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Women's Health > L22: Antenatal Physiotherapy Management > Flashcards

L22: Antenatal Physiotherapy Management Flashcards

1
Q

What is the PERFECT Scheme for pelvic floor assessment?

A
  • Power
  • Endurance
    • Get to 10 secs (how long they can hold) –> anything more has no extra benefit
  • Repetitions
    • Go up to 10 reps
  • Fast contractions
    • Has fast and slow twitch
  • Every contraction timed (ECT)
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2
Q

What is the ICS grading for pelvic floor assessment?

A
  • Non-contractile
  • Gr 1- flicker (spasmic contraction)
  • Gr 2- some contraction

Do grade both sides (unilaterally)

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3
Q

What are 4 characteristics of pelvic floor education?

A
  1. Individual one on one programs vs. group programs
  2. Antenatal PFMT = some evidence to support decreased UI in late pregnancy and post partum
  3. Targeted populations (ie, first baby, SUI in pregnancy).
  4. You cannot control the intra partum events, which may influence pelvic floor function.
    • Forceps
    • Birth weight > 4000g
    • Prolonged second stage labour (More than 2 hrs)
    • 3rd/ 4thdegree tears
    • LAM injuries
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4
Q

What are 5 features of the superficial pelvic floor assessment?

A
  1. Crook Lying / side lying education
  2. Progressing to upright
  3. +/-RTUS
  4. Palpate TA
  5. Monitoring for accessory muscle movement
    1. Holding breath
    2. Pelvic tilts
    3. Abdominal bulging
    4. Glut activation
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5
Q

What are 2 situations when you do superficial pelvic floor assessment

A

Done in a hospital setting

  1. When you done have an ultrasound
  2. When you can’t do a vaginal exam
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6
Q

How do you progress pelvic floor assessments?

A
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7
Q

What are 4 characteristics in the pelvic floor prescription?

A
  1. Explain Anatomy to the patient
  2. Explain the role of Pelvic floor in relation to pregnancy and post partum
  3. Explain the contraction
  4. Verbal cues
    • Squeeze and lift
    • Gentle pull up
    • Try to stop urinating
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8
Q

What are 3 verbal cues of the pelvic floor prescription?

A
  1. Squeeze and lift
  2. Gentle pull up
  3. Try to stop urinating
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9
Q

What are 4 characteristics in pelvic floor prescription in the PERFECT?

A
  1. Power of contraction
  2. Endurance (how long can they hold)
  3. Repetitions (to fatigue)
  4. Fast contractions (to fatigue)
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10
Q

What is an example of pelvic floor assessment for a patient with G1P0 (G1= pregnant PO= never had a baby before), 18 weeks pregnant, referred for PFMT, no pre-existing UI, BMI 23, No pregnancy complications. What is the program?

A

P = 4

E = 8

R = 8 (How many reps before she can no longer)

F = 10 (Won’t go pass 10)

  • 8 x 8 second holds
  • 10 short / sharp contractions
  • Lying –upright
  • 3 sessions per day
    • This is adequate loading –> any more has no added benefit
  • Increase to fatigue (ECT)
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11
Q

What is the European Guidelines For Diagnosis And Treatment of PGP?

A

“Pelvic girdle pain generally arises in relation to pregnancy, trauma, arthritis and osteoarthritis. Pain is experienced between the posterior iliac crest and the gluteal fold, particularly in the vicinity of the SIJ. The pain may radiate in the posterior thigh and can also occur in conjunction with/or separately in the symphysis. The endurance capacity for standing, walking, and sitting is diminished. The diagnosis of PGP can be reached after exclusion of lumbar causes. The pain or functional disturbances in relation to PGP must be reproducible by specific clinical tests.”

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12
Q

What does the pelvic girdle attach?

A

Attaches the vertebral column to the lower limbs with the strongest ligaments of the body

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13
Q

What does the pelvic girdle transmit?

A

Transmits weight/forces between the upper body and the lower limbs

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14
Q

What is the pivotal point for the pelvic girdle?

A

strength and stability is essential for optimal function

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15
Q

What is the function of the pelvic girdle?

A

Supports and protects the bladder, uterus

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16
Q

What are the 4 aetiology factors of PGP?

A
  1. Hormonal factors?
  2. Relaxin/alteration in relaxin receptors ?
  3. Asymmetrical movement or positioning of pelvic joints/altered pelvic girdle biomechanics secondary to altered neuro‐muscular control
  4. Pre existing LBP / joint hypermobility ?
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17
Q

What is the function of the pelvis in load transfer?

A

A primary function of the pelvis is to transfer the loads generated by body weight and gravity during standing, walking, sitting and other functional tasks.

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18
Q

Optimal force closure of the pelvic girdle requires just the right amount of _____ being applied at just the right ____.

A

force; time

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19
Q

What is the questionnaire for pelvic girdle pain for pregnancy?

A

Pregnancy –Related Pelvic Girdle Questionnaire

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20
Q

How does the PGP Questionnaire work?

A

Just tick the boxes

  • Look at which boxes have been ticked
  • Tick on left side = okay
  • Ticks on right side = not okay
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21
Q

What is the LDL test in pregnant women for CPP?

A

The patient lies on her side with slight flexion in both hip and knee joints. If the palpation causes pain that persists for more than 5seconds after removal of the examiner’s hand it is recorded as pain. If the pain disappears within 5seconds it is recorded as tenderness Over sacroilliac joint –> reproduction of pain Need to palpate both sides

22
Q

What is the active straight leg raise test for PGP?

A

The patient lies supine with straight legs and the feet 20cm apart. The test is performed after the instruction: “Try to raise your legs, one after the other, above the couch for 20cm without bending the knee”.

The patient is asked to score any feeling of impairment (on both sides separately) on a 6-point scale:

not difficult at all=0;

minimally difficult=1;

somewhat difficult=2;

fairly difficult=3;

very difficult=4;

unable to do=5.

The scores on both sides are added so that the sum score can range from 0 to 10.

  • Don’t get them to do lie on back for too long –> pregnant
  • Reproduction of pain in SIJ –> see if they have load transfer (eg. lift left leg –> should get symptoms in right leg)
23
Q

What is the Pain provocation of the symphysis by Modified Trendelenburg’s test for PGP?

A
  • The patient stands on one leg and flexes the hip and knee at 90degrees.
  • If pain is experienced in the symphysis the test is considered positive.
  • Load transfer –> pain in pubis symphysis
24
Q

What is the Symphysis pain palpation test for PGP?

A

The patient lies supine. The entire front side of the pubic symphysis is palpated gently. If the palpation causes pain that persists more than 5s after removal of the examiner’s hand, it is recorded as pain. If the pain disappears within 5s it is recorded as tenderness This test needs informed consent Pain even after 5 secs –> called “tenderness” Pain when palpating –> rate out of 10

25
Q

What is the Posterior pelvic pain provocation test “thigh thrust” test for PGP?

A

The test is performed supine and the patient’s hip flexed to an angle of 90degrees on the side to be examined: light manual pressure is applied to the patient’s flexed knee along the longitudinal axis of the femur while the pelvis is stabilized by the examiner’s other hand resting on the patients contralateral superior anterior iliac spine. The test is positive when the patient feels a familiar well localized pain deep in the gluteal area on the provoked side

  • Look for reproduction of symptoms
  • Only done if can’t reproduce symptoms in other test as it is very irritable
26
Q

What are 5 PGP assessment?

A
  1. The LDL test in pregnant women
  2. Active straight leg raise test
  3. Pain provocation of the symphysis by Modified Trendelenburg’s test
  4. Symphysis pain palpation test
  5. Posterior pelvic pain provocation test “thigh thrust” test
27
Q

What are 10 PGP treatments?

A
  1. Individually tailored programs -are more effective than general group training or no treatment. Cant pick up psychological, red flags, yellow flags
  2. Stability Exercises Bilaterally weight bearing (not shearing any of the joints)
  3. Massage -might be helpful. The working group agrees that massage could be given as part of a multifactorial individualized treatment program.
  4. Manipulation or joint mobilisation -may be used to test for symptomatic relief, but should only be applied for a few treatments.
  5. A pelvic belt may be fitted -to test for symptomatic relief, but should only be applied for short periods. •
  6. Ergonomics –Reduce abduction activities, 1 leg stance, heavy lifting, extended walking or sitting.
  7. Rest –may be helpful
  8. Pillow between legs at night –may be helpful
  9. Heat therapy (SIJ) / ice therapy (SPD)–may be helpful
  10. Mobility Aides for non –weight bearing PGP –may be helpful for shorty period (ie. Crutches)
28
Q

________ programs are more effective than general group training or no treatment in PGP treatment.

A

Individually tailored

29
Q

Why is massage helpful for PGP treatment?

A

might be helpful.

The working group agrees that massage could be given as part of a multifactorial individualized treatment program.

30
Q

Why is Manipulation or joint mobilisation helpful for PGP treatment?

A

may be used to test for symptomatic relief, but should only be applied for a few

31
Q

Why can a pelvic belt be fitted for PGP treatment?

A

to test for symptomatic relief, but should only be applied for short periods.

32
Q

When is a pelvic belt used?

A

If have isolated right PGP = Good candiate

‘Do not give for PS pain = Irritable

33
Q

Why is ergonomics important for PGP treatment?

A

Reduce abduction activities, 1 leg stance, heavy lifting, extended walking or sitting.

Can warn them but if they have some negative beliefs (eg. give modified exercise)

“Can do this for the rest of their life”

34
Q

Why are mobility aides important for PGP treatment?

A

for non –weight bearing PGP –may be helpful for shorty period (ie. Crutches)

Only if they are not responding to treatment

35
Q

What flexible compression - SPD?

A
36
Q

Exercises should focus on adequate advice concerning activities of ______ and to avoid _____ movement patterns and be pain free.

A

daily living; maladaptive

37
Q

There was no significant difference between the groups during pregnancy or at the follow-up (3, 6 and 12months postpartum) regarding pain ____ and _____. Two trials of moderate to low methodological quality studying individualized physical therapy with exercises show significant positive effects on pain intensity and sick leave.

A

intensity; activity

38
Q

What are 3 characteristics of stabilising exercises?

A
  1. Pelvic Floor Assessment ++ –make sure this can withstand increased IAP.
  2. Teach co-activation with exercises and with functional activities throughout the day.
  3. PFMT + TA with global muscle activation.
39
Q

What is changing posture during pregnancy?

A

decrease stress on joints, muscles, ligaments

40
Q

What occurs in hyper mobility?

A
  • Ligaments don’t stop range
  • No end range
41
Q

What are 5 PGP outcomes?

A
  1. Risk to psychological health, depression
  2. Increased sick leave
  3. ? Associated with urinary incontinence If poorly maintained –> some correlation
  4. ? Increased use of analgesics during pregnancy Does not work –> physio works
  5. ? Influence on mobility in labour and mode C-section VS vaginal
42
Q

What are 4 characteristics of Antenatal Exercise Classes?

A
  1. Appropriate screening tools –PGP, LBP, SUI, systemic issues (ie. BP)
  2. Class size
  3. Subgroup patients (trimesters / pain)
  4. Education and PFM training before class
43
Q

What are the benefits of regular exercise during pregnancy?

A

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).

44
Q

What are 8 precautions of exercises in pregnancy?

A
  1. Do Consult Your Doctor, Specialist or Midwife
  2. Watch Your Exertion Level
  3. Wear A Bra
  4. Eat Carbohydrates Before Exercise
  5. Monitor Your Rectus Diastasis
  6. Watch Your Posture
  7. Do Not Overheat
  8. ACOG guidelines.
    • ACOG: American College of Obstetrics and Gynaecology –> good guidelines
45
Q

Do Not Exercise on your back after ______ weeks of pregnancy

A

16

46
Q

Why should you not exercise on your back after 16 weeks of pregnancy?

A
  • 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.
  • Be aware of the effect of pregnancy hormones
  • Don’t lay on bad on hard surfaces for a long period of time without moving
  • Big vein though the left side –> feeds placenta
  • If lie on back –> can compress vein that goes to the placenta –> dangerous
47
Q

What is the purpose of the perineal massage?

A

Decrease risk of tears if everything is uncomplicated

Increase elasticity and stretch of perineum

Decrease perineal trauma?? Intrapartum factors!

48
Q

What timeline should perineal massage?

A

From approx 37 weeks (OBGYN / Midwife to advise patient)

49
Q

What motion should the perineal massage be done?

A

6’oclock to 3’oclock motion

50
Q

What are 12 Contraindications for Pregnant Women?

A
  1. NMES ( neuromuscular electrical stimulation)
  2. Short wave diathermy
  3. Therapeutic USSAs long as not over belly –> but don’t use it
  4. IF
  5. Heat over pregnant abdomen
  6. No supine positioning for treatment (side lying)
  7. No prone!
  8. No NSAID’s Anti-inflammatories –> thin the blood –> don’t want placenta to bleed
  9. No compressive garments over pregnant abdomen
  10. No high impact exercise (case appropriate)
  11. Sauna’s/spas are not OK ! If mum heats up –> baby heats up
  12. Always talk to senior WH physio or OBGYN if you are unsure as you are caring for the patient and the fetus.
51
Q

How to differentiate between lumbar spine or SIJ?

A

Active ROM

Women's Health (7 decks)

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