Demystifying Pregnancy Exercise: Who is PregXercise for and when is the best time to start?

As long as we have been doing Clinical Exercise with clients we have been we have been performing PregXercise with women during their pregnancies. Just like our last blog, to best demonstrate how Clinical Exercise works during pregnancy, I will give an example with a fictional client

PregXercise for Megan, 32 year old lady, who is a working professional and pregnant for the first time. She wants to do exercise during her pregnancy, but wants it supervised by a professional.

Megan is a typical client that comes to see us to start Pilates during her pregnancy. Megan is a HR professional, who is now 13 weeks pregnant with her first pregnancy. She doesn’t have any problems at the moment, but has had previous occasional episodes of back pain, which had gone away on their own.
As always, we start with a Full Body Assessment to find out the aims of her program and any major issues that we need to address during her program. Megan wants to

• Maintain a normal weight during her pregnancy

• Improve muscle tone for the pregnancy

As Megan is 13 weeks pregnant, we do not have any major restricted into terms of testing, however, if she was over 16 weeks pregnant, we would be a bit limited in testing as we would not want Megan lying on her back for testing (The blood supply to the legs is affected at that stage). Megan’s assessment findings indicate early signs of pelvic (SIJ) instability, the most common issue and cause of back pain during pregnancy. In general, Megan has relatively weak muscle tone, especially around the gluteals, which is a major contributing factor to the pelvic instability. We also ask Megan to return to us a specific clearance letter from her obstetrician, which makes sure she is medically safe to exercise
Megan starts our 13 week Pilates program. On the first day as always we start by testing Megan’s core stability. Normally we would test this via ultrasound, but during pregnancy we do this manually. Megan has level 3 control on both sides (Is unable to maintain core stability when bringing the leg out to the side). On day 1 it is important to get a good idea of the basics, in particular, activation of the core stabilisers, activation of the gluteal muscles ( The major stabilisers of the pelvis to minimise pelvic instability) and shoulder blade control (The major stabilisers of the upper half of the body). On Megan’s modafinil online second session, we focus even more on the gluteals, starting with exercises for these muscles, incorporating a core stability exercise and then returning to working on the gluteals.
Over the next few weeks we continue to work on all the major muscle groups, with particular focus on the gluteals and core stabilisers. We take advantage of the fact that Megan can lie on her back in the first 3 weeks of her program (before week 16), so there is a strong focus on core stability. After week 16, we work on these muscles in different positions. Megan has no complaints of pelvic pain, even though it was present on her assessment.
At week 7 (week 20 of her pregnancy) we do Megan’s re-assessment. She is doing well, no pelvic pain and improved muscle tone and core stability. Megan is happy with her program and her goals are unchanged. As we are happy with Megan’s progress and there are no major complications we are able to progress Megan to a 4 on 1 program, although if there are any issues in the future, we would bring her straight back to a 2 on1 program to supervise her more closely. There are still some signs of pelvic instability, however, again Megan doesn’t have any pain in the area.
At about week 10 into Megan’s program (Week 23 of her pregnancy), Megan begins to complain of some buttock pain. We assess the area again and testing shows pelvic instability once again, which is not unusual at this stage of pregnancy. Megan is brought back down to the 2 on 1 classes so we can manage her pelvic pain, by focussing more on the gluteal muscles and particular treatments that also help reduce pelvic pain. Megan continues her program until week 36 of her pregnancy. Her pelvic pain is on and off, but manageable through her pregnancy. At this stage, although Megan used to feel really good after her sessions, she now feels more tired after a session. This is her body telling her its time to slow down and is a good time to stop exercising.
Megan has an emergency ceaserian at week 39, but gets through the birth well. At week 6 after the birth of her baby, she gives us a call. Her obstetrician has given her the clear to start exercising again and we are re-commence her program after a re-assessment
(Although this is a fictional example, this is a very typical example of our Pilates clients)

Author: Michael Dermansky

Michael has now been working in physiotherapy for over 20 years, since graduating from Melbourne University in 1998 and is even more passionate about getting the best outcomes for clients than he was then. Michael is always studying and looking for new and innovative ways to improve the service at MD Health, including and not limited to the ideas from the fitness industry and great customer service companies. In his spare moments, he loves spending time with his two children, Sebastian and Alexander and hopefully taking them skiing more and more often.

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