Term
| What are the benefits of OMT in pregnancy? |
|
Definition
| Helps in adjusting the functions of the body to the demanda of a progressing pregnancy |
|
|
Term
| At what location on the spine is the area of transition between lumbar lordosis and thoracic kyphosis due to the anterior shift of center of gravity during pregnancy? |
|
Definition
|
|
Term
| What are the general physiological changes that occur in pregnancy? |
|
Definition
Increased interstitial fluid
Increased levels of estrogen and adrenal hormones which promote fluid retention in tissues
Decreased efficiency in removal of excessive interstitial fluids
So essentially a lot of fluids happening in yo body! |
|
|
Term
| What are some of the anatomical physiologic changes that occur during pregnancy? |
|
Definition
Forward tilting of the pelvis
Increased Lumbar lordosis
Psoas muscle shortening
Increase thoracic kyphosis
Stress shifted to muscles
Widening of the pubic symphysis |
|
|
Term
| What is the starting point of the anatomical changes that occur in pregnancy? |
|
Definition
| The pelvis shifting forward |
|
|
Term
| What are the attachment sites for the Psoas Muscle? |
|
Definition
Lateral surface of T12-L4 vertebral bodies and associated intervertebral disks
Transverse processes of L1-L5
Iliac Fossa
Lesser Trochanter of the Femur |
|
|
Term
| What is the innervation of the Psoas muscle? |
|
Definition
| Femoral Nerve and direct branches of the lumbar plexus |
|
|
Term
| What are the actions of the Psoas Muscle? |
|
Definition
Hip Flexion, External Rotation, Abduction
Lumbar unilateral contraction to ipsilateral side, bilateral contraction flexes trunk/raises from supine position |
|
|
Term
| What is the origin of the Psoas Major? |
|
Definition
| Lateral surface of T12-L4 vertebral bodies and associated intervertebral disks |
|
|
Term
| What is the origin of the Psoas Minor? |
|
Definition
| Transverse processes of L1-L5 |
|
|
Term
| What is the origin of the Iliacus? |
|
Definition
|
|
Term
| Name other physiological changes in pregnancy dealing with joints and gravity? |
|
Definition
Anteior shift of center of gravity
Strain on LBP and SI joints
Laxity of SI joints due to relaxin hormone |
|
|
Term
| What causes laxity of the SI joints in pregnancy? |
|
Definition
|
|
Term
| Name some sources of lower back pain in pregnancy |
|
Definition
Compression Neuropathy
Lumbosacral plexopathies
Disc herniation (rare)
Hip pain |
|
|
Term
| Name two compression neuropathies that occur in pregnancy |
|
Definition
Meralgia Paresthetica
Sciatic Nerve |
|
|
Term
| What nerve is involved in Meralgia Paresthetica? |
|
Definition
| Lateral femoral Cutaneous Nerve |
|
|
Term
| Where will there be sensory abnormalities in Meralgia Paresthetica? |
|
Definition
| Around the waist area and down the anterolateral thigh |
|
|
Term
| Where is the origin and track of the Lateral Femoral Cutaneous Nerve |
|
Definition
Arises from L3 and passes slightly medial and inferior to the ASIS
Exits pelvis beneath the inguinal ligament |
|
|
Term
| What factors of pregnancy can contribute to Meralgia Paresthetica? |
|
Definition
Increased lumbar lordosis
C-sections with wide incisions |
|
|
Term
| What causes lumbosacral plexopathies in pregnancy? |
|
Definition
| Prolonged standing, sitting, or squatting |
|
|
Term
| What are some examples of Lumbosacral plexopathies that may occur in pregnancy? |
|
Definition
| Foot drop from compression of the peroneal division of the sciatic nerve or common peroneal nerve compression at the fibular head |
|
|
Term
| What are some causes of hip pain in pregnancy? |
|
Definition
true hip pain
referred pain from low back or pubic symphysis |
|
|
Term
| What are the attachment sites of the Piriformis? |
|
Definition
Pelvic surface of the sacrum
Apex of the greater trochanter |
|
|
Term
| What are the actions of the piriformis? |
|
Definition
| External rotation, abduction, and extension of the hip |
|
|
Term
| Innervation of the Piriformis |
|
Definition
| Direct branches from the sacral plexus (L5-S2) |
|
|
Term
| Characteristics of Low Back Pain in Pregnancy |
|
Definition
Compensatory lordosis
stress across vertebral facets of lumbar spine
Increases shear forces across intervertebral disc spaces
Shortened paraspinal muscles |
|
|
Term
| Characteristics of SI joint pain in Pregnancy |
|
Definition
Excessive connective tissue streatch and microtrauma
Increased mobility due to distention of pelvis (relaxin) |
|
|
Term
| Characteristics of Posterior Pelvic Pain in Pregnancy |
|
Definition
| Radiation of pain in posterior part of thigh that extends down below knee |
|
|
Term
| CNS congestion in pregnancy commonly causes |
|
Definition
|
|
Term
| Increased Progesterone in Pregnancy causes what changes? |
|
Definition
Constipation (decreased peristalsis)
Reflux esophagitis (decreased esophageal sphincter tone)
Fluid Retention |
|
|
Term
| An expanding uterus causes what changes? |
|
Definition
Urinary frequency
Various Parestheisa or radicular symptoms such as direct pressure on nerve roots/plexi by gravid uterus or lumbar lordosis and Ilioguinal & Iliofemoral nerve distribution
Round ligament pain |
|
|
Term
| Round ligament pain corresponds to what tenderpoints? |
|
Definition
|
|
Term
| Sluggish venous return in pregnancy causes what changes? |
|
Definition
Lower extremeity edema
Hemorrhoids, varicosities
Breast soreness
Fluid Retention
Carpal Tunnel Syndrome
De Quervian's |
|
|
Term
| What are other common complaints in pregnancy? |
|
Definition
Muscle cramps
Joint pains
CNS congestion
Vomiting |
|
|
Term
| What structural changes occur during the first trimester? |
|
Definition
Shift in center of gravity
Widening of pubic symphysis
Moderate to severe muscle tension
Headaches
Nausea and vomiting |
|
|
Term
| When does the shift in center of gravity occur during pregnancy? |
|
Definition
|
|
Term
| What hormone causes widening of the pubic symphysis? |
|
Definition
|
|
Term
| What structural changes occur during the second trimester? |
|
Definition
Difficulty in liying prone
Large uterus impacts center of gravity leading to somatic dysfunction
Round ligament pain
Nerve compression/radiculopathy
End - carpal tunnel syndrome & De Quervain's Tenosynovitis |
|
|
Term
| When does it become difficult to lie prone in pregnancy? |
|
Definition
|
|
Term
| When does uterus enlargement impact the center of gravity enough to cause somatic dysfunction? |
|
Definition
|
|
Term
| What structural changes occur in the third trimester? |
|
Definition
Respiratory compromise
GI changes
Fluid Shift
Bowel compressed under rib cage
Gait becomes wide and unsteady
Feet become flat and fat
Pubic symphysis dysfunction starts |
|
|
Term
| When does the third trimester begin? |
|
Definition
|
|
Term
| Bowel compression in pregnancy can lead to what symptom? |
|
Definition
|
|
Term
| What causes respiratory compromise in the third trimester? |
|
Definition
| The diaphragm being pushed up into the chest |
|
|
Term
| What causes pubic symphysis dysfunction in pregnancy? |
|
Definition
Hormones
Weight Gain
Wide unsteady Gait |
|
|
Term
| Pubic symphysis dysfunctions in pregnancy result in... |
|
Definition
Streatching of the ligaments involved
and Hypermobility of the joint |
|
|
Term
| What are the pubic symphysis dysfunctions that can occur? |
|
Definition
Superior, Inferior, Anterior shears
Compression |
|
|
Term
| In what order do you treat Pubic Dysfunction? |
|
Definition
Open/Gap with adductor muscles
Treat Dysfunction
Close with abductors |
|
|
Term
| Which muscles are engaged when gapping the pubic symphysis? |
|
Definition
|
|
Term
| What muscles are enagaged when closing the pubic symphysis? |
|
Definition
|
|
Term
| Treating an inferior pubic shear is similar to treating what other dysfunction? |
|
Definition
|
|
Term
| Treat a superior pubic shear similar to what other dysfunction? |
|
Definition
|
|
Term
| What causes constipation and hemorrhoids in pregnancy? |
|
Definition
Compression under rib cage
Decreased motility of the bowel
Prenatal vitamins
Decreased venous return |
|
|
Term
| An increase in this hormone causes decreased bowel motility? |
|
Definition
|
|
Term
| A decrease in this hormone causes decreased bowel motility |
|
Definition
|
|
Term
| Why do prenatal vitamins cause constipation? |
|
Definition
| The iron levels act like cement |
|
|
Term
| How do we treat bowel dysfunciton in pregnancy? |
|
Definition
Lymphatic/ venous mobilization techniques
Lumar somatic dysfunction
Chapman's points |
|
|
Term
| What is the goal of treating bowel dysfunction in pregnancy? |
|
Definition
| Increase drainage and flow of interstitial fluids and aid venous return |
|
|
Term
| What is the parasympathetic innervation of the female pelvis? |
|
Definition
Pudendal Nerve (S2-4)
Vagus |
|
|
Term
| Sympathetic innervation of pelvic structures comes from where? |
|
Definition
Lesser Splanchnics T10-11
Least Splanchnics T12
Celiac Plexus L1-L2 - lumbar splanchnics
|
|
|
Term
| What hormones cause ligamentous laxity and assist counternutation of delivery? |
|
Definition
|
|
Term
| List the Preaortic Group involved in female pelvic innervation |
|
Definition
Celiac Plexus
Thoracic Splanchnics
Greater Splanchnics
Lesser Splachnics
Least Splanchnics |
|
|
Term
|
Definition
|
|
Term
| Thoracic Splanchnic nerves |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| T10-T11 - ovaries, uterus |
|
|
Term
|
Definition
|
|
Term
| What challenges arise in osteopathic treatment of LBP in pregnant patients |
|
Definition
Positioning
Some avoid HVLA due to increased laxity from relaxin |
|
|
Term
| What are the lymphatic techniques that can be used in pregnancy? |
|
Definition
Miller Lymphatic Pump (Thoracic)
Dalrymple Pump (pedal pump)
Hepatic/ Splenic pump
Pectoral traction
Seated Drainage |
|
|
Term
| When using lymphatic techniques where should you begin and progress? |
|
Definition
Thoracic Outlet/Inlet
Proximal to Distal |
|
|
Term
| What changes in scoliosis patients may occur with pregnancy? |
|
Definition
| Curves >25 degrees may progress |
|
|
Term
| Rheumatoid Arthritis in pregnancy tends to... |
|
Definition
|
|
Term
| Ankylosing Spondylitis in pregnancy tends to... |
|
Definition
|
|
Term
| What bone is important to treat in the 3rd trimester and why? |
|
Definition
Sacrum
To improve mobility and assist in delivery |
|
|
Term
| List the contraindications for OMT in Pregnancy |
|
Definition
Undiagnosed vaginal bleeding
Ectopic pregnancy
Placental Abruption
Untreated DVT
Elevated maternal BP
Preterm labor
Unstable maternal vital signs
Fetal distress |
|
|
Term
| What positioning should the patient use for dealing with acute pain? |
|
Definition
| Elevated the feet with hips flexed to reduce lumbar lordosis and ease muscle spasm |
|
|
Term
| What is the benefit of orthoses in pregnancy? |
|
Definition
| Reduce the anterior pelvic tilt while stretching the psoas |
|
|
Term
| What important musculoskeletal changes occur in late pregnancy? |
|
Definition
Compression of thoracic inlet
Sacral nutation
Lumbosacral strain
Sternal elevation
Abdominal weakness/strain
Anterior tilt of pelvis
Pressure on pubis |
|
|
Term
| What important musculoskeletal changes occur in early pregnancy? |
|
Definition
Flattening of lordosis
Contraction in rectus abdominis
Slight elongation of cervical column
Stretch at anterior hip and infrapubic muscles
Slight central tension in diaphragm |
|
|
Term
| To help with increased Vomiting in early pregnancy, what area can you treat? |
|
Definition
Vagus - OA, C1, C2
T5-T9 for GI discomfort |
|
|
Term
| What causes round ligament pain? |
|
Definition
| Increasing size of gravid uterus |
|
|
Term
| Viscerosomatic reflex of round ligament pain transmits to what spinal areas? |
|
Definition
|
|
Term
| How can you treat Round Ligament Pain? |
|
Definition
MFR of abdominal fascia
CS of L3-L5 tenderpoints |
|
|
Term
| Patient complaining of morning sickness, where will you palpate the viscerosomatic reflex? |
|
Definition
|
|
Term
| What technique would you use to treat nausea in a pregnant patient? |
|
Definition
Soft tissue of upper thoracics
T5-T9 sympathetics to gut |
|
|
Term
| What is the most common cause of carpal tunnel syndrome in the 2nd trimester? |
|
Definition
| Breast and axillary congestion |
|
|
Term
| What treatment technique will assist in drainage of the upper limbs? |
|
Definition
| MFR of the thoracic outlet |
|
|
Term
| What treatment is most important to focus on during the first trimester? |
|
Definition
| Normalization of the sacrum |
|
|
Term
| What are the diagnostic findings in a superior and inferior pubic shears? |
|
Definition
Positive standing flexion test ipsilaterally
ASIS restricted to compression ipsilaterally |
|
|
Term
| What is a common dysfunction in post-partum patients? |
|
Definition
|
|
Term
| In sacral torsions, in what direction will L5 rotate? |
|
Definition
| Always opposite to the sacrum |
|
|
Term
| In physiologic sacral torsion dysfunctions, L5 will be in what position? |
|
Definition
| Neutral, rotation and sidebent opposite |
|
|
Term
| In pathologic sacral torsion dysfunctions, L5 will be in what position? |
|
Definition
| Flexed, Rotated and sidebent same side |
|
|
Term
| A L on R sacral torsion produces what dysfunction in L5? |
|
Definition
|
|
Term
| A L on L sacral torsion produces what dysfunction in L5? |
|
Definition
|
|
