Pregnancy can sometimes be associated with a number of musculoskeletal problems. The weight and pull of the foetus, de-conditioning which results from a lack of exercise and hormonally-induced ligamentous softening can lead to a significant insult to the back and associated joints. Pubis symphysis dysfunction and sacroiliac joint problems are also common.

During pregnancy certain biomechanical changes take place, jeopardising posture (exaggerated lumbar lordosis and exaggerated thoracic kyphosis) and increasing shear forces through the joints of the lower back. The increased size and weight of the breasts may also cause postural changes intensified further by poor feeding positions. This causes increased stress to the spine, leading to neck and shoulder ache. A recent study suggested the incidence of back pain in pregnancy is over 68%, and more likely in the younger woman and those with a history of back pain.

Biomechanical changes which send the centre of gravity forward can cause some muscles to tighten (for example; pectorals, iliopsoas, hamstrings and lumbar extensors) while others lengthen and weaken (rectus abdominus, gluteals). The abdominal muscles undergo a great amount of stretch in all directions during pregnancy, and as the waistline increases, the two bands of recti muscles can stretch away from the midline to allow more space for the expanding uterus. This is known as diastasis recti and occurs in up to two-thirds of women during their second and third trimester. It can add to chronic backache due to decreased support from the abdominal muscles.

An increased pressure on the pelvic floor also ensues. Many women develop symptoms of urinary incontinence during pregnancy. While the pelvic floor muscles play an important part in lumbar-pelvic stability, they have other important functions too such as supporting the pelvic organs, ensuring resistance to sudden rises of intra-abdominal pressure (during sneezing and coughing) and control of continence. Pelvic floor exercises should ideally be performed throughout pregnancy, although if a woman has not been educated during the antenatal period, then it is advised that she begin as soon as possible after birth. Otherwise, muscles may remain stretched and weakened and recovery may be prolonged.


The available information on pregnancy and exercise can be very confusing - even conflicting. UK Government guidelines on general exercise during pregnancy high-light certain contra-indications to general exercise in pregnancy (these are not specific to Pilates) and include; 3 or more miscarriages, maternal heart disease, maternal diabetes or hypotension, pain, bleeding, high blood pressure, fever, headaches (if accompanied by swelling, blurring of vision, pain at the side of the ribcage), incompetent cervix, and placenta previa.

During a normal healthy pregnancy, however, moderate exercise is safe and effective. It can assist in the prevention of varicose veins, haemorrhoids and lower back pain and helps to boost self esteem, help the mother relax and open up the chest wall wider to give more space for the growing foetus, maintain fitness levels and prepare the body for the physical demands of motherhood.

In the hands of the right instructor, Pilates can be enjoyable and a highly effective form of therapy. Exercise during pregnancy offers many physical and emotional benefits and because of the gentle nature of many of the exercises, Pilates is increasingly being sought by mothers during and after pregnancy.

It is important to educate all mothers, as well as those involved in ante- and postnatal care, about exercises that are safe in pregnancy. Little can be done to alter the inevitable physiological and hormonal changes of pregnancy, but by strengthening the core stabilising muscles around the pelvis and spine, and improving breathing patterns, it is hoped that one can optimise the body for the challenges it may face. By maximising the mother's core stability before and during pregnancy, it should be possible to limit any potential harm. Returning to exercise soon after the birth is important for the mother's physical and mental wellbeing.

In the Pilates studio at Sussex Osteopathic and Complementary Health Clinic, we start the Pilates process in positions where there is the lowest load on the pelvic floor muscles, such as side-lying or supine positions. Once the mother has stabilised her pelvis and lumbar spine, gradual arm and leg movements are introduced to challenge this core stability. The exercises are adapted and modified as the pregnancy progresses. Mothers are then encouraged to progress to seated and standing exercises and to incorporate their exercises into their daily functional activities. Hence they are safe during the second and third trimester when a supine position is contraindicated.

Learning to perform the exercises correctly is not something that can be done very easily from a book or video, so it is recommended that mothers are referred early to a Pilates instructor for one-to-one tuition in the first instance. It is important to note that Pilates in the UK is not well governed, and it is therefore important that anyone who is considering seeing a therapist check their credentials carefully. Our Pilates Instructor is a registered exercise professional qualified with both Polestar Pilates and BCPA and has undertaken specialist courses in Women's Health and Pilates for Pregnancy with both training organisations. Polestar Pilates and the BCPA follow current standards practiced in the fitness industry regarding safety during pregnancy and the guidelines set out by professional organisations such as the American College of Obstetricians and Gynaecologists.