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Physical Therapy for the Antepartum Hospitalized Patient With Ehlers-Danlos Syndrome

Background:Antepartum bed rest is prescribed to minimize the risk of preterm delivery, but can lead to muscle weakness, deconditioning, musculoskeletal pain, fatigue, and depression, depending on the duration of bed rest. Study Design:The purpose of this case report is to identify the physical therapist's role in treating a pregnant woman with complications of Ehlers-Danlos syndrome (EDS) who was placed on hospitalized bed rest with resultant back and rib pain. Case Description:A 29-year-old woman, pregnant with twins, was placed on hospitalized bed rest for maternal and fetal monitoring. Medical history included depression, cardiac issues, glucose intolerance, scoliosis, and multiple joint surgeries in the past because of EDS. Within the first 2 weeks of bed rest, significant back and generalized joint pain occurred. This case analysis will discuss the management of her symptoms. Outcomes:The patient was able to successfully manage and reduce, although never fully eliminate, her mechanical and disease-related musculoskeletal back and rib pain, with education, exercise program compliance, proper bed positioning and position adjustments as needed, and therapist/family-assisted soft-tissue mobilization. Discussion:Musculoskeletal pain is common during any pregnancy. A physical therapy program is needed to maintain muscle strength, prevent atrophy, reduce fatigue, support functional endurance, reduce pain, and reduce the risk of blood clot formation for pregnant women with EDS on hospitalized antepartum bed rest.