Musculoskeletal Dysfunction In Pregnant And Post Partum Woman

Front 1

pregnant women exercise?

Back 1

in absence of either medical or obstetric complications, pregnant women can exercise of 30 minutes or more or moderate exercise on most, if not all days of the week.

Front 2

normal weight gain-overall
fetus-
placenta-
amniotic fluid-
uterine mm mass-
blood volume-
breast tissue-
Interstitial fluid-
added fat storage-

Back 2

overall-25-35 lbs.

fetus-7.5 lbs.
placenta-1.5 lbs.
amniotic fluid-2 lbs.
uterine mm mass-2.5 lbs
blood volume-3.5 lbs.
breast tissue-2 lbs.
Interstitial fluid-2.0-3.0 lbs
added fat storage-4.0 lbs.

Front 3

Physiologic changes-
pulmonary

Back 3

pulmonary-
-increased O2 consumption
-increased respiration
-dyspnea at rest

Front 4

physiologic changes
cardiovascular

Back 4

cardiovascular
20-40%-increases in total blood volume
plasma volume increases study
-RBC volume increase by 50%
-Total white cell court
-12% increase in heart volume
--heart changes
--heart is shifted upward
-20% increase in heart rate (HR)(15-20 bpm)
Leads to a 30-50% increase in CO

Front 5

Musculoskeletal exam:
approach similar to non-pregnant client
-structural and physiologic changes that occur during childbearing year effect examination
--choices of position during evaluation in an example

Back 5

PT EVAL
-precautions during pregnancy
--incompetent during pregnancy
---incompetent cervix
---adolescent or advanced maternal age
---absent or delayed prenatal care
---abnormal bleeding or discharge
---multiple pregnancy
---alterations in blood pressure
---history of miscarriage
---ruptured membranes

Front 6

positioning

Back 6

supine-as uturus enlarges the supine position should be used with caution
-can possibly cause partial occlusion of the inferior vena cava
-elevation of patient's right side to angle of 30° or more can relieve compressive forces

Front 7

Musculoskeletal dysfunction associated with pregnancy

Back 7

low back pain
-sacroiliac dysfunction
-carpal tunnel syndrome
-thoracic outlet dysfunction
-osteoporosis/transient hip pain
-worsening of pre-existing musculoskeletal conditions
-diastasis recti abdominis
-urinary incontinence

Front 8

Posture

Back 8

increases spinal curves
-forward head
-rounded shoulders
-increased anterior pelvic rotation
-tight back extensions
-stretched abdominus muscles
-hyperextended knees
-pronated feet

Front 9

thorax and ribs

Back 9

-during 3rd trimester diaphragm will elevate as much as 4 cm
-overall lung capacity not significantly change bc of rib expansion/flare
-effect on joints may cause pain or stiffness

Front 10

low back pain and pregnancy

Back 10

Incidence:48%-79% of all pregnant women
-1/3 considering pain as sever problem compromising normal, everyday life, and ability to work
-1/3 reporting back pain at night that contributes to insomnia
-most common cause of sick leave during pregnancy

Front 11

Low back pain risk factors

Back 11

pre-pregnancy episode of back pain (twice as likely to experience back pain)
-parity
-age-
-strenuous work
-smoking
-male sex of fetus

Front 12

Patterns of low back pain

Back 12

-A. lumbar pain
B. posterior pelvic pain

Front 13

Lumbar Pain

Back 13

Neurologic exam to rule out nerve root compression
-most commonly will have pain related to prolonged position or activity
-advise regarding posture(lumbar support), using foot-stool for standing, body mechanics-especially if has toddler already!)

Front 14

Posterior pelvic/SIJ
Can distinguish from LBP through symptom presentations and special tests

Back 14

--often will point to PSIS
--May have concomitant pubic symphysis pain
--apparent" leg length discrepency

Front 15

posterior pelvic pain/SIJ

-pain related to specific motions in which the pelvic unit is challenged

Back 15

-rolling in bed
-up/down stairs

support for use of ASLR test

Front 16

Active straight leg raise test

Back 16

In order for hip ms. to act on the hip, the pelvis must be stabilized by the trunk man

Quality:
-only the hip joint should move
-pt relates the ease as comfort
-compair R and L
-0-5 scale

Front 17

SIJ belt

Back 17

have been shown to reduce movement at SIJ
-vibration force
-mechanical effect of a pelvic belt in patients with pregnancy-related pelvic pain
-AND alternative novel taping techniques for posterior pelvic girdle pain in parous women

Front 18

symphysis pubis diastasis
separation
signs and symptoms

Back 18

average separation of pubis bones during pregnancy, 2.5mm to 10 mm

signs and symptoms-
-mild to severe pain exacerbated by walking and all weight bearing activities
-waddling gait typical
-may experience symphygeal clicking
-pain on palpation

Front 19

presentation

Back 19

onset of hip/thigh pain without known injury
-typically in last trimester
-pain with weight bearing: antalgic gait
-referral to MD for diagnosis

Front 20

Femoral Anterior Glide Syndrome

Back 20

Observation-more commonly symptomatic during pregnancy
=rotator cuff of the hip includes all the GOGO muscles
-obturator internus as hip and vaginal mm

Front 21

Fluid gain during pregnancy
Normal vs. abnormal

Back 21

Approximately 25% of weight gain during pregnancy is due to fluids.
Dietary and activity modifications

Front 22

Carpal tunnel syndrome-CTS

Back 22

second most frequent musculoskeletal compliant during pregnancy
-etiology with pregnant client is unique
--believed increased swelling with pregnancy decreases space of median nerve
--incedence:25%-56% during pregnancy
--may also develop postpartum while nursing

Front 23

Carpal tunnel syndrome symptoms

Back 23

numbness, tingling, pain in median nerve distribution
-objective confirmation of median nerve numbness at tip of thumb
-subjectively-shaking gives relief
-night splints effective
-address swelling as much as able

Front 24

thoracic outlet syndrome (TOS)

Back 24

implies compromise of brachial plexus, subclavian artery and/or subclavian vein associated with radiating symptoms into UE*
-scalenes
-1st rib
-pectoralis minor

Etiology in pregnant clients unique

-Postural changes with pregnancy secondary to increased breast weight, compensation for increased lumbar lordosis and changes in costal patterns

Front 25

thoracicc outlet syndrom treatment

Back 25

treatment:
address muscle imbalance
-supportive bracing
-taping
-education

Front 26

Diastasis Recti Abdominis

Back 26

midline separation of rectus abdomens
-linea alba
--increase in line alba width
-measured as inter-recto-distance

Front 27

how much is too much? diastasis recti abdominus

Back 27

normal:
15-22 mm

abnormal increase:
->2 finger-breadths
->2 cm

Front 28

Diastasis Recti Abdominis
Why is it a problem?

Back 28

66% of pregnant women
34.9%
74.4%
lack of natural resolution

Front 29

Diastasis REcti Abdominis-
Functional impairment

Back 29

abdominal muscle dysfunction
-LBP
-Lumbo-pelvic pain
-pelvic floor dysfunction
-stabilization

Front 30

DRA associated factors

Back 30

women>33 yo
multiparity
-multiple gestation
-c-section
-weight gain
-birth wieght

Front 31

Postpartum incontinence

Back 31

3 month postpartum
-urinary incontinence
-20-34% vaginal deliveries
-8.8% cesarean deliveries