therapeutic exercise in obstetrics

8/10/2019 Therapeutic Exercise in Obstetrics

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Copyright 2005 Lippincott Williams & Wilkins

THERAPEUTIC EXERCISE INOBSTETRICS


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Why Therapeutic Exercise for PregnantWomen?

Primary conditions unrelated topregnancy

Disorders related to physiologicchanges during pregnancy

Physical and psychological benefits

Preventative measures


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Physiologic Changes Related toPregnancy Support ElementEndocrine system Alterations in hormone

levels, GI function, etc.

CV system Changes in blood volume,hemoglobin levels, vasodilation.

Respiratory system Increased mucus in

respiratory tract, predisposition tocoughing, sneezing if pelvic floor andassociated muscles are weak.


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Physiologic Changes Related to Pregnancy Base Element

Musculoskeletal symptoms should not beconsidered normal.

COG shifts forward and upward (lumbarlordosis, forward head posture, roundedshoulders, etc).

Changes in hormone Joint laxity(increased foot pronation).


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Therapeutic Exercise Interventionfor Wellness

Moderate aerobic exercise (carefully monitored

and prescribed) is safe and beneficial for themother and fetus.


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Exercise Intensity Guidelines

In pregnancy, maternal resting HR iselevated over nonpregnant values by 15 20bpm.Mitral valve prolapse occurs more frequently

during pregnancy and may be aggravatedby heart rates above 140 bpm.Therefore, reduce exercise intensity by 25%to 60 75% to be safe.

A maximum HR of 140 bpm for noviceexercisers and 160 bpm for experiencedexercisers.


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Activities to Avoid

Horseback ridingSnow and waterskiing

Snow boardingIce skating

DivingBungee jumpingHeavy weight liftingHigh-resistanceactivities


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Therapeutic Exercise for CommonImpairments


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Adjunctive Interventions

Hot packs Safe for back, neck,andextremities.

Ultrasound Sites away from uterus.

Ice Used on joint pain andinflammation.

NMES/TENS Contraindicated(except for TENS during labor anddelivery).


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Impaired Muscle Performance

Abdominal Strength

Goal Improve muscle balance, posture, supportof uterus via pelvic floor, stabilization of trunk

and pelvis via lumbopelvic core.


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Exercise Examples

Supine hip and knee flexion with hipabduction and lateral rotation.

Progressive heel slides.

External oblique exercises to counteranterior pelvic tilt in variety of positions.

Concentric and eccentric abdominalcontractions in quadruped.


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Quadruped Abdominal Exercise


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Pelvic Floor Strength

Importance cannot be overemphasized!

Attention to pelvic floor strength should occur earlyin the pregnancy and continue throughout the duration

and into postpartum.


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Impaired Joint Integrity andMuscle Length

Joint Hypermobility

Greater degree of joint laxitythroughout the body during

pregnancy.


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Abdominal Muscle Length

External/internal oblique, transversusabdominis, rectus abdominis alllengthen.

Rectus muscles separate in midline,creating diastasis recti.


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Diastasis Recti


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Corrective Exercise

1. Patient manuallyapproximates rectimuscles towardmidline.

2. Performs a posteriorpelvic tilt.

3. Slowly exhale whilelifting head.


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Correction of Diastasis Recti


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Pelvic Floor Muscle Length

If coccyx pain is related to pelvic floortension myalgia, pelvic floor

relaxation must be emphasized.

1. Place hand over anal cleft.2. Place middle finger in cleft and other

fingers on buttocks.

3. Pretend to pass gas while feeling forcleft bulging out against middle finger.


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Impaired PostureBiomechanical Element

Restore ideal alignment

1. Lordosis intervention - Frequent inner

core activation in various positions.2. Wall abdominal isometrics.3. Kyphosis intervention Facilitate

strengthening to scapular upward

rotators, thoracic erector spinae, stretchpectoral muscles.


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Pain

Causes Include:Biomechanical strain from increased body mass and dimension.Postural changes such as lumbar lordosis creating joint stress.

Aggravation of preexisting conditions.Muscle fatigue from overload, particularly pelvic floor.

Pregnant Woman are particularly susceptible to:Lumbar painPosterior pelvic painNocturnal back pain


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High Risk Antepartum

20% of all pregnancies include bedrestprescription.Woman who delay childbearing may expecta higher incidence of obstetriccomplications resulting in bedrest.General strengthening, circulationexercises, and relaxation exercises are

indicated to prevent secondary conditionsas a result of bedrest.


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Therapeutic Exercise Considerations

Improve circulationPromote relaxation

Avoid increased intra-abdominal pressure by

minimizing abdominal contractions duringexercise and ADLs.Prevent decreased muscle tone anddeconditioning.

Prevent neuromuscular discomfort.


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Therapeutic Exercise Intervention forCommon Impairments

Nerve CompressiveSyndromes

Common during pregnancy due to: Fluid retention Edema Soft tissue laxity

Exaggerated postural changes


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Common Nerve CompressionSyndromes

Intercostal neuralgiaThoracic outlet syndromeCarpal tunnel syndromeLateral femoral cutaneous nerve entrapmentTarsal tunnel syndrome

Peroneal nerve compression


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Intercostal Neuralgia

Described as intermittent pain in therib cage or chest from flaring of the ribcage.

Intervention includes spinalelongation with arms overhead insupine, sitting, or standing postions,

and trunk sidebending away from thepain.


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Thoracic Outlet Syndrome

1. Strengthening of upper back andscapular muscles.

2. Lengthening of pectoral muscles.3. Support can be provided through good

brassieres and manufactured supportivedevices.


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Carpal Tunnel Syndrome

1. Decrease hand flexion activities.2. Night splints.

3. Finger mobility exercises.4. Look at scapula position and correct

scapula depression.


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Lateral Femoral Cutaneous NerveEntrapment

1. Exercises to balance hip muscles.2. Lying on side to draw uterus away from

compressed side.3. Soft tissue mobilization techniques for IT

band.4. Strengthening for underused synergists to

ITB (e.g., posterior gluteus medius).


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Tarsal Tunnel Syndrome

1. Elevation of foot and ankle.2. Active foot and ankle exercises to

reduce edema and compression.3. Evening posterior splint.


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Peroneal Nerve Compression

Discourage prolonged squatting during

exercise and delivery.


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Other Impairments

Temporomandibular dysfunctionPatellofemoral dysfunctionJoint discomfort or dysfunctionVaricosis


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Summary

Many physiologic changes that occur duringpregnancy affect a womans ability andmotivation to exercise.

Adherence to precautions, contraindications,

guidelines, and a safe exercise program can beestablished for pregnant women.Exercise during pregnancy has many benefitsincluding prevention or assistance in treatment

of impairments.


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Summary (cont.)

Therapeutic exercise focuses on key posturalmuscles affected by changes during pregnancy.High risk pregnancy may require bedrest.

Specific exercises may be performed and arebeneficial for high-risk patients.Therapeutic exercise is beneficial postpartum,even after cesarean section.

therapeutic exercise in obstetrics

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