Pregnancy and Exercise Flashcards
Goals of PT
Inc/maintain aerobic ex Improve cardiac reserve Improve/maintain mm tone Promote good posture Improve sleep Relieve pain Prevent excess weight gain Improve psych aspects Easier delivery Faster recovery
Maternal response to exercise
Blood shunted from uterus but inc blood volume and dec vascular resistance
Max exercise capacity reached faster
Maternal response to exercise - exercises and hematocrit
10-15% increase
Maternal response to exercise - stroke volume
30-50% inc in fit pregnancy
Maternal response to exercise - energy needs
Additional 500 calories per day for exercise and pregnant
Maternal response to exercise - core temp
dec in fit preg during exercise
Maternal response to exercise - uterine contractions
inc strength and freq of uterine contractions
Maternal response to exercise - ballistic WB exercise
Can be cont throughout preg without the risk of pre term labor or pre term rupture of membranes
Be careful with FALL RISK INC
Fetal response to exercise
Animal studies show less than 50% dec uterine blood flow - not detrimental
Fetal HR inc in response to dec blood flow
Dec body fat at birth and at 5 years
Impact on labor and delivery
COnflicting info
More active someone is, the faster they recovery
ACOG recommendations
Min risk and benefits
Mod may be necessary
No med reason to avoid exercise needs to be ensured
Aerobic and strength before, during, and after preg
Bed rest rarely indicated (though is freq rx)
ACOG recommendations - regular PA
improves or maintains physical fitness, helps weight management, reduces risk of gestational diabetes and enhances well being
ACOG - ex in pregnancy - duration
Reg moderate intensity 30 min or more daily
Stay 12-14 on Borg
ACOG - ex in pregnancy - avoid what
Avoid more than 5 min in supine
Avoid activities with high fall risk
Avoid scuba diving
Be cautious with ex over 6000ft
Adjust ex level to prenatal fitness level
Stop when fatigued and never go to exhaustion
ACOG - contraindications
Hemodynamically sig. heart disease Restrictive lung disease Incompentent cervix Multiple gestation at risk 2nd or 3rd tri bleeding Placenta previa Premature labor Ruptured membranes Preeclampsia Severe anemia
ACOG - precautions
Anemia Cardiac arr Obese Poorly controlled DM BMI less than 12 Sedentary life Intrauterine growth restriction (below 10th perc) Poor control HPTN Ortho limitations Seizures Hyperthyroid Heavy smoker
Warning signs to stop exercise
Vaginal bleed Dyspnea prior to exertion Dizzy HA Chest pain MM weakness Calf pain/swelling Preterm labor Dec fetal mvmnt Amniotic fluid leakage
ACOG - ex in postpartum for uncomplicated pregnancy
Physiological and morphological changes persist 4-6 weeks post partum
Gradual and as tolerated return to activity
No current lit showing adverse rxns
Mod weight reduction during nursing is safe
Returning to PA during post partum may assist in dev depression!
Meta analysis - ex for preg related lumbar and pelvic girdle pain
Better if supervised by exercise professional
Meta analysis - ex for prevention of LBP and PGP in preg
Ex reduced risk of LBP in preg by 9%
Prevented new episodes of sick leave of lumbopelvic pain
Flexibility
Remember joint are more mobile
Avoid forceful stretching
Emphasize - suboccipitals, pecs, hip flexors, adductors, hams, gastroc
Strengthening - emphasis on
DNF Thoracic paraspinals Rhomboids, mid/low trap Infraspinatus/teres TA, internal oblique Gluteals Quads Tib Ant
Preg induced path (MSK)
joint lax DR Postural back pain Round ligament pain PGP (SIJ, Pubic symphysis) Nerve compression Fall risk
Joint laxity
Use caution when stretching (esp add)
Elevated levels of hormones have been found up to 5 months post partum
Encourage lower impact ex
DRA
Separation of RA at linea alba
3rd trimesters has 66% incidence
7 wks post partum to years = 39%
Not only in pregnancy!
DRA clinical significance
Dec mechanical advantage Dec protection of fetus Potential for herniation Continence contribution Feelings of weakness Aesthetics
DRA causes
Posture Overactive EO Large body Excessive weight gain Multiple gestation
DRA - exam
Best evaluated with US or calipers
Finger width method is not reliable or valid!
DRA - finger method
Hooklying. Patient lifts head slowly off the surface. Place fingers horizontally between the mm bellies of the rectus abdominus. Document number of fingers or centimeters
DRA - treatment
Isometric TrA/PFM/diaphragm strengthening until lax CT is controlled
KT
Postural back pain
50-70% of preg women
Worsens throughout day
Postural back pain - causes
postural changes
lig laxity
Dec abd mm function
Postural back pain - intervention
Low back ex with TA contraction Superficial thermal mod STM/Manual therapy Gait Body mechanics Support belt (very low)
Posture - tips
Want shoulders on top of hips and ankles
Ribs down
Ears on top of shldrs
Adjust low back ccurve
Feet straight ahead
legs not too far apart
Avoid the waddle
Avoid shoulders WAY behind hips
Pelvic girdle pain
Symphysis pubis, SIJ, gluteal region
Pelvic girdle pain - location
From PSIS to gluteal folds
Pelvic girdle pain - incidence
variable
33-50% before 20 wks
60-70% late preg
Pelvic girdle pain - impairemnts
Stairs turning in bed Not usually relieved with rest SLS Transfers (STS)
pelvic girdle pain - risk factors
Multiparous Joint hypermob Amenorrhea High BMI Hip and LE dysfunction including glut med and PFM
Pubic symphysis dysfunction
Changes to pubic symph begin at 8-10 wks Widens to avg of 7mm prior to delivery Tenderness Radiation to groin Pain with WB Pain with LE abd Pain with asymm mvmtns
Pelvic girdle dysfunction tx
Manual - MET, joint mobs, STM External support belt Stabilization! AD for gait Water exercise Avoid exacerbating posture Identify causative factor!
Round ligament pain
Sharp, quick
Area of lateral low abdomen
OCcurs with movement
Often confused with psoas/hip flexor/add pain
Nerve comp can be where
Thoracic outlet
Carpal tunnel
Sciatic
Fall risk
Comparable to geriatric pop Incidence of 26.8% during preg 35.5% fallen more than twice during preg Changes in gait noted with inc stance width Changes in speed Inc AP postural sway
Physical agents in preg - contra/prec
US over trunk TENS Mechanical traction Diathermy Ionto and phono
Best activities
ealking Swimming Biking gentle yoga strengthening pf postural mm
Post partum considerations
posture skin care nursing positions body mechanics continence fatigue, exhaustion, baby blues, depression sexual health nutriton
Posture post partum
Forweard head thoracic kyphosis and flared ribs Scapular protraction pelvis position lumbar spine is flattened (or can be extra lordotic too)
Skin care PP
Perineal or C section
- US
- Scar mob
- Stretches
- Education on expectations (pain, numbness, PA)
Nursing positions
No righ tanswer
Use PT common sense
May be reclining on many pillows (esp during first 4-6 wks)
Pillows, pillows, pillows!
Body mechanics
Keep baby close to body Limit use of car seat carriers Use ring slings and front carriers with good support Avoid carrying baby on hips asymm Traditional lifting mechancis
Fatigue/exhaustion/baby blues/depression
Many causes nad very common
Post part dep can begin anytime up to a year post partum - 3x more likely if have LBP and pelvic pain
Acknowledgement is HUGE
Sexual health
Consider perineal lacerations and healing
Consider body image
Consider fatigue and new demands on time
Nursing mothers hormones dec lubrication and libido
