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Unfortunately, there is limited research available regarding physical therapy intervention for pregnant women experiencing Low Back Pain, so a homogenous approach tends to be used. The lumbar region is constituted of five unique vertebrae that are designed to withstand increased weight and retain a lordotic curve. To maintain stability and provide support, the lumbar region is connected and held secure by an intricate web of ligaments: ligamentum longitudinale anterior and superior, ligamentum flava, ligamentum interspinata, ligamentum intertransversarium and the ligamentum supraspinale.
A number of reviews investigated the prevalence of low-back pain during pregnancy in different populations. There are several possible mechanisms of injury which could be causing pregnancy related LBP. The most common onset tends to be during the 5th and 6th month of pregnancy, and the pain is usually worse in the evening. In order to formulate the correct diagnosis, the patient should be questioned about her past medical history. It is important at the time of initial assessment to differentiate between the lumbar spine and pelvic dysfunction. Different measure instruments can be used in the diagnosis to estimate the complaints more objectively: Visual Analogue Scale (VAS)[10], Roland Disability Questionnaire (RDQ), Impact on Participation and Autonomy (IPA), Photograph series Of Daily Activities (PHODA), and Pain Behavior Scale (PBS). It’s important to communicate with the patient and provide information about the relevant anatomy, ergonomics, back education (to prevent unnecessary mechanical stress on the back), and how to manage ADL activities (walking, standing, sitting, lying, and work position, learning how to control pain). Management includes specific interventions to address pain, weakness, and mobility in the low back region. Position the patient in a side lying and place an elastic around both legs above the knees. Ask the patient to perform an external rotation of her leg in order to strengthen the Gluteus Medius. Ask the patient to sit on a physioball and simulate a walk movement with the lower extremities.
The patient will be positioned on a physioball, which will force the pelvic, abdomen and back muscles to stay active in order to find a balanced sitting position. Even though most pregnant patients will be advised to exercises within their safe and pain free range, studies show that less than 50% will actually do so. TENSThere is no strong evidence on the benefits of Tens on Low back pain in pregnancy but it can be used as a supplementary therapy.
Patients should take caution when using ultrasound and electrical stimulation and avoid placing those modalities anywhere near the stomach or low back.
Walking, swimming1B,Tai chi, recumbent bicycle (or nu-step), are plausible to be beneficial at a low to moderate intensity. The exercises explained above could also be performed at home if both the patient and therapist feel confident that the exercises will be performed correctly without supervision.
Back tuck arch [12]: Lean with the back against the wall and alternate between anterior and posterior pelvic tilt. Prognosis (30)Patients recover from LBP in pregnancy within a few weeks or a few months after childbirth, but symptoms may return during a future pregnancy. Randomised controlled trial of the effectiveness of using back massage to improve sleep quality among Taiwanese insomnia postpartumwomen. This presentation was created by Carolyn Vandyken, a physiotherapist who specializes in the treatment of male and female pelvic dysfunction. Learn about the shoulder in this month's Physiopedia Plus learn topic with 5 chapters from textbooks such as Magee's Orthopedic Physical Assessment, 2014 & Donatelli's Physical therapy of the shoulder 2012. The following information pertains to experiments presently being conducted in the laser collisions lab of the above laboratory.
In these experiments atoms and molecules excited by electron impact are studied when they are in a metastable state following the collision. Many different processes can occur in this reaction, depending upon the energetics and kinetics of the reaction. The experiments described here look at the process of inelastic scattering, where the target is left in a metastable state. The experiments are precursors to measuring stepwise laser excitation of metastable atoms and molecules. An electron which has well defined energy Einc, and momentum Pei is incident on either an atom or a molecular target which is in its ground state.
The velocity of the gas is constrained to a narrow distribution by the supersonically expanding shock wave. The target beam enters a second vacuum chamber where it travels ~ 100mm prior to interacting with a well defined beam of electrons. These electrons are produced in an electron gun that controls both the direction and energy of the electrons. Only a very small number of these electrons will interact with the target beam, the majority passing through the interaction region and being collected by a Faraday cup 200mm downstream. The majority of the target beam is also unaffected during the reaction, and passes through the interaction region.
The majority undergo an elastic collision where only the direction of the incident electron may change and the target remains in its ground state. A small number of targets will be excited, and depending upon the energy that can be exchanged between the electrons and the target, excitation to various states can occur.
Depending upon the cross section for the state, which is a function of both the energy and the angle through which the electron is scattered, a small number of these targets will be excited to the metastable state.
Since these metastable excited targets cannot decay by photon emission, and since there are very few collisions between targets in the gas beam (their relative velocity is close to zero in the beam and therefore their relative position to each other does not change markedly), most of these will remain in the excited state as they pass out of the interaction region. Scattered Atoms (Molecules) in a Metastable State with internal energy Eexc and which carry momentum Paf away from the reaction.
Studying the momentum of the targets that have been deflected by the electron collision, since these are related to the electron momentum by conservation of momentum. It should be noted that in conventional electron scattering experiments which measure excitation cross sections, the target momentum is not usually considered. There are a number of complications that can arise in these experiments where the target momentum is exploited for measurement.
If the incident electron is of sufficient energy to excite not only the metastable state but also higher lying states which through photon emission can decay to the metastable state, there will be a contribution to the target signal due to these cascades. For a significant number of targets there is more than one metastable state, and these may be sufficiently close in excitation energy to be unresolvable when exploiting their individual momentum transfer contributions. This effect is particularly significant when the target is a molecule since the metastable vibrational and rotational states will be much closer together than can be resolved by even the highest resolution electron impact studies. The difficulties associated with cascading can be overcome by confining the study to the region close to threshold for excitation of the metastable state. For studies of excitation at energies where contributions from cascading become significant, a time resolved coincidence experiment between the scattered electrons and the deflected targets becomes necessary.
Unlike conventional coincidence studies, the direction of the coincident scattered electron is known since the momentum of the excited target is known, and hence the collection rate of the experiments can be enhanced by placing the electron detector at the appropriate point in space. The difficulties associated with state selectivity can be overcome by employing a further stepwise laser excitation step from the metastable state to an upper state using a high resolution laser probe. Since the laser radiation transfers information about the metastable state to this upper state, measurement of the upper state can in principal yield information about the lower state once the laser excitation mechanism is well understood.
Allows the electron excitation mechanism to be studied by analysing the stepwise excited state.
Field Ionisation if the laser excited state has sufficiently high principal quantum number (high yields, in principal 100% efficient).
The latter Field Ionisation technique is adopted in these experiments, although photon detection can be easily installed into the vacuum system if this proves advantageous to measurement of the signal. Molecular Vibrational & Rotational states can be studied in detail for a wide range of targets. A detailed analysis of the laser excitation process is required to fully characterise the electron excited state.
The processes where the linear momentum transferred from the electron to the target is exploited to determine cross sections for excitation of the state are now considered.
The square root in the above expression shows the origin of the two different momenta at any given deflection angle of the targets as described in figure 4. Note that for each atom detection angle qa there are 2 contributing momenta Paf1, Paf2 excepting the case of Forward & Backward scattered electrons, as shown in figure 5. Hence with sufficient time resolution and detection angle resolution the experiments should reveal 2 distinct peaks at any given detection angle. It should be noted that the lifetimes of the low l highly excited helium Rydberg targets, typically only a few microseconds, exclude them from being detected in the present experiments where the targets drift for around 300 microseconds from the interaction region to the metastable detector. The chamber is lined with a double layer of m-metal which reduces external magnetic fields to < 5mG at the interaction region.
Fast output deflector circuit only allows electrons to exit electron gun, preventing any ions created in field free region or other high potential region from reaching interaction region.
Angle selectivity is achieved using 1mm apertures 1 & 2 spaced 60mm apart prior to a 719BL CEM metastable detector at end of detector (LHS).
Electrostatic deflection plates remove unwanted electrons and ions from entering the detector and possibly reaching the detectors.
Visible Laser Diodes (VLD's) align the detector to the interaction region formed by electron beam, gas beam and rotation axis of detector. A control pulse (0 - 150Hz) drives the gas nozzle HT pulse & the electron gun Grid following an appropriate delay. The Turbo-MCS is gated to either sweep over ~100ms for each gas pulse or is set to count events for a set number of gas pulses at each detection angle.

The following graphs show the metastable angular distribution when the target gas is excited using a continuous electron beam, rather than a pulsed electron beam for four different excitation energies from 20eV to 50eV. As the incident energy increases forward scattering starts to dominate over backscattering as a collision mechanism as might be expected. The evolution from single atom momentum at q'a = 4A°through double momentum peaks at intermediate energies then back to a single peak at the highest scattering angles can clearly be seen as is discussed in figure 4. Gaussian profiles have been fitted to the peaks to establish the amplitude, width and position of each peak as a function of the deflection angle. Note that a 4ms electron excitation peak is visible at higher detection angles, which is thought to be due to either photon or stray electron contributions.
This accurately yields the time difference between excitation of the target and collection of the metastables. For these experiments the atoms excited by the incident electrons are counted and fitted to a Gaussian of width w and height h as shown in figure 14. Figure 15 shows the results of these least squares fit calculations at 40eV Incident Energy, showing the amplitude h and width w together with the associated peak positions. Note that this method allows the DCS to be determined over the complete set of scattering angles from forward to 180A° backward scattering of the electrons. Note that some discrepancies exist between the calculations from the fast and the slow atoms.
This effectively acts as a high resolution timing probe of the target gas beam which for helium has a time spread of the order of 6ms from the interaction region to the detector.
Exploring the Helium (e,2e) Differential Cross Section at 64.6eV with Symmetric Scattering Angles and Unequal Outgoing Electron Energies. In the experiments described here the gun angle y has again been varied from coplanar geometry (y = 0A°) to the perpendicular geometry (y = 90A°) and the scattering angles x are again symmetric (as shown in figure 1), but the symmetry of the outgoing electron energies has been relaxed. One purpose of the experiments described here was to investigate the dependence of the dip on the symmetry of the outgoing electron energies. The spectrometer is a fully computer controlled and real-time computer optimised (e,2e) coincidence spectrometer. The spectrometer is maintained at its optimum working condition during data accumulation, with automatic adjustment for any long term drifts. The vacuum pressure during operation was typically 10E-5 torr, with a background pressure of 10E-8 torr. Two hemispherical deflection analysers with acceptance half angles of 3A° rotate in the detection plane as shown in figure 1.
The discriminators feed a time to amplitude converter via appropriate delay lines, resulting in an 8ns FWHM coincidence signal accumulating in a multi-channel analyser located on the controlling computer bus.
The computer optimises the spectrometer at regular intervals as the analysers sweep around the detection plane using a modified simplex technique.
An additional check of the apparatus has been made to verify that the measured differential cross section is unchanged when the detected energies E1 and E2 are exchanged. Figures 2(a) - (d) show the helium (e,2e) differential cross sections obtained for the four selected energy pairs. At higher gun angles the angular range is limited only by the physical size of the analysers. A trend that can be noticed in the data is that the differential cross section becomes more isotropic as the energy asymmetry increases. For all energy sharing the forward scatter peak evolves into the lower angle peak in the perpendicular plane, while the backscatter peak evolves into the central peak.
In the perpendicular plane the central peak becomes broader as the asymmetry increases, and the side peaks become less distinct, almost disappearing at the highest asymmetry. The peak at xi = 90A° can arise either from collision with a valence electron whose momentum is equal in magnitude but opposite in direction to the incident electron, or via multiple collision processes due to long range Coulombic interactions between the outgoing electrons, as becomes increasingly important in the threshold region. The existence of the sharp dip at y = 67.5A°, xi = 70A° and E1 = E2 has been noted previously. For asymmetric energy sharing the deconvolved cross section at the minimum is insensitive to the width of the estimated experimental angular function, the deconvolved cross section being almost unchanged from the measured cross section. The sharpness of the dip clearly depends critically on the energy sharing of the detected electrons. This pain is not the result of a known pathology  such as disc herniation[25] and can begin at any point during pregnancy. However, back pain is not homogenous; therefore special considerations and precautions should be taken when treating this population. The vertebral canal of the lumbar region houses the tail end of the spinal cord and the Cauda Equina. All the mentioned ligaments will provide stability, whereas the longitudinal ligament will also be attached to the intervertebral disc in order to keep the discs in position. During pregnancy, changes occur in the facet joints, in the back muscles, and in ligaments. Other more common differential diagnoses are: disc disease, facet joint involvement and sacroiliac joint involvement. It is important to concentrate on experienced symptoms, limitations in activities, and movement possibilities. During the therapy session, continually check on pain levels and any aches radiating from the low back or stomach. Another intervention that is getting tractions and shows prominent research is acupuncture. Research shows that when the symptoms are explained, patients can feel more at ease and their anxiety may decrease. The Ottawa Panel also recommends massage therapy in order to treat subacute and chronic low back pain. It’s important to use a low intensity and avoid the acupuncture points which may induce throes. Combined squat stretch, back and hamstrings stretch: strengthens thighs (upper legs) and gluts, stretches hamstrings, inner thighs, pelvic floor muscles and back. She also provides education and mentorship to physiotherapists who are similarly interested in treating these dysfunctions.
Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider.
The electron impact occurs when a well controlled electron beam interacts with a well defined gas beam comprising ground state atoms or molecules under investigation. Here the electrons do not lose any energy in the reaction, however the momentum of the electrons may change. Here the incident electron loses energy in the reaction to the target, which is subsequently excited to one of its (usually discrete) states. In these experiments the target is prepared in some way so that it has internal energy prior to interaction with the electron beam. This is here defined as a state that cannot decay to a lower state of the target via a single photon emission (dipole allowed) transition. State selectivity is obtainable by exploiting momentum transferred to the atom by the electron impact.
This is brought about in these experiments by employing a supersonically expanded jet of target gas which is skimmed by an expontially flared aperture in a source chamber. These ground state targets eventually enter the high vacuum pump located at the top of the interaction chamber from where they are ejected. They can then drift for many hundreds of microseconds before a collisional de-excitation occurs either with each other or with a surface or stray molecule inside the vacuum chamber. Note that if the targets are molecules they may share this internal energy between rotational & vibrational states in the metastable electronic manifold. This can be achieved using conventional electron energy analysers that select electrons of a specific energy and scattering angle for measurement.
As the possible target deflection angles following the collision is confined to a much smaller range than the possible scattering angles of the electrons (which range from 0A° through to 180A° in space), in principle the cross section for excitation of the state can be completely mapped out over all possible electron scattering angles. In these experiments only the momentum of the electron is measured, both for the incident beam and for the scattered electrons using energy and angle selective analysers. The signal will then be an incoherent summation of the contributions fom these excited states. Of particular interest in this region is the study of temporary negative ion states that show up as resonances. Measurements of energy selected scattered electrons in coincidence with measurement of the excited targets then exclude any contribution from upper states, since the electrons which excite these states are excluded from the coincidence measurement. Tunable laser radiation has an energy resolution typically 1,000 to 1,000,000 times better than is possible using electron spectrometers, and so resonant excitation can individually select the metastable state for further excitation following electron impact excitation. The coplanar momentum transfer scheme, showing the relationship between the extrema of the electron scattering angles together with the corresponding extrema of the target deflaction angles. The graphs show the effects as a function of the momentum, velocity and deflection angle of the target helium atoms.
Variation of the maximum and minimum target deflection angle as a function of the incident energy of the electrons. This aperture together with the 1mm exit orifice of the nozzle are aligned using visible laser diodes. All are aligned using Visible Laser Diodes apertured to accurately define their individual axes. This is important as the detector may measure ions created as the electron beam interacts with the gas beam.
The calibrated angle plate which accurately measures the deflection angle of the target beam.

This additionally allows the zero angle to be calibrated wrt the apertures in the source chamber which define the ground state target beam direction. Since the interaction region to detector distance is accurately known, this immediately yields the value of final atom momentum Paf(qa) to substitute into the appropriate equations. Gaussian fitting parameters as a function of the Detection Angle for the time resolved metastable atom deflections at 40eV Incident Energy.
It can be seen that the DCS is forward peaked as expected, and that the DCS has been determined at the complete set of scattering angles from forward to backward scattering. This may be attributable to errors associated with the solid angle of detection of the analyser which has not been considered in the above calculation. The Experimental Geometry for asymmetric energies, where the scattered and ionised electrons do not take equal energy away from the reaction.
The outgoing electrons were selected to have equal energy and the same scattering angle x with respect to the projection of the incident electron trajectory onto the detection plane spanned by the electron analysers. Deconvolution of the experimental results using an estimated angular response function indicated that this dip is five or more orders of magnitude smaller than the maximum differential cross section at this energy. Following energy selection the electrons are detected by channel electron multipliers, whose pulses are amplified and noise discriminated. As discussed elsewhere, the side peaks near x = 45A° and 135A° are thought to arise from a double scattering process in which the incident electron scatters elastically from the nucleus and then collides with the valence electron in a quasi-free interaction. The (e,2e) differential cross-section at a gun angle y of 67.5A°, showing the evolution of the dip as a function of the energy sharing of the detected electrons. Variation of the minimum of the dip shown in figure 3 as a function of the energy difference (E1 - E2) when the experimental angular function is deconvolved from the data. Figure 3 shows how the energy sharing affects the shape of the differential cross section for the four different detection energy pairs, and figure 4 shows the dependence on the energy sharing of the minimum differential cross section at the dip, deconvoluted as described elsewhere. As the degree of asymmetry decreases this sensitivity correspondingly increases, until for symmetric energy sharing the calculated deconvolved differential cross section changes by two orders of magnitude compared to the measured cross section. Additionally, the lumbar region is supported by strong low back muscles, pelvic muscles and abdominal muscles.
Questions about past pregnancies such as – "Have you experienced any complications with prior pregnancy(s)?" are appropriate. Activities such as turning in bed, getting out of a car, walking and climbing stairs may indicate that the origin of pain may be due to pelvic dysfunction. Even though theActive Straight Leg Raise test seems accurate, the sensitivity will be elevated when combined with the Posterior Pelvic Pain Provocation (PPPP) test.
Some patients tolerate pain and discomfort better than others and will therefore mask their distress – Use a chart for Rate of Perceived Exertion to determine the patient's true status and take note of any changes that occur between the begging and end of the session. Recent studies show that a week of continuous acupuncture at specific auricular points can decrease pain and increase the capacity for some physical activity which can help diminish the need for drugs. Key questions must be asked and special modifications must be made for more complex patient experiencing pregnancy related back pain. In the presentation, Carolyn reviews pelvic anatomy, the history of Kegel exercises and what the evidence tells us about when Kegels are and aren't appropriate for our patients.
Thus the electrons may be scattered throughout space from the reaction zone, the distribution of these electrons then giving information on the elastic differential cross section for the target in question.
These states may be below the ionisation limit of the target, in which case the target usually remains neutral, or higher order excitation processes can occur where more than one electron in the target is excited. The interaction then removes energy from the target and so the electrons emerge from the reaction with greater energy than they had prior to the reaction. The excited target therefore has a very long lifetime, since the probability of 2 photon decay is much smaller than for single photon decay processes.
For light atoms and molecules (He & H2 for example) the metastable targets are deflected through angles from ~5A° for forward electron scattering to in excess of 30A° for backward scattering depending upon the impact energy.
An electron of well defined momentum Pei collides with a target atom or molecule in its ground state that has a well defined initial momentum Pai. These experiments are conventionally limited to a range of scattering angles that does not include either the forward scattering region of the backward scattering region. These experiments do not have the spatial or temporal resolution to define either the incident or the final target momentum, since they mostly produce a target beam via continuous effusive flow from a capillary.
These resonances occur since the scattered electron following excitation can remain in the region of the excited target for sufficient time to form a pseudo-stable state which has its own unique properties. As before the electron of incident momentum Pei is scattered inelastically from the target of incident momentum Pai, leaving the target in a metastable state.
Electrons incident along the z-axis have a well defined energy Einc and thus a well defined momentum Pei.
Electrons incident along the z-axis have a well defined energy Einc and a well defined momentum Pei. Electrons incident along the z-axis with well defined energy Einc and well defined momentum Pei can scatter throughout the range of angles from 0A° (forward scattering) through to 180A° (backward scattering) as shown in figures (a) and (b). Amplitude h, peak position and peak width w are all calculated using a least squares fit to the data, a sample of which is presented in figure 14. The dip is less pronounced at other incident energies where the excess energy is equally shared.
If the two electrons emerge from this reaction in the perpendicular plane then they have an angle of approximately 90A° to each other, as observed. This can then be confirmed with a range of tests for assessing the sacroiliac joint and pubic symphasisis. As patient centered practitioners, it is our job to research and implement evidence based practice to increase outcomes with minimal number of treatments.
The energy required to excite these processes is usually above the ionisation limit, and so these excitation mechanisms often lead to ionisation via photon emission or through autoionisation. In these experiments the initial target state is almost always prepared by excitation with a laser beam from the ground state, since very high yields (theoretically up to 50% for CW laser excitation) of target excitation can be achieved prior to electron collision. This long lifetime (which can be up to seconds if there are no other mechanisms for de-excitation) is exploited in these experiments, which measure the quantity of metastable targets as a function of the target deflection angle following electron collision.
The correspondence (via momentum and energy conservation equations) between the deflection angle and arrival time at the detector of the excited target with the electron scattering angle therefore allows differential cross sections to be measured over the full range of possible scattering geometries from forward to backward scattering. The target is excited to a metastable state, the electron losing energy Eexc during the reaction. Any variation in cross section due to variations in the target momentum is therefore averaged out in the signal that is collected. The target is then further excited using resonant laser radiation to a higher lying state which is then studied. These electrons interact with a beam of target atoms or molecules prepared with a well defined momentum Pai travelling along the x-axis with an initial thermal energy Eai. These electrons interact with a beam of target atoms or molecules prepared with a well defined momentum Pai travelling along the x-axis with an initial energy Eai. Since momentum must be conserved in the reaction, the change of electron momentum delta Pe along the z-axis for these cases must be balanced by a corresponding change in momentum Delta Pa of the targets along this axis.
The graph shows the effect discussed in figure 4, where for each deflection angle there are two distinct atom momenta corresponding to unique electron scattering directions.
These are normally pinched off from exiting the region of the filament using a -15V grid potential wrt the tip of the filament.
The following findings are commonly revealed: Paravertebral muscles are tender to palpation, back muscles weakness, decreased ROM in flexion.
Some experiments have also been conducted where the target beam is prepared in a metastable state using electron bombardment, but these experiments are very preliminary. The final momentum of the inelastically scattered electron is given by Pef, whereas the final momentum of the target is given by Paf.
The high resolution of the laser excitation allows details of the electron excitation to be studied in higher detail than is possible using electron spectroscopy alone. When requested the grid potential is rapildly raised so that the positive anode potential field reaches the filament to extract electrons which are accelerated and focussed onto the interaction region using 2 triple aperture electrostatic lenses. The scattered electrons leave the interaction region with momentum Pef at scattering angles (thetae, phie), whereas the deflected excited targets leave the interaction region with linear momentum Paf at polar angles (thetaa, phia). The scattered electrons are confined to the xz plane and leave the interaction region with momentum Pef at a scattering angles thetae. In general as shown in figure (c), for a particular target deflection angle between these two extrema there are two possible electron scattering angles that can result in targets deflected to this angle, as shown. A further set of output deflectors pulsed simultaneously with the grid allows the final focussed beam to pass through the exit aperture and onto the target beam.
The deflected excited targets therefore must also leave the interaction region in the xz-plane and are deflected to the angle thetaa.
In the example shown, electrons scattered in the lower xz-plane experience a momentum change larger than electrons scattered into the upper xz-plane.
This set of deflectors also removes any ions created inside the electron gun in the high potential regions from reaching the interaction chamber, since their flight times are much slower than the associated electron pulse.
Observation of the targets at any intermediate deflection angle will therefore display two different momenta for these targets. A patient with non-impaired flexibility should be able to extend her hip perpendicular to the floor. SI Joint Examination: If the patient is unable to stand, instruct the patient to lie in supine and perform a pelvic bridge.

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