OMM in pregnancy
Saroj Misra, DO, FACOFP
Marissa Rogers, DO Acknowledgements
Laura Dreyer, DO
Rachel Nixon, DO
Molly DiMatteo, DO
2 Goals/Objectives
Review evidence based benefits of OMT in pregnancy
Understand the implications of pregnancy on the somatic system
Recognize common somatic dysfunctions seen in pregnant women
Discuss and demonstrate OMT techniques that can be used to treat the somatic dysfunctions associated with pregnancy
3 Why use OMT?
Pain reduction during pregnancy and labor
Eliminate somatic dysfunction and maintain proper structure
Limit medication use
Improve quality of life
Return to homeostasis
Decrease pregnancy and labor complications
Patient satisfaction!!!
4 Background
Been using OMT on pregnant patients since early 20th century
1911 -Whiting - 223 pregnant women
Prenatal OMT decreased labor time by over 50% for pregnancies
1918 - Hart - 100 pregnant women
Of 100 deliveries all receiving OMT - only 3 required use of forceps compared to 6-18% of women not receiving OMT, in addition to similar decreases in length of labor
5 Background (cont.)
1982 - Guthrie & Martin - 500 women
Decreased need for analgesia during labor in women receiving OMT
1992 - Gitlin & Wolf
Stimulated uterine contractions through craniosacral manipulation
6 Recent research
2003 - King et al
Retrospective case control study - decreased probability of complications in treated women
2010 - Licciardone et al - 144 patients
Randomized, placebo controlled trial revealed decreased back pain in OMT group
7 Structural changes
Increased lumbar lordosis
Increased thoracic kyphosis
Increased pelvic tilt
Elevation of diaphragm
8 Physiologic changes
Progesterone: smooth muscle relaxation, fluid retention -> nausea/vomiting/reflux
Relaxin: soft tissue remodeling, SI laxity, pubic symphysis mobility -> pelvic pain/ back pain
Increased cardiac output, decreased total lung capacity -> shortness of breath
Sodium retention, water retention, increased blood volume -> edema, congestion, CTS
Pseudo-hypercoagulable state
9 Osteopathic Tenets
The body is a unit in which structure, function, mind and spirit are mutually and reciprocally interdependent
Body has its own self protecting, regulating and healing mechanisms
Structure and function are reciprocally related
Treatment considers the preceding three principles
10 Viscerosomatics
T10-L2: Stimulate uterine contractions/cervical→ dilation induction of labor
Inhibit uterine contractions/cervical dilation→reduced preterm labor
Atlas - C3: treat overstimulation of the vagus on the heart
Thoracic spine/rib raising: regulate SNS - improve CVS
Sacral treatment (S2-S4): treat pelvic splanchnic nerves → treat GI complaints, pelvic pain
11 Treatment Goals
Correct articular and muscular dysfunction
Restore autonomic balance
Release fascial diaphragms
Restore lymphatic and venous flow
12 Contraindications
Undiagnosed bleeding
Ruptured membranes
Avoid CV4, HVLA, lymphatic pumps
13 Common Osteopathic findings in pregnancy
BackHead/Occiput pain Nasal/Sinus Congestion,TART (OA) Neck TART (C2-5) Constipation Thoracics TART (especially T1-6) EdemaLumbar TART Sacrum B/L sacral flexion Carpal Tunnel Syndrome Reflux/n/vPelvis Pelvic Diaphragm Restriction Upper Extremity Carpal Tunnel Syndrome Headaches/migraines Lower Extremity Edema SinusRibs congestion TART, Inhalation of 11th and 12th ribs Abdomen Abd Diaphragm Restriction NeckLymphatics pain Edema in extremities may be present
14 Treatment considerations
Treat in whatever position is most comfortable
Avoid supine position for prolonged periods
Avoid prone position!
Utilize indirect techniques as much as possible
15 TREATMENTS OA release
Purpose: reset parasympathetic nervous system
17 Cervical Soft Tissue
Purpose:
Decrease muscle tension
Increase ROM
Promote relaxation
Treat cervical viscerosomatic reflexes
18 Cervical Counterstrain
Purpose:
Decrease tension of associated cervical muscles
Atlas of Osteopathic Techniques, Nicholas
19 Thoracic Inlet Release
Purpose:
Release facial tension
Decreases pain
Improve lymphatic drainage
20 Atlas of Osteopathic Techniques, Nicholas Frontal/Nasal Lift
Purpose:
Decrease nasal congestion
Release tension
Improve drainage
21 Sinus effleurage
Purpose:
Decrease lymphatic congestion of sinuses
22 Rib raising
Purpose:
Increase rib motion
Reset sympathetic nervous system
23 Kimberly Manual Abdominal Diaphragm Release
Purpose:
Increase diaphragm mobility
Decrease SOB
http://www.lastsite.ca/wp-content/uploads/2012/03/
24 Carpal Tunnel Release
Purpose:
Increase lymphatic drainage
Decrease pain
25 Ganglion Release
Purpose:
Decrease sympathetic tone to stomach through direct inhibition
26 Chapman Points: http://fce-study.netdna-ssl.com/images/upload-flashcards/back/9/4/31649888_m.jpg Stomach
Reset viscerosomatic reflex of stomach
27 Chapman points: IT band
Purpose: Reset viscerosomatic reflex of the colon
https://o.quizlet.com/41fkAW730kYXwE1dGg-1Kg_m.jpg
28 Thoracic Springing
Purpose:
Articulate thoracic spine
Improve motion
Decrease tension
Improve SOB
29 Soft tissue spine
Purpose:
Decrease tension
Increase laxity of muscles
Kimberly Manual 30 Modified Lumbar Roll
Purpose:
Stretch lumbar spine
Improve ROM
Decrease pain
31 ‘OB Roll’
Purpose:
Articulate & stretch lumbar/thoracic spine
32 Still technique
Purpose: Articulate sacrum/hip/innominate
Decrease tension & pain
Improve motion
33 Pelvic Diaphragm
Purpose:
Improves motion of the pelvic diaphragm
Increased venous and lymphatic drainage from pelvis
34 Direct Sacral Inhibition
Purpose:
Increase mobility of sacrum, decrease pain
Treat pelvic viscerosomatic reflex
Kimberly Manual 35 Home exercises
Lumbar Roll
Cat/Cow
Shoulder squares
36 Summary
OMT in pregnancy has been shown to decrease labor time, assisted delivery incidence, as well as decrease pain and complications associated with pregnancy
Common regions to look for somatic dysfunctions in pregnancy are thoracic, lumbar, pelvic, and breathing apparatus
There are a number of techniques identified which can assist in the management of the pregnant patient
37 Questions
38 References
Laura Dreyer, D.O. OMM in pregnancy. 2009
Paul Kimberly, D.O. Outline of Osteopathic Manipulative Procedures. The Kimberly Manual. Millennium Edition. Walsworth Publishing Co. 2000.
Channell, Millicent and Mason, David. The 5-Minute Osteopathic Manipulative Medicine Consult. Lippincott Williams and Wilkins. 2008.
John Licciardone et al. Osteopathic Manipulative Treatment of Back Pain and Related Symptoms during Pregnancy: A Randomized Controlled Trial. Am J Obstet Gynecol. 2010 January; 202(1): 43.e1–43.e8.
Hollis H. King, D.O. et al.Osteopathic Manipulative Treatment in Prenatal Care: A Retrospective Case Control Design Study. JAOA • Vol 103 • No 12 • December 2003
John M Lavelle, D.O. Osteopathic Manipulative Treatment in Pregnant Women. J Am Osteopath Assoc June 1, 2012 vol. 112 no. 6 343-346
Nicholas, A DO & Nicholas, E DO. Atlas of Osteopathic Techniques. Lippincott Williams and Wilkins. 2008
Anita Showalter, DO. Deliver us from Pain: OMT in the Obstetric patient. http://www.osteopathic.org/inside-aoa/events/omed/omed- presentations/documents/public-health-showalter.pdf
Laura Tinning, DO. OMT in OB. CME Course MSUCOM November 2015
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