systemic tx (pregnancy) Flashcards
pregnancy general edema
edema in hands/face etc.
mechanical edema
weight of uterus on inguinal area may reduce circulation from legs
—> edema in legs/feet
pregnancy massage treatment position
E.g.
semi-fowler?
side lying?
SOB –> pregnancy
uterus pushes abdominal contents to diaphragm — reduce respiratory function
on the other hand, increase in oxggen requirement (20%) d/t increased metabolism (baby)
ALSO ATP – pregnancy
d/t uterus pressure against pelvis
(also lumbar pulled forward by weight of belly)
diastases recti & pregnancy
“The term “diastasis recti” comes from the Greek word diastasis, which means “separation”, and the Latin word rectus, which means “straight” (muscle) “
“Diastasis recti happens when a person’s abdomen stretches during pregnancy and creates a gap in the abdominal muscles. What is diastasis recti?”
“Diastasis recti occurs when the linea alba is overstretched and doesn’t come back together.”
pubic symphysis pain – pregnancy
relaxin
varicosity – pregnancy
compression of veins @ inguinal area
hemorrhoids – pregnancy
d/t constipation (progesterone causes relaxation of smooth mm)
note pregnancy and stretch marks
..
other changes
nasal congestion
nosebleeds
headaches
gestational diabetes
“a condition characterized by an elevated level of glucose in the blood during pregnancy, typically resolving after the birth.”
“During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less well, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin.”
ketoacidosis
gestational diabetes
(ketones)
backache / SIJD
..
(Sacroiliac sprain: intensely painful; walking is difficult)
leg cramps
ischemia
poor circulation (hip/inguinal)
DVT is possible
loose joints (relaxin) & mm
loose joints causing tight muscles
Costal margin pain
as uterus compresses lower ribs
Frequent urination/incontinence
increased pressure on bladder (THIRD TRIMESTER)
vs.
first trimester (pregnancy)
Insomnia and restlessness
Heartburn, fetal movement and the need to urinate frequently all contribute to sleep difficulties
Referral pain from muscles & ligaments:
As the uterus grows the ligaments which suspend it in the pelvic cavity are stretched, and can be a source of referred pain.
relaxin & CT/joints VS. MM tonicity
As the connective tissue in the body is softened by relaxin, the joints become more loose & unstable, so they rely on muscular support for stability.
(loose joints causing tight muscles)
PRONE POSITION VS PREGNANCY TRIMESTERS
After the FIRST TRIMESTER prone position is not recommended
(Lying prone increases intrauterine pressure, and further stresses already taxed uterine ligaments (esp. Sacrouterine) and lumbar joints)
PRONE position vs pregnancy ?
Prone position may also be uncomfortable on tender breast tissue
another reason for prone being troublesome
CONGESTION
There is increased mucous production in pregnancy, so the patient may become uncomfortably congested in prone
IF DECIDING TO DO PRONE Tx
Adjustable pillow systems can allow for prone treatment in most healthy pregnancies
SUPINE position vs pregnancy?
After the first trimester supine position is not recommended
supine hypotensive syndrome
The weight of the uterus rests on the inferior vena cava, resulting in low maternal blood pressure & decreased maternal & fetal circulation (supine hypotensive syndrome)
Other symptoms include uneasiness, dizziness, SOB
how long can someone with healthy pregnancy be on back?
For patients with healthy pregnancies, it is usually ok for them to be supine for 2-5 minutes without risk
back sleeping during pregnancy?
“It’s best to avoid sleeping on your back during pregnancy, especially in the second and third trimesters. Sleeping on your back can compress blood vessels and reduce blood flow to the fetus. “
“Research has shown that in the third trimester (after 28 weeks of pregnancy) going to sleep on your back increases your risk of stillbirth.”
pillowing pelvis if short duration supine
You can place a pillow under the right side of the pelvis to shift the weight off the IVC, for extended supine positioning
semi-fowler vs pregnancy
Semi-fowlers position offers a safe alternative to supine treatments
side-lying vs massage
Side-lying is the recommended position for massage treatment
Minimizes strain on uterine ligaments
Prevents increased intrauterine pressure
side-lying vs circulation
Ensures placental & fetal circulation in high risk pregnancies
Prevents increased sinus pressure & congestion
which side is best during side-lying treatment (pregnancy) ?
LEFT side-lying
Most patients can lie on either side for treatment, although left side-lying allows maximum maternal cardiac functioning
1st timester
prone ok
supine ok
side-lying ok
semi-fowler ok
2nd trimester
prone no
—> prone with pregnancy pads/pillow
supine no
—> pillow under R hip OK
—> OK for short durations
(less than 15 mins)
side-lying yes
semi-fowler yes
3rd trimester
prone no
—> prone with pregnancy pads/pillow
(gets increasingly uncomfortable by end of 3rd trimester)
supine no
—> pillow under R hip OK
—> OK for short durations
(less than 5 mins)
side-lying yes
semi-fowler yes
i.e.
side-lying & semi-fowlers is always OK for pregnancy masssage
Pregnancy CI & precautions
Be cautious with joint mobilization due to the effects of relaxin
Avoid deep massage to the low back, sacrum and abdomen in the first trimester (Due to the greater risk of miscarriage -although there is no evidence of massage increasing the risk of miscarriage)
Be mindful with fascial techniques due to its stabilizing role
Massage is contraindicated if a sudden change in blood pressure is noticed - refer to MD or midwife
If patient has GESTATIONAL DIABETES - ensure they have eaten prior to massage
Avoid systemic hot hydro that may change increase maternal temperature
supine position (adjusted) during 2nd / 3rd trimester & patient feelings
If patient feels unwell in the supine position during the second or third trimester change positions or discontinue treatment
more precautions / CIs — pregnancy
pregnancy and blood clotting
Be aware of the increased risk of blood clots during pregnancy:
A patient’s blood clotting capacity increases 4-5 times normal to prevent potential hemorrhaging during delivery. This process also increases the potential for developing BLOOD CLOTS.
Clot formation is greatest in veins in which blood is moving slowly or is stagnant.
common veins for clot formation (pregnancy) — DVT (?)
Most common areas for this to occur are the…
iliac,
femoral
& saphenous veins,
… due to reduced venous return caused by the fetus blocking blood flow at the inguinal area
Tx considerations for CLOT RISKS (pregnancy)
AVOID MEDIAL LEG
If you are concerned about blood clots, avoid deep treatment to the medial side of the leg and refer to a physician
Pregnancy treatment technique considerations
Myofascial release:
Lumbo-sacral decompression - Cross-hands, iliac crest and thorax
Swedish Massage:
Slow petrissage techniques to back, glutes, legs
special JM & pregnancy Tx
Blood clot (leg) SSx
unilateral throbbing pain, swelling, redness, edema @ legs
DVT vs blood clot
blood clot is general term for either thrombus/embolus (inc. DVT)
—-> in this case (with pregnancy) we are generally referring to DVT
DEEP MASSAGE @ LB, sacrum, abdomen – WHEN TO AVOID ?
FIRST TRIMESTER
pregnancy posture
hyperkyphosis TS
hyperlordosis LS
protracted shoulder
APT
pes planus
note dilemma:
—> APT –> IR AFJ
—> however, widening abdomen —> ER AF
avoid which exercise during pregnancy
avoid crunches
TV abdominis strengthening E.g.
“Lying on your back with your knees bent, tighten your stomach as though you were trying to push your belly button into the floor.
Hold the contraction for 10 seconds.
After a few repetitions, try to hold the contraction while moving your arms and legs.”
—> be cautious about lying on back
AVOID ACTIVITIES WITH HIGH RISK FOR ____
Falls
note supine position
for brief periods is OK
PREVENT PUBIC SYMPHYSIS IRRITATION
ASYMMETRICAL LEG EXERCISES
E.g.
Lunges
CAN ALSO IRRITATE SIJ
SSx of over-excercise – or exercise that is too intense
E.g. vaginal bleeding (esp after exercise)
“Spotting”
But also — could indicate other issue(s)
NOTE VIDEO with TV abdominis — Can significantly change the appearance of the abdomen in later 3rd trimester —-> I.e. when activating TV abdominis
..
note kegal exercises
helpful for bladder control to prevent incontinence
prevent prolapse
helpful way to activate abdomen
tapping
TA strengthening, not ____ strengthening
not rectus abdominis
post-partum – why might prone not be the best position immediately post-partum?
breast tenderness
PREGNANCY VS HYDRO
NO HOT SYSTEMIC HYDRO
warm hydro OK
localized hot hydro may be OK
