Chapter-19_Exercise Therapy Regime

110 Textbook of Physiotherapy for Obstetric & Gynecological Conditions

Exercise TherapyRegime

CHAPTER

19

The physiotherapy plays very important role during this period for healthierpregnancy, easier childbirth and regain the shape back to the normal. So effectivepractice for physiotherapist is based on a sound knowledge and understandingof anatomy and physiology and of the social and psychological aspects of theeach stage of child bearing year

AIMS OF OBSTETRIC PHYSIOTHERAPY

1. To promote good health, price and sense of well-being during pregnancyand encourage preventive medicine.

2. To give women the opportunity to discuss their fears and expectations in arelaxed and sympathetic atmosphere and to acquire positive and accurateinformation about pregnancy and labor.

3. To offer instructors in skills to conserve energy, raise pain tolerance levelsand maintain control during labor.

4. To alleviate stress and strain of the pregnancy.5. To rehabilitate women during the puerperium to full physical activity and

mental well-being.The exercise regime of pregnancy is called Pilates. Pilates are defined as the

mild or moderate exercise method to be used in the months of pregnancy, afterbirth and to regain shape back to normal. The exercise designed to strengthenthe back, pelvic floor, to maintain tone of the abdominals and achieve the longer,leaner and stronger body.

Exercise Therapy Regime 111

PRINCIPLES

The Concentration

Concentration is fundamental aspect of exercise required or correct performanceof technique or diversion may occur on the concerns, anxieties that will haveaffect future mother and fetus.

The Breath

Breathing plays a vital role. There are two breathing exercises in the warm-upsession. This helps the woman to breath deeply, rhythmically and to the fullcapacity. When exercising she has to breathe in and breathe out with effort, thishelps the woman to relax a movement. If vice versa happens, i.e. if she breathesin for the effort she will get tensed up.

The Girdle of Strength

The girdle of strength is essential for all exercises. It includes three areas. Theyare the upper back, the abdomen and the buttock.

The Back

The upper limb exercises are very important in relieving the tension and can bethe major seat of tension. So, woman has to perform the upper limb exercisescorrectly from the midline of the back so that she will be free of tension.

Abdomen

All the exercises begin by drawing the navel gently towards the spine. Thisstrengthens the transverse abdominis muscle to regain a flat stomach and protectthe back against undue strain during the exercise.

Buttock

Buttock muscle movements and squeezing during the exercise will tone themuscles and also bring the body into the perfect alignment thereby improvesthe posture and protects the back from strain or injury.

Relaxation

Relaxation plays a vital role in the exercise session. The warm up should bedone whenever exercises are performed. This helps in reducing the tension inthe body. Breathing control is also important by slowing down the breathingand followed by the relaxation at the end of exercise session.


IMPORTANCE OF EXERCISE SESSION

1. The increase in hormones relaxes the ligaments and muscles make pregnantwomans body supple than normal woman, so body will be loose. Stretchingexercises should be avoided.

2. All the joints become unstable, so the pregnant woman should maintain thetone of the abdominal muscles or the back may get strained.

3. The posture should be checked regularly. In the 1st trimester utmost caremust be taken to prevent damage to her back. Because when the weight ofthe body changes, the center of gravity tends to induce a sway back in herstance.

4. Women breast also enlarge rapidly from the beginning of pregnancy, theextra-weight puts strain on the neck, shoulders, upper back as well asshoulders become rounded resulting in postural problem. So, a woman hasto perform regular shoulder, neck exercises, should know posture correction.This will release tension in the area, increases mobility. Woman should alsowear a well-fitting bra that will give her support at each stage of her pregnancy

5. The extra-blood is produced, waste disposal system increases, amnioticfluid surrounding her baby and the fluid to all of her body tissues in thepregnant woman body will increase, so regular exercises must be done tokeep the fluid moving and to prevent edema which is retention and swellingof the area, woman also has to drink plenty of water.

6. Pelvic floor exercises play an important role because this will help to reducethe risk of varicose veins as the effect of relaxin causes the wall of the womensblood vessels to relax which leads to varicose veins as well varicosities inthe vulva or anus called hemorrhoids or piles.

7. The digestive system is also affected with morning sickness and leads tonausea or actual vomiting. This usually disappears after the third month ofpregnancy. Digestion slows down during pregnancy and will result inheartburn or constipation. Exercise helps womens metabolism speed upgradually and risks are reduced.

8. After the birth of baby, body starts to return to its pre-pregnant state, reducingoutput and fluid balance immediately. Breastfeeding will speed up thisprocess. Women body will be back in shape, so women should take time torecover, relax, rest into mothers new role.

EXERCISE PROGRAM

Exercise is important during pregnancy on a number of levels. Pregnancy istime to focus of stretching, relaxing and general toning.


AIMS OF PHYSIOTHERAPY

1. To provide maximum possible physical independence.2. To give relief of symptoms.3. To improve functions of the body.4. To increase functional capacity.

GUIDELINES FOR EXERCISE DURING PREGNANCY

1. Exercise thrice a week.2. Maximum heart rate should not exceed 140 to 150 beats per minute.3. Maintain adequate fluid intake to avoid dehydration.4. Proper diet to be taken to meet the exercise needs.5. Avoid exercise during illness.6. Avoid exercising in supine position after end of the fourth month.

CONTRAINDICATIONS

1. Gestational diabetes.2. History of miscarriage, premature labor.3. Vaginal fluid loss.4. Hypertension.5. Multiple pregnancies.6. Abnormal placental function or position.7. Anemia.8. Decreased fetal movement.

EFFECTS AND USES OF EXERCISES

1. Helps to improve posture.2. Aids to reduce stress and anxiety.3. Maintains cardiovascular fitness.4. Reduces backache.5. Aids in preparation for labor.6. Maintains muscle flexibility and length.7. Helps in control of weight.8. Improves body awareness.9. Improves blood circulation.

10. Reinforces relaxation.11. Decreases fatigue.12. Reduces stress and anxiety.13. Increases endurance and stamina.14. Provides social interaction. Assist postnatal recovery.15. Helps in shaping up back to normal.


AIMS AND PLANS DURING PREGNANCY

1. Aim: To teach knowledge of awareness and control of posture.Plan: Postural awareness training, strengthening and stretching posturalmuscles.

2. Aim: To learn safe body mechanics.Plan: Body mechanics in sitting, standing, lifting lying, moving from oneposition to another, during labor and delivery.

3. Aim: To prepare the lower limbs for weight-bearing and prevent circulatoryproblems.Plan: Stretching exercises, resistance exercises to the muscles of lower limb,use of elastic stockings or edema control.

4. Aim: To teach the importance of the exercise and control of the pelvic floormuscles.Plan: Awareness of pelvic floor contraction and relaxation. Trainstrengthening and muscle control.

5. Aim: To maintain abdominal function and prevent diastasis rectipathology.

6. Aim: To promote safe cardiovascular fitness.Plan: Aerobic exercises.

7. Aim: To have knowledge about pregnancy and childbirth.Plan: Women should attend antenatal physiotherapy classes arranged atthe hospital.

8. Aim: To teach relaxation method.Plan: Women should make a habit of practicing relaxation techniques.

9. Aim: To prevent impairments associated with pregnancy like lowbackache, pelvic floor weakness, and decreased circulation.Plan: Women should attend classes to know about problems of pregnancy,preventive techniques and appropriate exercises.

10. Aim: To mentally prepare woman for labor and delivery.Plan: Women should have knowledge about of signs of starting of labor.

11. Aim: To develop awareness of the pelvic floor dysfunction.Plan: Pelvic floor exercises strengthening during pregnancy, after birthshould be taught.

First Trimester

In the first trimester strenuous exercise should be avoided as it may lead tomiscarriages, concentrate on improving posture, strengthening the pelvic floor,relaxation, and breathing techniques.


Posture Awareness

This helps in release of tension, improves the blood supply, improves thefunctions of the autonomic nervous system which in turn improves thefunctioning of the reproductive organs, it reduces the strain of muscles, jointsand ligaments.Standing posture: Head and neck: Head should be relaxed and balanced on the top of the spine

with neck straight. Shoulders and arms: The arms hang comfortably by the sides without tension

looking straight at the mirror; check the shoulders are at an even height.Turn sideways to the mirror and check that the shoulders are neither pulledback, which distorts neither neck nor slouched forward.

Back and stomach: Stand sideways on to the mirror to check your back. Let yourspine lengthen out. Draw the navel gently towards the spine and gently pullup the pelvic floor muscles, so doing like this prevents strain to the back.

Buttocks: The navel and back are in the correct placement, pelvis will belightly upward. So lowest muscle in the buttocks must be squeezed for correctalignment.

Legs and feet: The feet should be a hip foot apart with the toes facing forwardsweight should be taken equally on both the feet.

Pelvic Floor

Pelvic floor strengthening is important because the muscles support the babyand extra-weight of the uterus, prevent incontinence, hemorrhoids and prolapseof the uterus.

Position of patient: Standing up, sitting down, squatting on heels with kneesapart. If women has problems like hemorrhoids and varicose veins then prefersitting on a chair.

Contract and release: slowly contract pelvic floor muscles in long upwardmovements towards the uterus. Abdomen and buttocks should be relaxed. Holdand slowly release. Perform ten repetitions.

The lift: Contract pelvic floor muscles and pause three times.

Pulses: Contract all the pelvic muscles and then release rapidly, so do thisrepeatedly in time within pulse time.

Breathing Exercises (Fig. 19.1)

Relaxation and stretching are done with treath in a movement and effort takesplace in treath out.


Fig. 19.1: Breathing exercise

Breathe awareness: Lie on the back with a small cushion below head and feetshould be on the chair so that knee will be right angle. See to that back is straightand no tension in the shoulders or neck. Place the hands on abdomen so thatthe fingers touch each other. As woman breathes in the inhalation should reachthe abdomen and indicated by separation of the fingers, as she breathes out thefingers should meet again. Do not exaggerate the movement and repeat for 10breaths.

Rib Awareness (Fig. 19.2)

Sit on a ball or chair with feet on the floor with hip width apart, toes pointingforward. The back should be straight with no tension in the neck and shoulderswrap a long scarf around back at rib level, cross it in front and hold one end ineach hand breathe in and feel the expansion of ribs and breathe out and feel theribs contact. Repeat for 10 breaths.

Fig. 19.2: Rib awareness


Head Roll and Head Tilt (Figs 19.3A and B)

These exercises relieve tension in the shoulder and neck and keep the spine inproper alignment.1. Sit with both the feet flat on the floor with a long, straight back. Draw the

navel gently to the spine and pull up the pelvic floor. Check there is notension in the shoulders, neck or face particularly in jaw, forehead andaround the eyes. Take a few long deep breaths and let women relax.

2. Drop your chin down to your chest, without moving or tensing the shoulders.Roll the head around towards the right, center, left and return to the centralposition and lift the head, repeat for 4 to 5 times.

3. Turn the head and look to the right shoulder. Chin should be slightly tuckedin and turn to the left side and return to the center.

A B

Figs 19.3A and B: Head roll and head tilt

Shoulder Lifts and Circles (Figs 19.4A to D)

This exercise relieves tension in the upper back. Keep the backbone straight.1. Lift the shoulders as high as can reach towards your ears, letting the arms

hang loosely at your sides. Drop them heavily. Repeat each shoulder for 5times.

2. Draw the shoulder forwards so that she can close up the front of the chestand take them backwards to touch the shoulder blades. Repeat for five times.

Arm Stretches (Figs 19.5A to C)

This helps in toning up the arms:1. Sit on a chair with feet flat on the floor with backbone straight. Draw the

navel gently to the spine and pull up the pelvic floor. See to that there shouldbe no tension. Take a few long deep breaths and relax.


A B C D

Figs 19.4A to D: Shoulder lifts and circles

2. As she breathes out lift the arm straight to the shoulders level a breathe in putthe hands down. This causes stretch in the shoulders. Repeat 5 to 10 times.

3. Drop the arms down to your sides, take the arms straight behind you. Bringback to normal position, repeat the same for five times. This gives downwardstretch effect.

4. Sit with the arms bent at the elbows and fingers pointing to the sides andkeep the elbows tuck into sides. Breathe out return to normal position. Repeatfor five times.

A B C

Figs 19.5A to C: Arm stretches

Side Stretch (Fig. 19.6)

This gives side stretch1. Sit sideways on an armless chair with feet on the floor and left hand holding

the chair back. Backbone should be straight. Draw the navel gently to thespine and pull up the pelvic floor. Slowly breathe in and breathe out.

2. Place right hand behind your head. Breathe out turn your head to look awayfrom the chair back a pull through the ribs. Now, stretch gently away fromthe chair back feeling the lower ribs stretching up.


3. Breathe in to return to the starting position and repeat 5 to 10 times. Repeaton the other side.

Forward Bend (Fig. 19.7)

1. Stand facing a window ledge or heavy table or chair and arms length away.Feet should be firmly on the floor; hip-width part keep the backbone straight.Draw the navel gently to the spine and pull up the pelvic floor. Raise yourarms above your head without raising your shoulders.

2. Breathe in and while breathe out slowly bend forward. Let the fingers reston the support and feel a long stretch through the arms, neck a back. Holdthis position for a minute and breathe naturally.

3. Now, continue to bend forwards and drop the head towards the floor, ifstrain is felt bend the knees slightly.

4. Breathes in and breathe out slowly roll up back to the straight standingposition. Repeat this for five times.

Pillow Squeeze (Fig. 19.8)

This causes exercise to pelvic floor, inner thigh, postural awareness and relaxingthe lower back.

Position of woman is supine lying with a pillow below her head.1. Lie on your back with the knees bent and feet flat on the floor. Gently hold

the pillows between knees. Place the arms by side of the body with palmsdown. Whole body should be relaxed. Breathe in pull up the pelvic floormuscles.

Fig. 19.6: Side stretch


Fig. 19.7: Forward bend

Fig. 19.8: Pillow squeeze

2. Breathe out squeeze the pillows with your knees.3. Breathe in to release the cushion comes back to the starting position and

repeat the same for 10 times.

Relaxation: After exercising it is important to relax. This should be for 10 to 15minutes. This relieves stress levels, feeling of tiredness, ability to cope andoverall health will be fine.

Relaxation Sequence (Fig. 19.9)

Lie down on the floor with the spine straight, arms close to sides, palmsuppermost because it causes upper back and shoulders down, comfortable onthe floor close your eyes and relax total body and slowly roll the head from side-to-side to check the tension in the neck. Practice the relaxation techniques, i.e.Yoga-nidra.


Fig. 19.9: Relaxation sequence

Alternating the Breath

Alternate nostril breathing should be practiced after relaxation because itimproves oxygen intake, purification and circulation of the blood and lymph.Oxygen flow is increased to every cell in the body, improves alertness,concentration and a good exercise or lungs and respiratory muscles.1. Keep your backbone straight, sit on the floor with crossed legs or in the

chair. Breathe in and breathe out with force.2. Close the right nostril with the help of right thumb and breathe in and

breathe out with force through left nostril.3. Close the left nostril with right hand little finger and breathe in an breathe

out with the left nostril.4. Alternately close the right and left nostril and breath alternately with force.

Second Trimester

In the second trimester: All signs of nausea disappear. Women feel extremely wellboth physically and emotionally. So, exercises to protect against strain andinjury, to boost the circulation of both blood and lymph, to keep muscles toneand sense of well-being.

Curl-ups

This exercise causes increase mobility in the spine strengthens pelvic floor andabdominal muscles.

1. Lie on your back with knees bent, feet slightly apart and flat on the floor.Shoulders and neck are relaxed and arms by the side of the body. Place arolled towel between the knees and slowly lengthen the spine along thefloor, tuck the chin in and lengthen the neck.

2. Slowly breathe in and as you breathe out draw the navel gently towards thespine. Lift the buttocks and back slightly up so that shoulder blade shouldtouch the floor. This causes mobility of the spine.

3. When the body is lifted up, breathe in and breathe out, lower the back downslowly and place it on the floor. Repeat for 5 to 10 times.


Knee to Chest

This exercise helps in improving posture, releasing the tension in the lowerback and neck.1. Lie on your back with knees bent and feet flat on the floor, the spine, neck,

and head straight. Lift the knees up and feel the whole spine in contactsfloor. Place your hands just below the knees, holding them apart to fit aroundthe bump. Draw the navel gently back towards the spine throughout theexercise.

2. Breathe out draw your right knee towards the chest, breathe in release theknee, neck and shoulders should be relaxed.

3. On the next out breath, draw the left knee to the chest in the same way.4. Breathe out draw both the knees to the chest. Repeat the whole sequence 5 to

10 times.

Opposite Arm and Leg Stretch

This exercise helps in stretching out and relaxing the body.1. Lie on your back with your knees bent, feet flat on the floor and arms beside

you. As you breathe out slide your left leg away from you on to the floorsimultaneously lifting your right arm up above your head to lie flat on thefloor.

2. Breathe in and breathe out return your arm and leg to the starting position.3. On the next breathe out; repeat with the left arm and right leg. Alternate 5 to

10 times.

Arm Reaches

This exercise is useful for releasing tension in the shoulders, back and neck.

1. Lying on your back, place your feet on the floor, slightly apart with kneesbent. Reach your arms straight, so those finger tips are pointing at the ceiling.

2. Breathe out take your arms in the opposite directions, so one goes above thehead closely to the floor and other goes down to your side. Breathe out comeback to the starting position

3. Breathe out repeat the same in opposite direction. Perform alternatively for10 times.

Hip Rolls

This exercise is designed to release the tension from the back and neck andhelps for relaxation.

1. Lie on your back with your feet together and knees raised and slowly breathein and breathe out.


2. Breathe out roll the knees gently to one side keeping them together. Breathein return to the center.

3. Breathe out repeat the same on the opposite side. Repeat the whole sequence10 times on each side.

Knee Drops to Side

This exercise relaxes pelvic area.

1. Lie on your back with knees waist and feet flat on the floor slowly breathe inand breathe out.

2. Breathe out slowly drop one knee to the side without lifting the hip or movingthe pelvis, breathe in and return to the starting position.

3. Breathe out drop the other knee to the side and return back to the startingposition, and repeat the same for five times on each side.

Leg Slides

This exercise maintain good alignment and posture, mobilizes and stretchesthe joint of the leg.1. Lie on the floor with knees raised and feet together on the floor and slowly

breathe in and breathe out.2. Breathe out straighten one bent knee along the floor and breathe in return

back to the starting position.3. Repeat the same with the other leg and perform the same alternately five

times on both sides.

Hamstring Stretch

This is the stretch for hamstring muscles, this also release the feeling of heavinessin the legs, edema.1. Lie on your back with both the knees bent, feet flat on the floor, the shoulder

should be relaxed, wrap a long scarf or belt along the foot and slowly bringthe left knee up towards the chest and slowly breathe out straighten the legup towards the ceiling. The knee should be facing the woman try to feel thestretch for a count of ten to twenty.

2. Breathe in bent the leg slowly and relax for a moment and repeat the sameon the other side.

Leg Stretchers

This is the exercise that reduced the edema and strengthen the abdominals.1. Lie on your back with both the feet together flat on the floor and knees raised

now take your feet off the floor. Keeping the knees apart to make a V shapetowards your toes.


2. Breathe in and bring one knee up towards your chest and breathe out andstretch of the second leg.

3. Breathe out change the legs, so that second leg is drawn towards the chestand first is stretch up and repeat the same five to ten times on each side.

Leg Lift

This exercise help to reduce edema and keep the muscles strong.1. Lie on your side against a wall. Place a big cushion below the upper leg and

rolled up towels to support the waist, now stretch out your lower armsparallel to your spine and place a small cushion between head and arm,bent your lower leg and flex the foot of your upper leg on the cushions placeyour upper hand on your upper hip.

2. Breathe out slowly lift your whole upper leg slightly upwards, breathe inslowly bring back to starting position.

3. Breathe out perform the same on the other side by same arrangement of thepillows.

Posture Awareness

This exercise done in front of the mirror to check the position to know howspine does works and to improve the posture.1. Sit on a chair or a ball and keep your backbone straight in front of the mirror

with both arms folded and few inches in front of the chest only rest yourhands against your arms and slowly breathe in and breathe out.

2. Breathe out slowly turn your spine to the right side, breathe in return to thestarting position.

3. Breathe out turn to the left side and repeat the same alternately five times oneach side.

Squatting Against a Wall

This exercise helps to maintain the mobility of the pelvic and hip joint.1. Put a big cushion on the floor next to wall stand against the wall with feet

hip width apart and slowly breathe in and breathe out.2. Breathe out slowly begin to bent your knees and slowly slide your lower

back down the wall keep your heels flat on the floor. Stay in this position fora minute or two.

3. Slowly breathe in and breathe out slide slowly up back the wall.

The Quadruped Position (Figs 19.10A to C)

This exercise stretches and relaxes the back


1. Position yourself on your hand and knees with hip width apart in front ofthe mirror and check shoulders hips and knees are all in alignment andslowly breathe in and breathe out.

2. Breathe out slowly draw the naval back towards spine so that back archesup and head drops down between the arms. Breathe in and return to thestarting position.

3. Breathe out and arch your back so that it hollows out and raised your head.Breathe in and return to back to the starting position. Repeat the both for fiveto ten times.

A B C

Figs 19.10A to C: The quadruped position

Pillow Squeeze

This exercise is to strengthen the pelvic floor and tones up the inner thigh.1. Lie on your back with knees flexed with a harder pillow in between knees

and thighs and feet slightly apart and flat on the floor. Slowly breathe inand breathe out.

2. Breathe out pull the muscles of buttocks and thighs and squeeze the pillowsto the count of ten breathe in slowly relax. Repeat the same for five to tentimes.

Relaxation Sequence

Finish this whole exercise session with the relaxation sequence.

Third Trimester

In the third trimester women feel the extra weight unbearable. So exercise playsan important role in reducing the edema, correcting the postural imbalance. Sothe relaxation and the breathing technique are the best.

Foot Arching

This exercise decreases the risk of edema. Whenever possible keep the feet raisedwith a pillow, feet if lying on the bed.


1. Keep backbone straight and sit near the edge of a chair, with feet slightlyapart, flat on the floor and slowly breathe in and breathe out.

2. Without moving the heels slowly draw back the toes, so that arch increases.Go back to the starting position.

3. Stretch the toes upwards as far as they go. Come back to starting position.4. Raise your inner border of the foot. This is called eversion and come to

starting position then raise your outer border of the foot. This is calledinversion and come back to starting position. Repeat all of the above for fiveto ten times.

Ankle Exercises

This is the good exercise for swollen feet.1. Sit with the backbone straight against the wall, the lower legs are supported

with a pillow. Slowly breathe in and breathe out.2. Slowly bend your both feet forwards, this is called dorsiflexion. Hold and

count five and come back to starting position.3. Slowly bend both feet downward this is called plantar flexion, feel the stretch

and count five and come back to the starting position.4. Slowly circle the ankle for five times clockwise and anticlockwise direction

and come back to the starting position.

Hand and Wrist Exercises

This exercise helps in reducing tension and swelling too.1. Sit comfortably in the chair and keep your backbone straight, shoulders and

neck should be relaxed. Bring both your hands together so that finger tips ofboth the hands should touch each other and press them firmly without anyother parts of the hand touching each other. Hold for a count of ten andcome back to the starting position.

2. Shake your hands loosely in front of the mirror for ten times.3. Make and fist close them and open them for ten times.4. Rotate your wrist five times clockwise and anticlockwise direction.

Arm Raises

This exercise helps to improve posture, reduces tension in the necks andshoulders.1. Take a long scarf and stand with the feet hip width apart with the long

straight back and neck and slowly breathe in and breathe out and hold thescarf in front of you, breathe out raise the scarf on to the top of the head. Donot lift the shoulders and slowly breathe in.

2. Slowly breathe out and lower the scarf again and repeat the same.


Legs Against the Wall

This exercise reduces swelling in the ankles and feet. Need not perform thesecond one till you feel comfortable.1. Keep a cushion below head, position in such a way that bottom touches the

wall and lift your feet till you are comfortable on the wall, straighten the legsand flex the feet or toes can be pointed with knees bent. Hold this positionfor 10 minutes or longer depending on comfort of the woman.

2. If the first position is easy then go for second, this causes stretch of theinnerthighs. Slowly take both the legs outward and feel the stretch. Relax forfive minutes.

3. Bend the knees and roll sideways on to the floor to come out of either position.

Spinal Twist

This exercise relaxes back and stretches hamstring and calf muscles.1. Sit on the floor with backbone straight with legs stretched straight and

shoulders should be relaxed.2. Bend your left leg and cross your foot over the right leg and keep by the side

of the right knee in the bent position and hold the left knee with the rightarm. Place the palm of the left hand on the floor behind you and breathe out.Turn your head to look back and breathe in come to the center and repeat thesame exercise for ten times.

3. Repeat the same on the others side.

Sitting with Legs Wide Apart

This causes stretch of the hamstrings and the inner thighs. Increases mobility ofthe hip joints and releases the tension in the back and shoulders. Breathingexercises can also be done in this position.1. Sit down with backbone straight supported by the lower back, legs straight

in front and slowly breathe in and breathe out.2. Slowly open your legs wide apart to feel the stretch breathe deeply in and

relax and come back to the starting position.

Leg Raises with Pillow Support

This exercise helps to maintain the tone of the leg muscles.1. Sit on the floor with the backbone straight by the wall and legs straight in

front of you. Place a double pillow under your right knee so that it supportsthe leg and place the left foot on the floor with the knee bent.

2. Slowly straighten the right leg, point the toe, flex the heel and lower the legto the pillow. Repeat this ten times and then change the legs.


Child Pose with Pillow Support

This is the best relaxation position in the late pregnancy. It relieves the pressureon the lower back and opens up the pelvic area.1. This needs lot of cushions for comfort. Sit on the top of a cushion or bolster

with your knees as open as possible and feet close to your buttocks. Put alarge cushion in front of you and make sure spine is straight. Close youreyes and take five deep, slow breathes and feel your whole body relax.

2. Place your hands on the floor and walk your body to the cushions in front ofyou, placing your arms and head on top and relaxing into the pose. Keepyour back long and place your head to one side. Slowly breathe in andbreathe out and return to the starting position, sit with your eyes closed andbreathing deeply.

POSTNATAL PERIOD

This is the period lasted from immediately to six months after birth.

Aims and Plans of Physiotherapy

1. Aim: To develop awareness and control of the pelvic floor musculature.Plan: Pelvic floor muscle contraction and relaxation training andstrengthening program for muscle control and treatment for prolapse,incontinence or hypertonus.

2. Aim: To bring awareness and control of posture during postnatal period.Plan: Postural awareness training and strengthening and stretching of thepostural muscles.

3. Aim: To learn safe body mechanics.Plan: Body mechanics with baby equipment and childcare activities.

4. Aim: To develop upper limb strength to meet demands of infant care.Plan: Resistive exercises to the appropriate muscles.

5. Aim: To promote increased body awareness and a positive body image.Plan: Woman should know the importance of body awareness,proprioception activities and posture reinforcement.

6. Aim: To maintain abdominal function and correct diastasis recti pathology.Plan: Woman has to perform diastasis recti exercises, abdominalstrengthening exercises with diastasis recti protection.

7. Aim: To encourage for relaxation.Plan: Woman should practice relaxation techniques regularly.

8. Aim: To provide education on the safe postpartum exercise progression.Plan: Women should attend the exercise session before delivery to have aclear idea of the importance of postpartum exercises.


Immediately after the birth it is the feeling of joy and excitement and tiredness.The exercise session is divided into three sections. They are:1. First three months2. Three to six months3. Six month onwards

First Three Months After the Birth

Soon after the birth start the pelvic floor exercises. Mothers who go for thebreastfeeding should take of shoulders and neck. To relieve tension do exerciseregularly.

Flexing the Feet (Figs 19.11A and B)

The use of this exercise is to maintain tone of the muscles of legs, buttocks andabdominal muscles and reduce fluid retention in the ankles. Position of thepatient is standing, sitting on the floor, can use the ball to make abdominalmuscles work even harder.

A B

Figs 19.11A and B: Flexing the feet

1. Sit on the floor with the backbone straight and stretch the whole length ofthe leg. Shoulders should be dropped with arms outstretched in front at theshoulder height.

2. Maintain the same position and flex the feet so that the toes pointing up tothe ceiling.


Standing position: Stand holding on to the chair back and perform the same.Point and flex 10 to 20 times.

Arm Exercisers (Figs 19.12A to C)

This exercise prevents the edema.1. Sit down with the legs crossed and keep your backbone straight, if felt

uncomfortable, use a small cushion, stretch the arms out making a loose fist,a few inches off the floor.

2. Spread your fingers and make a fist continuously and take your hands upabove the head and do not raise your shoulders.

3. Repeat the same pattern and bring the arms down and repeat for five times.4. Stretch the arms outside to the shoulder height.5. Flex the hands so that the fingers are straight and pointing upwards towards

the ceiling. Stretch is felt all the way along the underside of the arms.6. Reverse the hands so they drop down, curling the fingers back towards the

body as far as possible. Stretch should be felt along the backside of thehands, wrist and forearms. Flex and curl 10 to 20 times.

A B C

Figs 19.12 A to C: Arm exercises

Bottom Walking (Fig. 19.13)

This exercise is best for the leg-toning.1. Sit on the floor with both the legs stretched and backbone straight. Stretch

your arms in front and move them along with legs.2. Moving from the hip and keeping the back straight, walk the right left forward

so that the right foot is in front of the left. Walk with the left leg in front of theright. Repeat forwards for ten steps. Walk the left leg in front of the right.Repeat forward for ten steps, then backwards for another ten steps.


Fig. 19.13: Bottom walking

The Pelvic Floor (Fig. 19.14)

This exercise strengthens pelvic floor.1. Lie on your back with knees flexed, feet flat on the floor. Back is long both the

hands on either side with palms of hands facing down and whole bodyrelaxed and slowly breathe in and breathe out.

2. As you breathe out squeeze the pelvic floor and the low buttock muscles andfeel the abdomen hollow. This movement occurs only in the lower body.Repeat up to ten times. Each time trying to extend the movement.

Fig. 19.14: The pelvic floor

Side Rolls (Fig. 19.15)

This exercise strengthens the spine and oblique abdominal muscles.1. Lie on your back with knees flexed and feet on the floor, place your arms at

a 45 degrees angle to your body, palms facing upwards and whole bodyrelaxed and slowly breathe in and breathe out.

2. Breathe out and start rolling your knees slowly in one direction and head inother direction, and feet turns on to their sides but should not come off thefloor. The back should be straight on the floor, and slowly breathe in.


3. Breathe out come back to the center using the abdominal muscles to roll theribs then back and buttocks. Now, repeat the same in the other direction.Repeat both for ten times.

Fig. 19.15: Side rolls

Buttock Squeeze (Fig. 19.16)

This exercise strengthens the lower abdominal and buttock muscles. Protectsthe back from undue strain.1. Lie down in prone-lying with a pillow under abdomen and other between

thighs and rest your forehead on hands, and turn your head to one side andshoulders and neck should be relaxed. Slowly breathe in and breathe out.

2. Breathe out squeeze the cushions between the thighs using the muscles atthe base of the buttocks and inner thigh. Hold for a count of 5 to 10 andrelease. Relax your body completely and repeat upto five times.

Fig. 19.16: Buttock squeeze

Heel Lifts (Fig. 19.17)

This exercises strengthens the lower abdominal and buttock muscles. Protectsthe back from undue strain.1. Lie down as in the previous exercise. Breathe out squeeze the pelvic floor

and buttock muscle and bend the right leg with a flexed foot towards rightbuttock.


2. Move slowly to feel the stretch of the hamstring muscle. While holdingbuttock and abdominal muscle firmly. Breathe out and lower the foot andrepeat the same with the correct breathing ten times on each side.

Fig. 19.17: Heel lifts

Arm and Leg Stretches

This exercise helps in stretching the arms and legs.1. Lie in the prone lying with a pillow under the abdominal muscles, stretch

your arms above your head, palms facing down the floor and place the feeta hip-width apart. Whole body should be relaxed slowly breathe in andbreathe out.

2. Breathe out squeeze the pelvic floor muscles and stretch the right arm andthe left leg as far as possible and little away from the floor and breathe inlower to the floor.

3. Breathe out and vice versa. Repeat the whole sequence upto 5 times.

Gluteal Muscles

This exercise tones up gluteal muscle of the buttocks.1. Lie in the prone lying with the cushion under the abdomen, fold your hands

in front of you and place forehead on top of them and turn face to one side tobe comfortable and slowly breathe in and breathe out. Slowly breathe outand draw the navel by trying to lift above the cushion and hold this positionfor rest of the exercise.

2. Stretch your right leg, pointing the toes, so that it comes off the floor. Now liftthe leg further so that you squeeze the pelvic floor muscle and the buttock,but without hollowing the lower back or letting any tension creep into theupper body.

3. Lift ten times on each side and then repeat the whole sequence with a flexedfoot, the toes pointing straight down the floor.


Standing Side Stretch

This exercise stretches the whole upper body and improves posture.1. Stand side on to a heavy table or chair with hand resting on it. Stand near by

for a gentle stretch and move further away for a greater stretch. Place yourfeet hip-feet apart, whole body should be relaxed and slowly breathe in andbreathe out.

2. Take a few deep breaths and try to feel growing taller by lengthening thespine.

3. Breathe out lift the outer arm in a wide circle up an over the head bendingand body away from the support. Keep facing forwards all the time.

4. Breathe in to return to the starting position. Repeat the same upto 10 timeson each side.

Twist Exercise (Figs 19.18A and B)

This exercise helps in checking the posture and the rotation of the spine.1. Stand straight with hip width apart, upper body relaxed. Slowly breathe in

and breathe out. Rotate the arms at the sides around the spine by turningfrom the waist and letting your arms swing as they follow the movement.Repeat the same for 10 times.

2. Make the swing looser by bending the knees each time as you come to thecenter. Keep the knees and hips facing front all the time. Only upper bodymoves. Repeat 10 times on each side.

A B

Figs 19.18A and B: Twist exercise


Feet and Ankle Exercise

This exercises feet and ankles.1. Stand with both feet together, holding on to a firm support. Stand straight

with whole body relaxed and slowly breathe in and breathe out.2. Breathe out pull up the pelvic floor muscles and tuck in the buttocks and

very slowly turn the feet out keeping the knees in line with the feet. Start themovement from the hips and whole leg should rotate.

3. Reverse the movement bringing the feet back to parallel. Repeat 10 times.

Foot Exercise

This exercise tones up the foot muscles.1. Stand tall with one hand on the support. Upper body should be relaxed and

slowly breathe in and breathe out.2. Take your right foot forward with a pointed toe. Now lift and flex the heel.

Put the toe back on to the floor and draw it back to the other leg. Repeat 5 to10 times and then repeat on the left.

Cushion Squeeze

This gives relaxation and tones up the inner backs.1. Lie on back with backbone straight. Two pillows are placed one below the

head and other in between thighs with knees flexed and flat on feet. Breatheout and squeeze the pillow for a count of 10. Repeat 5 to 10 times.

Relaxation Sequence

Practice the general relaxation technique for the whole body.

Three to Six Months After Birth

By this time a new rhythm of your lifestyle begins. Mothers will be havingbroken sleep at night, will be anxious to get back into shape do not rush up asthe ligaments are still soft and will get strained easily so continue with theexercises from the previous section up to the cushion squeeze and follow thenew ones like.

Knee Bends

This exercise helps in toning up the legs.1. Stand in straight posture with a long straight back the shoulders and neck

should be relaxed, take the support of the chair if required, slowly breathe inand breathe out.


2. Breathe out and turn the feet into V-shape. Breathe out and bend the kneeswithout lifting the heels off the floor. Breathe in and come back to the startingposition repeat the same upto 10 times.

3. Take the feet about 18 inches apart and perform the same.

Quadriceps Stretch (Fig. 19.19)

Stand straight with shoulders and neck relaxed hold a chair for additionalbalance. Bend the right knee and take the foot behind you, holding the anklewith one or both the hands. Hold the stretch for a minute and then change legs.

Fig. 19.19: Quadriceps stretch

Hamstring Stretch

1. Sit on the floor with backbone straight, right leg stretched and left foot placedagainst the right thigh. Slowly breathe in and breathe out.

2. Breathe out reach forwards along your right leg and take series of deepbreaths each times trying to reach further down the leg. Or use a long scarfaround the foot. Repeat on the other side.

Gluteal Stretch (Fig. 19.20)

Lie on your back with your knees bent and feet flat on the floor. Place your leftankle over the right knee then lift the right leg so that the left leg presses towardsyou. You will feel the stretch at the back of the left thigh and into the buttocks.Hold for a count of 20 and lower. Repeat on the other leg.


Fig. 19.20: Gluteal stretch

Pelvic Tilts (Figs 19.21A and B)

This exercises pelvic floor.1. Lie on your back on the floor with your feet on a stable chair. The body

should be relaxed, place the arms on either side of the body with palmsfacing down and slowly breathe in and breathe out.

2. Breathe out and slowly raise the pelvis up with the support of the handsdown, breathe in and come back to the starting position, repeat the sameupto 10 times.

A BFigs 19.21A and B: Pelvic tilts

Single Leg Stretch (Fig. 19.22)

This exercises pelvic floor.1. Lie on your back with feet flat on the floor and knees raised. Draw your

knees to your chest, keeping them apart to make a V-shape towards yourtoes. Back should be flat on the floor and shoulders and neck relaxed.

2. Breathe in and bring one knee up towards your chest and breathe out, pullup the pelvic floor and stretch out the second leg in front of you with apointed toe. The closer the leg is to the floor, the more effort the abdominalmuscles will have to make.


3. Take another long full breathe and as you breathe out, change the leg so thesecond leg is drawn in towards the chest as the first is stretched out. Alwayskeep the whole back on the floor. Alternate 5 to 10 times on each side.

Fig. 19.22: Single leg stretch

Variation

When this is done easily try the same with the head raised towards the knees.

Abominal and Pelvic Floor Exercise

This exercise strengthens the abdominal and lower buttock muscles.1. Lie face down on the floor with the feet slightly apart and the hands level

with the head, palms and elbows on the floor. Slowly breathe in and breatheout.

2. Draw the shoulders and the muscles of the upper back down and lift thehead off the floor keeping the chest open. Breathe in and return to the startingposition, repeat upto 10 times.

Inner Thigh Lifts (Fig. 19.23)

This exercise strengthens inner thigh muscles.1. Lie on your side with your back flat against the wall, the lower leg stretched

straight. Bends your upper leg so that knee forms a right angle and placesthe knee on a cushion. Rest your head on the lower arm and place the otherhand in front of you or support and slowly breathe in and breathe out.

2. Breathe out lift the lower leg, keeping the foot extended forwards. Lowerand repeat upto 10 times on each leg.


Fig. 19.23: Inner thigh lifts

Variation: Try with the flexed foot and to make it harder still by adding 2 lb or1 kg, ankle weight.

Arm Stretching

This exercises tones and strengthens and stretches the arms. Use weights of 2 lbor 1 kg weights are ideal.1. Stand about a foot away from the wall with the feet hip-width apart. Slightly

bend the knees and lean against the wall so that spine is in contact with thewall and slowly breathe in and breathes out.

2. Breathe out and draw down your shoulder blades as you raise your armsstraight out to the sides. Bring them towards the shoulders without liftingthem. Repeat 10 times.

3. Lift your arms 10 times to the front bending at the elbows to raise yourhands to your shoulders.

Windmill Arms (Figs 19.24A and B)

This exercise helps in releasing tension and mobilizing the shoulders.1. Lie with the knees flexed and feet flat on the floor. Now raise your arms so

that the fingertips point upto the ceiling.2. Breathe out and take the arms in opposite directions, one above your head,

and palm up, the other down by your side, palm down. Take your arms tillthey stretch.

3. Rotate the arms as you breathe in and reverse their positions, so that yourfirst arm is by your side the second above your head.

4. Breathe out, lift the arms up and repeat the sequence for upto 10 times.

Quadripued with a Leg Stretch (Figs 19.25A and B)

Those who have backache do not attempt these.1. Kneel down on all four, body should be relaxed and slowly breathe in and

breathe out.


A B

Figs 19.24A and B: Windmill arms

2. Breathe out and raise the right knee up towards the chest, dropping thehead down to meet it.

3. Breathe in and straighten the leg out behind you, raising the head back tothe starting position. Repeat upto 10 times with each leg.

A B C

Figs 19.25A and B: Quadripued with a leg stretch

Stretch to Release Tension (Figs 19.26A and B)

1. Begin the same position of the previous exercise, tuck your toes under,breathing out and press up from the floor so that the soles of your feet are flatand make a triangle with your bottom as the apex. Straighten your legs asmuch as possible, keeping your back long, the head and neck in line withthe spine. Try to extend the stretch as you take long, deep breaths. Hold upfor a minute.

2. Drop your knees back down to the floor and then sit back on your heels withyour arms stretched out in front of you. Rest your head on the floor on oneside if that is more comfortable. Relax and breathe deeply.

Ankle Circles (Figs 19.27A and B)

This exercise tones up the thigh and buttocks.1. Sit on the floor with your legs straight out in front of you. The body should

be relaxed and place your hands in front of your body. Point the toes andslowly breathe in and breathe out.


A B

Figs 19.26A and B: Stretch to release tension

2. Flex the feet back hard so that your toes and knees are pointing up at theceiling. Slowing turn the feet out to a V-shape.

3. Keeping the turnout, point the feet and return to the starting position. Repeatupto 10 times.

A B

Figs 19.27A and B: Ankle circles

Leg Toning with Weights

This is the same exercise from the second trimester of pregnancy but with theadditional 1 kg or 2 lb ankle weight.

Squeeze

This is pillow squeeze.

Relaxation Sequence

Practice complete body relaxation.

Six Months Plus

The exercises during six months are more strenuous than previous one to regainshape back, so start with the warm-up followed by the exercises from theprevious section and incorporate the following new exercises:


Sit-ups

This exercise strengthens the abdominal muscles.1. Lie on your back with your knees raised and your feet flat on the floor. Place

a cushion or a rolled up towel between your knees. Keep body relaxed andplace your hands slightly behind your head and slowly breathe in andbreathe out.

2. Breathe out and curl your head and shoulders of the floor. Breathe in androll down to the floor. Repeat upto 10 times.

Oblique Sit-ups

This exercise strengthens abdominal muscles.1. Lie on your back with your knees raised and your feet flat on the floor. Place

a cushion or a rolled up towel between your knees. Keep body relaxed andplace your hands slightly behind your head an slowly breathe in and breatheout.

2. Breathe out curl up to bring your left shoulder in the direction of your rightknee. Breathe in and lower to the floor. Repeat upto five times on each side.

Advanced Pelvic Tilts

1. Lie on your back with knees raised with a cushion between them feet flat onthe floor. The body should be relaxed and slowly breathe in and breathe out.

2. Breathe out and start to scoop out the abdomen a curl the spine up from thefloor one by one.

3. Holding the body in diagonal shape, breathe in and raise your arms, liftingthem above your head and placing them on the floor behind your head.

4. Keeping your arms behind you breathe out a curl the spine back down thefloor slowly, you will feel a strong stretch in the arms.

5. Breathe in and make a wide circle with your arms on the floor back downtowards your side. Repeat the same for 10 times.

6. Lift your arms so that they are of the floor, parallel to your body, the fingertipspointing towards your feet. Breathe out curl the head and shoulders of thefloor.

7. Breathe in and lower slowly back to the floor. Repeat the whole sequence upto 10 times.

Stretch for Abdominal, Gluteal and Back Muscles (Fig. 19.28)

1. Lie on the floor prone lying with a small cushion under the navel, feet andhip width apart, the legs and toes stretching away. Stretch your arms aboveyour head, palms down on the floor, keep a towel underneath the foreheadand slowly breathe in and breathe out.


2. Breathe out pull up the pelvic floor muscles and maintain this throughoutthe exercise. On the next breathe out stretch your right arm and left leg sothat they lift two inches off the floor. Breathe in and return to the startingposition.

3. Breathe out return to the starting position and on the next breathe out, liftthe left arm and right leg. Repeat upto 5 times on each side.

4. Lift both the arms and both the legs on the next breathe out. Repeat upto fivetimes and rest in the child pose.

Fig. 19.28: Stretch for abdominal, gluteal and back muscles

Side Stretches (Fig. 19.29)

1. Lie on your side with the back against a wall, legs stretched out in line withyour back. Place your lower arm on the floor and rest your head on it withyour upper arm on the floor in front of you as support. Your face, hips kneesand shoulders should be facing forwards. Completely relax your body andslowly breathe in and breathe out.

2. Breathe out and flex the feet and lift them two or three inches of the floor.Stretch away with the heels. Breathe in and lower the legs. Repeat upto 10times.

Fig. 19.29: Side stretch

Triceps Exercise (Fig. 19.30)

1. Sit in front of the chair with your back facing it with knee and feet together,backbone straight, your hands holding on to the edge of the seat and slowlybreathe in and breathe out.

2. Breathe out let your bottom drop down a few inches supporting your backwith your arms. Breathe out and rise up a few inches. Repeat upto 10 times.


Fig. 19.30: Triceps exercise

The Abdominal Exercise

1. Lie on your back a draw your knees up to that your thighs form a right angleto your chest. Keeping them parallel and your feet pointed, your armsstretched out with pointed fingers, just a few inches from your side. Slowlybreathe in and breathe out.

2. Breathe out lift your head to look straight towards your thighs and lift yourarms a few inches off the floor. Tap your hands on the floor for 5 times.

3. Breathe in and make another 5 taps. Repeat 5 times on each breathe in andbreathe out working up overall till you reach 100 taps. If tensed up lowerdown to ground and relax. Finish the exercise by lowering the head to theground and hugging the knees to the chest for a few moments.

Double Leg Stretch

1. Lie on your back and bend the knees up to your chest so that the knees areapart and the toes are together, your hands resting just below your knees.Breathe in and breathe out, pull up your pelvic floor muscles curl the headoff the floor so you are looking towards you knees.

2. Breathe out and straighten the legs upwards and reach out with the arms sothat they are parallel to the body with pointed fingers.

3. Breathe in, turn out the legs from the hip sockets and flex the feetthis willextend the stretch in the legs.

4. Breathe out and bring the arms up towards your face, behind your headand in a wide circle back to where they started.


5. Breathe in and lower your head to the floor and bend the knees to bring thelegs to their starting position. Relax for a moment repeat this exercise workingupto 10 times.

Roll Downs with a Swing

1. Stand with your feet and hip width apart and backbone straight, shouldersrelaxed lift both arms up above your head in front of the body with thepalms facing you. Bend your knees and begin to curl down and look at thepalms.

2. As you bent your knees look at the floor and let your body roll down on tothe knees.

3. As soon as your chest makes contact with your thighs, start to straightenyour legs as far as they will go without straightening.

4. Slowly uncurl to a standing position bring in your spine up slowly to a tallposition. Lift the arms and repeat five times.

Armside Stretches

1. Stand with the feet hip apart and lightly turned out, with a long, straightback and relaxed shoulders. Breathe in and breathe out.

2. Let your right hand start to slide down. Reach as far as you can and feel thestretch up to the left side of the body and bend your head on to the right side.Breathe in and breathe out, and come back to the starting position, breatheout and repeat five times on each side.

Variation

1. Stand as before this time with your right hand on your waist. Breathe in andbreathe out. Raise your left arm above your head.

2. Bend the upper body to the right as before taking your left arm with you,stretching your head. Keep your upper arm close to the side of your face andtaking care to keep facing square to the front.

3. Breathe in and breathe out return to the starting position. Repeat upto 5times on each side.

Wide Leg Circles (Figs 19.31A to C)

This exercise strengths and tones both the legs and abdominals.1. Lie on your back with your legs stretched out, parallel with the knees facing

to the ceiling and toes pointing. Check that your shoulders are drawn downinto your back and your arms are relaxed at your side. Breathe in and as youbreathe out.

2. Take another breathe in and raise the left leg to the ceiling and keep your legstraight and the toe pointed.


3. Lower the leg and repeat upto five times on each side.4. Keeping it on to the floor move your left leg out to the side.5. Let the leg continue its circle down the other side of the body. Repeat with

the alternating legs twice on each side.

A B C

Figs 19.31A to C: Wide leg circles

Bridging (Fig. 19.32)

This exercise mobilizes and strengthens the back. Do not do if having backache.1. Lie on your back with your knees raised, heels close to your bottom arms by

your sides. Slowly breathe in and breathe out and upper body should berelaxed.

2. Breathe out, lift the buttocks and waist from the floor slowly then hold forsome time.

3. Breathe out and come back to the starting position. Repeat slowly upto 5times.

Fig. 19.32: Bridging

Sitting Forward Stretch (Fig. 19.33)

This exercise stretches and releases the back muscles.1. Sit up with a long backbone straight and legs stretched in front of you on the

floor, knees facing the ceiling and toes pointed and slowly breathe in andbreathe out.

2. Breathe out and reach forwards over your legs and try little forward. Repeatover the next four or five time and each time stretch little further.


Fig. 19.33: Sitting forward stretch

Shoulder Release

This exercise helps in releasing the tension in the shoulders and need a belt orscarf.1. Kneel down, keep your backbone straight and slowly breathe in and breathe

out.2. Take the scarf or belt in your right hand an stretch the right arm up to the

ceiling then bend it at the elbow so the right hand reaches down behindyour neck, the scarf or belt hanging down your back.

3. Reach your left arm behind your back so that left hand catches hold of thescarf belt as close as it can to the right hand, hold this position till you can ifpossible to clasp the fingers together it is best, repeat on the other side.

Pillow Squeeze

Follow the same pattern as explained previously.

Relaxation Sequence

Finish the exercise session with complete body relaxation.

CESAREAN SECTION

The cesarean section is suggested for a woman in case of twins, pelvic outlet issmall. So the preparation for this before hand is necessary. If cesarean section isdone in emergency then woman can follow only postoperative physiotherapy.


Preoperative Physiotherapy

Aims and Plans

1. Aim: To prevent respiratory complications.Plan: Teach and make woman to practice breathing exercise.

2. Aim: To prevent circulatory complications.Plan: Women should be taught ankle and foot exercises.

3. Aim: To prevent joint stiffness.Plan: Woman should be taught mobilization of the joints.

4. Aim: To prevent backache.Plan: To teach correct lifting and bending technique.

5. Aim: To be aware of the ergonomics.Plan: Woman has to be taught proper body mechanics and postureawareness.

Postoperative Physiotherapy

Aims and Plans

1. Aim: To increase the pulmonary function and reduce the risk of infection.Plan: Breathing instructions, coughing and huffing should be given.

2. Aim: To decrease incisional pain associated with coughing, movement duringbreastfeeding.Plan: Postoperative TENS should be given, support the incision with pillowwhen exercising. Education regarding incisional care and risk of injuryshould be provided.

3. Aim: To prevent postsurgical vascular complications.Plan: Active leg exercises and early ambulation should be taught.

4. Aim: To enhance incisional circulation and healing, prevent adhesionformation.Plan: Gentle abdominal exercises with incisional support, scar mobilizationand friction massage should be taught.

5. Aim: To decrease postsurgical discomfort from flatulence, itching or catheter.Plan: Positioning instruction, massage and supportive exercises should betaught.

6. Aim: To correct posture.Plan: Women should have a clear idea about posture instruction, itsimportance and after effects.

7. Aim: To prevent injury to back and prevent low back pain.Plan: Instruction should be given regarding incisional splinting andpositioning for activities of daily living, body mechanics instruction.

8. Aim: To prevent pelvic floor dysfunction.


Plan: Pelvic floor exercises should be taught, and education regarding riskfactors, types of pelvic floor dysfunction.

9. Aim: To develop abdominal strengthen.Plan: Abdominal exercises including corrective exercises for diastasis rectiare taught.

HIGH RISK PREGNANCY

Aims and Plans

1. Aim: To decrease stiffness.Plan: Instruction should be given regarding the instruction or the positioning,assess for support, facilitation of the joints, and motion in the availablerange.

2. Aim: To maintain muscle length an bulk.Plan: Stretching and strengthening exercises within limits impose by thephysician.

3. Aim: To maximize the circulation and prevent deep vein thrombosis.Plan: Teach ankle pumping and range of motion exercises.

4. Aim: To improve proprioception.Plan: Movement activities for as many body parts as possible.

5. Aim: To improve posture within available limits.Plan: Posture instruction, bed mobility transfer techniques should be taughtand made to practice.

6. Aim: To relieve boredom.Plan: Vary activities and positioning for exercises.

7. Aim: To enhance relaxation.Plan: Relaxation techniques are taught for stress management.

8. Aim: To mentally prepare the woman for the delivery.Plan: Childbirth education, breathing training and exercises to assist andprepare for labor.

9. Aim: To enhance postpartum recovery.Plan: Exercise instruction and home program for postpartum period, bodymechanics instruction should be given.

Documents

Chapter-19_Exercise Therapy Regime