Back Pain Gynecologic Facts Myths BY Mohammad A

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

What is backache ? Is stiffness and/or pain in the back

RATIONALE &CONCEPT > Although back pain (Ba. P) is a common complaint, but it is a forgotten topic in most Ob& Gyn text books. > Ba. P 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 ).

Epidemiology Ø Female > male. Ø The second common complaint after headache Ø 30 -90 % in pregnancy.

Epidemiology cont… ØRarely due to any serious disease. ØSometimes a clear cause but mostly no cause can be elicited.

Causes of Ba. P in Women A. Obstetric (pregnancy associated Ba. P). B. Gynecologic. C. Others: ü ü ü Ligaments. Muscular. Bones and joints. Referred (renal, rectal). Psychological. Metabolic.

Gynaecologic Causes Ø Ø Ø Ø Ø Prolapse (uterine). RVF. Ch. Cervicitis. Tumours. Endometriosis. Pelvic congestain. PMTS. Ut. Contractrains (polyp). Menst. Molimia. Osteoporosis

Diagnosis (Milestones) Ba. P caused by a gynecologic lesion: Always diffuse. Midline OR bilat. Sacral, lumbo sacral and never high than L 4 (LBP). Ba. P which can be pointed with a finger tip ± local tenderness not due to intrapelvic lesion.

Role Of Gynaecologist 1. Determine cause: History – Exam – Invest. 2. If no cause: ü Reassurance. Correction of posture. Exercises. Simple drugs. Complementay &Alternative medicine. ü Psychological. ü ü 3. Consultation (Referral if serious problem is suspected).

Correction Of Posture Advices: v Stand up straight (smart). Drop your shoulders and relax your knees when standing.

Correction Of Posture cont. . Sit well back into your chair, legs slightly apart with both feet flat on the ground.

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.

Correction Of Posture cont. . v Always bend from your knees and lift objects and children from a crouching position to minimize the stress on your back.

Correction Of Posture cont. . v Maintain your weight within the given parameters of weight gain. v Avoid standing for long periods of time.

SPINAL EXERCISES

EXERCISES. Simple exercises (curative). . Activity not bed rest.

1. WAIST ROTATION

2. HIP ROTATION

3. SPINAL STRETCHSIDE TO SIDE

4. SPINAL STRETCHFORWARD AND BACK

5. TORSO-TWIST

6. PELVIC ROCK

Alternative & Complementary Medicine(CAM) v Acupuncture and acupressure. v Herbs (wheat oil……). v Aromatherapy (essential oils added to bath water). v Massage and manual therapies (Chiropractic care).

Alternative & Complementary Medicine cont…. v Hypnosis, music therapy, yoga as well as breathing exercises. v TENS & PENS. v Cupping. v. Praying.

Acupuncture & Ba. P In early pregnancy is not advised because can promote abortion

TENS & PENS v TENS: transcutaneous electric N. stim. v PENS: percutaneous electric N. stim. v PENS is more effective than TENS because it combines advantages of TENS + elect. Acupuncture.

Cupping (baguanfa) Cupping therapies often follow the point selection pattern that is used for standard acupuncture therapy.

Chiropractic "Chiropractic “comes from the Greek word Chiropraktikos, meaning "effective treatment by hand” v "Science based on theory that health and disease are life processes related to the function of the nervous system. v

Gynecological Role cont…. Referral to: v. Physiotherapist. v Osteopath. v when serious problem is suspected

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.

Psychological In majority No gross lesion. Patient is handed from physician to Gynecolog. to orthopedic to surgeon. Anxiety neurosis sequalae.

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.

Myths & Back Pain. v Lifting E S L FA heavy objects causes back pain. E S L v Bed rest is the best FA way to cure a bad back. E MRI can always S cat scans Aand L F of back pain. identify the cause v X-rays, E back pain will. Leventually need S A F surgery. v Most

OB& GYN, Mansoura Faculty of Medicine Mansoura Integrated Fertility Center (MIFC) EGYPT Telfax 0020502319922 & 0020502312299 Email. mae 335@hotmail. com www. ivfmifc. com