OMT for pregnant patient Flashcards
Most common cause of lower back pain in the pregnant pt
Biomechanical instability- usually has low anterior or posterior pelvic pain, aggravated by activity, relieved by rest, occasionally may have pain radiate down one or both buttocks into the posterior thighs to the knees
Factors that contribute to mechanical lower back pain
- Multifetal gestation
- Spinal curves (scoliosis)
- Leg length inequality
- Weight gain
- Ligamentous laxity
- Somatic dysfunction
DDX of mechanical lower back pain
- Biomechanical instability
- Lumbosacral plexopathy
- Neuropathy
- Spinal facet
- Spondylolisthesis
- Congenital disorders
- Discogenic
- Trauma
Nonmechanical, Metabolic DDX of LBP
Osteoporosis
Osteonecrosis
Nonmechanical, Vascular DDX of LBP
- Compression of great vessels
- Venous plexopathy
- Thrombosis
- Placental location
Nonmechanical, viscerogenic DDX of LBP
- Urinary tract changes
- Bowel fxn changes
- Endometriosis
- Pelvic infection
- Labor
Nonmechanical, Psychoemotional DDX or LBP
Seeking disability
Depression
Pregnancy effects on posture
Organ hypertrophy and mechanical stress produce structural changes:
- Postural changes- increased anterior pelvic tilt
- Lumbar spine has increased lordosis
- Thoracic spine has increase kyphosis
Postural compensation
- Shoulders back
- Head forward
- Increase in lordosis
- Sacrum nutates
- Ribs flare
- Feet flatten
- Stance widens in ambulation
Increased lumbar lordosis leads to?
- Increased load on facets
- Shearing of intervertebral disc spaces
- Posterior paraspinal muscles shorten and are unbalanced by overstretched abdominals
- Psoas muscles shorten
Anterior pelvic rotation leads to?
- Strains lumbar spine and SI joints
- As relaxin levels increase, lumbar spine and pelvis are increasingly strained
What are the effects of relaxin and estrogen
Causes the pubic symphysis to widen.
Beings during the 10-12 weeks of pregnancy and palpation may refer pain to the low back
What predisposes you to LBP during pregnancy?
A prior history of trauma or LBP through sensitization or spinal facilitation
Common neuropathies
- Carpal tunnel syndrome
- Meralgia paresthetica: compression of the lateral femoral cutaneous nerve
How can lumbosacral plexopathies occur and what can they be associated with?
May occur from prolonged standing, sitting, or squatting
Plexus- associated foot drop :
- compression of the peroneal division of the sciatic nerve in the pelvis
- compression of the common peroneal nerve at the fibular head
- True lumbar disc herniation is rare
- Previous sciatica may become aggravated
Spondylolisthesis
One vertebral body is anteriorly displaced on the one below.
Most commonly L5 on S1
Possible spondylolisthesis’?
Pars interarticulares (L5-S1) Degeneration (L4-5)
What hip problems must you rule out
- Transient osteoporosis of the hip
- Avascular necrosis of the femoral head
Must perform hip ROM
Transient osteoporosis of the hip and tx
- Occurs in 3rd trimester
- Pain increases with weightbearing
- Limited hip ROM
- Etiology unknown, pain may be sudden or insidious
Tx: reduce weightbearing
Failure to dx may result in failure
Avascular necrosis of the femoral head
Due to higher adrenocorticoid metabolism, weight gain, increased levels of estrogen and progesterone, and increased joint pressure and strain
Pain in hip, pelvis, groin with weight bearing
DX: pain with hip ROM testing
TX: reduce weightbearing to allow revascularization of the femoral head
Abnormalities or changes of the lumbar epidural venous plexus
IVC thrombosis
May mimic radiculopathy
Posterior placental location
Pain may occur as the enlarging uterus strains the vascular bed to which the placenta is attached
When to consider placental abruption
Consider if hx of trauma- fall of MVA
Requires emergent C/S
Urinary problems
- Pyelonephritis: dull, persistent pain with fever and chills
- Nephrolithiasis: colicky pain with palpatory tenderness of the CV angle
