Female pregnancy will cause extensive changes in the body. In addition to weight gain, the uterus and its related connective tissue, urinary system, respiratory system, circulatory system, musculoskeletal system, body temperature regulation system, posture and balance will all change. Among them, the musculoskeletal system and changes in posture and balance are the most common causes of low back and leg pain in pregnant women. In the lifetime of about half of the population, women may experience the risk of low back and leg pain due to pregnancy or childbirth. This kind of low back and leg pain is the low back and leg pain of pregnant women. This clinical phenomenon rarely arouses people's attention.
Effects of pregnancy on the skeletal-muscle system
Effects on the abdominal muscles: During pregnancy, the fetus gradually matures and the abdomen is gradually protruding, and the bilateral rectus abdominis is gradually stretched to the limit. At this time, the contraction and elasticity of the abdominal muscles are significantly reduced. As the body shape of pregnant women changes, the position of the center of gravity of the person changes, which will also cause the contraction of the abdominal muscles to weaken.
Impact on pelvic floor muscles: The muscles located at the bottom of the pelvis are in an anti-gravity position and carry the weight change of the pelvis. Pregnancy causes the pelvic floor muscles to be stretched and dropped 2.5cm.
Impact on connective tissue and joints: Hormonal changes in pregnant women cause ligaments to relax and reduce elasticity, and the back, pelvis, and lower limb weight-bearing joints reduce the ability to resist injury; it also reduces the effective stability of the trunk.
Influence of pregnancy on posture and balance
Influence on posture: The enlargement of the uterus and mammary glands during pregnancy makes the center of gravity move upward and forward, which requires postural compensation to maintain balance and stability. Generally, the movement of the center of gravity is compensated by increasing the protrusion of the lumbar and cervical vertebrae; the change in the center of gravity also causes the knee joint to hyperextension.
In addition, many activities of mothers taking care of their children contribute to long-lasting postural errors and asymmetry. For example, the continuous scapula forward posture of the mother makes the shoulder straps and upper back rounded, and the enlargement of the mammary glands causes the upper limbs to rotate; There is no active correction. These factors will have an impact on posture.
Impact on balance: With weight gain and weight redistribution, a compensation mechanism is needed to maintain balance. For example, pregnant women usually walk with a wider supporting surface of their feet.
Common muscles during pregnancy---skeletal problems and intervention
1. Separation of rectus abdominis
The rectus abdominis separation is the separation of the rectus abdominis along the middle white line. The separation of rectus abdominis occurs on the umbilicus, or at the level of the umbilicus, and rarely occurs below the umbilicus. Rectus abdominis separation is common in pregnant women. The incidence in the first trimester of pregnancy is 0, 27% in the second trimester, and 66% in the third trimester. It was 36% after 5 to 12 weeks postpartum.
The reason for the separation of the rectus abdominis is unknown, which may be related to the effect of hormones on the connective tissue during pregnancy and the changes in the biological mechanism of pregnancy that cause the separation of the rectus abdominis; it may also occur during labor, especially during the second stage of labor. Rectus abdominis separation usually has no obvious clinical symptoms. Individuals with good abdominal muscle function before pregnancy rarely have rectus abdominis separation.
The separation of rectus abdominis may cause skeletal muscle problems, such as low back pain, which is caused by the decreased ability of the abdominal muscles to stabilize the pelvis and lumbar spine.
Intervention: Be sure to check the degree of rectus abdominis separation before starting abdominal muscle exercises. For example, start correction exercises when the separation distance is reduced to 2cm (two finger width) or less.
Head up: Supine position, cross the midline and support your hands at the level of rectus abdominis separation. Ask the woman to exhale and just lift her head off the ground or just before the abdomen bulges. At the same time, gently bring the separated rectus abdominis closer with both hands toward the midline. Then, ask the woman to slowly lower her head and relax. This exercise focuses on the rectus abdominis, try to avoid the oblique abdominis participating in activities. Some women can't do it successfully, you can use a sheet to wrap the torso on the separation plane to provide support to make the separation rectus abdominis close.
Head up with pelvic tilt: lying on the back, with arms crossed on top of the separation and support. Ask the patient to slowly lift their head off the ground, while bringing the rectus abdominis closer and completing the pelvic tilt back, then slowly lower the head and relax. Complete all abdominal muscle contractions during exhalation to minimize intra-abdominal pressure.
Abdominal exercises: As the pregnancy progresses, the abdominal muscles will experience extreme stretch. Therefore, exercises must be selected according to individual needs and periodically evaluated (approximately every 4 weeks of pregnancy). The following exercises gradually progress from the least exertion to the greatest effort.
Note: Remember that after 13 weeks of pregnancy, the abdominal muscle exercises in the supine position cannot exceed 5 minutes.
Pelvic tilt exercise: Limb position (supporting both hands and knees), instruct the patient to tilt the pelvis back. When the patient keeps the back straight, let the lower abdominal muscles of equal length tension and maintain, then relax, complete the pelvic forward tilt in a very small range.
Additional exercises: While keeping the rectus abdominis stretched and the back straight, let the patient’s trunk bend to the right, look at the right hip, and then reverse to the left. Let women perform pelvic tilt exercises in various positions, including lateral and standing positions.
Leg sliding: supine position, pelvic tilt position. When instructing women to keep the pelvis tilted, slide one foot along the ground until the leg is straight, or slide until the pelvis tilt cannot be maintained. Slide the leg to the starting position again, and repeat with the other leg. Breathing is coordinated with exercises so that the abdominal muscles contract when exhaling.
Stability exercises: Promote abdominal and lower back muscle exercises and develop lumbar and pelvic stability control. Emphasize slow breathing control when developing muscle stability.
Note: Because many muscles of the trunk are contracted isometric exercises, they will hold their breath, which has a negative impact on blood pressure and heart rate. Women should pay attention to maintaining relaxed breathing and exhalation during each exertion phase.
The rectus abdominis separation can only perform postpartum abdominal muscle strength exercises when the separation is corrected to the width of two fingers or less.
Experience: The rectus abdominis separation therapy and functional exercise are highly professional, therefore, they must be carried out under the guidance of professionals.
2. Postural back pain
Back pain in pregnant women is mainly the result of changes in normal posture, increased ligament laxity and weakened abdominal muscle function during pregnancy. The incidence of back pain in pregnant women is 50 to 70%. Back pain makes pregnant women unable to work and reduces functional activities. In addition, 68% of back pain symptoms may last for more than a year after delivery.
Features: Static posture and muscle fatigue aggravate back pain. After rest or position changes, symptoms are relieved. Healthy women rarely experience low back pain during pregnancy.
Intervention: Low back pain can be effectively treated through traditional low back muscle exercises, posture guidance and posture improvement.
Pregnant women are contraindicated in deep hyperthermia, electrical stimulation and traction.
Experience: Targeted functional exercise before pregnancy is the basis for preventing postural back pain. Correct posture during pregnancy or postpartum is the key to treatment and prevention. Chiropractic is an effective way to treat postpartum postpartum back pain.
3. Pain in the sacroiliac/pelvic belt area
The study found that the incidence of postpelvic pain in pregnant women is four times that of low back pain. Sacroiliac pain is confined to the back of the pelvis and is manifested as a tingling pain in the deep distal buttocks and on the outside of L5/S1. The pain can radiate to the back of the thighs and knees, that is, back pain, but it will not reach the feet. Pain occurs after sitting, standing, walking, climbing stairs, turning over on bed, standing on one leg, or twisting activities. Rest symptoms cannot be relieved, and frequent activities aggravate. Symphysis dysfunction includes significant tenderness when touching the pubic bone, pain radiating toward the groin and medial thigh, and weight-bearing pain may occur alone or in combination with sacroiliac symptoms. In addition, excessive separation and displacement of the pubic bone may occur. This is a common cause of pelvic separation or pelvic rotation.
Intervention: Treatment of pelvic girdle and sacroiliac symptoms provides external support for the pelvis by improving tissue activity, stability exercises, and waist belt use.
Activity improvement: Changing daily activities to minimize the asymmetric forces acting on the trunk and pelvis. For example, when entering a car, first sit down, and then turn your legs at the fulcrum. Enter the car with your torso and keep your knees together. When you lie on your side, place a pillow between your knees for better symmetry; change your sex posture to avoid Full range of hip abduction. Avoid one-leg weight-bearing, excessive abduction, and sitting on soft cushions. In addition, take care to avoid: climbing more than one staircase, swinging one leg out of the bed when getting up, and sitting with legs crossed.
Exercise improvement: Avoid single-leg weight-bearing, hip joint excessive abduction and hyperextension exercises. Instruct patients to exercise pelvic floor muscles and transversus abdominis to stabilize the pelvis.
External stability: The application of a belt during pregnancy helps to reduce pain behind the pelvis, especially when walking. However, recent studies have made it clear that the use of pelvic girdle in patients with pubic symphysis separation has no practical significance.
Experience: The treatment of sacroiliac or pelvic area pain and pubic symphysis separation. Our experience is the effective implementation of Long’s maneuvers, correct posture correction and targeted functional training. Usually a course of treatment can basically relieve or cure.
4. Varicose veins
Pregnant women have increased uterine weight, obstructed blood flow in the veins of the legs, and increased venous swelling, thereby exacerbating varicose. Varicose can appear in the first three months of pregnancy, and it is more common in people who become pregnant repeatedly. Varicose occurs in the lower limbs, rectum (hemorrhoids), or vulva. Symptoms usually include heaviness or pain in the lower extremities; they become more severe as the pregnancy progresses. In addition, pregnant women are more prone to deep vein thrombosis.
Intervention: Wear elastic stockings to provide external pressure against venous expansion, encourage pregnant women to complete lower limb exercises, and raise the lower limbs as much as possible. Apply pudendal pads to provide tissue compression and support to relieve vulvar varicose.
Instruct pregnant women to prevent or minimize damage: skin care, self-massage for lymphatic swelling;
Prevent lymphatic swelling and venous stasis: wear compression clothing before getting up in the morning, walk regularly, raise the lower limbs after walking until the heart rhythm returns to normal, avoid prolonged static standing and sitting, and raise the affected limb higher than the heart during rest or sleep. Highly affected limb is about 30° to 40°)
Experience: It is not advisable to stand and sit for a long time. Actively move all the joints of the lower limbs frequently to effectively prevent it.
5. Joint relaxation
Increase the risk of all joint damage during pregnancy and early postpartum. There are many controversies about the role of hormones in the postpartum period.
Practice improvements: teach pregnant women safe exercises during pregnancy, including practice improvements to reduce excessive joint stress.
Aerobic exercises: It is recommended that no weight-bearing or less stress aerobic activities, such as swimming, walking or cycling, are recommended, especially for women who are relatively sedentary before pregnancy.
Experience: Actively move the joints of the limbs, increase the elasticity and compliance of the ligaments and muscles around the joints, and provide their tension.