Category Archives: Health

Pregnancy Low Back Pain

Pregnancy is a time of tremendous changes in term of musculoskeletal, physical and emotional condition. It imposes a tremendous stress on the body and yet is a condition of great satisfaction and happiness. During this period, the incidence of back pain is quiet common.

The causes of the increased incidence of Low Back Ache are:

Changes in musculoskeletal system

Stretching of abdominal muscles : Due to the growing fetus as a result of which the muscles are quiet stretched as a result of which the muscle is unable to generate strong contractions and thus decreases the efficiency of contraction.

Hormonal Changes : Due to the increased level of progesterone and relaxin, the tensile strength of ligaments decreases. This also has an effect on the ligaments of low back and pelvis. The joints become hyper mobile due to ligament laxity. This may predispose the patient to joint and ligamentous injury, especially in the weight bearing joints of the back and pelvis.

Changes in posture and balance

POSTURE

It shifted upward and forward because of the enlargement of the uterus and breasts. As a result of the postural compensation occurs. One of the compensation is the increased lumbar lordosis. This can further become habitual, if proper guidance is not provided. This increased lumbar lordosis puts lots of stress on the anterior longitudinal ligament which may lead to pain.

Moreover, there is approximation of facet joints which may become weight bearing thus leads to synovial irritation and inflammation.

BALANCE

With change In Centre of Gravity and increased weight there are compensations to maintain it. The woman starts walking with wide Base of support and increased external rotation at hip. Some activities such as walking, stooping, stair climbing, lifting and reaching. If these activities are repeated then it can be a potential source of low back ache.

Types

LUMBAR PAIN

This is basically due to the altered posture and the additional bio-mechanical stresses that are discussed above.

Symptoms

Worsen with muscle fatigue after static posture or as the day progresses. These symptoms are usually relieved by change in posture and rest. Pregnant females that are usually fit of have lesser chances to develop this type of backache.

SACROILIAC (POSTERIOR PELVIC) BACK PAIN

This is due to the ligamentous laxity that leads to increased stresses on the SI joint. This leads to SI joint pain and sometimes inflammation of the joint. This is more common in females as compared to Low Back Pain, even if the female is fit.

Symptoms

Localized to the post aspect of the upper buttock ad is described as stabbing pain deep into the buttocks distal and lateral to lumboscral joint. Pain may radiate up to knee joint. It is aggravated by prolonged sitting, standing or walking; pain when climbing stairs, turning in bel etc. This kind of pain in not relieved by rest. This type of pain can develop even in females with active lifestyle.

MANAGEMENT

The back pain in pregnant females presents a completely different challenge for physiotherapy and thus requires great expertise on the part of the therapist. Thus, the exercises and postural corrections must be done under a proper guidance of a physiotherapist in a physiotherapy clinic.

Stages Of The Cardiac Cycle

Cardiac cycle may be defined as the series of events which include mechanical, electrical, pressure-volumetric changes that occurs in the heart from the beginning of heartbeat to the next. The cardiac cycle can be divided into 2 phases:

  • Period of contraction –referred to as “sysytole”
  • Period of relaxation –referred to as “diastole”

The duration of the whole cardiac cycle is 0.08secs.

During the contractile phase, blood ejected from the heart, while during the relaxation phase, the chambers of the heart gets filled with blood.

Each chamber of the heart goes through the systolic and diastolic phase therefore there is arterial systole and diastole and ventricular systole and diastole.

Stages of the Cardiac Cycle

During late atrial diastole and early ventricular diastole, blood rushes freely into the heart chambers and this accounts for about 80% of ventricular filling.

At this point, the arterio-ventricular valves( bicuspid and tricuspid valves) are opened and the pressure in the ventricles begin to increase as the chamber become filled with blood.

The spontaneous generation of action potential form SA nodal tissues causes the spread of impulses through the atrial muscles causing them to contract. This contraction begins the atrial systolic period.

Atrial systole pumps the remaining 20% of blood into the ventricles before the ventricles contract. When the ventricles are fully filled with blood, the pressure within the chambers of the ventricles exceeds the atrial chambers. This produces the first heart sound which is the characteristic ‘LUB’ sound heard with the aid of stethoscope.

At this junction, the isovolumetric contraction phase begins and the volume of blood in the ventricle when it is fully filled with blood at the end of ventricular diastole is known as end diastolic volume.

During isovolumetric contraction phase, the ventricular muscle shortens and applies pressure on the volume of blood present within the ventricular chamber leading to increase in intraventricular pressure. When the pressure within the ventricles exceeds that within the pulmonary and aortic trunk, the pulmonary and aortic valves open (semilunar valves) and blood is ejected from the ventricles. This begins the ventricular ejection phase.

The ventricular systole begins during isovolumetric contraction phase and the ventricular ejection occurs simultaneously with artrial diastole. The ejection of blood from the heart is initiating rapid due to pressing build up and the initial inertia of blood flow. This however slows down as the pressure within the ventricles begins to fall. When the decline in pressure in the ventricles fall below that in the aortic and pulmonary trunk, the semilunar valves close in order prevent the backflow of blood. This produces the second heart sound which is the characteristic ‘DUB’ sound heard with the aid of a stethoscope,

The dicortic notch is a brief rise in aortic pressure caused by the backflow of blood rebounding to the semilunar valves.

The volume of blood left in the ventricle at the end of ventricular systole is referred to as end systolic volume.

Stroke volume is the volume of blood pump out of each ventricle per beta. It is a difference between the end diastolic volume and end systolic volume

At the end of ventricular systole, isovolumetric ventricular relaxation period begin and pressure within the ventricle begin to drop,.

When the drop in pressure is lower than that in the artrial the AV valves open and blood begins to enter or slow. This begins the ventricular diastole which coincide with midway into artial diastol