Pregnancy Massage 101: Musculoskeletal Adaptations II Extremities and Neck Focus

Transcription

1 Pregnancy Massage 101: Musculoskeletal Adaptations II Extremities and Neck Focus Carole Osborne Author Course developer Instructor National Teacher of the Year Therapist 1

2 Pregnancy Massage 101: Musculoskeletal Adaptations II Extremities and Neck Focus To offer massage therapists a foundation for understanding: Causes of prenatal arm, leg, hip and neck pain The joints, muscles, ligaments, and nerves in these areas that need attention Safety precautions when working on the extremities and neck Webinar Intention Note: This webinar does not certify you to practice prenatal massage. 2

3 Preview Test Questions 1. If the core muscles cannot maintain alignment integrity during pregnancy, what types of arm and neck pain commonly result? 2. Which nerves are easily entrapped during pregnancy? 3. Which type of headache is possibly related to a prenatal medical complication? 4. What type of pressure must you avoid to prevent unwanted energetic reflexes to acupuncture points? 5. What prenatal physiological change contributes to hand and foot pain? 6. Where on the calf is it generally safe and most effective to use deeper work when needed? Weight Gain & Anterior Load Increases spinal curvatures Encourages use of accessory respiratory muscles Inclines toward wider, externally rotated stance Redistributes weight toward toes and collapses lateral arches Modifies function and range of many muscles and joints 3

4 Hormonal Impacts to Musculoskeletal System Relaxin, synergistically with progesterone, softens and relaxes all connective tissue Systemic ligamental laxity Integrity of weight bearing joints compromised, especially in feet, knees, hip joint Headaches during Pregnancy Sinus headaches Tension headaches Trigger point referral pain Migraine-like headaches can be indicative of severe gestational hypertension (eclampsia) 4

5 Gestational Hypertensive Disorders Protein in urine Systemic, pitting edema Rapid weight gain Shortness of breath Severe mid-back to shoulder pain, esp. on right and near kidneys Pain mimicking heartburn Violent headaches accompanied with vomiting, visual disturbances Convulsions Structures Contributing to Neck &Headache Pain Neck Ligaments Posterior Fascial Line Trapezius Sternocleidomastoid Supraspinatus Levator Scapula Spelius Capitis Suboccipital Scalenes Pectoralis Major 5

6 Relief for Head and Neck Pain Mobilizations and other passive movements Resisted and other active stretching Stretching Friction Trigger point work Relief for Head and Neck Pain Deep Tissue and Myofascial Release Sinus relief points & head massage 6

7 Avoid Pointed Pressure on Apex Shoulder 2011 copyright, Pre- and Perinatal MT, Fig.2.8 Prenatal Alignment and Arm &Hand Pain Anterior shift in center of gravity Posterior shift of upper ribcage Anterior rotation pectoral girdle Fluid restriction - carpal tunnel syndrome Brachial plexus compression- thoracic outlet syndrome 7

8 Thoracic Outlet Syndrome Compression to brachial plexus Pain, numbness and/or tingling in hand and along the arm Thoracic Outlet Techniques Deep tissue, NMT, friction to compressors of brachial plexus Mobilizing and stretching neck and pectoral girdle 8

9 Carpal Tunnel Syndrome in Pregnancy General increase in fluid in carpel tunnel Any increase in blood pressure further fills space with additional fluid Repetitive use contributors too Pain in thumb and first 2 fingers Prenatal Carpal Tunnel Techniques Draining excess fluid, proximal then distal Mobilization and friction of wrist and hand ligaments Deep tissue to hand flexors 9

10 Prenatal Hip and Thigh Pain Additional compression to hip joint from weight Tendency toward external rotation Changes in gait Uterine ligament referrals Nerve entrapments Hip Structures Affected by Pregnancy Inguinal ligament and adjoining fascia Hip ligaments and other joint structures Iliopsoas, gluteus medius, lateral rotators 10

11 Referred Uterine Ligament Pain Pelvic Nerve Neuropathies Compression or entrapment Stretch injury Trauma Sciatic Lateral femoral cutaneous nerve Genitofemoral Obturator Saphenous Pudendal 11

12 Pelvic Nerve Neuropathies Lateral femoral cutaneous nerve Inguinal ligament Piriformis Syndrome Sciatic nerve compressed between piriformis and sciatic notch Worsened by relaxinsoftened ligaments All pelvic neuropathies worsened if prior stretch or trauma injuries 12

13 Pelvic Nerve Neuropathies Penny Simkin s Genitofemoral and other nerves Relieving Hip Pain Hip passive movements, stretches, positional release 13

14 Relieving Hip Pain Deep tissue, myofascial, and friction Other Prenatal Leg Pain Uterine pressure Ligamental laxity from relaxin Postural adaptations Edema Joint compression Fascial distortion Soreness and achiness Calf cramps Tarsal tunnel syndrome Restless legs Myofascial trigger points Nutritional Achy feet *Blood clots* 14

15 Lower Extremity Thrombi Very high levels of estrogen and progesterone + hypercoagulation (clotting) + decreased fibrinolysis (clot dissolving) + increased fluid + restricted iliac circulation + relaxed smooth muscle in veins = blood clots Worsens if reduced activity level Lower Extremity Thrombi In pregnancy, often without symptoms. Signs and Symptoms: Edema Heat Redness Achiness or tenderness that worsens when standing or walking Palpable thrombus 15

16 Review for Relieving Edema Discomforts Check for pitting &/or systemic edema; refer if either Superficial, repetitive, proximal to distal and toward regional nodes Semireclining Horizontal leg alignment Review of Leg Precautions 16

17 Highest Risks of Thromboembolism Moderate and severe varicose veins Smoker Recent use of birth control pills Obese Sedentary or on bedrest 4 + pregnancies Age over 30 Placental abnormalities Preeclampsia/eclampsia Intrauterine fetal death Lupus Relieving Leg Tension, Fascial & Joint Restrictions 17

18 Educational Activities Calf cramp relief Round ligament relief Postural Guidance 18

19 Positioning Recommendations Sidelying for access to lateral pectoral and pelvic girdles Semireclining for access to inguinal region and anterior thigh Equipment Considerations Space for shoulder joint and cushioning under hip and belly 19

20 Neutral Position for Hip Joint By aligning hip, knee and foot of ceiling side leg Positioning Legs for Edema Relief Unless symphysis pubis instability, don t stack legs with pillows between 20

21 Calf and Foot Guidelines Avoid bone-to-bone pressure on reflex points with downbearing energetic effect reflex points for uterus and endocrine glands. Precautionary Points Calf and Foot 21

22 Further Information and Training Other Pregnancy Massage 101 series webinars: #1 Fostering a Healthy Pregnancy-recorded #2 Cardiovascular Adaptations -recorded #3 Respiratory and Digestive System-recorded #4 Musculoskeletal System Adaptations I- recorded #6 Practice-Based Decision Making- Feb. 23 (#6 only available if purchase all 6 webinars) Further Information and Training 22

23 Terms of Participation for Pregnancy Massage 101 Webinars I realize that the health and well-being of my clients and their offspring are influenced by my understanding and application of this material; therefore, I am committed to the conscientious study and thorough absorption of the information presented in this webinar. I understand that this webinar offers reliable, yet limited education in prenatal massage therapy. I understand that it does NOT include labor, postpartum, or any clinical or hands-on instruction or evaluation; therefore, this is NOT a certification program. I agree not to represent myself directly or by implication in marketing activities or any communications to clients or others that I am certified, endorsed, or authorized by the Benjamin Institute or by Carole Osborne, Body Therapy Associates, or any other agency to practice or teach prenatal massage therapy on the basis of participation in this webinar. I recognize that, on the basis of this webinar, I am especially not prepared to work with those women whose pregnancies are complicated by medical conditions or a higher risk of complications developing; therefore, I will refer these individuals to others more thoroughly educated and certified in this specialization. The safety and health of the expectant woman and her child (children) are my foremost concern; therefore, I will seek guidance from her prenatal healthcare provider prior to providing services. If I have any doubt as to the prudence of any somatic practices for my pregnant client, I will refrain from such procedures and seek guidance from her prenatal healthcare provider regarding her care. I agree to conduct my practice of prenatal massage therapy in accordance with the ethical and legal guidelines of the organizations to which I belong or by which I am licensed or registered. Certification in Pre- and Perinatal Massage Therapy Four-day CE certification hands-on workshops available throughout the U.S Locations: Utah, California, Illinois, New Jersey, Texas, Washington, Massachusetts, Oregon, Louisiana, Georgia. For schedule and more information: Facebook: Carole Osborne s Prenatal and Deep Tissue Massage Training Important reminder: Neither this webinar nor this series certifies you to practice maternity massage therapy. 23

24 Free Educational Videos Carole s videos at /videos.php Peripartum Pelvic Pain Advantages of Sidelying Tips for Sidelying Positioning Secure SL Draping SL Body Mechanics Massage of the Legs Rhythmic Deep Tissue Oakworks Educational Videos at ional-series.asp References Field T, Hernandez-Reif M, Hart S, et al. Pregnant women benefit from massage therapy. J Psychos Obstet Gynecol 1999;20: Field T, Diego MA, Hernandez-Reif M, et al. Massage therapy effects on depressed pregnant women. J Psychos Obstet Gynecol 2004;25: Howard F. Pelvic Pain: Diagnosis and Management. Baltimore: Lippincott Williams & Wilkins, Moyer C, Rounds J, Hannum J. A meta-analysis of massage therapy research. Psychol Bull 2004;130:3 18. Noble E.Essential Exercises for the Childbearing Year. 4 th edition. Harwich:New Life Images, Osborne-Sheets C. Deep Tissue Sculpting. 2nd Ed. San Diego: Body Therapy Associates, Osborne C. Pre- and Perinatal Massage Therapy, 2 nd Ed. Baltimore: Lippincott, Williams, and Wilkins, 2011 Osborne C. Pre-and perinatal massage therapy: survey of massage therapists, Accessed June, Ostgaard HC, Andersson GBS, Karlsson K. Prevalence of back pain in pregnancy. Spine 1992;17: Quebec Task Force on Spinal disorders. Scientific approach to the assessment and management of activity-related spinal disorders. Spine 1987;12 (Suppl 1):524. Ricci S. Essentials of Maternity, Newborn, and Women s Health Nursing. 2nd Ed. Baltimore: Lippincott Williams & Wilkins, Tanaka T, et al. The effect of massage on localized lumbar muscle fatigue. BMC Complem Altern Med 2002;

25 Pregnancy Massage 101: Musculoskeletal Adaptations I I Extremities and Neck Focus Thank You! Stay Online! Any Questions? 25

26 CONTEST How to enter: Write a review of a Pregnancy Massage 101 webinar on Facebook ( You re eligible for one entry per webinar What you can win: Autographed copy of Pre- and Perinatal Massage Therapy A complete set of the Pregnancy Massage 101 webinar series to give to a friend or colleague 51 Other Webinars Available on Demand Unraveling the Mystery of Low Back Pain Unraveling the Mystery of Cervical Pain Unraveling the Mystery of Shoulder Pain Unraveling the Mystery of Knee Pain Unraveling the Mystery of Ankle Pain Unraveling the Mystery of Hip & Thigh Pain The Ethics of Touch Approaches to Upper Body Disorders Anatomy Trains Massage in Cancer Care Cardiovascular Conditions and Massage Functional Fitness and Massage Therapy All Webinars Available at

27 Title of Webinar Title of Webinar Date of Webinar Question 1 Possible Answer Options Question 2 Possible Answer Options 27

28 JOIN the Benjamin Institute ing List & Receive a FREE Ebook on the Low Back Go to: benbenjamin.com And click Join Our Mailing List 55 28