Obstetrics: Pathologies

Question 1

What is Coccydynia?

Answer 1

After childbirth the joint between the coccyx and sacrum can become hypermobile causing the soft tissue surrounding the coccyx to become painful

Question 2

What is the Etiology of Coccydynia?

Answer 2

Subluxation during delivery, adherence to tear or episiotomy scar

Question 3

What are the S/S of Coccydynia?

Answer 3

Difficulty sitting on hard surfaces, referred pain to the low back, SI joint, hip, buttock, groin or rectum areas, pain with the bowel movements, dyspareunia, and formation of hemorrhoids

Question 4

What can be done for treatment for Coccydynia?

Answer 4

Treatment may include heat, external joint mobilization, myofascial release, muscle energy techniques, biofeedback for pelvic floor muscle relaxation, postural training, abdominal strengthening exercises, stretching exercises for surrounding muscles, and the use of a cushion for sitting

Question 5

What is Diastasis Recti?

Answer 5

This is a separation of the rectus abdominis muscle along the linea alba that can occur during pregnancy. Testing for diastasis recti should be performed on all pregnant women prior to prescribing exercises that require the use of the abdominals

Question 6

What is the Etiology of Diastasis Recti?

Answer 6

Unknown, however, theories indicate biomechanical and hormonal changes in women may cause the separation
- The therapist must note how many fingers fit into the separation and modify threatment accordingly

Question 7

What are the S/S of Diastasis Recti?

Answer 7

A patient is considered to have diastasis recti if the therapist detects a separation greater than the width of two fingers when the woman lifts her head and shoulders off the plinth

Question 8

What can be done for treatment for Diastasis Recti?

Answer 8

Treatment will include stabilization and support with abdominal strengthening exercises, postural awareness exercises, and body mechanics training
- A newborn can also have diastasis recti secondary to incomplete development, however, in infants this condition usually resolves itself without intervention

Question 9

What is Piriformis Syndrome?

Answer 9

This refers to a persistent, severe radiating low back and buttock pain spanning from the sacrum to the hip and posterior thigh.
- However, controversy exists over piriformis syndrome’s efficacy as an accurate diagnosis

Question 10

What is the Etiology of Piriformis Syndrome?

Answer 10

During pregnancy the piriformis may shorten or spasm due to postural changes and hip lateral rotation while walking

Question 11

What are the S/S of Piriformis Syndrome?

Answer 11

The primary symptom is sciatic paresthesia due to nerve entrapment as the sciatic nerve passes under or through the piriformis muscle

Question 12

What can be done for treatment for Piriformis Syndrome?

Answer 12

Manual techniques for correcting pelvic or sacral alignment such as muscle energy techniques, joint mobilization, self-correction techniques for alignment, heat application, deep tissue massage, myofascial release, strain-counterstrain, abdominal strengthening, stretching exercises for both the piriformis and surrounding muscles, body mechanics, and postural education

Question 13

What is Pubic Sympthysis pain?

Answer 13

To prepare for delivery, the symphysis pubic joint become mobile in order to allow the joint to slightly separate during delivery

Question 14

What is the Etiology of Pubic Sympthysis pain?

Answer 14

Postural adaptations, ligamentous laxity, and complications during delivery or birthing of a large infant can result in more severe injury to the soft tissues surrounding the joint

Question 15

What are the S/S of Pubic Sympthysis pain?

Answer 15

Severe pain in the symphasis pubis and SI joints as well as in the urine due to injury to the urethra or bladder neck

Question 16

What can be done for treatment for Pubic Sympthysis pain?

Answer 16

Medical treatment includes pharm intervention for pain and surgical intervention based on the degree of separation in the joint.

• Treatment may also include heat or ice if acute, manual techniques for correcting pelvic or sacral alignment such as muscle energy techniques, self correction techniques for alignment, education on positioning, postural training, gait training, pelvic and lumbar stabilization exercises, and the use of a lumbo-pelvic brace or binder