Obs and Gynae 3
Diaphragm lift technique 1
1. Patient hands on hips > widens costal margin
2. Split stance of operator. Patient leans back on to operator.
3. Have thumbs forward, gather and get purchase under the
diaphragm.
4. Lean forward and have feet side by side. Widen your grip.
5. Get patient to breathe in and follow the diaphragm with expansion
6. Breathe out and patient extends up and you have palms onto
lateral ribs as breathing out.
7. Contraindication: old ladies with osteoporosis – too much rib
pressure > #.
Diaphragm lift technique 2
1. GORD/reflux: ↑ progesterone in pregnancy > mm spasm of
diaphragm > lowering > LOS rubbed and irritated by the baby
being compressed. With this technique the baby and uterus and
stomach goes south. Keep hands under the xiphoid on the “cancer
ribbon” to pull the LOS open.
2. This adaptation is for more GIT symptoms awareness technique.
3. Same position and process have hands under rib costal margin
4. Gather rock and stay under xiphyoid. Lean back onto back out,
elbows go out and then rock forward.
5. Fingers under xiphyoid and now move inferiorly.
6. Do not dig your fingers in (ulna border gathers the flesh). Keep
fingers loose and then direct inferiorly to open the LOS.
Visceral technique
 Barral technique is for organs in a non-pregnant patient.
 Finet and Williams – movement of organ in non-pregnant patient.
 Uterus rises in pregnancy > we simply don’t know where the
specific points end up (DJ, pylorus sphincter, colonic flexures, etc).
 As well the pregnant patient may be tall and thin and no fat in
mesentery or fat and squat with lots of visceral fat > different
changes in different patients.
 Barral - hands go where the bodies tell you where the organ is. Not
good enough for Sandler….”get over it Steve!”
 Motility technique is not useful for the pregnant patient. Motility,
according to Barral, is the inherent movement/energy in an organ
related to the embryological migration of organs.
 Mobility technique is the relation of organs to MSk and somatic
structures via attachments.
 Motricity is the movement of organs in relation to active
movements.
 As the baby grows > uterus expands and these fascial
attachments stretch and relaxed, therefore need relaxin to allow
this.
 Adhesion between the sliding surfaces are common. Fluid comes
from the lymph fluid and from the serous membranes. This can be
encouraged through valsalva and pelvic floor contraction > fluid
can be actively pushed via this type of treatment. This is not
motility TTT. Kidney motility is inspir and expir, but mobility is
inferior and superior. For a pregnant lady with diaphragmatic
changes and the kidney being retroperitoneal > changes in the
way you can treat the kidney. This will not work with motility if the
mobility is the thing you want to treat. Barrel here is too limited.
 Caecum > squeezing wet mud continuously against gravity. Very
active and the hardest working part of your gut. Caecum is
constipated part of gut and descending colonic flexure is diarrhoea
part of gut in terms of biomechanics and gravity.
 4 ligaments here laterally on each side – hepatic flexure and
splenic flexure. Medially the mesocolon anteriorly and the toldt’s
fascia posteriorly.
 Hepatic flexure at 10th rib – 4 peritoneal thickenings here
(diaphragm/1oth rib/gall bladder duodenum/stomach. Restriction
here > stasis in caecum being pushed against pelvic wall >
posterior and lateral > squeezing fluid out > dry area which
becomes sticky and adherent. An adhesion is viscous to viscous
dryness. Constipation is common here > squeezing rectum >
varices in rectum > possible vaginal varices.
 Osteopathic manipulations > adhesions release in pregnancy.
Pure mobility as it is related to pregnancy.
 Uterus rises > moves to right guided by sigmoid > siting on the
sigmoid > MSk elements and structure can become rigid and solid.
 More movement in the organ > more potential for health. Can
affect through MSk elements > release attachments.
 Transverse mesocolon rises. Diaphragm becomes dome shaped
lifting the mesocolon with it. Affect the diaphragm as pregnancy
affects upper rib breathing.
 Liver goes onto right abdominal wall and restricted in pregnancy
high up and lateral > mobility restricted.
 Stomach compressed and moves to the left abdominal wall.
 Heart moves 15° Left.
 Pituitary gland enlarges by 40%
 Relaxin appears in cycle in premenstrual stage to relax the cervix
for 6 hours other than in pregnancy.
GORD
 Baby and fat in mesentery > GORD due to oestrogen & relaxin.
 Cardiac sphincter loosens.
 Small stomach size due to inferior compression up with the
same size meals. Best to eat lest and more often, or go for a
walk after a meal.
 Poor posture > slumping after meals.
 Vomitting: 8% get hyperemesis gravidarium
 Morning sickness: no one knows why. Blood sugar is lowest in
the morning. This triggers “I need food” > nausea. Energy used
to get her around in the morning. No more energy > if excess
nausea > vomit. He says take a flat coke at night when she gets
up for a pee helps with morning sickness – need high sugar
content.
 Heliobacter pylori > destroys the stomach lining > ulceration &
bleeding > ↑ risk of cancer. LOS does not have a mucous lining
> cell changes.
 GORD in babies: ventuse or occipital birthing trauma > high
palate > poor seal over nipple > not feeding properly > half
water and half milk > GORD > screaming due to immature
diaphragm.
 Not caused by a hairy baby, pressure on a nerve, diet, toxaemia
of pregnancy.
 Principles; dietary advice, C2 on left, Diaphragm, Rib flaring
(diaphragm etc), Reflux direct relations (eg diaphragmatic
technques), Viscero-somatic relations into TSp (dog/ST
techs/artic).
1. Diet – raw foods with skins on should be avoided. Meat/fish
should be casseroled or poached (not roasted or fried).
Avoid gassy drinks & acids in food/drinks. Small meals and
more often (main meal is midday – afternoon the food will
drain when you are vertical. In evening the food will take
longer to pass when she is sitting down – have soup and ice
cream - family relations and getting fats and nutrients).
2. C2-T2 pattern: viscera-somatic reflex on Left C2 from
reflux/oesphagitis/indigestion (upper GIT reflex) – iliocostalis
cervicis T2 > C2. Cervical plexus C1/C2 has twig to vagus
nerve which is secretomotor to stomach (SYMPS?). Reason
is LOS irritation > T2 muscles hypertonicity. Muscle relation
to C2 via iliocostalis. C2 has relation to vagus via
communicating nerve > irritation of stomach acid >
Sympathetic stimulation of T2?
TTT of C1/C2: mid lever midrange HVT
 Flex head with belly. Side shift to analyse CSp.
 First MTP is applicator with hand going round ear. Keep
flexion and chin on chest. Go round and sit on corner of table
introduce ROT. Keep tension in side shift. Thumb toward
mouth. ROT thrust in line of mouth.
 Be careful with SB thrusts in upper cervicals as the
brainstem access is here and a shockwave could occur into
the brainstem here.
Constipation in pregnancy
 Reasons: relaxation of smooth muscle; long transit time;
calcitol increase calcium absorption from gut > increased
iron deposits > constipation; caecum ptosis.
 Prototcol: diaphragm/ribs & hepatic (10th rib L) and splenic
flexures (9th rib R). Visceral thrust techniques, caecum
functional technique.
 Visceral adhesiosn: TTT is to separate the two parts of the
adhesion > fluid flow between the two. This is not the same
as a surgical adhesion. This is a visceral adhesion.
TTT of caecum:
 ASIS & umbilicus draw line: 3 fingers of patient to iliocecal
valve from ASIS. Descend down to the ileum posterior to
caecum on medial border with fingers of both hands.
 Take little finger along lateral border of caecum. Feel where
the resistance = caecum. Put a shockwave through the
caecum along the lateral wall / border of the pelvis using
reinforced fingers. Repeat the technique to feel a release.
Vibrational technique.