Women's Health Flashcards
Pregnancy Related Back Pain
Possible causes
Back pain is a common complaint during pregnancy
Pregnancy-related back pain may be d/t:
1. Postural changes of pregnancy
2. Hormonal influences (up to 3-5 months post-partum)
RELAXIN - all in preparation for the birthing process
3. INC ligament laxity - relaxin
4. DEC abdominal mm function
Belly is descendant = ab mm are stretched = cannot function optimally
3&4 - help with spinal stability
Clincial Instability
Pregnancy Related Back Pain:
Characteristics
(3)
- Worse with mm fatigue (static postures or as day progresses)
- Relieved with rest or change in position
- Physically fit women have less back pain during pregnancy
Pregnancy Related Back Pain:
Postural Changes
(6)
- COG shifts upward & forward d/t enlargement of the breasts & uterus
- INC lumbar & cervical lordosis (FHP & anterior pevlic tilt)
- INC anterior pelvic tilt
- Scapular protraction & UE IR
~ Upper Cross Syndrome
Result of breast enlargement - Suboccipital muscle tightness - FHP (upward gaze)
- Genu recurvatum at kness
Counteract the belly going anteriorly
Re-establishes CoG w/in BOS
Pregnancy Related Back Pain: Interventions
(3)
Traditional low back exercises
- “core exercises”
- Posterior pelvic tilt exercises would be beneficial for this population = helps DEC stress on L/S
Proper body mechanics
Posture intstructions (sleeping, standing, sitting)
- Sleeping is unique for this population
- Sleeping in supine - pillows under the knees = posterior pelvic tilt = DEC stress on L/S
- Side-lying - knees & hips flexed = posterior pelvic tilt & pillow b/t knees to avoid leg ADD & twisting at the spine (lots of stressed if prolonged)
** AVOID sleeping on RT side = INC pressure on vena cava
Pregnancy Related Back Pain: Interventions - Modalities
Precautions / Contra-indications
Precautions
- Heat - Beware of ligament laxity
- Laser (local) - not around the abdominals or LB
Contraindications:
- Deep heating agents
- Electrical stimulation (local)
- Traction - ligament laxity - instability
- Ultrasound (local) - can use on periphery
- Thermal - deep heating
COLD IS SAFE
Diastasis Recti
Description & Epi & Etiology
Separation of the rectus abdominis muscles at the linea alba (midline)
** Any separation larger than two finger widths is significant OR 2 cm
Epi
- Commonly seen in childbearing women
- Less common in women with good abdominal tone prior to pregnancy
Etiology
- May occur as a result of hormonal effect on connective tissue & biomechanical changes
- May develop during labor - contraction &/or holding breath
Diastasis Recti: S/S
(3)
- Low back pain - DEC ability of the abs to stabilize the low back
- DEC functional activity - supine/sitting - d/t loss of alignment & function
- Herniation (severe cases)
Diastasis Recti: Examination
All pregnant patients should be tested for the presence of DR before performing abdominal exercises - potentially could make it worse
Test should be repeated throughout pregnancy
Test is not valid 0-3 days after delivery (inadequate tone for valid results)
Procedure:
- Have the patient in hook-lying & slowly raise head/shoulder off the floor & reaching hands towards the knees
- Therapist places fingers of one hand horizontally across the midline of the abdomen at the umbilicus
- The test is then repeated above & below the umbillicus
(+) Fingers will sink into the gap b/t rectus muscle
Number of fingeres that can be placed between the rectus muscles is documented
Diastasis Recti: Interventions
Severity
< 2 cm = ONLY a head lift or head lift w/ posterior pevlic tilt (DR corrective exercises) or TA activation w/o breath holding should be used until the separation is smaller
** Do not want to activate Rectus Abdom OR Obliques
Once DR is corrected (<2cm) - more advance abdom exercises may be resumed
Procedure:
- Exercises are peformed in hook-lying w/ hands crossed over midline (using arms to approzimate the tissue) @ the lvl of the diastasis for support
- EXHALE & lift only your head off the floor while gently approzimating the rectus mms toward midline
- Lower head slowly & relax
Exercise may be used in combination with posterior pelvic tilt
Pelvic Floor Dysfunction
Definition & Classification (3)
Inability to control the pelvic floor muscles
Classification:
1. Prolapse
AVOID exercises that INC intra-abdominal pressure - can contribute to making the prolapse worse
PT: help to retrain the coordination of these mm to prevent prolapse
2. Urinary or fecal incontinence = involuntary loss of control - d/t neuromuscular OR muscular impairments
3. Pain & Hypertonia
Pelvic Floor Dysfunction: RF
Pregnancy-related & other
Child birth:
- >30 years old
- Multiple deliveries
- Forced pushing
- Use of forceps
- Vacuum extraction
- Oxytocin
- Perineal tears
- Birth weight > 8lbs
During the birthing process there is significant trauma & stress on the pelvic floor structures
Other causes:
- Excessive straining
- Chronic constipation
- Obesity
- Chronic cough
- Smoking
- Hysterectomy
Pelvic Floor Dysfunction:
Interventions
(5)
- Patient education - function, RF, types of dysfunctions
- Neuromuscular reeducation - proprioception deficits - retrain & recruit the proper mm (isolate pelvic floor)
- Pelvic floor exercises - inner core/ outer core
- Biofeedback
- Manual treatment and modalities (intravaginal/ rectal techniques) - rostered act
Summary:
Strength training pelvic floor > improves structural support > helps w/ prolapse & incontinence & teaches pt how to effectively recruit the mm more efficiently & consistently
