Discussion Questions/Activities:

1) Using the Five Models as a guide, create a differential diagnosis for low back pain in
pregnancy.
Biomechanical: Somatic Dysfunction due to extra weight, prolonged sitting,
"waddling" gait and compensation, muscle strain, somatosomatic from pelvic floor
dysfunction/instability.
CV/Resp: DVT, Preeclampsia, venous compression on vena cava impeding circulation
Metabolic: Urinary tract changes in pregnancy, UTI (ureters, bladder, kidneys
viscerosomatics), hormonal changes (Relaxin) resulting in ligamentous laxity and
discomfort, fluid retention in the pregnant kidney
Neurological: spinal nerve compression, diminished blood flow to lumbar spine due to
compression of vena cava while lying down. Diaphragm restrictions leading to
venous/lymphatic congestion, lower rib dysfunctions interfering with autonomic nerve
activity and urine output. Parasympathetics at the sacral level influencing vascular
and visceral functions.
Biopsychosocial: stress of caring for 2 other children while pregnant, anxiety,
depression (stay at home mom), inability to perform physical activity, weight gain
assoc to lifestyle
2) List the red flags for low back in pregnancy.
3) What is meralgia paresthetica and the pathophysiology behind its presentation?
4) Describe the structural changes that occur during pregnancy and the associated physical
exam
findings.
5) Using the Five Models as a guide, create a treatment plan for the patients low back pain. If
using
OMT, please explain the rationale for each technique you choose.
OMT Treatment:
- Lateral Recumbent soft tissue of thoracics, lumbars.
- MFR
- Sacroiliac decompression
6) List the contraindications for OMT treatment for low back pain in the pregnant patient.
7) Using the Five Models as a guide, create a differential diagnosis for lower extremity swelling in
pregnancy.
8) What are the red flags for lower extremity swelling in pregnancy and how would you rule them
out?
9) Explain the structural exam findings that may contribute to lower extremity swelling in
pregnancy.
10)Using the Five Models as a guide, create a treatment plan for the patients lower extremity
swelling.
11)Using recent research, describe the effect of using OMT for low back pain in pregnancy.
12)Write the assessment and plan for our patient.

Assessment:
Pt Ed: inform this mother about correct posturing and movements during ADLs as to
not overload/misalign the spine. Advise pt to strengthen core muscles after delivery
to prevent risk and severity of LBP.