2. INTRODUCTION
Pregnancy is a time in a women’s life where she
experiences many changes physically &
psychologically.
The growing uterus, and its contents, can give rise
to experiences of discomfort or pain and many
physical changes.
These physical changes result in biomechanical
effects upon functional movement.
These discomforts must be thus reduced and
relieved.
5. SYMPHYSIS PUBIS DYSFUNCTION
It is also known as pelvic girdle pain.
Affects up to 1 in 5 women.
The width of symphysis pubis is 4.8 mm and it increases
asymptomatically in pregnancy from about 4.8mm to
7.9mm
A study of pelvic girdle relaxation in pregnancy found
that 31.7% of pregnant women reported the symphysis
as a site of pain
(MacLennan et al 1997)
6.
7. PAIN
Type of pain: generally described as ‘burning’ or
‘bruised’ feeling in and around the joint, which may
also radiate suprapubically and to the medial
aspect of thighs.
Severity- varies
Onset- Gradual/ Inscidious
It may be linked to specific activity/ traumatic
incident
Provoked by- weight bearing, especially on
unilateral side and hip abduction.
8. Activities causing pain in SPD include:
Getting in/out of the car
Changing position in bed, particularly turning over
Dressing
Walking
The possible link of SPD with SID has already been
suggested .
10. TREATMENT
Rest
Reduction of non-essential chores
Keeping the legs adducted
Avoiding single leg standing
Pelvic support- Tubigrip ‘roll-on’
Trochanteric belt
SPD belt
Maternity support garments
These reduce pain levels, by helping to stabilise
the pelvic mechanics
SPD belt
12. Severe cases- functional aids may be needed
(e.g.- walking aids, ‘helping hand’, etc)
Gentle isometric contractions of hip adductors,
keeping small cushion between knees in sitting
(while maintaining pelvic stability), may relieve
adductor tension.
Supervised gentle water based exercises are also
proven to be a positive approach.
16. COCCYDYNIA
Pain in the coccyx region during pregnancy is
referred as coccydynia.
Previous injury to coccyx predisposes to this
condition in pregnancy
Otherwise it is rare antenatally unless caused by a
fall
17. Type of pain- sharp or dull
Site- end of the spine between the upper buttocks
The pain is usually during the 3rd trimister as the
baby’s head can press upon the coccyx.
Other cause- During pregnancy, the hormones
relaxin and estrogen cause relaxation of ligaments
in the pelvic floor, which allow the coccyx to shift
more than usual and this can cause pain.
18. TRIGGERS OF COCCYDYNIA
Pressure upon the coccyx
Sneezing, coughing
Lying on the back, sitting on a hard surface, moving
from sitting to standing.
Prolonged standing
Bowel movement
Labour
19. MANAGEMENT
Use coccyx cushion while sitting, taking pressure
through ischial tuberosities and thighs
Gentle mobilization- grasping coccyx using gloved
index finger in the anus and thumb posteriorly
Ice packs, heat, Ultrasound and TENS
20. Coccyx cushion
Left: The woman is sitting upright
Right: The woman is leaning forward,
which can ease the pain
21. DO’S & DONT’S
Avoid prolonged standing and walking.
Avoid bending over to pick objects.
Try shoes with cushy soles.
Do not wear shoes with high heels.
Do wear maternity support belt.
Frequently change positions — from sitting to
walking and vice versa.
Empty the bowel regularly — a full rectum may
press upon the coccyx and worsen the pain.
Apply heat or ice pads.
25. THORACIC SPINE PAIN
Symptoms may radiate to upper limb
Mechanical effect upon
costovertebral joints resulting in pain
Rib cage expands during pregnancy
as a result of growing foetus
26.
27. Increase in the size and weight of the breasts during
pregnancy can alter posture and increase strain on
the neck, shoulders and thoracic spine.
May also be linked with pain along anterior margin of
lower ribs (rib-ache and intercostal neuralgia)
Flaring can increase diameter of chest as much as
10-15 cm
‘Intercostal neurlagia’ – intermittent pain, unilaterally
radiating around the chest and may be reffered to
lateral abdominal wall.
28. TREATMENT
Gentle mobilization – but there is increased joint
laxity so care should be taken
Posture correction- taping with proprioception
Self mobilization techniques
Exercise, stretching – useful for spasm and
stiffness
Well-fitting brassier
Rib lifting techniques- deals with rib flare.
Hot water bottle / Ice-pack
Cat and camel exercises
29.
30. DOORWAY PECTORALIS STRETCHING
Stand in a door frame and place your arms on the
door frame at shoulder height with the elbows bent to
90 degrees. Place one foot forward and gently lunge
forward until you feel a moderate stretch at the front
of the chest into the front of the shoulders. Hold for 30
seconds and repeat 3-5 times several times a day.
31.
32. SCAPULAR RETRACTION
After you have stretched the pectoral musculature as
noted above, keep the arms relaxed at your side and
gently pinch the shoulder blades together as if you
are trying to hold a pencil between them. Hold for 5
seconds and then relax. Repeat 20-30 times several
times a day.
35. During pregnancy body undergoes many changes
Due to which there is increased pressure on muscles
of the back
Due to which there are postural changes
Altered posture in pregnancy
Postural backache
Often described as tired ache in lower back often at
the end of the day.
36.
37. CAUSES
Hormone Changes
During pregnancy, your body makes a hormone called
relaxin that allows ligaments in the pelvic area to relax and
thus the joints to become looser in preparation for the birth
process. The same hormone can cause ligaments that
support the spine to loosen, leading to instability and pain,
particularly if prior to pregnancy you had some weakness
of the muscles supporting this region.
Muscle Separation
As the uterus expands, the rectus abdominis muscles,
which originates from symphysis pubis and iliac crest and
inserts into 5th to 7th costal cartilages and xiphoid process,
may separate. This separation may worsen back pain.
38. Weight Gain
During a healthy pregnancy, women typically gain
weight of about 11-15 kg. The spine has to support
that weight. That can cause lower back pain. The
weight of the growing uterus also puts pressure on the
blood vessels and nerves in the pelvis and back.
Posture Changes
Pregnancy shifts the center of gravity. As a result,
pregnant women, gradually adjust their posture. This
may result strain on the back muscles and back pain.
39.
40. PRECAUTIONS
Maintaining a neutral standing posture.
Stand up straight and tall with your chest high and
shoulders back and relaxed. Don’t lock your knees.
Use a wide stance for a good base of support and try
to keep weight equally distributed between sides. If
you are statically standing for prolonged periods of
time, rest one foot on a small step stool and change
feet regularly to change the weight distribution.
.
41.
42. Maintain a neutral sitting posture.
Use a chair that has good lumbar support or
purchase a lumbar support pillow. Do not cross your
legs and keep your feet flat on the floor
approximately shoulder width apart. If your feet do
not sit comfortably on the floor consider using a foot
stool. Make sure that your chair is of a proper height
with the hips positioned at approximately 90 degrees.
Your knees should never be higher than your hips in
sitting. By keeping the lower back supported, the
muscles in the upper back can relax more in sitting
43.
44. Maintain a neutral spine while sleeping.
It is recommended that pregnant women, especially
in the second and third trimesters of pregnancy, sleep
on their side. Placing a pillow between the knees and
under the abdomen can help to maintain a neutral
spine with sleeping. Also, using the appropriate
number of pillows to ensure a neutral neck or cervical
spine position is important.
Wearing supportive shoe wear without a heel can
help relieve some of the back discomfort by keeping
the spine more neutral and providing a good base of
support.
45.
46.
47. PHYSIOTHERAPY MANAGEMENT
Physiotherapy treatment may include:
Massage
Joint Mobilisation
Kinesiotaping
Heat or Ice
Joint mobility and stability exercises
Posture education
Pregnancy support prescription such as maternity
belt.
Yoga or pilates based exercises
