SCIATICA PAIN AND HOME REMEDIES

What is sciatica

Sciatic nerve compression or irritation results in Sciatica. It is the longest and the largest nerve. Begins in the lower back and runs through the buttock and the lower limb. The sciatic nerve supplies sensation to the skin of the foot as well as entire lower leg except inner side of the leg. This sciatica pain is usually associated with low back pain, but it represents an ideal symptom.

Symptom: The pain radiates to the gluteal region back of the thigh and legs. The pattern of pain depends on the nerve root compression. Depending on which area get effected,the pain or other symptoms will radiates to that area. Usually sciatica will affect only one side of the body and sometimes in both the legs.

Causes:

Any penetrating injuries

Entrapment of nerve at sciatica notch

Congenital or traumatic hip dislocations

Accidental damage from misplaced intramuscular injection

Degenerative disc disease

Lumbar disc herniation

Spondylolisthesis

Lumbar spinal stenosis

Piriformis syndrome

Sitting for prolonged time or sitting in a bad posture for more time results in stress on lower back and on the nerve.

The common symptoms are

Pain

Numbness

Tingling sensation 

Weakness in the hamstring muscles (thigh muscles) with loss of bending movement at the knee joint.

Distal foot and leg muscles are also get affected.

Sensory loss in the outer aspect of the leg.

Reduced knee and Ankle reflex.

Difficulty in raising the big toe, results in foot drop sometimes.

Difficulty in raising heel off from the ground

walking on the tiptoes 

The radiation of the pain begins with walking and is relived on rest. Thesymptoms may vary according to the nerve root compression

HOME REMEDIES

1)Ice and heat treatments are easily available and very inexpensive, applying ice or hot packs helps in reliving symptoms greatly.

2)Low impact aerobic exercises.

3)Yoga

4)Stretching.

5)Massage therapy: Trigger point massage.

6)Avoid prolong sitting

7)Topical administration 

8)Acupuncture

9)Sleeping position: Lie on your back with knees slightly bend towards ceiling and put pillows under the knee, the buttocks and ankles should be in contact with the bed.

10)How to reduce pain in sitting position: Feet flat on the floor, don’t cross your legs, keep hips and knees bent at 45 degrees angle

11)Lie on your back and raise your leg straight the foot should face the ceiling and the other leg should be in contact with the floor. Hold for 5 breaths and then relax.

12)Pelvic bridging exercises, lie on your back, bend your knees 

and lift your pelvis and lower back upwards by pressing knees together hold this position for 5-10 breaths and relax. 

Repeat 5 times initially and then progress to 10 times. 

13)Piriformis stretching can be done in a chair: 

Sit upright in a chair, Cross right ankle over the left knee and flex the foot by pushing through the heel. Then stay for 5 breaths & repeat for 5 times the same with the opposite side.

14)Lie on your back one leg should be straight and other leg should be bent at the knee and pull it towards your chest by holding or clasping with both the hands and then hold for 5 breaths and then relax and repeat the same with the other leg and then with the both legs. Repeat the exercises for 5-10 times.

15)Back thigh muscles stretch (Hamstring stretch): This exercise helps in reducing tightness in the back muscles. Stand in front of a chair and place your foot on the elevated surface of the chair, bend your body forward towards your foot and with both the hands try to touch the toes and hold for 5 breaths and then relax and repeat for five times and do the same for the other leg. The further you go, the deeper the stretch. Do not push so far you may feel pain.

16)Sit on the floor with your legs straight in front of you, then bend your left leg putting your left ankle on top of the right knee. Now lean forward so that your upper body will reach toward your thigh. Hold for 5 breaths and then relax and repeat the same for other leg. This exercise helps in stretching the gluteus muscle and lower back muscles

Do not overstretch your muscles you may feel pain. So, take proper training from your physiotherapist initially and practice the same at your home. These stretches help in relieving pressure and reduces pain.

Note: Please consult your doctor before starting the exercise programme.

POST-PREGNANCY EXERCISES

IMPORTANCE OF EXERCISES AFTER DELIVERY 

After delivery many women are facing post pregnancy problems, you can overcome them with proper exercises. Due to lack of proper guidance and due to our negligence post pregnancy problems are becoming worse and results in depression. 
Common post pregnancy problems after delivery are
Painful perineum
When sneezing and coughing , leakage of urine or faeces (Urinary or faecal incontinence)
Musculoskeletal problems
Urogenital dysfunction
Poor wound healing
Urinary or faecal urgency
Feeding baby in bad postures results in musculoskeletal pain.
Saggy skin
Fatty tummy
Depression
Physiotherapy treatment helps to overcome all these post pregnancy problems by proper education and training. Women with stress and stress with urge and urge incontinence and genital prolapse may all comes to normal by proper physiotherapy treatment. The pelvic floor muscles plays an important role in incontinence and for organ support mechanisms.For Women with caesarean, Bed exercises and mobility followed by early ambulation reduce the risk of respiratory tract problems and back pain.Abdominal and pelvic floor exercises and optimal feeding postures should be taught to new mothers.
For painful perineum , Physiotherapy therapeutic interventions like ice packs, pelvic floor exercises to increase blood supply and aid in healing,advice on supported defecation and the use of pillows under the buttocks when sitting to prevent pressure on the wound.
For Incontinence and urgency,  pelvic floor exercises are good.
The following are the exercises to relieve from signs and symptoms

• Pelvic Floor Exercises:They contribute to urethral closure pressure and provide tonic inhibition to the bladder.
• Exercising your pelvic floor: Imagine that you are trying to stop yourself from passing the wind,and at the same time try to stop your flow of urine in the midstream. The feeling is one of squeeze and lift, closing and drawing up the back and front passages and hold for 10 breaths and then relax for few seconds. Repeat as many as you can up to 10 repetitions but slowly increase the repetitions which will help to increase the endurance of the pelvic floor muscles. This exercise helps the muscles to react quickly to stop leakage with coughs and sneezes. These exercises can be practised  anywhere and at anytime and in any position but not while you are emptying bladder.
• Many new mothers face problems to adjust and how to take care of the new one during the first few weeks and results in Fatigue. Physiotherapists helps to motivate and encourage them to postnatal classes , will teach baby massages and postnatal groups promotes a positive outlook,reinforcing a healthy living for life.
• The following are the exercises for Abdominal obesity, for Strengthening abdominal muscles and for saggy skin in post pregnancy.

1)Pelvic bridging exercises, Lie on your back, bend your knees 
   and lift your pelvis up by pressing knees
   together hold this position for 5-10 breaths 
   and relax. Repeat 5 times initially
   and then progress to 10 times 
2)Lie on your back, raise your head and shoulder to look at feet
and hold for 5 breaths then relax. Repeat for 5-10 times.
3)Raise your head, shoulder and right hand and look at feet with your legs straight and then repeat for the other hand. Hold for 5 breaths and repeat for 5-10 times.Now raise both the hands and look at the feet.
4) The same procedure can be done with the knees bent first with one hand try to touch the knee and next with the other hand and then repeat for both the hands.
5)Lie on your back bent both the knees and raise one bent knee in 90 degrees and then raise your head, shoulders and right hand and look at the knee and repeat the same for the other hand and then with the both hands. Repeat for 5-10 times and hold for 5 breaths.
6)Lie on your back with knees bent and raise your knees up and do cycling movement (one knee in bent position and keep other leg straight off from the bed) at this position.
7)Lie on your back one leg should be straight and 

other leg should be bent at the knee  

and pull it towards your 
chest by holding with both the hands and then hold for 5 breaths and then relax and repeat the same with the other leg and then with the both legs. Repeat the exercises for 5-10 times.


8)In standing position separate your feet for 3 feet distance and foot should be supported sideways and now bend your trunk sideways with opposite arm swinging overhead. 




9)During pregnancy your knees bear more weight and results in weakness of the joint  in post-pregnancy so strengthen your Quadriceps muscle of the knee joint. Lie on a bed and roll a towel and place underneath your knee and press the towel with your knee and hold for 5-10 breaths and then relax and repeat the same for other knee and repeat the exercise for 10 times.You can strengthen your quadriceps muscle in sitting position also. Sit in upright position and lift the leg upwards or straightly and hold for 5-10 breaths and relax and then repeat the same for other leg.
10) Strengthen your back muscles, lie on your tummy and raise your head shoulders both hands and legs and hold for 5 breaths and then relax and repeat for 5-10 times and then gradually increase the sessions. 
11)Aerobics like Jogging, brisk walking, swimming, cycling, rope jumping, dancing helps in controlling and preventing the back pain occurs due to post pregnancy.
12)Gym activities like Cycling. Treadmill walking, Cross trainer, Swiss ball training helps in strengthening muscles and also helpful in reducing postpregnenancy obesity.
13)Yoga and meditation for decreasing stress and anxiety.

14)Feeding positions are very important to protect from musculoskeletal problems.

Regularly follow the physical fitness regimen under supervision of trained physiotherapist.


Before starting the exercise programme please consult your doctor and they will guide you when to start the exercises. 

LOW BACK PAIN AND EXERCISES

LOW BACK PAIN

Commonly seen in people with sedentary jobs more than those who work in varied activities. More commonly seen in Software professionals, surgeons, Dentists, Miners, Truck drivers. Also seen in persons who will do Bending activities more, sitting in a bad position, Standing for a long time, Fall injuries, Maintains static position in the bed for long time (Bed ridden).

Low back pain is of two types:

Acute low back pain which subsides within a month and

Chronic back pain recurs more.

Some of the causes are:

1.     In children the Back pain is uncommon but if present then it may be due to some organic diseases.

2.     In adults occurs due to Postural and traumatic back pain, spondylitis, disc prolapse.

3.     In Elderly persons because of Degenerative arthritis, osteoporosis, bone diseases.

4.     In women who have had several pregnancies, and, in these women, lack of exercises leads to poor muscle tone which results in low back pain and also seen in women who gain more weight during pregnancy and later develops Mechanical back pain.

5.     Occupation plays a major role in back pain, seen more commonly in people who will do sedentary jobs (less mobility).

6.     Any history of spinal diseases such as Traumatic or Inflammatory disease causes back pain.

7.     Psychoneurotic back pain due to anxiety, stress at work place or due to any family problems

People with Low Back Pain suffer from

• Pain may be localised or radiating to other areas,
• Stiffness early in the morning,
• Paraesthesia, 
• Numbness or weakness, 
• Spasm in acute back pain
• Localised Tenderness,
• Swelling if any underlying disease  and
• Limitation of movements.

Treatment

After complete assessement of your problem your doctor will prescribe you treatment.Absolute bed rest on a hard bed in Acute phase of back pain and some analgesics, Anti-inflammatory drugs, and in stiff spine Muscle relaxants.

Temporary use of any corset (Back pain belt).

Physiotherapy Treatment

Physiotherapy treatment plays a major important role in treating the persons with low back pain. The treatment consists of Strengthening exercises, Modalities treatment for pain and for nerve root compression Spinal Traction and ergonomic advice or educating the patient to avoid straining of back in activities of daily living such as sitting, standing, lifting weight.

Your physiotherapist will take proper assessment before starting the treatment programme.

The Assessment includes:

Detailed History of previous problem with the current problem.

Examination of Posture and gait (way of walking) to evaluate any spinal curves deviations like Scoliosis, Kyphosis, Flat back, Lordosis.

Evaluation of Pain: Type of pain, site of pain and characteristics of pain by using Visual Analogue scale.

Palpation to recognise specific tissue at fault.

Range and Rhythm of Spinal Movements

Neurological Examination for specific nerve root involvement and for sensory status, tendon reflexes.

Specialised diagnostic neuro musculoskeletal tests

After the assessment according to your problem he will plan the treatment.

Physiotherapy Modality treatments are:

For Pain and Relaxation: Ultrasound massage

For Radiating pain: Interferential therapy treatment

For Localised pain: TENS Machine treatment

Hot packs application

Spinal Traction 

Acupuncture

Spinal Manipulations

Massage techniques

Spinal Exercises

Many of us neglect doing exercises regularly and properly but 

Do you know the importance of Spinal exercises?

Helps to decrease pain. 

Strengthen the weak muscles, bones and ligaments.

Reduces mechanical stress to spinal structures.

Improve nutrition to joint cartilage

Improve posture.

Stabilise hyper mobile structures.

Improve mobility and flexibility.

Enhance oxidising capacity of skeletal muscles.

Reduces the symptoms like Anxiety and depression.

Increases the level of endorphin in the blood and cerebrospinal fluid, this endorphin helps in reducing pain and it is very less in people with the Low back pain.

Improves over all fitness level and prevents the recurrence.

Uses of spinal forward bending exercises: 

To strengthen abdominal muscles

To stretch back extensors

To open intervertebral foramen and reduces compression on the nerves.

Protects lumbar disc.

To increase endurance of abdominal muscle.

 Uses of spinal backward bending exercises:

Improves strength and endurance of back spine and hips.

Improves mobility of the spine.

Promotes normal physiologic lumbar curve.

Improves tone in the back muscles which is often reduced because of natural forward bending attitude in the humans.

Contraindications/People who are Not advisable to do exercises:

For the spinal flexion or spinal forward bend exercise programme:

Osteoporosis -weakness of the bone

Compression fracture

After prolonged bedrest the disc is hyper hydrated and is more susceptible to injury.

In acute disc prolapse which exerts more load on lumbar disc and open the posterior intervertebral space.

For the spinal extension or backward bend exercises programme:

In any acute disc lesions like wound, abscess or any tumour,

In Spinal stenosis: Narrowing of the spine which put pressure on the nerves that travel through the spine.

In Spondylolisthesis: Forwarding slipping of one vertebral body on the other.

Multiple surgeries on the back.

EXERCISES PROGRAMME:  

All exercises are not fit to everyone so meet your physiotherapist before starting the exercise programme he will assess and plan the treatment for you. The following are the few spinal exercises

1) Pelvic bridging exercises, Lie on your back, bend your knees and lift your pelvis up by pressing knees together hold this position for 5-10 breaths and relax. Repeat 5 times initially and then progress to 10 times

2)Prone kneeling back humping or arching, hallowing slowly hold for 5 breaths

and repeat for 5-10 times and then relax.

3)Lie on your back, raise your head and shoulder to look at feet

      and hold for 5 breaths then relax. 

       Repeat for 5-10 times.  

4)Raise your head, shoulder and right hand and look at feet with your legs straight and then repeat for the other hand. Hold for 5 breaths and repeat for 5-10 times.

5)Now raise both the hands and look at the feet. The same procedure can be done with the knees bent first with one hand try to touch the knee and next with the other hand and then repeat for both the hands.

6)Lie on your back bent both the knees and raise one bent knee in 90 degrees and then raise your head, shoulders and right hand and look at the knee and repeat the same for the other hand and then with the both hands. Repeat for 5-10 times and hold for 5 breaths.

7)Lie on your back with knees bent and raise your knees up and do cycling movement (one knee in bent position and keep other leg straight off from the bed) at this position.

8)Lie on your back one leg should be straight and other leg should be bent at the knee and pull it towards your chest by holding with both the hands and 

 then hold for 5 breaths and then relax and repeat the same with the other leg and then with the both legs. Repeat the exercises for 5-10 times.

9)For the whole spine exercise in standing position separate your feet for 3 feet distance and foot should be supported sideways and now bend your trunk sideways with opposite arm swinging overhead. 

10)For spine rotators- Ride sitting, trunk rotation to alternate sides with loose Arm swinging. 

11)Now lie on your tummy raise your head up and look at the ceiling upwards and then repeat the same with straight hand raise with right hand first, hold for 5 breaths and repeat for 5 times and repeat the same with other hand and with both the hands.

12)Now repeat the same exercise by raising your right hand straight and then lift the left leg straight upwards off from the floor and then with the left hand and right leg and then repeat the same for both the legs with both hands raising by holding for 5 breaths in each position and repeating for 5-10 times.

13)Aerobics like Jogging, brisk walking, swimming, cycling, rope jumping, dancing helps in controlling and preventing the back pain.

14)Yoga

NOTE: Please consult your doctor before starting the exercise programme.  

THYROID IN WOMEN

Thyroid is becoming  more common in women due to their stress or other physiological causes.  In women it will effect Menstrual period, which effects ovulation and problem in getting pregnancy, during pregnancy health problems to the mother and baby.
Below is an overview of Thyroid Gland and its hormones.

THYROID is an endocrine gland situated at the root of the neck on either side of the trachea.

It weighs about 20-40gm and it is larger in Females than Males. In females the structure and the function of the thyroid gland changes during their different stages of  sexual cycle .

Its function increased in Pregnancy and Lactation and decreased in Menopause.

The gland recieves rich blood supply the amount of blood recieved perminute is five times more than its weight..

TYPES OF HORMONES:

Thyriod gland secrets three hormones

1.Tetraiodothyronine- T4 ( Thyroxine)

2.Triiodothyronine -T3

3.Calcitonin

T4 forms about the 90% of total secrection whereas T3 9-10% but the potency of T3 is more than T4. Thats why T3 act on target cells immediately but T4 acts slowly.

Calcitonin major role is maintenance of blood calcium level, it reduces blood calcium level by acting on bones,kidneys & intestine.

FORMATION OF HORMONES

Iodine and Tyrosine are helpful for the formation of thyroid hormones. These two are consumed through diet and are absorbed from Gastrointestinal Tract.

PRODUCTION OF THYROID HORMONES

Thyroid stimulating factor:Anterior pituatry secrets Thyroid stimulating factor which stimulates thyroid to release thyroid hormones. Normal Level of TSH approximately 2U/ml.

By administration of Thyroid stimulating hormone, thyroxine can be released with in 30 minutes. 

Iodide is also an important factor to regulate thyroid hormones, In the diet when the iodine level is moderate then it is Normal. When intake is high the enzymes which are helful for the synthesis of hormones are inhibited results in suppression of hormone synthesis.

FUNCTIONS OF THYROID HORMONES

• Maintains Basal Metabolic Rate of the body
• Stimulates growth hormone in children
• Maintains body weight
• Maintains body temperature
• Helps in production of redblood cells 
• Maintains Heart Rate and Respiratory rate
• Increases  in Apetite & Food intake
• Essential for the growth and normal function of the central nervous system.
• Maintains proper sleep
• Essential for the normal activity of the Skeletal muscle.
• Regulates menstrual cycle properly.

DISORDERS OF THYROID GLAND

HYPERTHYROIDISM- Oversecretion secretion of thyriod hormones

Symptoms: 

• High release of thyroxine the body temperature increases  resulting in excess sweating.    
• More secretion of thyroid hormones in central nervous system leads to extreme nervousness and develpos psychoneurotic problems 
• Weight of the body decreased 
• Due to stimulatory effect of thyroxine on neurons , the person cannot sleep.  
• Muscle weakness and Mild Muscle tremors in hands
• During Menustration Hyperthyroidism leads to reduce bleeding.
• The increased motility of gastrointestinal tract causes diarrhea
• Toxic Goiter-Enlargement of thyroid gland which occurs due to tumour in the gland. The size of the gland increases due to increase in the number of hormone secreting cells results in increase in hormone level also.

HYPOTHYROIDISM-Decreased secretion of thyroid hormones 

Symptoms:

• Swelling of the face
• Constipation
• Bagginess under the eyes
• Fatigue and muscular sluggishness 
• Decreases Cardio vascular function 
• Increases body weight 
• Loss / depressed hair growth 
• During Menustration hypothyroidism causes excess bleeding 
• Husky voice
• Mental sluggishness
• Change in voice to husky  
• Non toxic Goiter: Enlargement of thyroid gland but hormonal secretion reduced

THYROID CANCER

Cancer cells will form from the tissues of the thyroid gland.

 In thyroid cancer thyroid nodule will appear, some have symptoms of swelling or lump in the neck and causes difficulty in swallowing. The voice also become hoarse. All thyroid nodules are not cancerous after proper diagnostics doctor will confirm it.

TREATMENT

Hyperthyroidism: Treated by Antithyroid substances & in advanced cases thyroid gland will be removed called Thyroidectomy.

Hypothyroidism:Adminstartion of thyroid extract or ingestion of pure thyroxine in the form of tablets orally.
Thyroid cancer: Radioactive iodine,Hormone therapy,Radiation, Chemotherapy, Thyroidectomy removal of thyroid gland.
DIET plays an important role in controlling the thyroid so meet your dietician and follow the diet. The following are the some of the foods that should be avoided
HYPOTHYROIDISM:Bread,Pasta,Cereals,Soya fods,Broccoli,Spinach,Cabbage,Peaches,Pears,Strawberries
HYPERTHYROIDISM: Diary products,Soy,Corn,High intake of sugar, Caffiene,Refined products,Limit intake of iodized salt and supplements contains iodine.According to your thyroid level dietician will plan diet for you , follow the diet and your thyroid levels get normal soon.
Yoga and Meditation helps to overcome from the stress, anxiety and gives relaxation, proper sleep . If the symptoms are becoming more severe then meet the clinical psychologist.
Meet your Gyanecologist if you are facing any disturbances during Menstrual cycle.
Meet your physical therapist and they will take an assessment of your muscle tone , Respiratory rate, heart rate and plan the treatment for you. 
Some physio advices like 

• Walking
• Cardio workouts
• Aerobics
• Breathing exercises
• Muscle strengthening exercises like leg raises, pushups
• Relaxation postures   
• Cycling
• Swimming
• Zumba dance
• Body weight exercises helps in building muscle mass
• Do low intensity and moderate exercises 
• Exercises helps you to control thyroid levels.
• Regular checkups with doctor

By proper planning of your day with diet, medications, exercises and yoga will reduce your thyroid symptoms.


CONSULT YOUR DOCTOR BEFORE STARTING ANY DIET AND EXERCISE PLAN

PRENATAL EXERCISES THE EXERCISES DURING PREGNANCY

EXERCISES IN PREGNANCY

Consult your Gynecologist before starting the exercise programme, according to your health issues doctor will suggest you. Don't start any exercise programme until you reach the 4th month of pregnancy and if you have any health issues listed below

• If you have any cardiovascular, respiratory, renal diseases
• Poorly controlled Type I Diabetes
• If there is any history of miscarriage, premature labor, cervical incompetence
• High blood pressure
• Vaginal bleeding

POTENTIAL BENEFITS OF THE EXERCISES

• Maintains cardiovascular fitness
• Maintains healthy weight
• Improves blood circulation
• Helps for normal delivery
• Increase stamina
• Possible prevention of Gestational Diabetes  
• For muscle strengthening, posture, coordination and for balance

STEPS TO FOLLOW BEFORE STARTING AN EXERCISE PROGRAMME

• Wear a loose and comfortable outfit 
• Wear supportive footwear 
• Fluid intake should be more to avoid dehydration
• Avoid exercises during hot weather
• Warm up and cooldown for at least 5 minutes 
• Carry a water bottle before you are going for a walk.
• Start exercises under the supervision of qualified experts.  Exercises should be simple and basic level initially for 15 min for few days and then gradually progress to moderate level for 20-30 min.

WHEN TO STOP EXERCISE

• When there is a abdominal pain, back or pubic pain
• Vaginal Bleeding
• Dizziness
• Shortness of breath
• Difficulty in walking
• Faintness
• Palpitations

Meet your doctor immediately if you feel more uncomfortable.

WHAT TO AVOID DURING PREGNANCY

Avoid Sports  
Avoid Toe touches and Deep Knee Bends

EXERCISE PROGRAMME

Start your exercise programme from a Brisk walk and then start doing exercises to your Arms, Neck rotations and then progress to lower parts of the body.

1. Walking is a good exercise from the first month of pregnancy onwards. First initially start with 15 min of a walk then increase slowly & gradually to 30 min walk.
2. Neck rotations: Turn your neck round & Move your head sideways 
3. Shoulder rotations: Bend your elbows and put your hands on shoulders do movements in clockwise and Anticlockwise direction.
4. Keep ups: Bend your elbows so that your arms are parallel to the elbow and raise your elbows overhead and slowly increase the speed and bring your elbows right back like sweeping motion and inhaling up and exhaling down. This exercise is most useful for shoulder and neck.
5. Deep breathing exercises like pranayama increase oxygen to the fetus and highly beneficial during labor pain.
6. Quadriceps Strengthening Exercise as body weight will fall on knee joints more you have to strengthen those muscles.
   Sit upright In a chair with knees bent slowly raise your bent knee straight, tighten your quadriceps muscle and hold for 5 breaths and slowly lower your leg down and repeat the same to other legs.
7. Pelvic floor exercises During pregnancy the pelvic joints become more mobile, pelvic tilts helpful to relieve from back pain.
8. BUTTERFLY POSE exercise helps in increasing blood supply to the pelvic area. If you are unable to do exercise take your help of your husband and start the exercise with caution. Slowly bent down and sit crosslegged, begin with sitting in crossed leg and breath in and out slowly and consistently. Now stretch your both legs towards the front, breath consistently, comfortably sit and relax comfortably with your back and shoulder straight. Just exercise as much as you able to. In this position place your knees upwards or bent and use your hands and touch both ankles and bring your feet close together then slowly Stretch your legs and pull your knees. If you feel any stretch at pelvis then stop and concentrate on your pelvic area and breath in and out deeply and consistently. If you feel any tiredness then immediately stop the exercises and stretch your feet outwards as before and place your hands behind your back and relax. 
9. CRAWL POSTURE In sitting position slowly bend your knees up and place your hands down as in crawling posture. Spread your legs apart in this position and arch the back upwards and downwards now tighten the pelvic floor muscles and bottom muscles, constrict the bottom muscles and arch the back upwards count for 5 breaths and relax &then straighten up your back and repeat again. Do not bend your back forward   
10. Half squats: Stand behind a chair and hold it with both hands and slowly lower down into half squat position and hold for two to three breaths and return to the standing position. Repeat this exercise three times in a day. This exercise helps to increase in flexibility and strength to your pelvic floor muscles.  
11. Ankle pumps: For swollen ankles, this exercise helps a lot, place a pillow under your foot and do ankle upward and downward movements slowly.

Please consult your doctor before starting any exercise programme