Antenatal Physiotherapy

Aims of antenatal care: We at physioline believe in safe motherhood and strongly recommend antenatal classes for women. This ensures

  • Awareness among them about dos and don’ts during pregnancy
  • to promote optimal physical and emotional maternal health throughout pregnancy
  • to detect any gynecological and obstetric complications during pregnancy
  • to recognize any fetal abnormalities as early as possible
  • to prepare both parents for successful pregnancy,labour and post delivery care of the baby
  • to ensure healthy mother and baby
  • Couples are shown the ways of coping with the physical changes of pregnancy
    discomfort and their associated
  • Couples are guided to the realistic understanding of labour and the assembly of a
    tool kit of coping skill
  • Couples are encouraged to consider the profound change in lifestyle that
    parenthood brings and the emotional maturity necessary to manage successfully
    their additional responsibility
  • Couples are encouraged to talk and air any fears ,ask questions and be helped to
    obtain satisfactory answers in an open environment.

Changes taking place during pregnancy:-

Weight gain total of 9.7 to 14.5 kg (20-30lb)

Pelvic viscera, fasciae and ligaments

The uterus increases from a prepregnant size of 5 by 10 cm to 25 by 36 cms. it increases 5 to 6 time in size 3000 to 4000 times in capacity and 20 times in weight by end of pregnancy. The ligaments connected to pelvic organs are more fibro elastic then ligament supporting

Urinary system

The ureter enters the bladder at a perpendicular angle because of uterine enlargement. This may result in reflex of urine out of the bladder and back into the ureter therefore there is an increase chance of developing urinary track infection in pregnancy because of urinary stasis.

Pulmonary system

Tissue congestion and edema of the upper respiratory track occur because of hormonal changes.

Changes in the rib position are hormonally stimulated and occur prior to uterine enlargement. the sub costal angle progressively increases ; the ribs flare out .the anterior posterior and transverse chest diameters each increases by 2 cm.

Total chest circumference by 5-7 cm. and does not always return to pre pregnant state.

The diaphragm is elevated by 4 cm. this is a passive change caused by the change in rib position

The respiration rate is unchanged, but the depth increases.

Tidal volume and minute ventilation increases but the total lung capacity is unchanged ot slightly decreased.

There is 15-20% increase in oxygen consumption .a natural state of hyperventilation occurs throughout pregnancy. this occurs to meet the oxygen demand of pregnancy.

The work of breathing increases coz of hyperventilation. Dyspnea is present with mild exercise as early as 20 weeks into pregnancy

Cardiovascular system

Blood volume progressively increases .plasma increase is greater than red blood cells increase leading to physiologic anemia .the increase in plasma volume occurs as a result of hormonal stimulation to meet oxygen demands of pregnancy.

Venous pressure in lower extremities increases when standing as a result of increase uterine size and increase venous distensibility

Pressure in inferior vena cava rises in late pregnancy esp. in supine position because of compression by uterus just below diaphragm.

Heart rate increases and returns to normal 6 weeks post pregnancy.

Cardiac output increases more in side lying position

Blood pressure decreases early in the first trimester. There is slight decrease of systolic pressure. although cardiac output increases ,blood pressure decreases because of venous distensibility.

Musculoskeletal system

Abdominal muscles are stretched to the point of their elastic limit by the end of pregnancy. This leads to weak abdominal muscles

Due to hormonal influence, there is a systemic decease in ligamentous tensile strength. joint hyper mobility occurs due to ligament laxity

Posture and balance changes

The center of gravity shifts upward and forward because of enlargement of the uterus and breasts

Cervical lordosis increases in the upper cervical spine and forward head posture develops to compensate for the shoulder alignment

Lumbar lordosis increase to compensate for shift in gravity

With increases weight and redistribution of the body mass there are compensations to maintain balance

Benefits of physiotherapy

  • Massaging effect on baby
  • Breathing exercise
  • Posture correction training is the ability to correct muscular imbalances, postural distortion patterns, and joint and muscle pains by reconditioning the body to perform better within the kinetic chain structural integrity. It strengthens weak muscles or muscles that are not working properly and increases flexibility and muscle and joint mobility with proper stretching
  • Stabilization exercises to improve core stability and decrease stress on the lumbar spine and thereby posture maintenance
  • Manual therapy techniques and massage aid in reducing joint pains
  • Pelvic floor exercises to prevent urinary incontinence
  • Specific stretching and strengthening exercises for your condition
  • Sacro-iliac joint bracing
  • Therapeutic modalities (ultrasound, laser, and muscle stimulation) and acupuncture can be used in pain relief during parturition as well as post pregnancy.
  • develop awareness of precautions to be taken during pregnancy

Physioline’s Guidelines for Exercising during Pregnancy

  • Do not begin an exercise program in the first trimester if you have not been exercising regularly prior to becoming pregnant. The exercise program can begin in the second trimester.
  • Past 4 months of gestation, avoid lying flat on your back. You may place a pillow under your right hip or lie on your side. Lying on your back allows the weight of the baby to exert pressure on a major vein going to the heart.
  • Do not over-stretch because your joints are more susceptible to injury during pregnancy due to increased levels of the hormone relaxin. Choose stretching exercise that are specific to a single muscle or muscle group; do not involve several group at once. Asymmetric or stretching multiple muscle groups can promote joint instability. Avoid ballistic movements
  • Avoid exercising in the heat or dehydrating yourself.
  • Do not allow any joint to be taken beyond its normal physiologic range.
  • Use caution with hamstring and adductor stretches. Overstretching of these muscles groups can increase pelvic instability or hyper mobility.
  • limit activities in which single leg weight bearing is required such as standing, leg kicks.
  • do not exceed 5 min of supine positioning at any one time after the fourth month of pregnancy to avoid vena cava compression by the uterus. When supine place a small wedge or towel .
  • To avoid the effects of postural hypotension, women should always rise slowly when moving from lying to standing position.
  • discourage breath holding and avoid activities that increase the tendency to elicit the valsalva maneuver because this may lead to undesirable downward force on the uterus and pelvic floor. In addition breath holding causes stress to the cardiovascular system in terms of blood pressure and heart rate.
  • Encourage complete bladder emptying prior to exercise. a full bladder places increased stress on a already weakened pelvic floor.
  • Post-partum avoid knee chest position because of risk of air embolism.

AT PHYSIOLINE:- Physiotherapist educate on following aspects-

  • Postural hormonal and weight changes
  • Pregnancy back care
  • Ergonomic education
  • Working position-bending, lifting and household activities
  • Exercise for various joint dysfunctions arising during pregnancy
  • Pelvic floor and pelvic tilting exercises
  • Exercise for circulation and cramp
  • Fatigue
  • Stress coping techniques
  • Breathing exercise.

Routine antenatal care:-

  • Routine blood tests
  • Calculate BMI
  • Take advice on diet, exercise, alcohol and smoking

During Subsequent visits one should include following tests:-

  • Blood pressure
  • Urine
  • Weight
  • Edema
  • Fundal height and the lie of the foetus
  • Foetal mvements
  • Foetal heart rate
  • Blood tests
  • Hemoglobin levels
  • Sexually transmitted infections
  • Blood groups
  • Hemoglobinopathies
  • Maternal serum screening
  • Ultrasound scanning
  • Chorionic villus sampling
  • amniocentesis

PHYSIOLINE MANAGEMENT:-

Find a comfortable stance with your feet approximately shoulder width apart. Breathe deeply into the pelvis and relax as you exhale do the following:

  • HEAD ROTATIONS: With your neck in a straight and upright position slowly drop your head forward and roll it counter-clockwise one full rotation until your head is tilted over your left shoulder. Now roll your head clockwise in the same manner. Repeat each rotation one more time.
    Rotate your shoulders forward two times and backward two times. Shake your arms and hands, legs and feet.
  • WOODCHOPPER: Stand with your feet a little wider than shoulder width apart. Clasp your hands together with your arms raised above your head. Bend your knees slightly and tuck in your bottom. Inhale and bring your clasped hands forcefully down between your legs in a chopping motion with and explosive exhalation (say “Haah!”). Repeat five times.
  • FENCING STRETCH: Stand with your heels together toes pointing outward. Move your left foot directly forward two or three feet until your left knee is bent at almost a right angle and the back leg is stretched out straight. Inhale and stretch as you exhale. You should feel the stretching in the inner thigh of your back leg. Now bring your leg back and repeat the exercise with your right leg forward and your left leg back. Repeat six times with each leg.
  • SQUAT: You may want to try this one with a solid table or chair to hang onto for support. Standing with your feet shoulder width apart, slowly drop your head and bend over one vertebra at a time, arms dangling forward to keep you balanced. Now fold your knees, straighten your back and raise your chin until you are in a squatting position, with knees under your armpits and heels flat on the floor. Relax the pelvic floor muscles and visualize the vagina being very open. Inhale and exhale a few times while you relax in this squatting position. On rising, straighten your knees while still bent over and come to a standing position moving up slowly one vertebra at a time.
  • HORSE: Stand with your feet about three feet apart with your toes turned outward, knees bent over your feet as much as possible at a 90 degree angle. Put your hands on your thighs and keep your arms straight. Lean slightly forward and rest the weight of your torso on your hands. Breathe deeply and relax the pelvic floor muscles. Inhale and exhale while relaxing. Hold the position as long as you are comfortable. This is a good substitute exercise for the squat if the squat is too uncomfortable.
  • LACTATION EXERCISE: While standing, cross wrists over your sternum (breast bone). In a pressing motion hug your ribs with your elbows. Then open and raise your arms straight above your head with palms facing each other. Swing your arms out to shoulder height and then down to your sides. Now press backwards as though you are pressing against a wall and then return to the cross wrist position and repeat five times.
  • HISS BREATH: On soft flooring or on a mat, kneel with your bottom on your heels and your knees spread apart. Inhale and as you exhale stretch down and try to touch your forehead to the floor. Breathe deeply and as you exhale relax the pelvic floor and thigh muscles. Sit up slowly one vertebra at a time.
  • THE CAT AND THE COW: Begin on your hands and knees with a flat back. As you inhale, stretch your chin upwards, like a cow mooing. As you exhale, shift your weight slightly to your knees, arch your back and neck, pull in your stomach and bottom muscles, like a cat arching her back. Return to the first position and repeat at least six times. This exercise is helpful for lower back pain.
  • RELAXATION: Lay down in a comfortable position. Now tense all your muscles beginning with your toes, feet, legs, and hips and moving up to your arms, hands, shoulders, chest, neck and face. Hold for two counts and release all the muscle tension back down your body until even your toes and fingers are relaxed. Repeat two times

Visit PHYSIOLINE for further treatment

AT PHYSIOLINE ,WE TREAT FOLLOWING PREGNANCY PROBLEMS :-

  • Back and pelvic girdle pain
  • Diastasis recti
  • Low back pain
  • Sacro iliac joint pain
  • Sciatica
  • Symphysis pubis dysfunction
  • Coccydynia
  • Thoracic spine pain
  • Postural backache
  • Pregnancy induced osteoporosis
  • Carpal tunnel syndrome
  • Brachial plexus pain
  • Meralgia paraesthetica
  • Post tibial nerve compression
  • Varicose veins in the legs
  • Vulvar varicose veins
  • Hemorrhoids
  • Muscle cramp
  • Thrombosis and thromboembolism
  • Chondromalacia patellae
  • Restless leg syndrome
  • Uterine ligament pain