POST NATAL EXERCISES

Post Natal exercises focus on strengthening of weak muscles which mainly includes

1. Pelvic floor muscles
2. Abdominals

Pelvic floor muscles
Strengthening of pelvic floor muscles is extremely important in the post partum phase as these muscles becomes lax and weak due to stretching with vaginal delievery.Their weakness can lead to leakage of urine with coughing or frequent urge to pass urine.

Kegel Exercises can be done for these muscles by squeezing the pelvic muscles as if trying to stop urine flow.The feeling is one of ‘squeeze and lift’. Hold it for 10seconds, release, rest for a few seconds and repeat 10 times. Practice it 3-5 times a day.

Avoid pulling in your tummy, squeezing your legs together, tightening your buttocks or holding your breath while doing kegel exercises.

Abdominals

Abdominal muscles like Rectus abdominis, Transverse abdominis and Obliques (External and Internal) also become lax after delivery. These needs to be strengthened for toning them up.
Following exercises can be one for this purpose.

1. Posterior Pelvic tilts- In crook lying position i. e. lying down with hip and knee flexed to 45 degrees and feet flat on the bed—Draw in your tummy and press lower part of your back into the bed to flatten your back. Hold this position for 5 -10 seconds, release and repeat 10 times.

2. Abdominal Curls- In crook lying position,lift your head and shoulders just to clear shoulder blades off the bed trying to reach towards your knees. Hold this position for 10 seconds, release and repeat 10 times.

3. Sit ups- This exercise can be done in advanced stages of strengthening.

4. Working for obliques- In crook lying position, lift your head and shoulders to reach with one hand towards opposite ankle. Repeat this with both sides.

5. One leg SLR( Straight Leg raising)-Raise between 30- 45 degrees for lower abdominals workout with other leg being flexed at hip and knee.

Note- Progression of these exercises must be guided by a Physical therapist depending on the the progress you have made.

Other important aspects-

1. Maintaining good posture is very important- keep your back straight, stand tall with tummy tucked in and relaxed knees. Use good body mechanics while bending and getting out of bed so as not to stress your back.
2. Continue with prenatal breathing exercises and foot and ankle movements to improve your circulation.
3. Hip adductors isometrics is also a good exercise.

Precautions
1.Consult with your doctor before starting any post natal exercise program. Every post natal exercise program vary depending on whether you have delivered vaginally or by C- section and how much you have recovered post delivery.
2.Stop exercise if it hurts, pains or if you are tired or unwell.
3.Keep yourself hydrated.

Therapeutic Modalities - ULTRASOUND

Ultrasound(US) is a sound wave that has a frequency greater than 20 KHz.
It is generated by applying an alternate current to a piezoelectric
crystal (found in the transducer in the sound head). This crystal
contracts and expands at the same frequency at which current changes
polarity. The sound field generated by this crystal in turn makes the
molecules in the sound field vibrate and oscillate.
The crystal commonly used in US units is synthetic plumbium
zirconium titanate (PZT), lead zerconate.

Therapeutic ultrasound has a frequency range of 0.75 and 5.0 MHz.
Most modalities have 1 MHz and 3 MHz sound head

Ultrasound energy is absorbed mostly in tissues with high collagen
content (bone, periosteum, cartilage, ligaments, capsules, tendons, fascia,
scar tissue and tissue interface i.e. bursa & synovium).


Physiological effects of Ultrasound:
1. Enhance inflammatory response and tissue repair
2. Heat soft tissue

Common uses for pulsed non-thermal ultrasound
· Facilitate healing in the inflammatory and proliferative phase
following soft tissue injury (tendonitis, bursitis, acute soft tissue
injuries)
· Bone healing

Common use for continuous ultrasound:
· Prior to stretching at tight structure (tendon, capsule, ligaments,
fascia, scar)
· Pain control in chronic pain
· Chronic inflammatory conditions

CONTRAIDICATIONS
· Undiagnosed pain
· Cancer
· Active tuberculosis
· Psoriasis
· Decreased circulation
· Infection
· Pregnancy
· Central nervous system tissue
· Joint cement (cannot use continuous mode, but may use pulsed
mode 50% or less)
· Plastic components
· Pacemakers
· Thrombophlebitis
· Uncontrolled bleeding or blood-thinning medication (coumadin)
· Eyes
· Reproductive organs
· Heart

PRECAUTIONS
· Acute inflammation (use non-thermal settings only)
· Epiphyseal plates (use pulsed, low intensity <0.5w/cm2)>

EXERCISES FOR TYPE 2 DIABETES MELLITUS

Type 2 diabetes is growing at an alarming rate. With so many prevalent risk factors and morbidity associated with type 2 diabetes, its essential to prevent it and retard its progression.

According to the relevant research done in the field of type 2 diabetes and exercises, its proven that physical activity or exercise is one such modality which can be helpful. The main hypothesis supporting the results is the increased uptake of glucose in muscles as a result of exercise.

Various types of exercises are advocated for the same which can be broadly categorized into two:
1.- Aerobic exercises in the form of walking- 90 minutes of moderate intensity walk per week is sufficient.
2.- Resistance exercises- With moderate amount of resistance involving the major muscle groups of the body.
For example,
-Biceps Curls
-Triceps Curls
-Front and Back lateral pull downs
-Hamstring curls
-Knee extension exercises
-Abdominal curls.
8-10 repetitions of each exercise 3 times per week is sufficient to achieve the desired effect.

The long term benefits of these exercises are as follows-

• Improved glucose tolerance
• Decreased level of fasting blood glucose and HbA1c levels
• Improved quality of life
• Increased muscle strength with resistance exercises
• Improved cardiovascular fitness
• Decreased morbidity associated with Type 2 diabetes
• Improved balance
  
• Improved lipid profile
• Improved resting blood pressure levels and heart rate
• Improved body composition- more of muscle mass and less of fat with resistance exercise

Precautions for doing exercise.

1. Get a resting ECG done
2. Take care of fasting blood glucose levels. Avoid exercise if its <70>250mg/dl
3. Avoid resistance training if hypertensive.
4. Avoid exercising the muscle in which insulin is being injected. Timing of injection and exercise has to be scheduled with help of your physician and physical therapist.
5. Avoid hypoglycemia.
6. Be aware of the signs and symptoms of hypoglycemia.
7. Keep an orange candy or juice handy.
8. Take care of your feet. Keep them clean and dry.
9. Maintain your hydration levels.
10. Incorporate a period of warm up and cool down in your exercise program.

NOTE: Consult your physician before embarking on any exercise program