THE ROLE OF PHYSIOTHERAPY IN PRE AND POST NATAL WOMEN

he physical changes to a women’s body as related to pregnancy are multiple. The centre of mass changes, there is more pressure on the organs, and there is increased weight to be carried. All of this in a relatively short span of time often leads to back pain, pelvic pain and urinary incontinence. In fact, over two thirds of pregnant women experience back pain, one fifth experience pelvic pain and over 40% experience urinary incontinence in their first pregnancy – with half remaining incontinent at 8 weeks post-partum, and one third experiencing a new onset of incontinence after childbirth.

Evidence shows that group training programs designed and delivered by physiotherapists can relieve lower back pain, pelvic pain and urinary incontinence in pregnant women.

A randomized controlled trial by Morkved et al., of 289 pregnant women showed that 12 weeks of specially de-signed group training by a physiotherapist was effective in preventing lumbo-pelvic pain at 36 weeks of preg-nancy. The trial group participated in physiotherapist lead exercises 60 minutes a week from the 20th through the 36th week of pregnancy. There were significantly fewer women in the training group that reported lumbo-pelvic pain during pregnancy and after delivery.

A Cochrane review conducted in 2007 looked at interventions for preventing and treating back and pelvic pain in pregnant women, and found evidence for strengthening exercises, pelvic exercises, and water gymnastics reduc-ing lower back pain intensity better than standard prenatal care.

Another study by Morkved et al. of 301 pregnant women showed strong evidence for the prevention of urinary in-continence after a 12 week intensive pelvic floor muscle training supervised by physiotherapists at both 36 weeks of pregnancy and 3 months post-partum.

Harvey’s 2003 study of pregnant women showed that post-partum pelvic floor muscle training appeared to be effective in decreasing post-partum urinary incontinence.

In 2005 the Canadian Physiotherapy Association and the Society of Obstetricians and Gynecologists of Canada issued a joint policy statement on Postural Health for Women and the Role of Physiotherapy. With respect to pregnant women, the joint policy statement recommends:

1. Physiotherapist directed pelvic floor muscle training to prevent urinary incontinence during pregnancy and after delivery.

2. Physiotherapist directed core stability training to prevent and treat back and pelvic pain during and following pregnancy.

While pre and post natal exercise programs are common, and they help many mothers, they may be harming oth-ers. An informal survey of a small number of these programs revealed;

– most lack even a basic screening, assessment or continued monitoring
– exercises were not adapted for any pain, posture or incontinence issues
– key factors such as the presence of a diastasis recti or caesarean section delivery were not addressed programs
– presented exercises that were contraindicated or not suitable for pregnant women in general
– there was no accommodation for the stage of pregnancy or post-partum status
– exercises presented in group class settings were the same for all participants, regardless of ability, stage of pregnancy and health status

HOW CAN A PHYSIOTHERAPIST HELP PREGNANT WOMEN?

It is within the scope of practice of a physiotherapist to properly assess, treat and educate pregnant women in effective and safe exercises that have been shown to decrease back pain, pelvic pain and urinary incontinence – throughout their pregnancy and post-partum.

A good physiotherapist delivered program for pregnant women would;

1. Screen patients to ensure they could safely participate in an exercise program;

2. Assess patients for posture, strength, flexibility, balance as well as any musculoskeletal issues that could have a bearing on pregnancy;

3. Instruct patients on how to perform exercises safely and effectively;

4. Utilize an individualized approach – even in a group setting;

5. Enable group discussion and education regarding pre and post natal issues.

The goal of such a program would be to offer women improved prenatal fitness – that would lead to a healthier and easier pregnancy and delivery. A good program would also offer an integrated approach to health care – and share detailed assessment findings with the participant’s primary and pregnancy health care providers. As well, for women who are experiencing a high risk pregnancy, private sessions should be arranged with strict observa-tion of the health care provider’s restrictions with a focus on maintaining the pelvic floor and alleviating pain.

In researching this subject matter, this author discovered that the ideal program as described above – does not exist in our area. This program will be added to the authors personal practice. The program will be delivered in two parts
– one for pre natal mothers called ―Deliver Strong‖, and
– one for post natal mothers called ―Restore the Core‖.

Further program details will be sent to all Guelph area MD’s, but please feel free to contact the author directly through South City Physiotherapy of you would like more information.

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 Common Injuries from Weight Lifting

Common Injuries from Weight Lifting
Weight lifting helps build muscle mass, tone the body, increase strength and boost metabolism, but improper techniques can result in painful or debilitating injuries.Weight Lifting Injuries

Weight lifters who fail to take proper precautions put themselves at risk for injury, especially to the shoulders, knees and back.

Shoulder Injuries

Overhead weight lifting activities, such as bench and shoulder presses and lateral raises, can result in shoulder impingement syndrome.

With this condition, inflammation and swelling of the rotator cuff leads to pain in the front and side of the shoulder and upper arm. Initially, the pain may be noticeable only when you lift your arms, but as the injury progresses, you may feel pain even when sitting still or lying down.

The same types of weight lifting activities that can cause shoulder impingement syndrome can also result in a tear to the rotator cuff. A rotator cuff tear is a painful condition that causes pain and weakness with activity.

Proper diagnosis is imperative to proper treatment. Treatments may include physical therapy, anti-inflammatory medicines, cortisone injections, regenerative techniques, or potentially surgical repair.

Knee Injuries

Repetitive leg lifts, including hack squats, lunges, deep knee bends, jumps, and knee extension can cause injury to the patellar tendon.

The patellar tendon connects the kneecap (patella) to the shinbone (tibia). When the patellar tendon is overused tiny tears can develop in the tendon. As a result, you may begin to feel pain in the patellar tendon, usually just below the kneecap.

Physical therapy and a patellar tendon strap can often help reduce the symptoms of patellar tendinopathy, however, further treatment is often needed. Your doctor may recommend treatment with anti-inflammatory medications or may try regenerative treatments such as platelet-rich plasma injections. In rare cases, surgery may be necessary to repair extensive damage.

Back Injuries

Bench presses, rows, and dead lifts are among the most common weight lifting exercises leading to back sprains and strains. Sprains — tears or stretches in the ligaments — are acute injuries directly caused by trauma.

Strains also occur from injury; however, those usually affect the muscles or tendons rather than the ligaments. Most sprains and strains can be effectively treated with the R.I.C.E. method, or rest, ice, compression and elevation. Severe injuries may warrant surgical repair.

Lifting heavy weights with the back muscles, rather than the leg muscles, can result in a herniated disk. This painful condition occurs when one of the rubbery cushions, or discs, between the vertebrae slips out of place or ruptures.

Treatment for a herniated disc usually includes a combination of medications and physical therapy. In some cases, surgery may be necessary.

Other Concerns

In addition to shoulder, knee and back problems, improper weight lifting techniques can result in wrist, elbow and neck injuries as well. If you have begun to experience pain or discomfort as a result of a sports injury, schedule a consultation today with Dr.Nasir Physiotherapy And Rehabilitation (www.drnasirphysio.com) 9891878611/333

Our experienced orthopedic and sports medicine specialists can help you avoid further damage and get you back to your favorite strength training or weight lifting regimen.