Gyn Backpain

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  • Mohey elking
  • Mohey elking
  • Gyn Backpain

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

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