Cardiovascular system changes during pregnancy
- increased blood volume
- increased plasma volume
- increased cardiac output
- heart size increases and HR increases 10-20bpm
Pregnancy Complications
- Hypertension
- Symphysis Pubic Dysfunction/Diastasis
Symphysis Pubic - Low Back Pain
- SI Joint dysfunction
- Coccydynia
- Gestational Diabetes
- Diastasis Rectus Abdominus
- Supine Hypotension
Physiological changes during pregnancy
- Glandular
- Hormone level
- Musculoskeletal
- Neurological
- Gastrointestinal
- Cardiovascular
- Respiratory
- Renal/Urological
What are the factors that lead to LBP in pregnant women?
- shift in COG
- ligament and structural changes due to relaxin
- hypermobile joint ligaments
- Coccydynia: coccyx pain with sitting
What complication does Supine have with a pregnant patient?
Inferior Vena Cava Syndrome - weight of the uterus can place pressure on aorta and IVC. *place towel roll on L tilt
Benefits of Prenatal Exercises
Maintain circulatory and respiratory systems Decrease leg cramps Minimize excessive weight gain Increase endurance for labor and recovery Decrease constipation and heartburn Increase energy Improve muscle tone and strength Improve posture Decrease back pain Prevention of musculoskeletal injuries Improve sleep
Pregnancy Exercise Precautions
Gestational diabetes Severe anemia Overheating response Rectus diastasis Musculoskeletal pain
Symptoms to Watch During Exercise
Uterine contractions at 20 minutes intervals or closer
Vaginal bleeding
Leaking amniotic fluid
Absolute Contraindications to Exercise in Pregnancy
Pre-Pregnancy and Acute Conditions
- active myocardial disease
- CHF
- rheumatic heart disease
- thrombophlebitis
- recent PE
- acute infectious disease
- signs of toxemia (fluid gain, HTN)
Absolute Contraindications to Exercise in Pregnancy
History Risk Factors
- At risk for premature labor
- Triplets or more
- Hx of 3 or more spontaneous abortions
- Contractions lasting several hours after ex
Absolute Contraindications to Exercise in Pregnancy
Physiologic Risk Factors
- Incompetent cervix
- Uterine bleeding
- Rupture membranes
- Intrauterine growth retardation
- Suspected fetal distress
- Placenta previa
Indications to Intolerance to Exercise
- Persistent palpitations
- Decreased fetal movement
- Excessive fatigue
- Recurrent dizziness
- Excessive nausea
- Persistent headache
- Excessive shortness of breath
- Pain that limits ADL’s
Pregnancy Exercise Guidelines
- 50-60% of MHR for a max of 15-30 min
- do not overexert
- do not over stretch joints (only grades 1&2)
- no prone exercises
- adequate hydration/ventilation
- supine brief 5-10 min
- 3rd TRI: do not do ab curl ups.
- avoid strenuous ab exercises: heel slides only!
Low risk stretching exercises for pregnant patients
Upper neck extensors and scalene muscles Scapula protractors, shoulder internal rotators Low back extensors Hip flexors Ankle plantar-flexors
Low risk strengthening exercises for pregnant patients
Upper neck flexors Upper thoracic extensors Scapula retractors and depressors Shoulder external rotators Trunk flexors (modified exercise positions) 3rd trimester heel slides
Trunk Flexor exercises that are Low Risk
Pelvic tilt exercise Leg/heel slides Pelvic clock Standing push up Modified supine bridge Modified wall squat
Post Natal Exercises
- Pelvic floor strengthening
- Pelvic tilts /pelvic clocks
- Abdominal strengthening
- Aerobic conditioning
- Stretching
What should you educate the patient on about Diastasis Rectus Abdominis?
- Teach protection of ab musculature positioning - ADL transfers - Roll with symmetrical legs - SL with pillow under knees (Left side) - Ab support belt - Contoured Pillow
What should you educate the patient on about Supine Hypotension IVC Syndrome?
- supine position can decrease bp
- place pillow under hip to modify abdominal pressure
- encouraging SL on Left side
Musculoskeletal System changes during pregnancy
- abdominal muscles stretched/weakened
- rib cage circumference increases
- pelvic floor weakness
- postural changes
What neurological disorders can occur during pregnancy due to nerve entrapments?
- thoracic outlet syndrome
- carpal tunnel syndrome
