The document outlines an antenatal physiotherapy program with the aims of teaching safe body mechanics during and after pregnancy, developing posture control, preventing impairments, promoting cardiovascular fitness, and preparing for labor and infant care. It describes common physical changes in pregnancy like weight gain, abdominal stretching, and postural changes. The program consists of exercises targeting the pelvic floor, back, ankles, legs, and breathing to address issues like back pain, pelvic girdle pain, and relaxation. Guidelines stress safety and avoiding high-risk movements.

1. By: Babita Pandey
Antenatal
Physiotherapy
Program

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Introduction:
Pregnancy is a time of tremendous musculoskeletal, physical and emotional
changes for the lady and yet is a condition of wellness. Exercise programs
during pregnancy and after childbirth are designed to minimize impairments
and help the woman maintain or regain function while she is preparing for
arrival of body

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Aims:
• Learn safe body mechanics
• Develop awareness & control of posture during & after pregnancy
• Prevent / treat impairments & painful conditions associated with pregnancy.
• Promote / maintain safe CV fitness
• Develop upper bod strength for demands of child care
• Learn relaxation skills to relieve stress of labor
• Offer education for parenthood
• Prepare the woman for labor, lactation & care of infant

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CHANGES DURING PREGNANCY:
• Weight gain of approximately 11 kg
• Uterus becomes more of an abdominal organ rather than pelvic organ
• Abdominal muscles are stretched
• Blood pressure decreases in early trimester ,reaches its lowest level
midway through pregnancy and then rises gradually from mid
pregnancy to up to 6 weeks of delivery
• Ligaments become lax
• Postural changes occur like rounded shoulders, increased curvature
of low back, walking with wider base of support

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Stages:
*1st trimester of pregnancy: 0-3 months
• Problems: Vaginal bleeding, Nausea, Vomiting, High fever, Vaginal discharge
& itching, pain or burning during urination, Calf pain, headaches, swelling,
flow ups of chronic diseases.
*2nd trimester of pregnancy: 3-6 months
• Problems: Nasal problems, Dental issues, Urinary incontinence, Dyspnea,
Dizziness, UTI
*3rd trimester of pregnancy: 6-9 months
• Problems: Preterm labor, Vaginal bleeding, Pre-eclampsia
*Others common problems. *( Included in next page)

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*Stages:
*Others common problems.
Diastasis recti – This is separation of the rectus abdominal muscle. Any separation larger than two finger width is considered
significant. One can have low back pain due to this and transitions from lying down straight to sitting position can be hampered.
Every pregnant woman must be tested for this and only then exercises should be started.
Upper and Lower back pain – This occurs because of postural changes of pregnancy, increased ligamentous laxity and decreased
abdominal function. Learning correct body mechanics is vital.
Sacroiliac joint pain – This could be caused again due to lax ligaments in a pregnant female. In early stages rest and ice, manual
therapy techniques to correct asymmetry, gentle non weight bearing movements in the bed return the joint to its normal position.
Work involving leaning forward should be avoided and avoid single leg standing activities.
Carpal tunnel syndrome – This is a compression disorder caused due to fluid retention, hormonal changes or circulatory
compromise. The pregnant female complaints of tingling or numbness in hands or weakness of the hand with pain could be present.
Splints, ultrasound therapy and exercises to strengthen the hand are helpful.
Symphysis pubis dysfunction – This dysfunction is due to asymmetry that would have occurred at the pubic bone at the pelvis
due to muscle imbalance and lax ligaments .Rest and reduction of nonessential activities. Pelvic support, water based exercise is a
good option but breaststroke to be avoided.

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GUIDELINES FOR EXERCISE:
• Get a physical examination from your gynecologist before
participating in any exercise program
• Exercise should not exceed pre- pregnancy levels
• Drink fluids before, during and after exercise
• Include appropriate warm up and cool down
• Avoid ballistic movements
• Don’t allow any joint to go beyond its physiological range
• Don’t hold your breath
• Don’t do any exercise that causes pain
• Don’t do any exercise where there is a possible loss of balance
• Don’t exercise in hot humid environment
• No contact sports e.g. horse riding, scuba diving, jumping should be done

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Physiotherapy Program:
It is a type of program that aims to preventing low back
pain an enhancing physical preparation for delivery by
means of joint stretching and muscle strengthening.
Antenatal care is the pillar of safe motherhood.

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Types of antenatal exercise:
(1) Pelvic floor exercise
• Sit on a chair with your back against the seatback
• Tighten the vaginal, urethral and anal muscles as if trying to withhold urination or
defecation. You can also do this exercise in a standing position.
*Pelvic floor exercise enhances the control and support of pelvic floor muscles. It
helps you prepare for childbirth and prevents uterine prolapse, urinary incontinence a
nd hemorrhoid.

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*Types of antenatal exercise:
(2) Back and abdominal exercise
• Sit on a chair with your back against the seatback
• Breathe naturally
• Tighten the abdomen and then press the pelvis downwards to flatten your low back against the
seatback. Hold for 5 seconds, and relax
*This exercise helps you by correcting the low back and pelvic posture. It strengthens your abdominal
muscles and prevents back pain.
• Tailor Exercise for pregnancy
It strengthen the pelvic, hip and thigh muscles and can help relieve low back pain.
• Tailor Sit: Sit on the floor with your knees bent and ankles crossed. Lean slightly forward and
keep your back straight but relaxed.
• Tailor press: Sit on the floor with your knees bent and the bottoms of your feet together. Grasp
your ankles and pull your feet gently toward your body. Place your hands under your knees. While
pressing your knees down against your hands, press your hands up against your knees. Hold for a
count of five.

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*Types of antenatal exercise:
(3) Ankle exercise
• Sit on a chair with your back against the seatback
• Start with one ankle and turn the foot upwards and downwards. Each up-and
-down movement is counted as one time. Repeat ten times
• Rotate the ankle to draw an inward or outward circle. Each circular moveme
nt is counted as one time. Repeat ten times
• Repeat the same steps at the other ankle
• Ankle exercise helps reduce leg swelling and varicose vein, thus alleviating
the problem of leg cramps

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*Types of antenatal exercise:
(4) Lower limbs relaxation exercise
• This exercise enhances the flexibility and strength of inner thighs and
pelvic muscles. It helps you get accustomed to the delivery position
and prevent thigh spasm during delivery
• Sit on a stable low chair against a wall and spread your thighs sideways
. Hold for 5 seconds and relax

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*Types of antenatal exercise:
(5) Breathing exercise
• Breathing techniques for pain relief during labor. Exhale before inhale is suggested A. Abdominal
breathing
• Suitable for mild pain
• Breathe in through the nose and feel the abdomen expand. Then breathe out through the mouth B.
Lower costal breathing
• Suitable for medium pain
• Put your hands on the lower rib cage. Breathe in through the nose and feel your chest expand. Then
breathe out lightly through the mouth 79 C. Apical breathing Subsequent Visits
• Suitable for severe pain
• Cross your hands below the clavicles with your mouth slightly open. Breathe in through the nose
and the mouth. Breathe out lightly as if trying to flicker the flame of a candle without blowing it
out, and feel the upper lungs moving slightly up and down
* During contractions, try to relax and control your breathing
* In between contractions, rest and relax as much as you can in the most comfortable position

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Stretching exercises for pregnancy:
Stretching exercise makes the muscles limber and warm, which can be especially
helpful when you’re pregnant. Here are some simple stretches you can perform
before or after exercise:
• Neck rotation
• Shoulder rotation
• Swim
• Thigh shift
• Leg shake
• Ankle rotation

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Kegel Exercises During Pregnancy:
Kegel exercises help strengthen the muscles that support the bladder, uterus, and
bowels. By strengthening these muscles during your pregnancy, you can develop
the ability to relax and control the muscles in preparation for labor and birth. Kegel exercises are also
highly recommended during the postpartum period to promote the healing of perineal tissues,
increase the strength of the pelvic floor muscles, help these muscles return to a healthy state, and
increase urinary control.
To do Kegels, imagine you are trying to stop the flow of urine or trying not to pass gas. When you do
this, you are contracting the muscles of the pelvic floor and are practicing Kegel exercises. While
doing Kegel exercises, try not to move your leg, buttock, or abdominal muscles. In fact, no one
should be able to tell that you are doing Kegel exercises. You can do them anywhere!
We recommend doing five sets of Kegel exercises a day. Each time you contract the muscles of the
pelvic floor, hold for a slow count of five and then relax. Repeat this ten times for one set of Kegels.

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Contraindications:

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EXERCISES TO BE DONE DURING PREGNANCY:
•In the first trimester usually no exercises are advised .Only simple walking for 15-20
minutes is advised.
•In the second trimester one should do exercises for the core strengthening, buttock
strengthening and upper back strengthening.
•In the third trimester more of duck walking, squats, lunges and relaxation methods
should be done

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UNSAFE EXERCISES DURING PREGNANCY:
•Both straight leg raising should be avoided as it puts undue stress on the low back more
than it can tolerate. It can cause back injury or diastasis recti hence should not be attempted.
•Fire hydrant exercise –This exercise is done in all fours position – like dog peeing. If the
leg is elevated too high then it can stress the sacroiliac joint and low back hence should be
done with caution.
•Standing on one leg exercises can also cause balance problems because of increased body
weight and shift in center of gravity.

19. Thank You