Use of Osteopathic Manipulative Treatment in Pregnancy. Why OMT offers the extra edge and a complete form of medical treatment.

Source: By Rick Clofine, D.O., F.A.C.O.O.G Please visit: http://www.millennium-healthcare.com/ Millennium Healthcare 4370 Georgetown Square Atlanta, GA 30338 Phone: 770-390-0012 Fax: 770-457-4428

One reason I chose to become an Osteopathic Physician, was for it’s holistic foundation and it’s tradition of hands on healing, Osteopathic Manipulative Therapy (OMT). I was fortunate to go to medical school with a strong department entirely devoted to OMT. My mentors were general practice physicians who integrated OMT into medicine long before the term ‘integrative medicine’ was ever coined. From the start of my training, I was particularly fascinated by the application of this hands on therapy to the pregnant woman.

The dramatic changes of pregnancy often times result in common musculoskelatally related complaints. These include headaches, neckache, backaches, exacerbation of preexisting strain problems and edema (swelling). The complaints of pregnancy shift with each progressive trimester (every 3 months). Once conception occurs, the woman rapidly enters a state, which is completely different in almost every way. The very biochemical, and hormonal, milieu of the blood and fluid, bathing every body cell, is completely changed from what she had always known before. Virtually EVERY body system is drastically affected by pregnancy, and these changes become even more dramatic as the woman approaches term.

The nonpregnant uterus (womb) is about the size of your fist. By the end of a average pregnancy this organ has grown large enough to hold a 7-8 pound baby!! As the uterus grows larger it generally gets a slight twist, known as a dextrorotation, which allows it to fit more easily in the abdominopelvic cavity. With progression of pregnancy, the bodies center of gravity shifts forward resulting an increase in the front to back spinal curves. This often leads to a ‘swayback’ or accentuation of the low back (lumbar) lordotic curve. This is responsible for a lot of low back pain in pregnancy. Due to this shift in center of gravity, some pregnant women feel off balance and may be more prone to falls.

Along with this there is often a subtle rotational component which causes a torsional stress pattern up the spine. This restricts motion of the spine and ribs and thus adversely influences the mechanisms of chest, rib and diaphragmatic motion which provides the pressure pumping mechanism to move air, lymph and venous fluid. This strain is distributed throughout the body via the fascia (strength layer) envelope that encases all the muscles bones and ligaments.
The hormones of pregnancy (such as progesterone, relaxin and human placental lactogen) tend to cause some muscle and joint relaxation. In fact the ligaments that hold the joints together tend to become softer and looser. This provides some ‘give’ to the pelvic bones when the fetal passenger makes it’s journey through this region. It also results in some give in all the other joints of the body, which may make them more vulnerable to trauma from repeated high impact activity (like jogging). This ligamentous loosening contributes to the strain pattern induced by the pregnancy.

As the uterus rapidly enlarges it takes up space in a new way. This influences many systems in the body. The bowels are pushed to the periphery of the abdominal cavity. The bladder often serves as a pillow for the head of the baby. All the blood vessels and nerves of the pelvis are compressed. Even the way the heart and lungs move blood and air are drastically altered.

ALL OF THESE CHANGES are normal adaptive processes to maintain balance and health. Our bodies are plastic and responsive to the demands placed upon it. The demands may be great enough, at times, that they manifest as symptoms. These aches and pains maybe treated symptomatically with pain medication. This is the common response of conventional obstetrics. Usually acetaminophen is the recommended pharmacy medicine to treat pain in pregnancy. While generally safe to use, there are many pregnant women who would like to resolve any risk associated with it, by not using it at all.

Sometimes pelvic tilt exercises and abdominal supports are prescribed. These both can be helpful, though they do little to address the underlying strain patterns caused by the progressing pregnancy. Beyond these measures, conventional obstetricians have little to offer.
Osteopathic Manipulative Therapy (OMT) is a complete method of diagnosis and therapy based on a thorough evaluation of the structure and function of the body. Osteopathic Medicine emphasizes that all body systems, including the musculoskeletal system, operate in unison, and disturbances in one system can alter the function of other systems. OMT evaluates and treats the entire structure and function of the body, not just the bones, muscles and joints!

OMT provides a therapeutic approach to address many of the root causes of common pregnancy complaints. By using a variety of hands on techniques in any one therapeutic session (determined by the specific clinical situation) much of the primary strain on the spine, and other organs, can be relieved. It is not magic. It is not a cure for all problems. It is extremely helpful in relieving physical and mental stress, which allows all other problems to be addressed from a more optimal physiologic state.

Generally, after an OMT session, a woman feels a sense of relaxation and well being. OMT is about applying a proper stimulus to the body, so that the bodies’ response is one of healing and balance. Often times there is significant relief of back pain, neck ache and headaches. Patients frequently remark that they sleep better and have more energy. They feel like they can take a breath easier. It promotes the relaxation response, which lowers stress.

OMT does not remove the cause of these symptoms (the growing pregnancy). Rather it helps the body to have a more functional and adaptive response to these changes, thus the woman feels better. Repeated therapy sessions are often helpful because the strain patterns tend to intensify as the due date approaches. In my experience, this rarely requires more than once a month therapy. Although, frequency of treatments may increase near term.

A variety of hands on techniques are used in my OMT sessions. They may include soft tissue work which is massage like. Other methods include using the bodies muscles to move parts in a specific way (Muscle Energy Techniques). There are a variety of trigger point therapies. Myofascial Release and CranioSacral Therapy both originate in the Osteopathic profession. Sometimes high velocity low amplitude methods are helpful, these are gentle pressure maneuvers that create popping noise in the joints of the back or neck. There are a number of other methods as well.

While delivering babies for 10 years (I am now retired from Obstetrics) I was often asked by my patients if it was safe to see their chiropractor, or massage therapist, during pregnancy. Not knowing the individual practitioner, this was often a difficult question to answer. I fell that properly applied bodywork is safe in pregnancy. Properly applied means that the practitioner is educated in the specific needs of the pregnant patient. If inappropriately applied, manipulative therapy can cause problems. As with any other treatment, a thorough evaluation is required to determine the when indications or contraindications to treatment are present.
I feel uniquely qualified to treat the pregnant patient with bodywork. Being a board certified Obstetrician, I am fully cognizant of all the medical aspects of normal and high risk pregnancy. I am not interested in providing obstetric advice to these patients, they have their physicians and midwives for that purpose. As an Osteopathic bodyworker, I have been treating pregnant women with OMT for 20 years. I am well versed in the proper and safe approach to the pregnant woman and I have a wide range of therapeutic tools to draw upon. I find little more gratifying than providing manipulative therapy care to the pregnant woman.

On an almost daily basis a patient will inquire about the initials at the end of my name, D.O. as opposed to M.D. This may occur on the first visit, but often times will not come up till later in our relationship. They know they are seeing a board certified Obstetrician/Gynecologist, so what's up? What's the difference?

Osteopathic Medicine and Osteopathic Physicians have been a part of American Medicine since 1874. That is the year Andrew Taylor Still first espoused the philosophy and science of Osteopathic Medicine. Dr. Still was a former civil war physician and surgeon who was dissatisfied with the ineffectiveness of nineteenth-century medicine. Dr. Still developed an appreciation for the bodies ability to heal itself. Through intense study he came to understand the great importance of the musculoskeletal system, and its intimate relationship to all organ systems in the body, and to overall good health. He stressed preventative medicine, eating properly and keeping fit. He identified palpation and human touch as vital to gaining patient confidence and providing effective medical care. He introduced a system of manipulation as a noninvasive form of diagnosis and therapy. While originally a drugless school of medicine (due to the dangerous drugs of the day), as prescription of medication became a science, it was accepted by the profession.

Today, Osteopathic Medicine in the United States is fueled by 17 fully accredited osteopathic medical schools graduating about 1800 physicians annually. Approximately 38,000 Osteopathic Physicians (about 6% of the nations physicians) are licensed with FULL MEDICAL PRACTICE PRIVILEDGES in every state. Osteopathic postgraduate specialty training is available in 62 specialty and subspecialty areas of medicine. As opposed to in the past, today there are few institutions (hospitals or medical schools) that are composed of purely osteopathic or allopathic (MD) physicians. Almost all metropolitan hospitals are mixed staff; there are M.D.’s teaching at D.O. medical schools and vice versa.

Osteopathic medical education is very similar to M.D. training; an undergraduate degree followed by four years of medical school followed by post graduate training. There are several distinct differences in the training. Osteopathic training is oriented toward primary care medicine (family medicine, internal medicine, pediatrics and obstetrics/gynecology) with around 75% of Osteopathic Physicians practicing in primary care areas. Osteopathic Manipulative Therapy (OMT) is taught as part of the medical school curriculum. Osteopathic physicians are trained in hands on musculoskeletal diagnosis and manipulative therapy. While not all D.O.’s choose to utilize this training , all have had this exposure and are thus generally knowledgeable about the concepts involved and will refer for Osteopathic manipulation when indicated.
The knowledge of the bodies own inherent drive to heal is optimized through hands on treatment that maximizes the balanced well being of the structure. OMT is designed to support, stimulate and, in some instances, initiate the body’s trend toward health. When the bodies musculoskeletal structure is altered, abnormalities can occur in internal body systems. And, vice versa, when internal organ system dysfunction occurs, it is reflected in the musculoskeletal system. This knowledge is useful in both diagnosis and treatment.

So in practical terms, as an osteopathic physician, how do I treat my patients differently?? When I see patients in pregnancy I recommend manipulative therapy to help avoid the typical postural discomfort of pregnancy. When the aches and pains of advancing pregnancy exist, OMT is a safe and effective way of providing relief. I feel there is benefit to manipulative therapy before and after surgical procedures. Prior to surgery it helps optimize the system to deal with the upcoming stress. It is very common to have back and neck pain post operatively due to positioning on the operating room table in association with complete muscle relaxation. This responds very well to OMT. I have found OMT to be helpful in treating menstrual cramping and PMS. In cases of chronic pelvic pain it helps resolve musculoskeletal involvement ,thus making the evaluation less confusing, and sometimes avoiding surgery.

Osteopathic Medicine provides a needed alternative to the mainstream of conventional western medicine. It provides all the security and benefit of high-tech medicine implemented from a perspective that respects the bodies innate healing ability. Over the last 100 hundred years it has kept abreast of our rapidly advancing medical knowledge without discarding time proven hands on therapy.

By Rick Clofine, D.O., F.A.C.O.O.G
Please visit: http://www.millennium-healthcare.com/
Millennium Healthcare 4370 Georgetown Square Atlanta, GA 30338 Phone: 770-390-0012 Fax: 770-457-4428