WOMEN health 1

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Gaurav shah

Rikhil makwana

Avinash boyet

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Introduction:

A focus on health issues relevant to females has been increasing over last two decades.

The multiple roles that women play, tend to give low priority to her personal time. Women

always place the need of others before themselves and priority to their health, exercise or any

form of relaxation is never given preference.

The new York declarationWomen and children first presented at United Nations in July

2008 by the international Academy of Perinatal Medicine has highlighted biases in the allocation

of health care resources for women and children especially in the developing countries.

Adequate health care for woman and children are not provided and it reflects in high

perinatal mortality. Hence proper allocation of health care resources for woman and children is

required. This shows that specialized health needs of a woman are not being adequately met by

the medical community of which physical therapist are also important members.

India being the second most populous country in the world and rated as below income

class by World Bank has health missions-National rural health mission, Janani Suraksha Yojana

and Reproductive child health Phase-II, which seeks to improve access of rural women and

children to public health services. Their main objective is to reduce infant and maternal mortality

and reduce total fertility rate.

However other health issues which affect the morbidity and mortality like osteoporosis,

urinary incontinence & obesity in women are not considered in our countrys health missions.

Hence, our role of physiotherapy care in these womens health and well being issues cannot be

expected to be even mentioned in any of these key policies. It is for us to take the initiative to

make our services available to rural and urban poor women along with the privileged women of

our country.

As primary health care professional physiotherapists participate in prevention programs

which are committed to improve and maintain functional independence and physical

performance. Public health camps should be organized to provide information to women

regarding various health issues, the risk factors associated and prevention by changes in lifestyle

and empowering them to take the decision of their health.

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Hence we are an important member of multi disciplinary team addressing various issues

which are fundamental to her well being and health. Improving womans health will also result

in improving the health and well being of families and communities through the caring nurturing

and educative roles that woman performs on a daily basis.

PURPOSE:-

Over 50% of population is female and this alone is sufficient reason to focus on womens health

issues.

Mutual dependence between womens activity roles, anatomy and physiology and this health

It is a complex and rewarding field for further investigation

Goals of Physiotherapy care during adolescence are:

1) Health education: adolescent female should be educated to minimize the adverse impact

of growth on her musculoskeletal system. The importance of appropriate levels of exercise,

participating in sports and good nutrition for long term health and wellness should be

emphasized.

2) Postural education and training: To build the necessary kinesthetic awareness of

appropriate joint position in combination with positive input regarding self image, back care and

lifting techniques are essential component of treatment.

3) Supervised flexibility: Program for all the muscles who have propensity to develop

tightness must be emphasized. Stretching exercises to the hamstrings, quadratus lumborum,

dorsolumbar fascia, hip flexors, iliotibial band, gastroc and soleus, upper trapezium, adductors

and medical rotators of the shoulder should be done on daily basis.

4) Strengthening: Strengthening program for muscles developing stretch weakness for

transverse abdominis and multifidus to improve core stability, quadriceps, rotator cuff muscles,

scapula depressors & retractors erector spinae & gluteal muscles.

5) Proprioceptive trainings: To provide positive afferent feedback and agility training is

necessary. Use of balance board, minitrampoline. One leg stance with eye open and closed, rapid

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jumping or hopping in different directions at different speeds are necessary to ensure safe return

to sports.

6) Appropriate footwear & advice: It is for prevention of injury while playing sports is

important. Warm up and cool down sessions should be a part of training and avoiding rapid

increases in the intensity, frequency and duration of sessions is must.

7) Relief of pain: Local application to the injured area with ultrasound, moist heat,

cryotherapy, TENS can be advocated.

WHO includes: - (global strategies)

Equity in health

Healthy promotion

Need to develop primary health care and to enhance prevention activity in primary health care

settings.

Co-operation between revelant agencies of government and community.

The need to participate of consumer in decision making.

PHYSIOTHERAPISTS ROLE: - (as a health promotion and health

education)

Someone who uses all the knowledge and skills available to them to improve health and well-

being of individuals and communities in which they live and work.

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ROLE OF PHYSIOTHERAPY IN ADOLESCENT & PUBERT AGE

GROUP

Aerobic training including agility exercises is documented to be one of the most effective

preventive mode for prevention of obesity.

Physiotherapy expert should also visit schools and sports club regularly to impart health

education amongst pre pubertal students, their parents, teachers and coaches involved in

training students in sports.

During the visit the expert physiotherapist should conduct regular assessment of mobility

and body fat levels and accordingly give guidance for health promotion.

ROLE OF PHYSIOTHERAPY DURING REPRODUCTIVE AGE

In this age group, obesity continues to be high risk factor with evidence of certain related

health issue having already cropped in.

The impact is frequency seen in a reversed order i.e. when estrogen balance is tempered

naturally or artificially obesity is found to set in.

Women on contraceptive is pills or those who undergo tubectomy as family planning

measure or those after hysterectomy are known to develop obesity.

Physiotherapy plays a major role in combating obesity related sterility.

ROLE OF PHYSIOTHERAPY DURING CLIMACTERIC & MENOPAUSAL

AGE:

Obesity, depression, stress urinary incontinence & enhancement of bone resorption

posing risk of osteoporosis are some of the most common repercussions of menopause.

This stage is also associated with aging issue.

Problems in sustain balance are also reported to be evident.

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Only an expert physiotherapist can do justice in selecting appropriate exercise regain

regimen as per individual needs

GOALS:-

Provide education regarding its role, anatomy and physiological changes during various stages of

life and health and fitness.

Providing education in preparation for childbirth and parenthood.

Describe normal physiological changes of pregnancy on various systems, major stages and

characteristics of pregnancy, labour and delivery.

To help women adjust to physiological changes throughout pregnancy, management of

complication, antenatal and postnatal care.

Develop goals and guideline for an obstetric exercise programme in uncomplicated pregnancy.

Development of child and maternal care.

Management of caesarean childbirth and high-risk pregnancy.

Womans health education, counseling and support.

a) Child bearing years :the child bearing years encompasses large time frame from

merarche to menopause. Physiotherapist defienes it as the time from conception to post partum

adjustment .

Musculoskeletal impairments during pre natal & post partum period :adaptive

changes in musculoskeletal system take place to accommodate the growing foetus & weight gain

in the mother due to pregnancy.Physiotherapy intervention will focus on education regarding

posture, back care, modification of ADLs along with core muscle strengthening to to ensure

alignment of body & minimize the stress & development of pain.

c)Menopause & beyond

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1) Vasomotor changes: like hot flushes & night sweats, insomnia, mood changes, joint aches &

pains. Regular exercises decrease these symptoms.

2) Pelvic floor dysfunctions: urinary incontinence & pelvic organ prolapsed are examples of

pelvic floor dysfunction. Stress incontinence is documented in young female athletes & in

postpartum, peri & post menopausal women. Pelvic floor muscles training appeared to be an

effective treatment for adult woman with stress in mixed incontinence.

3) Obesity: Weight gains, redistribution of fat from thigh and buttock to abdomen, loss of

muscle mass and continuous decline of skin collagen makes a women feel that she is less

attractive and starts experiencing negative body image which makes it difficult for her to focus

on emotional well being. Exercise program designed by physiotherapist during this years will

help regulate weight.

4)Chronic pelvic pain: This is also one of the impairment seen in 18-50years old women & is a

physical, emotional & social issue for many women & the treatment costs are very high. Altered

tone of pelvic floor muscles & spasm of hip buttock & trunk muscles. PT aims are to relax the

pelvic floor muscles with biofeedback, relax techniques, other modalities & SWD can be used

for treatment.

5) Breast & Cervix Cancer: After the breast surgery physiotherapist regaining shoulder range

& function without increasing the risk of lymph edema is necessary. If lymph edema takes place

then treatment include manual lymphatic drainage/massage. Hysterectomy done for cervical

cancer can give rise to pelvic floor dysfunction.

6) Osteoporosis: India is one of the largest affected countries in the world in osteoporosis cases.

Two major complications, accentuated thoracic kyphosis & vertebral fractures are seen in post

menopausal women causing significant increase in morbidity & mortality.

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Plan for the health education:

1) Women have particular health needs which are related to their biological fitness, their roles insociety and their participation in workplace.

Reproductive of health and sexuality.

Health and ageing women.

Emotional and mental health.

Health needs women as cares.

2) Antenatal preparation for parenthood classes must be designed to fulfill the parents

expressed needs and should never simply be a forum for professionals to impact the sort of

information they think their audience requires.

National health service centre Organize classes. The main aim is education regarding

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3) Changes of pregnancy are chiefly the direct result of interaction of four factors

Hormonally mediated changes in collagen & involuntary muscles.

Increase total blood volume with increased blood flow to uterus & kidney.

Growth of foetus in consequent enlargement & displacement of uterus.

Increase body weight & adaptive changes in COG & posture.

Explain series of events take place in genital organs in an effort to expel foetus.

Identify normal & abnormal labour.

Explain just stages of labour i.e. cervical & effacement of cervix.

Explain 2nd stage i.e. bearing down effects.

3rd stage: Phases of placental separation & descent to lower segment.

Explain series of movement that occur on the head in process of adaptation during journey

through pelvis.

4) Complication during pregnancy & after childbirth.

Stress : Mitchell method of physiological relaxation

Contrast method

Suggestion & visualization

Touch & massage

Breathing control

Diet & weight gain : Normal 10-12.5 kg gain

Alcohol, smoking & medication in pregnancy

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Joint laxity : Safe exercise programme

Non weight bearing less stressful activities

Pelvic floor dysfunction : Pelvic floor strengthening exercise

Biofeedback

NMES

IFT

Muscle re-education

Compression syndromes : Postural correction

Ergonomic assessment

Splint

Modalities

Diastasis recti : Abdominal strengthening exercise

Abdominal drawing & bracing

Stability exercise

Core-strengthening exercise

Low backache & pelvic pain :

Extensions stabilization by belts as corset

Postural correction

Deep heat modalities

Strengthening exercise

Varicose vein : Minimal dependant position

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Elastic support stockings

Elevation of extremity

5) Minimize impairment & help the women to maintain or to regain function while she is

preparing for arrival of baby & then carrying for the infant.

Sequence of exercise:

Rhythmic activity to warm up

Gentle selective stretching for postural alignment & flexibility

Aerobic activity for CVS conditioning

Postural exercise

Cool-down exercise

Pelvic floor exercise

Relaxation techniques

Labour & delivery techniques

Educational information

Post-partum exercise instruction

6) Examination of the baby at a time of delivery.

Clinical assessment of new born

Musculoskeletal & neurological abnormality

Respiratory distress

Meconium aspiration

Dubowitz & neurosensory motor development assessment

Baby handling & parent education

Vision & hearing

Posture & movement

Feeding

Handling techniques

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Baby massage

Purpuerium-follow up mothers and baby

7) Prevent vascular complications

Decrease incisional pain assess with coughing

Breast feeding

Facilitate healing

Decrease post-surgical discomfort

Self monitoring technique

Modified exercise programme

8) Developing healthy public policy

Individual, ecological and community approach

Creating supporting environment

Nutrition and hygiene in an attempt to lower maternal and infant mortality rate.

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WOMEN health 1