ANTENATAL PHYSIOTHERAPY: IS IT THE MOST IMPORTANT AND PRODUCTIVE MEDICAL CARE FOR PREGNANT WOMEN?
Pregnancy is a normal physiological process usually experience by healthy women. Most of the neuro- musculoskeletal problems that arise during pregnancy can be prevented and treated by physiotherapy. Individualized physical therapy programs have been found more effective than group sessions for the reduction of pain and sick leave to pain in pregnancy. The women’s health physiotherapist come in contact with pregnant woman in various communities, health centre, leisure centre or the physiotherapy department and their role is to:
• Educate the pregnant women about pregnancy, labour and beyond (especially during antenatal classes).
• Advise on safe and appropriate exercise that should be carried out during and after pregnancy.
• Identify, assess and treat musculoskeletal problems.
Most women present with complains like lower back pain especially after walking or standing for a long time, knee pain, waist pain, neck pain, lack of sleep, pain around the pelvic or the buttock region down to the leg, bladder control problem, abdominal bulging (rectus diastasis), pain around the pubic bone especially when walking or separating the leg.
Factors that contribute to these major musculoskeletal complains experienced during pregnancy include:
The position of the spine and pelvis alters as pregnancy progresses but there is still confusion as to the exact nature of any associated postural adaptation. With weight gain, increased blood volume and growth of the fetus, the centre of gravity no longer falls over the feet and the woman may need to lean backwards to gain balance. Abnormal spinal curves results, and an adaptive posture which include an increase of the lumbosacral angle (increase lumbar curve) or anterior displacement of the pelvis. There will also be a compensatory posterior displacement of the shoulders, thoracic spine and increase of the cervical lordosis (back neck curve). Postural changes may still be present 12 weeks after birth.
Pregnancy is governed and controlled by hormones, which affect the various body systems. Some of which are relevant to the physiotherapist. Progesterone decreases smooth muscle tone, oestrogen influences uterine and breast growth, prepares prime receptor sites for relaxin (e.g. pelvic joints), and causes increased water retention. Relaxin replaces the collagen in target areas with a modified form, which has greater pliability and extensibility. It also has a softening effect on connective tissue (pelvic floor and abdominal fascia), increasing extensibility in those structures.
Nerve Compression Syndromes:
Fluid retention may occur during the third trimester, which can lead to a variety of nerve compression syndromes. These include carpal tunnel syndrome (CTS), brachial plexus compression, meralgia paraesthetica (compression of the lateral cutaneous nerve of the thigh as it passes under the inguinal ligament, presenting as tingling and burning in the outer thigh) and posterior tibial nerve compression. These entrapments normally resolve postpartum also wrist
splints and ice are useful for CTS and posterior tibial nerve compression.
It is important and exciting to know that those problems that arise during pregnancy can be prevented and treated through Antenatal physiotherapy.
Antenatal physiotherapy promotes and maintains optimal physical and emotional maternal health throughout pregnancy, recognise and treat correctly complications occuring during pregnancy. It is usually carried out during the prenatal classes within the first 20 weeks and 34week of gestation.
Antenatal physiotherapy entails and educates women on the following:
• Breathing and relaxation technique during pregnancy and labour.
• Correct sitting, sexual and sleeping position throughout the various stages of pregnancy.
• Back care and postural education.
• Labour position and massage technique.
• Management of musculoskeletal disorders using TENS, use of physio belt to stabilize the pelvis etc.
• Safe and appropriate exercise antenatal exercise.
Most women can survive the multiple hazards of pregnancy, labour and the puerperium with a healthy baby within an environment where there is substantial increase in the maternal and foetal mortality rates through exercises. These exercises will improve their strength, flexibility, stamina and endurance in preparation for childbirth. However, it is not possible to set strict guidelines for women wanting to exercise during pregnancy as there are too many variables, such as individual fitness levels, the intensity and type of exercise and the individual factors affecting each pregnancy. With exercise such as kegel exercises (known as pelvic floor exercises), pelvic tilting exercises, swimming and water exercises, yoga and Pilate, exercises for circulation and cramps, stretching and aerobic exercises, now being encouraged as part of a healthy lifestyle, more women are likely to be exercising before and during pregnancy. The women’s health physiotherapists are involved in educating and encouraging exercise in many different situations. These range from leading antenatal exercise groups, advising women who are habitual exercisers and are wishing to continue with exercise, pregnant women who wish to become more active but do not regularly exercise, and about the use of suitable home exercise videos.