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OPP 4 midterm > OMT for pregnant patient > Flashcards

OMT for pregnant patient Flashcards

1
Q

Most common cause of lower back pain in the pregnant pt

A

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

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2
Q

Factors that contribute to mechanical lower back pain

A
  1. Multifetal gestation
  2. Spinal curves (scoliosis)
  3. Leg length inequality
  4. Weight gain
  5. Ligamentous laxity
  6. Somatic dysfunction
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3
Q

DDX of mechanical lower back pain

A
  • Biomechanical instability
  • Lumbosacral plexopathy
  • Neuropathy
  • Spinal facet
  • Spondylolisthesis
  • Congenital disorders
  • Discogenic
  • Trauma
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4
Q

Nonmechanical, Metabolic DDX of LBP

A

Osteoporosis

Osteonecrosis

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5
Q

Nonmechanical, Vascular DDX of LBP

A
  • Compression of great vessels
  • Venous plexopathy
  • Thrombosis
  • Placental location
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6
Q

Nonmechanical, viscerogenic DDX of LBP

A
  • Urinary tract changes
  • Bowel fxn changes
  • Endometriosis
  • Pelvic infection
  • Labor
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7
Q

Nonmechanical, Psychoemotional DDX or LBP

A

Seeking disability

Depression

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8
Q

Pregnancy effects on posture

A

Organ hypertrophy and mechanical stress produce structural changes:

  • Postural changes- increased anterior pelvic tilt
  • Lumbar spine has increased lordosis
  • Thoracic spine has increase kyphosis
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9
Q

Postural compensation

A
  • Shoulders back
  • Head forward
  • Increase in lordosis
  • Sacrum nutates
  • Ribs flare
  • Feet flatten
  • Stance widens in ambulation
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10
Q

Increased lumbar lordosis leads to?

A
  • Increased load on facets
  • Shearing of intervertebral disc spaces
  • Posterior paraspinal muscles shorten and are unbalanced by overstretched abdominals
  • Psoas muscles shorten
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11
Q

Anterior pelvic rotation leads to?

A
  • Strains lumbar spine and SI joints

- As relaxin levels increase, lumbar spine and pelvis are increasingly strained

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12
Q

What are the effects of relaxin and estrogen

A

Causes the pubic symphysis to widen.

Beings during the 10-12 weeks of pregnancy and palpation may refer pain to the low back

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13
Q

What predisposes you to LBP during pregnancy?

A

A prior history of trauma or LBP through sensitization or spinal facilitation

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14
Q

Common neuropathies

A
  • Carpal tunnel syndrome

- Meralgia paresthetica: compression of the lateral femoral cutaneous nerve

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15
Q

How can lumbosacral plexopathies occur and what can they be associated with?

A

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
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16
Q

Spondylolisthesis

A

One vertebral body is anteriorly displaced on the one below.

Most commonly L5 on S1

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17
Q

Possible spondylolisthesis’?

A 
Pars interarticulares (L5-S1)
Degeneration (L4-5)
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18
Q

What hip problems must you rule out

A
  • Transient osteoporosis of the hip
  • Avascular necrosis of the femoral head

Must perform hip ROM

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19
Q

Transient osteoporosis of the hip and tx

A
  • 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

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20
Q

Avascular necrosis of the femoral head

A

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

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21
Q

Abnormalities or changes of the lumbar epidural venous plexus

A

IVC thrombosis

May mimic radiculopathy

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22
Q

Posterior placental location

A

Pain may occur as the enlarging uterus strains the vascular bed to which the placenta is attached

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23
Q

When to consider placental abruption

A

Consider if hx of trauma- fall of MVA

Requires emergent C/S

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24
Q

Urinary problems

A
  • Pyelonephritis: dull, persistent pain with fever and chills
  • Nephrolithiasis: colicky pain with palpatory tenderness of the CV angle
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25
Q

GI problems

A

Constipation from slowed bowel fxn and decreased fluid intake

26
Q

How do psychoemotional problems effect pain?

A

Pain alters the HPA axis –> increased cortisol and depression symptoms
- Clinical depression is associated with lowered tolerance for nociception, a heightened pain perception, and increased risk for developing chronic pain

27
Q

Treatment of LBP

A
  • Avoid heat excess
  • Nutrition: Vitamin D, calcium, fish oil, Mg
  • Exercise- gentle, normal temp pool
  • Maternity back supports and sacroiliac support belts
  • TENS unit
  • Accupuncture
  • OMT
28
Q

Indication for OMT

A
  • SD during pregnancy
  • Scoliosis or other structure condition
  • Edema, congestion, or other pregnancy associated condition amenable to OMT
29
Q

CIs to OMT

A
  • Undiagnosed vaginal bleeding
  • Threatened of incomplete abortion
  • Ectopic pregnancy
  • Placenta previa
  • Plcanetal abruption
  • PPROM/PROM
  • Prolapse umbilical cord
  • Severe preeclampsia/eclampsia
  • Other surgical or medical emergencies
30
Q

Stages of treatment

A
  • Structural stage
  • Congestive stage
  • Preparatory stage
  • Recovery and maintenance stage
31
Q

Early structural stage

A

0-12 weeks

  • Postural exam (3 planes)
  • Thoracic inlet fascia
  • Thoracic cage
  • Pelvis and sacrum
  • Chapmans reflexes
32
Q

T10-L2

A

Sympathetics-Uterus

Contractions, pain

33
Q

S2-S4

A

Parasympathetics- cervix (dilation)

34
Q

Stomach hyperacidity anterior and posterior TP

A

anterior: 5th intercostal space from the mid clavicular line to the sternum on the left
posterior: Midway b/w the spinous and transverse processes, b/w 5th and 6th vertebrae on the left

35
Q

Stomach peristalsis anterior and posterior TP

A

Anterior: 6th ICS from the mid clavicular line to the sternum on the left

Posterior: midway b/w the spinous and transverse processes b/w 6-7th vertebrae on the left

36
Q

Liver/gallbladder anterior and posterior TP

A

Anterior: 6th ICS from mid clavicular line to the sternum on the right

Posterior: between 6-7 vertebrae on the right

37
Q

Pancreas anterior and posterior TP

A

Anterior: 7th ICS space on right
Posterior: midway b/w spinous and transverse processes b/w 7-8th vertebrae on R

38
Q

Intestinal peristalsis (constipation) posterior TP

A

Face of 11th rib at its jxn with tip of TP of 11th vertebrae on right

39
Q

ovaries anterior and posterior TP

A

Anterior: Round ligaments from the upper border of the pubic bone downward to the attachment of the muscles on the lower border

Posterior: ntertransverse space between 9th and 10th vertebrae (inner half of the ovary) and 10th and 11th vertebrae (outer half of the ovary)

40
Q

Uterus anterior and posterior TP

A

Anterior: laterally on either side of the pubic symphysis – extends downward and outward at an angle, for about 2” across the inner, lower margin of the obturator foramen

Posterior: tip of TP of L5 toward iliac crest

41
Q

broad ligament, fallopian tubes, uterus, vagina anterior and posterior TP

A

Anterior: from the trocanter downward on the outer aspect of the femur to within 2” of the knee joint

Posterior: between PSIS and spinous process of L5

42
Q

Vagina and clitoris TP

A

upper, inner aspect of the posterior thigh 3-5” long and 1.5-2” wide (anterior points), on the side of the articulation of the coccyx with the sacrum (posterior points)

43
Q

Fallopian tube tenderpoint- anterior

A

Midway between acetabulum and sciatic notch

44
Q

Vagina (leukorrhea) TP- anterior

A

inner femoral condule and upwards from 3-6” on the posterior aspect

45
Q

Interstitial peristalsis (constipation) TP

A

B/w ASIS and greater trocanter

46
Q

Rectum TP

A

Lesser trocanter downward

47
Q

Colon (spastic constipation or colitis) TP

A

an area 1-2” wide, extending from the trocanter to within an inch of the patella on the front, outer aspect of the femur – on the right side = upper 1/5 indicates cecum, next 3/5 ascending colon, last 1/5 for the first 2/5 of transverse colon; on the left side = first 1/5 just above the knee corresponds to the last 3/5 of transverse colon, middle 3/5 is the descending colon, last 1/5 is the sigmoid; extreme upper end of the trocanter on the left side is the recto-sigmoid junction

48
Q

Colon TP

A

TP of L2 – TP of L4 a triangular area reaching across to the iliac crest

49
Q

Hemorrhoids, rectum TP

A

on the sacrum close to the ilium at the lower end of the SI jt

50
Q

Hemorrhoids TP

A

Just above the ischial tuberosity

51
Q

Treatment in early structural stage

A
  • Treat any SD found
  • Hyperemesis gravidarum
  • Treat areas C2 and T5-9 and related chapman’s reflexes
52
Q

What do you expect to find in late structural stage

A

12-28 weeks

  • Pelvis to rotate anterior about a right/left axis at S2 (increased pelvic tilt)
  • Increase in lumbar lordosis
  • Compensatory increase of thoracic kyphosis
53
Q

Treatment in late structural stage

A
  • Fascial release: abdominal wall pain above pubes
  • Anterior counterstain points L3-5 may help round ligament pain
  • Treat sacrum and pelvis with any modality comfortable to pt
  • Carpal tunne syndrome
54
Q

What do you expect to find in congestive stage

A

28-36 weeks

  • Gravitational effects on the uterus accentuate abdominal fascial drag on the inguinal tissues- increases pressure on the venous and lymphatic return flow from the LE’s and IVC
  • Increase in interstitial fluids
  • Increase in uterus size
  • Size impedes diaphragmatic and rib excursion
  • Diaphragm works harder due to volume and pressure changes
55
Q

ball-valve effect

A

Due to increased uterus size
Effects the veins of the lower extremities - edema
- Some may get HYPOTENSIVE when suppine

56
Q

What to treat in the congestive stage

A
  • Viscerosomatics: Upper GI T5-9, T10-L2: adrenal, ovarian, caution with uterine contraction
  • Pelvic diaphragm- lifts abdominal contents to relieve constipation
  • Cranial: can provoke uterine contractions
57
Q

Preparatory stage

A

36 weeks-delivery

  • Maintain good structural balance and lymphatic flow
  • Build psychological support while planning for delivery
58
Q

Labor treatments

A

Women don’t tolerate aggressive modalities

  • Thoracics: influence uterine contractions via sympathetics
  • Sacral base: influence cervical dilation via parasympathetics
  • Cranial mechanism: influence uterine contractions
59
Q

Recovery and maintenance stage

A

Delivery-6 weeks

Start on post-partum day 2
Goal: assist the pt’s body to return to its normal pre-gravid state
-Evaluate sacral mechanics

Final visit

  • CTS can persist during breast feeding period due to prolactin
  • May also see De Quervian tenosynovitis that resolves after cessation of breast feeding
60
Q

What does the intant and lithotomy position do to the sacrum?

A

infant and lithotomy position encourage a b/l flexed sacrum and extended L5

Associated with symptoms of fatigue, depression, and low energy

OPP 4 midterm (8 decks)

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