Term
| what is primary control for the kidneys? |
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Definition
| endocrine system (can affect w/cranial OMM) |
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Term
| how does sympathetic innervation regulate the kidney? |
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Definition
| preganglionic fibers originate in the segments T11-L1 and help regulate Na+ retention. |
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Term
| what is the path of sensory afferents to the kidney? |
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Definition
| they follow the thoracic splanchnics back to the spinal cord, then the vagus back to the brainstem |
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Term
| are parasympathetics involved with the kidney? |
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Definition
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Term
| what is peristalsis in the ureters controlled by? |
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Definition
| intrinsic pacemaker cells |
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Term
| what is innervation to the upper ureters? |
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Definition
| T10-L1 and the vagus (via celiac and superior mesenteric plexus) |
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Term
| what is innervation to the lower ureters? |
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Definition
| L1-2 and the pelvic splanchnics (S2-4) |
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Term
| what parts of the bladder get autonomic innervation? |
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Definition
| the body (detrusor) and the base (trigone) which both receive parasympathetic/sympathetic stimulation in reciprocal fashion. |
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Term
| what innervates the the sphincter urethra (deep transverse perineal skeletal muscle) which is part of the bladder? |
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Definition
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Term
| what is sensory innervation to the reproductive tract? |
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Definition
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Term
| what is sympathetic innervation to the uterus+cervix? |
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Definition
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Term
| what is parasympathetic innervation to the uterus+cervix? |
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Definition
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Term
| what is the somatic innervation to erectile tissue? |
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Definition
| S2-4, which innervate the skeletal muscles: bulbocavernosus, ischiocavernosus, superficial/deep perineal, external urethral sphincters, and anal sphincter |
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Term
| what is the parasympathetic innervation to erectile tissue? |
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Definition
| S2-4 (postganglionic fibers follow the routes of associated perineal vasculature) |
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Term
| what is the sympathetic innervation to erectile tissue? |
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Definition
| T11-L2 (postganglionic fibers follow the routes of associated perineal vasculature) |
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Term
| what structures are key to considering the R-GU biomechanically? |
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Definition
| ribs (compression w/pregnancy into inhalation dysfunction), lumbar, sacral, innominate, and lower extremities |
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Term
| how can the viscera be accessed for tx w/OMM? |
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Definition
| myofascial release (indirect/direct) or balancing ligamentous tension since all fascia is continuous and all viscera is invested by fascia |
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Term
| can pregnancy affect tensegrity? how? |
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Definition
| yes, rapidly via 1)androgenic-induced somatic dysfunction, 2) large/fast non-traumatic biomechanical change, 3) and challenge via biomechanic/circulatory/digestive systems |
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Term
| what is the biomechanical challenge presented by pregnancy? |
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Definition
| low back pain, bladder strain, stomach strain, foot swelling/pain, neck pain, upper back pain, and breast discomfort |
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Term
| what is the circulatory challenge presented by pregnancy? |
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Definition
| hemorrhoids, varicose veins, lower extremity edema, and a different position for sleeping+relationship to the heart |
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Term
| what is the hormonal challenge presented by pregnancy? |
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Definition
| the ligaments are signaled to become more lax - necessary for delivery, but also creates instability |
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Term
| can a fibroid prevent a pregnancy from implanting? |
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Definition
| yes (structure/function relationship) |
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Term
| what happens to the A-P curves in pregnancy? |
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Definition
| increased lumbar, thoracic, and cervical changes - which do affect fluid dynamics |
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Term
| what characterizes biodynamic movement of body fluids in pregnancy? |
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Definition
| pregnancy involves increased interstitial fluids, secondary to both *increased production and *increase fluid retention in body tissues. movement of additional fluid is dependent on the lymphatic system. |
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Term
| how does the pregnant uterus affect fluid movement? |
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Definition
| fluid movement has dually impediments w/pregnancy, through a ball-valve effect on the leg veins and connections between the IVC. some women thus suffer from supine hypotension. |
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Term
| how does the pregnant uterus affect the lungs? |
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Definition
| by pushing up on the diaphragm, possibly adversely affecting air intake. by reducing the amount of negative pressure (reduces lymphatics/circulation back to the heart. and by enhancing costal motion, which improves the ability to optimize the homeostatic mechanism for fluid movement and cellular support. |
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Term
| how does hypersympathetic tone affect blood/lymph flow? how is this increased in pregnancy? |
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Definition
| this decreases blood/lymph flow and increases tissue congestion. hypersympathetic tone in pregnancy may be the result of a somatic dysfunction in the thoracolumbar region (facilitation via autonomic innervation) |
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Term
| how do new fascial patterns due to pregnancy cause nerve dysfunctions in pregnancy? |
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Definition
| carpal tunnel syndrome (increased fluid pressure on the wrist - release thoracic outlet) and restless legs syndrome (also may be secondary to iron deficiency) may result |
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Term
| what should be considered early in pregnancy? |
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Definition
| a structural exam - which may serve as a predictor of possible difficulties later (esp consider trauma hx to pelvis/sacrum) |
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Term
| what dysfunctions should be addressed in the first trimester of pregnancy? |
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Definition
| sacral/innominate dysfunctions: can impede drainage of the lower extremities. lumbar dysfunction: lordosis will exacerbate any previous problems. |
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Term
| what potential medical problems should be addressed in the first trimester? |
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Definition
| hyperemesis (wk 4-12[+], tx: hydration), UTIs, thyroid disease, DM, emotional issues, and nutritional issues. |
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Term
| what are commonly reported structural findings in the first trimester of pregnancy? |
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Definition
| C2 recurrent dysfunction (potential PNS effects), T4-7 dysfunction (associated w/breast tenderness), and pelvic/sacral imbalance |
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Term
| what characterizes changes to the pregnant body during the 2nd trimester? |
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Definition
| increased fat storage, blood volume expansion, uterine growth, breast hypertrophy, possible continuing tissue congestion, and cervical/sub-occipital strain may develop as A-P curves exaggerate |
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Term
| what is essential to OMM tx in the third trimester? |
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Definition
| maintenance of proper biomechanical/lymph drainage (want to avoid "S" curve formation) |
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Term
| what happens to the sacral base in the third trimester? |
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Definition
| the sacrum tilts anteriorly w/increased lordosis (flexion) |
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Term
| what are relative contraindications to OMT during pregnancy? |
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Definition
| PROM, PTL, abruptio placenta, ectopic pregnancy, idiopathic vaginal bleeding, threatened/complete abortion, prolapsed cord, and eclampsia/severe preeclampsia |
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Term
| what is the first step in treating the pregnant pt? |
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Definition
|
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Term
| what is the second step in treating the pregnant pt? |
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Definition
| doming the diaphragm. later in pregnancy, can use AP approach w/lower lateral rib cage |
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Term
| what is the third step in treating the pregnant pt? |
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Definition
| ischiorectal fossa release. hormonal changes during pregnancy relaxes muscles/ligaments decreasing the effectiveness of lymphatic flow, therefore lifting the perineum increases muscle excursion, allowing for a more efficient pump (from the lower extremities into the pelvic vasculatur and lymphatic system). popliteal fossa release can help promote lymphatic drainage of swollen feet. |
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Term
| what are the 3 steps to balanced ligamentous tension (can be performed on knee/ankle in pregnancy)? |
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Definition
| D.E.D., disengage (reproduce the position of injury), exaggerate (take joint through ROM, and balance (wait for tissues to respond) |
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Term
| once all the diaphragms have been opened, what is a good tx for facilitating lymphatic movement and decreasing congestion? |
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Definition
| marian clarke drainage - which allows gravity to take uterine pressure off the lymphatic and vasculature channels |
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Term
| what can marian clarke drainage be augmented with? |
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Definition
| thoracic (2/sec, can be continuous w/normal respirations or synchronized w/exhalation) or pedal pumps (2/sec, dorsiflexion:post muscles, plantarflexion:ant muscles) |
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Term
| how can pectoral traction help w/pregnant pts? |
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Definition
| this is often used after the thoracic lymph pump to alleviate possible exhalation rib dysfunctions (larger breasts/abdomen) created by compressing the chest and permits improved costal expansion/increased tidal volume. it also helps to open the thoracic outlet, allowing for improved upper extremity drainage. |
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Term
| how can the sacral rock help w/pregnant pts? |
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Definition
| this helps to mimic the cranial-sacral mechanism/enhances fluid drainage. parasympathetic tone is modified by influence of the pelvic splanchnic nerves (S2-4). this is done *supine in the pregnant pt. |
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Term
| when is a good time to perform OMM on a post-partum pt? |
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Definition
| ~ day 2, b/c relaxin is still in the system. do another structural exam and consider autonomics, lymphatics, biomechanics. *check the pubic symphysis. |
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