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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

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Kilder

•  RenzoMollinari(hlps://www.molinari-insDtute-health.org)

•  JeanPierreBarral(hlps://www.iahp.com/jeanpierrebarral/)

•  KåreMaispeciallægeireumatologi•  ArneBergspeciallægeianæstesi

•  Div.Bøger(besøgklinikkensstand)