Pregnancy can induce several pathological conditions involving the back, joints, and veins. Posture-related back pain is common in pregnancy due to postural and hormonal changes, affecting 50-80% of women. Sacroiliac joint pain causes localized pain in the pelvis and posterior thigh. Varicose veins are aggravated by increased weight and venous stasis. Joint laxity increases injury risk requiring exercise modification. Nerve compression syndromes like thoracic outlet syndrome and carpal tunnel syndrome can occur. Treatment focuses on activity modification, external support, exercise modification, and splinting/injections.

1. Pregnancy-Induced Pathology

3. Pregnancy-Induced Pathology
Diastasis Recti
Sacroiliac/Pelvic Girdle
Pain
Posture-Related Back
Pain
Varicose Veins
Joint Laxity
Nerve Compression
Syndromes

4. Posture-Related Back Pain

5. 1. The postural changes of pregnancy,
2. Increased ligamentous laxity,
3. Hormonal influences,
4. decreased abdominal muscle function.
CAUSES
Incidence •50% to 80% of pregnant women
• In the postpartum period, with
prevalence in as many as 68% of
women, for as long as 12 months
after delivery.
Characteristics
The symptoms of low back pain
usually worsen with muscle fatigue
from static postures .
As the day progresses; symptoms
are usually relieved with rest or
change of position.
Women who are physically fit
generally have less back pain during
pregnancy
Interventions
Low back pain symptoms can be treated effectively with many traditional low back
exercises, proper body mechanics, posture instructions, improvement in work
techniques, along with superficial modality application.
The use of deep heating agents, electrical stimulation, and traction is generally
contraindicated during pregnancy.
Posture-Related Back Pain

7. Sacroiliac/Pelvic Girdle
Pain

8. Sacroiliac/Pelvic Girdle
Pain
Characteristics
Sacroiliac pain is localized to the posterior pelvis and is described as
stabbing deep into the buttocks distal and lateral to L5/S1.

9. Sacroiliac/Pelvic Girdle
Pain
Characteristics
Pain may radiate into the posterior thigh or knee but not into the
foot.

10. Sacroiliac/Pelvic Girdle
Pain
Symptoms
Symptoms include pain with prolonged sitting, standing
or walking, climbing stairs, turning in bed, unilateral
standing, or torsion activities.
Symptoms may not be relieved by rest and frequently
worsen with activity.

11. Pubic symphysis dysfunction may occur
alone or in combination with sacroiliac symptoms and
includes significant tenderness to palpation at the
symphysis, radiating pain into the groin and medial
thigh, and pain with weight bearing
Sacroiliac/Pelvic Girdle
Pain
Symptoms

12. Sacroiliac/Pelvic Girdle
Pain
interventions
Activity modification. Exercise modification. External stabilization..

13. Sacroiliac/Pelvic Girdle
Pain
interventions
Activity modification.
•Daily activities should be adapted to minimize asymmetrical forces acting on the
trunk and pelvis.
•For example, getting into a car is done by sitting down first, then pivoting both legs
and the trunk into the car, keeping the knees together;
•side-lying is made more symmetrical by placing a pillow between the knees and
under the abdomen;
•and sexual positions are altered to avoid full range of hip abduction.
•Single-leg weight bearing, excessive abduction, and sitting on very soft surfaces
should be avoided.
•In addition, caution patients to avoid climbing more than one step at a time,
swinging one leg out of bed at a time when getting up, or crossing the legs when
sitting.

14. Sacroiliac/Pelvic Girdle
Pain
interventions
Exercise modification.
Exercise must be modified so as not to aggravate the
condition.
Avoid exercises that require single-leg weight bearing and
excessive hip abduction or hyperextension.
Teach the patient to activate the pelvic floor and transverse
abdominals when transitioning from one position to another
and with any lifting in order to stabilize the pelvis.

15. Sacroiliac/Pelvic Girdle
Pain
interventions
External stabilization
Use of external stabilization such as belts or corsets designed
for use during pregnancy helps reduce posterior pelvic pain,
especially when walking.

16. Varicose Veins

17. Varicose Veins
Varicosities are aggravated in pregnancy by the increased uterine weight,
venous stasis in the legs, and increased venous distensibility.
Varicosities can present in the first trimester and are more prevalent with
repeated pregnancies.
They can occur in the lower extremities, the rectum (hemorrhoids), or vulva.
Symptoms usually include heaviness or aching discomfort, especially with
dependent leg positions;
intensity may become severe as the pregnancy progresses.
In addition, pregnant women are more susceptible to deep vein thrombosis.
Characteristics

18. Exercise modification. If there is discomfort, exercises may need to be
modified so that minimal dependent positioning of the legs occurs.
External support. Elastic support stockings should be worn to provide
an external pressure gradient against the distended veins, and the woman
should be encouraged to perform lower extremity exercises and to elevate the
lower extremities as often as possible.
Vulvar varicosities may benefit from use of a perineal pad or belt that
provides counter-pressure and support to the tissues.
Interventions

19. Joint Laxity
• Significance
• All joint structures are at increased risk of injury during pregnancy
and during the immediate postpartum period. The tensile quality of
the ligamentous support is decreased, and therefore injury can
occur if women are not educated regarding joint protection. There
is much controversy regarding the impact of postpartum hormone
levels; however, elevated levels have been found 3 to 5
months after delivery.
• Interventions
• Exercise modification. Teach the woman safe exercises to perform
during the childbearing year, including modification of exercises to
decrease excessive joint stress
• Aerobic exercise. Suggest nonweight-bearing or less stressful
aerobic activities such as swimming, walking, or biking, particularly
for women who were relatively sedentary before pregnancy.

20. NERVE COMPRESION SYNDROMES
• Thoracic outlet syndrome
• Carpel tunnel syndrom
• consult book for details (therapeutic exercises-special topic)

21. TOS

22. • Thoracic outlet syndrome (TOS) is a
condition in which there is compression of the
nerves, arteries, or veins in the passageway
from the lower neck to the armpit. There are
three main types: neurogenic, venous, and
arterial. The neurogenic type is the most
common and presents with pain, weakness,
and occasionally loss of muscle at the base
of the thumb.The venous type results in
swelling, pain, and possibly a bluish
coloration of the arm. The arterial type results
in pain, coldness, and paleness of the arm

23. • TOS may result from trauma, repetitive
arm movements, tumors, pregnancy, or
anatomical variations such as a cervical
rib. The diagnosis may be supported by
nerve conduction studies and medical
imaging. Other conditions that can
produce similar symptoms include rotator
cuff tear, cervical disc disorders,
fibromyalgia, multiple sclerosis, and
complex regional pain syndrome

24. • Initial treatment for the neurogenic type is with exercises to
strengthen the chest muscles and improve posture.
• NSAIDs such as naproxen may be used for pain.
• Surgery is typically done for the arterial and venous types and
for the neurogenic type if it does not improve with other
treatments.
• Blood thinners may be used to treat or prevent blood clots.
The condition affects about 1% of the population.It is more
common in women than men and it occurs most commonly
between 20 and 50 years of age.The condition was first
described in 1818 and the current term "thoracic outlet
syndrome" first used in 1956

27. • Carpal tunnel syndrome (CTS) is a medical
condition due to compression of the median nerve
as it travels through the wrist at the carpal tunnel.
The main symptoms are pain, numbness and
tingling in the thumb, index finger, middle finger
and the thumb side of the ring finger.
• Symptoms typically start gradually and during the
night. Pain may extend up the arm.Weak grip
strength may occur, and after a long period of time
the muscles at the base of the thumb may waste
away. In more than half of cases, both hands are
affected

28. • Risk factors include obesity, repetitive
wrist work, pregnancy, genetics, and
rheumatoid arthritis

29. • Being physically active can decrease the risk
of developing CTS.
• Symptoms can be improved by wearing a
wrist splint or with corticosteroid injections.
• Taking NSAIDs or gabapentin does not
appear to be useful.
• Surgery to cut the transverse carpal ligament
is effective with better results at a year
compared to non-surgical options. Further
splinting after surgery is not needed

32. Year 2020