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Pregnancy related LBP - management, Hx, red flags etc
This is a draft cheat sheet. It is a work in progress and is not finished yet.
PRLBP
- Affects up to 80% of pregnant women |
- High recurrence rate |
- Functional stress (weight gain, gait changes, postural strains due to ligamentous laxity) |
- Anterior pelvic tilt and lx hyperlordosis - strain on ligaments, discs, lx facets and SI joints |
- Abdo muscles stretched |
- Hormone relaxin (released by ovaries) |
- Usually starts at the 5th and 7th Month and sometimes the 1st trimester |
Presentation
- LS pain which radiates to buttock and posterior thigh |
- Provoked by standing, sitting, coughing, sneezing, straining |
- Gets worst at the end of the day sometimes night pain |
Red Flags
- Lightheadness |
- SOB |
- Chest pain |
- Headache |
- Calf pain/swelling |
- Decreased fetal movement |
- Neuro involvement |
- Fever |
- Chills |
- Bleeding |
- Spotting |
- Unusual discharge |
- Cramping |
- High blood pressure |
- Sudden onset pelvic pain |
PE
+ve SI tests (distraction, thigh thrust, compression, sacral thrust) |
+ve ASLR |
+ve Gaeslens |
+ve Kemps |
- +ve Thomas test (pelvic anteversion = tight iliopsoas) |
DDx
- Lx segemental joint dysfunction |
- SI joint dysfunction |
- Lx facet syndrome |
- LS strain/sprain |
- Lx disc |
- Degeneration |
- Lx instability |
- Hip pathology |
- F# |
- Infection |
- Neoplasm |
- Diastasis rectus abdominis |
Management
- Education and reassurance |
- SMT |
- PIR of tight muscles (piri and iliopsoas) |
- Exercises (pelvic tilts, knee to chest, sciatic nerve floss, hammy stretches, kegel exercises, stability exercises of gluts, QL, abdominal wall and intrinsic spine muscles |
- Gentle aerobic exercises (water aerobics and yoga) |
- Round ligament STW (gentle release) |
- Advice (take frequent breaks from sitting/standing, small footstool, sleeping with pilllow between knees whilst side lying) |
- SI/pregnancy support belt |
- Pelvic floor strengthening |
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