Back Pain: Gynecologic Facts

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

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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 ).

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Epidemiology

• Female gt male.
• The second common complaint after headache
• 30-90 in pregnancy.

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Epidemiology cont

• Rarely due to any serious disease.
• Sometimes a clear cause but mostly no cause can
  be elicited.

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Causes of BaP in Women

• A. Obstetric (pregnancy associated BaP).
• B. Gynecologic.
• C. Others
• Ligaments.
• Muscular.
• Bones and joints.
• Referred (renal, rectal).
• Psychological.
• Metabolic.

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Gynaecologic Causes

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

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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.

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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).

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Correction Of Posture

• Advices
• Stand up straight (smart).
• Drop your shoulders and relax your knees when
  standing.

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Correction Of Posturecont..

• Sit well back into your chair, legs slightly
  apart with both feet flat on the ground.

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Correction Of Posturecont..

• In front of a computer screen
• Sit up straight
• Keep your feet slightly raised off the floor on
  a footstool or other low object.

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Correction Of Posturecont..

• Always bend from your knees and lift objects and
  children from a crouching position to minimize
  the stress on your back.

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Correction Of Posturecont..

• Maintain your weight within the given parameters
  of weight gain.
• Avoid standing for long periods of time.

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• SPINAL EXERCISES

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EXERCISES

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

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1. WAIST ROTATION
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2. HIP ROTATION
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3. SPINAL STRETCH-SIDE TO SIDE
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4. SPINAL STRETCH-FORWARD AND BACK
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5. TORSO-TWIST
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6. PELVIC ROCK
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Alternative Complementary Medicine(CAM)

• Acupuncture and acupressure.
• Herbs (wheat oil).
• Aromatherapy (essential oils added to bath
  water).
• Massage and manual therapies (Chiropractic
  care).

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Alternative Complementary Medicine cont.

• Hypnosis, music therapy, yoga as well as
  breathing exercises.
• TENS PENS.
• Cupping.

• Praying.

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Acupuncture BaP

• In early pregnancy is not advised because can
  promote abortion

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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.

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Cupping (baguanfa)

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

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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.

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Gynecological Role cont.

• Referral to
• Physiotherapist.
• Osteopath.
• when serious problem is suspected

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Back pain with possible serious features (Royal c
of radiologists guidelines)

• Onset lt 20, gt55 yrs.
• Sphincter or gait disturbance.
• Saddle anaesthesia.
• Severe or progressive motor loss.
• Widespread neurological deficit.
• Previous cancer.
• Weight loss.
• Steroids.
• Structural deformity.

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Psychological

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

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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.

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Myths Back Pain.
FALSE

• 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
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Thank you
Prof. MOHAMMAD EMAM
OB GYN, Mansoura Faculty of Medicine Mansoura
Integrated Fertility Center (MIFC) EGYPT Telfax
0020502319922 0020502312299 Email.
mae335_at_hotmail.com www.ivfmifc.com