Pelvic Health Pt. 2

Question 1

what should be done insure bladder health

Answer 1

1. go every 3-4 hours
2. 5-7x in 24 hours
3. no “just in case”
4. go for 8 “Mississippi’s”
5. sit on toilet
6. no straining
7. avoid constipation
8. drink enough water

Question 2

MSK compensations and physiologic changes with pregnancy

Answer 2

1. increased ligament laxity due to hormone changes
2. weight gain and fluid excess
3. forward shift of COG
4. flattened arches, diastasis recti abdominis
5. pubic symphysis and SIJs widen
6. nerve compression and neuropathy
7. forward pelvic tilt, increased thoracic, kyphosis and lumbar lordosis stretching/weaken abdominals, lumbar strain
8. thoracic cage expansion
9. subcostal angle increases from 68-108 degrees
10. rib cage increases by 2 cm transversely and 10-15 cm in circumference

Question 3

describe urogenital changes with pregnancy

Answer 3

1. kidneys elongate by 1 cm with ureter dilation
2. detrusor hypertrophy, decreased bladder tone and increased capacity
3. urethral vesicle angle becomes perpendicular, pelvic floor muscles on stretch which increases stress urinary incontinence urgency and frequency
4. 2 lb increase in breast tissue
5. uterus rises above pelvic ring at 12 weeks which limits supine positioning

Question 4

describe postpartum changes

Answer 4

1. mostly in the 6-8 week phase
2. full urinary continence by 4 weeks
3. joint laxity decreases and returns to normal 3 months after delivery or cessation of nursing

Question 5

list different types of MSK pain in pregnancy

Answer 5

1. LBP
2. SIJ dysfunction
3. Thoracic pain
4. Coccydynia
5. Diastasis Recti Abdominis
6. Pelvic Floor Dysfunction
7. Urinary incontinence

Question 6

list post-partum indications for treatment

Answer 6

1. MSK dysfunction of spine, ribs, pelvis, etc.
2. postural dysfunctions
3. post-op pain and immobility
4. pelvic organ prolapse
5. pelvic pain
6. incontinence
7. diastasis recti

Question 7

who is at risk for pelvic floor dysfunction and other MSK issues?

Answer 7

1. multiparous women
2. systemic hypermobility
3. increased BMI
4. previous lumbopelvic injury or pain
5. advanced maternal age
6. increased parity
7. pre-existing MSK condition

Question 8

describe postpartum pelvic floor dysfunction

Answer 8

1. pelvic floor is stretched and exposed to strain from increased intra-abdominal pressure during pregnancy and delivery
2. changes may result in urinary and/or fecal incontinence and prolapse of pelvic organs
3. urinary incontinence is normal for 3-4 weeks postpartum but should resolve by 8-12 weeks postpartum
4. about ⅓ of women have UI and 10% have fecal incontinence after childbirth

Question 9

list risk factors for persistent postpartum incontinence

Answer 9

1. SUI during pregnancy
2. older age at first pregnancy
3. greater parity
4. obesity (abdominal girth)
5. vaginal delivery
6. previous UI

Question 10

describe postpartum PT

Answer 10

1. evidence supports a combo of approaches
2. multiple studies support combo intervention including exercise, edu, support belts, and manual therapy
3. review of 26 RCTs indicate pain and function sig improved with osteopathic manipulation and combination of manual therapy, exercise and education

Question 11

describe proper postpartum biomechanics

Answer 11

1. avoid forward bending and twisting
2. bring your child close to you
3. avoid stepping over baby gates
4. when getting out of a vehicle, move both legs together to avoid SIJ torsion
5. kneel on seat to fasten carseat

Question 12

describe proper postpartum carrying/holding

Answer 12

1. use of slings and supports are helpful to reduce postural faults
2. keep the child in the center of your body
3. avoid asymmetrical holding positions for long periods of time

Question 13

list orthopedic considerations for diastasis recti abdominis

Answer 13

1. separation of the linea alba at the midline of the rectus abdominis
2. measured via finger width above and below the umbilicus
3. 3 fingers is considered clinically significant
4. check for separation during abdominal contractions
5. bracing with towel or sheet and use taping or an abdominal binder during exercise

Question 14

describe scar tissue management for postpartum pts

Answer 14

1. heat can make the soft tissue more pliable for manual technique
2. divide the scar into portions
3. use fingertips to assess the scar in all directions
4. look for areas of restrictions
5. stretch techniques
   
   1. circular, longitudinal, or vertical
   2. cross pattern
   3. skin rolling

Question 15

T/F: dry needling can be used in pregnant and post-partum pts

Answer 15

TRUE

1. reduced pain and increased function and ability to work
2. as effective as combo of stabilization training, massage, and stretching for post-partum pain
3. no serious adverse events reported
4. strong level of evidence for effect of acupuncture treatment during pregnancy

Question 16

what is the goal of exercise during pregnancy?

Answer 16

to MAINTAIN fitness

1. it is recommended provided there are no medical/OB complications
2. moderate intensity 20-30 minutes/day
3. should include improving balance, stability, strength, LB, pelvis, PF and TA

Question 17

list some benefits of physical activity during pregnancy

Answer 17

1. reduced fatigue, varicosities, peripheral edema
2. improved aerobic capacity and BP
3. helps counteract increased IAP, hormonally mediated reduction in urethral closure
4. counteracts laxity
5. reduced risk of gestational diabetes in obese women
6. 35-45% reduction in risk of preeclampsia in first 20 weeks
7. lower incidence of depressive symptoms

Question 18

list several pearls for treatment of the pregnant and post-partum pt

Answer 18

1. most MSK dysfunctions develop in the 2nd trimester
2. hormonal changes can cause instability
3. all women should practice pelvic muscle training
4. don’t forget about supports
5. the rib cage angle changes dramatically

Question 19

things to remember with exercise during pregnancy

Answer 19

1. check for diastasis recti
2. do not exercise in supine for more than 15 minutes w/o a break
3. decrease target HR by 25%
4. exercising on all 4s is a great idea
5. it is not the best time to “get in shape”

Question 20

list treatments that can be used in pregnant pts

Answer 20

1. HNP gentle extension exercises and positioning
2. stabilization exercises
3. use of muscle energy for joint mobilizations
4. carpal tunnel → rest (splint if needed), modalities (ice, K-tape), ergonomics and posture

Question 21

modalities considerations during pregnancy

Answer 21

1. soft tissue mobilization in sitting or sidelying
2. medium heat after the 1st trimester
3. Ice
4. Surface EMG biofeedback

Question 22

Contraindications to modality use during pregnancy

Answer 22

1. estim in pelvic region
2. therapeutic US in the area of pelvis
3. high impact activities
4. aggressive manipulations or stretching
5. heat over abdomen during 1st trimester