6.3 Gastrointestinal and reproductive systems

Achievable NPTE-PTA

6. Other system

Our NPTE-PTA course is now in "early access" - get 50% off for a limited time.

Gastrointestinal and reproductive systems

8 min read

Font

Discuss

Feedback

PTA role reminder: Across every system in this chapter, the PTA’s job is to carry out the plan of care the supervising PT has already established - not to diagnose a condition or change the plan. That means monitoring for the signs and adverse responses described below, collecting objective data, and reporting significant changes to the PT rather than modifying the intervention yourself.

Common gastrointestinal tests

Gastroesophageal reflux disease (GERD)

Description: Backflow of stomach acid into the esophagus due to a weakened lower esophageal sphincter
Symptoms: Heartburn, regurgitation, chest pain, difficulty swallowing
PT implications: Avoid exercises that increase intra-abdominal pressure; encourage upright positions after eating

Peptic ulcer disease (PUD)

Description: Open sores in the stomach or duodenal lining, often caused by H. pylori infection or NSAIDs
Symptoms: Epigastric pain, nausea, bloating, bloody stool (if severe)
PT implications: Monitor for signs of GI bleeding (dark stool, fatigue, pallor)

Irritable bowel syndrome (IBS)

Description: Functional GI disorder with chronic abdominal pain and altered bowel habits (diarrhea, constipation, or both)
Symptoms: Cramping, bloating, diarrhea, constipation, mucus in stool
PT implications: Stress management, exercise to regulate bowel motility

Crohn’s disease

Description: Chronic inflammation of any part of the GI tract, often the small intestine
Symptoms: Abdominal pain, diarrhea, weight loss, fatigue, malnutrition
PT implications: Address fatigue, joint pain, and osteoporosis risks due to long-term steroid usage for disease management.

Ulcerative colitis

Description: Chronic inflammation and ulcers in the colon and rectum
Symptoms: Bloody diarrhea, urgency, abdominal cramping, weight loss
PT implications: Monitor for dehydration, anemia, and musculoskeletal complications

Diverticulitis

Description: Infection or inflammation of diverticula (pouches in the colon wall)
Symptoms: Lower left quadrant pain, fever, nausea, bowel habit changes
PT implications: Avoid increased intra-abdominal pressure (e.g., Valsalva maneuver)

Celiac disease

Description: Autoimmune disorder triggered by gluten, leading to villous atrophy in the small intestine
Symptoms: Malabsorption, diarrhea, bloating, fatigue, weight loss
PT implications: Monitor for signs of malnutrition, osteoporosis, and neurological symptoms (tingling, numbness)

Hepatitis (A, B, C, D, E)

Description: Inflammation of the liver, often viral
Symptoms: Jaundice, fatigue, dark urine, nausea, right upper quadrant pain
PT implications: Energy conservation techniques, avoid strenuous exercise during active infection

Cirrhosis

Description: Chronic liver disease with fibrosis and impaired liver function
Symptoms: Jaundice, ascites, hepatomegaly, fatigue, confusion (hepatic encephalopathy)
PT implications: Watch for bruising, bleeding, and fall risk due to balance deficits

Pancreatitis

Description: Inflammation of the pancreas, often due to gallstones or alcohol abuse
Symptoms: Severe epigastric pain radiating to the back, nausea, vomiting
PT implications: Monitor for signs of multi-organ failure, avoid activities that increase abdominal pressure

When to stop and notify the PT: New or worsening abdominal pain or signs of GI bleeding (dark or bloody stool, unexplained fatigue, pallor) are reasons to stop the current activity and notify the supervising PT - not signs to work through.

Key referred pain sites

Key clinical patterns

Peptic ulcers → Epigastric pain that may radiate to the back
Pancreatitis → Pain in the mid-back and left shoulder
Gallbladder issues (cholecystitis, gallstones) → Right shoulder, right upper quadrant pain, worsens after fatty meals
Appendicitis → Periumbilical pain progressing to the right lower quadrant (McBurney’s point)
Hepatic (liver) issues → Right upper quadrant pain, right shoulder pain, jaundice may be present
Esophagus → mid chest, mid-back
Stomach → epigastric region, left upper quadrant, mid-back
Small intestine → periumbilical region
Large intestine → lower abdomen, sacral region
Rectum → sacral region, perineum

Reproductive system

Male reproductive system

Anatomy and physiology

Primary structures: Testes, epididymis, vas deferens, seminal vesicles, prostate gland, urethra, and penis
Function: Produces sperm and male sex hormones (testosterone)
Hormonal regulation:
- Hypothalamus → Gonadotropin-releasing hormone (GnRH)
- Pituitary → Luteinizing hormone (LH) & Follicle-stimulating hormone (FSH)
  - LH stimulates testosterone production in the testes.
  - FSH supports spermatogenesis

Definitions

Testosterone: Steroid hormone that drives male secondary sexual characteristics. It’s produced mainly by the testes (Leydig cells) in males, and in smaller amounts by the ovaries and adrenal cortex in females.
Gonadotropin-releasing hormone: Hormone produced in the hypothalamus that stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which in turn regulate the function of the gonads (testes and ovaries).
Luteinizing hormone: Hormone secreted by the anterior pituitary; in males it stimulates testosterone production in the testes, and in females it triggers ovulation and stimulates estrogen and progesterone production.
Follicle-stimulating hormone: Stimulates egg production in females, regulates the menstrual cycle, and supports sperm production in males.

Common male reproductive disorders

Benign prostatic hyperplasia (BPH)

Non-cancerous enlargement of the prostate
Symptoms: Urinary frequency, nocturia, weak stream, incomplete bladder emptying
Treatment: Medications (alpha-blockers), surgery if severe

Prostatitis

Inflammation of the prostate, often bacterial
Symptoms: Painful urination, pelvic pain, flu-like symptoms
Treatment: Antibiotics, anti-inflammatories

Prostate cancer

Most common cancer in men
Symptoms: Often asymptomatic early, later include urinary dysfunction and bone pain (metastasis)
Treatment: Surgery, radiation, hormone therapy

Erectile dysfunction

Inability to achieve/maintain an erection
Causes: Vascular disease, diabetes, psychological factors
Treatment: Medications, lifestyle modifications

Testicular cancer

Most common in men 15-35 years
Symptoms: Painless testicular lump, swelling
Treatment: Surgery (orchiectomy), chemotherapy, radiation

Female reproductive system

Anatomy and physiology

Primary structures: Ovaries, fallopian tubes, uterus, cervix, vagina, external genitalia
Function: Produces eggs, sex hormones (estrogen, progesterone), and supports fetal development during pregnancy
Hormonal regulation:
- Hypothalamus → Gonadotropin-releasing hormone (GnRH)
- Pituitary → Luteinizing hormone (LH) & Follicle-stimulating hormone (FSH)
  - LH regulates the menstrual cycle, triggers ovulation, and stimulates the ovaries to produce essential steroid hormones like estrogen and progesterone.
  - FSH stimulates the ovaries to grow follicles and mature eggs each month.

Definitions

Estrogen: Any of a group of steroid hormones that promote the development and maintenance of female characteristics of the body.
Progesterone: Steroid hormone released by the corpus luteum that stimulates the uterus to prepare for pregnancy.

Common female reproductive disorders

Polycystic ovarian syndrome (PCOS)

Hormonal disorder causing irregular ovulation, excess androgens, and ovarian cysts
Symptoms: Irregular periods, infertility, insulin resistance, and hirsutism, a condition characterized by excessive hair growth in women in a male-pattern distribution.
Treatment: Hormonal therapy, weight management, insulin sensitizers

Endometriosis

Growth of endometrial tissue outside the uterus
Symptoms: Pelvic pain, dysmenorrhea, infertility
Treatment: Pain management, hormonal therapy, surgery

Uterine fibroids

Non-cancerous tumors of the uterus
Symptoms: Heavy menstrual bleeding, pelvic pain, infertility
Treatment: Hormonal therapy, surgery (hysterectomy, myomectomy)

Pelvic inflammatory disease (PID)

Infection of the female reproductive organs (often due to sexually transmitted diseases)
Symptoms: Pelvic pain, fever, abnormal vaginal discharge
Treatment: Antibiotics, hospitalization if severe

Ovarian cancer

Often detected late because early symptoms are vague and nonspecific
Symptoms: Abdominal bloating, pelvic pain, urinary urgency
Treatment: Surgery, chemotherapy

Breast cancer

Most common cancer in women
Risk factors: Family history, hormone exposure
Symptoms: Lump, nipple changes, skin dimpling
Treatment: Surgery, chemotherapy, radiation, hormone therapy

Pregnancy considerations for physical therapy

Physiological changes during pregnancy

Musculoskeletal changes

Increased lumbar lordosis and anterior pelvic tilt → low back pain
Increased ligamentous laxity due to Relaxin hormone → joint instability, risk of injury
Widening of the pelvis → sacroiliac (SI) joint pain, pubic symphysis dysfunction
Diastasis recti (separation of the rectus abdominis)

Definitions

Relaxin hormone: Hormone, primarily associated with pregnancy, that loosens ligaments and softens the cervix, preparing the body for childbirth.

Cardiovascular changes

Increased blood volume (40-50%) and heart rate
Decreased blood pressure in the first and second trimesters (due to vasodilation)
Risk of supine hypotensive syndrome (compression of the inferior vena cava)

Respiratory changes

Increased oxygen consumption
Decreased lung expansion due to elevated diaphragm → shortness of breath

Metabolic changes

Increased caloric demands.
Gestational diabetes risk due to insulin resistance.

Other changes

Increased urinary frequency due to bladder compression
Weight gain (25-35 lbs is the normal range)
Hormonal changes (progesterone, estrogen, relaxin) affect mood, joints, and metabolism
De Quervain’s and carpal tunnel syndrome can both occur during pregnancy due to hormonal changes and fluid retention, which increase pressure on the nerves and tendons in the wrist.

Safe exercise guidelines for pregnancy

Mode: Walking, swimming, cycling, low-impact aerobics.
Intensity: Moderate (should be able to talk while exercising)
Duration: 150 minutes per week (30 min/day, most days)
Avoid:
- Supine exercises after 20 weeks (risk of supine hypotensive syndrome)
- Overheating (hot yoga, saunas).
- Valsalva maneuver (holding breath during exertion)
- High-impact or contact sports

Contraindications to exercise during pregnancy

Absolute:
- Incompetent cervix
- Placenta previa (after 26 weeks)
- Preeclampsia
- Multiple gestation with risk of preterm labor
- Ruptured membranes
- Persistent vaginal bleeding
- Preterm labor
Relative:
- Severe anemia
- Unevaluated maternal cardiac disease
- Chronic bronchitis
- Poorly controlled diabetes or hypertension

Postpartum considerations

Pelvic floor dysfunction
- Interventions: Kegels, biofeedback, bladder retraining
Postural syndromes
- Due to breastfeeding, baby-carrying
- Interventions: Strengthening of the upper back, postural correction, stretching
Return to exercise
- Clearance from physician (typically 6 weeks post-vaginal, 8+ weeks post-C-section)
- Progressive return to impact activities

PTA role reminder

Carry out PT’s established plan of care; never diagnose or modify interventions
Monitor for adverse signs, collect objective data, report changes to PT

Gastroesophageal reflux disease (GERD)

Backflow of stomach acid from weak lower esophageal sphincter
Symptoms: heartburn, regurgitation, chest pain, dysphagia
PT: avoid increased intra-abdominal pressure exercises; upright positioning after eating

Peptic ulcer disease (PUD)

Open sores in stomach/duodenum from H. pylori or NSAIDs
Symptoms: epigastric pain, nausea, bloody stool if severe
PT: monitor for GI bleeding signs (dark stool, fatigue, pallor)

Irritable bowel syndrome (IBS)

Functional GI disorder with altered bowel habits
Symptoms: cramping, bloating, diarrhea/constipation
PT: stress management, exercise to regulate motility

Crohn’s disease

Chronic inflammation anywhere in GI tract (often small intestine)
Symptoms: abdominal pain, diarrhea, weight loss, malnutrition
PT: address fatigue, joint pain, steroid-related osteoporosis risk

Ulcerative colitis

Chronic inflammation/ulcers of colon and rectum
Symptoms: bloody diarrhea, urgency, cramping, weight loss
PT: monitor for dehydration, anemia, musculoskeletal complications

Diverticulitis

Infection/inflammation of colon diverticula
Symptoms: LLQ pain, fever, nausea, bowel changes
PT: avoid Valsalva/increased intra-abdominal pressure

Celiac disease

Autoimmune gluten reaction causing villous atrophy
Symptoms: malabsorption, diarrhea, bloating, fatigue
PT: monitor for malnutrition, osteoporosis, neuro symptoms (tingling/numbness)

Hepatitis (A-E)

Viral liver inflammation
Symptoms: jaundice, fatigue, dark urine, RUQ pain
PT: energy conservation; avoid strenuous exercise during active infection

Cirrhosis

Chronic liver disease with fibrosis
Symptoms: jaundice, ascites, hepatomegaly, hepatic encephalopathy
PT: watch for bruising/bleeding, fall risk from balance deficits

Pancreatitis

Pancreatic inflammation (gallstones, alcohol)
Symptoms: severe epigastric pain radiating to back, nausea/vomiting
PT: monitor for multi-organ failure signs; avoid abdominal pressure activities

When to stop and notify PT

New/worsening abdominal pain
Signs of GI bleeding (dark/bloody stool, unexplained fatigue, pallor)

Key referred pain sites

Peptic ulcers → epigastric, radiates to back
Pancreatitis → mid-back, left shoulder
Gallbladder → right shoulder, RUQ, worsens after fatty meals
Appendicitis → periumbilical → RLQ (McBurney’s point)
Liver → RUQ, right shoulder, jaundice
Esophagus → mid chest/back; Stomach → epigastric/LUQ/mid-back
Small intestine → periumbilical; Large intestine → lower abdomen/sacral
Rectum → sacral/perineum

Male reproductive system anatomy

Structures: testes, epididymis, vas deferens, seminal vesicles, prostate, urethra, penis
Function: sperm and testosterone production
Hormonal axis: Hypothalamus (GnRH) → Pituitary (LH, FSH)
- LH → testosterone production
- FSH → spermatogenesis

Male reproductive disorders

BPH: non-cancerous prostate enlargement; urinary frequency/nocturia/weak stream
Prostatitis: prostate inflammation; painful urination, pelvic pain
Prostate cancer: often asymptomatic early; later urinary/bone symptoms
Erectile dysfunction: vascular, diabetic, or psychological causes
Testicular cancer: common ages 15-35; painless lump/swelling

Female reproductive system anatomy

Structures: ovaries, fallopian tubes, uterus, cervix, vagina
Function: egg production, hormone production, pregnancy support
Hormonal axis: GnRH → LH & FSH
- LH → ovulation, estrogen/progesterone production
- FSH → follicle growth and egg maturation

Female reproductive disorders

PCOS: irregular ovulation, excess androgens, insulin resistance, hirsutism
Endometriosis: ectopic endometrial tissue; pelvic pain, dysmenorrhea, infertility
Uterine fibroids: benign tumors; heavy bleeding, pelvic pain
PID: reproductive organ infection; pelvic pain, fever, discharge
Ovarian cancer: vague early symptoms, often detected late
Breast cancer: most common in women; lump, nipple changes, skin dimpling

Pregnancy - musculoskeletal changes

Increased lumbar lordosis, anterior pelvic tilt → low back pain
Relaxin-induced ligamentous laxity → joint instability
Pelvic widening → SI joint/pubic symphysis dysfunction
Diastasis recti

Pregnancy - cardiovascular/respiratory changes

Increased blood volume (40-50%) and heart rate
Decreased BP in 1st/2nd trimester; supine hypotensive syndrome risk (IVC compression)
Increased oxygen consumption; decreased lung expansion → shortness of breath

Pregnancy - metabolic and other changes

Increased caloric needs; gestational diabetes risk
Increased urinary frequency; normal weight gain 25-35 lbs
Hormonal shifts affect mood/joints/metabolism
Risk of De Quervain’s and carpal tunnel syndrome

Safe exercise guidelines for pregnancy

Mode: walking, swimming, cycling, low-impact aerobics
Intensity: moderate (talk test); duration: 150 min/week
Avoid: supine exercise after 20 weeks, overheating, Valsalva, high-impact/contact sports

Contraindications to exercise during pregnancy

Absolute: incompetent cervix, placenta previa (>26 wks), preeclampsia, multiple gestation w/ preterm risk, ruptured membranes, persistent bleeding, preterm labor
Relative: severe anemia, unevaluated cardiac disease, chronic bronchitis, poorly controlled diabetes/hypertension

Postpartum considerations

Pelvic floor dysfunction: Kegels, biofeedback, bladder retraining
Postural syndromes from breastfeeding/carrying: upper back strengthening, postural correction
Return to exercise: physician clearance (~6 wks vaginal, 8+ wks C-section); progressive impact return

Next | 6.4 Urinary incontinence and renal disorders

Gastrointestinal and reproductive systems

Common gastrointestinal tests

Gastroesophageal reflux disease (GERD)

Description: Backflow of stomach acid into the esophagus due to a weakened lower esophageal sphincter
Symptoms: Heartburn, regurgitation, chest pain, difficulty swallowing
PT implications: Avoid exercises that increase intra-abdominal pressure; encourage upright positions after eating

Peptic ulcer disease (PUD)

Description: Open sores in the stomach or duodenal lining, often caused by H. pylori infection or NSAIDs
Symptoms: Epigastric pain, nausea, bloating, bloody stool (if severe)
PT implications: Monitor for signs of GI bleeding (dark stool, fatigue, pallor)

Irritable bowel syndrome (IBS)

Description: Functional GI disorder with chronic abdominal pain and altered bowel habits (diarrhea, constipation, or both)
Symptoms: Cramping, bloating, diarrhea, constipation, mucus in stool
PT implications: Stress management, exercise to regulate bowel motility

Crohn’s disease

Description: Chronic inflammation of any part of the GI tract, often the small intestine
Symptoms: Abdominal pain, diarrhea, weight loss, fatigue, malnutrition
PT implications: Address fatigue, joint pain, and osteoporosis risks due to long-term steroid usage for disease management.

Ulcerative colitis

Description: Chronic inflammation and ulcers in the colon and rectum
Symptoms: Bloody diarrhea, urgency, abdominal cramping, weight loss
PT implications: Monitor for dehydration, anemia, and musculoskeletal complications

Diverticulitis

Description: Infection or inflammation of diverticula (pouches in the colon wall)
Symptoms: Lower left quadrant pain, fever, nausea, bowel habit changes
PT implications: Avoid increased intra-abdominal pressure (e.g., Valsalva maneuver)

Celiac disease

Description: Autoimmune disorder triggered by gluten, leading to villous atrophy in the small intestine
Symptoms: Malabsorption, diarrhea, bloating, fatigue, weight loss
PT implications: Monitor for signs of malnutrition, osteoporosis, and neurological symptoms (tingling, numbness)

Hepatitis (A, B, C, D, E)

Description: Inflammation of the liver, often viral
Symptoms: Jaundice, fatigue, dark urine, nausea, right upper quadrant pain
PT implications: Energy conservation techniques, avoid strenuous exercise during active infection

Cirrhosis

Description: Chronic liver disease with fibrosis and impaired liver function
Symptoms: Jaundice, ascites, hepatomegaly, fatigue, confusion (hepatic encephalopathy)
PT implications: Watch for bruising, bleeding, and fall risk due to balance deficits

Pancreatitis

Description: Inflammation of the pancreas, often due to gallstones or alcohol abuse
Symptoms: Severe epigastric pain radiating to the back, nausea, vomiting
PT implications: Monitor for signs of multi-organ failure, avoid activities that increase abdominal pressure

Key referred pain sites

Key clinical patterns

Peptic ulcers → Epigastric pain that may radiate to the back
Pancreatitis → Pain in the mid-back and left shoulder
Gallbladder issues (cholecystitis, gallstones) → Right shoulder, right upper quadrant pain, worsens after fatty meals
Appendicitis → Periumbilical pain progressing to the right lower quadrant (McBurney’s point)
Hepatic (liver) issues → Right upper quadrant pain, right shoulder pain, jaundice may be present
Esophagus → mid chest, mid-back
Stomach → epigastric region, left upper quadrant, mid-back
Small intestine → periumbilical region
Large intestine → lower abdomen, sacral region
Rectum → sacral region, perineum

Reproductive system

Male reproductive system

Anatomy and physiology

Primary structures: Testes, epididymis, vas deferens, seminal vesicles, prostate gland, urethra, and penis
Function: Produces sperm and male sex hormones (testosterone)
Hormonal regulation:
- Hypothalamus → Gonadotropin-releasing hormone (GnRH)
- Pituitary → Luteinizing hormone (LH) & Follicle-stimulating hormone (FSH)
  - LH stimulates testosterone production in the testes.
  - FSH supports spermatogenesis

Definitions

Testosterone: Steroid hormone that drives male secondary sexual characteristics. It’s produced mainly by the testes (Leydig cells) in males, and in smaller amounts by the ovaries and adrenal cortex in females.
Gonadotropin-releasing hormone: Hormone produced in the hypothalamus that stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which in turn regulate the function of the gonads (testes and ovaries).
Luteinizing hormone: Hormone secreted by the anterior pituitary; in males it stimulates testosterone production in the testes, and in females it triggers ovulation and stimulates estrogen and progesterone production.
Follicle-stimulating hormone: Stimulates egg production in females, regulates the menstrual cycle, and supports sperm production in males.

Common male reproductive disorders

Benign prostatic hyperplasia (BPH)

Non-cancerous enlargement of the prostate
Symptoms: Urinary frequency, nocturia, weak stream, incomplete bladder emptying
Treatment: Medications (alpha-blockers), surgery if severe

Prostatitis

Inflammation of the prostate, often bacterial
Symptoms: Painful urination, pelvic pain, flu-like symptoms
Treatment: Antibiotics, anti-inflammatories

Prostate cancer

Most common cancer in men
Symptoms: Often asymptomatic early, later include urinary dysfunction and bone pain (metastasis)
Treatment: Surgery, radiation, hormone therapy

Erectile dysfunction

Inability to achieve/maintain an erection
Causes: Vascular disease, diabetes, psychological factors
Treatment: Medications, lifestyle modifications

Testicular cancer

Most common in men 15-35 years
Symptoms: Painless testicular lump, swelling
Treatment: Surgery (orchiectomy), chemotherapy, radiation

Female reproductive system

Anatomy and physiology

Primary structures: Ovaries, fallopian tubes, uterus, cervix, vagina, external genitalia
Function: Produces eggs, sex hormones (estrogen, progesterone), and supports fetal development during pregnancy
Hormonal regulation:
- Hypothalamus → Gonadotropin-releasing hormone (GnRH)
- Pituitary → Luteinizing hormone (LH) & Follicle-stimulating hormone (FSH)
  - LH regulates the menstrual cycle, triggers ovulation, and stimulates the ovaries to produce essential steroid hormones like estrogen and progesterone.
  - FSH stimulates the ovaries to grow follicles and mature eggs each month.

Definitions

Estrogen: Any of a group of steroid hormones that promote the development and maintenance of female characteristics of the body.
Progesterone: Steroid hormone released by the corpus luteum that stimulates the uterus to prepare for pregnancy.

Common female reproductive disorders

Polycystic ovarian syndrome (PCOS)

Hormonal disorder causing irregular ovulation, excess androgens, and ovarian cysts
Symptoms: Irregular periods, infertility, insulin resistance, and hirsutism, a condition characterized by excessive hair growth in women in a male-pattern distribution.
Treatment: Hormonal therapy, weight management, insulin sensitizers

Endometriosis

Growth of endometrial tissue outside the uterus
Symptoms: Pelvic pain, dysmenorrhea, infertility
Treatment: Pain management, hormonal therapy, surgery

Uterine fibroids

Non-cancerous tumors of the uterus
Symptoms: Heavy menstrual bleeding, pelvic pain, infertility
Treatment: Hormonal therapy, surgery (hysterectomy, myomectomy)

Pelvic inflammatory disease (PID)

Infection of the female reproductive organs (often due to sexually transmitted diseases)
Symptoms: Pelvic pain, fever, abnormal vaginal discharge
Treatment: Antibiotics, hospitalization if severe

Ovarian cancer

Often detected late because early symptoms are vague and nonspecific
Symptoms: Abdominal bloating, pelvic pain, urinary urgency
Treatment: Surgery, chemotherapy

Breast cancer

Most common cancer in women
Risk factors: Family history, hormone exposure
Symptoms: Lump, nipple changes, skin dimpling
Treatment: Surgery, chemotherapy, radiation, hormone therapy

Pregnancy considerations for physical therapy

Physiological changes during pregnancy

Musculoskeletal changes

Increased lumbar lordosis and anterior pelvic tilt → low back pain
Increased ligamentous laxity due to Relaxin hormone → joint instability, risk of injury
Widening of the pelvis → sacroiliac (SI) joint pain, pubic symphysis dysfunction
Diastasis recti (separation of the rectus abdominis)

Definitions

Relaxin hormone: Hormone, primarily associated with pregnancy, that loosens ligaments and softens the cervix, preparing the body for childbirth.

Cardiovascular changes

Increased blood volume (40-50%) and heart rate
Decreased blood pressure in the first and second trimesters (due to vasodilation)
Risk of supine hypotensive syndrome (compression of the inferior vena cava)

Respiratory changes

Increased oxygen consumption
Decreased lung expansion due to elevated diaphragm → shortness of breath

Metabolic changes

Increased caloric demands.
Gestational diabetes risk due to insulin resistance.

Other changes

Increased urinary frequency due to bladder compression
Weight gain (25-35 lbs is the normal range)
Hormonal changes (progesterone, estrogen, relaxin) affect mood, joints, and metabolism
De Quervain’s and carpal tunnel syndrome can both occur during pregnancy due to hormonal changes and fluid retention, which increase pressure on the nerves and tendons in the wrist.

Safe exercise guidelines for pregnancy

Mode: Walking, swimming, cycling, low-impact aerobics.
Intensity: Moderate (should be able to talk while exercising)
Duration: 150 minutes per week (30 min/day, most days)
Avoid:
- Supine exercises after 20 weeks (risk of supine hypotensive syndrome)
- Overheating (hot yoga, saunas).
- Valsalva maneuver (holding breath during exertion)
- High-impact or contact sports

Contraindications to exercise during pregnancy

Absolute:
- Incompetent cervix
- Placenta previa (after 26 weeks)
- Preeclampsia
- Multiple gestation with risk of preterm labor
- Ruptured membranes
- Persistent vaginal bleeding
- Preterm labor
Relative:
- Severe anemia
- Unevaluated maternal cardiac disease
- Chronic bronchitis
- Poorly controlled diabetes or hypertension

Postpartum considerations

Pelvic floor dysfunction
- Interventions: Kegels, biofeedback, bladder retraining
Postural syndromes
- Due to breastfeeding, baby-carrying
- Interventions: Strengthening of the upper back, postural correction, stretching
Return to exercise
- Clearance from physician (typically 6 weeks post-vaginal, 8+ weeks post-C-section)
- Progressive return to impact activities

Achievable NPTE-PTA

6. Other system

Our NPTE-PTA course is now in "early access" - get 50% off for a limited time.