like kind of wrap the muscles in around the baby and hold the baby in, you can kind of think that same, that same thing, when I was pregnant, I remember thinking I just wanna like create a hammock with my muscles almost like I'm gonna lift my whole belly up. And it felt really good to feel that contraction to fill that kind of lift at the same time. And even none of us separate one being pregnant here, but you don't have belly yet, you can still feel that need to kind of wrap in, and postpartum we're gonna start to really draw those cues in, of pulling the abdominal wall together, does that make sense? (indistinct) For pregnancy? That's a really good point, she asked if, you know, the queuing of hollowing is gonna be beneficial.

And I think it's gonna depend on what the person responds to, what imagery they respond to. They can still feel, especially if they are experienced with Pilates they're gonna know what that hollowing sensation feels like. I'm probably not using it right now, because I'm not in my pregnant body, does that make sense? But it might be more of like a flattening or a wrapping or a supporting yeah, exactly. Hollowing that's a really great point, because they're not gonna be able to just hollow and scoop like a postpartum woman will or like we can you know, but exactly, that's a really good point.

So maybe changing the language of our words for pregnant women to more of a wrapping supporting kind of imagery rather than a hollow or a scooping When you're in the seated position, are you trying to keep your pelvis completely neutral or can you add tell it, tell when you're doing that chest lift or should you remain neutral in the pelvis? That's a good question. So she's asking when you do the seated like little variation on chest lift, can you stay upright and neutral? Should you say neutral in your pelvis? And I'm gonna say, it's gonna depend, you could do either way, you could just work the upper back but because of tension on the lower back and wanting to facilitate the pelvic floor I would encourage you to allow a posterior tilt to happen and come back up, yeah, great question.

Good number four on this list is lateral flexion exercises, lateral friction exercises are fantastic, for pre and postnatal, because they're not using our traditional flexion at all, they're getting the obliques, they're getting the transverse abdominis in a really nice, safe way. So a lot of our lateral flexion exercises are gonna be great, will some of them become problematic. For instance, I'll go this way, the traditional like side lifts, the only reason this becomes problematic later into pregnancy and early postpartum is the sensitivity of the pubic synthesis because of the laxity that's happening there. So that can kind of become problematic, but, you know, exercises like this are gonna be helpful. Another one that I like to do a lot, is it's not a very big range of motion it's small, but just a little bit of a upper body lift and down to get that lateral flexion extra range of motion, upper body lift and down.

So that's a nice, safe way and from the sideway of cuing, you can, again, cue that underside of holding and supporting the belly and the baby up, or even postpartum of supporting that lower aspect of the belly. And that way they're gonna get that nice transverse work as well. You can do fantastic lateral flexion exercises in a seated position, just as simple as side to side you know, adding arms, you know, all of these types of exercises are gonna be really beneficial and helpful to keep those side oblique muscles working in that range of motion working. So we have trunk and pelvis stability exercises. And so these most often are gonna come in the form of some of them are gonna be supine, some of them are gonna be sitting.

But what I mean by these is some of our basic hip disassociation things like single-leg lifts, and changes where all of these exercises, we have to keep the pelvis nice and steady, and stable against a moving leg, and keep the trunk nice and steady as well. Anything from like single-leg bicycle, up and down here, and this is all supine. So you're gonna ask what do you do later in pregnancy. Okay, but these are great for postpartum and that before 20 weeks gestation kind of exercises there. For later in pregnancy for pelvic trunk, and pelvic stability, you can do stuff in seated positions, it's hard to move the legs like if you were to do like a seed, like so as lift or something like that.

It's a belly and the limited range of motion, it gets quite challenging. So some of these other exercises what I categorize into some of these for like later into the third trimester is gonna be some of my quadruped, and some of my plank position exercises. And I call it trunk and pelvic stability, and what I mean by that, in you see this all the time in prenatal work and because it's valid is, you know, I'm not talking cat stretch here, but I'm talking just simple ways of stabilizing the torso and the pelvis as much as you can, while you're doing movement of the legs, you can have come all sorts of variety and move it here, or even shoulder movements and arm movements just to work on that sense of stabilization. That's what we're gonna get some into some of our quadruped positions here. So that there's that idea of, again, supporting almost like creating a hammock with your abdominal muscles of the belly and of the baby, so that is always drawn in and supported.

And you're gonna feel those work and start to get fatigued and that role of stabilization there. I personally don't, if I'm gonna bring props in... I'm not a very proppy gal, I mean, I like props, but I don't use them a lot, I personally, I don't like the seat and I don't like the way it feels, and on the reformer, I use some different devices that I think feel a lot more comfortable For instance and I don't wanna show you this I want to see if you guys would come up with any of your own, but for instance, like for like a modification for an abdominal exercise, I'd much rather go on my elbows, because the seat cushions are gonna put me here permanently. Now, if I'm up on my elbows, I can go in and out of that position, I get much more range and then I can start, you know, all this fun stuff of my legs and do whatever I want. So I prefer this position, because it gets your backing sensors involved, it gets a shoulder stretch involved.

Oh, she had asked me, sorry, I couldn't hear she'd asked me if I use a seat cushion in my work with prenatal clients. So my answer is not really, I don't. So I think you can kind of think about yeah. Using your own body and that way you can get a bigger range of motion there. Another great range that we can work in that safe is a seated rotation exercises.

Okay, so I showed you the one example of this. Okay, we have all sorts of great rotation exercises here, I mean, the list could go on forever, you could even like a short box kind of variation of the twist, all of this is gonna be safe yet challenging abdominal exercises to be able to perform all of these ranges of motion. So it's up to you to take these six safe things and start to play with them. If had all day, I would show you everything that's at my asleep, now I have on point is anytime I have four or five prenatal classes and two postpartum classes, so there's tons of variations and modifications that you can learn from those classes as well. But this is where you're gonna start, does that give you a good base, now look at that, that's six different, I mean, and there's more, we could probably add to that, you know, you could even add seven saying, oh, totally categorized the quadruped stuff in a different category, so let's just do that and say that there's seven.

And that gives you, and under that how many different modifications and variations of those exercises can you create, there's a whole array of repertoire that you have there. Yeah, good fantastic. Okay, so I want to explore some of these modifications together, I kind of want to have you guys do a little bit of exploration. We have five, so two and two, we're actually might have you guys work as a trio and you guys work together, and we're just gonna take a few minutes for each exercise, and I want you to think about this. So I chose three, like very common exercises, and this is also why I didn't want to show you all my modifications in this last part, 'cause I want you guys to think of some on your own.

So the first is gonna be chest lift, then we're gonna do the double-leg stretch and then the criss-cross, right, do you guys agree? Those are like pretty much in like every session, okay? That we get, so I want you to really think about what's the objective of the original exercise, why do we do it, what are we trying to achieve? Abdominal strength, trunk flexion, pelvic stability spinal movement, you know, and deflexion, write those all down, and then you're gonna just play with like, okay, so I can't lie supine, I can't do flexion. What are some different ways I can achieve some of those same objectives, just in a modified version that's safe for my pregnant client, let's keep this as per pregnancy right now, for like this woman's in her late second trimester early third trimester under the third trimester.

So she's done with flexion, and those same rules are gonna apply for early postpartum as well, okay? So we're gonna to do each one, we're just gonna take a few minutes with each one. You at home watching this as well, I want you to do this too wants you to take these exercises, write down your objectives and try to come up with some of your own little modifications here. And then what we'll do is as we discover some good ones together, we'll go ahead and bring you up here and have you demonstrate them? Okay, sound good.

So let's start with the chest lift. Okay, so our first exercise we want to discuss was the chest lift, and some of our objectives that we came up with were strengthening of the abdominals, mobility of the spine, what's that? Trunk flexion, producing trunk flexion. One that we do talk about a lot in some of the tests is pelvic stability, pelvic lumbar stability, so a lot of the ones that I showed you earlier like the seated rollback or the sitting chest lift was really good, but something interesting, so those are gonna be great modifications that you're gonna be able to use for the chest lift, but Marta come up and so this, is we also had, if you did have a client or a group class or something like that, you could also do a version up against the wall to give them that tactile feedback of the wall. And this might even lend itself a little bit more to actually keeping pelvic stabilization public lumbar stabilization, so breathe in, and she's gonna contract and draw down, and at the same time be drawing the abdominal wall in, good and then inhale come back up.

So this could be another kind of modification that you could use for the chest lift, do one more. So she's really focusing on folding her upper spine. Good, and come back in, nice good perfect. And that's gonna get a little bit more limited, that version as somebody progresses later into their third trimester, so when that's the case that might be a good time to really incorporate those seated roll back exercises as well, okay? Is that clear, do you guys see the process that we're going through here?

The next one is gonna be the double-leg stretch, so I'll show you guys the, this is what I should have done before, I'll show you guys the real version, the original versions of breathing in and we come up so the double-leg stretch is reach, exhale. Reach, exhale, and reach, exhale. So that's our double-leg stretch. That's a big, no, no for the pregnant ladies, right? Okay, so what are our objectives, and what are some ways that we can modify it?

So go ahead and jot some of those down and play with some of those ideas, and then we'll come back and show you what we come up with. Okay, so we just got finished working on some of our double-leg stretch modifications that we came up with the few, yeah? So our objectives are gonna be trunk stabilization, abdominal strength, shoulder mobility, hip disassociation, pelvic lumbar stability, spinal flexion exactly, trunk flexion, good. So Laurie is gonna come up and show us one kind of very good creative modification here. She and her partner decided to do like a quadruped position, okay?

So we're gonna start with like that bird dog, right? Position, now you're gonna come out good. So here, so what she's trying to establish is that sense of shoulder movement and that sense of hip movement, by coming into a safe flexion. So come in and you're gonna come into as much flexion as you can. Now, this is safe flexion to do, it might get harder once the belly gets bigger, just because of limited space but it's still very safe to do, then inhale back out.

Good and exhale, so think of drawing up through the center first, so flexing the spine and then letting the arms and legs come in as a result of that, which is kind of like what we do with the double-leg stretch, and then reaching out. So we're not getting the trunk stability 'cause we're going in and out of flexion on this version but it's still kind of getting that same idea of that drawing the abdominal wall in drawing the arm and the leg in and come back out. Now rest, come back to the quadruped exactly, you took the words exactly out of my mouth. So just I was gonna say, so this exercise is probably good for a second trimester, maybe early third trimester but once somebody gets larger in their pregnancy the balance is gonna become a bigger issue at this point. And you don't want anybody falling over, even though they're close to the ground, you still don't want them falling over.

So, and like I said before, there's gonna be a much bigger obstruction, so they're not gonna be able to come and flex in as much. So my suggestion would be to come back, is to do maybe just the arm, so take the right arm out. So breathe in, then exhale, come into like your cat stretch and bend your elbow in, in, in, in and then inhale go back out. Yes, and then exhale come back and so that's one way you could do it. Do feel your abdominals, Laurie.

Good, and then, or you can stabilize the shoulders and do just the leg, do one leg at a time. So take one leg out, breathe in and then exhale, draw it in and drop your head. And then even if that doesn't become an option going in and out like that, you can keep arms and legs down and just perform the cat stretch, which would be also a very good modification as well. Good, yeah, so it's about taking some of the concepts from our original exercises and just trying to adapt them. So Marta, I'm gonna use you again, another modification that another one of our groups came up with and maybe you came up with yourself at home is on the elbows, two different ways can do this again, probably second trimester or early second trimester maybe into the later aspect of the second trimester one knee up at a time to tabletop, you could perhaps reform it like the angle that actually happens on the double-leg stretch, inhale and exhale, but as the belly gets bigger this position is gonna get much more challenging, so at that point we would take one leg down and we would do a single-leg, inhale and exhale.

Inhale and exhale, the third option is to bring both legs up and to do extend straight up to the ceiling and bring it back down, and straight up to the ceiling and bring it back down, that's another option. Now, come back down, another thing that I want you to think about is, are you gonna perform this in extended quote unquote neutral position? Or are you gonna lie your clients to come into a little bit of a posterior tilt? That's gonna be your discretion, you can do either or it's gonna depend on, are you going for that neutral sense of co-contracting stabilizing the spine there, or are you going for that drawing up with those lower abdominal fibers, and getting that stabilization there? So that's really up to you, that'd be two totally different exercises or you could combine them, and what I may need that is as the leg is out in extension, the spine goes into extension.

As the knee bends you bring it into a posterior tilt and you come back out, so then you add the mobilization of the pelvis and the spine there. So just to not one modification, we had one, two, three, like four or five different modifications that modification does that there variations rather that modification. Good, nice, good and probably one of our third ones that we could do, is kind of from a seated position here and into a little bit of a tuck here, you could even start playing with a reach exhale draw in and reach exhale draw in. And that's another great modification of the double-leg stretch, I'm holding this little flexion and I just did three and I'm feeling nice and fatigued. So I'd come back up, go back down and I could do the other side, isn't that fun?

You guys came up with those all in your own. Very good, (laughing) you are as smart as you look. How about that? (all laughing) Okay, you likes the other way better. Okay, so let's go into the third mat exercise we're gonna play with today is the criss-cross, the criss-cross, so let me show you that not one of my favorite exercises, I'm not gonna lie.

Okay, so here I go, say, Oh, demonstrate it, Okay, so breathe in and up, so criss-cross is, (exhaling) and down, okay? So criss-cross, what are your objectives and what modifications are you gonna come up with? Yeah, so remember, yeah, it was your modifications you can break it down into parts it, I mean, sometimes we want them to look like the original two, but you know, like you were doing, but see how you could break it down into bigger, smaller parts as well. Okay, so we've had some time to talk about how we're gonna create modifications for our criss-cross, so let's go over what our objectives were first. Trunk rotation, trunk flexion, pelvic stabilization abdominal oblique strength.

Good nice, again, an element of hip disassociation with the legs bending and straight, full body coordination. These are all objectives of the exercise. So we came up with a couple really kinda neat modifications here and again, just very experimental experiment with your clients, see what they like, we're gonna go back to Emily, I'll have you come up and do the version, kind of like the quadruped position that we were doing with the double-leg stretch, but now we're getting a sense of rotation to it to get the obliques involved. So let's just break it down with the arm first. Okay, so we're gonna just do the arms only.

So you're gonna take the right arm out, as you flex your spine into flexion, you're gonna rotate and cross that right elbow around to your left hip and almost bring the right shoulder down and around and under, do you feel those obliques? So you're here and then articulate back to the straight neutral spine and come all the way and then exhale come back into that position. And once you get there, think of just a little more rotation. Yes, you guys see that adjustment I need. Yeah, so it's almost like you're doing the twist from that the mat work and then come back out to the straight line and back down.

So let's try to do just the leg only, let's see your left leg. So a little bit different getting more of the I'm sorry, yes exactly, getting a little different sequencing of the firing of the muscles here, as she bends her left knee in, she's gonna flex and she's gonna rotate now her pelvis and bring that knee up to that right armpit, so she's getting that deep, so as work, but that deep rotation work there as well, then inhale, come back. Now this isn't gonna work late into pregnancy this one, because there's gonna be a belly there, but up until then she can probably do this comfortably, and this is a great one for postpartum as well. Good and back to center. And on top of that, I'm gonna even add another modification.

So let's say belly's really big, so go ahead and come all the way down. Walk your hands over to the left side. Boom, boom boom, just like this. And now she's gonna come in and out of her cat stretch this way, so she's automatically putting herself into rotation to get that sense of oblique work, and then come back into that position. So is it perfectly like the criss-cross?

No, but we're getting some of the same range of motion, not all of the objectives, but we're hitting some of the objectives with this modification as well. Cool, thank you. Okay Marta got it, have you show this other one? Marta here was, did a really nice modification. Yes, so hands are up behind the head, so this kneeling position is nice, so we're gonna keep the rotation of the torso but we're also gonna add a really beautiful thigh stretch to it.

So go ahead, rotate as she rotates, she flexes and comes into a posterior tilt but also goes down with her hips to get that stretch to her thighs. She articulated back backup to the rotation in the vertical position and back to center, isn't it pretty? And to come into flexion, now I'm telling you as a pregnant standpoints this would feel really, really good. Because you have this nice lifted position here, which is gonna help you create this beautiful space. So rotate, you're gonna get this flexion and this drawing of the abdominals and this stretching here which feels really nice and come back up and center.

Excellent, good and rest, so our last modification here that we've created for our criss-cross, thank you. It's just come from the seated roll down, so we have the seated roll down exercise here, but what we can do is we can come into rotation maybe bring the arms on front, bring the hands behind the head, there's a lot of different variations, you can come down and bring that leg up, you could hold it in an isometric hold and then extend the knee there. Or you can just roll in and out lifting that leg up. Into tabletop, or you could hold isometrically and lift the leg up and down, and then you would just simply go to the other side, bring the leg up and inhale, exhale, inhale, exhale, bring it down and center. Yeah, so when you're doing some now these, you can feel these exercises are they're good, they're resourceful, you can even describe them as challenging.

The thing you wanna watch for when you're queuing your clients on these modified safe, but yet still challenging, and if they're not in the range of motion that they can control, or if you're adding too much like what's gonna happen just like anybody else, the integrity of the movement is gonna be potentially sacrificed. So they're gonna start to release their abdominal wall, they're not gonna support properly, so the same thing goes for a normal client, you just pull back the reins a little bit, maybe not at as big of a range of motion or as much leg movement or change the lever, you know, shorten, modify it, in some sort of way so that they can still produce the basic of the exercise that you're trying to do, but they can do it with control and with integrity. Yeah, does that make sense? Okay, good, but all of these are good, there's nothing wrong with challenging in a safe way, the abdominal muscles of a pregnant woman or of a postpartum woman. It's okay for them to feel their abdominals working.

It is okay, we just need to make sure that it's done in the correct way. So now we're gonna go onto the reformers, we're gonna bring the reformers out, we're gonna bring one out, and we're gonna have you guys play again, and we'll demonstrate what we've come up with for three more, just abdominal exercises. Yup, good, okay. Okay, so now we're gonna get on the reformer

Chapter 9

and do a couple of that, a couple of those exercises, but I wanted to bring up something that we just spoke about here Candace. Saying that, you know, these modifications are so fun and they feel really good on the body, and they're not just reserved for this special subgroup of people for pregnant and newly pregnant, you know, pre and postnatal women.

These exercises are also fantastic for older adults people with disc issues, obese clients, overweight clients these are gonna be all really fantastic modifications for abdominal exercises for them. So that's something to keep in mind as well for the reformer, we're gonna do the 100 and 100 prep, the abdominals with legs and straps. And I actually chose a lot of flexion exercise, I chose sides over, okay? 'Cause that's when I wanted us to play with as well. So we're gonna do the 100 and the a 100 preps.

So you guys all know what this looks like, but just to show it to you, it's like, so I'll do 100 prep and then we'll go into the 100. So looking at what the range of motion looks like, and what the objectives are, and how we're gonna try to recreate and modify in a safe way for our pre and postnatal clients, okay? So for all of you, go ahead and think of those objectives and then go ahead and come up with a couple of different modifications and we'll come back and meet and share our experiences with each other. So coming back together, let's go over our objectives of the 100s, so we have trunk stabilization, isometric contraction, strengthening of the abdominals, the pumping of the arms increasing circulation, right through that pumping, okay. That's a big one, the breath pattern, in flexion of the trunk which you know, is given with all of these, okay?

So there's a couple ways that we can do this. The first one which might be the most common of what maybe you guys came up with off the top of your head is just good, old lying in the supine position and staying supine and working on stabilization. So I could do the 100 prep like that, where I'm just simply, you know working on keeping the abdominal wall nice and flat, I could add my pumps there so I can incorporate the breathing pattern, the circulation but I wanted to challenge a little bit more, I could extend the legs. But that's only gonna work for what group of our pregnant women? I'm sorry, yeah exactly, up into 20 weeks.

And it will work for our postnatal women as well. So what we're gonna do we have the option of using the C-curve, the C-cushion, which will I'll get that out in a moment. But what I actually prefer is to use the jump board. So taking the jump board, and placing it up the first bar here on the back, up against the shoulder rest, you could also put a little pad down here and you could also include a little pad behind the head if you'd like to as well. But what I'm gonna do from there, so if I just had a head you know, my head would just be popped up, is now I'm no longer in that risky supine position.

My heart is up, I'm not putting that pressure on. So from there, I would just proceed to do the a 100 prep and the 100 without coming into the flexion. So getting my straps here and again, you might feel a little bit more comfortable with little cushion behind your head, and I could come into stuff, my head was just up there for my cushion, but I could come into my 100 here. Yes, now the only reason I prefer, excuse me this over the seat cushion is the seat cushion put your chest and your pelvis into this really curved position, it's different from the seated rollback that we do, where the chest is still pretty upright. So you're not getting into this total hunched position.

So that's the only reason I don't personally like the seat cushion, I think it's a supported position but it's a supportive position that's not necessarily beneficial in up for a postural reason, where this we're in a straight spine, we're in more of a neutral spine. I think it lends itself a little bit better to kind of the alignment that we wanna be in, okay? I'm gonna show you one more modification here for the 100 that we can do, and that is we're gonna sit. There's two ways I'm gonna show you. The first way we're gonna sit facing the risers and holding the straps, taking the breath in, we're gonna roll back, hold the stabilization here and just little pumps with the arm.

So I wouldn't do it as fast, I would go a little slower and I would come up in between and roll back down and go one, two, three, four, five, and roll up in between. So that's gonna be another type of modification that you can do for the 100 here. So you're not gonna get that same cus of breathing 'cause we're facing the different way the line of pull on the stops is a little bit different, but you can get that nice slow pressing, but we're still engaging in the isometric hold of the abdominal muscles engaging in that trunk flexion in a nice, safe way. Yeah, that's a nice one as well, you could even do that I'll grab this here, you could even do the same exact thing for somebody later in their pregnancy to give them a little bit more comfort with their belly being large, it could sit on a long box or you could turn it and sit on the short box, whichever you prefer and just roll back. And do the same thing in there, yeah.

Good, now you guys are smiling for me. You guys are lighting up, wonderful. Okay, let's move on to the next exercise, the next exercise we're gonna do is the abdominals with legs in straps, I'll show you what this one looks like, this is a very challenging abdominal exercise and believe it or not there are some great ways that you can create modifications here. So the normal full version of the exercise is kind of like the double-leg stretch on the reformer with some added resistance on the flexors. So the shops go around the thighs, hands go behind the head and we inhale out and exhale in, inhale out and exhale in.

So that is our abdominals with legs and straps. So how can we modify that for our pregnant ladies? (indistinct) Oh, thank you. Yes, so we could do with rotation as well, I did include that, and inhale and the rotation looks like twisting your knees come in, inhale and twist when your knees come in. Inhale and twist, but let's first focus on the regular version first, yeah, okay, good.

Haha, so again, remember to find your objectives and then go through to your modifications. So we've just finished working on our abdominals with legs and straps. Some of our objectives are again abdominal strength, trunk stabilization trunk flexion, isometric contraction, hip flexor, strength, hip disassociation, you know, all of those things come in. So we need to try some modifications now, by nature, this abdominal exercise is pretty challenging. So the modifications can also be made to be pretty challenging, but so we're gonna kind of start with some of the more challenging ones, and then we're gonna show you kind of how to even break it down further than that, okay?

So one version we have, is going to be on our long box. Now again, these modifications you need to play with, you need to see what works for your client and what doesn't, where is it gonna depend on where your client is in their pregnancy, that's gonna really affect this. So, we want to make all of those decisions. I'm gonna keep you, you want the red spring before, I have some blue. Okay, so we're gonna do either a red or blue spring.

So either our one full spring or a half a spring. Okay, so lying down supine, you wanna make sure that you slide your hips down along the box so that the head is resting. Now, if you have somebody very tall, you're not gonna be able to do this exercise, it's just not gonna happen, this is gonna be good for early postpartum and also maybe good for some of that early second trimester kind of work. And before 20 weeks before we get into where we can't lie supine any longer, so knees up. Good, so we're gonna take the trunk flexion out of it and work on just the stabilization.

But it's just gonna keep the movement involved, so inhaling and exhaling and inhaling, so she's loading up her hip flexor scared the same way that we do on the regular abdominals with legs up, but she's really feeling the challenge of having to keep the abdominal wall nice and flat as she moves the legs in and out and against as she moves against that resistance, you feel that? Good and rest, nice and come up, so that's gonna be one modification that we're gonna use here, you guys think of that one? Yeah, okay, so I'll just keep you up here, Emily and have you, you don't mind. Our second modification is going to be a couple of different variations of it, let's start with a single-leg up, we're gonna take one strap and place it over the knee on top of the thigh, and we're gonna come down on the elbows, and bring the knee into that tabletop position. So again you can choose whether you wanna work into extension or if you wanna have a slight posterior tilt of the pelvis, okay?

So from here she's gonna inhale, extend the leg out, then exhale, she's gonna drop back in a little further if you can, and so she feels that nice deep abdominal work. Inhale, so again, if you're late into your third trimester you're not gonna be able to bring your leg in this far. You can still do it but you might just have to really change the range of motion and draw it in. So that's gonna be our elbow type version of it. Let's see here, probably the most advanced and I would say the one that's you should be pretty careful with is a double-leg version.

There's two ways that we can do this though, the one is we can just lift up to tabletop and take it back down, so more like a double-leg lift but it does demand a lot of control of your abdominals, and so if your abdominals aren't there, it's gonna put a lot of stress on your lower back, okay? So bring both knees up to tabletop, and you could go just legs up, inhale and legs back. This one, I wanna show you just so that you know, if you're bringing your postpartum client, advancing them and bringing them out, this is one that maybe you could work up to, if you didn't feel like you wanted to go into that regular flexion, but it is quite advanced here, good and come on down. I think the single-leg version is probably gonna be a little bit more user friendly for you. And I will show you good, thank you.

A couple other versions that you could do is you could do this either sitting on the long box like we were earlier, or you could sit on the carriage here whichever feels more comfortable is we're gonna do a seated roll back type of variation of it, so taking the breath in, we can bend the elbows and come into that seated roll back position. And then I could take my arms out to the side if I wanted to. Now I could either keep my arms there and just perform a single-leg lift, and an extension and a flexion of the leg, or I could bring my arms in and out every time, I lift that leg up right now I'm on a blue spring, so it feels nice I'm on that half spring. So it feels nice, so that can be one option. Now we also showed the version of with rotation.

So beautiful way to do that, is to come into the posterior tilt and open the arms and rotate the trunk, and then from there open the arms wider and bring it back up, open the arms wider and bring it back. You could also do a single-leg lift here, and bring it back, a single-leg lift. And again, challenging, but safe and effective. And I think you'll find that to be so fun, while you do this work its still really good abdominal work, it's just safe abdominal work, okay? Yeah, nice, our final exercise that we're gonna do today

Chapter 10

on the reformer, is gonna be our sides over on the short box, so I've chose the lateral flexion here because this is a popular exercise for the abs, you know, that good oblique work, people want the kind of whittle of the waist kind of thing going, so this is a really popular exercise but it's a very challenging exercise, a very challenging exercise and probably not really appropriate, for a lot of different reasons.

Not that the range of motion is unsafe for pregnant and postnatal women, is that the stability isn't there, the support isn't there. Not only not from the box and from the carriage, but in the bod, so I wanna show it to you guys, and then I want you guys to kind of come up with some different types of modifications that can access the obliques in the lateral flexion range of motion. Okay so, what does this look like? Short box, all of your springs are on and you grab your strap here at the bottom. You grab your strap here at the bottom.

(metal clanking) Ah, okay. Technical difficulty, still giving me trouble, sorry. (metal clanking) Yeah, it's turned the wrong way sorry, I could just get it. No, I'm feeling retarded here, there we go. I got it, I got it, I got it.

Yeah? It's good. (all laughing) Let's try that again. Okay, so I'm gonna show you the sides over on the short box. So we're gonna have all of our springs on, our short box here up against the shoulder vest and we're gonna grab our strap and the foot is flexed.

So as you can see, I have very little support here I'm pretty much just out there. So it demands a lot of my own body it's capability to support itself, which becomes problematic when we talk about pre and postnatal Pilates, okay? But lateral flexion, as we know is a fantastic range of motion for pre and postnatal women. Wonderful, but this is probably a little bit too strenuous for them to be doing, do you guys agree with that? Totally, okay, not that to say that some pregnant women couldn't, but let's just play with our modifications.

I think we'll be very satisfied with some of the things that we come up with. So I want you to think about the objectives of this exercise and then what are some different ways that you can move and lateral flex, you can use the short box or you don't have to use the short box. There's some different ways that we can do it. So let's go ahead and explore that and then we'll come back together and show each other. So we have started to play a little bit with our sites over which our objectives are: lateral flexion, oblique abdominal, strength or abdominal oblique strength, pelvic stability, correct, anything else?

No, okay (laughing) good okay. So we are going to start with main keeping our short box on and doing some if you don't know, if you see that as my son right there. (all laughing) And we're gonna start actually, you know what? I'm gonna sit facing you so you guys can see me. So you're gonna sit on your box with your hands behind your head and very simple, just like our short box, you could go tilt one side and up through the center, tilt other side inhale and up through the center.

Tilt one side and, so I'm some still getting that oblique range of motion as not as big, and I'm not working against so much resistance or so much you know, gravity, if you will, but I'm still getting that nice range of motion. So I would do that either sitting straight straddling the box, doing it long box like that or I would do it as a part of my short box series here. If you want it to, although it's not pure lateral flexion you could bring in the tilt, excuse me, the twist into it as well, which could also be a nice option. But that lateral flexion is really, what's gonna count. Probably the best modification that we can come up with here, it's going to be a sitting or a kneeling side bend.

Okay, so there's two different ways or three different ways. You can do it here, but you could sit down on your heels with your bottom here, or you could kneel. My personal favorite is to kneel, I love this variation of it. So one hand is gonna be out, the other hand is gonna be behind the head, or you could reach it up. I'm gonna go into a side bend, touching the bar here.

Hi, do you wanna do this with me? Yeah, I know, okay stay right here. We can do a side bend. So go over into the side bend, and then you're gonna fill your underside obliques as you continue to push the carriage out getting that nice stretch through the opposite side then you're gonna control the carriage in, whoops and then use the opposite side to lift yourself back up. So you're gonna feel both sides of the obliques contracting and stretching and contracting.

So it's gonna be a real nice play there, so one more time, one more time. Okay, right here. You can do it with your baby, so you're gonna go over and side bend, nice big side bend, and then contract those obliques and come all the way back up into the vertical position. So really nice oblique work here. I'm also getting some adductor work here, trying to hold him So that's gonna be your oblique work.

If somebody feels unstable that they don't want to be on their knees, or if they can't sit on their knees with their bottom on their heels, you could also very easily do this in a seated position here. He's hungry, he wants to nurse. (all laughing) So you can go over and get this beautiful side stretch here and back up and hold and over again, nice side stretch here and back. Is it as strenuous as our sides over? Definitely not, but are we still getting some good oblique work?

Definitely, good fantastic. Let's take a little pause here. (all laughing) Okay, so today in our workshop, we've gone through the anatomy of what happens to the abdominal muscles during pregnancy and after pregnancy explaining what a diastasis recti is and why we wanna continue abdominal work. Any questions on any of that information? Yes, Christie.

What's your son's name? (giggling) My son's name is Turner, and he is 18 months old on Tuesday. So he is a Pilates anytime baby for sure. First came to Pilates when I was 15 weeks pregnant and did my first prenatal class. So yeah, any other questions?

Okay, then I think that probably the best thing is showed you seven foundational ranges of motion that you can use for pre and postnatal clients, the seated rollbacks you know, those type of exercises. And then we went through six different exercises and you guys came up with your own modifications that still carry some of the objectives of the original exercise. So I hope that this helped you guys, get a really good foundational knowledge of how you can use the abdominals, the importance of the abdominals pre and post pregnancy. Yeah, I remember that if you want to learn more information, you can always look at my other pre and postnatal classes on Pilates Anytime, I have a DVD and that's a postnatal Pilates program is a force section that progresses from immediately after birth to six months and beyond. And then of course the pre and postnatal teacher training course from BASI Pilates which I designed and wrote, and that I teach as well.

So you can look into all of those things as well, but thank you so much for spending some time with me here today. And if you have any questions, email me, leave comments in the comment box below, and I'd be happy to answer them. Thank you ladies. (ladies clapping)


1 person likes this.
This was a beautiful workshop, full of so much great information. It has helped me immeasurably in progressing my clients through their pregnancies safely and with integrity, along with Leah's other pre and postnatal videos here on Pilates Anytime.
Thank you Leah and Pilates Anytime!!
Awww....thank you, Emilie!! I am so very happy to hear that this workshop has helped with your clients! Please let me know if you have any questions.

2 people like this.
What a wonderful workshop, Leah! Thank you for all this valuable information and your charming presentation. Your son is adorable :)) Also a big thank you to you Kristi, for giving us access to such excellent teacher trainers and instructors. At this end of the world (Egypt) Pilates Anytime is priceless!!!!
You're Welcome Petra
1 person likes this.

I am so happy to hear that you enjoyed the workshop! It is information and a population that I am very passionate about, as you know

And always, a big hug and thank you to dear Kristi!! You know I love and adore you to pieces!

Hi Leah, great workshop. Thank you :) It has been very informative with some creative modifications which make perfect sense! And by the way, you have an absolutely gorgeous boy! Just like mommy :)
1 person likes this.
oh and of course, if it were not for Kristi and her hard work we would not have PA so thank you so much Kristi :)

Thank you for taking the workshop, and I am so happy to hear that you enjoyed it! Thank you for your compliment of little Turner as well. He's a good boy!

And yes, Kristi is the driving force and her encouragement and inspiration is a blessing for all of us.

Take care!
So glad I finally purchased this workshop. I am really starting to enjoy the pre-post natal Pilates & think I may have to go for one of your workshops Leah.. This is well taught of course but I expected nothing less from Leah! Such great modifications for not only pre and post natal but other clients, with back and osteo conditions... wonderful!!

Thank you so much! So happy to hear that you are beginning to enjoy pre- and post-natal Pilates work - it is truly so diverse and wonderful!

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