Lab 8Lab 8

Low Back Pain and PregnancyLow Back Pain and Pregnancy

Presented by:Presented by:

Katie FarrellKatie Farrell Kimberly HarperKimberly Harper

Carly Lepp Carly Lepp Meggan McCleodMeggan McCleod

Low Back PainLow Back Pain

General AnatomyGeneral Anatomy

There are 24 independent vertebrae in the There are 24 independent vertebrae in the human spine. human spine.

7 in the cervical region, 12 in the thoracic 7 in the cervical region, 12 in the thoracic region and 5 in the lumbar region. region and 5 in the lumbar region.

The lower lumbar vertebra is attached to The lower lumbar vertebra is attached to the sacrum which is a bone consisting of the sacrum which is a bone consisting of several vertebrae fused together. several vertebrae fused together.

This area around the lumbar spine and This area around the lumbar spine and sacrum is the most common site for back sacrum is the most common site for back pain due to the instability caused by the pain due to the instability caused by the changing curvature of the spine in this area.changing curvature of the spine in this area.

Between each vertebra is a disc designed Between each vertebra is a disc designed to reduce the frictional and compressive to reduce the frictional and compressive forces between the bones. forces between the bones.

Causes of Low Back PainCauses of Low Back Pain

Lower back pain is one of the most Lower back pain is one of the most common illnesses experienced by humans common illnesses experienced by humans and usually is associated with the aging and usually is associated with the aging process. However, aside from the natural process. However, aside from the natural aging process there are several different aging process there are several different causes for lower back paincauses for lower back pain

Causes of Low Back PainCauses of Low Back Pain

Lower back pain could be a result of Lower back pain could be a result of Muscle strainMuscle strain Spondylolysis or spondylolisthesis *Spondylolysis or spondylolisthesis * Lumbar disc injury/degenerationLumbar disc injury/degeneration General disc disfunctionGeneral disc disfunction

* Spondylolysis is the occurrence of a stress fracture to the spine. If * Spondylolysis is the occurrence of a stress fracture to the spine. If the stress fracture worsens and the vertebra can no longer the stress fracture worsens and the vertebra can no longer

maintain its position and shifts it is known as spondylolisthesismaintain its position and shifts it is known as spondylolisthesis. .

Muscle StrainMuscle Strain Low back pain caused by a muscle strain involves tears Low back pain caused by a muscle strain involves tears

to the muscle fibers in the muscles surrounding the to the muscle fibers in the muscles surrounding the spine. This condition is quite common and can be spine. This condition is quite common and can be caused by a number of things but is usually caused by caused by a number of things but is usually caused by trauma or by overuse. trauma or by overuse.

If the strain is caused by trauma the affected muscle If the strain is caused by trauma the affected muscle must go through the three phases of soft tissue healing must go through the three phases of soft tissue healing and rest is usually prescribed. The three phases of soft and rest is usually prescribed. The three phases of soft tissue healing are:tissue healing are:

The acute inflammitory phaseThe acute inflammitory phase The proliferative/ repair and regenerate phaseThe proliferative/ repair and regenerate phase The maturation/ remodelling phase The maturation/ remodelling phase

The entire healing process can take up to one year but the majority The entire healing process can take up to one year but the majority of healing is complete within the first two weeks and a return to of healing is complete within the first two weeks and a return to normal activity is usually permitted at this time.normal activity is usually permitted at this time.

Muscle StrainMuscle Strain

If the strain is caused by overuse it is required that the If the strain is caused by overuse it is required that the cause of the incorrect movement patterns be corrected. cause of the incorrect movement patterns be corrected. Retraining the muscles and improving posture will also Retraining the muscles and improving posture will also help prevent further injury. Once the cause has been help prevent further injury. Once the cause has been corrected rest may be prescribed. corrected rest may be prescribed.

The muscle does have to go through the phases of soft The muscle does have to go through the phases of soft tissue healing but if the initial cause is not corrected the tissue healing but if the initial cause is not corrected the muscle will not heal.muscle will not heal.

If the overuse injury causes a stress facture in the If the overuse injury causes a stress facture in the vertebra it is known as spondylolysis. If the fracture is vertebra it is known as spondylolysis. If the fracture is not treated and worsens the vertebra will become not treated and worsens the vertebra will become unstable and shift causing a spondylolisthesis. unstable and shift causing a spondylolisthesis.

Progressive Disc DegenerationProgressive Disc Degeneration

Low back pain caused by disc degeneration involves a Low back pain caused by disc degeneration involves a decrease in the function of the intervertebral discs.decrease in the function of the intervertebral discs.

Disc degeneration occurs in all humans as a part of the Disc degeneration occurs in all humans as a part of the natural aging process that causes an overall decrease in natural aging process that causes an overall decrease in collagen and water levels in the body. collagen and water levels in the body.

The disc is made up mostly of collagen and water and is The disc is made up mostly of collagen and water and is divided into two parts; the annulus fibrosis and nucleus divided into two parts; the annulus fibrosis and nucleus pulposa. The nucleus pulposa contains a highly hydrated pulposa. The nucleus pulposa contains a highly hydrated matrix filled with collagen making it particularly matrix filled with collagen making it particularly vulnerable to the aging process. vulnerable to the aging process.

The loss of fluids and collagen causes the disc to The loss of fluids and collagen causes the disc to compress thus no longer providing the cushioning to compress thus no longer providing the cushioning to absorb the forces placed on the spine.absorb the forces placed on the spine.

Progressive Disc DegenerationProgressive Disc Degeneration Although the natural aging process is to blame Although the natural aging process is to blame

for some degeneration, improper posture can for some degeneration, improper posture can worsen the problem.worsen the problem.

Improper posture causes a change in the Improper posture causes a change in the biomechanics of the spine. This causes undue biomechanics of the spine. This causes undue wear and tear to the disc adding to the loss of wear and tear to the disc adding to the loss of function. function.

Also, the accumulation of debris in the disc Also, the accumulation of debris in the disc because of enzymatic dysfunction can because of enzymatic dysfunction can accelerate the degenerative effects. There is accelerate the degenerative effects. There is little that can be done to prevent this but proper little that can be done to prevent this but proper posture and maintaining hydration are good posture and maintaining hydration are good ways to lessen the negative effects.ways to lessen the negative effects.

TreatmentTreatment

Medications- analgesics, muscle relaxants, and anti- Medications- analgesics, muscle relaxants, and anti- inflammatory drugsinflammatory drugs

BedrestBedrest Decreasing physical activity- especially contact sportsDecreasing physical activity- especially contact sports Exercise- within limits Exercise- within limits ManipulationManipulation Postural re-trainingPostural re-training Bio-feedbackBio-feedback ThermotherapyThermotherapy PsychotherapyPsychotherapy ChemonucleolysisChemonucleolysis SurgerySurgery

Contraindications for ExerciseContraindications for Exercise

Passive lumbar flexionPassive lumbar flexion Active lumbar extensionActive lumbar extension Stretches that call for the knees to be Stretches that call for the knees to be

brought towards the chestbrought towards the chest Also avoid any exercise that does not Also avoid any exercise that does not

provide adequate support or the lower provide adequate support or the lower backback

* It should be noted that the cause of the pain needs to be * It should be noted that the cause of the pain needs to be examined by a physician before a person can begin examined by a physician before a person can begin exercise to avoid making the pain worseexercise to avoid making the pain worse

PregnancyPregnancy

PregnancyPregnancy Pregnancy begins the moment a sperm fertilizes a Pregnancy begins the moment a sperm fertilizes a

woman’s egg or ovum. The average pregnancy lasts 40 woman’s egg or ovum. The average pregnancy lasts 40 weeks (roughly 9 months). The 9 month period is divided weeks (roughly 9 months). The 9 month period is divided into three equal time periods of about 3 months called into three equal time periods of about 3 months called trimesters. trimesters.

During the first trimester there is little change in the During the first trimester there is little change in the mother’s body however this is a critical period for the mother’s body however this is a critical period for the developing fetusdeveloping fetus

At the beginning of the second trimester the physical At the beginning of the second trimester the physical changes such as weight gain begin to become evident in changes such as weight gain begin to become evident in the mother. the mother.

The third trimester is the period of most rapid fetal The third trimester is the period of most rapid fetal growth which corresponds with the period of most growth which corresponds with the period of most extreme change in the woman’s body as she prepares extreme change in the woman’s body as she prepares for the birthing process for the birthing process

Changes to the Woman’s BodyChanges to the Woman’s Body

Many changes occur within the woman’s body to Many changes occur within the woman’s body to prepare her for the birthing process. The prepare her for the birthing process. The following changes are a concern when following changes are a concern when prescribing exercise to pregnant women.prescribing exercise to pregnant women. Hormone release resulting in joint laxity especially in Hormone release resulting in joint laxity especially in

the pelvis and lower backthe pelvis and lower back Weight gain concentrated in the abdomen resulting in Weight gain concentrated in the abdomen resulting in

a forward shift of the center of massa forward shift of the center of mass Changed body composition resulting in an increased Changed body composition resulting in an increased

fat mass.fat mass.

Weight Gain during PregnancyWeight Gain during Pregnancy

Weight gain during pregnancy is the most drastic Weight gain during pregnancy is the most drastic of the changes a woman experiences as she of the changes a woman experiences as she can gain anywhere from 15 to 40 pounds by the can gain anywhere from 15 to 40 pounds by the end of the third trimester. The weight is end of the third trimester. The weight is distributed unevenly (most goes to the belly distributed unevenly (most goes to the belly area) causing a shift of the woman’s center of area) causing a shift of the woman’s center of mass anteriorly. The copious weight gain is one mass anteriorly. The copious weight gain is one of the main motivators for exercise during of the main motivators for exercise during pregnancy as it can have negative effects such pregnancy as it can have negative effects such as low back pain, fatigue and weight retention as low back pain, fatigue and weight retention after the birth. after the birth.

Reasons for Exercise during Reasons for Exercise during PregnancyPregnancy

There are also several other motivators for There are also several other motivators for exercise during pregnancy including:exercise during pregnancy including: Feelings of self-consciouness about the Feelings of self-consciouness about the

changing bodychanging body Concern about having a healthy babyConcern about having a healthy baby Desire to stay in shapeDesire to stay in shape Want to be able to handle the physical rigors Want to be able to handle the physical rigors

of labor and deliveryof labor and delivery Social interactions and supportSocial interactions and support

Benefits of ExerciseBenefits of Exercise Improved cardiovascular and muscular fitnessImproved cardiovascular and muscular fitness Facilitated recovery from laborFacilitated recovery from labor Faster return to pre pregnancy weight, strength and Faster return to pre pregnancy weight, strength and

flexibility levelsflexibility levels Reduced post partum bellyReduced post partum belly More energy reserveMore energy reserve Fewer obstetric interventions Fewer obstetric interventions Shorter active phase of labor and less painShorter active phase of labor and less pain Less weight gainLess weight gain Enhanced maternal psychological well being that may Enhanced maternal psychological well being that may

reduce feelings of stress, anxiety, and depression often reduce feelings of stress, anxiety, and depression often experienced during pregnancy.experienced during pregnancy.

Increased likelihood of adopting permanent healthy Increased likelihood of adopting permanent healthy lifestyle habitslifestyle habits

Exercise Specifics for Pregnant Exercise Specifics for Pregnant WomenWomen

Moderate exercise sessions are advised because research has Moderate exercise sessions are advised because research has shown that there is a link between reduced birth weights in babies shown that there is a link between reduced birth weights in babies whose mothers performed high-intensity exercise throughout whose mothers performed high-intensity exercise throughout pregnancy by 300-350grams (10-12 ounces) on average. Also pregnancy by 300-350grams (10-12 ounces) on average. Also there was an increase in fetal heart rate in babies whose mothers there was an increase in fetal heart rate in babies whose mothers who performed high-intensity exercise during pregnancy by 5-who performed high-intensity exercise during pregnancy by 5-15bpm on average. Rating of perceived exertion should be used to 15bpm on average. Rating of perceived exertion should be used to determine moderate exercise levels.determine moderate exercise levels.

Should use weight machines which provide more stability and Should use weight machines which provide more stability and support than free weights.support than free weights.

Back lying (supine) position may result in restricted venous return of Back lying (supine) position may result in restricted venous return of blood because of increasingly large uterus. Women should perform blood because of increasingly large uterus. Women should perform more exercise on their side or hand and knees, then on their back. more exercise on their side or hand and knees, then on their back.

Pelvic floor exercises (kegels) are another important element of Pelvic floor exercises (kegels) are another important element of resistance training during pregnancy. This involves tightening and resistance training during pregnancy. This involves tightening and relaxing muscle groups in the pelvic region which will help with relaxing muscle groups in the pelvic region which will help with delivering the baby. delivering the baby.

Although exercise is most often beneficial Although exercise is most often beneficial there are three key concerns for potential there are three key concerns for potential adverse outcomesadverse outcomes Insufficient oxygen or energy substrates to the Insufficient oxygen or energy substrates to the

fetusfetus Hyperthermia- induced fetal distress or birth Hyperthermia- induced fetal distress or birth

abnormalitiesabnormalities Increased uterine contractions Increased uterine contractions

Contraindications for ExerciseContraindications for ExerciseA pregnant woman experiencing any of the following should avoid exerciseA pregnant woman experiencing any of the following should avoid exercise Pregnancy induced hypertensionPregnancy induced hypertension Ruptured membranesRuptured membranes Premature labor during the current pregnancy Premature labor during the current pregnancy Persistent bleeding after 12 weeksPersistent bleeding after 12 weeks A cervix that dilates ahead of scheduleA cervix that dilates ahead of schedule Heart diseaseHeart disease Lung diseaseLung disease Multiple birth pregnancyMultiple birth pregnancy A placenta that blocks the cervix after 26 weeksA placenta that blocks the cervix after 26 weeks DiabetesDiabetes SeizuresSeizures Extreme obesityExtreme obesity Extreme low body weightExtreme low body weight History of a very sedentary lifestyle History of a very sedentary lifestyle

Discontinue exercise if:Discontinue exercise if: Any signs of bloody dischargeAny signs of bloody discharge Swelling of ankles, hands or faceSwelling of ankles, hands or face Headaches, fainting, dizzinessHeadaches, fainting, dizziness Swelling, pain or redness in the calf of one legSwelling, pain or redness in the calf of one leg Increase pulse rate or blood pressure that Increase pulse rate or blood pressure that

persist after exercisepersist after exercise Persistent contractionsPersistent contractions Unexplained abdominal painUnexplained abdominal pain Insufficient weight gain Insufficient weight gain If any of the above should happen it is important that the If any of the above should happen it is important that the

woman seek medical attention immediately. woman seek medical attention immediately.

Exercise GuidelinesExercise Guidelines

30 minutes of moderate exercise 5-7 days per 30 minutes of moderate exercise 5-7 days per week including both strength training and week including both strength training and some aerobic conditioningsome aerobic conditioning

Age-predicted HR targets are less reliable Age-predicted HR targets are less reliable during pregnancy. Thus, a talk test or Borg during pregnancy. Thus, a talk test or Borg scale is a better predictor of intensity.scale is a better predictor of intensity.

It is very important that pregnant women It is very important that pregnant women consult with a physician before beginning an consult with a physician before beginning an exercise regimen to ensure that exercise is exercise regimen to ensure that exercise is healthy for both the mother and child.healthy for both the mother and child.

The EndThe End

Thank you for your time.Thank you for your time.