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Exercise TherapyRegime
CHAPTER
19
The physiotherapy plays very important role during this period
for healthierpregnancy, easier childbirth and regain the shape back
to the normal. So effectivepractice for physiotherapist is based on
a sound knowledge and understandingof anatomy and physiology and of
the social and psychological aspects of theeach stage of child
bearing year
AIMS OF OBSTETRIC PHYSIOTHERAPY
1. To promote good health, price and sense of well-being during
pregnancyand encourage preventive medicine.
2. To give women the opportunity to discuss their fears and
expectations in arelaxed and sympathetic atmosphere and to acquire
positive and accurateinformation about pregnancy and labor.
3. To offer instructors in skills to conserve energy, raise pain
tolerance levelsand maintain control during labor.
4. To alleviate stress and strain of the pregnancy.5. To
rehabilitate women during the puerperium to full physical activity
and
mental well-being.The exercise regime of pregnancy is called
Pilates. Pilates are defined as the
mild or moderate exercise method to be used in the months of
pregnancy, afterbirth and to regain shape back to normal. The
exercise designed to strengthenthe back, pelvic floor, to maintain
tone of the abdominals and achieve the longer,leaner and stronger
body.
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PRINCIPLES
The Concentration
Concentration is fundamental aspect of exercise required or
correct performanceof technique or diversion may occur on the
concerns, anxieties that will haveaffect future mother and
fetus.
The Breath
Breathing plays a vital role. There are two breathing exercises
in the warm-upsession. This helps the woman to breath deeply,
rhythmically and to the fullcapacity. When exercising she has to
breathe in and breathe out with effort, thishelps the woman to
relax a movement. If vice versa happens, i.e. if she breathesin for
the effort she will get tensed up.
The Girdle of Strength
The girdle of strength is essential for all exercises. It
includes three areas. Theyare the upper back, the abdomen and the
buttock.
The Back
The upper limb exercises are very important in relieving the
tension and can bethe major seat of tension. So, woman has to
perform the upper limb exercisescorrectly from the midline of the
back so that she will be free of tension.
Abdomen
All the exercises begin by drawing the navel gently towards the
spine. Thisstrengthens the transverse abdominis muscle to regain a
flat stomach and protectthe back against undue strain during the
exercise.
Buttock
Buttock muscle movements and squeezing during the exercise will
tone themuscles and also bring the body into the perfect alignment
thereby improvesthe posture and protects the back from strain or
injury.
Relaxation
Relaxation plays a vital role in the exercise session. The warm
up should bedone whenever exercises are performed. This helps in
reducing the tension inthe body. Breathing control is also
important by slowing down the breathingand followed by the
relaxation at the end of exercise session.
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IMPORTANCE OF EXERCISE SESSION
1. The increase in hormones relaxes the ligaments and muscles
make pregnantwomans body supple than normal woman, so body will be
loose. Stretchingexercises should be avoided.
2. All the joints become unstable, so the pregnant woman should
maintain thetone of the abdominal muscles or the back may get
strained.
3. The posture should be checked regularly. In the 1st trimester
utmost caremust be taken to prevent damage to her back. Because
when the weight ofthe body changes, the center of gravity tends to
induce a sway back in herstance.
4. Women breast also enlarge rapidly from the beginning of
pregnancy, theextra-weight puts strain on the neck, shoulders,
upper back as well asshoulders become rounded resulting in postural
problem. So, a woman hasto perform regular shoulder, neck
exercises, should know posture correction.This will release tension
in the area, increases mobility. Woman should alsowear a
well-fitting bra that will give her support at each stage of her
pregnancy
5. The extra-blood is produced, waste disposal system increases,
amnioticfluid surrounding her baby and the fluid to all of her body
tissues in thepregnant woman body will increase, so regular
exercises must be done tokeep the fluid moving and to prevent edema
which is retention and swellingof the area, woman also has to drink
plenty of water.
6. Pelvic floor exercises play an important role because this
will help to reducethe risk of varicose veins as the effect of
relaxin causes the wall of the womensblood vessels to relax which
leads to varicose veins as well varicosities inthe vulva or anus
called hemorrhoids or piles.
7. The digestive system is also affected with morning sickness
and leads tonausea or actual vomiting. This usually disappears
after the third month ofpregnancy. Digestion slows down during
pregnancy and will result inheartburn or constipation. Exercise
helps womens metabolism speed upgradually and risks are
reduced.
8. After the birth of baby, body starts to return to its
pre-pregnant state, reducingoutput and fluid balance immediately.
Breastfeeding will speed up thisprocess. Women body will be back in
shape, so women should take time torecover, relax, rest into
mothers new role.
EXERCISE PROGRAM
Exercise is important during pregnancy on a number of levels.
Pregnancy istime to focus of stretching, relaxing and general
toning.
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AIMS OF PHYSIOTHERAPY
1. To provide maximum possible physical independence.2. To give
relief of symptoms.3. To improve functions of the body.4. To
increase functional capacity.
GUIDELINES FOR EXERCISE DURING PREGNANCY
1. Exercise thrice a week.2. Maximum heart rate should not
exceed 140 to 150 beats per minute.3. Maintain adequate fluid
intake to avoid dehydration.4. Proper diet to be taken to meet the
exercise needs.5. Avoid exercise during illness.6. Avoid exercising
in supine position after end of the fourth month.
CONTRAINDICATIONS
1. Gestational diabetes.2. History of miscarriage, premature
labor.3. Vaginal fluid loss.4. Hypertension.5. Multiple
pregnancies.6. Abnormal placental function or position.7. Anemia.8.
Decreased fetal movement.
EFFECTS AND USES OF EXERCISES
1. Helps to improve posture.2. Aids to reduce stress and
anxiety.3. Maintains cardiovascular fitness.4. Reduces backache.5.
Aids in preparation for labor.6. Maintains muscle flexibility and
length.7. Helps in control of weight.8. Improves body awareness.9.
Improves blood circulation.
10. Reinforces relaxation.11. Decreases fatigue.12. Reduces
stress and anxiety.13. Increases endurance and stamina.14. Provides
social interaction. Assist postnatal recovery.15. Helps in shaping
up back to normal.
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AIMS AND PLANS DURING PREGNANCY
1. Aim: To teach knowledge of awareness and control of
posture.Plan: Postural awareness training, strengthening and
stretching posturalmuscles.
2. Aim: To learn safe body mechanics.Plan: Body mechanics in
sitting, standing, lifting lying, moving from oneposition to
another, during labor and delivery.
3. Aim: To prepare the lower limbs for weight-bearing and
prevent circulatoryproblems.Plan: Stretching exercises, resistance
exercises to the muscles of lower limb,use of elastic stockings or
edema control.
4. Aim: To teach the importance of the exercise and control of
the pelvic floormuscles.Plan: Awareness of pelvic floor contraction
and relaxation. Trainstrengthening and muscle control.
5. Aim: To maintain abdominal function and prevent diastasis
rectipathology.
6. Aim: To promote safe cardiovascular fitness.Plan: Aerobic
exercises.
7. Aim: To have knowledge about pregnancy and childbirth.Plan:
Women should attend antenatal physiotherapy classes arranged atthe
hospital.
8. Aim: To teach relaxation method.Plan: Women should make a
habit of practicing relaxation techniques.
9. Aim: To prevent impairments associated with pregnancy like
lowbackache, pelvic floor weakness, and decreased circulation.Plan:
Women should attend classes to know about problems of
pregnancy,preventive techniques and appropriate exercises.
10. Aim: To mentally prepare woman for labor and delivery.Plan:
Women should have knowledge about of signs of starting of
labor.
11. Aim: To develop awareness of the pelvic floor
dysfunction.Plan: Pelvic floor exercises strengthening during
pregnancy, after birthshould be taught.
First Trimester
In the first trimester strenuous exercise should be avoided as
it may lead tomiscarriages, concentrate on improving posture,
strengthening the pelvic floor,relaxation, and breathing
techniques.
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Posture Awareness
This helps in release of tension, improves the blood supply,
improves thefunctions of the autonomic nervous system which in turn
improves thefunctioning of the reproductive organs, it reduces the
strain of muscles, jointsand ligaments.Standing posture: Head and
neck: Head should be relaxed and balanced on the top of the
spine
with neck straight. Shoulders and arms: The arms hang
comfortably by the sides without tension
looking straight at the mirror; check the shoulders are at an
even height.Turn sideways to the mirror and check that the
shoulders are neither pulledback, which distorts neither neck nor
slouched forward.
Back and stomach: Stand sideways on to the mirror to check your
back. Let yourspine lengthen out. Draw the navel gently towards the
spine and gently pullup the pelvic floor muscles, so doing like
this prevents strain to the back.
Buttocks: The navel and back are in the correct placement,
pelvis will belightly upward. So lowest muscle in the buttocks must
be squeezed for correctalignment.
Legs and feet: The feet should be a hip foot apart with the toes
facing forwardsweight should be taken equally on both the feet.
Pelvic Floor
Pelvic floor strengthening is important because the muscles
support the babyand extra-weight of the uterus, prevent
incontinence, hemorrhoids and prolapseof the uterus.
Position of patient: Standing up, sitting down, squatting on
heels with kneesapart. If women has problems like hemorrhoids and
varicose veins then prefersitting on a chair.
Contract and release: slowly contract pelvic floor muscles in
long upwardmovements towards the uterus. Abdomen and buttocks
should be relaxed. Holdand slowly release. Perform ten
repetitions.
The lift: Contract pelvic floor muscles and pause three
times.
Pulses: Contract all the pelvic muscles and then release
rapidly, so do thisrepeatedly in time within pulse time.
Breathing Exercises (Fig. 19.1)
Relaxation and stretching are done with treath in a movement and
effort takesplace in treath out.
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Fig. 19.1: Breathing exercise
Breathe awareness: Lie on the back with a small cushion below
head and feetshould be on the chair so that knee will be right
angle. See to that back is straightand no tension in the shoulders
or neck. Place the hands on abdomen so thatthe fingers touch each
other. As woman breathes in the inhalation should reachthe abdomen
and indicated by separation of the fingers, as she breathes out
thefingers should meet again. Do not exaggerate the movement and
repeat for 10breaths.
Rib Awareness (Fig. 19.2)
Sit on a ball or chair with feet on the floor with hip width
apart, toes pointingforward. The back should be straight with no
tension in the neck and shoulderswrap a long scarf around back at
rib level, cross it in front and hold one end ineach hand breathe
in and feel the expansion of ribs and breathe out and feel theribs
contact. Repeat for 10 breaths.
Fig. 19.2: Rib awareness
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Head Roll and Head Tilt (Figs 19.3A and B)
These exercises relieve tension in the shoulder and neck and
keep the spine inproper alignment.1. Sit with both the feet flat on
the floor with a long, straight back. Draw the
navel gently to the spine and pull up the pelvic floor. Check
there is notension in the shoulders, neck or face particularly in
jaw, forehead andaround the eyes. Take a few long deep breaths and
let women relax.
2. Drop your chin down to your chest, without moving or tensing
the shoulders.Roll the head around towards the right, center, left
and return to the centralposition and lift the head, repeat for 4
to 5 times.
3. Turn the head and look to the right shoulder. Chin should be
slightly tuckedin and turn to the left side and return to the
center.
A B
Figs 19.3A and B: Head roll and head tilt
Shoulder Lifts and Circles (Figs 19.4A to D)
This exercise relieves tension in the upper back. Keep the
backbone straight.1. Lift the shoulders as high as can reach
towards your ears, letting the arms
hang loosely at your sides. Drop them heavily. Repeat each
shoulder for 5times.
2. Draw the shoulder forwards so that she can close up the front
of the chestand take them backwards to touch the shoulder blades.
Repeat for five times.
Arm Stretches (Figs 19.5A to C)
This helps in toning up the arms:1. Sit on a chair with feet
flat on the floor with backbone straight. Draw the
navel gently to the spine and pull up the pelvic floor. See to
that there shouldbe no tension. Take a few long deep breaths and
relax.
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A B C D
Figs 19.4A to D: Shoulder lifts and circles
2. As she breathes out lift the arm straight to the shoulders
level a breathe in putthe hands down. This causes stretch in the
shoulders. Repeat 5 to 10 times.
3. Drop the arms down to your sides, take the arms straight
behind you. Bringback to normal position, repeat the same for five
times. This gives downwardstretch effect.
4. Sit with the arms bent at the elbows and fingers pointing to
the sides andkeep the elbows tuck into sides. Breathe out return to
normal position. Repeatfor five times.
A B C
Figs 19.5A to C: Arm stretches
Side Stretch (Fig. 19.6)
This gives side stretch1. Sit sideways on an armless chair with
feet on the floor and left hand holding
the chair back. Backbone should be straight. Draw the navel
gently to thespine and pull up the pelvic floor. Slowly breathe in
and breathe out.
2. Place right hand behind your head. Breathe out turn your head
to look awayfrom the chair back a pull through the ribs. Now,
stretch gently away fromthe chair back feeling the lower ribs
stretching up.
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3. Breathe in to return to the starting position and repeat 5 to
10 times. Repeaton the other side.
Forward Bend (Fig. 19.7)
1. Stand facing a window ledge or heavy table or chair and arms
length away.Feet should be firmly on the floor; hip-width part keep
the backbone straight.Draw the navel gently to the spine and pull
up the pelvic floor. Raise yourarms above your head without raising
your shoulders.
2. Breathe in and while breathe out slowly bend forward. Let the
fingers reston the support and feel a long stretch through the
arms, neck a back. Holdthis position for a minute and breathe
naturally.
3. Now, continue to bend forwards and drop the head towards the
floor, ifstrain is felt bend the knees slightly.
4. Breathes in and breathe out slowly roll up back to the
straight standingposition. Repeat this for five times.
Pillow Squeeze (Fig. 19.8)
This causes exercise to pelvic floor, inner thigh, postural
awareness and relaxingthe lower back.
Position of woman is supine lying with a pillow below her
head.1. Lie on your back with the knees bent and feet flat on the
floor. Gently hold
the pillows between knees. Place the arms by side of the body
with palmsdown. Whole body should be relaxed. Breathe in pull up
the pelvic floormuscles.
Fig. 19.6: Side stretch
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Fig. 19.7: Forward bend
Fig. 19.8: Pillow squeeze
2. Breathe out squeeze the pillows with your knees.3. Breathe in
to release the cushion comes back to the starting position and
repeat the same for 10 times.
Relaxation: After exercising it is important to relax. This
should be for 10 to 15minutes. This relieves stress levels, feeling
of tiredness, ability to cope andoverall health will be fine.
Relaxation Sequence (Fig. 19.9)
Lie down on the floor with the spine straight, arms close to
sides, palmsuppermost because it causes upper back and shoulders
down, comfortable onthe floor close your eyes and relax total body
and slowly roll the head from side-to-side to check the tension in
the neck. Practice the relaxation techniques, i.e.Yoga-nidra.
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Fig. 19.9: Relaxation sequence
Alternating the Breath
Alternate nostril breathing should be practiced after relaxation
because itimproves oxygen intake, purification and circulation of
the blood and lymph.Oxygen flow is increased to every cell in the
body, improves alertness,concentration and a good exercise or lungs
and respiratory muscles.1. Keep your backbone straight, sit on the
floor with crossed legs or in the
chair. Breathe in and breathe out with force.2. Close the right
nostril with the help of right thumb and breathe in and
breathe out with force through left nostril.3. Close the left
nostril with right hand little finger and breathe in an breathe
out with the left nostril.4. Alternately close the right and
left nostril and breath alternately with force.
Second Trimester
In the second trimester: All signs of nausea disappear. Women
feel extremely wellboth physically and emotionally. So, exercises
to protect against strain andinjury, to boost the circulation of
both blood and lymph, to keep muscles toneand sense of
well-being.
Curl-ups
This exercise causes increase mobility in the spine strengthens
pelvic floor andabdominal muscles.
1. Lie on your back with knees bent, feet slightly apart and
flat on the floor.Shoulders and neck are relaxed and arms by the
side of the body. Place arolled towel between the knees and slowly
lengthen the spine along thefloor, tuck the chin in and lengthen
the neck.
2. Slowly breathe in and as you breathe out draw the navel
gently towards thespine. Lift the buttocks and back slightly up so
that shoulder blade shouldtouch the floor. This causes mobility of
the spine.
3. When the body is lifted up, breathe in and breathe out, lower
the back downslowly and place it on the floor. Repeat for 5 to 10
times.
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Knee to Chest
This exercise helps in improving posture, releasing the tension
in the lowerback and neck.1. Lie on your back with knees bent and
feet flat on the floor, the spine, neck,
and head straight. Lift the knees up and feel the whole spine in
contactsfloor. Place your hands just below the knees, holding them
apart to fit aroundthe bump. Draw the navel gently back towards the
spine throughout theexercise.
2. Breathe out draw your right knee towards the chest, breathe
in release theknee, neck and shoulders should be relaxed.
3. On the next out breath, draw the left knee to the chest in
the same way.4. Breathe out draw both the knees to the chest.
Repeat the whole sequence 5 to
10 times.
Opposite Arm and Leg Stretch
This exercise helps in stretching out and relaxing the body.1.
Lie on your back with your knees bent, feet flat on the floor and
arms beside
you. As you breathe out slide your left leg away from you on to
the floorsimultaneously lifting your right arm up above your head
to lie flat on thefloor.
2. Breathe in and breathe out return your arm and leg to the
starting position.3. On the next breathe out; repeat with the left
arm and right leg. Alternate 5 to
10 times.
Arm Reaches
This exercise is useful for releasing tension in the shoulders,
back and neck.
1. Lying on your back, place your feet on the floor, slightly
apart with kneesbent. Reach your arms straight, so those finger
tips are pointing at the ceiling.
2. Breathe out take your arms in the opposite directions, so one
goes above thehead closely to the floor and other goes down to your
side. Breathe out comeback to the starting position
3. Breathe out repeat the same in opposite direction. Perform
alternatively for10 times.
Hip Rolls
This exercise is designed to release the tension from the back
and neck andhelps for relaxation.
1. Lie on your back with your feet together and knees raised and
slowly breathein and breathe out.
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Exercise Therapy Regime 123
2. Breathe out roll the knees gently to one side keeping them
together. Breathein return to the center.
3. Breathe out repeat the same on the opposite side. Repeat the
whole sequence10 times on each side.
Knee Drops to Side
This exercise relaxes pelvic area.
1. Lie on your back with knees waist and feet flat on the floor
slowly breathe inand breathe out.
2. Breathe out slowly drop one knee to the side without lifting
the hip or movingthe pelvis, breathe in and return to the starting
position.
3. Breathe out drop the other knee to the side and return back
to the startingposition, and repeat the same for five times on each
side.
Leg Slides
This exercise maintain good alignment and posture, mobilizes and
stretchesthe joint of the leg.1. Lie on the floor with knees raised
and feet together on the floor and slowly
breathe in and breathe out.2. Breathe out straighten one bent
knee along the floor and breathe in return
back to the starting position.3. Repeat the same with the other
leg and perform the same alternately five
times on both sides.
Hamstring Stretch
This is the stretch for hamstring muscles, this also release the
feeling of heavinessin the legs, edema.1. Lie on your back with
both the knees bent, feet flat on the floor, the shoulder
should be relaxed, wrap a long scarf or belt along the foot and
slowly bringthe left knee up towards the chest and slowly breathe
out straighten the legup towards the ceiling. The knee should be
facing the woman try to feel thestretch for a count of ten to
twenty.
2. Breathe in bent the leg slowly and relax for a moment and
repeat the sameon the other side.
Leg Stretchers
This is the exercise that reduced the edema and strengthen the
abdominals.1. Lie on your back with both the feet together flat on
the floor and knees raised
now take your feet off the floor. Keeping the knees apart to
make a V shapetowards your toes.
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2. Breathe in and bring one knee up towards your chest and
breathe out andstretch of the second leg.
3. Breathe out change the legs, so that second leg is drawn
towards the chestand first is stretch up and repeat the same five
to ten times on each side.
Leg Lift
This exercise help to reduce edema and keep the muscles
strong.1. Lie on your side against a wall. Place a big cushion
below the upper leg and
rolled up towels to support the waist, now stretch out your
lower armsparallel to your spine and place a small cushion between
head and arm,bent your lower leg and flex the foot of your upper
leg on the cushions placeyour upper hand on your upper hip.
2. Breathe out slowly lift your whole upper leg slightly
upwards, breathe inslowly bring back to starting position.
3. Breathe out perform the same on the other side by same
arrangement of thepillows.
Posture Awareness
This exercise done in front of the mirror to check the position
to know howspine does works and to improve the posture.1. Sit on a
chair or a ball and keep your backbone straight in front of the
mirror
with both arms folded and few inches in front of the chest only
rest yourhands against your arms and slowly breathe in and breathe
out.
2. Breathe out slowly turn your spine to the right side, breathe
in return to thestarting position.
3. Breathe out turn to the left side and repeat the same
alternately five times oneach side.
Squatting Against a Wall
This exercise helps to maintain the mobility of the pelvic and
hip joint.1. Put a big cushion on the floor next to wall stand
against the wall with feet
hip width apart and slowly breathe in and breathe out.2. Breathe
out slowly begin to bent your knees and slowly slide your lower
back down the wall keep your heels flat on the floor. Stay in
this position fora minute or two.
3. Slowly breathe in and breathe out slide slowly up back the
wall.
The Quadruped Position (Figs 19.10A to C)
This exercise stretches and relaxes the back
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1. Position yourself on your hand and knees with hip width apart
in front ofthe mirror and check shoulders hips and knees are all in
alignment andslowly breathe in and breathe out.
2. Breathe out slowly draw the naval back towards spine so that
back archesup and head drops down between the arms. Breathe in and
return to thestarting position.
3. Breathe out and arch your back so that it hollows out and
raised your head.Breathe in and return to back to the starting
position. Repeat the both for fiveto ten times.
A B C
Figs 19.10A to C: The quadruped position
Pillow Squeeze
This exercise is to strengthen the pelvic floor and tones up the
inner thigh.1. Lie on your back with knees flexed with a harder
pillow in between knees
and thighs and feet slightly apart and flat on the floor. Slowly
breathe inand breathe out.
2. Breathe out pull the muscles of buttocks and thighs and
squeeze the pillowsto the count of ten breathe in slowly relax.
Repeat the same for five to tentimes.
Relaxation Sequence
Finish this whole exercise session with the relaxation
sequence.
Third Trimester
In the third trimester women feel the extra weight unbearable.
So exercise playsan important role in reducing the edema,
correcting the postural imbalance. Sothe relaxation and the
breathing technique are the best.
Foot Arching
This exercise decreases the risk of edema. Whenever possible
keep the feet raisedwith a pillow, feet if lying on the bed.
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1. Keep backbone straight and sit near the edge of a chair, with
feet slightlyapart, flat on the floor and slowly breathe in and
breathe out.
2. Without moving the heels slowly draw back the toes, so that
arch increases.Go back to the starting position.
3. Stretch the toes upwards as far as they go. Come back to
starting position.4. Raise your inner border of the foot. This is
called eversion and come to
starting position then raise your outer border of the foot. This
is calledinversion and come back to starting position. Repeat all
of the above for fiveto ten times.
Ankle Exercises
This is the good exercise for swollen feet.1. Sit with the
backbone straight against the wall, the lower legs are
supported
with a pillow. Slowly breathe in and breathe out.2. Slowly bend
your both feet forwards, this is called dorsiflexion. Hold and
count five and come back to starting position.3. Slowly bend
both feet downward this is called plantar flexion, feel the
stretch
and count five and come back to the starting position.4. Slowly
circle the ankle for five times clockwise and anticlockwise
direction
and come back to the starting position.
Hand and Wrist Exercises
This exercise helps in reducing tension and swelling too.1. Sit
comfortably in the chair and keep your backbone straight, shoulders
and
neck should be relaxed. Bring both your hands together so that
finger tips ofboth the hands should touch each other and press them
firmly without anyother parts of the hand touching each other. Hold
for a count of ten andcome back to the starting position.
2. Shake your hands loosely in front of the mirror for ten
times.3. Make and fist close them and open them for ten times.4.
Rotate your wrist five times clockwise and anticlockwise
direction.
Arm Raises
This exercise helps to improve posture, reduces tension in the
necks andshoulders.1. Take a long scarf and stand with the feet hip
width apart with the long
straight back and neck and slowly breathe in and breathe out and
hold thescarf in front of you, breathe out raise the scarf on to
the top of the head. Donot lift the shoulders and slowly breathe
in.
2. Slowly breathe out and lower the scarf again and repeat the
same.
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Legs Against the Wall
This exercise reduces swelling in the ankles and feet. Need not
perform thesecond one till you feel comfortable.1. Keep a cushion
below head, position in such a way that bottom touches the
wall and lift your feet till you are comfortable on the wall,
straighten the legsand flex the feet or toes can be pointed with
knees bent. Hold this positionfor 10 minutes or longer depending on
comfort of the woman.
2. If the first position is easy then go for second, this causes
stretch of theinnerthighs. Slowly take both the legs outward and
feel the stretch. Relax forfive minutes.
3. Bend the knees and roll sideways on to the floor to come out
of either position.
Spinal Twist
This exercise relaxes back and stretches hamstring and calf
muscles.1. Sit on the floor with backbone straight with legs
stretched straight and
shoulders should be relaxed.2. Bend your left leg and cross your
foot over the right leg and keep by the side
of the right knee in the bent position and hold the left knee
with the rightarm. Place the palm of the left hand on the floor
behind you and breathe out.Turn your head to look back and breathe
in come to the center and repeat thesame exercise for ten
times.
3. Repeat the same on the others side.
Sitting with Legs Wide Apart
This causes stretch of the hamstrings and the inner thighs.
Increases mobility ofthe hip joints and releases the tension in the
back and shoulders. Breathingexercises can also be done in this
position.1. Sit down with backbone straight supported by the lower
back, legs straight
in front and slowly breathe in and breathe out.2. Slowly open
your legs wide apart to feel the stretch breathe deeply in and
relax and come back to the starting position.
Leg Raises with Pillow Support
This exercise helps to maintain the tone of the leg muscles.1.
Sit on the floor with the backbone straight by the wall and legs
straight in
front of you. Place a double pillow under your right knee so
that it supportsthe leg and place the left foot on the floor with
the knee bent.
2. Slowly straighten the right leg, point the toe, flex the heel
and lower the legto the pillow. Repeat this ten times and then
change the legs.
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Child Pose with Pillow Support
This is the best relaxation position in the late pregnancy. It
relieves the pressureon the lower back and opens up the pelvic
area.1. This needs lot of cushions for comfort. Sit on the top of a
cushion or bolster
with your knees as open as possible and feet close to your
buttocks. Put alarge cushion in front of you and make sure spine is
straight. Close youreyes and take five deep, slow breathes and feel
your whole body relax.
2. Place your hands on the floor and walk your body to the
cushions in front ofyou, placing your arms and head on top and
relaxing into the pose. Keepyour back long and place your head to
one side. Slowly breathe in andbreathe out and return to the
starting position, sit with your eyes closed andbreathing
deeply.
POSTNATAL PERIOD
This is the period lasted from immediately to six months after
birth.
Aims and Plans of Physiotherapy
1. Aim: To develop awareness and control of the pelvic floor
musculature.Plan: Pelvic floor muscle contraction and relaxation
training andstrengthening program for muscle control and treatment
for prolapse,incontinence or hypertonus.
2. Aim: To bring awareness and control of posture during
postnatal period.Plan: Postural awareness training and
strengthening and stretching of thepostural muscles.
3. Aim: To learn safe body mechanics.Plan: Body mechanics with
baby equipment and childcare activities.
4. Aim: To develop upper limb strength to meet demands of infant
care.Plan: Resistive exercises to the appropriate muscles.
5. Aim: To promote increased body awareness and a positive body
image.Plan: Woman should know the importance of body
awareness,proprioception activities and posture reinforcement.
6. Aim: To maintain abdominal function and correct diastasis
recti pathology.Plan: Woman has to perform diastasis recti
exercises, abdominalstrengthening exercises with diastasis recti
protection.
7. Aim: To encourage for relaxation.Plan: Woman should practice
relaxation techniques regularly.
8. Aim: To provide education on the safe postpartum exercise
progression.Plan: Women should attend the exercise session before
delivery to have aclear idea of the importance of postpartum
exercises.
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Exercise Therapy Regime 129
Immediately after the birth it is the feeling of joy and
excitement and tiredness.The exercise session is divided into three
sections. They are:1. First three months2. Three to six months3.
Six month onwards
First Three Months After the Birth
Soon after the birth start the pelvic floor exercises. Mothers
who go for thebreastfeeding should take of shoulders and neck. To
relieve tension do exerciseregularly.
Flexing the Feet (Figs 19.11A and B)
The use of this exercise is to maintain tone of the muscles of
legs, buttocks andabdominal muscles and reduce fluid retention in
the ankles. Position of thepatient is standing, sitting on the
floor, can use the ball to make abdominalmuscles work even
harder.
A B
Figs 19.11A and B: Flexing the feet
1. Sit on the floor with the backbone straight and stretch the
whole length ofthe leg. Shoulders should be dropped with arms
outstretched in front at theshoulder height.
2. Maintain the same position and flex the feet so that the toes
pointing up tothe ceiling.
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Standing position: Stand holding on to the chair back and
perform the same.Point and flex 10 to 20 times.
Arm Exercisers (Figs 19.12A to C)
This exercise prevents the edema.1. Sit down with the legs
crossed and keep your backbone straight, if felt
uncomfortable, use a small cushion, stretch the arms out making
a loose fist,a few inches off the floor.
2. Spread your fingers and make a fist continuously and take
your hands upabove the head and do not raise your shoulders.
3. Repeat the same pattern and bring the arms down and repeat
for five times.4. Stretch the arms outside to the shoulder
height.5. Flex the hands so that the fingers are straight and
pointing upwards towards
the ceiling. Stretch is felt all the way along the underside of
the arms.6. Reverse the hands so they drop down, curling the
fingers back towards the
body as far as possible. Stretch should be felt along the
backside of thehands, wrist and forearms. Flex and curl 10 to 20
times.
A B C
Figs 19.12 A to C: Arm exercises
Bottom Walking (Fig. 19.13)
This exercise is best for the leg-toning.1. Sit on the floor
with both the legs stretched and backbone straight. Stretch
your arms in front and move them along with legs.2. Moving from
the hip and keeping the back straight, walk the right left
forward
so that the right foot is in front of the left. Walk with the
left leg in front of theright. Repeat forwards for ten steps. Walk
the left leg in front of the right.Repeat forward for ten steps,
then backwards for another ten steps.
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Fig. 19.13: Bottom walking
The Pelvic Floor (Fig. 19.14)
This exercise strengthens pelvic floor.1. Lie on your back with
knees flexed, feet flat on the floor. Back is long both the
hands on either side with palms of hands facing down and whole
bodyrelaxed and slowly breathe in and breathe out.
2. As you breathe out squeeze the pelvic floor and the low
buttock muscles andfeel the abdomen hollow. This movement occurs
only in the lower body.Repeat up to ten times. Each time trying to
extend the movement.
Fig. 19.14: The pelvic floor
Side Rolls (Fig. 19.15)
This exercise strengthens the spine and oblique abdominal
muscles.1. Lie on your back with knees flexed and feet on the
floor, place your arms at
a 45 degrees angle to your body, palms facing upwards and whole
bodyrelaxed and slowly breathe in and breathe out.
2. Breathe out and start rolling your knees slowly in one
direction and head inother direction, and feet turns on to their
sides but should not come off thefloor. The back should be straight
on the floor, and slowly breathe in.
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3. Breathe out come back to the center using the abdominal
muscles to roll theribs then back and buttocks. Now, repeat the
same in the other direction.Repeat both for ten times.
Fig. 19.15: Side rolls
Buttock Squeeze (Fig. 19.16)
This exercise strengthens the lower abdominal and buttock
muscles. Protectsthe back from undue strain.1. Lie down in
prone-lying with a pillow under abdomen and other between
thighs and rest your forehead on hands, and turn your head to
one side andshoulders and neck should be relaxed. Slowly breathe in
and breathe out.
2. Breathe out squeeze the cushions between the thighs using the
muscles atthe base of the buttocks and inner thigh. Hold for a
count of 5 to 10 andrelease. Relax your body completely and repeat
upto five times.
Fig. 19.16: Buttock squeeze
Heel Lifts (Fig. 19.17)
This exercises strengthens the lower abdominal and buttock
muscles. Protectsthe back from undue strain.1. Lie down as in the
previous exercise. Breathe out squeeze the pelvic floor
and buttock muscle and bend the right leg with a flexed foot
towards rightbuttock.
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Exercise Therapy Regime 133
2. Move slowly to feel the stretch of the hamstring muscle.
While holdingbuttock and abdominal muscle firmly. Breathe out and
lower the foot andrepeat the same with the correct breathing ten
times on each side.
Fig. 19.17: Heel lifts
Arm and Leg Stretches
This exercise helps in stretching the arms and legs.1. Lie in
the prone lying with a pillow under the abdominal muscles,
stretch
your arms above your head, palms facing down the floor and place
the feeta hip-width apart. Whole body should be relaxed slowly
breathe in andbreathe out.
2. Breathe out squeeze the pelvic floor muscles and stretch the
right arm andthe left leg as far as possible and little away from
the floor and breathe inlower to the floor.
3. Breathe out and vice versa. Repeat the whole sequence upto 5
times.
Gluteal Muscles
This exercise tones up gluteal muscle of the buttocks.1. Lie in
the prone lying with the cushion under the abdomen, fold your
hands
in front of you and place forehead on top of them and turn face
to one side tobe comfortable and slowly breathe in and breathe out.
Slowly breathe outand draw the navel by trying to lift above the
cushion and hold this positionfor rest of the exercise.
2. Stretch your right leg, pointing the toes, so that it comes
off the floor. Now liftthe leg further so that you squeeze the
pelvic floor muscle and the buttock,but without hollowing the lower
back or letting any tension creep into theupper body.
3. Lift ten times on each side and then repeat the whole
sequence with a flexedfoot, the toes pointing straight down the
floor.
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Standing Side Stretch
This exercise stretches the whole upper body and improves
posture.1. Stand side on to a heavy table or chair with hand
resting on it. Stand near by
for a gentle stretch and move further away for a greater
stretch. Place yourfeet hip-feet apart, whole body should be
relaxed and slowly breathe in andbreathe out.
2. Take a few deep breaths and try to feel growing taller by
lengthening thespine.
3. Breathe out lift the outer arm in a wide circle up an over
the head bendingand body away from the support. Keep facing
forwards all the time.
4. Breathe in to return to the starting position. Repeat the
same upto 10 timeson each side.
Twist Exercise (Figs 19.18A and B)
This exercise helps in checking the posture and the rotation of
the spine.1. Stand straight with hip width apart, upper body
relaxed. Slowly breathe in
and breathe out. Rotate the arms at the sides around the spine
by turningfrom the waist and letting your arms swing as they follow
the movement.Repeat the same for 10 times.
2. Make the swing looser by bending the knees each time as you
come to thecenter. Keep the knees and hips facing front all the
time. Only upper bodymoves. Repeat 10 times on each side.
A B
Figs 19.18A and B: Twist exercise
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Exercise Therapy Regime 135
Feet and Ankle Exercise
This exercises feet and ankles.1. Stand with both feet together,
holding on to a firm support. Stand straight
with whole body relaxed and slowly breathe in and breathe out.2.
Breathe out pull up the pelvic floor muscles and tuck in the
buttocks and
very slowly turn the feet out keeping the knees in line with the
feet. Start themovement from the hips and whole leg should
rotate.
3. Reverse the movement bringing the feet back to parallel.
Repeat 10 times.
Foot Exercise
This exercise tones up the foot muscles.1. Stand tall with one
hand on the support. Upper body should be relaxed and
slowly breathe in and breathe out.2. Take your right foot
forward with a pointed toe. Now lift and flex the heel.
Put the toe back on to the floor and draw it back to the other
leg. Repeat 5 to10 times and then repeat on the left.
Cushion Squeeze
This gives relaxation and tones up the inner backs.1. Lie on
back with backbone straight. Two pillows are placed one below
the
head and other in between thighs with knees flexed and flat on
feet. Breatheout and squeeze the pillow for a count of 10. Repeat 5
to 10 times.
Relaxation Sequence
Practice the general relaxation technique for the whole
body.
Three to Six Months After Birth
By this time a new rhythm of your lifestyle begins. Mothers will
be havingbroken sleep at night, will be anxious to get back into
shape do not rush up asthe ligaments are still soft and will get
strained easily so continue with theexercises from the previous
section up to the cushion squeeze and follow thenew ones like.
Knee Bends
This exercise helps in toning up the legs.1. Stand in straight
posture with a long straight back the shoulders and neck
should be relaxed, take the support of the chair if required,
slowly breathe inand breathe out.
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2. Breathe out and turn the feet into V-shape. Breathe out and
bend the kneeswithout lifting the heels off the floor. Breathe in
and come back to the startingposition repeat the same upto 10
times.
3. Take the feet about 18 inches apart and perform the same.
Quadriceps Stretch (Fig. 19.19)
Stand straight with shoulders and neck relaxed hold a chair for
additionalbalance. Bend the right knee and take the foot behind
you, holding the anklewith one or both the hands. Hold the stretch
for a minute and then change legs.
Fig. 19.19: Quadriceps stretch
Hamstring Stretch
1. Sit on the floor with backbone straight, right leg stretched
and left foot placedagainst the right thigh. Slowly breathe in and
breathe out.
2. Breathe out reach forwards along your right leg and take
series of deepbreaths each times trying to reach further down the
leg. Or use a long scarfaround the foot. Repeat on the other
side.
Gluteal Stretch (Fig. 19.20)
Lie on your back with your knees bent and feet flat on the
floor. Place your leftankle over the right knee then lift the right
leg so that the left leg presses towardsyou. You will feel the
stretch at the back of the left thigh and into the buttocks.Hold
for a count of 20 and lower. Repeat on the other leg.
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Exercise Therapy Regime 137
Fig. 19.20: Gluteal stretch
Pelvic Tilts (Figs 19.21A and B)
This exercises pelvic floor.1. Lie on your back on the floor
with your feet on a stable chair. The body
should be relaxed, place the arms on either side of the body
with palmsfacing down and slowly breathe in and breathe out.
2. Breathe out and slowly raise the pelvis up with the support
of the handsdown, breathe in and come back to the starting
position, repeat the sameupto 10 times.
A BFigs 19.21A and B: Pelvic tilts
Single Leg Stretch (Fig. 19.22)
This exercises pelvic floor.1. Lie on your back with feet flat
on the floor and knees raised. Draw your
knees to your chest, keeping them apart to make a V-shape
towards yourtoes. Back should be flat on the floor and shoulders
and neck relaxed.
2. Breathe in and bring one knee up towards your chest and
breathe out, pullup the pelvic floor and stretch out the second leg
in front of you with apointed toe. The closer the leg is to the
floor, the more effort the abdominalmuscles will have to make.
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3. Take another long full breathe and as you breathe out, change
the leg so thesecond leg is drawn in towards the chest as the first
is stretched out. Alwayskeep the whole back on the floor. Alternate
5 to 10 times on each side.
Fig. 19.22: Single leg stretch
Variation
When this is done easily try the same with the head raised
towards the knees.
Abominal and Pelvic Floor Exercise
This exercise strengthens the abdominal and lower buttock
muscles.1. Lie face down on the floor with the feet slightly apart
and the hands level
with the head, palms and elbows on the floor. Slowly breathe in
and breatheout.
2. Draw the shoulders and the muscles of the upper back down and
lift thehead off the floor keeping the chest open. Breathe in and
return to the startingposition, repeat upto 10 times.
Inner Thigh Lifts (Fig. 19.23)
This exercise strengthens inner thigh muscles.1. Lie on your
side with your back flat against the wall, the lower leg
stretched
straight. Bends your upper leg so that knee forms a right angle
and placesthe knee on a cushion. Rest your head on the lower arm
and place the otherhand in front of you or support and slowly
breathe in and breathe out.
2. Breathe out lift the lower leg, keeping the foot extended
forwards. Lowerand repeat upto 10 times on each leg.
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Exercise Therapy Regime 139
Fig. 19.23: Inner thigh lifts
Variation: Try with the flexed foot and to make it harder still
by adding 2 lb or1 kg, ankle weight.
Arm Stretching
This exercises tones and strengthens and stretches the arms. Use
weights of 2 lbor 1 kg weights are ideal.1. Stand about a foot away
from the wall with the feet hip-width apart. Slightly
bend the knees and lean against the wall so that spine is in
contact with thewall and slowly breathe in and breathes out.
2. Breathe out and draw down your shoulder blades as you raise
your armsstraight out to the sides. Bring them towards the
shoulders without liftingthem. Repeat 10 times.
3. Lift your arms 10 times to the front bending at the elbows to
raise yourhands to your shoulders.
Windmill Arms (Figs 19.24A and B)
This exercise helps in releasing tension and mobilizing the
shoulders.1. Lie with the knees flexed and feet flat on the floor.
Now raise your arms so
that the fingertips point upto the ceiling.2. Breathe out and
take the arms in opposite directions, one above your head,
and palm up, the other down by your side, palm down. Take your
arms tillthey stretch.
3. Rotate the arms as you breathe in and reverse their
positions, so that yourfirst arm is by your side the second above
your head.
4. Breathe out, lift the arms up and repeat the sequence for
upto 10 times.
Quadripued with a Leg Stretch (Figs 19.25A and B)
Those who have backache do not attempt these.1. Kneel down on
all four, body should be relaxed and slowly breathe in and
breathe out.
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A B
Figs 19.24A and B: Windmill arms
2. Breathe out and raise the right knee up towards the chest,
dropping thehead down to meet it.
3. Breathe in and straighten the leg out behind you, raising the
head back tothe starting position. Repeat upto 10 times with each
leg.
A B C
Figs 19.25A and B: Quadripued with a leg stretch
Stretch to Release Tension (Figs 19.26A and B)
1. Begin the same position of the previous exercise, tuck your
toes under,breathing out and press up from the floor so that the
soles of your feet are flatand make a triangle with your bottom as
the apex. Straighten your legs asmuch as possible, keeping your
back long, the head and neck in line withthe spine. Try to extend
the stretch as you take long, deep breaths. Hold upfor a
minute.
2. Drop your knees back down to the floor and then sit back on
your heels withyour arms stretched out in front of you. Rest your
head on the floor on oneside if that is more comfortable. Relax and
breathe deeply.
Ankle Circles (Figs 19.27A and B)
This exercise tones up the thigh and buttocks.1. Sit on the
floor with your legs straight out in front of you. The body
should
be relaxed and place your hands in front of your body. Point the
toes andslowly breathe in and breathe out.
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Exercise Therapy Regime 141
A B
Figs 19.26A and B: Stretch to release tension
2. Flex the feet back hard so that your toes and knees are
pointing up at theceiling. Slowing turn the feet out to a
V-shape.
3. Keeping the turnout, point the feet and return to the
starting position. Repeatupto 10 times.
A B
Figs 19.27A and B: Ankle circles
Leg Toning with Weights
This is the same exercise from the second trimester of pregnancy
but with theadditional 1 kg or 2 lb ankle weight.
Squeeze
This is pillow squeeze.
Relaxation Sequence
Practice complete body relaxation.
Six Months Plus
The exercises during six months are more strenuous than previous
one to regainshape back, so start with the warm-up followed by the
exercises from theprevious section and incorporate the following
new exercises:
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Sit-ups
This exercise strengthens the abdominal muscles.1. Lie on your
back with your knees raised and your feet flat on the floor.
Place
a cushion or a rolled up towel between your knees. Keep body
relaxed andplace your hands slightly behind your head and slowly
breathe in andbreathe out.
2. Breathe out and curl your head and shoulders of the floor.
Breathe in androll down to the floor. Repeat upto 10 times.
Oblique Sit-ups
This exercise strengthens abdominal muscles.1. Lie on your back
with your knees raised and your feet flat on the floor. Place
a cushion or a rolled up towel between your knees. Keep body
relaxed andplace your hands slightly behind your head an slowly
breathe in and breatheout.
2. Breathe out curl up to bring your left shoulder in the
direction of your rightknee. Breathe in and lower to the floor.
Repeat upto five times on each side.
Advanced Pelvic Tilts
1. Lie on your back with knees raised with a cushion between
them feet flat onthe floor. The body should be relaxed and slowly
breathe in and breathe out.
2. Breathe out and start to scoop out the abdomen a curl the
spine up from thefloor one by one.
3. Holding the body in diagonal shape, breathe in and raise your
arms, liftingthem above your head and placing them on the floor
behind your head.
4. Keeping your arms behind you breathe out a curl the spine
back down thefloor slowly, you will feel a strong stretch in the
arms.
5. Breathe in and make a wide circle with your arms on the floor
back downtowards your side. Repeat the same for 10 times.
6. Lift your arms so that they are of the floor, parallel to
your body, the fingertipspointing towards your feet. Breathe out
curl the head and shoulders of thefloor.
7. Breathe in and lower slowly back to the floor. Repeat the
whole sequence upto 10 times.
Stretch for Abdominal, Gluteal and Back Muscles (Fig. 19.28)
1. Lie on the floor prone lying with a small cushion under the
navel, feet andhip width apart, the legs and toes stretching away.
Stretch your arms aboveyour head, palms down on the floor, keep a
towel underneath the foreheadand slowly breathe in and breathe
out.
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Exercise Therapy Regime 143
2. Breathe out pull up the pelvic floor muscles and maintain
this throughoutthe exercise. On the next breathe out stretch your
right arm and left leg sothat they lift two inches off the floor.
Breathe in and return to the startingposition.
3. Breathe out return to the starting position and on the next
breathe out, liftthe left arm and right leg. Repeat upto 5 times on
each side.
4. Lift both the arms and both the legs on the next breathe out.
Repeat upto fivetimes and rest in the child pose.
Fig. 19.28: Stretch for abdominal, gluteal and back muscles
Side Stretches (Fig. 19.29)
1. Lie on your side with the back against a wall, legs stretched
out in line withyour back. Place your lower arm on the floor and
rest your head on it withyour upper arm on the floor in front of
you as support. Your face, hips kneesand shoulders should be facing
forwards. Completely relax your body andslowly breathe in and
breathe out.
2. Breathe out and flex the feet and lift them two or three
inches of the floor.Stretch away with the heels. Breathe in and
lower the legs. Repeat upto 10times.
Fig. 19.29: Side stretch
Triceps Exercise (Fig. 19.30)
1. Sit in front of the chair with your back facing it with knee
and feet together,backbone straight, your hands holding on to the
edge of the seat and slowlybreathe in and breathe out.
2. Breathe out let your bottom drop down a few inches supporting
your backwith your arms. Breathe out and rise up a few inches.
Repeat upto 10 times.
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Fig. 19.30: Triceps exercise
The Abdominal Exercise
1. Lie on your back a draw your knees up to that your thighs
form a right angleto your chest. Keeping them parallel and your
feet pointed, your armsstretched out with pointed fingers, just a
few inches from your side. Slowlybreathe in and breathe out.
2. Breathe out lift your head to look straight towards your
thighs and lift yourarms a few inches off the floor. Tap your hands
on the floor for 5 times.
3. Breathe in and make another 5 taps. Repeat 5 times on each
breathe in andbreathe out working up overall till you reach 100
taps. If tensed up lowerdown to ground and relax. Finish the
exercise by lowering the head to theground and hugging the knees to
the chest for a few moments.
Double Leg Stretch
1. Lie on your back and bend the knees up to your chest so that
the knees areapart and the toes are together, your hands resting
just below your knees.Breathe in and breathe out, pull up your
pelvic floor muscles curl the headoff the floor so you are looking
towards you knees.
2. Breathe out and straighten the legs upwards and reach out
with the arms sothat they are parallel to the body with pointed
fingers.
3. Breathe in, turn out the legs from the hip sockets and flex
the feetthis willextend the stretch in the legs.
4. Breathe out and bring the arms up towards your face, behind
your headand in a wide circle back to where they started.
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Exercise Therapy Regime 145
5. Breathe in and lower your head to the floor and bend the
knees to bring thelegs to their starting position. Relax for a
moment repeat this exercise workingupto 10 times.
Roll Downs with a Swing
1. Stand with your feet and hip width apart and backbone
straight, shouldersrelaxed lift both arms up above your head in
front of the body with thepalms facing you. Bend your knees and
begin to curl down and look at thepalms.
2. As you bent your knees look at the floor and let your body
roll down on tothe knees.
3. As soon as your chest makes contact with your thighs, start
to straightenyour legs as far as they will go without
straightening.
4. Slowly uncurl to a standing position bring in your spine up
slowly to a tallposition. Lift the arms and repeat five times.
Armside Stretches
1. Stand with the feet hip apart and lightly turned out, with a
long, straightback and relaxed shoulders. Breathe in and breathe
out.
2. Let your right hand start to slide down. Reach as far as you
can and feel thestretch up to the left side of the body and bend
your head on to the right side.Breathe in and breathe out, and come
back to the starting position, breatheout and repeat five times on
each side.
Variation
1. Stand as before this time with your right hand on your waist.
Breathe in andbreathe out. Raise your left arm above your head.
2. Bend the upper body to the right as before taking your left
arm with you,stretching your head. Keep your upper arm close to the
side of your face andtaking care to keep facing square to the
front.
3. Breathe in and breathe out return to the starting position.
Repeat upto 5times on each side.
Wide Leg Circles (Figs 19.31A to C)
This exercise strengths and tones both the legs and
abdominals.1. Lie on your back with your legs stretched out,
parallel with the knees facing
to the ceiling and toes pointing. Check that your shoulders are
drawn downinto your back and your arms are relaxed at your side.
Breathe in and as youbreathe out.
2. Take another breathe in and raise the left leg to the ceiling
and keep your legstraight and the toe pointed.
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3. Lower the leg and repeat upto five times on each side.4.
Keeping it on to the floor move your left leg out to the side.5.
Let the leg continue its circle down the other side of the body.
Repeat with
the alternating legs twice on each side.
A B C
Figs 19.31A to C: Wide leg circles
Bridging (Fig. 19.32)
This exercise mobilizes and strengthens the back. Do not do if
having backache.1. Lie on your back with your knees raised, heels
close to your bottom arms by
your sides. Slowly breathe in and breathe out and upper body
should berelaxed.
2. Breathe out, lift the buttocks and waist from the floor
slowly then hold forsome time.
3. Breathe out and come back to the starting position. Repeat
slowly upto 5times.
Fig. 19.32: Bridging
Sitting Forward Stretch (Fig. 19.33)
This exercise stretches and releases the back muscles.1. Sit up
with a long backbone straight and legs stretched in front of you on
the
floor, knees facing the ceiling and toes pointed and slowly
breathe in andbreathe out.
2. Breathe out and reach forwards over your legs and try little
forward. Repeatover the next four or five time and each time
stretch little further.
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Exercise Therapy Regime 147
Fig. 19.33: Sitting forward stretch
Shoulder Release
This exercise helps in releasing the tension in the shoulders
and need a belt orscarf.1. Kneel down, keep your backbone straight
and slowly breathe in and breathe
out.2. Take the scarf or belt in your right hand an stretch the
right arm up to the
ceiling then bend it at the elbow so the right hand reaches down
behindyour neck, the scarf or belt hanging down your back.
3. Reach your left arm behind your back so that left hand
catches hold of thescarf belt as close as it can to the right hand,
hold this position till you can ifpossible to clasp the fingers
together it is best, repeat on the other side.
Pillow Squeeze
Follow the same pattern as explained previously.
Relaxation Sequence
Finish the exercise session with complete body relaxation.
CESAREAN SECTION
The cesarean section is suggested for a woman in case of twins,
pelvic outlet issmall. So the preparation for this before hand is
necessary. If cesarean section isdone in emergency then woman can
follow only postoperative physiotherapy.
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Preoperative Physiotherapy
Aims and Plans
1. Aim: To prevent respiratory complications.Plan: Teach and
make woman to practice breathing exercise.
2. Aim: To prevent circulatory complications.Plan: Women should
be taught ankle and foot exercises.
3. Aim: To prevent joint stiffness.Plan: Woman should be taught
mobilization of the joints.
4. Aim: To prevent backache.Plan: To teach correct lifting and
bending technique.
5. Aim: To be aware of the ergonomics.Plan: Woman has to be
taught proper body mechanics and postureawareness.
Postoperative Physiotherapy
Aims and Plans
1. Aim: To increase the pulmonary function and reduce the risk
of infection.Plan: Breathing instructions, coughing and huffing
should be given.
2. Aim: To decrease incisional pain associated with coughing,
movement duringbreastfeeding.Plan: Postoperative TENS should be
given, support the incision with pillowwhen exercising. Education
regarding incisional care and risk of injuryshould be provided.
3. Aim: To prevent postsurgical vascular complications.Plan:
Active leg exercises and early ambulation should be taught.
4. Aim: To enhance incisional circulation and healing, prevent
adhesionformation.Plan: Gentle abdominal exercises with incisional
support, scar mobilizationand friction massage should be
taught.
5. Aim: To decrease postsurgical discomfort from flatulence,
itching or catheter.Plan: Positioning instruction, massage and
supportive exercises should betaught.
6. Aim: To correct posture.Plan: Women should have a clear idea
about posture instruction, itsimportance and after effects.
7. Aim: To prevent injury to back and prevent low back
pain.Plan: Instruction should be given regarding incisional
splinting andpositioning for activities of daily living, body
mechanics instruction.
8. Aim: To prevent pelvic floor dysfunction.
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Exercise Therapy Regime 149
Plan: Pelvic floor exercises should be taught, and education
regarding riskfactors, types of pelvic floor dysfunction.
9. Aim: To develop abdominal strengthen.Plan: Abdominal
exercises including corrective exercises for diastasis rectiare
taught.
HIGH RISK PREGNANCY
Aims and Plans
1. Aim: To decrease stiffness.Plan: Instruction should be given
regarding the instruction or the positioning,assess for support,
facilitation of the joints, and motion in the availablerange.
2. Aim: To maintain muscle length an bulk.Plan: Stretching and
strengthening exercises within limits impose by thephysician.
3. Aim: To maximize the circulation and prevent deep vein
thrombosis.Plan: Teach ankle pumping and range of motion
exercises.
4. Aim: To improve proprioception.Plan: Movement activities for
as many body parts as possible.
5. Aim: To improve posture within available limits.Plan: Posture
instruction, bed mobility transfer techniques should be taughtand
made to practice.
6. Aim: To relieve boredom.Plan: Vary activities and positioning
for exercises.
7. Aim: To enhance relaxation.Plan: Relaxation techniques are
taught for stress management.
8. Aim: To mentally prepare the woman for the delivery.Plan:
Childbirth education, breathing training and exercises to assist
andprepare for labor.
9. Aim: To enhance postpartum recovery.Plan: Exercise
instruction and home program for postpartum period, bodymechanics
instruction should be given.