• Stage I: acute/reversible stage.
This stage of vasodilation lasts 3 weeks to 6 months. Pain, the predominant feature, is usually out of proportion to the severity of the injury. There is hyperhidrosis, warmth, erythema, rapid nail growth, and edema in the distal extremity.
• Stage II: dystrophic or vasoconstriction (ischemic) stage.
This stage lasts 3 to 6 […]

Neurological Compromise
Stretch and compression of the pudendal nerve occurs during labor as the baby’s head travels through the birth canal; this stretch can be as much as 20% of the total length of the nerve. This compromise to the pudendal nerve is most intense during pushing (the second stage of labor), through the completion of […]

Pelvic floor muscle training is a valuable modality regardless of a patient’s presentation or cause of symptoms. The majority of women are unfamiliar with the presence of the pelvic floor muscles, and even less aware of their function and role in daily activities. Intervention is slowly becoming more common during the childbearing years owing to […]

Common synonyms used in the past for RSD include shoulder-hand syndrome, Sudeck’s atrophy, reflex neurovascular dystrophy, traumatic angiospasm or vasospasm, and sympathetically maintained pain (SMP). SMP is frequently a component of CPRS but is not a distinct diagnosis in itself. Pain is a key feature; other symptoms and signs may include sensory abnormalities (spontaneous burning […]

Treatment of pelvic floor impairment has become more visible and accepted in the physical therapy community over the last 5 to 10 years. However, advanced and in-depth study of anatomy, physiology, evaluation, and treatment continues to be highly recommended for therapists who wish to specialize in this area.
Pelvic Floor Musculature
The pelvic floor musculature is composed […]

As the abdomen enlarges, it becomes impossible to comfortably assume the prone position. Exercises that are usually performed in the prone position must be modified.
Standing Push-Ups
Patient position and procedure. Standing, facing a wall, feet pointing straight forward, shoulder-width apart, and approximately an arm-length away from the wall. The palms are placed on the wall at […]

Center of Gravity
The center of gravity shifts upward and forward because of the enlargement of the uterus and breasts. This requires postural compensations to maintain balance and stability.
• The lumbar and cervical lordoses increase to compensate for the shift in the center of gravity, and the knees hyperextend, probably because of the change in the […]

They should be initiated and progressed at the intensity that the woman is able to safely control. Slow, controlled breathing is emphasized while developing the stabilizing function of the muscles.
Precautions
• Because the trunk muscles are contracting isometrically in many of these abdominal exercises, there is a tendency to hold the breath; this is detrimental to […]

CRPS type I (reflex sympathetic dystrophy)
• Develops after an initiating noxious event
• Spontaneous pain or allodynia/hyperalgesia
• Edema, vascular abnormalities
• Abnormal sudomotor activity
• Non-nerve origin
CRPS type II (causalgia) 
• Develops after nerve injury
• Not limited to territory of injured nerve
• Edema; skin blood flow abnormality
• Abnormal sudomotor activity
Clinical Features of CRPS (in addition to the differences […]

A check for diastasis recti must always be performed before initiating abdominal exercise. Only the corrective exercises (head lift or head lift with pelvic tilt) should be used until the separation is corrected to 2 cm (two fingerwidths) or less.
Head lift
Patient position and procedure. Hook-lying with her hands crossed over midline at the level of […]

• Pain and paresthesia along the ulnar side of the palm of the hand and digits in the distribution of the ulnar nerve
• Progressive weakness or atrophy in the intrinsic muscles innervated by the ulnar nerve
• Restricted mobility in the extrinsic finger flexor and extensor muscles
• Possible restricted mobility of the pisiform
Common Functional Limitations/Disabilities
• Decreased […]

Considerable changes occur in the woman’s body as the pregnancy progresses.
Weight Gain During Pregnancy
Current recommendations for weight gain during pregnancy are an average of 25 to 27 lbs.
Changes in Organ Systems
Uterus and Related Connective Tissue
Uterus. The uterus increases from a prepregnant size of 5 by 10 cm (2 by 4 inches) to 25 by 36 […]

Posture Exercises
The growing fetus places added stress on postural muscles as the center of gravity shifts forward and upward and the spine shifts to compensate and maintain stability. In addition, after delivery, activities involving holding and caring for the baby stress postural muscles. Muscles that require emphasis for strengthening and stretching are listed. General exercise […]

Etiology of Symptoms
Injury or irritation of the ulnar nerve in the tunnel between the hook of the hamate and pisiform results from sustained pressure, such as prolonged handwriting or leaning forward onto extended wrists while biking; from repetitive use of the gripping action of the fourth and fifth fingers, as with knitting, tying knots, or […]

Protect the nerve
• Splint wrist in neutral
• Protect areas in decreased sensitivity
Modify activity and educate the patient
• Teach patient about provoking activities and how to modify them
• Teach safe exercises for home exercise program
• Teach patient how to protect areas of decreased sensitivity in the hand
Mobilize restricted joints, connective tissue, and muscle/tendon
• Mobilize carpals if […]

• Fetus 3.36-3.88 kg (7.5-8.0 lb)
• Placenta 0.48-0.72 kg (1.0-1.5 lb)
• Amniotic fluid 0.72-0.97 kg (1.5-2.0 lb)
• Uterus and breasts 2.42-2.66 kg (5.0-5.5 lb)
• Blood and fluid 1.94-3.99 kg (4.0-7.0 lb)
• Muscle and fat 0.48-2.91 kg (1.0-6.0 lb)
 • Total: 9.70-14.55 kg (20.0-30.0 lb)
Buy the Book that holds this excerpt: Therapeutic Exercise: Foundations and Techniques (Therapeutic […]

There are some circumstances where exercise is contraindicated or requires very specific restrictions and precautions.
Absolute Contraindications
• Incompetent cervix: early dilation of the cervix before the pregnancy is full term
• Vaginal bleeding, especially second or third trimester
• Placenta previa: placenta is located on the uterus in a position where it may detach before the baby is […]

In a recent review on the sensitivity and specificity of the various tests used when screening for CTS, MacDermid and Doherty, summarized the key signs and symptoms that increase the probability of diagnosing CTS.
History. Sensory changes in the median nerve distribution of the hand (excluding the palm, which is innervated by the palmar cutaneous branch […]

• It is strongly recommended for all women to participate in mild to moderate exercise, for both strength and cardiopulmonary benefits, 15 to 30 minutes/session, most days of the week. Individualized programs, based on prepregnancy fitness level, are preferable.
• Currently, there are no data in humans suggesting that pregnant women need to decrease their intensity […]

The carpal tunnel is a confined space between the carpal bones dorsally and the transverse carpal ligament (flexor retinaculum) volarly. In this region the median nerve is susceptible to pressure as it courses through the tunnel with the extrinsic finger flexor tendons on their way into the hand. Carpal tunnel syndrome (CTS) is characterized by […]

Placental stage (expulsion of the placenta). After delivery, the uterus continues to contract and shrink, causing the placenta to detach and be expelled.
• As the uterus decreases in size, the placenta detaches from the uterine wall, blood vessels are constricted, and bleeding slows. This can occur 5 to 30 minutes after the baby is delivered.
• […]

Stage 2 involves “pushing” and expulsion of the fetus. Intra-abdominal pressure is the primary force expelling the fetus; it is produced by voluntary contraction of the abdominal muscles and diaphragm. Relaxation and stretching of the pelvic floor during stage 2 are also necessary for successful vaginal delivery. Uterine contractions may last as long as 90 […]

Suggest that your patients discuss with their physicians any guidelines or restrictions to exercise before engaging in an exercise program, either in a class or on a one-to-one basis. As always, follow your state practice act for physical therapy regarding referral, evaluation, and treatment.
Examination. Individually examine each woman before participation to screen for pre-existing musculoskeletal […]

Educate the patient
• Teach posture correction
• Teach how to modify provoking stresses
• Teach safe exercises for home exercise program
Correct impaired posture
Mobilize restricted neurological tissue
• Nerve mobilization techniques if testing is positive for restricted mobility
Mobilize restricted joints, connective tissue, and muscle
• Tissue-specific manual techniques to restricted structures if testing is positive for restricted mobility
• Self-stretching exercises […]

Labor is divided into three stages, each containing specific events. The exact mechanism that initiates labor is not known. Regular and strong involuntary contractions of the smooth muscles of the uterus are the primary symptom of labor. True labor produces palpable changes in the cervix, which are known as effacement and dilation.
• Effacement is the […]

Potential Impairments and Functional Limitations
Stress, pain, and muscle imbalances from faulty postures
Poor body mechanics; related to lack of knowledge, changing body size and caring for growing child
Lower extremity edema and discomfort from altered circulation, varicose veins
Pelvic floor dysfunction
• urinary or fecal incontinence
• organ prolapse
• hypertonus
• poor episiotomy healing
• poor proprioceptive awareness and disuse atrophy
Abdominal muscle […]

Throughout a woman’s life cycle, specific gender differences need to be recognized for their relevance to rehabilitation. Recent research has shown repeatedly that women have specific and distinct physiological processes that extend beyond the obvious considerations of anatomy and hormones, including differences in symptoms of heart attack and metabolism of medications. Clearly, the pregnant or […]

• Intermittent brachial plexus and vascular symptoms of pain, paresthesia, numbness, weakness, discoloration, and swelling
• Muscle length-strength imbalance in the shoulder girdle with tightness in anterior and medial structures and weakness in posterior and lateral structures
• Faulty postural awareness in the upper quarter
• Poor endurance in the postural muscles
• Shallow respiratory pattern characterized by upper […]

No human research has conclusively proven a detrimental fetal response to mild- or moderate-intensity maternal exercise. Recent studies suggest that even vigorous exercise does not have the detrimental effects on the fetus that once were feared, and therefore restrictions on exercise because of concerns for the effects on the embryo and fetus have been lessened. […]

There are three primary sites for compression or entrapment of the neurovascular structures that lead to tension or compression signs.
• Interscalene triangle: bordered by the scalenus anterior and medius muscles and the first rib. If these muscles are hypertrophied, tight, or have anatomical variations, they may compress the proximal portion of the brachial plexus normal […]