Physiotherapy plays a crucial role in managing the immense physiological loads of pregnancy, delivery, and menopause. This guide covers high-yield topics for AIIMS, Jamia, and clinical practice exams.
1. Physiological & Musculoskeletal Changes in Pregnancy
A. Musculoskeletal System
- Center of Gravity (COG): Shifts upward and forward due to breast and uterine growth.
- Posture: To compensate for the forward COG, the patient develops Lumbar Hyperlordosis and an Anterior Pelvic Tilt. Shoulders may round (Protraction).
- Hormonal Influence: The hormone Relaxin increases ligament laxity to prepare the pelvis for birth, leading to joint instability (e.g., Sacroiliac joint pain, Pubic Symphysis dysfunction).
B. Cardiovascular & Respiratory System
| Parameter | Change Direction | Reason |
|---|---|---|
| Blood Volume | Increases (35-50%) | To meet metabolic demands of fetus. |
| Cardiac Output | Increases (30-50%) | Stroke volume increases. |
| Blood Pressure | Decreases slightly | Due to decreased peripheral resistance (vasodilation). |
| Tidal Volume | Increases | Progesterone stimulates deeper breathing. |
2. Diastasis Recti Abdominis (DRA)
Definition: The separation of the two bellies of the Rectus Abdominis muscle along the Linea Alba.
[Image of diastasis recti assessment]Assessment (Finger Test)
- Patient lies supine with knees bent (crook lying).
- Patient lifts head and shoulders off the floor (curl up).
- Therapist places fingers horizontally at the umbilicus, above, and below.
- Positive Result: A gap of >2 finger widths (approx 2-2.5 cm) is considered significant.
Management
- Avoid: Full sit-ups, crunches, and heavy lifting (increases Intra-abdominal pressure).
- Do: Transverse Abdominis (TA) activation exercises, Pelvic tilts, Heel slides with core engagement.
- Binder: Abdominal binders can provide external support in severe cases.
3. Pelvic Floor Rehabilitation (Kegel’s)
Weakness in pelvic floor muscles (Levator Ani) can lead to Stress Urinary Incontinence (SUI) and Prolapse.
[Image of pelvic floor muscles anatomy]Kegel's Exercises (Procedure)
- Identification: Ask the patient to imagine stopping the flow of urine or holding in gas. (Note: Do not actually stop urine flow regularly as it increases infection risk.)
- Technique: "Lift and Squeeze" the pelvic floor muscles. Hold for 5-10 seconds, then relax for 10 seconds.
- Dosage: 10 repetitions per set, 3 times a day.
- Knack Maneuver: Teach patient to contract pelvic floor muscles before coughing or sneezing to prevent leakage.
4. Post-Natal Exercises (Kab aur Kya?)
The timeline depends on the mode of delivery.
A. Vaginal Delivery (Normal)
- Immediate (Day 1-3):
- Deep breathing exercises.
- Ankle Toe Movements (pump circulation).
- Kegel’s: Gentle contractions to reduce edema and promote healing.
- Weeks 1-6: Walking, gentle pelvic tilts, TA activation.
- After 6 Weeks: Full aerobic and strengthening program (after doctor clearance).
B. Cesarean Section (C-Section)
- Immediate: Support incision with a pillow (splinting) while coughing. Deep breathing. Ankle pumps.
- Weeks 1-6: Avoid heavy lifting (> baby's weight). Focus on posture.
- After 6-8 Weeks: Abdominal strengthening begins slowly. Scar tissue mobilization.
5. Menopause & Osteoporosis Link
Mechanism: Estrogen plays a vital role in inhibiting bone resorption (breakdown). During menopause, Estrogen levels drop drastically.
- Effect: Osteoclast (bone breaker) activity increases > Osteoblast (bone builder) activity.
- Result: Rapid bone density loss, leading to Type 1 (Post-menopausal) Osteoporosis.
- Physio Role: Weight-bearing exercises (walking, jogging) and Resistance training are essential to stimulate bone formation (Wolff's Law). Balance training prevents falls/fractures.
Frequently Asked Questions (FAQs)
The forward shift of COG causes an anterior pelvic tilt, putting mechanical stress on the lumbar facets. Additionally, Relaxin hormone makes the SI joints unstable.
Perform the "Head Lift Test". If you feel a gap wider than 2 fingers near your navel or see a "doming/bulging" when lifting your head, you likely have DRA.
Traditional crunches should be avoided until Diastasis Recti is healed (gap < 2 fingers) and core strength is restored, usually 3-4 months post-partum. Start with TA activation first.
Exam Quiz: Gynae & Obs Physiotherapy (10 MCQs)
Test your knowledge. Click the correct option to see the answer and reasoning.
1. Which hormone is primarily responsible for ligament laxity during pregnancy?
Relaxin softens the ligaments of the pelvis (Sacroiliac and Symphysis Pubis) to allow expansion for childbirth, but also causes joint instability.
2. Supine Hypotensive Syndrome occurs due to compression of which structure?
The heavy gravid uterus compresses the Inferior Vena Cava against the spine when lying flat, reducing venous return to the heart.
3. A separation of the Rectus Abdominis greater than how many finger widths is considered significant for Diastasis Recti?
A gap of more than 2 finger widths (approx 2 cm) is generally considered a clinical Diastasis Recti requiring management.
4. Which exercise is CONTRAINDICATED in the early management of Diastasis Recti?
Sit-ups and crunches increase intra-abdominal pressure and can push the abdominal contents out through the gap, worsening the separation.
5. Why does Osteoporosis risk increase significantly after menopause?
Estrogen is protective for bones. Its withdrawal leads to increased osteoclast activity and rapid bone resorption.
6. Ideally, how soon can basic Kegel's exercises be started after an uncomplicated vaginal delivery?
Gentle Kegel's can be started almost immediately to improve circulation, reduce edema, and jumpstart healing, provided there is no severe tear/pain.
7. The "Knack Maneuver" refers to:
This is a functional coordination strategy used to prevent Stress Urinary Incontinence during events that increase intra-abdominal pressure.
8. Which postural change is most common in the third trimester of pregnancy?
To balance the anterior weight of the uterus, the woman leans back, increasing the lumbar curve (Lordosis).
9. In a C-Section recovery, "Splinting" refers to:
Holding a pillow firmly over the incision site reduces pain and protects the stitches from sudden pressure during coughing or sneezing.
10. Which law states that bone adapts to the loads placed upon it (justifying weight-bearing exercise for osteoporosis)?
Wolff's Law states that bone density increases in response to mechanical stress (loading). This is why walking/resistance training is crucial for post-menopausal women.
References
- Mantle, J., Haslam, J., & Barton, S. (2004). Physiotherapy in Obstetrics and Gynaecology. Butterworth-Heinemann.
- Polden, M., & Mantle, J. (1990). Physiotherapy in Obstetrics and Gynaecology. Elsevier.
- Kisner, C., & Colby, L. A. (2012). Therapeutic Exercise: Foundations and Techniques. F.A. Davis.
No comments:
Post a Comment