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 (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 ).

Epidemiology
Female

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

Epidemiology cont
Rarely due to any

serious disease.
Sometimes a clear
cause but mostly
no cause can be
elicited.

Causes of BaP in
Women
A. Obstetric (pregnancy associated BaP).
B. Gynecologic.
C. Others:

Ligaments.
Muscular.
Bones and joints.
Referred (renal, rectal).
Psychological.
Metabolic.

Gynaecologic Causes

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

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.

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).

Correction Of Posture
Advices:
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..

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..

Maintain your weight within the given

parameters of weight gain.
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)
Acupuncture

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

Alternative & Complementary

Medicine cont.
Hypnosis,

music therapy, yoga as

well as breathing exercises.
TENS & PENS.
Cupping.

Praying.

Acupuncture &
BaP
In early pregnancy
is not advised
because can
promote abortion

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.

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
"Science based on the
theory that health and
disease are life processes
related to the function of the
nervous system.

Gynecological Role
cont.
Referral to:
Physiotherapist.
Osteopath.
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.

E
S
L
A
Lifting heavy objects
F
causes back pain.
Bed

SEto cure a bad back.

rest is the bestL
way
FA

X-rays,

cat scans and MRI can always

identify the cause of back
SE pain.

Most

L
A
F

back pain will eventually need surgery.

E
S
L
A
F

OB& GYN, Mansoura Faculty of Medicine

Mansoura Integrated Fertility Center (MIFC)
EGYPT
Telfax 0020502319922 & 0020502312299
Email. mae335@hotmail.com
www.ivfmifc.com