SPECTRUM OF MUSCULOSKELETAL DISCOMFORTSIN PREGNANT WOMEN AND IMPACT OF ANTENATALEXERCISES OR POSTURAL CARE ON STATUS OF RELIEF: A SYSTEMATIC REVIEW STUDY

Pregnancy is a normal physical state of women’s life when they carried a 9 month developmental stages of the foetus. On these durations some pregnancy induced changes leads normal signs naturally but there is an increased risk of musculoskeletal pain or discomforts associated with increase of uterine size and mental stress of pregnant women, needed non-medicines approached like antenatal physiotherapy care. These possible pain or discomforts can make difficult to carry the pregnancy may leadsome complications. Various research studies are point out these problems of pregnant women and find out the triggers. Some studies show the spectrums of these musculoskeletal problems during pregnancy period. Various case studies are assuredtheparticular physiotherapy techniques as antenatal exercises have good impact on relief of respective musculoskeletal pain.Various researches are also covered some another aspects of musculoskeletal problems during pregnancies. In thepresent study an attempt has been made to comprehensive analysis of these review studies to identify

Pregnancy is a normal physical state of women's life when they carried a 9 month developmental stages of the foetus. On these durations some pregnancy induced changes leads normal signs naturally but there is an increased risk of musculoskeletal pain or discomforts associated with increase of uterine size and mental stress of pregnant women, needed non-medicines approached like antenatal physiotherapy care. These possible pain or discomforts can make difficult to carry the pregnancy may leadsome complications. Various research studies are point out these problems of pregnant women and find out the triggers. Some studies show the spectrums of these musculoskeletal problems during pregnancy period. Various case studies are assuredtheparticular physiotherapy techniques as antenatal exercises have good impact on relief of respective musculoskeletal pain.Various researches are also covered some another aspects of musculoskeletal problems during pregnancies. In thepresent study an attempt has been made to comprehensive analysis of these review studies to identify the most common musculoskeletal problems in different stages of pregnancy and efficacy of physiotherapy techniques and antenatal exercises to overcome the problem. It was found in the spectrum analysis that most of the women (68.33 %) faced this problem during their pregnancy. On the analysis of most commonmusculoskeletal problem, the mean percent of review's reveals showed that the most of the women found to be in muscle cramps and pain in neck and shoulder during I trimester whereas maximum women had low back pain (42.87 %) and pelvic girdle pain (11.65 %) on II and III trimester respectively. The satisfactory impacts of antenatal exercises were observed in different musculoskeletal pain by different techniques of Physiotherapy.These results can utilize to make suggestions and recommendations foradoption of suitable physiotherapy techniques in pregnancy to avoid the problem.
1154 knee and ankle-foot in a diagram of the human body. Stress due to developing foetus, on the axial skeleton, pelvic girdle, and genitaltract may lead to acute disorders, including nonspecific pain, neurologic compression, joint disruption, and septic arthritis in pregnancy. According to Sabino J, Grauer JN (2008),the low back pain is a common problem in pregnancy. The pain is episodic in nature, is usually aggravated by hard work or stress and is worse at night.A woman's body undergoes various changes during pregnancy which include weight gain, changes in posture, and joint and ligament laxity along with changes in musculotendinous strength. The diagnosis is using ultrasonography.
Antenatal care refers to the care that is given to an expected mother from time of conception is confirmed until the beginning of labor. The goals of antenatal care are to reduce maternal and perinatal mortality andmorbidity rates.The antenatal exercises are most required package to provide relief it includesbridging, wall push-up, kegal, clamshell, stretching and strengthening of abdomen & trunk, squatting, breathing etc.Posture is important to relief the muscles and spine stiffness during pregnancy.The efficacy of these antenatal exercises and postural care on relief and improvement of musculoskeletal discomforts is an area of research interest as very few attempts were obtained in this aspect.
The present study has been able to represent the actual scenario of the musculoskeletal discomforts faced by pregnant women during pregnancy. The attempt is based on the review of literatures, aimed at to compile the reveals of these studies and utilise it to make suggestions for physiotherapists and promote them to generate the easy going techniques of physiotherapy as accordance to type and intensity of the musculoskeletal discomforts faced by pregnant women.

Methodology:-
A precise methodology was adopted to achieve the objectives of this systematic review study. The literatures were collected from different journals of physiotherapy and other medical sciences available in e-libraries and research articles on the following aspects as the research objectives: 1. Research studies on spectrum of musculoskeletal pain or discomforts during pregnancy 2. Type of musculoskeletal problem prevalent in particular trimester of pregnancy 3. The intensityand severity of musculoskeletal problem faced by pregnant women. 4. Assessment of efficiency and impact of different techniques of physiotherapies to relief as in antenatal exercises and postural care package.
After collection of minimum 20 review articles in each aspect, the reveals of studies were compiled then a comprehensiveanalysis was made to reveals the review based results finally. The studies showed their reveals on percentage, here the mean of these mean's percentage were found statistically and used in ranking of prevalence.

Results and Discussion:-
After the analysis of reviews data the results have been interpreted in its presentation. The revealed results have been presented on the selected aspects:

Spectrum of musculoskeletal pain or discomforts during pregnancy:
The compile reveals of review studies has been provided the information that presented in table no. 1.

The prevalence scenario:
The  The type of most common musculoskeletaldiscomforts: It showed in table no. 1 (b) thatmaximum pregnant women (42.67 %) were experiencing low back pain (LBP), got 1 st rank; back pain has 2and rank with 43.67%; pelvic girdle painin 3 rd rank; Calf and thigh muscle cramps got 4 th rank; Hip joint pain in 5 th rank;Neck and shoulder pain in 6 th rank, other pain and discomforts such as elbow pain, knee, ankle-foot pain etc. show in 7 th rank and hand-wrist was found to be in 8 th rank. On whole, it was found that most of the women faced these types of musculoskeletal pain on III trimester of pregnancy with LBP in maximum.

Interpretation:
According to Sabino J, Grauer JN (2008), the low back pain is a common problem in pregnancy. It is defined as pain localized below the line of the twelfth rib and above the inferior gluteal folds. It could present as axial or parasagittal discomfort in the lower back region. It is a common musculoskeletal discomfort and may be began due to a combination of mechanical, circulatory, hormonal, and psychosocial factors. The statement of physiotherapist is proved in the finding's analysis in this review study. The intensity and severity of musculoskeletal problem faced by pregnant women: It was investigated in most of the studies by using Numeric Rating Scale (NRC). VAS scale and some other scales can also estimate the intensity of pain. Table no. 2 shows that most of the women (18.93 %) of I trimester were experienced mild or low pain intensity, moderate in II but it reaches highest pain intensity in III trimester. Maximum pain intensity was moderate category analysed in II trimester i.e. 49.56 percent.

Impact of antenatal exercises and postural care on musculoskeletal discomforts during pregnancy:
Many case studies have been carried out on the impact of antenatal exercises and postural care of pregnant women but very few has presented statistically. There are some studies concluded reviews presentedhere as following manner: There is considerable evidence that exercise during healthy pregnancy has positive effects on the mother and fetus. Further-more, there is some evidence that suggests positive effects on the child. Women, therefore, should be encouraged to initiate or continue exercise during a healthy pregnancy. Further research is required to assess the short-and long-term effects of weight management on maternal and infant health, the psychosocial, importance of exercise during pregnancy, and the effect of exercise during pregnancy on the neurodevelopment of children.
These reviews have compressed the literature on exercise during pregnancy and presents some suggestions about when and how interventionists might best intervene to enhance pregnant women's exercise. Albeit, there are many opportunities for future research and continuous efforts to study exercise during pregnancy will increase our knowledge about the determinants and outcomes of exercise participation and improve our ability to effectively intervene.

Conclusion:-
The present attempt of review study has been concluded that status of musculoskeletal discomforts and pain pregnant women with the reporting of impact of antenatal exercises and postural care and treatment on the relief status. Most of the women were faced this problem during different trimester of pregnancy. Maximum women experienced this problem during III trimester of pregnancy. The pain intensity was gradually increases from I to III trimester of pregnancy as low, medium and highest pain intensity, therefore a constant antenatal exercises and postural care package is a need as non medicine approaches to improve the painful burden of pregnancy.A proper pain and discomfortsmanagement under the antenatal care can be possible by health care experts and physiotherapists to avoid the side effects of analgesic used to pain relief, because the study shows a good impact to physiotherapy to relief, control and prevents the musculoskeletal discomforts during pregnancy.