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Class 2/3 Flashcards

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1
Q

What are some contraindications for abdominal pregnancy massage?

A

-First trimester of pregnancy or High Risk Pregnancies
-Problems with cervix and placenta
-threat of pre-term labour
-Vaginal/Uterine bleeding
-When the health of the fetus is in question

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2
Q

What are some indications for abdominal pregnancy massage?

A

-greatly beneficial for connection with baby,
-increase tissue and fascial stretch in the second and third trimesters,
-to enhance birth parent’s connection
with baby

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3
Q

Why do we massage from lateral to medial when performing pregnancy abdominal massage?

A

so as to not increase the
diastasis recti

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4
Q

What are some contraindications for pregnancy breast massage?

A

-High Risk Pregnancy
-Mastitis
-Breast cancer or presence of an undiagnosed lump
-Post surgical infection
-Current active infection
-Abscess

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5
Q

What are some indications in pregnancy patients for breast massage?

A

-High level of change in the
breast tissue
-Pain
-Congestion
-MSK structural imbalances
d/t pregnancy posture, Trp’s
and ↑ MRT in pectorals
-TOS d/t pregnancy posture

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6
Q

What are some indications in postpartum patients for breast massage?

A

Breastfeeding can lead to:
-Pain
-Congestion
-MSK structural imbalances
d/t breastfeeding positions
-TOS d/t breastfeeding
positions

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7
Q

What are some benefits of breast massage for pregnant patients?

A

-improves milk production,
-eases breast discomforts,
-reduces engorgement, and prevents mastitis,
-enhances emotional responses to breast changes,
-increases ability to hand
express milk

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8
Q

________ may appear for the first time during pregnancy.

A

Varicosities

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9
Q

With severe varicosities, there may be ______ in deeper veins

A

Clots

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10
Q

What are some symptoms of blood clots?

A

-Sudden severe Pain, swelling, heat and redness
-80-90% left leg/iliofemoral vein occurrence
- ↓ circulation to affected limb
-Pain upon palpation

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11
Q

_______ and ________ can increase the risk of clots.

A

bedrest and surgery

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12
Q

DVT’s are __x more likely to occur in pregnant Pt’s

A

6X

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13
Q

DVT’s are __x more likely to occur in the postpartum period and the patient has a __x
greater risk for developing a pulmonary emboli in comparison to pregnancy.

A
  • 5X
  • 15X
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14
Q

What are some risk factors for blood clots?

A

-caesarean section
-recent hip, pelvic or knee surgery
-leg injury
-history of previous DVT
-smoking
-40+
-obesity
-family history

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15
Q

T or F All blood clots are symptomatic.

A

F not all blood clots are symptomatic.

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16
Q

What are some contraindications in regards to varicosties and DVT?

A

-No Mx over varicosities or known blood clots/phlebitis
-No deep pressure to the adductor mm or inguinal region
* No Mx to legs if there are known clots

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17
Q

_______ increases as pregnancy progresses (needed for labour and delivery)

A

Relaxin

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18
Q

________ is usually more an issue than mobility in pregnany patients

A

Stability

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19
Q

What considerations should RMTs make to adapt a tx. to high levels of relaxin in pregnant patients?

A

-decrease MRT discomfort, but don’t want to destabilize their joints
-give exercises to increase stability

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20
Q

What hormones function to soften connective tissue in the body?

A

Relaxin and progesterone

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21
Q

When does the hormone ramp up of relaxin begin?

A

-begins at 10 weeks and continues through until 6 months postpartum

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22
Q

Which structures are most effected by the high amounts of relaxin released during pregnancy?

A

-Pelvis & lumbar spine primarily
-but also all other ligaments, joints, tendons, and fascia

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23
Q

How does the body compensate for the laxity of the connectivity tissue in pregnancy?

A

By increasing MRT

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24
Q

With which techniques should you take special care with during pregnancy massage in regards to the effects of relaxin?

A

-joint mobs,
-rhythmic mobs,
-stretching
-and overpressure.
-esp. if there’s a history of prior dislocation

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25
What type of pressure should RMTs use when performing joint mobilizations on pregnant patients?
low grade pressure
26
What kind of joint mobilizations are completely CI'ed as they may induce pre-term labour?
Pelvic and sacral
27
What are some CI's for sacral work in pregnancy massage?
* No deep prolonged/pointed pressure work (may induce pre-term labour) * No sacral joint mobilizations * High Risk Pregnancies: sacral work completely CI’d
28
For non-high-risk patients, what kind of techniques should be applied to the sacrum?
general, broad massage techniques
29
When pregnant, an individual cannot have their body temperature exceed ____°F. This is because the fetus is unable to cool itself down.
102.6
30
Later in pregnancy, the pregnant patient is unable to tolerate ____ as well and can become dizzy and lightheaded with immersion in ____ or ___ temperatures.
heat hot temperatures
31
What are some CI's for hydrotherapy in pregnancy?
-Large scale or full body heat treatments: -Saunas, whirlpools, steam treatments and are CI-ed -baths can be modified with warm water, and partial immersion
32
What kind of hydrotherapy treatments is it safe to use during preganancy?
localized treatments, ie: o thermophore to the low back and gluteals o Paraffin wax to the iliotibial band o Hydrocollator to the posterior trunk
33
How can a bath be modified for pregnant patients?
- keeping the water temperature between 36.7 - 37.2 °C (body temperature), -not fully submerging the patient (keep their torso and arms out of the water). -fully CI-d for High-Risk Pregnancies.
34
What are some uses for hydrotheraphy in pregnancy massage?
- reduce edema -reduce breast congestion, TOS, mastitis -warm-up tissues before performing scar tissue work to caesarian section scar
35
How can hydrotherapy be used to help with edema in pregnant patients?
-Cool towel wraps plus elevation can be placed on the feet and ankles or hands and wrists to decrease edema caused by fluid retention -Can be helpful for carpal tunnel syndrome
36
How can hydrotherapy be used to help with breast congestion, TOS, and mastitis in pregnant patients?
- Cool figure 8 towels can be wrapped around the breasts to treat breast congestion, TOS and mastitis (pregnancy and postpartum)
37
_____ towels can be draped over the chest wall to decrease edema and fluid retention leading to TOS (pregnancy and postpartum) o Can use _____ towels on the breast postpartum if congestion has decreased
-Cool -Warm
38
What are some hydrotheraphy modalities that could be used to warm up the area for caesarian section scar work?
-Castor Oil -Paraffin Wax Treatments -Deep Moist Heat
39
What are some indications for postpartum massage?
* Stress reduction/improves connection with baby * Lower Back Px * Re-align pelvis * Breast Mx Assessing and treating postpartum/breastfeeding positional postural dysfunctions * Helps postpartum patient connect with new postpartum body (body forgets how not to be pregnant) * Discussing pelvic floor changes – referral when necessary * Assess diastasis recti
40
What are some postpartum Massage CI's?
-DVT -Hemorrhage
41
How long must you wait before performing deep work to the adductors, inguinal region or gastrocs?
-6 weeks postpartum at the earliest
42
If the patient hemorrhages during delivery, what are they at increased risk of?
hemorrhage 1-3 days post partum
43
What are some modifications for post partum patients who experienced hemorrhaging?
-No deep stimulating circulatory massage -Use energetic work, or focused point-specific work to areas of tension -Consider lack of energy from the loss of blood and any orthostatic hypotension when the Pt sits up after the mx.
44
When is it safe to begin performing post partum abdominal massage?
-o 4-6 weeks postpartum vaginal birth -6-8 weeks postpartum caesarean birth
45
What needs to happen before it's safe to begin performing work to the caesarean scar?
-Cannot commence until incision has healed- -No deep work til 12 weeks post partum
46
What are some important questions to ask postpartum patients?
-Vaginal or Caesarean Birth? -1st, 2nd, 3rd-degree tears?
47
What is an episiotomy?
-tearing of the perineum.
48
When will episiotomies and caesarean incisions be sensitive to techniques that pull on the sutures?
during Joint mobilizations of pelvis, and glute/hip work.
49
How long does relaxin remain present in the body for post partum?
-6 months -low grade joint play only
50
The post-partum patient may have increased ______ d/t the pregnancy and delivery
Edema
51
What should be done to address post partum edema?
Lymph drainage
52
What are common pelvic misalignments during the post partum period?
-SIJ dysfunction -Innominate dysfunction -Pubic Symphysis dysfunction
53
What techs can be used to re-align the pelvis during post partum?
-MET, -GST, -Mm stripping, -PIR
54
What kind of hydro will you employ for postpartum patients?
- breasts may be too tender in the postpartum period for Mx. Can use cool figure 8 towel wraps -Utilize side-lying position
55
Is it within our scope to ax. the pelvic floor?
Nope
56
What are some postpartum symptoms which may lead you to refer out to a pelvic floor physiotherapist?
* Poor bladder control * Urgency * LB, groin, pelvic Px * Pressure in vagina and rectum * Painful intercourse
57
What is diastasis recti?
-thinning of the linea alba and a distancing of the abdominal mm from the linea alba -Diagnosed by palpating a two-finger width between the rectus abdominis fibres
58
When can diastasis recti begin in the pregnancy?
-DR can start in the second trimester, most common in the third trimester -can also occur during labour and delivery
59
If the DR is not corrected, what can it lead to as abdominal support is decreased?
back pain
60
Why should you always massage the abdomen from lateral to medial?
to make sure you're not increasing the diastasis recti
61
How and when can you assess diastasis recti?
-any trimester, or postpartum -in hooklying position
62
T/F Pelvic floor issues can be a cause of diastasis recti?
True. consider referral to a pelvic floor physiotherapist
63
When pregnant, jackknifing forward from supine or sidelying to seated position causes strains and spasms to uterine _________ and can contribute to diastasis recti.
Ligaments
64
Why might you give transverse abdominal contractions as a self care instruction?
-to support the transverse abdominis during pregnancy, -to build the strength needed to push the baby out, -to facilitate a stronger core in post-partum
65
In what positions can pregnant patients perform pelvic tilts?
-supine -hands and knees
66
What are some factors which increase the risk of diastasis recti?
-obesity -muscle weakness in core -straining due to constipation -large baby in comparison to size of pregnant parent -previous hernia -previous or multiple pregnancies -relaxin and estrogen -pushing during birth
67
What may happen to postural dysfunctions in pregnancy?
Any dysfunction that was present prior to pregnancy may develop further.
68
How often should you reassess posture during pregnancy?
-once per trimester (at least)
69
Why might pregnancy encourage a kyphotic posture?
-Weight of breasts, uterus and fetus shift upper thoracic area posteriorly as inferior ribcage shifts anteriorly -can lead to TOS
70
Which muscles are most affected by kyphotic posture during pregnancy, because of their role in supporting the weight of the breasts?
Rhomboids, pectorals, subscapularis, scalenes and levator scapula.
71
________ breathing occurs D/T increasing size of uterus, which restricts full diaphragmatic engagement and full ribcage expansion.
Apical
72
What muscles are most affected by an anterior pelvic tilt during pregnancy, because of their role in supporting the weight of the abdomen?
Abdominals, iliopsoas, spinal erectors, adductors, lateral hip rotators, and pelvic floor
73
What are some muscular presentations which may be present with anterior pelvic tilt?
* Short psoas creates an anterior tilt * Short QL and erectors pull the iliac crests and sacrum superiorly increasing lordosis * Weak gluteals increase anterior tilt as they are unable to stabilize the pelvis and stop an external rotation of the coxafemoral joint * Hip flexors become short and tight -Hamstrings become long and weak and cannot stabilize the pelvis
74
Which 2 chemicals help soften connective tissue in the body?
Relaxin and Progesterone
75
Which structures are most affected by relaxin?
pelvis and lumbar spine -but all ligaments, joints, tendons and fascia are effected
76
When is relaxin present in the body?
-from 10 weeks gestation, can last up to 6 months PP
77
How can relaxin affect the pelvis?
Joints can become hypermobile and lead to: o Pain o Up-slip of the iliac crest o SIJD * Pubic Symphysis joint dysfunction/separation * Rotation of the innominate bone
77
How can relaxin affect the pelvis?
Joints can become hypermobile and lead to: o Pain o Up-slip of the iliac crest o SIJD * Pubic Symphysis joint dysfunction/separation * Rotation of the innominate bone
78
Why do pregnant patients sometimes presenf with a waddle in 3rd trimester?
-psoas become hypertonic and spasmed. cannot maintain proper pelvic alignment -Coxafemoral joints externally rotate -Hip rotators initiate gait rather than the psoas
79
Why may edema present in pregnant patients?
-Hormonal changes, mechanical constriction, ↓activity levels- -esp in ankles, feet, hands and wrists
80
What are some complications due to edema?
-carpal tunnel syndrome -TOS
81
How should you treat pregnancy related edema?
-↓ anterior pelvic tilt to help fluid flow past inguinal ligament o Hydrotherapy modalities o Elevation during tx and as self-care o Encourage ↑ activity levels o LD and GST
82
What areas of the body are most likely to radiate pain in a sciatica-like presentation during pregnancy?
-piriformis syndrome -psoas -SIJ -round ligament
83
What are some symptoms of Meralgia Paresthetica?
usually caused by entrapment of the inguinal ligament -Symptoms appear in anterolateral thigh o Pain, burning, numbness, Muscle aches, coldness, lightning, buzzing
84
What typically entraps the lateral femoral nerve to cause meralgia paresthetica?
usually the inguinal ligament
85
What tends to aggravate and alleviate meralgia paresthetica?
-aggravates: standing for long periods, walking -alleviates: sitting, lying down
86
What happens to ligaments during pregnancy, which causes much discomfort for the patient?
ligaments may go into to spasm due to lengthening and stretching
87
Where does the round ligament refer pain to?
lower pelvis, anterior leg, and most frequently sharp pain in groin
88
Where does the broad ligament refer pain to?
lower back and glutes
89
Where does the sacro-uterine ligament refer pain to?
sacrum, sciatic-like pain down the back of the leg, SIJ pain and diffuse LBP
90
What do we use in order to properly position pt. on table in a way that adequately supports uterus?
towel roll
91
What should we teach the pt. to do in order to relieve pain from the round ligament?
o Instruct to flex the hip of the affected side and apply direct palm or fingertip pressure to the painful area near the inguinal region or pubic bone o Use slow, focused breathing during a spasm
92
Which ligaments are AKA the suspensory ligaments of the breasts?
Cooper's ligaments
93
Why is the retro-mammary space clinically relevant?
-breast implants are often placed here -Plays important role in lymphatic drainage of breast tissue
94
The ______ _______ are glandular epithelium, designed to produce milk.
mammary glands
95
The Production of Milk: o All ______ drain into the ductile o All ductules drain into a _____ o All _____ drain into a lactiferous sinus where the milk collects
-alveoli -duct -ducts
96
Milk is not produced until __ - __ days postpartum
4-5
97
What is the name of the yellow, antibody-filled substance that is produced by the breast, and acts as the baby's first nourishment immediatedly postpartum?
colostrum
98
What is the arterial supply for the breasts?
large subclavian artery
99
What are the actual borders of the breast?
-Upper: lower edge of the clavicle -lower: 1” or so below the breast contour, -medial: sternal mid-line, -lateral: anterior edge of lats, and into axilla
100
What are some breast changes in 1st trimester?
o Growth of new ducts and early formation of new lobules o increased size o Dilation of superficial veins, increased pigmentation of the nipple/areola, and tissue `heaviness’
101
What are some breast changes in 2nd trimester?
-Lobule formation and glandular cell activation o Alveolar epithelium converts into more specialized secretory cells with surface microvilli o Colostrum begins to form in alveoli o Hypertrophy of myoepithelial cells occurs in preparation to mobilize milk o Increased connective tissue and fat
102
What are some breast changes in 3rd trimester?
-Increased glandular cells and development o Ongoing addition and dilation of acini o Increased production of colostrum o 180% increase in mammary blood flow o Achy and heavy breasts
103
What are acini?
-smallest functional unit of the breast and milk production
104
What are some breast changes in postpartum?
-Epithelial cells convert into secretory state o Breasts grow from birth to 4-5 days postpartum o Colostrum is initially expressed, milk after 4-5 days o Increased nipple soreness o increased risk of mastitis d/t cracks in nipples and areolae

Pregnancy (1 decks)

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