Osteopathic Manipulative Treatment Protocol for Pain Management During Pregnancy

Introduction

This tutorial outlines an osteopathic manipulative treatment protocol specifically designed for managing pain and dysfunction during pregnancy. These techniques can help alleviate discomfort and promote overall well-being in pregnant individuals. It is important to perform these techniques with care and ideally under the guidance of a trained professional.

Step 1: Seated Forward Leaning Thoracic Spine Articulation

1. Position the Subject: Have the subject sit facing the physician.
2. Identify Contact Points: Locate the thoracic spinous processes and make contact on the transverse processes or costo-transverse junction.
3. Stabilize the Subject:
   • The subject crosses her arms on the physician's upper chest and rests her head on her arms.
   • The physician braces her anterior knee against the subject's knee for stabilization.
4. Apply Technique:
   • The physician reaches behind the subject to make contact.
   • Draw the subject forward into extension, rotation, and side bending towards the restrictive barrier.
   • Apply low-velocity, medium-amplitude springing until motion improvement is felt.
5. Alternate Positions:
   • Approach from the side with anterior springing.
   • Have the subject place arms straight over the physician's shoulder while stabilizing the knee.

Step 2: Cervical Soft Tissue Technique

1. Position the Subject: Lay the subject supine with the physician at the head of the bed.
2. Contact the Muscles:
   • Use the medial aspect of the cervical paraspinal muscles.
   • Knead the tissue by drawing it anteriorly, moving up and down the cervical spine.
3. Assess Relaxation: Continue until tissue relaxation is palpated.
4. Recheck the Area: Ensure all significant soft tissue somatic dysfunctions are treated.
5. Alternate Position: Treat each side individually by stabilizing the subject’s head with the cephalad hand while kneading.

Step 3: Occipital Atlantal Decompression

1. Contact Points: Use the middle two or three fingers to contact the occiput near the condyles.
2. Apply Tension:
   • Gradually increase pressure towards the subject's orbits based on tissue response.
   • Create traction by moving the physician's elbows medially, leveraging the fingertips laterally.
3. Use Respiratory Assistance: Enhance the release by coordinating with the subject's inhalation or exhalation.
4. Hold Position: Maintain for 20 to 30 seconds or until release is felt, then reassess.

Step 4: Thoracic Inlet Myofascial Release

1. Contact the Anterior and Posterior Areas:
   • Anterior contact across the sternoclavicular junction and first two ribs.
   • Posterior contact across T1 and T2.
2. Use Layer Palpation: Assess the thoracic inlet with a broad hand contact.
3. Approach the Barrier: Use rotation, side bending, and flexion/extension to reach a balance point.
4. Hold for Release: Maintain for 20 to 60 seconds until tissue creep indicates a release, then reassess.

Step 5: Lateral Recumbent Scapula-Thoracic Myofascial Release

1. Position the Subject: Have the subject lay on her side facing the physician.
2. Contact the Scapula:
   • Place one hand on the superior angle and the other on the inferior medial angle.
   • Initiate a rhythmic circular motion while moving the scapula laterally.
3. Assess Fascial Restrictions: Examine in superior-inferior, medial-lateral, and rotatory motions.
4. Hold for Release: Maintain until a release is palpated, then reassess.
5. Part 2: Move the subject’s arm over the physician’s cephalad arm and repeat the process with a broad contact over the shoulder.

Step 6: Supine Diaphragm Release

1. Broaden Contact on Ribs: Spread fingers over the lower six ribs.
2. Assess Motion: Use layer palpation to evaluate diaphragmatic tissues in all planes.
3. Approach the Barrier: Maintain contact for 20 to 60 seconds until a release is felt, then reassess.
4. Alternate Position: Approach from the side, one hand below the xiphoid and the other at the thoracolumbar junction.

Conclusion

This tutorial provided an overview of key osteopathic manipulative treatment techniques for pain management during pregnancy. Always ensure these techniques are performed by trained professionals to ensure safety and effectiveness. Regular reassessment is crucial to monitor progress and adjust treatments as needed. Consider seeking further training or professional guidance for a comprehensive understanding of these techniques.