Practical Class 15-16 Antenatal and Intrapartum Physiotherapy

Question 1

In order, what are the 5 tests that are used in PGP assessment?

Answer 1

1. Modified Trendelenburg
2. ASLR test (Active Straight Leg Raise)
3. LDL test
4. Symphysis Pain Palpation
5. Thigh Thrust (posterior pelvic pain provocation test)
   
   • NOTE: this is not always necessary if you already have a suspected diagnosis from other tests, and may not be appropriate as can be quite aggravating for the patient

Question 2

What is the joint/structure tested in the Modified Trendelenberg?

Answer 2

PS

Question 3

What is the patient positioning in the Modified Trendelenberg?

Answer 3

Standing

Question 4

What is the application of technique in the Modified Trendelenberg?

Answer 4

Ask patient to raise one leg at a time and ask if they are feeling any pain  If yes, then ask where the pain is

Question 5

What are the positive signs in the Modified Trendelenberg?

Answer 5

Pain in symphysis pubis (NB: the patient may also feel discomfort in SIJ, but confirm with SIJ specific test)

Question 6

What is the joint/structure tested in the ASLR?

Answer 6

SIJ

Question 7

What is the patient positioning in the ASLR?

Answer 7

Supine

Question 8

What is the application of technique in the ASLR?

Answer 8

Ask the patient to raise one leg at a time and ask if they feel pain –> If yes, then ask where the pain is

Question 9

What are the positive signs in the ASLR?

Answer 9

Pain on contralateral side in SIJ (NB: may also feel symptoms in Symphysis Pubis)

Question 10

What is the joint/structure tested in the LDL Test?

Answer 10

LDL

Question 11

What is the patient position in the LDL Test?

Answer 11

Side lye (do both sides)

Question 12

What is the application of technique in the LDL Test?

Answer 12

Apply manual PA pressure to the LDL (over the SIJ) and ask if this produces any discomfort/pain

Question 13

What are the positive signs in the LDL test?

Answer 13

Pain on palpation of LDL. Compare to other side. (NB: remember in general population this may be a tender area so fit into clinical picture)

Question 14

What is the joint/structure tested in the Symphysis Pain Palpation?

Answer 14

PS

Question 15

What is the patient positioning in the Symphysis Pain Palpation?

Answer 15

Supine/crooklie

Question 16

What is the application of technique in the Symphysis Pain Palpation?

Answer 16

Ask special permission to do this technique.

To locate the SP, run your fingertips from the ASIS bilaterally round the rim of the pelvis (under the pregnant belly) to the symphysis pubis (located in the midline)

Very lightly apply manual AP pressure to the pubic rami on each side close to the SP

Question 17

What is the positive signs in the Symphysis Pubis palpation?

Answer 17

Pain on palpation of Symphysis Pubis.

Question 18

What is the joint/structure tested in the Thigh Thrust Test?

Answer 18

SIJ

Question 19

What is the patient positioning in the Thigh Thrust Test?

Answer 19

Supine

Question 20

What is the application of technique in the Thigh Thrust Test?

Answer 20

Bend the patient’s hip and knee to 90 degrees and support their lower leg on your closest forearm.

Place your other hand under the pelvis at the position of the ipsilateral SIJ.

Lean forward and use your shoulder to apply gentle AP pressure through the femur to the SIJ

Ask if the patient is experiencing discomfort or pain.

Question 21

What are the positive signs in the Thigh Thrust Test?

Answer 21

Pain in ipsilateral SIJ with movement of joint

Question 22

What are the 4 things in the warm up of the antenatal class?

Answer 22

• Arm movements, large inhalations / exhalations, talk to class, make participants feel comfortable and welcome
• Walking on spot / Walking in circles –> Increasing heart – rate
• Keep them walking and do some Upper Limb stretches (ie cross your arm across your body and point to where they should feel the stretch)
• Start some Lower limb stretches –> gentle squatting (educate re good vs bad technique) –> Engage pelvic floor whilst squatting
  
  • Then progress into specific lower limb stretches ie calf (gastrocnemius & soleus)/ quad stretches

Question 23

What are 3 pelvic floor exercises when siitting on a swiss ball?

Answer 23

1. Ensure good posture (avoid hunching, make sure not sitting forwards)
2. Gentle bouncing on swiss ball up and down
3. Gentle side to side movement on ball

Question 24

What are 5 pelvic floor exercises on swiss ball?

Answer 24

1. Gentle lifts
2. Up – up – up ….and let go x 5 (may need > 5)
3. Short sharp contractions x 10 (may need > 10)
4. Avoid global movement through shoulders / glutes (will see shoulders shrug, or bouncing on ball if activating glutes)
5. Can use hands to demonstrate pelvic floor movement

Question 25

What are 2 pelvic floor progressions?

Answer 25

1. Sitting on ball, leaning forwards, arms out in front, continue pelvic floor contractions
2. Incorporating upper body / lower body to challenge pelvic floor

Question 26

What are 3 cardiovascular exercises for an antenatal class?

Answer 26

• Standing, holding swiss ball in front, marching up and down on the spot
• Standing, holding swiss ball up above head, marching up and down on the spot
• May go for 5 mins to increase heartrate