Gyn Backpain
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  • Mohey elking
  • Mohey elking

Transcript

  • 1. Back Pain : Gynecologic Facts & Myths BY Mohammad A. Emam Prof. OB& GYN Mansoura Faculty of Medcine Mansoura integrated fertility center (MIFC) EGYPT www.ivfmifc.com
  • 2. What is backache ?
    • Is stiffness and / or pain in the back
  • 3. RATIONALE &CONCEPT
    • Although back pain (BaP) is a common complaint, but it is a forgotten topic in most Ob& Gyn text books.
    • BaP represents a dilemma for the gyaecologists ,as many myths, facts and fictions not resolved by evidence- based data.
    • Era of complementary and alternative medicine ( CAM ) .
  • 4. Epidemiology
    • Female > male.
    • The second common complaint after headache
    • 30-90 % in pregnancy .
  • 5. Epidemiology cont…
      • Rarely due to any serious disease.
      • Sometimes a clear cause but mostly no cause can be elicited.
  • 6. Causes of BaP in Women
    • A. Obstetric (pregnancy associated BaP).
    • B. Gynecologic.
    • C. Others:
      • Ligaments.
      • Muscular.
      • Bones and joints.
      • Referred (renal, rectal).
      • Psychological.
      • Metabolic.
  • 7. Gynaecologic Causes
    • Prolapse (uterine).
    • RVF.
    • Ch. Cervicitis.
    • Tumours.
    • Endometriosis.
    • Pelvic congestain.
    • PMTS.
    • Ut. Contractrains (polyp).
    • Menst. Molimia.
    • Osteoporosis
  • 8. Diagnosis (Milestones)
    • BaP caused by a gynecologic lesion:
      • Always diffuse.
      • Midline OR bilat.
      • Sacral, lumbo sacral and never high than L4 (LBP).
    • BaP which can be pointed with a finger tip ± local tenderness
    • not due to intrapelvic lesion.
  • 9. Role Of Gynaecologist
    • 1. Determine cause:
    • History – Exam – Invest.
    • 2. If no cause:
      • Reassurance.
      • Correction of posture.
      • Exercises.
      • Simple drugs.
      • Complementay &Alternative medicine.
      • Psychological.
    • 3.Consultation (Referral if serious problem is suspected).
  • 10. Correction Of Posture
    • Advices:
    • Stand up straight (smart).
    • Drop your shoulders and relax your knees when standing.
  • 11. Correction Of Posture cont..
    • Sit well back into your chair, legs slightly apart with both feet flat on the ground.
  • 12. Correction Of Posture cont..
    • In front of a computer screen:
      • Sit up straight
      • Keep your feet slightly raised off the floor on a footstool or other low object.
  • 13. Correction Of Posture cont..
    • Always bend from your knees and lift objects and children from a crouching position to minimize the stress on your back.
  • 14. Correction Of Posture cont..
    • Maintain your weight within the given parameters of weight gain.
    • Avoid standing for long periods of time.
  • 15.
    • SPINAL EXERCISES
  • 16. EXERCISES
    • . Simple exercises (curative).
    • . Activity not bed rest.
  • 17. 1. WAIST ROTATION
  • 18. 2. HIP ROTATION
  • 19. 3. SPINAL STRETCH-SIDE TO SIDE
  • 20. 4. SPINAL STRETCH-FORWARD AND BACK
  • 21. 5. TORSO-TWIST
  • 22. 6. PELVIC ROCK
  • 23. Alternative & Complementary Medicine (CAM)
    • Acupuncture and acupressure.
    • Herbs (wheat oil……).
    • Aromatherapy (essential oils added to bath water) .
    • Massage and manual therapies ( Chiropractic care).
  • 24. Alternative & Complementary Medicine cont….
    • Hypnosis, music therapy, yoga as well as breathing exercises.
    • TENS & PENS.
    • Cupping.
    • Praying.
  • 25. Acupuncture & BaP
    • In early pregnancy is not advised because can promote abortion
  • 26. TENS & PENS
    • TENS: transcutaneous electric N. stim.
    • PENS: percutaneous electric N. stim.
    • PENS is more effective than TENS because it combines advantages of TENS + elect. Acupuncture.
  • 27. Cupping (baguanfa)
    • Cupping therapies often follow the point selection pattern that is used for standard acupuncture therapy .
  • 28. Chiropractic
    • "Chiropractic “comes from the Greek word Chiropraktikos, meaning "effective treatment by hand”
    • "Science based on the theory that health and disease are life processes related to the function of the nervous system.
  • 29. Gynecological Role cont….
    • Referral to:
      • Physiotherapist.
      • Osteopath.
    • when serious problem is suspected
  • 30. Back pain with possible serious features (Royal c of radiologists guidelines)
    • Onset < 20, >55 yrs.
    • Sphincter or gait disturbance.
    • Saddle anaesthesia.
    • Severe or progressive motor loss.
    • Widespread neurological deficit.
    • Previous cancer.
    • Weight loss.
    • Steroids.
    • Structural deformity.
  • 31. Psychological
    • In majority No gross lesion.
    • Patient is handed from physician to Gynecolog. to orthopedic to surgeon.
    • Anxiety neurosis sequalae.
  • 32. FACTS OR FICTIONS;;
    • Cervical erosion (ectopy) never causes back pain.
    • Vaginal prolapse never cause backache.
    • Uterine prolapse and RVF rarely cause dragging pain on uterosacral and cardinal ligaments.
  • 33. Myths & Back Pain.
    • Lifting heavy objects causes back pain.
    • Bed rest is the best way to cure a bad back .
    • X-rays, cat scans and MRI can always identify the cause of back pain.
    • Most back pain will eventually need surgery.
    FALSE FALSE FALSE FALSE
  • 34. OB& GYN, Mansoura Faculty of Medicine Mansoura Integrated Fertility Center (MIFC) EGYPT Telfax 0020502319922 & 0020502312299 Email. [email_address] www.ivfmifc.com Prof. MOHAMMAD EMAM Thank you