Copyright © F.A. Davis Company Part V: Special Areas of Therapeutic Exercise Chapter 24 Women’s Health: Obstetrics and Pelvic Floor
Copyright © F.A. Davis Company OVERVIEW OF PREGNANCY AND RELATED CONDITIONS
Copyright © F.A. Davis Company First Trimester Changes Second Trimester Changes Third Trimester Changes Characteristics of Pregnancy
Copyright © F.A. Davis Company Weight Gain During Pregnancy Changes in Organ Systems – Uterus and related connective tissue – Urinary system Kidneys Ureters Anatomical and Physiological Changes of Pregnancy
Copyright © F.A. Davis Company Changes in Organ Systems (cont’d) – Pulmonary system Hormonal influences Respiration – Cardiovascular system Blood pressure and volume Heart Anatomical and Physiological Changes of Pregnancy (cont'd)
Copyright © F.A. Davis Company Changes in Organ Systems (cont’d) – Musculoskeletal system Abdominal muscles Pelvic floor muscles Connective tissue and joints – Thermoregulatory system Metabolic rate Anatomical and Physiological Changes of Pregnancy (cont'd)
Copyright © F.A. Davis Company Changes in Posture and Balance – Center of gravity – Balance Anatomical and Physiological Changes of Pregnancy (cont'd)
Copyright © F.A. Davis Company Female Pelvic Floor Innervation Function Pelvic Floor Musculature
Copyright © F.A. Davis Company Neurological Compromise Muscular Impairment Episiotomy Effect of Childbirth on the Pelvic Floor
Copyright © F.A. Davis Company Classification of Pelvic Floor Dysfunction – Prolapse – Urinary or fecal incontinence – Pain and hypertonus Risk Factors for Dysfunction – Childbirth – Other causes Pelvic Floor Dysfunction
Copyright © F.A. Davis Company Patient Education – Teach the patient about pelvic floor anatomy and function – Provide individual instruction in exercise performance Neuromuscular Re-Education – Facilitate pelvic floor muscular activation Exercise and Biofeedback – Use biofeedback with instrumentation – Combined biofeedback with exercise Manual Treatment and Modalities Interventions for Pelvic Floor Impairments
Copyright © F.A. Davis Company Diastasis Recti Incidence Significance – Functional limitations – Decreased fetal protection – Potential for herniation Examination for diastasis recti Intervention for diastasis recti
Copyright © F.A. Davis Company Incidence Characteristics Interventions Postural Back Pain
Copyright © F.A. Davis Company Characteristics Interventions – Activity modifications – Exercise modifications – External stabilization Sacroiliac/Pelvic Girdle Pain
Copyright © F.A. Davis Company Characteristics Interventions – Exercise modifications – External support Varicose Veins
Copyright © F.A. Davis Company Significance Interventions – Exercise modifications – Aerobic exercise Joint Laxity
Copyright © F.A. Davis Company Causes Interventions Nerve Compression Syndromes
Copyright © F.A. Davis Company EXERCISE INTERVENTIONS FOR PREGNANCY, LABOR, AND RELATED CONDITIONS
Copyright © F.A. Davis Company Blood Flow Respiratory Rate Hematocrit Level Inferior Vena Cava Compression Energy Needs Core Temperature Uterine Contractions Healthy Woman Response Maternal Response to Aerobic Exercise
Copyright © F.A. Davis Company Blood Flow Fetal Heart Rate (FHR) Heat Dissipation Newborn Status Fetal Response to Maternal Aerobic Exercise
Copyright © F.A. Davis Company Guidelines for Managing the Pregnant Woman – Examination – Education – Stretching/flexibility – Muscle performance and aerobic fitness – Precautions Recommendations for Fitness Exercise Precautions and Contraindications to Exercise – Absolute contraindications – Precautions to exercise Exercise for the Uncomplicated Pregnancy and Postpartum
Copyright © F.A. Davis Company Posture Exercises Corrective Exercises for Diastasis Recti Abdominal Muscle Exercises – Head lift – Head lift with pelvic tilt Stabilization Exercises Dynamic Trunk Exercises – Pelvic motion training – Trunk curls Critical Areas of Emphasis and Selected Exercise Techniques
Copyright © F.A. Davis Company Modified Upper and Lower Extremity Strengthening – Standing push up – Supine bridging – Quadruped leg raising – Modified squatting – Scapular retraction Critical Areas of Emphasis and Selected Exercise Techniques
Copyright © F.A. Davis Company Perineum and Adductor Flexibility – Self-stretching Critical Areas of Emphasis and Selected Exercise Techniques (cont'd)
Copyright © F.A. Davis Company Contract-Relax Quick Contractions “Elevator” Exercise Pelvic Floor Relaxation Pelvic Floor Awareness, Training, and Strengthening
Copyright © F.A. Davis Company Visual Imagery Muscle Setting Selective Tension Breathing Relaxation and Breathing During Labor Relaxation and Breathing Exercises for Use During Labor
Copyright © F.A. Davis Company Bilateral Straight-Leg Raising “Fire Hydrant” Exercise All-Fours (Quadruped) Hip Extension Unilateral Weight-Bearing Activities Unsafe Postures and Exercises During Pregnancy
Copyright © F.A. Davis Company Pelvic Floor Strengthening Diastasis Recti Correction Aerobic and Strengthening Exercises Exercise Critical to the Postpartum Period
Copyright © F.A. Davis Company Significance to Physical Therapists – Surgical risks – Interventions Pelvic floor rehabilitation Postsurgical rehabilitation Emotional support Cesarean Childbirth
Copyright © F.A. Davis Company Exercises Coughing or Huffing Interventions to Relieve Intestinal Gas Pains – Abdominal massage or kneading – Pelvic tilting and/or bridging – Bridge and twist Scar Mobilization Suggested Activities for the Patient Following a Cesarean Section
Copyright © F.A. Davis Company High-Risk Conditions – Premature onset of labor – Preterm rupture of membranes – Incompetent cervix – Placenta previa – Pregnancy-related hypertension or pre-eclampsia – Multiple gestation – Diabetes High-Risk Pregnancy
Copyright © F.A. Davis Company Management Guidelines and Precautions – Exercise suggestions with high-risk pregnancies Positioning Range of motion (ROM) Ambulation/standing Relaxation techniques, bed mobility, and transfer activities Preparation for labor Postpartum exercise instruction High-Risk Pregnancy (cont'd)