The trainer in the photo above is missing it…
When working with prenatal or postpartum clients, perhaps you begin by considering which exercises you’ll include in their programs. However, how they move is even more important. This holds true for how they move during their workouts, and throughout the rest of their day, because good alignment leads to fewer pregnancy pains and a faster postpartum recovery.
Therefore, one of the most critical coaching tips when working with pregnant or postpartum clients is neutral alignment.
Neutral alignment is important for any individual, but it’s especially important for your pre and postnatal clients. Let’s discuss what it is, why it’s so important, and how to help your clients find (and move in) neutral alignment.
For this lesson, you can choose to watch this video or read the lesson below it.
What is Neutral Alignment?
When the body is in neutral alignment, the skeleton is vertically stacked, as you see in the far-left image below. This top-down alignment is desirable because the skeletal structures hold the body upright. If the body is out of neutral alignment (as you see in the middle and right images below), it increases stress on the soft tissues, which forces the tissues to use more of their capacity just to manage the added stress placed upon them. This means they have less capacity to generate movement (or resist unwanted movement), which can result in movement compensations, pains, or injuries. Therefore, neutral alignment is much less costly energetically and much more efficient muscularly.
There are two criteria for being in neutral alignment:
- Vertical stacking: The first goal is to have vertical stacking of 5 landmarks: ears, shoulders, hips, knees, and ankles, as demonstrated by the yellow dotted line on the far-left photo above.
- Neutral pelvis: The other qualification is to ensure that the rib cage is stacked parallel on top of the pelvis, as noted by the horizontal lines in the far-left image. To find this, locate your ASIS (bony prominences in front of your pelvis) and imagine they are flashlights. Aim your lights straight ahead (as demonstrated in far-left photo). If the lights point to the ground, then you are in an anterior tilt (middle photo) and if they point to the sky then you are in a posterior tilt (right photo).
Common Pregnancy Alignment Shifts
As stated above, when the body is out of neutral alignment, it can lead to increased pains or injuries. Unfortunately, the physical changes of pregnancy tend to pull a person out of neutral. You can see this in the image below.
You can likely see the following common pregnancy alignment shifts:
- Anterior Pelvic Tilt: As the belly grows, it often tips the pelvis anteriorly resulting in lumbar lordosis (or the excessive lower back arch). This is one of the reasons that low back pain is the #1 most common pain during pregnancy.
- Rounded Shoulders: A consequence of the lumbar lordosis is that the other curves in the spine will accommodate, often leading to a more pronounced kyphosis of the thoracic spine. This can be exaggerated by the weight of the growing breasts.
- Shift in Center of Gravity (COG): A non-pregnant person’s COG is just below the navel. During pregnancy, the growing belly shifts the COG out and up. Some people may lean backwards to counterbalance the weight in front (as you can see in the photo). This places even greater pressure on the lower back.
- Wider Pelvis: The pelvis widens a bit to accommodate the growing baby and provide mobility for birth. A wider pelvis increases foot width, which means that gait and movement patterns will likely be altered, which can result in movement compensations.
It’s important to note that the movement compensations – and resulting pains and injuries – discussed above do NOT have to be an inevitable part of pregnancy. Therefore, coaching your client into neutral alignment will be a critical component of your prenatal training. It is also very important in postpartum training to minimize stress on a body that is trying to heal.
How to Coach Your Clients into Neutral Alignment
Once your client has found neutral alignment in a static position, the goal is to try to maintain this alignment during movement (at least for the most part). To maintain neutral during movement, think of keeping a straight line between ear-shoulder-hip so that the trunk moves as a unit.
The most important daily movement habits to help your pre and postnatal clients adjust are sitting and bending over due to the amount of time most people spend performing these activities each day. Try to help your clients achieve the alignment pictured below. Note the vertical stacking of ear-shoulder-hip.
Neutral alignment is especially important to keep in mind during workouts, as often you are adding load. Note the common anterior pelvic tilt we often see below in pregnant clients, which increases the stress on the low back and abdominal wall. Help your clients make the appropriate adjustments to achieve that vertical stacking and neutral pelvis.
It’s also important to correct the opposite alignment issue: spinal flexion (rounding), especially during hinge patterns (first photo below) or when sitting on the bike for a cycling class (second photo). When hinging, encourage clients to initiate the movement by reaching their tailbone toward the back wall and keeping that ear-shoulder-hip alignment. For cycling, encourage clients to raise their handlebars as pregnancy progresses.
Interested in Learning More?
While neutral alignment is the first concept we teach pre & postnatal clients, there is a lot that comes after that. To learn how to develop effective prenatal and postpartum training programs for clients of all stages and fitness levels, explore our education to become a Pre/Postnatal Performance Training Specialist.
Or, for a great free resource, check out our FREE 5-Day Guide to Training Pregnant Clients.