An Integrated Approach for Treating the OB Patient: Treating the Five Diaphrams of the Body, Part I
by Ken Johnson, DO Introduction ratory rate is unchanged. The tidal helpful and detrimental from a struc- regnant volume increases by 40% and the tural point of view. Women who have women are a residual volume (which is the volume pre-existing somatic dysfunction be- joy to treat. aftermaximum exhalation) decreases fore pregnancy may be helped greatly They seem to by 20%. The expiratory reserve vol- during pregnancy. The relaxation of be tied di- ume (the amount that can be expired the ligaments allows for a greater, as rectly into the at the end of normal exhalation) in- well as easier, mobilization of a re- primary life creases by 20% and the functional stricted joint. There is also a negative force of the residual capacity decreases. The tho- effect in that the relaxation of the universe. Pregnancy is a time of racic cage also flares, increasing the ligaments can promote somatic dys- change; anatomically, physically, subcostal angle from 68° to 103°. The function occurring at a joint; a com- mentally and emotionally. Part 1 of diaphragm, due to the changes of mon example is an acute pubic sym- this paper will discuss the physiologi- pregnancy, must increase in its excur- physis shear. This can be an excruci- cal as well as anatomical changes that sion to oxygenate the increased blood atingly painful somatic dysfunction. occur during pregnancy. Part 2 will volume. discuss diagnosis and use treating the A common complaint of preg- five diaphragms of the body (the foot nancy is a subjective feeling of dys- arches, the pelvis, the respiratory dia- pnea. Dyspnea is possibly due to the ANATOMY phragm, Sibson's fascia covering the increase in blood volume to be oxy- There are many anatomical thoracic inlet and the tentorium cer- genated, and the anatomic changes changes that occur during pregnancy. ebelli) as a model for treatment. which lead to altered respiratory The growing fetus within the uterus function. causes an overall anterior shift in the center of gravity of the pregnant PHYSIOLOGY woman with a compensatory poste- Cardiovascular System Renal System rior shift in the shoulders - the so- The blood volume increases by Because there is more blood to be called "pride of pregnancy stance". approximately 40-55%. There are in- circulated by the cardiovascular sys- There is an increase in the lumbar creases in stroke volume by 30%, tem, there is more blood to purify. lordosis. These shifts cause changes heart rate by 10-20% and possibly an Therefore, the glomerular filtration in the thoracoabdominal pelvic cavi- increase in the cardiac volume by rate increases by approximately 50% ties which impede function and will 10%. The changes in the cardiovas- with a corresponding increase in so- be discussed in the following sec- cular system indicate that there is dium retention. tions. more blood for the cardiovascular system to circulate. Endocrine System First Diaphragm - There are numerous vascular The corpus luteum of pregnancy Arches of the Feet changes that occur as well. The uter- produces a polypeptide hormone The navicular bone is like the key- ine blood flow changes from approxi- called "relaxin". Also, there is an stone of the medial arch. With the mately 30-50 rril up to 500-1000 ml increase in the production of estro- postural changes that occur during per minute. There is also an increase gen. These hormonal changes cause pregnancy, it is common to find a in the breast blood flow. relaxation of the pelvic ligaments and functional pes planus or "flatfoot". also a general relaxation of many The arch, especially the navicular Respiratory System ligaments throughout the body. bone, drops inferiorly. There is a It has been proposed that the respi- These endocrine changes are change in the relationship of the talus