Case Study
1. A 23 year-old G1P0 at 33 weeks and 5 days comes in to see you for a regular prenatal visit. She is normotensive, no proteinuria or glucosuria, and has no history of lower extremity edema. To this point she has gained 21 pounds during pregnancy. Fetal heart tones, uterine growth, and all physical examination results fall within normal limits. Her only new complaint is constant pain in the lumbosacral region, which is starting to limit her capacity to exercise daily.
Upon examination, she has increased lumbar lordosis, a nutated sacrum, and tightness bilaterally in the upper glutes and lateral lumbar region. You also note that her hip flexors are tight and that she is not firing her glutes. She does not, however, have signs of burning pain on her anterolateral thighs.
Using myofascial, muscle energy, counterstrain, and balanced ligamentous techniques, you treat her lumbar, sacral, pelvic and lower extremities, focusing on mobility, stretching, and muscle balance. You recommend that that she go to pregnancy yoga classes and swim, and cash in the certificate for a pregnancy massage that she was given at her baby shower.
Readings
- Foundations Volume 2, Chapter 31 “Obstetrics”
- Foundations Volume 2, Chapter 52
- Foundations Volume 3, Chapter 64, "Low Back Pain in Pregnancy"
- Jang J, Hsiao KT, Hsiao-Wecksler ET. Balance (perceived and actual) and preferred stance width during pregnancy. Clinical Biomechanics. Volume 23, Issue 4, Pages 468-476 (May 2008)
- King, Hollis H. et.al. Osteopathic Manipulative Treatment in Prenatal Care: A Retrospective Case Control Design Study. J A O A Vol 103 No 12 December 2003.
- Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. Am J Obstet Gynecol. 2010 Jan;202(1):43.e1-8. Epub 2009 Sep 20.
- Bonus Reading with bibliography on pregnancy and low back pain: A dissertation-length study of OMT in 3rd trimester Pregnancy: Hensel, Kendi Lee. Osteopathic Manipulative Medicine in Pregnancy: Acute Physiological and Biomechanical Effects. May, 2009, 157 pp.
