Exercise therapy in gynecology and obstetrics

Therapeutic physical culture in obstetrics and gynecology practice used during pregnancy, childbirth, the postpartum period, as well as in the treatment of various gynecological diseases. The goals of exercise therapy are to influence the central mechanisms of neuroendocrine regulation, improve the general somatic condition of the body, strengthen muscles, normalize blood and lymph circulation, prevent postoperative complications, correct defects in the position of the uterus, and create a positive psycho-emotional state.

1. Pregnancy
2. Chronic inflammatory diseases.
3. Anomalies in the position of the female genital organs
4. Exercise therapy for urinary incontinence

Pregnancy

Exercise therapy during pregnancy, along with psychoprophylactic measures, is an essential component of a woman’s comprehensive preparation for childbirth. LH exercises help improve general metabolism, strengthen the muscles involved in labor, eliminate congestion and formations in the pelvis and lower extremities, and increase blood oxygenation. Physical exercises activate placental blood circulation, normalize the motor activity of the fetus, to a certain extent preventing and preventing incorrect positions and breech presentation. In a word, exercise therapy in obstetrics and gynecology allows you to achieve, with the help of special exercises, correction of the position of the fetus.

Physical therapy is prescribed to all women in the absence of complications and a mandatory condition for the normal course of pregnancy after doctor consultations from the moment they are registered until the moment of birth. Trainings are carried out mainly in a small group method (usually 6-8 people) 3 times a week (with a break per day). Duration of classes - from 20-30 to 45 minutes. Groups are formed according to the principle of homogeneity, including women with approximately the same gestational age and level of physical fitness. If there are complicating factors that are not contraindications, individual supervised sessions are conducted. LH procedures are best performed in the morning, no earlier than an hour after meals. It is important to create a favorable emotional background, therefore it is advisable to conduct group PH classes with musical accompaniment. The main forms of exercise therapy during pregnancy are morning hygienic gymnastics, exercise therapy, dosed walking, aerobics, exercises with a “Fit ball,” and physical exercises in water. Outdoor games, applied sports exercises, and hardening elements are widely used. Throughout pregnancy, preference should be given to dynamic exercises rather than static stress. Each set of LH exercises includes general strengthening, breathing and specialized exercises focused on the abdominal muscles, as well as the long back muscles - as the most important and main groups for a pregnant woman. Also, emphasis is placed on the muscular-ligamentous apparatus of the feet and on increasing the elasticity of the perineum. Much attention should be paid to learning correct breathing patterns, skills to relax certain specific muscle groups, and also to achieve complete relaxation. Select exercises that are simple in form and easy to perform at a slow pace that matches the rhythm of breathing. All exercise therapy exercises in obstetrics, especially for the lower extremities, are performed with large amplitude. The load should be such that the heart rate increases by no more than 10-15 beats per minute. When performing exercises, use a variety of starting positions - a) standing, b) sitting, c) standing on all fours, d) lying down. In the last months of pregnancy, most of the exercises are performed in a lying position. Lying face down is contraindicated throughout pregnancy. When completing physical exercise, as always, it is recommended to take a shower or dry off. In addition, daily (20-25-minute) strength exercises at home, as well as 1-2 hour light walking or/and swimming - 2-3 workouts per week - will not be superfluous.

In the first trimester Women need to develop the skill of regular exercise therapy. The LH complex includes dynamic exercises for the muscles of the upper and lower extremities, back, and relaxation exercises. Women are trained in abdominal and full breathing, combining and combining movements with breathing. All exercises that can cause sharp fluctuations and surges in intra-abdominal pressure and significant tension in the muscles of the frontal abdominal wall are excluded from the lesson. All movements are carried out at a slow and/or medium pace, keeping breathing calm and rhythmic.

In the second trimester prescribe exercises that increase mobility in the joints (mainly in the sacroiliac, as well as the hip), use training to develop strength qualities and muscle endurance with an emphasis on the muscles of the trunk and lower extremities, actively use exercises for stretching and relaxing muscles, as well as exercises to improve and increase blood and lymph circulation in the pelvic organ systems, and, of course, breathing exercises. Exercises with holding your breath, static load, or sudden muscle stretching should not be prescribed. By the end of the trimester, physical impact is reduced, more exercises are performed in a supine position, and only some of them are available with raised legs (use heels on the 3rd or 4th crossbar of a gymnastic wall bar).

In the third trimester physical activity is significantly reduced. Use simple, light exercises at a slow speed from the initial position lying on your side or sitting. The main attention is paid to learning and consolidating skills and abilities that are important for the correct course of labor: the ability to voluntarily relax some muscles while simultaneously tensing others, as well as continuous breathing with synchronized tension of the torso muscles. To correct walking, walking is recommended. Exercise therapy procedures are carried out with caution, exercises that increase intra-abdominal pressure are avoided.

Contraindications for exercise therapy during pregnancy are conditions requiring emergency surgical and obstetric care, severe toxicosis of pregnancy, ectopic pregnancy, habitual abortions, a history of stillbirths in mothers with a negative Rh factor, threatened miscarriage, divergence of the symphysis pubis, acute infectious and inflammatory diseases , low-grade fever of unknown etiology, acute and subacute thrombophlebitis, active phase of rheumatism, acute kidney and (or) bladder diseases, residual effects of inflammatory processes in the pelvis, decompensated diseases of the cardiovascular system, blood diseases, abdominal aortic aneurysm, as well as diseases liver in the active phase, epilepsy, glaucoma, threat of retinal detachment, severe prolapse of internal organs, cramping abdominal pain.

Therapeutic exercise applied in the postpartum period, is aimed at strengthening the muscles and ligaments of the abdominal press, pelvic floor, restoring normal topographic relationships and connections between the pelvic organs and the abdominal cavity. Physical exercise accelerates the involution of the uterus, improves lactation, eliminates congestion in the pelvic organ systems and limbs, and restores the function of the cardiorespiratory system and musculoskeletal system.

LH, in the absence of contraindications, after a relatively easy birth is prescribed on the 1st day (after 12-16 hours), and after difficult ones - on the 2nd day after birth. The main forms of exercise therapy in the postpartum period are UGG, LH, and independent exercises. The peculiarities of the technique are a gradual increase in load using general strengthening, specialized and breathing training. The first classes are carried out exclusively in a lying position with an emphasis on breathing exercises and arm training; starting from the 2-3rd day, use training for the legs, pelvic floor muscles and abs. From day 1, it is recommended to contract the rectal sphincter several times throughout the day (the so-called Kegel exercise). From the 4th day, the load gradually increases, the initial position and positions are lying on the stomach, standing on all fours, standing upright. In case of sutures in the perineal area, movements with abduction of the legs are excluded for 5-6 days, and in case of third-degree ruptures, LH is carried out according to the method for postoperative patients.

Upon discharge, the woman in labor is given instructions for carrying out a complex of therapeutic exercises at home. To restore the function of the abdominal, back and pelvic floor muscles, 2-3 months of daily LH exercises are sufficient. Walking is also recommended.

Exercise therapy in the postpartum period is contraindicated in acute thrombophlebitis, mastitis, endometritis, fever, postpartum hemorrhage, nephropathy and eclampsia during childbirth, third degree perineal rupture, progressive failure of various systems, postpartum psychosis, severe subcutaneous emphysema, severe, prolonged and debilitating labor, severe anemia due to blood loss during childbirth.

Chronic inflammatory diseases.

The use of physical therapy for chronic inflammatory diseases of the female genital organs is based on its ability to improve blood and lymph circulation, especially in the pelvic organs and systems, stretch adhesions and prevent their formation, accelerate the resorption of inflammatory formations, tone the muscular-ligamentous system of the abdominal press, as well as the pelvic floor. Exercise therapy in gynecology is carried out in the forms of UGG and LH. The starting positions must provide for vertical pressure relief: a) sitting on the floor, b) lying on your back, c) side, d) stomach, e) standing on all fours. Doctors have recommended thoracic and diaphragmatic breathing, training for the distal and proximal limbs, as well as for the hip and knee joints, exercises to strengthen the abductor and adductor muscles of the hips, various forms of walking (with high knees, squats, half-squats, straight leg swings) and etc.). If it is necessary to fix and strengthen the uterus in the correct position, positional treatment is used (lying on the stomach, knee-elbow, knee-wrist). Classes are conducted daily, first individually (10-15 minutes), then in a group method (20-25 minutes) under the control of pain, preventing pain from intensifying and exacerbating after LH classes. If pain occurs, the activity must be stopped.

Contraindications to prescribe exercise therapy: acute inflammatory process or exacerbation of a chronic one, encysted purulent processes, bleeding, phlebitis and thrombophlebitis in the blood vessels of the pelvic organs and lower extremities, acute pain that intensifies after movements. Classes are started in the subacute stage of the disease with normal or subfebrile temperature, no increase in the blood picture and severe pain in the area of ​​infiltration.

Anomalies in the position of the female genital organs

Therapeutic physical training for abnormal positions of the female genital organs in combination with gynecological massage, as well as physiotherapy, is most widely used for acquired forms of uterine retrodeviation, prolapse of the uterus and vagina. The main goals of physical therapy for abnormal positions of the uterus are considered to be:

1. ensuring proper blood circulation in the pelvic organs and systems,
2. strengthening and increasing the tone of the abdominal muscles, pelvic floor,
3. strengthening the ligamentous apparatus,
4. increased uterine mobility,
5. moving it to its normal position,
6. improvement of gastrointestinal tract function.

1. a) movement of internal organs upward,
2. b) relaxation of the abdominal wall,
3. c) changing intra-abdominal pressure and bringing the uterus to its normal position,
4. d) stretching of adhesions with fixed retroflexions.

From these starting positions, various exercises are performed with movements of the torso and lower extremities. Lying horizontally on your back is contraindicated. Physical therapy classes also include weight-bearing exercises using a “Fit ball,” swimming, elements of various sports games, and light, measured walking.

Exercise therapy for prolapse of internal organs serves main treatment. LH is especially effective for grades I and II of prolapse, and for the rest it is considered as an obligatory component of the pre- and postoperative treatment periods.

Are used starting points, contributing to the normalization of the position of the uterus:

1. a) lying on your back,
2. b) side
3. in a stomach.

From special exercises To strengthen the muscle groups of the pelvic floor, the following are used: retraction of the anus for 3-7 seconds with simultaneous isotonic tension of the gluteal and adductor muscles of the thigh, retraction of the anus in combination with various gymnastic exercises. General strengthening exercises should not cause strengthening and contribute to the prolapse of internal organs; it is for this reason that jumping, skipping, and running are excluded. LH is carried out 1.5-2 hours after the end of physiotherapeutic procedures and gynecological massage with the bladder and rectum emptied. The duration of the procedures is 40-50 minutes.

Treatment of prolapses should be long-term, since its effect often occurs only after 5-6 months of regular training.

Exercise therapy for urinary incontinence

Therapeutic exercises stimulate compensatory reactions of the closure apparatus of the bladder and urethra, improve trophism of the pelvic organs, strengthen the muscular-ligamentous apparatus, have a general strengthening effect on the body, and contribute to the destruction of the pathological dominant in the subcortex of the brain. In PH classes, focused on ailments of urinary incontinence, special attention is paid to special dynamic exercises and isometric stresses for:

1. muscles of the perineum,
2. pelvis,
3. backs,
4. belly,
5. gluteal region.

Isometric stress performed with maximum intensity 6-7 times for 2-7 seconds, alternating with voluntary muscle relaxation and breathing exercises. For training the strength of the adductor muscles of the hips in exercise therapy complexes for urinary incontinence

They use walking, the so-called cross step, as well as walking while holding a medicine ball between the knees, all kinds of exercises with resistance, and others. During the classes, running, jumping, straining, holding your breath, and variations of the starting positions lying on your stomach are excluded. Classes are held initially 3 times a week, and then daily, lasting from 20 to 50 minutes at a density of 60-80%, preferably with musical accompaniment. The course of treatment is at least 4-6 months of regular classes.