Monday, January 27, 2014

Post Natal Injury Prevention

Common complaints for new mothers include lower back strain, shoulder and neck and arm pain, and headaches. The good news is that all of these conditions are preventable. The aim of this article is to help you to understand the cause of these symptoms and how to prevent them. Following are some tips on posture and correct lifting techniques, along with some preventative exercises.

It is important to remember that all exercises should be absolutely pain free. If you experience any pain while attempting them stop immediately. The chances are that you need some treatment so do not attempt the exercise again until you have sought medical advice.

Injury Prevention

The time you are most susceptible to back injury in particular, is in the weeks following the birth. The abdominal and pelvic muscles and ligaments are stretched and weak, dramatically reducing the core stability that protects your back as you repeatedly bend to lift your babies and toddlers, and go about your normal household chores.

The first thing you need to learn is how to contract your pelvic floor and abdominal muscles before you lift your child, and keep them contracted as you lift and while you are carrying them. Strengthening these muscles will protect your back and reduce the incidence of bladder problems.

The Exercises

You can do these standing, sitting or lying down, or even as you walk. You will probably remember the pelvic floor exercises from post natal care at hospital. These are the muscles which prevent the flow of urine. Squeeze these muscles now so that you can feel the contraction internally. Try and hold them in contraction for as long as possible. It is not uncommon for you to have difficulty feeling this contraction soon after birth, but it is very important that you keep trying. At first they may feel very weak and you may only be able to hold the contraction for a few seconds. Work up to holding for a full minute, this may take several weeks to accomplish. Practice the exercise several times a day.

The next stage is to begin to increase your awareness of the interaction between the internal pelvic floor muscles and the abdominal muscles. Again contract internally and keeping those muscles tight, move your focus to the area between your pubic bone and navel. Slowly contract this area until you feel your naval sink towards your spine and your waist get smaller. This is called "bracing".

In the weeks and months following the birth it is absolutely essential that you practice this exercise several times a day. I suggest you try to build to 10 in a row. These are the muscles that you should contract before you attempt any activity which requires bending or lifting.

A major cause of back pain is incorrect lifting techniques of your baby.
Next time you go to lift your baby out of the cot, notice your posture; if your feet are close together you will be forced to lean over more to reach the baby, your arms will be stretched away from your body, and as you lift your wriggling infant, you will put enormous strain on your back. Take time to notice if you are twisting from the hips too - this will cause pain in the muscle between your hip and ribs. Notice your head and neck, there should be no tilting or rotating of your head as this will lead to neck pain and headaches.

Correct lifting techniques

Taking the baby from the cot

Before you attempt to lift your infant from the cot, spread your legs and feet wide, with hips and knees slightly flexed, as though you are sitting astride a horse. Have your thighs leaning against the edge of the cot. Brace your abdominal muscles as above, and lower your self by bending your legs so that you are closer to the baby. As you take hold of him, draw him closer to you without lifting him, until your arms are close to your trunk. Now make sure the abdominal muscles are braced, and gently lift and draw the baby to your body, using your legs not your back to straighten up.

Lifting toddlers

Always bend at the knee, get down to their level, brace abdominals, and draw the child in close to your body, then lift with your legs. Lifting toddlers in and out of cars usually requires some incredible contortions. You can reduce the risk of injury by keeping your legs bent, back straight and your head, arms hips and feet all pointing in the same direction. Try and keep the child's body as close to yours as possible and manoeuvre yourself as close to the child seat as possible before placing them in it.

Neck and Arm Pain

You may have experienced a strange discomfort, ranging from a toothache like pain in your arm, to tingling, numbness or weakness. This can come from a combination of poor lifting techniques, and your posture while breast feeding.

Once again, notice your posture while you are feeding the baby. Tension in your neck and shoulders may be from supporting the weight of the infant, and a tend to tilt your head as you watch it suckle. This distorted position is going to lead to muscle strain. Nerve impingement may arise from muscle and connective tissue placing pressure on the nerve, or from mal-alignment of the skeleton, and this can give rise to the arm pain and other symptoms I have mentioned. If you do have any of these symptoms, then you should seek treatment to avoid more serious injury.

To prevent these injuries, you need to experiment with the way you support the infant. Try placing them on an extra pillow so that you are not supporting their weight, and once they are settled, avoid prolonged tilting and rotation of your neck.

Exercises for upper back and shoulder tension
First, take a look at your posture. Stand in front of a mirror, try to stand as you would normally. Ideally your shoulders should be relaxed and not elevated. The rounded tops of your arm (humerus) should be sitting level and not forward of your collar bone. Your palms should facing the side of your thigh, with your thumbs approximately in line with the seam of your pants or skirt.

Its very rare that I see this ideal posture, so lets assume that you are perfectly normal and could do with some help in this department!

Shoulder Rolls

Stay in front of the mirror.

1. Bring your shoulders up towards your ears, as high as you can. Remember this
should be pain free.

2. Next squeeze your shoulder blades back as though you are trying to get them to

3. The next step is vital; relax your shoulders and imagine your shoulder blades
gradually sliding down your ribs. Let gravity do the work. Watch the top of your shoulders in the mirror, you should see that they are totally relaxed. Don't be tempted to use these muscles to push the shoulders down.

4. Once the shoulder blades are relaxed into place, imagine that you are now going to take them as far apart as possible, look in the mirror again. The movement must come from the shoulder blades, not from the arms, and again, the upper shoulders must be relaxed and not lifting. As you separate the shoulder blades, arch your mid to upper back, imagine lifting this section of your spine back and up, until you feel a good stretch between the shoulder blades. If you like you can hold this position for 30 secs.

That completes one full shoulder roll, now you can start over again, repeat a minimum of six repetitions several times a day.

Posture Correction Exercise for the Neck and Shoulders

This involves the first three steps of the shoulder rolls.

1. Once again raise your shoulders towards your ears.

2. Squeeze shoulder blades back, and relax.

3. Allow the shoulder blades to slide down the ribs into a resting position. This time, keep them in that position, that is, don't let your shoulder roll forward.

Now you will probably feel like your neck is hanging forward, so let it relax back onto its new center of gravity. You will also feel like you are sticking your chest out. This is probably because the pectoral muscles are tight. Check that you are not sticking your tummy out, if you are, relax your pelvis and spine. This should reduce the any tension in your back, and to some extent, your chest. It will take a while for this new posture to feel normal. What you should feel is reduced tension in your neck and upper shoulder, while the muscles between your shoulder blades should be gently contracted. This too will feel unnatural for a while, as these muscles are unused to working for a living!

When you should seek advice

I believe in the old adage that prevention is better than cure. This information is designed to help you to maintain a pain free status. If you are already in pain or discomfort then you may need to seek treatment. Most people put up with pain for too long, in the belief it will go away. In reality, the longer you have had pain, the longer it will take to resolve. As a rough guide, if pain persists, worsens or recurs after 3 days then it is advisable to seek treatment, to prevent the condition from becoming chronic. Remember that pain killers treat the symptoms not the cause of pain. Persistent symptoms need to be investigated. Most muscular pain is easily remedied by remedial massage, but it is a good idea to speak to your doctor first.

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