1. Physiotherapy in Pregnancy

2. WHAT ARE THE CHANGES DURING PREGNANCY ?

3. Changes during pregnancy Anatomical changes - Stretching abdominal muscles -Decreased in ligamantous strength -Hypermobility of joints -Pelvic floor drops as much 2.5 cm Physical changes - lordotic posture -COG shifts forward and upwards -Balance – mother walks with wider BOS

4. Stages of pregnancy Pre natal stage During labour Post natal stage

5. Problems during pre natal stage - Faulty posture -Upper & lower extremity stress -Varicose vein,LL oedema -Urine incontinence & Stress incontinence -Abdominal muscle stretch & diastasis recti -Development of musculosketal pathologies-knee pains,back pains

6. How to minimize these complications ???? Posture Standing -stretch head up and out of shoulders and pull in abdominals -tighten buttocks -lean back against a wall for support if standing prolong time -try to go up & down for several times

7. Sleeping -quarter turn from prone,pillow under the abdomen and between knees -avoid supine positions -when turning in the bed,keep knees flex together to decrease the strain -Turn to a side,put off the bended leg out of the bed,put weight on to a one hand and slowly come to the sitting position

8. Sitting - Sit back into the chair with well support - keep the feet well on a stool if necessary - Do pelvic tilt regularly - Small cushion should be kept back to maintain slight lumbar curve

9. Postures in ADL activities - playing with children kneeling position -cleaning -ironing -cutting vegetables Feet apart,one foot forward possibly on a low stool. At intervals of this activities it is important to ease the spine by placing the hands on the iliac crest and easing the spine into extension.

10. Exercises to prevent varicose veins,oedema and lower limb strain -Do not hang off the legs for prolong period of time -Move feet up-down,in-out and circle -buregers’ exercises

11. Pelvic floor muscle strengthening * Important in pre & post natal period

12. Abdominal strengthening Concern on rectus abdominis specially * Prior to abdominal strengthening, pelvic floor muscle strengthening is important

13. Important exercises during pre natal stage Stretching exercises Legs,ankle hip adductors,back, shoulder girdle

14. Strengthening exercises Abdominal Back Pelvic floor

15. Relaxation exercises

16. Breathing exercises

17. Mobilization exercises

18. Important exercises during labour Breathing & relaxation exercises 1 st stage –relax diaphragmatic breathing with short duration of pains 2 nd stage –concentrate on expiration.

19. Important exercises in Post – natal stage Normal delivery caesarean section

20. Normal delivery - care of perineum & reliving perineal pain -Sitting on ring cushion or folded pillow, side sitting during breast feeding

21. Advices on posture to prevent back strain with activities related to the baby Awareness of stress incontinence Advice on bed mobility, avoid straight sit ups and lifting techniques

22. Caesarian section 1 st week Breathing exercises Huffing with pillow support Ankle & toe exercises Move on bed &getting out of bed After 1 week Deep breathing Strengthening exercises – pelvic floor,abdominal Pelvic tilting

23. Pelvic tilting exercises Crook lying position Tilt- Relax-Tilt – Relax Exercise

24. 6 weeks -6 months Prone kneeling Back humping &hollowing

25. Back care and lifting - avoid transferring weight through one leg for long time -never stoop,feet apart,and the lifting object must be held in close to the body lifting steps floor chair upright

26. Postures during post natal stage Breast feeding

27. Carrying the baby

28. What not to do in Pregnancy??? Bilateral SLR. Unilateral wt. bearing activities. Driving. Heavy weight lifting.

29. THANK YOU !!!