Sunday, December 6, 2009

Pregnancy changes them all- Stability, continence and breathing. The role of fascia in these changes.


(Figure 1)

Pregnancy & pelvic Girdle Pain (PGP):

Pregnancy-related pelvic girdle pain (PRPGP) has a prevalence of approximately 45% during pregnancy and 20-25% in the early postpartum period. Most women become pain free in the first 12 weeks after delivery, however, 5-7% do not.

Pregnancy & urinary incontinence (UI):

Wilson, Herbison, Glazener, McGee & MacArthur (2002): found that 45% of women experienced UI at 7 years postpartum and that 27% who were initially incontinent in the early postpartum period regained continence, while 31% who were continent became incontinent.

The abdominal canister (container) in pregnancy and delivery:

Muscles and fascia of the lumbopelvic region play a significant role in
a. musculoskeletal function
b. continence and
c. respiration
It seems that there is an existence of an interlinked trio of lumbopelvic pain, incontinence and breathing disorders.

Musculoskeletal loading & the interlinked trio: (see figure 1 above)
Synergistic function of all trunk muscles is required for loads to be transferred effectively through the lumbopelvic region during of varying load.

While transferring load, there must be a balance in controlling the movement, maintaining optimal joint axes, maintain sufficient intra-abdominal pressure without compromising the organs (preserve continence, prevent prolapse or herniation) and support efficient respiration.

Non-optimal strategies for posture, movement and/or breathing create failed load transfer which can lead to pain, incontinence and/or breathing disorders.

Individual or combined impairments in multiple systems including the articular, neural, myofascial and/or visceral can lead to non-optimal strategies during single or multiple tasks.

Which faults are encountered in pregnency
1. Trauma to the linea alba and endopelvic fascia produces a non-optimal strategies for load transfer.
2. Fascial changes also occurs secondary to altered breathing behaviour during pregnancy.

Reference(s):

1. Wilson, Herbison, Glazener, McGee & MacArthur (2002): Obstetric practice and urinary incontinence 5-7 years after delivery. ICS Proceedings of the Neurourology and Urodynamics, vol. 21(4), pp. 284-300.
2. Lee, Lee & McLaughlin: Stability, continence and breathing: the role of fascia following pregnancy and delivery. J Bodyw Mov Ther. 2008 Oct;12(4):333-48. Epub 2008 Jul 1.



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