OMM Clinical Case Considerations - acoog.org · • Supine, place a small pillow under right hip to...
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Transcript of OMM Clinical Case Considerations - acoog.org · • Supine, place a small pillow under right hip to...
PresenterDisclosure
• Dr.Hammes hasnoconflictofinteresttodisclose
• Dr.Hammes hasnofinancialorscientificdisclosures
• Dr.Hammes hasnooff-labeldisclosures.
LearningTopics• GeneralconsiderationsfortreatmentofOBGYNpatients• OMTcontraindicationsinpregnancy• Musculoskeletalchangesduringpregnancy• Commoncomplaintsinpregnancy• PROMOTEstudyresults• Casediscussion
OsteopathicConsiderationsinPregnancy• Pregnantwomenarenotfragile,don’tbeafraidtotreatthem!• Relaxin isyourfriendwithOMT,somaticdysfunctiontreatsmoreeasily• Directorindirecttreatmentsareuseful,butmostpatientsprefergentleandcomfortabletreatments• Patientpositioningiskey
• Pronefirsttrimesterandearlysecond• Lateralrecumbent• Seated• Supine,placeasmallpillowunderrighthiptotiltpelvisleft
OMTContraindicationsinPregnancy
• Undiagnosedvaginalbleeding• Ectopicpregnancy• Placentalabruption• Untreateddeepveinthrombosis• Elevatedmaternalbloodpressure• Pretermlabor• Unstablematernalvitalsigns• FetalDistress
FoundationsofOsteopathicMedicine,3rd ed,p.971
PosturalChangesinPregnancy• CompensatoryChanges
• Exaggeratedcervicallordosis• Exaggeratedthoracickyphosis• Pubicbonesseparate• Sacrumflexes• Iliarotateposterior&inflare• Legsexternallyrotateatthehips
www.adamhocke.com
PosturalChangesinPregnancy
www.teresachartrand.comTheNaturalWayHealthClinicNewsletter2/2015
www.Prepartumpelvicpain.weebly.com
PosturalChangesinPregnancy
• Centerofgravityshiftsanterior• Exaggeratedlordosisinthecervicalandlumbarspine• Exaggeratedthoracickyphosis
• Thischangestrainsallthediaphragms
DiGiovanna &Schiowiz pg.460
ZinkRespiratory-CirculatoryModel
• Howdofluidsmovethroughthebody?
PosturalChangesinPregnancy• LowBackPain(LBP)complaintsin70%ofpatients• RiskFactors:Multipara,increasedmaternalage,Hx LBP• HowdoyoumanagewithOMT?• Establishthesegmentaldefinition/etiology• Muscleenergyisusefulformuscleimbalances• HVLAcanbeusedforjointrestrictions• SCSisoftenusedforcontributingroundligamentpain
• Patientmanagement• Walkingtwiceadayforshortperiodsoftime• Avoidsittinglongerthan1houroruseanexerciseball• Supportbelts• Stretchesandexercises
PosturalChangesinPregnancy
BabyBellyBandGabrialla StrongSupportPrenatalCradle
PregnancyPhysiologicChanges:⬆ Fluids
• Increasedbloodvolumeandinterstitialfluid
• Second&ThirdTrimester• Interstitialbloodvolumeincreasesby40-50%• Redbloodcellvolumeincreasesby20-30%• Twinsbloodvolumeincreasesby60%• Leukocytosis
PregnancyPhysiologicChanges:⬆ Fluids• Swellingoccursin90%ofpregnantwomen• HowdoyouhelpthemmanagewithOMT?• Improvediaphragmaticexcursion• Releasefascialrestrictionswhichimpedelymphaticflow• Treatthethoracicinlet• Teachleftsidelayingandfeetelevation• Teachinversionstretchingtorelieveuterinecompressiononvenacava
Huffingtonpost.com article3/27/14
Knee-ChestPositioning
• Decongeststhepelvisinpregnancyandalsodysmenorrhea• Oftensuggestedpriortosleep• Fulltimeworkingmothersbenefitaftervenousstasisfromstanding
Kuchera,OsteopathicConsiderationsSystemicDysfunctionp.142
CommonPregnancyComplaintsAreasoftreatment
• CarpalTunnel:cervicothoracic junction/lymphatics,carpaltunnelrelease,forearm
• Constipation: Ribraising,sacrum,pelvis,pelvicdiaphragm• Extremityedema:lymphatics,diaphragms,knee-chest• Lowbackpain:sacrum,pelvis,pubicdecompression,diaphragms,lumbosacralarticulation
• Nausea/Emesis: OA/Cranial,thoracics,seabands(acupressure)
• GERD: OA/Cranial,thoracics,abdominaldiaphragm• Roundligamentpain:SCS,sacrum,pelvis
PROMOTESTUDY
• https://www.unthsc.edu/texas-college-of-osteopathic-medicine/osteopathic-manipulative-medicine/omm-research-division/
• Atthebottomofthewebpagethereisavideowhichwouldbegoodtowatchifyou’dliketoincorporateOMMtreatmentswithproveneffectivenessintoyourpractice• Results:OMTwaseffectiveformitigatingpainandfunctionaldeteriorationcomparedtotheusualcareonlyprenatalcareinpregnancy
Hensel KL,BuchananS,BrownSK,etal.PregnancyResearchonOsteopathicManipulationOptimizingTreatmentEffects:thePROMOTEstudy.AMJObstetGynecol 2015:212:108.e1-9
OMTdecreasesPostpartumPainRecentJAOAarticle
• N=59• Bothvaginalorcesareandelivery• Significantdecreaseinpainfor:• LowBack• Abdominal• Vaginal
• 13patients(22%)hadcompletepainalleviation
Hastings,Curtis,McCallister,Valant,YaoEfficacyofosteopathicmanipulativetreatmentFormanagementofpostpartumpain.JAmOsteopathAssoc.2016;116(8)502-509
PregnancyAnatomy
Edensbalance.com
Intuitivehandspt.com
CaseDiscussion• 36y/oprimiparousfemale• 20weekIUP• C/Operipheraledema• C/Obilateralhippain• C/OGERD
CaseDiscussion
• OsteopathicFindings• C3-5RSr• 1st ribsuperiorright• T5ERSr• Rib5leftexhalepreferred• Respiratorydiaphragmpullingleft• L1-L5SlRr• Leftupslip innominate• +2Pittingedematokneesb/l
• Treatment• IndirectMFRcervicothoracic junction• MEcervical• Stilltechniqueribs,thorax• DirectMFRdiaphragm• MEpelvis,lumbars• Lumbosacraldecompression• Lymphaticpedalpump
ResponsetoTreatment
• Patient• Decreasededemafor48hoursafterOMT
• Decreasedhippain
• Patient’sOBGYNadvice• “eatlesssalt”
• Mysuggestions• Supporthose20-30mmHgpressure
• Kneechestpositiondaily• Bellysupportband• OMTeveryotherweek• Leftsidesleepingwithelevatedfeet
• Teachhusbandpedalpump
• Pregnancymassage
DiscussionandQuestions
References
• Chila;AOA,2011FoundationsofOsteopathicMedicine,3rdedition
• Hensel KL,BuchananS,BrownSK,etal.PregnancyResearchonOsteopathicManipulationOptimizingTreatmentEffects:thePROMOTEstudy.AMJObstet Gynecol 2015:212:108.e1-9
• Kuchera M.,Kuchera W,1994,OsteopathicConsiderationsinSystemicDysfunction,revised2nd edition
• Licciardone JC,BuchananS,Hensel KL,etal.Osteopathicmanipulativetreatmentofbackpainandrelatedsymptomsduringpregnancy:aradomized controlledtrial.AmJObstetGynecol 2010;202:43.1-8
• Maganito JP,ShowalterA,Tettambel M,2009,OsteopathicManagementoftheFemalePatient
• Still,AT,PhilosophyofOsteopathy,1899,7th reprint,1995byAOA
