Physiotherapy in Pregnancy

WHAT ARE THE CHANGES DURING PREGNANCY ?

Changes during pregnancyAnatomical changes

-Stretching abdominal muscles-Decreased in ligamantous strength-Hypermobility of joints -Pelvic floor drops as much 2.5 cm

Physical changes -lordotic posture -COG shifts forward and upwards -Balance – mother walks with wider BOS

Stages of pregnancy

•Pre natal stage•During labour•Post natal stage

Problems during pre natal stage

-Faulty posture

-Upper & lower extremity stress

-Varicose vein ,LL oedema

-Urine incontinence & Stress incontinence

-Abdominal muscle stretch & diastasis recti

-Development of musculosketal pathologies-knee pains ,back pains

How to minimize these complications ???? Posture

Standing -stretch head up and out of shoulders and pull in abdominals -tighten buttocks -lean back against a wall for support if standing prolong time -try to go up & down for several times

Sleeping-quarter turn from prone ,pillow under the abdomen and between knees

-avoid supine positions-when turning in the bed ,keep knees flex together to decrease the strain

-Turn to a side ,put off the bended leg out of the bed ,put weight on to a one hand and slowly come to the sitting position

Sitting - Sit back into the chair with well

support - keep the feet well on a stool if

necessary - Do pelvic tilt regularly - Small cushion should be kept back

to maintain slight lumbar curve

Postures in ADL activities-playing with children kneeling position

-cleaning-ironing -cutting vegetables

Feet apart ,one foot forward possibly on a low stool.

At intervals of this activities it is important to ease the spine by

placing the hands on the iliac crest and easing the spine into

extension.

Exercises to prevent varicose veins ,oedema and lower limb strain

- Do not hang off the legs for prolong period of time

- Move feet up-down ,in-out and circle

- buregers’ exercises

Pelvic floor muscle strengthening

* Important in pre & post natal period

Abdominal strengtheningConcern on rectus abdominis specially

* Prior to abdominal strengthening , pelvic floor muscle strengthening is important

Important exercises during pre natal stage

Stretching exercises

Legs ,ankle hip adductors ,back , shoulder girdle

Strengthening exercises

• Abdominal• Back • Pelvic floor

Relaxation exercises

Breathing exercises

Mobilization exercises

Important exercises during labour

Breathing & relaxation exercises

• 1st stage –relax diaphragmatic breathing with short duration of pains

• 2nd stage –concentrate on expiration.

Important exercises in Post – natal stage

Normal delivery caesarean section

Normal delivery

-care of perineum & reliving perineal pain

-Sitting on ring cushion or folded pillow, side sitting during breast feeding

Advices on posture to prevent back strain with activities related to the baby

Awareness of stress incontinence

Advice on bed mobility, avoid straight sit ups and lifting techniques

Caesarian section

1st weekBreathing exercisesHuffing with pillow support Ankle & toe exercises Move on bed &getting out of bed

After 1 weekDeep breathingStrengthening exercises – pelvic

floor ,abdominalPelvic tilting

Pelvic tilting exercises

Crook lying position

Tilt- Relax-Tilt – Relax Exercise

6 weeks -6 monthsProne kneeling Back humping &hollowing

Back care and lifting

- avoid transferring weight through one leg for long time

-never stoop ,feet apart ,and the lifting object must be held in close to the body

lifting steps floor chair upright

Postures during post natal stage

• Breast feeding

• Carrying the baby

What not to do in Pregnancy???

• Bilateral SLR.• Unilateral wt. bearing activities.• Driving.• Heavy weight lifting.

THANK YOU !!!