Physiotherapy for women

Menopause is the beginning of the period of infertility in women and occurs gradually (it can last up to 10 years) between the ages of 45 and 55.

The cessation of ovarian function leads to hormonal changes, in particular a drop in oestrogen. Hormonal changes due to menopause start several years before and can last up to several years after menopause. 

As a result of hormonal changes, the menopausal period is characterised by a number of joint and connective tissue problems. 

60% of women experience low back pain during menopause, women can lose up to 25% of their bone density after menopause, and joint inflammation and joint swelling are more common.

In late menopause, women experience accelerated muscle atrophy, which is manifested by a loss of skeletal muscle density and strength in the stabilising muscle groups that support the joints.

Low back pain in menopausal women is often severe and occurs repeatedly or persists for more than 12 weeks continuously. Lumbar pain is the leading cause of sickness absence in menopausal women. At Medicofit, we often treat sciatica, which accompanies spinal pain, with physiotherapy for menopause.

Specialised physiotherapy for menopause addresses the risk factors that are specific to this period of a woman’s life, in particular strengthening the core of the body, the hip stabilisers and the spine. For women with acute painful spinal conditions, we offer a holistic physiotherapy approach with TECAR therapy, LASER therapy and HiTOP high-tone electrostimulation for a biostimulating effect. 

Increasing the load-bearing capacity of the spine and other joints is a priority in physiotherapy for menopause. Due to the loss of bone density and muscle strength, every woman needs to perform tailored strength exercises that include free weights. The Medicofit menopause programme also includes exercises to improve the pelvic floor muscles, which often lose strength with ageing and cause urinary incontinence.

Coccygodynia is a pain condition of the sacrum or a defect of the sacrum causing low back pain or low back pain.

More than ¾ of lumbar spine disorders and pain occur in women and coccygodynia is 5 times more common in women than in men. 

It is a relatively common pain condition in women that is under-represented in the clinical practice of physiotherapy for women.

Coccygodynia is characterised by pain that is concentrated in the area of the occiput.

The pain is often exacerbated by sitting with a backward tilt, running or more intense walking. The pain is worse when getting up from a chair, and worsens if the chair is forced.

Typically, the pain may spread to the sacrum and be recognised as general low back pain. Direct strain on the occiput is very painful, and if the patient falls on the buttocks, the pain is sharp and intense. 

In general, two types of coccygodynia can be distinguished:

• Acute coccygodynia (present for less than 10 weeks).

• Chronic coccygodynia (present for several months or years)

This is a condition that should not be equated with disc herniation, spinal arthrosis, spinal stenosis or other spinal disorders. Therapy should be in the form of acute physiotherapy directly targeting the spine with TECAR therapy, LASER therapy and PERSIO therapy.

Acute coccygodynia requires a holistic instrumented approach, isolated manual therapy is not the leading method of treatment. 

The final part of physiotherapy also includes exercises to increase the weight-bearing capacity of the lower limb and to teach correct patterns of squatting, walking and running.

Ženski spolni hormoni so pogosto krivec za bolj pogosta mišično-skeletna obolenja in degenerativna stanja sklepov žensk.

Kljub temu, da se z bolečinami v križu sooča 80 % ljudi vsaj enkrat v svojem življenju, pa nosijo ženske v nosečnosti in menopavzi visoko tveganje za močan napad akutne bolečine v hrbtenici in nastanek degenerativnih stanj medvretenčnih diskov. 

Pogosta napaka žensk sta počitek in pasivna fizioterapija usmerjena zgolj v zmanjšanje bolečine. Vaje za aktivacijo hrbteničnih mišic se morajo pričeti že zgodaj v akutni fazi sicer se mišična atrofija poveča, obdobje bolečin pa za žensko lahko postane dolgotrajno.

Pomembno je, da potencialna tveganja za bolečine v križu ženske naslovijo že pred prvimi težavami s hrbtenico.

V okviru preventivne fizioterapije morajo ženske opraviti analizo gibalnih vzorcev hrbtenice saj so pogosto prisotna odstopanja od pravilnih položajev ledvene in prsne krivine hrbtenice v obliki ledvene lordoze, prsne kifoze in tudi vratne lordoze.

Preventivna fizioterapija mora nasloviti mišice, ki skrbijo za ustrezno stabilizacijo hrbtenice med rotacijskimi obremenitvami, ki so v  vsakdanjem življenju zelo pogoste. Večina programov skupinskih vadb in vadb za ženske žal ne vključuje rotacijske preventivne vadbe v obliki anti-rotacijske krepitve,  ravno te  obremenitve pa pogosto povzročijo močne bolečine v križu.

V primeru bolečin v križu svetujemo diagnostični pregled najkasneje 3 dni po prvih znakih boleče hrbtenice saj lahko pravočasna protibolečinska terapija do 70 % skrajša akutno bolečinsko fazo.

Zdravljenje se izvaja v treh fazah:

• Prva faza: Nazdorovane in prilagojene vaje za krepitev jedra telesa, abduktorjev kolka, ekstenzorjev hrbtenice in anti-rotatorjev hrbtenice
• Druga faza: obremenjevanje hrbtenice  v polnih stopinjah ekstenzije, fleksije, laterofleksije in rotacije hrbtenice.
• Tretja faza: vključuje vaje za povečanje obremenilne kapacitete hrbtenice v obliki učenja različninh vaj moči kot so mrtvi dvig, počepanje, izpadni korak z bremenom na vratu, enostransko nošenje bremen in kasneje tudi tek.