Low pack, pelvic and pubic-symphysis pain during pregnancy - an osteopathic perspective

Low pack, pelvic and pubic-symphysis pain during pregnancy - an osteopathic perspective

An osteopath treating the pregnant patient suffering with pelvic or low back pain must apply physiology and anatomy to a body in flux. Major weight increases, altered spinal curves and unique hormonal make up put a huge stress on the body over a short time. The inability to cope with these changes is often the cause of sacroiliac strains and pubic symphysis diastasis.

Unlike regular back pain, pregnant women have the extra consideration of an enlarged uterus whose strong uterosacral and round ligaments attach onto the sacrum and pubis putting extra stress through these structures. Combined with the production of a hormone relaxin in preparation for the birth, the pelvis ironicallly has to increase its weight-bearing capabilities whilst accommodating for softer supportive ligaments. This makes the pelvic girdle a more relaxed, vulnerable piece of architecture during pregnancy.

Orthodox medicine tends to classify mechanical back and pelvic pain during pregnancy into roughly 3-5 categories according to the location of symptoms; low back pain due to either joint or disc dysfunction, sacroilliac dysfunction either unilaterally or bilaterally, pubic symphysis pain or pain in all 3 pelvic joints.

From an osteopathic perspective all these conditions are variations on a theme, that is, they are all the result of poor accommodation to the increased physical demands put on the body during pregnancy. Symptoms are likely to occur at the weakest most vulnerable joint in the kinetic chain. The job of the osteopath is to assess the patient and make a structural osteopathic analysis or "diagnosis" to determine why the body is not adapting well to the changes. Furthermore, the osteopath must decide which structures are central to treatment in order for the body to adjust adequately and compensate during the transition.

Osteopathy does not encourage a protocol treatment and needless to say the osteopath should routinely check and treat each joint in the body, however, there are central structures that require extra attention. The sacrum, hips and perineum are the closest associated structures to the joints of the pelvis and they are expected to accommodate. Any excess tightness in any of these joints reduces their ability to absorb forces and strains the sacroiliac and pelvic joints.

The sacrum for example needs to nutate and counter-nutate (flex and extend) according to the movement of the spinal vertebrae superior to it. If the sacrum is unable to rock back and forth and twist on its vertical axis the illiolumber and pubic symphysis will be strained. Similarly, any tightness in the hip adductors, external or internal hip rotators mean the femur and ischium tend to function as one unit. Movement of the leg results in traction and stress of the pubic symphysis.

The muscles must also be considered. Any tightness in psoas, abdominal muscles, lumber erector spinae, diaphragm and quadratus lumborum will result in further spinal and pelvic instability.

The osteopath must have an coordinated treatment approach directed at the hips, sacroiliac joints, spinal curves, lumber and abdominal muscles and uterine ligaments in order to treat the pregnant woman affectingly. If the osteopath manages to integrate these structures into a treatment plan the patient is likely to benefit in the long run from a thorough assessment that addresses the root of the problem.

Danny Sher qualified from the British School of Osteopathy (1996) and practices in Jerusalem and Modiin.
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What is a clinic visit like?

A typical osteopathic consultation has four parts: interview, physical examination, diagnosis and treatment.

Interview
You will be asked about your medical history, including details of your home, work and family.

Physical Examination
You will have a complete physical examination. If necessary, tests will be recommended. Following this, your osteopath will carry out a structural examination, starting with a check on your posture, spine and balance. Using his fingers, the Osteopath will feel your back, arms and legs, checking your joints, muscles, tendons and ligaments.

Diagnosis
After considering the results of the interview and examination, the Osteopath will tell you what may be causing your symptoms.

Treatment
A treatment plan will then be suggested. This may include Osteopathic Manipulative Treatment. Depending on the severity of your problem, more than one treatment session may be recommended.

OSTEOPATHY: Babies and children.

Osteopathy is an effective and natural approach to healthcare for all life stages. Osteopathic treatment for babies and children covers a variety of common complaints, and ensures healthy postural development.

Can osteopathy help my child?
Many common problems suffered by babies and children can be treated effectively with
osteopathy. Problems suffered by babies that respond well to osteopathic treatment include:
crying and irritability, especially when lying down.
feeding difficulties, vomiting colic and wind and sleep disturbances.


At what age should my child be treated?

Children of all ages can benefit from osteopathy. It is never too early to start, and for best results, treatment should begin before the age of five. Early treatment reduces hindrances to growth and limits the severity of any developing learning difficulty.

Osteopathy for Babies and toddlers:
Many problems that babies and children suffer are caused before, during and immediately after birth, resulting in uncomfortable stresses in the head and body. These stresses can lead to problems such as suckling and latching-on difficulties, irritability, colic, wind and disturbed sleep patterns. Toddlers may suffer from difficulties with mobility and play, seeking movement to relieve physical discomfort. Sleep patterns are disturbed, teething may be uncomfortable and head-banging or hair-pulling may occur.
Osteopathic treatment can result in significant improvement in these cases. Osteopathy is also successful in treating the problems suffered by premature babies. These babies
often suffer stresses and trauma during birth, complicated by further stresses from the equipment used to stabilise their condition.

OSTEOPATHY: Pregnancy
Pregnancy is a time when women are more aware of the workings of their body. It produces the largest postural change that a woman’s body will undergo. For many years, osteopaths have used their skills to help relieve the aches and pains caused by weight and posture changes during and after pregnancy.
For many women pregnancy means having to cope with a whole range of symptoms from back pain to morning sickness. As the baby grows in the womb, its extra weight results in a changed centre of gravity and posture changes from week to week. This can lead to a variety of aches and pains in the back, neck, arms and legs.


Why osteopathy?
Osteopathic treatment through pregnancy is a wonderfully gentle way of helping the body adapt to the changes which are taking place. The safety of mother and baby is the osteopath’s first concern.
Advice from your osteopath can help you to change your posture and learn to use your body correctly through pregnancy. Osteopaths can also help to ease other side effects of pregnancy such as heartburn, indigestion, constipation and pain in the buttock, groin or leg (commonly called sciatica).

Osteopathic Training of Members of the IOA:
Osteopathic training is demanding and lengthy, and the IOA recognises qualifications available from osteopathic educational institutions accredited by the GOsC (The General Osteopathic Council of Great Britain). Trainee osteopaths study anatomy, physiology, pathology, biomechanics and clinical methods, underpinned by a thorough clinical training during a four-year full-time honours degree programme. Such wide-ranging medically-based training gives osteopaths the skills to diagnose conditions when osteopathic treatment is not advisable, and the patient must be referred to a GP for further investigation. IOA members are committed to a programme of continuing professional development.

Membership of Israeli Osteopathic Association:
An osteopath practicing in Israel should be a member of the Israeli Osteopathic Association (IOA). Always ask to see their membership certificate. Membership indicates that the osteopath is sufficiently qualified with a 4 year full time degree in osteopathy, has professional indemnity insurance, works to a code of ethics and is bound by disciplinary procedures.The Israeli Osteopathic Association aims to maintain high standards of osteopathic practice in Israel, thereby protecting the public from unqualified practitioners. Avoid osteopaths who are not fully qualified and are not members of the Israeli Osteopathic Association.The Israeli Osteopathic Association is working with Misrad Habriut (Health Ministry) defining who in Israel may legally call themselves osteopaths.

What is Osteopathy?

Osteopathy (Osteopathic Medicine) was founded in the U.S.A. some 120 years ago and to date, there are 19 Osteopathic teaching hospitals in the U.S. as well as statutory recognition of the profession in Britain, France and Australia.

From its inception, Osteopathy has played a leading role in emphasising a patient-centred rather than symptom focused approach to medicine.

Throughout this long period of time it has continued to develop and refine especially those clinical methods of treatment that effectively promote the body's innate ability to heal itself.

Futhermore, Osteopathic Medicine has consistently encouraged the appreciation that treatment and recovery from illness require a partnership of effort between physician and patient, while the maintanance of health and prevention of disease necessitate a life-style that pays due attention to the essentials of diet, exercise, hygiene, relaxation and mental wellbeing.

These very same conditions that are considered essential to maintain health are also recognised to be some of the most effective modes of treatment, often reducing the need for medication or surgery.

But perhaps Osteopathy's most unique contribution to modern medicine has been its appreciation of the intimate two-way relationship, both in health and disease, between the anatomy and mechanics of the body and its internal function and physiology.

By way of the most careful observation and palpation, Osteopaths have recorded the frequent expression of disease and illness in the musculo-skeletal system, not least in and around the spinal column. They have also observed that precise, gentle and skilled osteopathic manipulative methods of treatment to these areas may relieve pain, restore function and provide a powerful stimulus to the body's immune system.

The use by Osteopaths of skilled manual treatment has earned the profession an enviable reputation for success in helping those suffering from many orthopoedic and rheumatological conditions. However, these two fields are but a small part of the range and breadth of health care that Osteopaths provide the sick, injured and infirm, from infancy to ripe old age. by Mervyn Waldman