Women's Health in P.

T Problem solving

Problem: weak abdominal muscles, bad posture, shallow breathing,

difficult labor.

Occurrence: during labor, during puerperium, sedentary life and after

surgeries.

Solution: abdominal exercises.

Abdominal Exercises
Functions of the abdominal muscles:

They help in respiration and defecation.

They protect the abdominal viscera and keep them in their position.

They concern with forward flexion of the trunk.

They play an important role in labor, since they assist uterus with other
muscles during expulsion of the fetus.

They assist in maintaining a good erect posture.

They stabilize pelvis (especially rectus abdominis) during straight leg

raising.

Values of abdominal exercises:

They keep abdominal muscles in a good healthy condition.

They make abdominal muscles very strong.

They help to maintain a good posture and prevent postural problems.

They assist excretory functions.

They make abdominal muscles so efficient during labor.

They improve breathing

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Women's Health in P.T Problem solving

Testing the strength of the abdominal muscles

I-Subjective methods.

A) Rectus Diastasis Test

This test can be done by the patient herself or by the therapist.

Position of the patient Crock lying position.

Position of the Stride standing position at the level of the waist
therapist line with the four fingers are fitted vertically
across the linea alba between xiphoid process
and umbilicus.
Procedure The mother is asked to raise her head and
shoulders off from the plinth until the spines of
the scapulae left the plinth while the therapist
measures for diastasis by turning her fingers
horizontally across the linea alba between
xiphoid process and umbilicus to determine how
many fingers fit into the space between the
borders of the two rectal bellies.

B) Abdominal girth measurement

Here, the abdominal circumferences at the umbilical level is measured by

using tape measurement. The difference on tape measurement before and
after performing the strengthening exercises indicates more muscular
strength.

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Women's Health in P.T Problem solving

C) Testing the efficiency of the abdominal muscles (2 steps)

1st step (From supine to sitting)

Position of Supine lying position

the patient
Position of The therapist is standing beside the patient, fitting 4
the fingers vertically between the two recti.
therapist
Command Ask the mother to raise trunk until sitting position (about
50°flexion of the trunk) while the therapist turning her
four fingers inward to detect the amount of separation
between two recti.
What 1-The amount of separation between the 2 recti.
should the 2-The behavior of the lumbar spine.
therapist 3-The behavior of the pelvis
notice
Precautions -Legs should not be fixed to avoid the action of the hip
flexors.
-Not to raise trunk more than 50° because after that hip
flexors come into action.
Possibilities 1st possibility 2nd possibility 3rd possibility
The 2 recti and The 2 recti only The 2 recti and
obliques are very weak. obliques are
strong. *Slight separation weak.
*There is no between the 2 *she initiate
separation recti. movement rapidly
between the 2 *Insufficient or fix and support
recti. rocking of the lower limbs, so
*The pelvis is pelvis upward and initiate movement
sufficiently back ward. by hip flexors.
rocked up ward *Incomplete *Great separation
and back ward. flatting in the between the 2
*There is lumbar region. recti.
complete flatting *pelvic rocking of
in the lumbar the pelvis
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Women's Health in P.T Problem solving

region. downward and

forward.
*↑ Lumbar
lordosis.
N.B If there is shortening in the hamstring muscles, change
the starting position of the patient from supine lying to
crock lying position.
nd
2 step (double straight leg raising)

Command Ask the patient to make double straight leg raising, while
the therapist is observing the lumbar region and the pelvis.
Possibilities 1st possibility 2nd possibility
If the abdominal muscles If the abdominal muscles
are very strong so, the are weak so, there is
lumbar region will be hyperextension in the
completely flatten and the lumbar region and the pelvis
pelvis is sufficiently rocked is not sufficiently rocked
upward and backward. upward and backward.

II-objective method

The electrical activities of the abdominal musculature can be recorded by

electromyogram (EMG) bio feedback to indicate the muscular strength
before and after performing the strengthening exercises.

Types of the abdominal exercises

I-Static abdominal exercises.

II-Dynamic abdominal exercises.

Static abdominal exercises

Position of Crock lying position

the patient
Position of Stride standing beside the patient, with the inner hand under
the the lumbar region of the patient while outer hand above the
therapist abdomen at the level of waist line.
Command Contract abdominal muscles firmly and press lumbar region
down, hold then relax.

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Women's Health in P.T Problem solving

N.B.

Static abdominal contraction can be done through diaphragmatic

breathing position of the patient and the therapist the same as in static
abdominal exercise.
Command: Take deep breathing from the nose make abdomen like a
balloon then expire the air from the mouth, contract abdominal muscles,
press lumbar region down, hold then relax.

Dynamic abdominal exercises

*This exercise is Very effective to strengthen quadratus lumborum muscles

*The leg which perform the exercise should be maintained extended,
*static abdominal contraction must precede and maintain during performing
the exercises.
Position of Half crock lying position.
the patient
Position of Stride standing with the outer hand is holding the straight leg just
the above ankle joint, while inner hand supporting posterolateral
therapist aspect of the knee and the thumb just above knee joint to prevent
its flexion during movement.
Command Contract abdominal muscles, draw the straight leg up towards the
ribs to seem shorter then push down to seem longer, relax and
return to starting position.

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Women's Health in P.T Problem solving

Command stride standing position: Asking the mother to contract her

from abdominal muscles, then perform alternate raising of the right
different then left leg up several times and relax.
positions Sitting on stool with whole body supported on out stretched
arms while the lower limb keeps flexion of the hip, knee joints
and the foot supported on the ground in spite of the other
lower limb extended with the heel rested on the ground:
Asking the mother to contract her abdominal muscles, draw the
straight leg up towards the ribs to seem shorter then push down to
seem longer, relax and return to starting position.
Prone kneeling position with one leg stretched straight behind
and the toes of the straight leg touching the edge plinth (i.e.
toes on the edge of the plinth):
The same order as in sitting.

*This exercise is Very effective to strengthen the internal oblique muscles.

Position of Crock, supine, stride sitting, stride standing positions.
the patient
Command From crock or supine lying position:
from Contract abdominal muscles, try to touch with the tips of fingers
different farthest point on your leg with the head follow the movement
positions and eyes look behind the shoulder, hold and relax.
From sitting position:
Contract abdominal muscles, try to touch ground by your fingers
with the eyes should look behind the shoulder to avoid leaning
forward of the trunk, hold then relax.
From standing position:
Contract abdominal muscles, try to touch by your fingers the
farthest your leg with eyes looked behind the shoulder, hold and
relax.
Progression To make this exercise so difficult ask the patient to perform it
from side lying position.

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Women's Health in P.T Problem solving

Lateral flexion of trunk from crock lying position

*This exercise is Very effective to strengthen external oblique muscles.

(a)
Position of crock lying position.
the patient
Grasp Inner hand of the therapist on the lateral aspect of the knee joint,
just to guide the movement and to give slight pressure to
complete the range of motion and the other hand around the
ankle joint.
Command Contract abdominal muscles, try to touch the plinth with flexed
knees, hold and relax.
)B) to make this exercise more difficult
Position of Half crock lying position
the patient
Grasp Therapist outer hand holding the leg just above the ankle joint
while inner hand on the lateral aspect of the knee joint.
Precautions 1-Contraction of the abdominal muscles must be maintained all
through the exercise.
2-Shoulders should be fixed on the bed all through the exercise.

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Women's Health in P.T Problem solving

Abdominal muscles as pelvic rotators from crock lying

*This exercise is Very effective to strengthen the oblique muscles.

(a)
Position of Stride sitting on stool or stride standing with the hands around
the patient the waist.
Command With maintaining pelvis fixed forward, contract abdominal
muscles, turn upper trunk to the right side as far as you can and
let your head and eyes follow the movement, hold and relax.
Repeat the same exercise to the left side.
)b)
Position of Prone kneeling position.
the patient
Command Swing arm under trunk till make tips of the fingers facing the
ceiling, then ask the patient to contract abdominal muscles,
swing arm till doing abduction of the arm till fingers facing
ceiling, hold then relax, return to the starting position.
)c)
Position of Crock lying position
the patient
command Contract abdominal muscles, try to touch the left knee with the
right hand, hold and relax. Repeat the same exercise for the
opposite side.

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Women's Health in P.T Problem solving

*This exercise is Very effective to strengthen the rectus abdominis muscles.

(a)
Position of crock or supine lying position.
the patient
Command 1-Contract abdominal muscles, raise the head and look to the
feet, hold and relax.
2- Contract abdominal muscles, raise the head, the shoulders and
look to the feet, hold and relax.
3- Contract abdominal muscles, raise the head, the shoulders,
upper trunk and look to the feet, hold and relax.
4- Contract abdominal muscles, raise the head, the shoulders,
upper trunk and come to sitting position with both arms stretched
out in front, hold and relax.
5- Contract abdominal muscles, raise the head, the shoulders,
upper trunk and come to sitting position with both arms stretched
out beside the body, hold and relax.
6- Contract abdominal muscles, raise the head, the shoulders,
upper trunk and come to sitting position with both arms crossed
in front of the chest, hold and relax.
7- Contract abdominal muscles, raise the head, the shoulders,
upper trunk and come to sitting position with both arms crossed
behind the head, hold and relax.

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