P.NO.

1
ID.NO.16BPT058
SEMESTER: 7TH
COURSECODE: PT451
COURSENAME: WOMEN’S HEALTH
VARIOUS MUSCULOSKELETAL CHANGES DURING
PREGNANCY AND ITS PHYSIOTHERAPY
 Musculoskeletal system is consist muscular , articular and neural system .
 Estrogen cause proliferation of soft tissue and relaxin cause softening of
connective tissue it result in laxity in joints
 Impulse interruption in mechanoreceptor of joint capsule in CNS it results in
disturbance in proprioception and kinesthesia ,it affect gait and balance .

1. POSTURAL CHANGES-muscle imbalance :

 The pelvis and spine Balance is alter with progression of pregnancy. Increase
in a weight due to growth of fetus, increase in blood volume and deviation in
the centre of gravity that cause in changes in posture.
 Anterior deviation in the centre of gravity it will result in go backward from
spine to maintain the balance, it result in increase in lumbar lordosis and for
compensation increase cervical and thorasic curve, shoulder are posterior
and pelvic tilt anterior and hip extension and knee hyperextension.
 Due to increase in breast weight that result in posterior displacement of
thorasic spine and shoulders and scapular retraction is present, these all
changes cause pain in back due to increase in lumbosacral angle.
 Patient walk with wide base of support for balance.
 Muscle:

Tight : backflexors, chest ,calf

weak and overstretch : upper back ,abdomen ,gluteal pelvicfloor ,hamstring

P.NO.02

 Weakness of abdomen muscle that cause diastasis recti

2. Neurological involvement due to musculoskeletal changes :
 Compression between vertebrae and other joints due to weight gain that will
result in neurological and vascular structure entrapment it will cause
sciatica , carpal tunnel syndrome

PHYSIOTHERAPY MANAGEMENT

GUIDELENE
20 min moderate exercise
HRmax is 140-150bpm

Wear supportive footwear to reduce skeletal stress

38 degree below temperature for exercise

Low impact activity
Proper fluid intake
AVOID
Extreame range stretching
supine lying exercise after 16week
sports
fatigue
overtraining
exercise in hot humid atmosphere
CONTRAINDICATION :
Cardiovascular
Renal
Thyroid
Respiratory
Anemia
AIM :
Educate her about pregnancy
Physically and mentally healthy
Prevent complication
 three session during pregnancy
1. first trimester only need for patient education
2. 2nd trimester
Pelvic floor strength exercises e.g. kegle exercise
Balance exercise on physioball
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Strengthen weak muscle e.g. upper back ,abdomen ,gluteal , pelvicfloor

hamstring

Mild Stretching of tight muscle Of UL-LL

Breathing exercise e.g. diaphragmatic & segmental

Weight bearing exercise

3. Third Trimester
Relaxation in savasana and mitchel’s relaxation
Teach relax position
Strengthening exercise with dumb bell and theraband…….
Biceps with dumb bell
Shoulder flexor ,adductor ,extensors
SLR , SLA ,Pelvic bridging mild squats with chair
Abdominal strengthening in standing
Stretching :
Calf , adductor , pectoralis
 BALANCE AND PROPRIOCEPTION EXERCISE
Close chain exercise for
proprioception Balance physioball and balance board
also go with the yoga postures
P.NO.04

Altered levels of relaxin, oestrogen and progesterone during

pregnancy result in an alteration to collagen metabolism
and increased connective tissue pliability and extensibility.
Therefore, ligamentous tissues are predisposed to laxity
with resultant reduced passive joint stability. The
symphysis pubis and sacroiliac joints are particularly
affected to allow for birth of the baby. Ligamentous laxity
may continue for six months postpartum. Biomechanical
changes of the spinal and pelvic joints may involve an
increase in sacral promontory, an increase in lumbosacral
angle, a forward rotatory movement of the innominate
bones, and downward and forward rotation of the
symphysis pubis. The normal pubic symphyseal gap of 4–5
mm shows an average increase of 3 mm during pregnancy .
Pelvic joint loosening begins around 10 weeks, with
maximum loosening near term. Joints should return to
normal at 4–12 weeks postpartum .The sacrococcygeal
joints also loosen. By the last trimester, the hip abductors
and extensors, and the ankle plantarflexors increase their
net power during gait and there is an increase in load on the
hip joints of 2.8 times the normal value when standing and
working in front of a worktop . As the uterus rises in the
abdomen the rib cage is forced laterally and the diameter of
the chest may increase by 10–15 cm