natal exercises

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Prenatal Exercises / Antenatel Exercises :Prenatal Exercises / Antenatel Exercises P.Sam Jeba Selvan Physiotherapist 1

Introduction :Introduction Duration Pregnancy Traditionally calculated by the clinicians in terms of 10 Lunar months or 9 months and 7days or 280 days or 40 weeks. Calculated from the first day of the menstrual period. This is called menstrual or gestational age. But fertilization usually occur 14 days prior to the expected missed period and in a previously normal cycle of 28 days duration. 2

Slide 3:It is about 14days after the first day of the period. Thus , the true gestational period is calculated by subtracting 14 days from 280 days ie 266 days. This is called fertilization or Ovulatory age and is widely used by theEmbryologist. First Trimester (First 12 Weeks) Second Trimester (13 – 28 Weeks) Third / Last Trimester (29 – 40 Weeks) 3

First Trimester Symptoms :First Trimester Symptoms Amenorrhoea Morning sickness – appear soon after the missed period and rarely last beyond the 3rd Month. Frequency of Micturition – quite troble during 8 – 12 weeks of pregnancy. Breast discomfort – feeling fullness and pricking sensation is evident as early as 6 -8th week specially in primigravidae. Fatigue – occur in early pregnancy. 4

Second Trimester Symptoms :Second Trimester Symptoms Subjective symptoms – such as nausea, Vomiting and frequency of micturition usually subside, while amenorrhoea continues. The new features that appear are Quickening symptoms (feeling of life) denotes the perception of active fetal movements by the women. Felt about the 18th weeks, about 2weeks earlier in multipara. 5

Slide 6:Progressive enlargement of the lower abdomen by a mass Chloasma – Pigmentation over forehead and cheek may appear at about 24th week. Breast Changes – a) More enlarged with prominent veins under the skin. b) Secondary areola specially demonstrated in primigravidae, usually appears at about 20th week. c) Motgomery’s tubercles are prominent and extended to the secondary areola. d) Colostum becomes thick and yellowish by 16th week. e) Variable degree of striae may be visible with advancing weeks. 6

Last Trimester Symptoms :Last Trimester Symptoms Amenorrhoea persists. Enlargement of the abdomen is progressive which produces some mechanical discomfort to the patient such as palpitation or dyspnoea following exertion. Lightening – about 38th week specially in primigravidae a sense of relief of the pressure symptoms is abstained due to engagement of the presenting parts. Frequency of micturation – reappears. Foetal movements are more pronounced. 7

Slide 8:8 Exercises to Avoid During Pregnancy Ball sports Contact sports: ultimate fighting, wrestling, football Sports that involve bouncing, leaping, a sudden change of direction (increased joint laxity from hormones make joints susceptible to sprains) Exercises that put you at risk for falls: rollerblading, horseback ridding, skiing After 1st trimester avoid exercise in the supine position Lying in the prone position Lifting heavy free weights

Slide 9:9 Contraindications to Exercise Pregnancy induced hypertension Premature rupture of membranes Preterm labor during the prior or current pregnancy Persistent 2nd or 3rd trimester bleeding There should be an evaluation to determine whether an exercise program is appropriate if the woman has conditions such as: Cardiac disease, constrictive lung disease Chronic hypertension Severe anemia Chronic bronchitis Extreme obesity Extreme underweight History of an extremely sedentary lifestyle Orthopedic limitations Heavy smoker

Slide 10:10 Recommendations for Exercise Beginners non weight bearing activities pose the least risk of injury 20 – 30 minutes of activity a day at a comfortable pace Previously active women participation in aerobic activities are generally safe Exercise in high altitudes is not recommended Running can be continued late into pregnancy to maintain fitness, less than 45 min Weight training light weights and moderate reps will maintain flexibility and muscle tone and reduce the risk of joint/ligament injury Should be able to converse while exercising – vigorous exercise offers no benefits during pregnancy, only more complications Listen to your body – stop if you feel breathless, nausea, dizzy, tired Pulse should NEVER exceed 140 beats per minute!

Slide 11:11 Recommendations for Exercise Positions/Posture: Avoid lying on your back after 12th week of pregnancy Abdominal exercises Avoid standing for long periods Avoid back swaying (lordosis) – cat back stretch, strengthen abdominals Rounded upper back (kyphosis) – chest stretches, upper back strengthening Avoid valsalva maneuver – increase blood and intra-abdominal pressure Avoid lying in the prone position after the 1st trimester

Slide 12:12 Pelvic Tilts

Slide 13:13 Side Leg Lifts

Slide 14:14 Precautions for Exercise Dehydration and hyperthermia: Avoid exercise in hot humid environments Drink plenty of liquids – prior, during, after Appropriate clothing may help dissipate heat Hot tubs/saunas Poor Balance: Centre of gravity shifts as pregnancy progresses Exercise cautiously Pay attention to changes to terrain Muscle cramps and soreness: Stretch muscles and warm-up before exercising Wear supportive well cushioned shoes

Slide 15:15 Don’t over do it! Watch for dizziness, blurred vision, nausea, shortness of breath Stop or slow down Heart rate should not exceed 140-145 beats per minute Contact doctor the following occur: vaginal bleeding, uterine contractions, leaking amniotic fluid

I st Trimester :I st Trimester 16

Slide 17:17 Respiratory Changes Respiratory capacity increases Shortness of breath Pulmonary reserve decreases Increased risk of muscle soreness Tendency to hyperventilate

Slide 18:18 Digestive Changes Digestive system slows Intestines are pushed up and to the sides Smooth muscle of the stomach relaxes and can cause heartburn Constipation and hemorrhoids are common during pregnancy Morning sickness

Slide 19:19 Urinary Changes Kidneys grow and filter more blood as the blood volume increases Become more susceptible to bladder and kidney infections Bladder becomes compressed causing frequent urination and incontinence

Slide 20:20 Skin Changes Stretch marks Dark pigmented line on there abdomen which is called Linea Nigra Pigment changes on their face and neck Small blood vessels in the face, neck and upper chest MOST OF THESE RESOLVE AFTER PREGNANCY

Slide 21:21 Breast Changes Nipples become larger and darker A thick yellowish fluid can be expressed from the nipple Early in pregnancy, tenderness and tightness is common After 8 weeks, breasts grow and blood vessels often are visible

Slide 22:22 Biomechanical Changes Weight distribution shifts Joint movement Balance of muscle strength Spinal curves increase Joint laxity becomes greater More structural discomfort Increased potential for nerve compression

Slide 23:23 Potential for Injury Nerve compression syndromes Low back discomforts or pelvic pain Upper back fatigue Lower extremity Pelvic floor function

Slide 24:24 Postural Dynamics Increased curve of the waist Top of pelvis tilts forward More flexion in the hip joint Increased hunching in the upper back and neck Tailbone is pushed back

Slide 25:25 Muscles Affected Overstretching & weakening of gluteal muscles & hamstrings Overstretching & weakening of abdominal muscles & pelvic floor Overstretching & weakening of upper back muscles Shortening and tightening of low back & hip flexors muscles Shortening of upper back flexors & pectoral muscles

Slide 26:26 Combat Effects of Gravity/ Hormones Do pelvic tilts Alter the stance Shorten the jog stride Lower or eliminate the step in aerobics Avoid rapid leg abduction Avoid breast stroke kick in swimming Recognize tolerance for activities will vary Do pelvic floor exercises to prevent trauma Emphasize strengthening & stretching exercises Wear abdominal support/ sports bra when exercising for support

Slide 27:27 Changes to Body System First Trimester Baby begins to grow Increased urination Changes with skin and hair Thickening waistline Nausea/fatigue Second Trimester Baby’s weight increases Energy level improves Heartburn Leg cramps Pelvis relaxes causing SI discomfort Third Trimester Baby has more rapid growth & weight gain Backaches Swelling of the hands, legs, and feet Breathlessness More frequent urination

Slide 28:28 EXERCISE GUIDELINES Relax & breathe deeply between each exercise. Stop exercising if bleeding increases or bright red blood appears. Avoid exercises that raise the hips & pelvis above the chest. Avoid jerky movements, extreme stretching & heavy weight lifting for 12 weeks. Do the exercises at least twice daily.

Slide 29:29 To reduce the risk of respiratory dysfunction Deep breathing exercises Position : crook lying. Upper chest, mid chest & diaphragmatic with abdominal wall tightening. Huffing : to prevent post-operative complications

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Slide 32:32 Maintenance of circulation Active dorsi flexion & plantar flexion of ankles. Active ankle circling – clockwise & counter-clockwise. To prevent DVT, Continue until the mother stands without difficulty.

Slide 33:33 Kegel’s exercises Any position of comfort. Tighten the muscles around the vagina & urethra as if holding back urine flow & relax. Improve muscle tone. Heals episiotomy wound, reduces edema, encourages good circulation in that area. Pain-relieving property. Strengthens the pelvic floor.

Slide 34:34 CORRECT POSTURE HEAD SHOULDERS & CHEST ABDOMEN & GLUTEALS KNEES FEET Straighten neck. Tuck chin in. Lift up thru ribcage & pull back shoulder girdle. Roll arms out. Contract abdominals to flatten back. Tuck gluteals under & tilt pelvis back. Bend to ease body weight over feet. Distribute body weight thru center of each foot.

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