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Physiotherapy in
Obstetrics & Gynecology
OBSTETRICS AND GYNAECOLOGYOBSTETRICS AND GYNAECOLOGY
Obstetrics concerns itself with pregnancy, labour, delivary &the care of the mother
after child birth
Gynaecology is the study of disease associated with women which in effect means condition involving the female
genital tract.
Importance of pelvic floor
• Provide support for the pelvic organs and their contents
• Withstand increases in intra-abdominal pressure• Contribute to stabilization of the spine/pelvis• Maintain continence at the urethral and anal
sphincters• reproductive function
Effect of Childbirth on the
Pelvic Floor• Neurological compromise• Muscular impairment• Episiotomy (second degree perineal tear)
Pelvic floor dysfuntion
• Prolapse• Urinary or faecal incontinence• Pain and hypertonus• Specific exercises:• Kegel’s exercise
1. Contract relax (hold for 3-5 seconds)2. Quick contractions (15-20 reps)3. Elevator exercise
Interventions for pelvic floor
• Patient education• Neuromuscular re-education• Biofeedback
1. Stretching of abdominal muscles 2. Decrease in ligamentous tensile
strength.
3. Hyper mobility of joints due to ligamentous laxity.
4. Pelvic floor drops as much as 2.5 cm.
Changes during pregnancy Musculoskeletal system
Mechanical changes. a. COG shifts upwards & forwards. b. posture –
*shoulder girdle becomes rounded, *scapular protraction, upper
*limb internal rotation.*increase in cervical lordosis.
*knee hyperextension.*increase in lumber lordosis.
c. balance – pt. walks with wider BOS.
Exercises in pregnancy
1. Prenatal exercises
2. Preparation for labour
3. Postnatal exercises
Prenatal Exercise:
Potential impairments of pregnancy • Development of faulty posture
• Upper & lower extremities stress
• Altered circulation, varicose vein LL edema
• Pelvic floor stress
• Abdominal muscle stretch & diastasis recti
• Inadequate relaxation skills necessary for labour & delivery
• Development of musculosketal pathologies
General Guidelines for Exercise Instruction
Contraindications to exercise
Precautions Precautions
Suggested sequence for Exercises
Postural ExercisesPostural ExercisesStretching Stretching
• Upper neck extensors & scalenes
• Scapular protractors, shoulder internal rotators & levetor scapulae
• Low back extensors
• Hip adductors [caution do not over stretch in
women with pelvic instability]
• Ankle planter flexor.
Strengthening Strengthening Exercise Exercise
• Upper neck flexors lower neck &upper thoracic extensors
• Scapular retractors &depressor
• Shoulder external rotators
• Hip & knee extensors
• Ankle dorsi flexors
Strengthening of External Rotators
Corner Press Out
ABDOMINAL EXERCISES1. Corrective ex. for diastesis recti • Head lift • Head lift with pelvic tilt
Head Lift
2. Trunk curls3. Leg sliding
Hook lying with posterior pelvic tilt
Maintain pelvic tilt as the feet slide along the floor away from the body
Leg Sliding
4 Quadruped pelvic tilt ex.
Stabilization ExercisesStabilization Exercises
Pelvic floor exercises
Isometric ex. / kegals ex.
• Pt position – any position
• Instruction - to tighten the pelvic floor as if
attempting to stop urine, &hold for 3 to 5 sec.
• This ex is valuable in treating leaky bladder.
Modified Upper Limb & Lower Limb Exercise.
1. Modified push ups /standing pushups2. Hip extension a. supine bridging
b. All four leg raising
Quadruple position with posterior pelvic tilt
Leg is raised only until it is in line with the trunk
a.
b.
3. Modified squatting
a. Supported squatting using a chair or wall.b. Wall slide.
PERINEUM & ADDUCTOR PERINEUM & ADDUCTOR FLEXIBILITYFLEXIBILITY• Self stretching
1. Women's position supine or side lying .
instruct to abduct the hip &pull the knees towards the sides of her chest & hold the position for as long as comfortable.
2. Sitting – have the women sit on a short stool with the hips abducted & feets flat on the floor.
RELAXATION & BREATHING EXRELAXATION & BREATHING EX1. Patient position in kneeling forward on to one’s arm
on a cushion placed on a seat of a chair.2. In this position wt. of the fetus lies on the anterior
abdominal wall & pelvic floor relaxes3. In this position pt. take deep diaphragmatic
breathing.4. Other methods of relaxation are
a. mental imagery. b. muscle settings
POST NATAL EXERCISES1. Ex. Can be started as soon as after delivery as the
women feels able to ex.
2. All prenatal ex. Can be performed safely in postpartum
period.
3. Before starting ex. Proper assessment of position &
consistency of the fundus of the uterus should be
done
4. Monitoring of lower limb edema, varicosities.
5. Care & advise on breast feeding & baby care.
INITIAL POSTNATAL EX.
Breathing Ex.
Leg exercise
Abdominal exercise
Pelvic tilting exercise
Deep breathing for circulatory & relaxing effect
Foot ankle leg exercise
In crook line position combined with expiration
Crook lying position
Tilt- Relax-Tilt – Relax Exercise
CESAREAN CHILDBIRTH• It is an operative procedure whereby the fetuses after the
end of 28th wk. are delivered through an incision on the abdominal &uterine wall.
• Impairments /Problem Due To Cs
1. Risk of pneumonia2. Postsurgical pain.3. Risk of adhesion.4. Formation at incisional site.5. Risk of vascular complication.6. Faulty posture.7. Pelvic floor dysfunction.8. Abdominal weakness
PREGNANCY INDUCED PATHOLOGY
PATOHLOGY
1. diastesis recti
2. Lower back pain & pelvic pain.
3. SI dysfunctioN
PT MANAGEMENT
1.Modified abdominal muscle
ex. With crossed hand
over the abdomen.
2.In acute condition bed rest
do’s or don’t
gentle heat & massage
pelvic tilting in croock lying
TENS if indicated
3. Modified ex. For SI pain
4. Nerve compression
syndrome
-Carple tunnle syndrome
-Brachial pluxus pain
-Meralgia paraesthetica
-Posterior tibial nerve
compress
5.Circulatory problem
varicose vein of leg
leg cramps
-thrombosis &
-
thromboembolism
4. Splinting
ice packs
elevation of the limb
TENS
5. –prolonged standing avoided
ankle ex. ,calf stretching
- raising foot end of standing should bed.
deep kneading massage
- stocking & breathing ex.
6. Stress incontinence
7. Postural backache
8. coccydynia
6. pelvic floor ex
7. postural correction
8. Ice packs ,heat, US,
TENS,
use of rubber ring to relieve pressure in sitting.
Sitting posture in coccydynia
Correction for diastasis recti
THANKYOU
THANKS