Physiotherapy in Pregnant Population - Treatment and Conditions

Question 1

Benefits from Exercise During Pregnancy (10)

Answer 1

• ↓ neonatal complications
• ↓ nr of C-sections
• ↓ Risk of depression
• ↓ Hypertension
• ↓ Gestational diabetes
• ↓ Risk of pre-eclampsia
• ↓ UI
• ↓ intensity of LBP
• ↑ Venous return
• ↑ Sleep

Question 2

PA Guidelines During Pregnancy

Answer 2

All women without contraindications.
150 min/week, 3x/week, aerobic and resistance. PFM training.

Question 3

PA Warning Symptoms - Stop + Doctor (8)

Answer 3

• Uterine contractions
• Important Tx pain
• Important shortness of breath
• Vertigo or weakness
• Persistent leakage
• Vaginal bleeding
• Unusual abd pain
• High level of fatigue

Question 4

LBP - Definition and Treatment

Answer 4

Pain between 12th rib and gluteal crest.
↓ Quality of life.
Exercise does not ↓ risk of LBP but is effective in ↓ severity of LBP.
Pelvic floor training.

Question 5

Pelvic Girdle Pain - Definition and Cause

Answer 5

Pain in PSIS to gluteal fold and or pubic symphysis. Between 14-30th week of gestation.
Cause unknown. Multifactorial. Global hypersensitivity? Not relaxin.

Question 6

PGP - Symptoms (5)

Answer 6

• Pain radiating to posterior thigh
• Gradual onset
• Worse at night
• ↓ tolerance to standing, walking and sitting.
• Pain during weight shifting and transfers.

Question 7

PGP - Risk Factors (6)

Answer 7

• Previous pregnancy
• High BMI
• Orthopedic dysfunction
• Smoking
• Poor job satisfaction
• Belief that it won’t get better

Question 8

PGP - Assessment (6) and Special Tests (3)

Answer 8

Hip and lumbar scan
ROM
Palpation
Neurological
Posture
Special Tests:
- SIJ pain provocation test
- Pubic symphysis provocation test
- Active straight leg raise

Question 9

PGP - Treatment (2)

Answer 9

Support belt
Exercise (does not ↓ risk but ↓ severity of symptoms).

Question 10

Pubic Symphysis Diastasis - Definition

Answer 10

Gap between the 2 pubic bones. Inadequate SI force closure.
No correlation between size of gap and severity of symptoms.

Question 11

Pubic Symphysis Diastasis - Signs and Symptoms (5)

Answer 11

• Difficulty rolling over
• ↑ pain with stairs
• Discomfort with full length steps
• Hard to get up from low chair
• Pain with adduction

Question 12

Pubic Symphysis Diastasis - Special test and Treatment

Answer 12

Pubic symphysis provocation test
Promote pelvic symmetry -> with exercises.
Belt?

Question 13

Pelvic Floor Muscle Training - Benefits (4)

Answer 13

• ↓ severe perineal trauma
• ↓ LBP intensity significantly
• ↓ UI
• ↑ sexual function

Question 14

Perineal Massage - Benefits (4)

Answer 14

• ↓ Episiotomy
• ↓ Perineal tears
• ↓ Perineal pain
• ↓ Anal incontinence

Question 15

Diastasis Recti Abdominis - Definition and Treatment

Answer 15

Separation of rectus abdominis along the linea alba.
TrA pre-activation + exercises increasing strain on linea alba.

Question 16

Neuropathies (3) - Cause

Answer 16

Due to compression, posture adaptation or fluid retention.
- Carpal tunnel syndrome
- Meralgia paresthetica (lateral cutaneous femoral nerve)
- De Quervain’s tenosynovitis**

Question 17

Physiotherapy Post-Partum (5)

Answer 17

• Scar massage + PFM rehabilitation
• DRA training
• Return to exercise gradually, when medically safe.
• ↑ risk of stress fracture in women with RED-S.
• Return to running 3-6 months Postnatal, gradually working towards it.