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The (Critical) Importance of Neutral Alignment

Before you even think about movement selection for your pregnant (and non-pregnant) clients, it’s essential to ensure their bodies are in proper neutral alignment.  When the body is out of neutral alignment, it places excessive stress on muscles — especially the core muscles — and if it isn’t obvious from the photo above, pregnancy pulls the body out of neutral.  When we couple this with the fact that a growing belly is also going to add excessive pressure to the core muscles, you can see where the potential for pains and injuries comes in.  Read on to learn how a woman’s alignment shifts and what you can do to help your clients Get in Neutral. 

Finding Neutral Alignment

Neutral alignment requires the following two checkpoints to be true:

  1. Vertical top-to-bottom stacking of ear-shoulder-hips-knees-ankles, as shown in the vertical dotted yellow line below.
  2. Neutral pelvis position (ASIS pointing directly forward), so the pelvis is stacked in parallel under the rib cage, as shown with the two solid yellow lines below.

Pregnancy Alignment Shifts

The growing belly and breasts during pregnancy tend to shift the body’s alignment in the following ways:

  • Her growing belly tips her pelvis forward into an anterior pelvic tilt
  • The belly also shifts her center of gravity (from just below the navel) out and up  
  • Her pelvis widens from the effects of the hormone, relaxin
  • Her growing breasts pull her shoulders forward into a rounded position

The more weight a woman gains outside the healthy weight gain guidelines, the greater her alignment shifts will be, and the greater chance she will have of experiencing pain and injuries like diastasis recti, pelvic floor dysfunction, lower back pain, SI joint pain, sciatica, pelvic girdle pain, carpal tunnel….the list goes on.

Finding Neutral

The first step is to help your client feel neutral alignment in a standing static position.  Watch this video to learn a few techniques you can use with clients to help them find their own neutral alignment (which is different for every person).

Moving in Neutral

Once your client is able to find her own neutral alignment in a standing position, you must then be able to help her stay in neutral throughout her movements.  The movements below all show examples of common anterior tilt alignment errors you’ll likely see, especially during pregnancy.  Use various cues (“close the rib cage,” “flashlights forward,” etc) to help her make the appropriate adjustments.  In quadruped, you can even place your hand above her lower back where neutral should be, and ask her to lift her lower back to touch your hand.

It’s also important to look out for spinal flexion, like in the movements below.  Remember to always cue neutral spine.  When hinging, make sure she initiates the movement by sending her hips backward vs. rounding forward.  For indoor cycling, often the biggest issue during pregnancy is less related to the heart rate elevation, and more so to her alignment on the bike.  You will likely need to move her seat back, and handle bars up as her belly grows.


Living in Neutral

Even if you had a client who trained with you every single day (and who does?), that’s still only 7 hours per week.  How she moves in her other 110+ waking hours of her week can have a far greater impact.  Ensure you are educating her on proper alignment in her daily life.  The two primary positions to focus on first are her seated alignment and bending over alignment.  We name these two because of the amount of time most people spend in these positions each day, and how common it is to perform them in poor alignment, like the photos below. These hunched over positions place excess stress on the core muscles, especially when you add a growing belly to that.

Once your client understands the principles of neutral alignment, you can move onto the other fundamental principle of helping her learn how to properly activate her deep core muscles.  Learn the #1 most important movement to teach your clients FIRST.