PREGNANCY & PHYSIOTHERAPY

Discussion on Pregnancy and physiotherapy

1. ROLE OF A PHYSICAL THERAPIST IN PREGNANCY AND POSTPARTUM Dr. AISHWARYA RAI, MPT (NEURO), FELLOWSHIP IN REGENRATIVE REHABILITATION ASSISTANT PROFESSOR DEPARTMENT OF NEUROLOGICAL PHYSIOTHERAPY JYOTIRAO PHULE SUBHARTI COLLEGE OF PHYSIOTHERAPY SWAMI VIVEKANAND SUBHARTI UNIVERSITY MEERUT

2. WHY SHOULD PREGNANT WOMEN EXERCISE? All pregnant women without contra indications should be encouraged to exercise. Habits adopted during pregnancy could affect a woman’s health. Women with complicated pregnancy are discouraged from exercising for fear of aggravating the complications.

3. BENEFITS OF EXERCISES? PROBLEMS FACED BENEFITS Weight gain Low back ache Nausea F atigue V aricose veins Constipation Leg cramps Wrist and ankle swelling Insomnia Depression & anxiety Low self-confidence Body image issues Increases body awareness and builds a positive self –image Better ability to cope with labor and childbirth, reduces length of labor and prepares the body physically for physical demands of labor Promotes quicker post natal recovery. Improves core stability and pelvic floor strength. Improves glycemic control Protective effect on CAD, HTN, PAO Less maternal wt. gain and decreased BW. Helps acheive pre-pregnancy fitness levels. ANTENATAL

4. MUSCULOSKELETAL CHANGES

5. INCREASE IN THE ABDOMINAL SIZE COUNTER-BALANCED BY INCREASE OF LUMBOSACRAL ANGLE INCREASE OF LUMBAR LORDOSIS AND THORACIC KYPHOSIS BENDING FORWARD OVER THE ENLARGING UTERUS PROTRACTION OF SHOULDERS HYPEREXTENSION OF THE KNEES POSTURAL CHANGES

6. ANTENATAL CARE CARE OF THE WOMAN DURING PREGNANCY AIM IS TO ACHEIVE A HEALTHY MOTHER AND BABY AT THE END OF PREGNANCY STARTS IMMEDIATELY FROM THE TIME OF CONCEPTION

7. ABSOLUTE CONTRAINDICATIONS HEART DISEASES- IHD, RHD, CHF PLACENTA PRAEVIA PRETERM RUPTURE OF MEMBRANES PIH H/O PRETERM LABOR INCOMPETENT CERVIX ACUTE INFECTION THROMBOEMBOLISM PULMONARY EMBOLISM PERSISTANT SECOND OR THIRD TRIMESTER BLEEDING INTRAUTERNINE GROWTH RETARDATION

8. RELATIVE CONTRAINDICATIONS CHRONIC HTN UNCONTROLLED TYPE 1 DIABETES EXTREME MORBID OBESITY POORLY CONTROLLED SEIZURE DISORDER MILD TO MODERATE CARDIAC DISEASES SEVERE ANAEMIA TWIN PREGNANCY AFTER 28 TH WEEK EXERCISE INDUCED ASTHMA

9. WHEN TO STOP EXERCISING? EXCESSIVE SOB CHEST PAIN/PALPITATIONS PAINFUL UTERINE CONTRACTIONS PRESYNCOPE/ DIZZINESS VAGINAL BLEEDING EXCESSIVE FATIGUE ABDOMINAL PAIN REDUCED FETAL MOVEMENT LEAKAGE OF AMNIOTIC FLUID

10. OBJECTIVES SCREENING FOR FOETAL ABNORMALITIES EARLY IDENTIFICATION OF THE COMPLICATIONS AND ITS TREATMENT PROMOTE MUSCLE TONE, STRENGTH & ENDURANCE ENHANCE RELAXATION PREPARE FOR POST NATAL PROGRAM PROVIDING EDUCATION ON NUTRITION, PERSONAL HYGEINE AND BIRTHING PROCESS.

11. ROLE OF PHYSIOTHERAPY IN ANTENATAL CARE

12. BACK & PELVIC GIRDLE PAIN POSTURAL EDUCATION FOR PAIN RELIEF: GENTLE MASSAGE HOT PACKS TENS ACTVITIES THAT PRODUCE PAIN SHOULD BE AVOIDED.

13. SI JOINT DYSFUNCTION SUPPORT BELT SELF HELP MANEUVRES

14. SYMPHYSIS PUBIS DYSFUNCTION REST & REDUCTION OF NON ESSENTIAL CHORES KEEPING THE LEG ADDUCTED AVOIDING SINGLE LEG STANCE AVOIDING LONG STRIDES WALKING ON UNEVEN SURFACES OR ECCESSIVE USE OF STEPS GENTLE ISOMETRICS OF HIP ADDUCTORS PELVIC SUPPORT BELTS ICE PACKS

15. COCCYDYNIA DONUT CUSIONS GENTLE MOBILISATIONS ICE PACK HEAT TENS

16. PELVIC FLOOR DYSFUNCTION STRESS INCONTINENCE INCREASED RISK OF PELVIC ORGAN PROLAPSE KEGELS EXERCISE KEGELS BALLS, WEIGHTS, VAGINAL CONES, ELECTRONIC KEGEL EXERCISER IFT EMG TO TRAIN CONTROL BLADDER RETRAINING PROGRAMS

17. NERVE COMPRESSION SYNDROMES CTS MERALGIA PARAESTHETICA POSTERIOR TIBIAL NERVE COMPRESSION ICE PACK REST WITH HAND ELEVATED ULTRASOUND THERAPY SPLINTING LIMITING WRIST FLEXION TAPING

18. VARICOSE VEINS AVOIDING STANDING FOR LONG PERIODS OR SITTING WITH LEGS DEPENDANT ANKLE TOE PUMPS BRISK WALKING ELEVATION OF FEET WHEN SITTING OR LYING COMPRESSION STOCKINGS

19. MUSCLE CRAMPS CALF STRETCHES MASSAGE- DEEP KNEADING VIGOROUS FOOT EXERCISES PRE BEDTIME BRISK WALK WARM BATH ICE PACKS

20. CHONDROMALACIA PATALLAE ICE PACKS- 2-3 TIMES A DAY QUADRICEPS STRENGTHENING UTERINE LIGAMENT PAIN MASSAGING/STROKING AT THE AREA OF PAIN ICEING/WARMTH GENTLE STRETCHES MATERNITY BELT

21. SEAT BELTS ABOVE & BELOW THE BUMP, NOT OVER IT THREE POINT SEAT BELTS SHOULD BE WORN THROUGHOUT

22. POSTURE & ERGONOMIC ADVICE

23. EXERCISES FOR ANTENATAL PERIOD

24. RELAXATION WARM UP AEROBICS COOL DOWN

25. EXERCISES FOR DURING LABOUR

26. PAIN RELIEF IN LABOUR

27. RELAXATION BODY AWARENESS BREATHING MASSAGE MUSIC TENS

28. RELAXATION TECHNIQUES MITCHELL METHOD SHAVASANA BREATHING EXERCISES PURSED LIP BREATHING DEEP BREATHING VISUALISATION IMAGERY TOUCH MASSAGE

29. ROLE OF PHYSIOTHERAPY IN POST NATAL CARE

30. PROBLEMS FACED BENEFITS Incontinence Weight gain Flabby abdomen Back pain Fatigue Depression and anxiety. Weakness of the abdominal and back muscles. Improved strength and endurance Boosts self confidence Improves body posture Assisting recovery Teaching correct of ergonomics for breast feeding, handling baby & household chores. POSTNATAL

31. EXERCISES FOR POSTNATAL PERIOD

32. BREASTFEEDING POSITIONS

33. POSTNATAL PROBLEMS

34. PERINEAL PAIN REST ICEING FOR 10-15MINS EVERY 2-4 HOURS PELVIC FLOOR EXERCISES. USING CUSION WHILE SITTING PEME UST LLLT IRR

35. DIASTASIS RECTI ABDOMINAL ISOMETRICS HEAD LIFTS HEAD LIFT WITH PELVIC LIFTS LEG SLIDES WITH PELVIC TILTS PELVIC TILTS IN QUADRUPED POSITIONS ABDOMINAL BINDER

36. BACK PAIN ABDOMINAL INDURATIONS THORACIC PAIN SYMPHYSIS PUBIS VARICOSE VEINS OEDEMA DVT

37. STRESS INCONTINENCE KEGELS EXERCISE KEGELS BALLS, WEIGHTS, VAGINAL CONES, ELECTRONIC KEGEL EXERCISER IFT EMG TO TRAIN CONTROL BLADDER RETRAINING PROGRAMS

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