Orthopedic Injury in Pregnancy.

There are many reasons why a woman's pregnancy can put her at risk for orthopedic pain and injury. Given the high percentage of pregnant patients experiencing some degree of musculoskeletal pain, it is surprising that this is not an area of wider study. This chapter takes an evidence based approach to help the reader understand the implications of the numerous anatomic and physiologic changes associated with the gravid state, and how they act to promote both discomfort and injury. One-third of pregnant women in America are obese, further increasing risk. Exercise in most pregnancies is recommended and regarded as safe and thus obstetric care providers need to understand risk, diagnostic techniques and treatments.

A randomized controlled trial comparing a multimodal intervention and standard obstetrics care for low back and pelvic pain in pregnancy.

OBJECTIVE: Women commonly experience low back pain during pregnancy. We examined whether a multimodal approach of musculoskeletal and obstetric management (MOM) was superior to standard obstetric care to reduce pain, impairment, and disability in the antepartum period. STUDY DESIGN: A prospective, randomized trial of 169 women was conducted. Baseline evaluation occurred at 24-28 weeks' gestation, with follow-up at 33 weeks' gestation. Primary outcomes were the Numerical Rating Scale (NRS) for pain and the Quebec Disability Questionnaire (QDQ). Both groups received routine obstetric care. Chiropractic specialists provided manual therapy, stabilization exercises, and patient education to MOM participants. RESULTS: The MOM group demonstrated significant mean reductions in Numerical Rating Scale scores (5.8 ± 2.2 vs 2.9 ± 2.5; P < .001) and Quebec Disability Questionnaire scores (4.9 ± 2.2 vs 3.9 ± 2.4; P < .001) from baseline to follow-up evaluation. The group that received standard obstetric care demonstrated no significant improvements. CONCLUSION: A multimodal approach to low back and pelvic pain in mid pregnancy benefits patients more than standard obstetric care.

Back and pelvic pain in an underserved United States pregnant population: a preliminary descriptive survey.

OBJECTIVE: The objective of this study was to identify the prevalence of back pain and treatment satisfaction in a population of low-socioeconomic pregnant women. METHODS: This study used a cross-sectional design to determine the prevalence of self-reported musculoskeletal pain in pregnancy for 599 women. Women completed an author-generated musculoskeletal survey in the second trimester of their pregnancy that addressed pain history, duration, location, and intensity, as well as activities of daily living, treatment frequency, and satisfaction with treatment. RESULTS: Sixty-seven percent of the total population reported musculoskeletal pain, and nearly half presented with a multi-focal pattern of pain that involved 2 or more sites. Twenty-one percent reported severe pain intensity rated on a numerical rating scale. Eighty percent of women experiencing pain slept less than 4 hours per night and 75% of these women took pain medications. Importantly, 85% of the women surveyed perceived that they had not been offered treatment for their musculoskeletal disorders. CONCLUSION: Multi-focal musculoskeletal pain in pregnancy was prevalent in this underserved patient population. The pain in this population negatively affected sleep and treatment appeared inadequate.

The effects of active release technique on hamstring flexibility: a pilot study.

OBJECTIVE: The aim of this study is to determine if active release technique (ART) significantly increases hamstring flexibility in healthy male participants. METHODS: Twenty physically active male participants with no current or previous history of lower extremity injury received ART on the origins and insertions of the hamstrings and dorsal sacral ligament. The sit-and-reach test was used before and after treatment to determine hamstring flexibility. Summary statistics were calculated, and pre and post hamstring flexibility scores were compared using a related samples t test. RESULTS: There was a significant difference between the pre- and posttest groups (mean pre = 35.5 cm, df = 19, SD = 7.56; mean post = 48.3 cm, df = 19, SD = 7.07; P = .0015). All 20 participants increased their sit-and-reach scores following the application of ART. CONCLUSIONS: This study demonstrated that a single ART treatment increased hamstring flexibility in a group of healthy, active male participants.

Upper gastrointestinal hemorrhage after nonresponsive thoracic spine pain: a case report.

OBJECTIVE: This case study reports the findings of an upper gastrointestinal hemorrhage in a patient with thoracic spine pain reporting to a chiropractic clinic. The purpose of this article is to highlight the importance of identifying a patient's medication history as well as reviewing the signs and symptoms of gastrointestinal bleeding from a nonvariceal lesion. CLINICAL FEATURES: A 61-year-old woman presented with worsening middle thoracic spine pain of 3 months' duration along with recent abdominal pain. Medications, physical therapy, and spinal manipulation did not provide considerable improvement. The patient was taking ibuprofen daily to cope with her back pain. INTERVENTION AND OUTCOME: The initial physical examination demonstrated mild increased tissue tension in the thoracic paraspinal muscles with mild restriction of thoracic spine range of motion secondary to the patient's pain. There was pain on palpation of the T4-5 and T7-8 spinal segments. The physical examination findings did not correlate to the patient's pain presentation, and she was referred back to her primary care physician. Two days after the initial examination, the patient experienced an upper gastrointestinal hemorrhage and underwent emergency surgery. It was determined postoperatively that she had a medication-induced duodenal ulcer that subsequently ruptured. CONCLUSION: An upper gastrointestinal bleed should be considered in the differential diagnosis of a patient with a history of prolonged aspirin or nonsteroidal anti-inflammatory drug use with nonspecific abdominal symptoms.

The effect of cervical spine manual therapy on normal mouth opening in asymptomatic subjects.

OBJECTIVE: Temporomandibular disorders are a group of disorders affecting the temporomandibular joint and/or masticatory muscles. One of the signs associated with temporomandibular disorders is a reduction in mouth opening. During normal mouth opening, extension occurs at the cervical-cranial junction. The purpose of this investigation was to determine if manual therapy applied to the cervical-cranial junction would significantly improve mouth-opening capacity. METHODS: One hundred one participants were randomly assigned to either an Active Release Technique (ART) group; high-velocity, low-amplitude manipulation (HVLA) group; or control group. A blinded investigator measured mouth opening using a TheraBite range of motion scale (TheraBite Corporation, West Chester, PA). Participants received ART to the suboccipitals or HVLA to the cervical spine at C1 or sat with an investigator for 3 minutes with no treatment. After the treatment session, mouth opening was remeasured. A repeated-measures analysis of variance was used to compare the group mean values. The a priori alpha level was .05. RESULTS: The repeated-measures analysis of variance showed no significant difference between the ART, HVLA, and control groups' pretreatment and posttreatment measurements (F = 0.41, P > .05). CONCLUSION: Manual therapy to the cervical spine did not significantly improve mouth opening in this asymptomatic population. Future trials using participants with restricted mouth-opening measures are warranted.

The effects of active release technique on carpal tunnel patients: A pilot study.

OBJECTIVE: To examine changes in electromyography (EMG) and a valid self-administered outcome measure after applying active release technique to carpal tunnel syndrome (CTS) patients. METHODS: Five subjects (mean age 48.2 SD +/- 16.7) with CTS were included in the trial. Subjects completed the Boston Questionnaire (BQ) and an EMG examination before the first treatment. Participants were treated with Active Release technique using a protocol intended to affect the median nerve 3 times a week for 2 weeks. The BQ was re-administered following the final treatment. The mean scores for the initial and final BQ were compared using a paired samples t-test. An analysis of variance compared the mean contraction amplitudes for EMG parameters before and after the first treatment. RESULTS: There was significant improvement (p < 0.05) in the mean symptom severity and functional status scores of the BQ following the intervention. There were no significant differences found in the EMG analyses. CONCLUSION: The preliminary data from this clinical pilot trial suggest that active release technique may be an effective conservative management strategy for CTS patients. These results support the need for further clinical trials with larger samples.

Characterization of the hamster FancG/Xrcc9 gene and mutations in CHO UV40 and NM3.

The human FANCG/XRCC9 gene, which is defective in Fanconi anemia complementation group G (FA-G) cells, was first cloned by genetic complementation of the mitomycin C (MMC) sensitivity of CHO mutant UV40. The CHO NM3 mutant was subsequently assigned to the same complementation group. The parental AA8 CHO cells are hemizygous at the FancG locus, and we identified frameshift mutations that result in N-terminal truncations of the protein in both UV40 and NM3. Hypersensitivity to DNA cross-linking agents, such as MMC, typically characterizes FA cells. By introducing the native CHO FancG gene into mutant NM3, we demonstrate that hamster FancG fully corrects the 3-fold sensitivity to methyl methanesulfonate (MMS) as well as the 10-fold sensitivity to MMC, whereas resistance to ionizing radiation did not increase appreciably. In contrast, hamster cDNA transformants showed incomplete correction for both MMC and MMS sensitivity. The constitutively expressed FancG protein is present in the cytoplasmic, nuclear and chromatin fractions. FancG protein levels and subcellular localization do not change appreciably as a function of cell cycle position. Our results are consistent with roles of FancG in both the nuclear and cytoplasmic compartments to maintain genomic stability in response to various genotoxic agents.