Lab 8

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					         Lab 8
Low Back Pain and Pregnancy
Presented by:
   Katie Farrell
 Kimberly Harper
    Carly Lepp
 Meggan McCleod
Low Back Pain
                   General Anatomy
   There are 24 independent vertebrae in the
    human spine.
   7 in the cervical region, 12 in the thoracic
    region and 5 in the lumbar region.
   The lower lumbar vertebra is attached to
    the sacrum which is a bone consisting of
    several vertebrae fused together.
   This area around the lumbar spine and
    sacrum is the most common site for back
    pain due to the instability caused by the
    changing curvature of the spine in this
   Between each vertebra is a disc designed
    to reduce the frictional and compressive
    forces between the bones.
    Causes of Low Back Pain
 Lowerback pain is one of the most
 common illnesses experienced by humans
 and usually is associated with the aging
 process. However, aside from the natural
 aging process there are several different
 causes for lower back pain
      Causes of Low Back Pain
Lower back pain could be a result of
     Muscle strain
     Spondylolysis or spondylolisthesis *
     Lumbar disc injury/degeneration
     General disc disfunction

  * Spondylolysis is the occurrence of a stress fracture to the spine. If
     the stress fracture worsens and the vertebra can no longer
      maintain its position and shifts it is known as spondylolisthesis.
                      Muscle Strain
   Low back pain caused by a muscle strain involves tears
    to the muscle fibers in the muscles surrounding the
    spine. This condition is quite common and can be
    caused by a number of things but is usually caused by
    trauma or by overuse.
   If the strain is caused by trauma the affected muscle
    must go through the three phases of soft tissue healing
    and rest is usually prescribed. The three phases of soft
    tissue healing are:
       The acute inflammitory phase
       The proliferative/ repair and regenerate phase
       The maturation/ remodelling phase

    The entire healing process can take up to one year but the majority
      of healing is complete within the first two weeks and a return to
      normal activity is usually permitted at this time.
                   Muscle Strain
   If the strain is caused by overuse it is required that the
    cause of the incorrect movement patterns be corrected.
    Retraining the muscles and improving posture will also
    help prevent further injury. Once the cause has been
    corrected rest may be prescribed.
   The muscle does have to go through the phases of soft
    tissue healing but if the initial cause is not corrected the
    muscle will not heal.
   If the overuse injury causes a stress facture in the
    vertebra it is known as spondylolysis. If the fracture is
    not treated and worsens the vertebra will become
    unstable and shift causing a spondylolisthesis.
Progressive Disc Degeneration
   Low back pain caused by disc degeneration involves a
    decrease in the function of the intervertebral discs.
   Disc degeneration occurs in all humans as a part of the
    natural aging process that causes an overall decrease in
    collagen and water levels in the body.
   The disc is made up mostly of collagen and water and is
    divided into two parts; the annulus fibrosis and nucleus
    pulposa. The nucleus pulposa contains a highly hydrated
    matrix filled with collagen making it particularly
    vulnerable to the aging process.
   The loss of fluids and collagen causes the disc to
    compress thus no longer providing the cushioning to
    absorb the forces placed on the spine.
 Progressive Disc Degeneration
 Although the natural aging process is to blame
  for some degeneration, improper posture can
  worsen the problem.
 Improper posture causes a change in the
  biomechanics of the spine. This causes undue
  wear and tear to the disc adding to the loss of
 Also, the accumulation of debris in the disc
  because of enzymatic dysfunction can
  accelerate the degenerative effects. There is
  little that can be done to prevent this but proper
  posture and maintaining hydration are good
  ways to lessen the negative effects.
   Medications- analgesics, muscle relaxants, and anti-
        inflammatory drugs
   Bedrest
   Decreasing physical activity- especially contact sports
   Exercise- within limits
   Manipulation
   Postural re-training
   Bio-feedback
   Thermotherapy
   Psychotherapy
   Chemonucleolysis
   Surgery
  Contraindications for Exercise
 Passive  lumbar flexion
 Active lumbar extension
 Stretches that call for the knees to be
  brought towards the chest
 Also avoid any exercise that does not
  provide adequate support or the lower
* It should be noted that the cause of the pain needs to be
    examined by a physician before a person can begin
    exercise to avoid making the pain worse
   Pregnancy begins the moment a sperm fertilizes a
    woman’s egg or ovum. The average pregnancy lasts 40
    weeks (roughly 9 months). The 9 month period is divided
    into three equal time periods of about 3 months called
   During the first trimester there is little change in the
    mother’s body however this is a critical period for the
    developing fetus
   At the beginning of the second trimester the physical
    changes such as weight gain begin to become evident in
    the mother.
   The third trimester is the period of most rapid fetal
    growth which corresponds with the period of most
    extreme change in the woman’s body as she prepares
    for the birthing process
Changes to the Woman’s Body
   Many changes occur within the woman’s body to
    prepare her for the birthing process. The
    following changes are a concern when
    prescribing exercise to pregnant women.
       Hormone release resulting in joint laxity especially in
        the pelvis and lower back
       Weight gain concentrated in the abdomen resulting in
        a forward shift of the center of mass
       Changed body composition resulting in an increased
        fat mass.
Weight Gain during Pregnancy
Weight gain during pregnancy is the most drastic
 of the changes a woman experiences as she
 can gain anywhere from 15 to 40 pounds by the
 end of the third trimester. The weight is
 distributed unevenly (most goes to the belly
 area) causing a shift of the woman’s center of
 mass anteriorly. The copious weight gain is one
 of the main motivators for exercise during
 pregnancy as it can have negative effects such
 as low back pain, fatigue and weight retention
 after the birth.
      Reasons for Exercise during
 Thereare also several other motivators for
 exercise during pregnancy including:
     Feelings of self-consciouness about the
      changing body
     Concern about having a healthy baby
     Desire to stay in shape
     Want to be able to handle the physical rigors
      of labor and delivery
     Social interactions and support
           Benefits of Exercise
 Improved cardiovascular and muscular fitness
 Facilitated recovery from labor
 Faster return to pre pregnancy weight, strength and
  flexibility levels
 Reduced post partum belly
 More energy reserve
 Fewer obstetric interventions
 Shorter active phase of labor and less pain
 Less weight gain
 Enhanced maternal psychological well being that may
  reduce feelings of stress, anxiety, and depression often
  experienced during pregnancy.
 Increased likelihood of adopting permanent healthy
  lifestyle habits
     Exercise Specifics for Pregnant
   Moderate exercise sessions are advised because research has
    shown that there is a link between reduced birth weights in babies
    whose mothers performed high-intensity exercise throughout
    pregnancy by 300-350grams (10-12 ounces) on average. Also there
    was an increase in fetal heart rate in babies whose mothers who
    performed high-intensity exercise during pregnancy by 5-15bpm on
    average. Rating of perceived exertion should be used to determine
    moderate exercise levels.
   Should use weight machines which provide more stability and
    support than free weights.
   Back lying (supine) position may result in restricted venous return of
    blood because of increasingly large uterus. Women should perform
    more exercise on their side or hand and knees, then on their back.
   Pelvic floor exercises (kegels) are another important element of
    resistance training during pregnancy. This involves tightening and
    relaxing muscle groups in the pelvic region which will help with
    delivering the baby.
 Although exercise is most often beneficial
 there are three key concerns for potential
 adverse outcomes
     Insufficient oxygen or energy substrates to the
     Hyperthermia- induced fetal distress or birth
     Increased uterine contractions
  Contraindications for Exercise
A pregnant woman experiencing any of the following should avoid exercise
 Pregnancy induced hypertension
 Ruptured membranes
 Premature labor during the current pregnancy
 Persistent bleeding after 12 weeks
 A cervix that dilates ahead of schedule
 Heart disease
 Lung disease
 Multiple birth pregnancy
 A placenta that blocks the cervix after 26 weeks
 Diabetes
 Seizures
 Extreme obesity
 Extreme low body weight
 History of a very sedentary lifestyle
        Discontinue exercise if:
 Any signs of bloody discharge
 Swelling of ankles, hands or face
 Headaches, fainting, dizziness
 Swelling, pain or redness in the calf of one leg
 Increase pulse rate or blood pressure that
  persist after exercise
 Persistent contractions
 Unexplained abdominal pain
 Insufficient weight gain
If any of the above should happen it is important that the
    woman seek medical attention immediately.
         Exercise Guidelines
   30 minutes of moderate exercise 5-7 days per
    week including both strength training and
    some aerobic conditioning
   Age-predicted HR targets are less reliable
    during pregnancy. Thus, a talk test or Borg
    scale is a better predictor of intensity.
   It is very important that pregnant women
    consult with a physician before beginning an
    exercise regimen to ensure that exercise is
    healthy for both the mother and child.
    The End
Thank you for your time.

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