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Copenhagen14.november2017
Typicalpregnancyanda.erbirthproblems,seeninanosteopathictherapeu7cperspec7ve.
PregnancypainPrengancypain,canandwillbedifferentfromwomantowoman.Inaclinicalview,itisimpossibletodefinethecauseofthepain,onlyfrom
thesymptomsInanosteopaDcview,weoEenfindtypicalrelaDons,thatcanexplaincauses
andsymptoms.-Typicalcausesandsymptoms,2-3months.-Typicalcausesandsymptoms,3-5months.-Typicalcausesandsymptoms,5-7months.AEerthe7thmonth,alltypesofintervenDontorelievepainispalliaDve
Causesandsymptoms2-3months
Causes:-cervixuteri-uterus-uterosacralligamentSymptoms:-Lowbackpain!!
Explana7on:InnervaDonens(ps)islocatedatsegments2-s4.ThePiriformismuscleisinnervatedfromthesesegments(sacralplexus).Theuterosacralligamentispullingonthesacrum.Sacrumanduterus,theymirroreachother.
ExplanaDonandillustraDon2-3months
Piriformisandplexuslumbalis Uterosacralligament
Causesandsymptoms3-5months
Causes:-Kidneys/plexuslumbalis-ligamentumteresuteriSymptoms:-Lowbackpain-Groinpain-Abdominalpain
Explana7on:Thegrowinguterusispushingthekidneyscranial.Thekidneyswillcompressandinflamethenervesbehind,fromthelumbarplexus.Thesenervesinnervatesthelumbarspine. TheLigamentumteres,willlengthenalot.Normallengthis15cm.Attheendofweek40,thelengthwillbeapp.40cm.
ExplanaDonandillustraDon3-5months
• Ligamentumteresuteri • Plexuslumbalis
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Syndromeofroundligament. Arterieepigastricinferior,
anastomoses,withinternaliliacarteryandsupplyapartofuterus.Normalperfusionapp.4-5literblood/min.Duringpregnancythisincreaseswith30%toapp6literblood/min. SYMPTOMS:
Abdominalpain(afraidofloosingbaby)andgroinpain(labiamajor)ilioinguinalnervecompression.(nerveofvulvodynia)
Causeandsymptoms5-7monthsCause:-kidneys-VenacavainferiorSymptoms:-Lowbackpain-Problemswithlyingsuppine-Fluidinbody-Nausea
Explana7on:Kidneysagain,butinamorevasculartermnow.DevelopmentofvenuscongesDoninthepevisorgans.Becauseofthechangeofthelumbarlordosis,thevenacavainferiorwillbemevedanterior,compressedbetweenthespineandtheuterus.ThisleadstovenuscongesDonoftheskeleton,ligamentsandmusclesofthepelvis.
ExplanaDonandillustraDon5-7months
Nutcrackersyndrome
ExplanaDonandillustraDon5-7months
MayThurnersyndrome
AEerbirth Normalbirth
Symptoms:-SciaDcpain-Coccyxpain
Explana7on:Thebabysheadcompressesthesacralplexus,thesciaDcnerveandthecoccyx,asitturnsinthebirthcanal.
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ExplanaDonandillustraDonnormalbirth Normalbirth+epiduralSymptoms:-Coccyxpain-Lowbackpain-Headache
Explana7on:Epiduralanesthesiawillduetothevolume,inducecompressionontheduramater.Theduramaterhasalotofmechanoreceptosaswellasnociceptors.Theduramateritselfcanbecomeverypainfull(neurology).Thebodywilltrytocompensatetoanalteredmechanoreceptoricinput.ThiswilloEenhappen,wheretheduramaterinserts coccyxandc2.EffracDonwithPostponcturesyndromecanalsobethecase.
ExplanaDonandillustraDonepidural
Volumeofepidural
NormalBirth+episeptomiSymptoms:-Coccyxpain-Perineumpain-Cannotrideabike
Explana7on:Thepudendalnervecomesfromthes2-s4,itrunsbetweentheSSandSTligamentsandlast,itliesinthecanalofalcock. Bigriskofcompressionofthepudendalnerve.Apressureincreasementof10%(physiscalfromfibrosedDssusorvenuscongesDon)cancausemono-neuropaD.
ExplanaDonandillustraDonepiseptomiOsteopathictreatment
• Toapplytoanyproblem!
ArDcularcomponent-ManipulaDon
Muscularcomponent-MET,strech
Ligamnetuscomponent-mobelise
Visceralcomponent-mobeliseviscera(adhesions)
Sacro-Occipitalcomponent-Cranialosteopathy(eg.Duralproblems,coccyxproblems)
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OsteopathicPalpaDon
• 5qualiDesofpalpaDon1) size(whenpossible)2) shape(whenpossible)Mostforosteopaths!3)Tone4)trophicity(segment)5) MOBILITYversussurroundings(possibleadhesions)-otherorganseg.bladdervsuterus-parietalsystemeg.ceacumvsm.Iliacus.
Adhesion?
Duringlifenon-specificadhesionsoccour,inallindividuals.Afall,anoperaDon,pregnancy,abluntforce,aninfecDonareallpossiblecausesofadhesions.Ithasbeenshownthatadhesionscontainssensorynerveendings.ThisisapossibleexplanaDonofwherethepainisoriginaDng.
Adhesion?
Evenadhesionwithinanorganispossible.Eg.AdhesionofthecervixuterihavebeenproposedtocauseinferDlity,dysmenorrheaandvaginismus.
VisceralmobilitylossduetoadhesionCaninfluence
• ThetoneofvisceralandmusculoskeletalDssue(eg.StressinconDnense)• Thearterial,venousandlymphaDccirculaDonandthereforethetrophicstateoftheorgan.
• ThesecreDonsoftheglandsinthewalloftheorganasaresultofthetrophicchangesandpoorvascularsupply.
• Thetransitofcertainorgans.• Andmore…….
WhyvisceraltreatmentScience!!!
• 36qpainavarageover3,7year• Devidedrandomlyinto2groupsof18
• GroupA,recivedvisceraltreatmentofthepelvisorgans,whichwasmostrestricted.
• GroupB,recivedjointmobilizaDonofthepelvisareajoints,which
wasmostrestricted.
RESULTS A(visceral) B(joint)
VASpretreatment 6,9 6,7
VASonemonthfollowup 1,8 4,1
Exercisesforpregnant
• Supine,legsbentandkneestogether.Rotatetoside,whilepusingintogrynfeldtspace.
• All4.Husbandfingers/thumbsingrynfeldtspace,sidebentbothsides. -tofreethelumbarplexus