Antenatal Physiotherapy Management

Question 1

Why is PF education important during Antenatal?

Answer 1

• PF is individual to everyone and we can not predict the type of Childbirth that will happen. It is important to be educated on your PF so that we can be most prepared for labour and post partrum.
• Evidence has been shown that PFMT during pregnancy can help reduce the risk of UI in late pregnancy and post partum
• As we can’t control Intrapatrum factors which may impact PF, including
  - Forceps
  - Birth weight >4kg
  - Prolonged Labour 2nd stage
  - 2nd/3rd degree tears
  - LAM injuries

Question 2

How to prescribe PF and activation?

Answer 2

o Explain Anatomy to patient
o Explain role of PF in relation to pregnancy and post-partum
o Explain the contraction
o Verbal cues
 Squeeze and lift
 Gentle pull up
 Try to top urinating

Question 3

What is the Pelvic Girdle?

Answer 3

• The pelvic girdle attached the vertebral column to the limbs
• It helps to transmit force between the Upper and lower body
• Strength and stability is essential for optimal function

Question 4

How to assess the PG?

Answer 4

o Always exclude Lx pain
o LDL test in pregnant
 Palpation of LDL with patient side lying with slight hip and knee flexion. Pain persisting over 5 seconds after removal of examiners hand = positive
 If disappears = tenderness
 No pain = negative
o ASLR test
 20cm off bed
 Pain
o Provocation of symphysis by Modified Trendelenburg’s test
o Symphysis pain palpation test
o Thigh thrust test for posterior pelvic pain test

Question 5

Treatment of PGP

Answer 5

o Individually tailored programs - are more effective than general group training or no treatment.
o Stability Exercises
 Daily living exercises,
 Wall squats with exercise ball behind back
 Teach TA activation
 Progress eventually to a group program
o Massage - might be helpful. The working group agrees that massage could be given as part of a multifactorial individualized treatment program.
o Manipulation or joint mobilisation - may be used to test for symptomatic relief but should only be applied for a few treatments.
o A pelvic belt may be fitted - to test for symptomatic relief but should only be applied for short periods.
o Ergonomics – Reduce abduction activities, 1 leg stance, heavy lifting, extended walking or sitting. – MOST INFO SUPPORTING
o Rest – may be helpful
o Pillow between legs at night – may be helpful
o Heat therapy (SIJ) / ice therapy (SPD) – may be helpful
o Mobility Aides for non –weight bearing PGP – may be helpful for shorty period (ie. Crutches)

Question 6

What are the benefits of Exercise during pregnancy?

Answer 6

• Regular exercise can help reduce back pain, improve, or maintain muscle tone, reduce leg cramps, swelling and constipation and improve sleep patterns. - - When you exercise regularly it can help you to feel better, have more energy and tune in more to the changes happening in your body as your baby grows (or your babies if you are having twins or more).

Question 7

What are the precautions for exercise in pregnancy?

Answer 7

o Do Consult Your Doctor, Specialist or Midwife
o Watch Your Exertion Level
o Wear A Bra
o Eat Carbohydrates Before Exercise
o Monitor Your Rectus Diastasis
o Watch Your Posture
o Do Not Overheat

Question 8

What are the essentials for Exercise in pregnancy?

Answer 8

o Do Not Exercise on your back after 16 weeks of pregnancy
o Lying on your back can cause the weight of your growing baby to press down on the major veins to your heart and can result in you feeling dizzy or lightheaded and can reduce the blood flow to you and your baby.
o Be aware of the effect of pregnancy hormones

Question 9

Pelvic Girdle Pain (PGP) Influencing/Factors/Causes:

Answer 9

• Hormones (relaxin) after ~ 15 weeks may cause pain/instability in joints
• SIJ + Symphysis pubis instability
• Poor exercise options (i.e. NO unilateral WB, running, lunges)
• Behavioural/psychosocial factors (stress, anxiety)
• Rectus diastasis
• Medical history/co-morbidities may affect treatment options given
• Previous pregnancies
• Weak pelvic floor
• Birth weight/baby’s weight
• Patient’s BMI (high) increased stress on joints, particularly when sitting
• Ergonomics
• Previous/pre-existing lumbar spine pain
• Joint hypermobility (or other musculoskeletal pain)
• Footwear (i.e. high heels)