Reproduction System- Lower Back Pain In Pregnancy By Nemitz/lemley

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Reproduction System- Lower Back Pain in Pregnancy by Nemitz/Lemley

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Reproduction System- Lower Back Pain in Pregnancy by Nemitz/Lemley

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Lemley:
-Understand postural / gravitational stress of pregnancy
-List the indications and contraindications for OMT during pregnancy
-Relate the above to a case of a 32-week pregnant woman with low back pain
-List the other OB/GYN indications for OMT

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Nemitz:
-To define the musculoskeletal characteristics underlying the case
-To describe the lymphatic, venous drainage patterns affected by the case
-To understand the neurological implications of the case
-To describe the viscerosomatic reflexes associated with the affected area

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increase in lumbar lordosis because of the

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anterior load.

Large anterior load will affect the posterior aspects (giving more lordosis)

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thoracic diaphragm is located at which levels? what else can happen?

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T12-L1. increased lumbar lordosis will cause a pulling down of the diaphragm. this will affect blood vessels and lymphatic drainage.

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Right lymphatic duct drains what? What about the Thoracic duct?

where do the ducts drain?

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right: drains the from the thoracic diaphragm superiorly, including right arm and half the face.

thoracic duct: the rest of the body.

bifurcation of the subclavian and internal jugular is where the drainage happens on both sides.

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Blood follows the path of least resistance. So keeping this in mind, where do the posterior abdominal veins go if there's congestion?

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Post. abdo veins go to the vertebral plexus because they don't have valves, then this goes to the CNS and brain, so there's a potential for head aches.

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Autonomic innervates the uterus. what levels for sympathetics? what's the long-@$$ pathway?

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SNS: T10-T11

The preganglionic/presynaptic symps leave the spinal cord via the ventral roots, then the ventral primary ramus, then the symp chain via the white ramus communicans, but they don't synapse in the chain. so they're going to leave the chain as the lumbar splanchnic nerves which means they're originating off the lumbar portion off the symp chain on both sides of the body. so originates in IML T10-11, goes through the sympathetic chain, doesnt synapse, comes out as the LUMBAR SPLANCHNIC NERVES. they are then going to go and synapse in a series of ganglia that you can't see called the MESENTERIC ganglia which is ass'd with the mesenteric blood vessels. that's where the synapse occurs. the ganglia is called prevertebral ganglia (pre and post synaptic symps interact). the postsynaptic symps for a plexus around the pelvis and eventually there's a uterine plexus and goes to the smooth musculature of the uterus.

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ok, now parasympathetics

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starts at S2,3,4

comes out the ventral roots of s2-3-4, get into ventral primary rami but then, the presynaptic parasymps axons become a new nerve called the PELVIC SPLANCHIC NERVE and that's going to go and provide pns innervation of the uterus. then goes to the WALL of the uterus where it synapses with the post-synaptic neurons are located.

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what about the pudendal nerve.

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comes out of the pelvic sacral plexus, it's the nerve to the perineum and that's whats anesthetized during delivery.

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how do viscerosomatic reflexes happen?

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sensory axons which hook up to the receptors and feeding back to the spinal cord. the input comes in, but over chronic irritation--> more autonomic outflow to the uterus, but you'll also see affects to somatic body.

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what innervates the vertebral column?!

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medial branch of the dorsal ramus. this innervates all the CT that connects the bones and ligaments and discs. this is a major source in back pain. so back pain from muscle stretching of the ligaments or the innervations of the dorsal ramus to the musculature that causes pain as well.

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where is the center of gravity?

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L3

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Increased lumbar lordosis (Gravitational strain)

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Stresses lumbar facets
Increases shearing forces across the disc space

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Sacroiliac pain

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Anterior tilt of pelvic brim
Increased mobility of SI joint

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Sciatica

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Pain radiation down posterolateral thigh, usually no farther than knee
Postpartum: piriformis syndrome.

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what happens if the ilipsoas is in spasm?

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the baby cannot descend into the true pelvis. so that can retard labor.

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Posterior pelvic pain

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No lumbar pain
Pain in the posterior part of pelvis distal and lateral to the lumbosacral junction (to the iliac crest)

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Radicular symptoms

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Direct pressure on nerve roots by gravid uterus
Herniated discs are rare in pregnancy = 1:10,000.
Lightening - fetus descends into the true pelvis

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OMT Contraindications in Pregnancy

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Undiagnosed vaginal bleeding
Threatened or incomplete abortion
Ectopic pregnancy
Placenta previa
Abruptio placenta
Eclampsia or severe pre-eclampsia
Premature rupture of membranes
Premature labor
-Regular uterine contractions <37 weeks gestation
-Cervix 2 cm dilated and 80% effaced
Percussion vibrator below thoracic diaphragm (may cause an abruptio)