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Gender Health Exam #1

Terms in this set (208)

what is dysmenorrhea?
menstrual periods that are accompanied by either sharp intermittent pain or dull aching pain usually in the pelvis or lower abdomen

pain severe enough to limit normal activities or require medication
is the pain with dysmenorrhea before, during, or after menstruation?
it can precede menstruation by several days or may accompany it and subsides as menstruation tapers off
dysmenorrhea may coexist with what other condition?
menorrhagia (excessively heavy blood loss)
dysmenorrhea affects about what percentage of menstruating women?
50%
what percentage of dysmenorrhea patients are incapacitated for up to 3 days?
10%
at what age is dysmenorrhea most common?
late teens and 20's and declines with age
if a women in her late 30's/40's is experiencing menstrual pain, what is the probable cause?
endocrine system preparing for menopause
what is primary dysmenorrhea?
menstrual pain that occurs in otherwise healthy women that is not related to any specific problems with uterus or other pelvic organs
what is secondary dysmenorrhea?
menstrual pain attributed to underlying disease process or structural abnormality either within or outside the uterus
what are 5 examples of secondary dysmenorrhea?
1. endometriosis
2. pelvic inflammatory disease
3. adhesions
4. adenomyosis
5. retroverted uterus
what are 3 risk factors for primary dysmenorrhea?
1. obesity
2. cigarette smoking
3. positive family history
what are 3 risk factors for secondary dysmenorrhea?
1. pelvic infection
2. STD
3. endometriosis
when does primary dysmenorrhea occur?
during regular ovulatory cycles
what is a major factor of primary dysmenorrhea?
prostaglandin F2a
what are 4 things that prostaglandin F2a has in primary dysmenorrhea?
1. increase in uterine prostaglandin or increased sensitivity to prostaglandin or both
2. prostaglandin F2a levels much higher in those with severe menstrual pain
3. increased prostaglandin F2a leads to increased uterine contractions, ischemia, and pain
4. prostaglandin F2a is potent stimulator of smooth muscle of GI tract leading to nausea, vomiting, and diarrhea
what are 8 symptoms of primary dysmenorrhea?
1. cramping a few hours before start of bleeding and continues for a few days
2. pain diffusely across suprapubic area with radiation around and through to the back
3. nausea
4. vomiting
5. fatigue
6. diarrhea
7. lower backache
8. headache
what is recommended at home treatment for symptoms of primary dysmenorrhea?
lay in fetal position and use heating pad or hot water bottle to decrease discomfort
what is strength of normal contractions?
50-80 mmHg
what is strength of primary dysmenorrhea contractions?
400 mmHg
what is duration of normal contractions?
15-30 seconds
what is duration of primary dysmenorrhea contractions?
>90 seconds
what is frequency of normal menstruation contractions?
1-4/10 minutes
what is frequency of primary dysmenorrhea contractions?
every 15 seconds
what is resting pressure of normal menstruation?
5-15 mmHg
what is resting pressure during primary dysmenorrhea?
80-100 mmHg
what else is occurring with primary dysmenorrhea?
significant ischemia
what are 5 other treatments for primary dysmenorrhea?
1. drugs which inhibit prostaglandin production (NSAIDs)
2. oral contraceptives (90% effective)
3. high dose of zinc
4. PT (stretching, jogging, pelvic floor strengthening, diaphragmatic breathing)
5. TENS
how do oral contraceptives help with primary dysmenorrhea?
suppresses ovulation
thinner, more atrophic endometrium with less prostaglandins
menstruation is shorter, lighter, and less cramping
what dose of zinc may help treat primary dysmenorrhea?
30 mg, 1-3x/day
what are 3 options for electrode placement for TENS to treat primary dysmenorrhea?
1. crossed pattern over abdomen
2. crossed pattern over low back
3. one pair on abdomen and one pair on back
what is pathophysiology of secondary dysmenorrhea?
caused by identifiable condition acting on the uterus, tubes, ovaries, or pelvic peritoneum and alters pressure in or around the pelvic structures, change or restrict blood flow, or cause irritation of the pelvic peritoneum
when does secondary dysmenorrhea happen?
symptoms may occur between menstrual periods and be a source of chronic pelvic pain
what are 6 intrauterine causes of secondary dysmenorrhea?
1. adenomyosis
2. myomas
3. polyps
4. IUD
5. infection
6. benign disease of vagina or cervix
what are 7 extrauterine causes of secondary dysmenorrhea?
1. endometriosis
2. tumors
3. inflammation
4. adhesions
5. psychogenic
6. pelvic congestive syndrome
7. non-gynecological cause
what is adenomyosis?
a lot of endometrium muscle inside the uterus growing which causes pain going to rectum and sacrum
how common is a myoma?
can sometimes find during pelvic exam
20% of women over 30
what are signs of intrauterine infection?
scarring and adhesions
pain during menstruation, bowel movements, sex
what is pelvic congestive syndrome?
veins in pelvic region get dilated and enlarged causing pain
what are symptoms of secondary dysmenorrhea?
vary depending on cause
seen in older women
associated with infertility
what are 5 ways to diagnose secondary dysmenorrhea?
1. signs and symptoms
2. physical examination
3. labs
4. x ray
5. ultrasonography
what are 5 treatments for secondary dysmenorrhea?
1. treat underlying cause
2. NSAIDs
3. hormonal contraception
4. progestational agents
5. GnRH agonists
what are 2 functions of the testicles?
1. produce sperm
2. secrete several male hormones
what is average age of testicular cancer diagnosis?
33 years old
90% of testicular tumors will develop in what type of cells?
germ cells
what are the 2 major types of tumors for testicular cancer?
1. seminoma
2. nonseminoma
how does the treatment differ for seminoma vs nonseminoma?
it is the same
what are 6 risk factors for testicular cancer?
1. age
2. undescended or late descended testes
3. family history in brother
4. HIV infection
5. cancer in other testicle
6. race and ethnicity (caucasian, native american, asian, african)
what are signs and symptoms of early stage testicular cancer?
none
what are 8 signs and symptoms of testicular cancer?
1. small, painless lump in a testicle
2. change in size of testicle
3. feeling of heaviness in testicle or groin
4. pain in testicle
5. pain in low back, abdomen, or groin
6. a change in the way the testicle feels
7. enlarged male breasts and nipples
8. blood or fluid suddenly accumulating in scrotum
what are 5 year survival rate for stage 1 testicular cancer?
99%
what is stage 1 testicular cancer?
just in testes
what is stage 2 testicular cancer?
testes and proximal lymph nodes
what are 5 year survival rate for stage 2 testicular cancer?
96%
what is stage 3 testicular cancer?
testes, proximal lymph nodes, and distal lymph nodes
what are 5 year survival rates for stage 3 testicular cancer?
73%
if testicular cancer is going to recur when does it usually occur?
in the first 2 years
what are 6 ways to diagnose testicular cancer?
1. self exam
2. history and physical
3. ultrasound
4. blood test
5. surgery
6. CT and/or MRI
why don't they ever biopsy testicle?
due to increased change of metastasis so they just remove whole testicle rather than small piece
what are TNMS for staging testicular cancer?
T- how much the TUMOR has spread to tissues next to the testicle

N- how much the cancer has spread to nearby lymph NODES

M- whether the cancer has METASTASIZED to distant lymph nodes

S- SERUM blood levels of tumor markers
number after staging range from what numbers and indicate what?
0-4
indicate increasing severity
if "IS" comes after the T in the staging what does that mean?
in situ
which means the tumor is contained in one place and hasn't penetrated deeper tissue
if an "X" is after TNMS, what does that mean?
that it can't be assessed
can come after any of the letters in TNMS
what are 4 treatment options for testicular cancer?
1. surgery
2. surveillance
3. chemotherapy
4. radiation
what are 5 implications of life after testicular cancer?
1. psychosocial implications
2. potency
3. treatment may affect sperm or sperm production
4. storage of sperm before treatment is recommended
5. implants
at what age should testicular self exam begin?
monthly from age 15 or older
lump should be immediately checked by physician
when is the best time to do self testicular exam?
in shower or after warm bath
what are 5 steps of testicular self exam?
1. stand in mirror and check for any swelling of scrotal skin
2. support testicles in one hand and feel each with other hand
3. gently roll each testicle with thumb and fingers. separate tube from testicle to examine testicle itself (should be firm and smooth)
4. feel for any swelling or lumps
5. if you detect swelling or lumps see a physician
does the US preventative task force recommend testicular cancer screening?
no
the female athlete triad consists of what 3 things?
1. disordered eating
2. menstrual dysfunction
3. osteoporosis
what are 2 examples of disordered eating?
1. anorexia
2. bulimia
what are 2 examples of menstrual dysfunction?
1. delayed menarche
2. absence of menstrual cycle
what are 2 implications of osteoporosis?
1. increased risk of stress fractures
2. low bone density
what are 3 risk factors for female athlete triad?
1. dieting at young age
2. pressure to excel at chosen sport
3. focus on achieving an "idea" body weight or body composition
what are 5 factors of sports that may influence female athlete triad?
1. endurance sports
2. competitors are judged by appearance
3. tight fitting apparel is worn
4. where pre-pubertal body types are preferred
5. with weight classifications
is the female athlete triad only in competitive athletes?
NO also occurs in physically active women and some sports have high incidence of eating disorders in men
what are 3 other abnormal eating behaviors?
1. restrictive eating
2. over exercising
3. abnormal eating behavior
how do female athletes differ greatly from patients with anorexia? (3)
1. physical status
2. metabolic differences
3. psychological differences
what are 9 warning signs of disordered eating?
1. dramatic weight loss
2. preoccupation with food
3. baggy clothing
4. excessive exercise
5. mood swings
6. avoiding food related activity or refusing to eat with other people
7. frequent comments about weight
8. criticism of others eating habits
9. highly self critical
what are 8 side effects of disordered eating?
1. morbidity due to fluid and electrolyte losses during purging
2. GI disorders
3. erosion of tooth enamel
4. low self-esteem
5. anxiety
6. depression
7. suicide
8. death
what are 4 possible reasons for eating disorders?
1. fear of fatness
2. peer or social pressure
3. concern with performance
4. athletes think disordered eating is harmless
what are 4 types of menstrual dysfunction?
1. menarche
2. eumenorrhea
3. oligomenorrhea
4. amenorrhea
what is menarche?
onset of menses
what is eumenorrhea?
normal menses
28-30 days
what is oligomenorrhea?
irregular/infrequent menses
<6/year
what is amenorrhea?
absence of menses
what is primary amenorrhea? what 3 sports is this common with?
menses never started by age 16

common with college cheerleaders, diving, and gymnastics
what is secondary amenorrhea? what 2 sports is this common in?
menses occurred then ceased
ballet dancers and long distance runners
when is the age of menarche for athletes? how does this compare to general population?
12-13 years
later than general population
what are 2 other types of amenorrhea?
1. anatomic
2. hypothalamic
what is anatomic amenorrhea?
due to trauma, pathology, or surgery
what is hypothalamic amenorrhea?
caused by functional abnormalities in the neural mechanisms regulating secretion of GnRH and is reversible
how does hypothalamic amenorrhea occur?
signal to stop the menstrual cycle is coming from the brain

brain is probably responding negatively to energy drain due to excessive exercise and/or inadequate diet

NOT SOLELY CAUSED BY LOW BODY FAT
how is amenorrhea defined?
more than 6 months since last menstrual period
less than 3 periods/year
no more than 1 period during previous 10 months
what are 3 misconceptions with amenorrhea?
1. menstruation stops when body fat is optimal
2. amenorrhea is a form of birth control
3. amenorrhea is normal consequence of training
what are 3 side effects of amenorrhea?
1. low estrogen
2. infertility
3. loss of bone density
how does amenorrhea affect bone density?
lose at 2x the rate of controls
training cannot compensate
supplementing with oral contraceptives may be counteracted by high cortisol levels
what consequences does amenorrhea have on cardiovascular system?
increased cholesterol and triglycerides
what are consequences of amenorrhea on immune function?
immune system is suppressed
estrogen is positive for immune function but cortisol is negative for immune function
what are 12 other consequences of amenorrhea and disordered eating?
1. affects cognitive ability
2. greater anger score
3. reduced memory and concentration
4. altered sleeping and eating patterns
5. soft tissue injuries
6. stress fractures
7. anemia
8. hypoglycemia
9. loss of muscle mass
10. dehydration
11. reduced glycogen stores
12. reduced physical performance
what is the relationship between estrogen and bone mineral density?
estrogen decreases the rate of resorption of bone

estrogen does not stimulate bone formation
low levels of what 2 things result in bone loss?
1. estrogen
2. progesterone
what percent of skeletal mass and adult height are achieved during adolescence?
48% skeletal mass
15% adult height
what is a primary determinant of bone mineral density?
menstrual history
amenorrhea athletes have what 3 bone changes?
1. vertebral BMD lower
2. lower peripheral bone mass
3. stress fractures
who is more likely to get injured in their career: gymnasts or NFL players?
gymnasts
what are 6 warning signs of the female athlete triad?
1. amenorrhea (any disruption of menstrual cycle)
2. easy fractures
3. frequent stress fractures
4. frequent overuse injuries
5. low energy/fatigue
6. anemia
what is treatment for eating disorders?
individualized, long term, multidisciplinary approach
what is prognosis for eating disorders?
depends on early interventions, duration, severity of disorder and individual's willingness to remain in treatment
what is treatment for amenorrhea?
reduce training to reduce energy expenditure

increase caloric intake
is hormone replacement therapy shown to increase bone mineral density?
shown to maintain but not increase
what are 5 ways to prevent female athlete triad?
1. educate coaches, parents, athletes, medical community
2. eliminate daily weigh ins
3. judges should not score based on weight and shape
4. monitor menstrual cycles
5. ACSM requires medical assessment within first 3 months of amenorrhea
what should education programs for female athlete triad include?
1. promote healthy eating with emphasis on adequate calories, protein, calcium, and iron
2. emphasize strength and stamina and de-emphasize body weight
3. address misconceptions about weight and performance
4. advise young athletes that sexual maturation is desirable
5. encourage athletes to discuss changes in menstrual and or eating patterns with someone
what are 4 special considerations for PT with female athlete triad?
1. monitor vitals
2. wound healing may be impaired
3. posture is often poor
4. exercise tolerance is low
what is normal gestation?
40 weeks
when is the first trimester?
weeks 1-12
when is the second trimester?
weeks 13-27
when is the third trimester?
weeks 28-40 (can go up to 42 weeks)
how long is recovery after birth?
6-8 weeks
what are 7 signs and symptoms during first trimester?
1. nausea and vomiting
2. fatigue
3. frequent urination due to hormonal changes
4. breast changes: tingling and bigger
5. headache from hormonal changes
6. food aversions and cravings
7. indigestion
what are 8 signs and symptoms during second trimester?
1. decreased urinary frequency
2. decreased nausea and vomiting
3. continued indigestion and headache
4. nasal congestion
5. bleeding gums and nose
6. increased appetite
7. low back pain
8. feel fetal movement
what are 6 signs and symptoms during third trimester?
1. continuation of symptoms
2. increased urinary frequency
3. shortness of breath
4. edema
5. difficulty sleeping
6. braxton hicks contractions
what are 21 potential problems in pregnancy?
1. lax ligaments
2. increased spinal curves at neck and back
3. sway or hollow back
4. tight back muscles causing low back fatigue and pain
5. increased laxity of sacroiliac joints and pubic symphissis
6. pelvic floor descends
7. hamstring tightens
8. calf cramps
9. ankles swell
10. feel rollin, arches sag
11. head tends to move forward
12 nasal congestion
13. increase in weight of breasts pulls shoulders forward
14. fingers can tingle or go numb
15. stretching skin may itch
16. weight of baby moves center of gravity forward
17. pressure on bladder
18. round ligament spasm in groin
19. hip flexors tighten in sitting
20. knees hyperextend
21. heel cords tighten
what are 3 metabolic changes during pregnancy?
1. gestational diabetes
2. water retention
3. weight gain
what 8 things that contribute to weight gain?
1. fetus
2. placenta
3. amniotic fluid
4. increased uterine muscle mass
5. increased blood volume
6. increased breast tissue
7. increased interstitial fluid
8. additional fat storage
what are 5 pulmonary changes during pregnancy?
1. increased respiration rate by up to 2 breaths/minute
2. increased tidal volume by 40%
3. increased oxygen consumption
4. increased diaphragmatic excursion by 2 cm
5. decreased oxygen reserve leads to dyspnea
which 4 glands enlarge to support growth of fetus and placenta?
1. adrenals
2. thyroid
3. parathyroid
4. pituitary
which 4 hormones surge during pregnancy?
1. relaxin (highest after conception and highest in first trimester)
2. estrogen
3. progesterone
4. human gonadotrophin
what is human gonadotrophin responsible for?
most physiological changed and is secreted by placenta
what 3 changes occur to diaphragm and rib cage?
1. increased mobility of rib articulations
2. flaring of lower ribs
3. diaphragm elevated
what are 7 cardiovascular changes during pregnancy?
1. increased size of heart
2. increased cardiac output by 30-50%
3. increased heart rate
4. increased blood volume by 50%
5. alterations in blood flow to organs
6. decreased blood pressure
7. supine hypotensive syndrome
how much does heart rate increase in early pregnancy?
8 bpm
how much does heart rate occur in 3rd trimester?
15-20 bpm
how does position of the heart change during pregnancy?
enlarged and rotate to the right
if heart rate increases higher than normal, then what should you do?
call doctor immediately because could be preeclampsia
what is supine hypotensive syndrome?
supine position may compromise vena cava renal blood flow as uterus compresses the great vessels
what are 5 signs of supine hypotensive syndrome?
1. decreased HR
2. dizziness
3. sweating
4. bradycardia
5. weakness
after the fourth month of pregnancy, how long can woman be in supine?
no more than 3 minutes
what are 7 dermatological changes during pregnancy?
1. increased pigmentation
2. cutaneous vascular markings
3. skin tags
4. sweating
5. itching
6. hair growth or loss
7. nail alteration
what are 4 musculoskeletal changes during pregnancy?
1. increased ligament laxity
2. changes in posture
3. changes in trunk mobility
4. feet pronation
what is stretch weakness?
muscles in lengthened position beyond neutral
what is adaptive shortening?
muscles in a shortened state, unable to lengthen in response to relaxation of the antagonist group
how much does total breast tissue change during pregnancy?
increases 1-2 lbs
which muscles make up the core canister?
posterior: psoas, QL, iliacus, multifidus
anterior: rectus abdominis
lateral: transverse abdominis, internal obliques, external obliques
superior: respiratory diaphragm
inferior: pelvic floor diaphragm
how does transverse abdominis function?
like a corset to stabilize low back and pelvis BEFORE movement of arms and legs occur
how does multifidus function?
with transverse abdominis and pelvic floor muscles to stabilize low back and pelvis BEFORE movement of arms and legs
how do pelvic floor muscles work?
in cooperation with multifidus and TA for lumbar spine, SI joints, bladder, and uterus to be stabilized properly
what are the 5 S's of the pelvic floor?
1. sphincteric control of bladder and bowel
2. supports pelvic organs and their contents
3. stabilizer of spine, abdomen, and pelvis
4. sexual- enhances sexual response
5. slide- assists birthing
what are 4 things to consider for exam of pregnant patient?
1. be mindful of comfort
2. organize for fewest positional changes
3. ask about positional sensitivities
4. beware of supine hypotensive syndrome
what are 7 key exam questions for pregnant patient?
1. number of pregnancies and deliveries?
2. high risk for any reason?
3. level of activity
4. responsibilities at home/work?
5. descrive pain
6. does pain prevent you from caring for self, housework etc?
7. what self help measures have you tried?
what is diastasis recti abdominis?
excessive widening or separation between 2 bellies of rectus abdominis muscles at linea alba
why does rectus become vulnerable at linea alba?
due to expanding uterus, stretching of abdominals, strain during transitional movements, and hormonal changes
what other symptom is related to DRA?
low back or pelvic pain
what are 6 exercises to avoid with DRA?
1. long lever exercises
2. curl ups
3. trunk rotation
4. sitting straight up from supine
5. leg lowering
6. boot camps
where is DRA most common?
at umbilicus
what 4 things increase chance of DRA?
1. pre-pregnancy abdominal fitness
2. multiparous pregnancy
3. obesity
4. large babies
how do PT's measure DRA?
finger width palpation
greater than 2 fingers= positive
what 2 things occur during stage 1 of labor?
1. true labor contractions
2. cervix fully effaced and dilated
what occurs during stage 2 of labor?
1. full cervical dilation to expulsion of fetus
what occurs during stage 3 of labor?
delivery of placenta and membranes
what is first degree tear?
skin and vaginal mucosa
what is second degree tear?
tears into superficial muscles
what is third degree tear?
tears into anal sphincter
what is fourth degree tear?
tears all the way to rectal lining
what is an episiotomy?
surgical cut to widen vaginal opening for birth
what are 15 common prenatal/postpartum issues?
1. low back pain
2. DRA
3. incontinence
4. painful intercourse
5. pelvic pain
6. carpal tunnel syndrome
7. costal rib pain
8. thoracic outlet syndrome
9. pubic symphysis seperation
10. piriformis pain
11. nerve palsies
12. coccyx pain
13. leg and vulvar varicosities
14. foot changes
15. hemorrhoids
what are 2 reliable and safe ways to determine LBP vs SI pain during pregnancy?
1. posterior pelvic pain provocation
2. active straight leg test

both tests+ = SI
both tests - = LBP
how does performs problem present?
LE externally rotated and tender buttocks ipsilateral

patient may complain of persistent severe radiating LBP extending from sacrum to hip over gluteal region and posterior aspect of upper LE
what 3 things may occur to coccyx during or after birth?
1. subluxation
2. heal in extension
3. become hypomobile
what changes occur to ulnar and median nerves during pregnancy?
postural changes increase cervical lordosis and shoulder protraction and cause aching, numbness and weakness in UE
what changes occur in lumbar nerve plexus during pregnancy?
result of anterior pelvic tilt, uterine weight, and stress to iliopsoas causes irritation to sensory nerves and compression on peripheral nerves increases risk of disc herniation
when do nerve palsies most often occur?
during delivery
which 3 nerves are most common for nerve palsies?
1. obturator nerve (L3-4)
2. femoral nerve palsy (L2-3)
3. peroneal nerve (L4-5)
what can cause obturator nerve palsy?
compression of fetal head before birth or during delivery
what can cause femoral nerve palsy?
psoas muscle hemorrhage, pelvic trauma, or compression of pelvic cavity
what can cause peroneal nerve palsy?
compression from the stirrups used in delivery
what are 5 common nerve compressions associated with pregnancy?
1. intercostal neuralgia
2. thoracic outlet syndrome
3. carpal tunnel syndrome
4. lateral femoral cutaneous
5. femoral
what are 2 treatments for edema during pregnancy?
1. elevation of limbs
2. aquatic therapy
what causes round ligament pain?
attaches anterior ligament to groin and changing positions causes jabbing pain
what are 2 treatments for round ligament pain?
1. rest
2. general stretches in quadruped and lower head to floor while keeping butt in air
if a patient has pubic symphysis pain, what will they complain of?
pain in symphysis pubis, groin, and SI and joint will be extremely sensitive to touch
a shift at pubic symphysis has to be how big to be positive?
>1 cm
what are 4 treatments for pubic symphysis pain?
1. supportive belt
2. HEP to strengthen abdominals, pelvic floor, glue max, lats, hip adductor
3. heat or cold over pubis
4. AD and home care
what causes varicosities?
increase in interstitial fluid and edema causes swelling in the veins patient will complain of fullness or pressure in legs or vulva
what are 4 treatments for varicosities?
1. exercise
2. elevate feet 6 inches above heart in partial left sidelying
3. take frequent breaks with LE elevated and small pillow under buttocks to elevate pelvic/vulvar
4. wear supportive stockings and loose fitted clothes
can pregnant women be supine in pool?
yes
what are 3 precautions for PT for pregnant women?
1. no quadruped or passive inverted postures due to risk for air embolism
2. avoid hyperextension of joints
3. be careful with mobilizations and no manipulation
what are 7 exercises to avoid during pregnancy?
1. double leg raising
2. double leg lowering
3. full sit ups
4. bicycling in shoulder stand position
5. candlestick exercise
6. bow pose
7. W position
what are 7 contraindications for PT during pregnancy?
1. positions that involve abdominal compression in mid to late pregnancy
2. positions that maintain supine > 3 min after first trimester
3. stretching at end range
4. rapid, uncontrolled bouncing movements
5. use of deep heat modalities or estim
6. traction
7. joint manipulation
what is postpartum depression?
extreme sadness, anxiety, and exhaustion which interferes with ability to care for self and others

affects 15% of women

begins shortly before or anytime after childbirth, but typically between 1-4 weeks after delivery
what are 4 goals for high risk pregnancy patients?
1. improve circulation
2. promote relaxation
3. prevent muscle atrophy and reconditioning
4. prevent musculoskeletal discomfort
what are 6 PT interventions for high risk prenatal patients?
1. position for comfort
2. deep breathing
3. DVT prevention
4. gentle ROM
5. gentle manual therapy
6. soft tissue mobilization
what are 8 reasons to exercise during pregnancy?
1. reduces LBP, constipation, and swelling
2. helps to prevent or treat gestational diabetes
3. increase energy
4. improves mood
5. improves posture
6. promotes muscle tone, strength, and endurance
7. helps you sleep better
8. helps prepare for labor and childbirth
how much activity should be done for physically active women with history or at risk for preterm labor?
reduce activity in 2nd and 3rd trimester
pregnant HR should not exceed what during exercise?
140 bpm
what are 7 contraindications to exercise during pregnancy?
1. pregnancy induced hypertension
2. ruptured membranes
3. premature labor during pregnancy
4. incompetent cervix
5. placenta previa
6. multiple gestation at risk for premature labor
7. bleeding in 2nd or 3rd trimester
what are 8 warning signs for exercise termination during pregnancy?
1. vaginal bleeding
2. dyspnea prior to exercising
3. dizziness
4. headache
5. chest pain
6. muscle weakness
7. calf pain or swelling
8. decreased fetal movement
what are 5 benefits of pelvic floor exercise?
1. improve pelvic blood circulation
2. promotes healing for tears and episiotomies
3. decrease painful muscle tension or spasms
4. increase in circulation increases lubrication
5. relieves constipation
how long should a woman wait after birth to resume high impact exercise?
at least 6 weeks
what are 6 benefits of exercise within 6 weeks postpartum?
1. increase weight loss
2. improvement or resolution of urinary incontinence
3. reduction or resolution of DRA
4. reduction or resolution of LBP
5. enhanced energy level
6. significant decrease in anxiety, depression, and mood disturbances
what 5 exercises should be performed within 24 hours after vaginal delivery?
1. diaphragmatic breathing
2. TA exercise
3. multifidus exercise
4. pelvic tilts
5. walking
what 6 exercises should be performed within 24 hours after C section?
1. diaphragmatic breathing
2. TA exercise
3. multifidus exercise
4. pelvic tilts
5. walking
6. log rolling in and out of bed
when can a woman resume sit ups after birth?
not until she can hold TA contraction for 15 seconds 10x without DRA
what is core training?
focus on timing and co-activation with other muscles

anticipatory
what is core strengthening?
loading muscles in different planes
what are 3 rehab principles for core muscle training?
1. learn to isolate muscles
2. teach to co-contract as you breathe
3. co-contract and use in functional activity
when is DRA best treated?
postpartum
what is progression of abdominals in supine?
1. hooklying isometric
2. hooklying isometric with UE challenges in all planes
3. supine feet on ball with UE challenges in all planes
4. supine isometric with UE challenges and feet moving simultaneously
what is abdominal progression when seated on physioball?
1. abdominal isometric
2. abdominal isometric with UE challenges in all planes
3. abdominal isometric with UE and lE challenges
4. mid/lower trap rows with resistance
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