THERAPEUTIC EXERCISES TRANS.k

EFFACEMENT

SHORTENING OR THINNING OF THE CERVIX FROM A THICKNESS OF 5 CM (2 IN.)

DILATION

OPENING OF THE CERVIX FROM THE DIAMETER OF A FINGERTIP TO APPROXIMATELY 10 CM (4 IN.).

• EFFACEMENT

• DILATION

TRUE LABOR

• CERVICAL DILATION PHASE

• FETAL DESCENT

• PLACENTAL STAGE

STAGES OF PREGNANCY

CONNECTIVE TISSUES

THE ROUND, BROAD, AND UTEROSACRAL LIGAMENTS IN PARTICULAR PROVIDE SUSPENSORY SUPPORT FOR THE UTERUS

LEVATOR ANI

THE PRIME MOVER OF THE PELVIC FLOOR

• LEVATOR ANI

• COCCYGEUS

FORMS THE DIAPHPRAGM

• ISCHIOCAVERNOSUS

• BULBOCAVERNOSUS

• EXTERNAL ANAL SPHINCTER

PELVIC FLOOR MUSCULATURE SUPERFICIAL MUSCLES

• PUDENDAL NERVE

• LEVATOR ANI NERVE

• SACRAL NERVE

THE NERVE SUPPLY TO THE PERINEAL TISSUES INCLUDES:

• NEUROLOGICAL COMPROMISE

• MUSCULAR IMPAIRMENT

• EPISIOTOMY

EFFECT OF CHILDBIRTH ON THE PELVIC FLOOR

• PROLAPSE

• PAIN AND HYPERTONUS

• URINARY OR FECAL INCONTINENCE

CLASSIFICATION OF PELVIC FLOOR DYSFUNCTION

• NEUROMUSCULAR REEDUCATION

• PATIENT EDUCATION

• BIOFEEDBACK

• MANUAL TREATMENT AND MODALITIES

INTERVENTIONS FOR PELVIC FLOOR IMPAIRMENTS

Diastasis recti

These are the muscles commonly associated with the “six-pack” appearance in the front of your belly.

Diastasis recti

During pregnancy, the growing uterus stretches the abdominal muscles to accommodate the developing baby.

Corrective Exercise

Diastasis recti Intervention

Back Pain

This condition can lead to lost work days, decreased functional ability, and lower quality of life scores

Varicose veins

Aggravated by increased uterine weight, venous stasis in the legs, and increased venous distensibility, can occur in the lower extremities, rectum (hemorrhoids), or vulva

Varicose veins

Symptoms include heaviness or aching discomfort, especially with dependent leg positions, and pregnant women are more susceptible to deep vein thrombosis

Joint Laxity

All joint structures are at increased risk of injury during pregnancy and during the immediate postpartum period

Joint Laxity

The tensile quality of the ligamentous support is decreased, and therefore injury can occur if women are not educated regarding joint protection.

• Diastasis recti

• Back Pain

• Varicose veins

• Joint Laxity

PREGNANCY I N D U C E D P A T H O L O G Y

• BLOOD FLOW

• RESPIRATORY RATE

• HEMATOCRIT LEVEL

• INFERIOR VENA CAVA COMPRESSION

• ENERGY NEEDS

• CORE TEMPERATURE

• UTERINE CONTRACTIONS

PHYSIOLOGICAL EFFECTS OF AEROBIC EXERCISE DURING PREGNANCY: MATERNAL EFFECTS

INFERIOR VENA CAVA COMPRESSION

occur after the fourth month of pregnancy, with relative obstruction of venous return. This leads to decreased cardiac output and orthostatic hypotension.

Hypoglycemia

occurs more readily during pregnancy.

Carbohydrate

intake is important for the pregnant woman who exercises

500 CALORIES

An additional (HOW MANY) calories per day is suggested to support the energy needs of pregnancy and exercise

• BLOOD FLOW

• FETAL HEART RATE BLOOD FLOW

• HEAT DISSIPATION

• NEWBORN STATUS

PHYSIOLOGICAL EFFECTS OF AEROBIC EXERCISE DURING PREGNANCY: FETAL EFFECTS

• EXAMINATION

• EDUCATION

• Stretching/flexibility

• Muscle performance and aerobic fitness

Guidelines for Managing the Pregnant Woman

vena cava compression

Do not exceed 5 minutes of supine positioning at any one time after the first trimester of pregnancy to avoid (COMPRESSION) by the uterus.

• Placenta previa

• Preeclampsia

• Premature labor

Contraindications to Exercise

• Severe anemia

• Systemic infection

• Diastasis recti

• Overheating

Precautions to Exercise

• HEAD LIFT

• HEAD LIFT WITH PELVIC TILT

Corrective Exercises for Diastasis Recti

STABILIZATION EXERCISES

Exercises for activating the abdominal and low back muscles and developing control of their stabilizing function in the lumbar spine and pelvis.

• PELVIC TILT EXERCISES

• PELVIC CLOCK

• PELVIC CLOCK PROGRESSION

• TRUNK CURLS

• DIAGONAL CURLS

DYNAMIC TRUNK EXERCISE/PELVIC MOTION TRAINING

• STANDING PUSH-UPS

• SUPINE BRIDGING

• QUADRUPED LEG RAISING

• MODIFIED SQUATTING

• SCAPULAR RETRACTION

Modified Upper and Lower Extremity Strengthening

• SIDE-LYING HIP ABDUCTION

• SITTING ADDUCTOR STRETCH

Perineum and Adductor Flexibility

• Contract-Relax

• Quick Contractions

• Elevator Exercise

• Pelvic Floor Relaxation

Pelvic Floor Awareness, Training, and Strengthening

• BILATERAL STRAIGHT LEG RAISING

• FIRE HYDRANT EXERCISE

• ALL FOURS (QUADRUPED) HIP EXTENSION

• UNILATERAL WEIGHT-BEARING ACTIVITIES

UNSAFE POSTURES EXERCISE DURING PREGNANCY

INCOMPETENT CERVIX

is the painless dilation of the cervix that occurs in the second trimester (after 16 weeks’ gestation) or early in the third trimester of pregnancy.

PLACENTA PREVIA

As the cervix dilates, the placenta begins to separate from the uterus and may present before the fetus, thus endangering fetal life.

MULTIPLE GESTATION

More than one fetus develops.

Deep breathing

is interwoven throughout exercise regimens for the management of lymphedema.

FLEXIBILITY EXERCISES

gentle, self-stretching exercises are used to minimize soft tissue and joint hypomobility.

• DEEP BREATHING

• FLEXIBILITY EXERCISES

• STRENGTHENING AND MUSCULAR ENDURANCE

• CARDIOVASCULAR CONDITIONING EXERCISES

• LYMPHATIC DRAINAGE EXERCISES

COMPONENTS OF EXERCISE REGIMENS FOR MANAGEMENT OF LYMPHEDEMA

LYMPHATIC DRAINAGE EXERCISES

often referred to as pumping exercises, move fluids through lymphatic channels.

20 to 30 minutes

PREPARATION FOR LYMPHATIC DRAINAGE EXERCISES: Set aside approximately (TIME) for each exercise session.

• TOTAL BODY RELAXATION

• POSTERIOR PELVIC TILTS AND PARTIAL CURL-UPS

• UNILATERAL KNEE-TO-CHEST

• CERVICAL ROM

EXERCISES COMMON TO UPPER AND LOWER EXTREMITY SEQUENCES

• EXERCISE ON A FOAM ROLL

• BILATERAL HAND PRESS

• WAND EXERCISE

• TOWEL STRETCH

• OVERHEAD WALL PRESS

• PARTIAL CURL UPS

• REST

EXERCISES SPECIFICALLY FOR UPPER EXTREMITY LYMPHEDEMA CLEARANCE

• UNILATERAL KNEE-TO-CHEST

• BILATERAL KNEES TO CHEST

• EXTERNAL ROTATION OF THE HIPS

• ACTIVE ANKLE MOVEMENTS

• PARTIAL CURL-UPS

• REST

EXERCISES SPECIFICALLY FOR LOWER EXTREMITY LYMPHEDEMA CLEARANCE

Contract-Relax

Instruct the woman to tighten the pelvic floor as if attempting to stop urine flow or hold back gas.

type Il-fiber

Quick Contractions fiber response is important to develop in order to withstand pressure from above, especially with coughing or sneezing.

BILATERAL STRAIGHT LEG RAISING

This exercise typically places more stress on the abdominal muscles and lower back than they can tolerate.

FIRE HYDRANT EXERCISE

This exercise is performed on hand and knees, and one hip is abducted and externally rotated at a time.

ALL FOURS (QUADRUPED) HIP EXTENSION

Become unsafe and can cause lower back pain when the leg is elevated beyond the physiologic range of hip extension.

UNILATERAL WEIGHT-BEARING ACTIVITIES

Can cause sacroiliac joint irritation and should be avoided by women with preexisting sacroiliac joint symptoms.

PELVIC FLOOR STRENGTHENING

This exercise may increase circulation and aid the healing of lacerations.

DIASTASIS RECTI CORRECTION

the mother should be taught this test and encouraged to perform it on the third postpartum day

20 - 30 minutes

PREPARATION FOR LYMPHATIC DRAINAGE EXERCISES: Set aside approximately (TIME) for each exercise session.

30 minutes

AFTER LYMPHATIC DRAINAGE EXERCISES: If possible, rest with the involved extremity elevated for (TIME)

FALSE

TOTAL BODY RELAXATION: (TRUE OR FALSE)

Have the patient assume a comfortable supine position and begin deep breathing. Then isometrically contract and relax the muscles of the upper back, shoulders, upper arms, forearms, wrist, and fingers.

Then contract and relax the muscles of the lower trunk (abdominals and erector spinae), followed by the hips, lower legs, feet, and toes.

Finally, contract and relax the muscles of the neck and face

TRUE

TOTAL BODY RELAXATION: (TRUE OR FALSE)

Have the patient assume a comfortable supine position and begin deep breathing. Then isometrically contract and relax the muscles of the lower trunk (abdominals and erector spinae), followed by the hips, lower legs, feet, and toes.

Then contract and relax the muscles of the upper back, shoulders, upper arms, forearms, wrist, and fingers.

Finally, contract and relax the muscles of the neck and face

TRUE

TOTAL BODY RELAXATION: TRUE OR FALSE

Perform diaphragmatic breathing throughout the entire sequence. Avoid breath-holding and Valsalva’s maneuver

UNILATERAL KNEE-TO-CHEST

designed to target the inguinal nodes. This is important even for upper extremity lymphedema

UNILATERAL KNEE-TO-CHEST

WHAT EXERCISE: In the supine position, flex one hip and knee and grasp the lower leg. Pull the knee to the chest. Gently press or bounce the thigh against the abdomen and chest about 15 times

• Rotation

• Lateral flexion

CERVICAL ROM MOVEMENTS

90°

ACTIVE CIRCUMDUCTION OF THE ARM: Flex the involved arm to WHAT DEGREE (reach toward the ceiling)

6 - 12 inches

ACTIVE CIRCUMDUCTION OF THE ARM: Perform active circular movements of the arm about (DIAMETER) in diameter.

• clockwise

• counterclockwise

• five

ACTIVE CIRCUMDUCTION OF THE ARM: Do this ——— and ———— , (HOW MANY) repetitions in each direction.

• SHOULDER ABDUCTION

• SHOULDER ADDUCTION

• SHOULDER FLEXION

• SHOULDER EXTENSION

EXERCISE ON A FOAM ROLL PROMOTE WHAT MOVEMENT?

FLEX

BILATERAL HAND PRESS: With arms elevated to shoulder level or higher and with the elbows EXTENDED.

TRUE

BILATERAL HAND PRESS: With arms elevated to shoulder level or higher and with the elbows

FLEX.

BILATERAL HAND PRESS

place the palms of the hands together in front of the chest or head.

PECTORALIS MAJOR

WHAT MUSCLE INITIATE DURING BILATERAL HAND PRESS?

UNILATERAL ARM EXERCISE WITH ARM ELEVATED

WHAT EXERCISE: Shoulder rotation with the elbow extended; Elbow flexion and extension; Circumduction of the wrist; Hand opening and closing

BILATERAL HORIZONTAL ABDUCTION AND HORIZONTAL ADDUCTION.

WHAT EXERCISE: The Patient is in Standing or Sitting Position Place both hands behind the head Horizontally Abduct & Adduct the shoulders by bringing elbows together and then pointing them laterally.

15 repetitions

UNILATERAL KNEE-TO-CHEST MOVEMENTS: REPITITIONS

UNILATERAL KNEE-TO-CHEST

If lymphdema is present in only one lower extremity,

15 REPITITIONS

BILATERAL KNEES TO CHEST: REPITITONS

5 REPITITIONS

GLUTEAL SETTING AND POSTERIOR PELVIC TILTS: REPETITIONS

• static balance control

• dynamic balance control

• automatic postural reactions

Types of Balance Control

static balance control

to maintain a stable antigravity position while at rest, such as when standing and sitting

dynamic balance control

to stabilize the body when the support surface is moving or when the body is moving on a stable surface, such as sit-to-stand transfers or walking

automatic postural reactions

to maintain balance in response to unexpected external perturbations, such as standing on a bus that suddenly accelerates forward

Feedforward

is utilized for movements that occur too fast to rely on sensory feedback (e.g., reactive responses) or for anticipatory aspects of postural control

Anticipatory Control

involves activation of postural muscles in advance of performing skilled movements, such as activation of posterior leg and back extensor muscles prior to a person pulling on a handle when standing30 or planning how to navigate to avoid obstacles in the environment

Closed loop control

is utilized for precision movements that require sensory feedback

“Stretch” reflexes

mediated by the spinal cord comprise the first response to external perturbations

<70 ms

“Stretch” reflexes latencies

>150 ms

Voluntary responses latencies

Voluntary responses

have the longest latencies are dependent on task parameters, and produce highly variable motor outputs.

Automatic postural reactions

have intermediate latencies and are the first responses that effectively prevent falls.

80 to 120 ms

Automatic postural reactions latencies

Suspension Strategy

is observed during balance tasks when a person quickly lowers his or her body COM by flexing the knees, causing associated flexion of the ankles and hips.

Hip Strategy

For rapid and/or large external perturbations or for movements executed with the COG near the limits of stability.

Stepping Strategy

If a large force displaces the COM beyond the limits of stability, a forward or backward step is used to enlarge the BOS and regain balance control.

• Balance during single leg stance

• Balance while standing with resistance

• Balance while standing with arm abducting

• Balance while standing and catching a ball.

• Balance while standing on wobble boards

Static Balance Control Activities

Anticipatory Balance Control

Dynamic Balance Control

• Otego Home Exercise Program

• Tai Chi for Balance Training

Evidence-Based balance exercise Program for fall Prevention in the Elderly

Otego Home Exercise Program

is a cost-effective program for reducing falls for people aged 80 and over.

Anticipatory Balance Control

having the patient lift objects of varying weight in different postures at varying speeds, open and close doors with different handles and heaviness, or maneuver through an obstacle course