1. Lab 8 Low Back Pain and Pregnancy

2. Presented by:  Katie Farrell  Kimberly Harper  Carly Lepp  Meggan McCleod

3. Low Back Pain

4. General Anatomy  There are 24 independent vertebrae in the human spine.  7 in the cervical region, 12 in the thoracic region and 5 in the lumbar region.  The lower lumbar vertebra is attached to the sacrum which is a bone consisting of several vertebrae fused together.  This area around the lumbar spine and sacrum is the most common site for back pain due to the instability caused by the changing curvature of the spine in this area.  Between each vertebra is a disc designed to reduce the frictional and compressive forces between the bones.

5. Causes of Low Back Pain  Lower back pain is one of the most common illnesses experienced by humans and usually is associated with the aging process. However, aside from the natural aging process there are several different causes for lower back pain

6. Causes of Low Back Pain Lower back pain could be a result of Muscle strain Muscle strain Spondylolysis or spondylolisthesis * Spondylolysis or spondylolisthesis * Lumbar disc injury/degeneration Lumbar disc injury/degeneration General disc disfunction General disc disfunction * Spondylolysis is the occurrence of a stress fracture to the spine. If the stress fracture worsens and the vertebra can no longer maintain its position and shifts it is known as spondylolisthesis.

7. Muscle Strain  Low back pain caused by a muscle strain involves tears to the muscle fibers in the muscles surrounding the spine. This condition is quite common and can be caused by a number of things but is usually caused by trauma or by overuse.  If the strain is caused by trauma the affected muscle must go through the three phases of soft tissue healing and rest is usually prescribed. The three phases of soft tissue healing are: The acute inflammitory phase The acute inflammitory phase The proliferative/ repair and regenerate phase The proliferative/ repair and regenerate phase The maturation/ remodelling phase The maturation/ remodelling phase The entire healing process can take up to one year but the majority of healing is complete within the first two weeks and a return to normal activity is usually permitted at this time.

8. Muscle Strain  If the strain is caused by overuse it is required that the cause of the incorrect movement patterns be corrected. Retraining the muscles and improving posture will also help prevent further injury. Once the cause has been corrected rest may be prescribed.  The muscle does have to go through the phases of soft tissue healing but if the initial cause is not corrected the muscle will not heal.  If the overuse injury causes a stress facture in the vertebra it is known as spondylolysis. If the fracture is not treated and worsens the vertebra will become unstable and shift causing a spondylolisthesis.

9. Progressive Disc Degeneration  Low back pain caused by disc degeneration involves a decrease in the function of the intervertebral discs.  Disc degeneration occurs in all humans as a part of the natural aging process that causes an overall decrease in collagen and water levels in the body.  The disc is made up mostly of collagen and water and is divided into two parts; the annulus fibrosis and nucleus pulposa. The nucleus pulposa contains a highly hydrated matrix filled with collagen making it particularly vulnerable to the aging process.  The loss of fluids and collagen causes the disc to compress thus no longer providing the cushioning to absorb the forces placed on the spine.

10. Progressive Disc Degeneration  Although the natural aging process is to blame for some degeneration, improper posture can worsen the problem.  Improper posture causes a change in the biomechanics of the spine. This causes undue wear and tear to the disc adding to the loss of function.  Also, the accumulation of debris in the disc because of enzymatic dysfunction can accelerate the degenerative effects. There is little that can be done to prevent this but proper posture and maintaining hydration are good ways to lessen the negative effects.

11. Treatment  Medications- analgesics, muscle relaxants, and anti- inflammatory drugs  Bedrest  Decreasing physical activity- especially contact sports  Exercise- within limits  Manipulation  Postural re-training  Bio-feedback  Thermotherapy  Psychotherapy  Chemonucleolysis  Surgery

12. Contraindications for Exercise  Passive lumbar flexion  Active lumbar extension  Stretches that call for the knees to be brought towards the chest  Also avoid any exercise that does not provide adequate support or the lower back * It should be noted that the cause of the pain needs to be examined by a physician before a person can begin exercise to avoid making the pain worse

13. Pregnancy

14. Pregnancy  Pregnancy begins the moment a sperm fertilizes a woman’s egg or ovum. The average pregnancy lasts 40 weeks (roughly 9 months). The 9 month period is divided into three equal time periods of about 3 months called trimesters.  During the first trimester there is little change in the mother’s body however this is a critical period for the developing fetus  At the beginning of the second trimester the physical changes such as weight gain begin to become evident in the mother.  The third trimester is the period of most rapid fetal growth which corresponds with the period of most extreme change in the woman’s body as she prepares for the birthing process

15. Changes to the Woman’s Body  Many changes occur within the woman’s body to prepare her for the birthing process. The following changes are a concern when prescribing exercise to pregnant women. Hormone release resulting in joint laxity especially in the pelvis and lower back Hormone release resulting in joint laxity especially in the pelvis and lower back Weight gain concentrated in the abdomen resulting in a forward shift of the center of mass Weight gain concentrated in the abdomen resulting in a forward shift of the center of mass Changed body composition resulting in an increased fat mass. Changed body composition resulting in an increased fat mass.

16. Weight Gain during Pregnancy Weight gain during pregnancy is the most drastic of the changes a woman experiences as she can gain anywhere from 15 to 40 pounds by the end of the third trimester. The weight is distributed unevenly (most goes to the belly area) causing a shift of the woman’s center of mass anteriorly. The copious weight gain is one of the main motivators for exercise during pregnancy as it can have negative effects such as low back pain, fatigue and weight retention after the birth. Weight gain during pregnancy is the most drastic of the changes a woman experiences as she can gain anywhere from 15 to 40 pounds by the end of the third trimester. The weight is distributed unevenly (most goes to the belly area) causing a shift of the woman’s center of mass anteriorly. The copious weight gain is one of the main motivators for exercise during pregnancy as it can have negative effects such as low back pain, fatigue and weight retention after the birth.

17. Reasons for Exercise during Pregnancy  There are also several other motivators for exercise during pregnancy including: Feelings of self-consciouness about the changing body Feelings of self-consciouness about the changing body Concern about having a healthy baby Concern about having a healthy baby Desire to stay in shape Desire to stay in shape Want to be able to handle the physical rigors of labor and delivery Want to be able to handle the physical rigors of labor and delivery Social interactions and support Social interactions and support

18. Benefits of Exercise  Improved cardiovascular and muscular fitness  Facilitated recovery from labor  Faster return to pre pregnancy weight, strength and flexibility levels  Reduced post partum belly  More energy reserve  Fewer obstetric interventions  Shorter active phase of labor and less pain  Less weight gain  Enhanced maternal psychological well being that may reduce feelings of stress, anxiety, and depression often experienced during pregnancy.  Increased likelihood of adopting permanent healthy lifestyle habits

19. Exercise Specifics for Pregnant Women  Moderate exercise sessions are advised because research has shown that there is a link between reduced birth weights in babies whose mothers performed high-intensity exercise throughout pregnancy by 300-350grams (10-12 ounces) on average. Also there was an increase in fetal heart rate in babies whose mothers who performed high-intensity exercise during pregnancy by 5-15bpm on average. Rating of perceived exertion should be used to determine moderate exercise levels.  Should use weight machines which provide more stability and support than free weights.  Back lying (supine) position may result in restricted venous return of blood because of increasingly large uterus. Women should perform more exercise on their side or hand and knees, then on their back.  Pelvic floor exercises (kegels) are another important element of resistance training during pregnancy. This involves tightening and relaxing muscle groups in the pelvic region which will help with delivering the baby.

20.  Although exercise is most often beneficial there are three key concerns for potential adverse outcomes Insufficient oxygen or energy substrates to the fetus Insufficient oxygen or energy substrates to the fetus Hyperthermia- induced fetal distress or birth abnormalities Hyperthermia- induced fetal distress or birth abnormalities Increased uterine contractions Increased uterine contractions

21. Contraindications for Exercise A pregnant woman experiencing any of the following should avoid exercise  Pregnancy induced hypertension  Ruptured membranes  Premature labor during the current pregnancy  Persistent bleeding after 12 weeks  A cervix that dilates ahead of schedule  Heart disease  Lung disease  Multiple birth pregnancy  A placenta that blocks the cervix after 26 weeks  Diabetes  Seizures  Extreme obesity  Extreme low body weight  History of a very sedentary lifestyle

22. Discontinue exercise if:  Any signs of bloody discharge  Swelling of ankles, hands or face  Headaches, fainting, dizziness  Swelling, pain or redness in the calf of one leg  Increase pulse rate or blood pressure that persist after exercise  Persistent contractions  Unexplained abdominal pain  Insufficient weight gain If any of the above should happen it is important that the woman seek medical attention immediately.

23. Exercise Guidelines  30 minutes of moderate exercise 5-7 days per week including both strength training and some aerobic conditioning  Age-predicted HR targets are less reliable during pregnancy. Thus, a talk test or Borg scale is a better predictor of intensity.  It is very important that pregnant women consult with a physician before beginning an exercise regimen to ensure that exercise is healthy for both the mother and child.

24. The End Thank you for your time.