Accepted Manuscript

Pilates workouts can reduce pain in pregnant women

Ika Oktaviani

PII: S1744-3881(17)30392-4
DOI: 10.1016/j.ctcp.2017.11.007
Reference: CTCP 787

To appear in: Complementary Therapies in Clinical Practice

Received Date: 28 August 2017

Revised Date: 11 November 2017
Accepted Date: 14 November 2017

Please cite this article as: Oktaviani I, Pilates workouts can reduce pain in pregnant women,
Complementary Therapies in Clinical Practice (2017), doi: 10.1016/j.ctcp.2017.11.007.

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 ACCEPTED MANUSCRIPT
PILATES WORKOUTS CAN REDUCE PAIN IN PREGNANT WOMEN

Ika Oktaviani

Metro Midwifery Study Programme, Tanjungkarang Ministry of Health Polytechnic, Metro

City, Lampung, Sumatera, Indonesia

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Address: Jl. Brigjend Sutiyoso No. 1, Metro City, Lampung, Sumatera, Indonesia

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Email: ika.oktaviani@yahoo.com

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PILATES WORKOUTS CAN REDUCE PAIN IN PREGNANT WOMEN

ABSTRACT

Objective: This study aims to evaluate the effects of Pilates exercises for a decreasing pain
in pregnant women. Methods: A total of 40 pregnant women were divided into two groups, a
control group (followed a standard pregnancy exercise regimen) and a Pilates group
(completed a Pilates exercise regimen). A pain assessment was carried out after exercise,
using a visual analog scale. The Pilates group workout program lasted 70-80 minutes per

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day, once a week, for 8 weeks. Results: The reduction in the level of pain was found to be
significantly greater in the group of pregnant women who completed the Pilates workout (p <
0.05). Conclusions: The results of this study indicated that Pilates is an effective, healthy,

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and feasible method of reducing pain in pregnancy, and is therefore a beneficial alternative
workout for the suppression of pain in the third trimester of pregnancy.

Key words: workout; pregnancy; pain; musculoskeletal dysfunction.

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INTRODUCTION

A woman's body will experiences many changes throughout pregnancy. These changes

include weight gain, changes in posture, weakness of joints and ligaments and

musculotendinous stretching [1]. The incidence of back pain is very high, occuring in about

30-70% of pregnant women [2-5]. It has also been reported that 31.7% of pregnant women

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have pubic symphysis pain. In addition to back and symphysis pubis pain, other complaints

include upper back pain, sacroiliac joint pain, muscle cramps, pain in the lower extremity

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joints, limb discomfort, pedal edema, carpal tunnel syndrome, imbalance and collapse [6, 7].

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Pregnancy-related musculoskeletal dysfunction is influenced by the degree of physical

activity, cultural influences, environment, and hormonal changes. The hormone relaxin

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serves to relax ligaments in the pelvis for the birthing process [8], but also relaxes the
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ligaments supporting the spine thus triggering pregnancy-related pain. This condition is

aggravated by separation of muscles resulting from stretching of the uterus as well as by

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emotional stress [9].

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The Pilates workout method is a technique focused on developing stability of the core

(muscles of the abdomen, low back, and hips), and improving posture, respiration, flexibility,
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strength and muscle control [10]. The Pilates approach focuses on actively utilizing the trunk

muscles to stabilize the pelvic-lumbar region [11]. There is evidence that lumbar stabilization
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exercises can improve internal muscle strength [12]. The Pilates method has been reported
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to be more effective than ordinary workout methods in reducing pain [13]. To our knowledge,

applying the Pilates method for the purpose of reducing pregnancy pain has not previously

been evaluted [14]. This study aims to evaluate the effects of Pilates exercises for

decreasing pain in pregnant women in the thrid trimester.

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MATERIAL AND METHODS

Subject

This is an experimental study design. A total of 40 pregnant women were divided into two

groups, a control group (that followed a standard exercise regimen in pregnancy) and a

Pilates group (that performed Pilates exercises in pregnancy). The inclusion criteria for this

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study include the following: pregnant women in the third trimester which was defined by

gestational age ≥ 28 weeks; musculoskeletal pain (back and waist) affecting the pregnancy;

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maternal age 20-35 years; parity ≤ 3; and the absence of heavy lifting in daily activities. The

exclusion criteria of this study included maternal complications such as kidney disease (low

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back pain due to kidney disorder), pre-eclampsia, bone disorders, and placenta previa.

Assessment of pain
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Pain assessment was carried out using a visual analog scale (VAS) according to Bourbanis,

and completed by making a checklist (√) or circling (O) numbers on a pain scale
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corresponding to the level of pain felt. We included a brief interview guide equipped with
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images corresponding to specific pain scale ratings. A pain assesment was performed after
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completion of the entire period of exercise.

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Pregnancy exercise

The exercises were performed once a week for 8 weeks. Every exercise was guided by a
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certified exercise instructor.

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Pilates workout method

The Pilates workout regimen consisted of 70-80 of Pilates exercises per day, once a week

for 8 weeks. This workout group performed a warm-up exercises comprising mild breathing

and stretching for 10 minutes. This was followed by the main workout, which lasted for 50-60

minutes, and a cool-down routine lasting 10 minutes. The Pilates workout program was

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based on the recommendations of the New York Pilates Academy International-Pilates (PAI)

and San Francisco Balanced Body University-Pilates (BBU) method [15].

Ethics

This study passed an ethical review by the Ethics Commission of Health Polytechnic,

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Tanjung Karang (No: LB.02.01/I.1/3235/2015)

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RESULTS

Table 1 presents the following data for both treatment groups: subjects age, gestational age,

gravidity, type of work, and initial pain score. There were no significant differences in the

mean age of the subjects, gestational ages, gravidity, type of work, or initial pain scores

between the two treatment groups (p > 0.05).

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Figure 1 presents the pain scores before the workout, pain scores after the workout, and the

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differences between the two treatment groups. The pain scores in both groups before

undertaking their respective workouts were comparable (p <0.05). After undertaking the

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workout, there was a reduction in the pain scores in both groups. The reduction in the pain

scores was found to be significantly greater in the group of pregnant women that completed

the Pilates workout (p < 0.05).

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DISCUSSION

In this study, there were no significant differences in the subjects ages, gestational ages,

gravidity, and types of work between the two study groups, and therefore these two groups

could be legitimately compared. To our knowledge, this study is the first to assess the effects

of Pilates exercises of the reduction of pain in pregnant women in the third trimester. In this

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study, after completion of their workouts, there was a reduction in the level of pain in both

groups. The reduction in the level of pain was found to be significantly greater in the group

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of pregnant women who followed the Pilates workout regimen (p < 0.05). This would indicate

that the Pilates workout is seemimgly better than a common workout at reducing pain in the

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pregnant women in the third trimester. Researchers suspect that the reduction of pain in the

pregnant women who performed Pilates was caused by a decrease in levels of the hormone

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relaxin, but this possibility will need to be evaluated further in future studies. The hormone
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relaxin serves to relax ligaments in the pelvis for the birthing process [8], and also relaxes

the ligaments supporting the spine thus triggering pregnancy pain. Pregnancy pain is also
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aggravated by the separation of muscles due to the stretching of the uterus as well as by
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emotional stress [9]. Although the effects of Pilates are found only in short term [16], this
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study expands on previous findings that indicate that Pilates has been able to reduce pain in

women suffering from lower back pain [17], fibromyalgia [18], postmenopausal osteoporosis
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[19], and pain as results of infectin with the HTLV-1 virus [20].
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In conclusion, the results of this study showed that the Pilates workout is an effective,
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healthy, and feasible method of reducing pain, and thus is an alternative workout that is easy

to implement for the suppression of pain in the third trimester of pregnancy.

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REFERENCES
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16. Miyamoto GC, Costa LOP, Cabral CMN: Efficacy of the Pilates method for pain and
disability in patients with chronic nonspecific low back pain: a systematic review with
meta-analysis. Braz J Phys Ther 2013; 17:517-532.
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active/passive interventions on pain, anxiety, and quality of life in women with
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19. Angın E, Erden Z, Can F. The effects of clinical pilates exercises on bone mineral
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A randomized crossover clinical trial. J Bodyw Mov Ther 2014; 18(1):68-74.
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Figure 1. The pain scores before and after performing regular and Pilates exercise. The

reduction in the level of pain was found to be significantly greater in the group of pregnant

women undertaking the Pilates workout (p < 0.05).

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Table 1. Baseline clinical characteristics among subjects

Parameter Pregnant women + Pregnant women + p value

regular exercise Pilates exercise

(n = 20) (n = 20)

Age (years) 26.95 ± 4.94 28.70 ± 6.46 0.345

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Gestational age (weeks) 29.55 ± 0.98 29.65 ± 1.81 0.828

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Gravidity 1.55 ± 0.74 1.85 ± 0.81 0.235

Profession

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Homemaker 14 (70.00 %) 14 (70.00 %) 1.000

Professional 6 (30.00 %) 6 (30.00 %)

Initial pain scoring

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4.40 ± 1.69 4.45 ± 1.64 0.926
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Pregnancy complications none none
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Note: values are presented as mean ± standard deviation. Pregnancy complcations including

preeclampsia, hypertesion, postpartum hemorrhagic, premature birth.

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HIGHLIGHTS

• Pain in pregnant women was treated by Pilates

• Pain was significantly decreased by Pilates

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