Pregnancy

Question 1

Changes in centre of gravity

Answer 1

Anterior and superior displacement
- More ant weight
- Posterior chain (starting from nuchal point) needs to work harder to maintain upright standing position (inc pressure on facets, discs, ligs, muscles)
- Lsp lordosis reduces at start as pelvis tilts posteriorly
- Further into pregnancy= pelvis tilts anteriorly, inc lordosis

Question 2

Changes in spinal curves- how body adapts
1st trimester

Answer 2

Grapefruit
Uterus rises above pelvic rim

Ant musculature
-reactive shortening of rectus abdominalis
-ant hip muscles need to be stretched

Tsp
-breasts enlarged
-inc thoracic kyphosis
-compromised TOS

Pelvis
-post pelvic tilt
-dec Lsp lordosis- facet
-inc sacral counternutation

Question 3

Changes in spinal curves- how body adapts
2nd trimester

Answer 3

Ant muscles
-expanding uterus + displaced viscera
-pressure under diaphragm as it elevates

Tsp
-lower ribs expand laterally
- inc kyphosis-

Question 4

Changes in spinal curves- how body adapts
3rd trimester

Answer 4

80% develop lordotic pressure
Stretch through abdominals

Tsp
-altered head carriage w inc kyphosis (discs- keeping eyes in line with horizon)
- strain at CT
-TOS compromised
-sternal angle elevates 1st rib

Pelvis
-deep Lsp lordosis
- ant pelvic rotation
-inc sacral nutation
-coccyx needs to flex

Legs
-laterally rotated hips
-altered orientation of knees + feet
-waddling gait

Question 5

40 weeks

Answer 5

• Pelvis rotated posteriorly, flattened Lsp
• Weight bearing through pelvic floor/ligaments (working hard to stabilise) rather than Abd ms and SP
• Rib circumference inc by 5-7cm
• Increased venous pressure and congestion leading to haemorrhoids or varicose veins (hard for venous return from Lexx)
• Usually delivered at this time- 1st children common to arrive late
• 42 weeks- induced- done because blood vessels in umbilicus start to calcify

Question 6

Internal supports- ligaments of uterus

Answer 6

Internal ligaments in trunk/viscera
Helps to support internal organs
round ligament- supports fallopian tubes and ovaries

Pubovesical ligament
Inguinal ligament
Uterosacral
Transverse cervical
Pubocervical

Question 7

Role of relaxin

Answer 7

• Hormone only produced during pregnancy and for short amount of time post-labour (allows pelvis and innominate to open)
• Increases flexibility of ligaments during pregnancy to help open pelvis during labour
• 89% of symphysis pubis dysfunction (SPD) occurs in 2nd/3rd trimester
• Peak production is at 12 weeks
• Body stops producing relaxin 3 months after breast feeding has stopped, could be up to 9 months post-partum
• 18 months between pregnancies- allows relaxin production to stop and ligs to heal

Question 8

Hyper mobility

Answer 8

• Can be difficult to treat
• Generally, have restriction in thoracic spine, with increased tension in erector spinae muscles to try and stabilise hypermobile segments
• Should avoid doing yoga (relaxin inc flexibility, potentially making themselves unstable), encourage swimming or Pilates