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Pregnancy > Class 2/3 > Flashcards

Class 2/3 Flashcards

1
Q

What are some contraindications for abdominal pregnancy massage?

A

-First trimester of pregnancy or High Risk Pregnancies
-Problems with cervix and placenta
-threat of pre-term labour
-Vaginal/Uterine bleeding
-When the health of the fetus is in question

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2
Q

What are some indications for abdominal pregnancy massage?

A

-greatly beneficial for connection with baby,
-increase tissue and fascial stretch in the second and third trimesters,
-to enhance birth parent’s connection
with baby

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3
Q

Why do we massage from lateral to medial when performing pregnancy abdominal massage?

A

so as to not increase the
diastasis recti

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4
Q

What are some contraindications for pregnancy breast massage?

A

-High Risk Pregnancy
-Mastitis
-Breast cancer or presence of an undiagnosed lump
-Post surgical infection
-Current active infection
-Abscess

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5
Q

What are some indications in pregnancy patients for breast massage?

A

-High level of change in the
breast tissue
-Pain
-Congestion
-MSK structural imbalances
d/t pregnancy posture, Trp’s
and ↑ MRT in pectorals
-TOS d/t pregnancy posture

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6
Q

What are some indications in postpartum patients for breast massage?

A

Breastfeeding can lead to:
-Pain
-Congestion
-MSK structural imbalances
d/t breastfeeding positions
-TOS d/t breastfeeding
positions

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7
Q

What are some benefits of breast massage for pregnant patients?

A

-improves milk production,
-eases breast discomforts,
-reduces engorgement, and prevents mastitis,
-enhances emotional responses to breast changes,
-increases ability to hand
express milk

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8
Q

________ may appear for the first time during pregnancy.

A

Varicosities

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9
Q

With severe varicosities, there may be ______ in deeper veins

A

Clots

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10
Q

What are some symptoms of blood clots?

A

-Sudden severe Pain, swelling, heat and redness
-80-90% left leg/iliofemoral vein occurrence
- ↓ circulation to affected limb
-Pain upon palpation

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11
Q

_______ and ________ can increase the risk of clots.

A

bedrest and surgery

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12
Q

DVT’s are __x more likely to occur in pregnant Pt’s

A

6X

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13
Q

DVT’s are __x more likely to occur in the postpartum period and the patient has a __x
greater risk for developing a pulmonary emboli in comparison to pregnancy.

A
  • 5X
  • 15X
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14
Q

What are some risk factors for blood clots?

A

-caesarean section
-recent hip, pelvic or knee surgery
-leg injury
-history of previous DVT
-smoking
-40+
-obesity
-family history

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15
Q

T or F All blood clots are symptomatic.

A

F not all blood clots are symptomatic.

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16
Q

What are some contraindications in regards to varicosties and DVT?

A

-No Mx over varicosities or known blood clots/phlebitis
-No deep pressure to the adductor mm or inguinal region
* No Mx to legs if there are known clots

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17
Q

_______ increases as pregnancy progresses (needed for labour and delivery)

A

Relaxin

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18
Q

________ is usually more an issue than mobility in pregnany patients

A

Stability

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19
Q

What considerations should RMTs make to adapt a tx. to high levels of relaxin in pregnant patients?

A

-decrease MRT discomfort, but don’t want to destabilize their joints
-give exercises to increase stability

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20
Q

What hormones function to soften connective tissue in the body?

A

Relaxin and progesterone

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21
Q

When does the hormone ramp up of relaxin begin?

A

-begins at 10 weeks and continues through until 6 months postpartum

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22
Q

Which structures are most effected by the high amounts of relaxin released during pregnancy?

A

-Pelvis & lumbar spine primarily
-but also all other ligaments, joints, tendons, and fascia

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23
Q

How does the body compensate for the laxity of the connectivity tissue in pregnancy?

A

By increasing MRT

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24
Q

With which techniques should you take special care with during pregnancy massage in regards to the effects of relaxin?

A

-joint mobs,
-rhythmic mobs,
-stretching
-and overpressure.
-esp. if there’s a history of prior dislocation

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25
Q

What type of pressure should RMTs use when performing joint mobilizations on pregnant patients?

A

low grade pressure

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26
Q

What kind of joint mobilizations are completely CI’ed as they may induce pre-term labour?

A

Pelvic and sacral

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27
Q

What are some CI’s for sacral work in pregnancy massage?

A
  • No deep prolonged/pointed pressure work (may induce pre-term labour)
  • No sacral joint mobilizations
  • High Risk Pregnancies: sacral work completely CI’d
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28
Q

For non-high-risk patients, what kind of techniques should be applied to the sacrum?

A

general, broad massage techniques

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29
Q

When pregnant, an individual cannot have their body temperature exceed ____°F. This is because the fetus is unable to cool itself down.

A

102.6

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30
Q

Later in pregnancy, the pregnant patient is unable to tolerate ____ as well and can become dizzy and lightheaded with immersion in ____ or ___ temperatures.

A

heat
hot temperatures

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31
Q

What are some CI’s for hydrotherapy in pregnancy?

A

-Large scale or full body heat treatments:
-Saunas, whirlpools, steam treatments and are CI-ed
-baths can be modified with warm water, and partial immersion

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32
Q

What kind of hydrotherapy treatments is it safe to use during preganancy?

A

localized treatments, ie:
o thermophore to the low back and gluteals
o Paraffin wax to the iliotibial band
o Hydrocollator to the posterior trunk

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33
Q

How can a bath be modified for pregnant patients?

A
  • keeping the water temperature
    between 36.7 - 37.2 °C (body temperature),
    -not fully submerging the patient (keep their torso and arms out of the water).
    -fully CI-d for High-Risk Pregnancies.
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34
Q

What are some uses for hydrotheraphy in pregnancy massage?

A
  • reduce edema
    -reduce breast congestion, TOS, mastitis
    -warm-up tissues before performing scar tissue work to caesarian section scar
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35
Q

How can hydrotherapy be used to help with edema in pregnant patients?

A

-Cool towel wraps plus elevation can be placed on the feet and ankles or hands and
wrists to decrease edema caused by fluid retention
-Can be helpful for carpal tunnel syndrome

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36
Q

How can hydrotherapy be used to help with breast congestion, TOS, and mastitis in pregnant patients?

A
  • Cool figure 8 towels can be wrapped around the breasts to treat breast congestion,
    TOS and mastitis (pregnancy and postpartum)
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37
Q

_____ towels can be draped over the chest wall to decrease edema and fluid
retention leading to TOS (pregnancy and postpartum)
o Can use _____ towels on the breast postpartum if congestion has decreased

A

-Cool
-Warm

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38
Q

What are some hydrotheraphy modalities that could be used to warm up the area for caesarian section scar work?

A

-Castor Oil
-Paraffin Wax Treatments
-Deep Moist Heat

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39
Q

What are some indications for postpartum massage?

A
  • Stress reduction/improves connection
    with baby
  • Lower Back Px
  • Re-align pelvis
  • Breast Mx Assessing and treating
    postpartum/breastfeeding positional
    postural dysfunctions
  • Helps postpartum patient connect with
    new postpartum body (body forgets how
    not to be pregnant)
  • Discussing pelvic floor changes – referral
    when necessary
  • Assess diastasis recti
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40
Q

What are some postpartum Massage CI’s?

A

-DVT
-Hemorrhage

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41
Q

How long must you wait before performing deep work to the adductors, inguinal region or gastrocs?

A

-6 weeks postpartum at the earliest

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42
Q

If the patient hemorrhages during delivery, what are they at increased risk of?

A

hemorrhage 1-3 days post partum

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43
Q

What are some modifications for post partum patients who experienced hemorrhaging?

A

-No deep stimulating circulatory massage
-Use energetic work, or focused point-specific work to areas of tension
-Consider lack of energy from the loss of blood and any orthostatic hypotension when the Pt sits up after the mx.

44
Q

When is it safe to begin performing post partum abdominal massage?

A

-o 4-6 weeks postpartum vaginal birth
-6-8 weeks postpartum caesarean birth

45
Q

What needs to happen before it’s safe to begin performing work to the caesarean scar?

A

-Cannot commence until incision has healed-
-No deep work til 12 weeks post partum

46
Q

What are some important questions to ask postpartum patients?

A

-Vaginal or Caesarean Birth?
-1st, 2nd, 3rd-degree tears?

47
Q

What is an episiotomy?

A

-tearing of the perineum.

48
Q

When will episiotomies and caesarean incisions be sensitive to techniques that pull on the sutures?

A

during Joint mobilizations of pelvis, and glute/hip work.

49
Q

How long does relaxin remain present in the body for post partum?

A

-6 months
-low grade joint play only

50
Q

The post-partum patient may have increased ______ d/t the pregnancy and delivery

A

Edema

51
Q

What should be done to address post partum edema?

A

Lymph drainage

52
Q

What are common pelvic misalignments during the post partum period?

A

-SIJ dysfunction
-Innominate dysfunction
-Pubic Symphysis dysfunction

53
Q

What techs can be used to re-align the pelvis during post partum?

A

-MET,
-GST,
-Mm stripping,
-PIR

54
Q

What kind of hydro will you employ for postpartum patients?

A
  • breasts may be too tender in the postpartum period for Mx. Can use cool figure 8
    towel wraps
    -Utilize side-lying position
55
Q

Is it within our scope to ax. the pelvic floor?

A

Nope

56
Q

What are some postpartum symptoms which may lead you to refer out to a pelvic floor physiotherapist?

A
  • Poor bladder control
  • Urgency
  • LB, groin, pelvic Px
  • Pressure in vagina and rectum
  • Painful intercourse
57
Q

What is diastasis recti?

A

-thinning of the linea alba and a distancing of the abdominal mm from the linea alba
-Diagnosed by palpating a two-finger width between the rectus abdominis fibres

58
Q

When can diastasis recti begin in the pregnancy?

A

-DR can start in the second trimester, most common in the third trimester
-can also occur during labour and delivery

59
Q

If the DR is not corrected, what can it lead to as abdominal support is decreased?

A

back pain

60
Q

Why should you always massage the abdomen from lateral to medial?

A

to make sure you’re not increasing the diastasis recti

61
Q

How and when can you assess diastasis recti?

A

-any trimester, or postpartum
-in hooklying position

62
Q

T/F Pelvic floor issues can be a cause of diastasis recti?

A

True.
consider referral to a pelvic floor physiotherapist

63
Q

When pregnant, jackknifing forward from supine or sidelying to
seated position causes strains and spasms to uterine _________ and can
contribute to diastasis recti.

A

Ligaments

64
Q

Why might you give transverse abdominal contractions as a self care instruction?

A

-to support the transverse abdominis during pregnancy,
-to build the strength needed to push the baby out,
-to facilitate a stronger core in post-partum

65
Q

In what positions can pregnant patients perform pelvic tilts?

A

-supine
-hands and knees

66
Q

What are some factors which increase the risk of diastasis recti?

A

-obesity
-muscle weakness in core
-straining due to constipation
-large baby in comparison to size of pregnant parent
-previous hernia
-previous or multiple pregnancies
-relaxin and estrogen
-pushing during birth

67
Q

What may happen to postural dysfunctions in pregnancy?

A

Any dysfunction that was present prior to pregnancy may develop further.

68
Q

How often should you reassess posture during pregnancy?

A

-once per trimester (at least)

69
Q

Why might pregnancy encourage a kyphotic posture?

A

-Weight of breasts, uterus and fetus shift upper
thoracic area posteriorly as inferior ribcage shifts anteriorly
-can lead to TOS

70
Q

Which muscles are most affected by kyphotic posture during pregnancy, because of their role in supporting the weight of the breasts?

A

Rhomboids, pectorals, subscapularis,
scalenes and levator scapula.

71
Q

________ breathing occurs D/T increasing size of uterus, which restricts full diaphragmatic engagement and full ribcage expansion.

A

Apical

72
Q

What muscles are most affected by an anterior pelvic tilt during pregnancy, because of their role in supporting the weight of the abdomen?

A

Abdominals, iliopsoas, spinal erectors, adductors, lateral hip rotators, and pelvic floor

73
Q

What are some muscular presentations which may be present with anterior pelvic tilt?

A
  • Short psoas creates an anterior tilt
  • Short QL and erectors pull the iliac crests and sacrum superiorly increasing lordosis
  • Weak gluteals increase anterior tilt as they are unable to stabilize the pelvis and stop an external rotation of the coxafemoral joint
  • Hip flexors become short and tight
    -Hamstrings become long and weak and cannot stabilize the pelvis
74
Q

Which 2 chemicals help soften connective tissue in the body?

A

Relaxin and Progesterone

75
Q

Which structures are most affected by relaxin?

A

pelvis and lumbar spine
-but all ligaments, joints, tendons and fascia are effected

76
Q

When is relaxin present in the body?

A

-from 10 weeks gestation, can last up to 6 months PP

77
Q

How can relaxin affect the pelvis?

A

Joints can become hypermobile and lead to:
o Pain
o Up-slip of the iliac crest
o SIJD
* Pubic Symphysis joint dysfunction/separation
* Rotation of the innominate bone

77
Q

How can relaxin affect the pelvis?

A

Joints can become hypermobile and lead to:
o Pain
o Up-slip of the iliac crest
o SIJD
* Pubic Symphysis joint dysfunction/separation
* Rotation of the innominate bone

78
Q

Why do pregnant patients sometimes presenf with a waddle in 3rd trimester?

A

-psoas become hypertonic and spasmed. cannot maintain proper pelvic alignment
-Coxafemoral joints externally rotate
-Hip rotators initiate gait rather than the psoas

79
Q

Why may edema present in pregnant patients?

A

-Hormonal changes, mechanical constriction, ↓activity levels-
-esp in ankles, feet, hands and wrists

80
Q

What are some complications due to edema?

A

-carpal tunnel syndrome
-TOS

81
Q

How should you treat pregnancy related edema?

A

-↓ anterior pelvic tilt to help fluid flow past inguinal ligament
o Hydrotherapy modalities
o Elevation during tx and as self-care
o Encourage ↑ activity levels
o LD and GST

82
Q

What areas of the body are most likely to radiate pain in a sciatica-like presentation during pregnancy?

A

-piriformis syndrome
-psoas
-SIJ
-round ligament

83
Q

What are some symptoms of Meralgia Paresthetica?

A

usually caused by entrapment of the inguinal ligament
-Symptoms appear in anterolateral thigh
o Pain, burning, numbness, Muscle aches, coldness, lightning, buzzing

84
Q

What typically entraps the lateral femoral nerve to cause meralgia paresthetica?

A

usually the inguinal ligament

85
Q

What tends to aggravate and alleviate meralgia paresthetica?

A

-aggravates: standing for long periods, walking
-alleviates: sitting, lying down

86
Q

What happens to ligaments during pregnancy, which causes much discomfort for the patient?

A

ligaments may go into to spasm due to lengthening and stretching

87
Q

Where does the round ligament refer pain to?

A

lower pelvis, anterior leg, and most frequently sharp pain in groin

88
Q

Where does the broad ligament refer pain to?

A

lower back and glutes

89
Q

Where does the sacro-uterine ligament refer pain to?

A

sacrum, sciatic-like pain down the back of the leg, SIJ pain and diffuse LBP

90
Q

What do we use in order to properly position pt. on table in a way that adequately supports uterus?

A

towel roll

91
Q

What should we teach the pt. to do in order to relieve pain from the round ligament?

A

o Instruct to flex the hip of the affected side and apply direct palm or fingertip pressure to the painful area near the inguinal region or pubic bone
o Use slow, focused breathing during a spasm

92
Q

Which ligaments are AKA the suspensory ligaments of the breasts?

A

Cooper’s ligaments

93
Q

Why is the retro-mammary space clinically relevant?

A

-breast implants are often placed here
-Plays important role in lymphatic drainage of breast tissue

94
Q

The ______ _______ are glandular epithelium, designed to produce milk.

A

mammary glands

95
Q

The Production of Milk:
o All ______ drain into the ductile
o All ductules drain into a _____
o All _____ drain into a lactiferous sinus where the milk collects

A

-alveoli
-duct
-ducts

96
Q

Milk is not produced until __ - __ days postpartum

A

4-5

97
Q

What is the name of the yellow, antibody-filled substance that is produced by the breast, and acts as the baby’s first nourishment immediatedly postpartum?

A

colostrum

98
Q

What is the arterial supply for the breasts?

A

large subclavian artery

99
Q

What are the actual borders of the breast?

A

-Upper: lower edge of the clavicle
-lower: 1” or so below the breast contour,
-medial: sternal mid-line,
-lateral: anterior edge of lats, and into axilla

100
Q

What are some breast changes in 1st trimester?

A

o Growth of new ducts and early formation of new lobules
o increased size
o Dilation of superficial veins, increased pigmentation of the nipple/areola, and
tissue `heaviness’

101
Q

What are some breast changes in 2nd trimester?

A

-Lobule formation and glandular cell activation
o Alveolar epithelium converts into more specialized secretory cells with surface microvilli
o Colostrum begins to form in alveoli
o Hypertrophy of myoepithelial cells occurs in preparation to mobilize milk
o Increased connective tissue and fat

102
Q

What are some breast changes in 3rd trimester?

A

-Increased glandular cells and development
o Ongoing addition and dilation of acini
o Increased production of colostrum
o 180% increase in mammary blood flow
o Achy and heavy breasts

103
Q

What are acini?

A

-smallest functional unit of the breast and milk production

104
Q

What are some breast changes in postpartum?

A

-Epithelial cells convert into secretory state
o Breasts grow from birth to 4-5 days postpartum
o Colostrum is initially expressed, milk after 4-5 days
o Increased nipple soreness
o increased risk of mastitis d/t cracks in
nipples and areolae

Pregnancy (1 decks)

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