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Pregnancy Symptoms First Trimester Nausea Frequent urination – initially hormonal, later pressure Constipation – hormonal Low Blood Pressure – hormonal Breast enlargement Musculoskeletal changes – relaxin increases elasticity in joints capsules, ligaments, fascia – pelvic, SI joints, ankles, knees affected most Mood – fatigue, anxiety Second Trimester Edema – legs especially Hypertension Supine hypotension – compression of aorta and IVC Shortness of breath Back pain – stretched ligaments and tendons of pelvis and lumbar spine, ribs flare out, muscles spasms to support laxity in ligaments, postural changes – hyperlordosis and hyperkyphosis – abd muscles stretches and not supporting low back anymore, excessive weight gain, shoes, previous injuries become re-activated Abdominal pain – stretching of ligaments ie. round ligament of uterus/groin, stretching of abdominal muscles, linea alba, may lead to diastasis recti Diastasis symphysis pubis – pubic and inner thigh pain due to separation of pubic symphysis Varicose veins – Hemorrhoids Pigmentation Stretch marks Other – headaches, migraines, nosebleeds…. Emotional changes Third Trimester Gestational diabetes Ketoacidosis Edema – legs, hands, fingers, face Compression Syndromes – TOS, CTS, sciatic, piriformis – lead to muscles tension and TPs Back pain Sacroiliac pain Leg cramps Pelvic discomfort – softening ligaments, pressure from head of baby on pelvis or nerves Costal margin pain Frequent urination Fatigue Insomnia and restlessness Emotional changes Postpartum Physical changes – unstable joints, severe back pain, shoulder pain, poor posture with breast feeding Post-surgical recovery Breast pain Emotional changes – depression Contraindications for Massage Therapy Essential oils – may induce uterine contractions Abdominal and sacral massage – use caution or avoid in first trimester Deep massage over low back in first trimester Caution with abdominal massage throughout whole pregnancy Avoid aggressive joint play Avoid deep pressure over varicose veins Avoid massage if blood pressure unstable Use caution with diabetes – encourage eating prior to and after treatment Alter position as necessary – seated or sidelying, supine Modify if client experiences heartburn Health History Questions General health status Any health conditions posing risk to the pregnancy Stage of pregnancy Previous pregnancies? Complications? Family history of complications? Current symptoms Blood pressure Be aware of serious symptoms where immediate medical attention is needed: Bleeding Severe abdominal pain Water breaking Pre-eclampsia signs – vision changes, BP, severe headache Swelling in hands Upper right abdominal pain Massage Treatment Goal – relaxation, reduce MSK discomfort Hydrotherapy Warm foot bath Heat for hypertonic muscles Cold to feet and legs to reduce edema Cold to breasts to decrease pain Essential oils only after first 4 months First Trimester Prone, supine or sidelying Relaxation massage, focus on discomfort areas Abdomen, low back, sacrum – gentle massage (stroking or petrissage) or avoid these areas Second and Third Trimesters Goal – reduce pain and postural discomforts Sidelying, seated, supine Reduce trigger points, spasm, hypertonicity of low back, gluts Address hyperlordosis and hyperkyphosis muscles Treat nerve compression – treat hypertonicity and edema Treat breast congestion with cold and drainage techniques Left sidelying may be most comfortable Supine hypotension may occur – raising right hip may help Reduce time spent supine in final couple months or use extra pillows Hyperlordosis – treat QLs and erectors, iliac crest to relax obliques Intercostals, serratus anterior, lats Hyperkyphosis – upper back, anterior chest, lateral neck, fascial techniques Upper traps, scalenes Subscapularis, infraspinatus, teres major, teres minor, supraspinatus, levator, rhomboids, middle traps, serratus posterior superior Don’t stretch overstretched, fatigued hyperkyphotic rhomboids and middle traps Gluts, piriformis, SI joint, greater trochanter Fascial work and PIR for adductors and gluts Long circulatory strokes and lymphatic drainage on legs Foot massage if pes planus present Stretch neck, pecs Abdominal massage helps constipation, relaxation Passive ROM, gentle joint play mobilizations to GH joint, SI joint, spine Self-Care Relaxation exercises, diaphragmatic breathing Self massage – costal border, abdominal attachments at pubis ROM of ankle and feet for leg cramps Care for varicose veins – avoid standing still and crossing legs, elevate, PROM Mild to moderate exercise – walking, swimming Stretch scalenes, scapular muscles, shoulder internal rotators, levator scapula, hip adductors plantar flexors – to balance postural imbalances pre and post birth Strengthen neck flexors, shoulder extensors, external rotators, scapular retractors, depressors, hip extensors, knee extensors, dorsiflexors Self-Care after delivery Exercises to restore postural alignment Hydrotherapy for inflamed muscles Relaxation