Osteopathic manipulative medicine in pregnancy: Acute physiological and biomechanical effects.

摘要

Introduction. During pregnancy, a woman's body is challenged by significant physiological and biomechanical changes which can adversely affect normal function, mobility and quality of life. These changes may also contribute to co-morbid conditions accompanying pregnancy. Osteopathic manipulative medicine (OMM) is theorized to facilitate the body's adjustment to the physiological and biomechanical demands of pregnancy and improve the outcomes of pregnancy, labor and delivery. Thus, this dissertation research was designed to examine the possible effects of an acute regimen of OMM on the autonomic and hemodynamic control mechanisms and gait and mobility function in women during the third trimester of pregnancy.;Methods. Two studies were performed with 60 women at the 30th week of pregnancy. Study 1: The hemodynamic and autonomic (heart rate variability) responses to head-up tilt with and without engagement of the muscle pump via toe raising were assessed before and after a regimen of either randomly assigned OMM, sub-therapeutic placebo ultrasound, or a time-control. Study 2: Assessment of a cadre of gait parameters and functions was performed before and after application of the same randomized treatment regimens.;Results. In Study 1, the response to tilt was not affected by OMM or placebo ultrasound, however, the systolic blood pressure response to toe raising was increased after OMM and was accompanied by a lower heart rate and enhanced vagal control of heart rate. In study 2, there were no statistically significant differences between groups at baseline. In addition, there were no statistically significant differences between pre-and post-treatment values for any spatiotemporal gait parameters. However, improvements in stride width and base of support trended toward significance.;Conclusions. These data suggest that OMM improved hemodynamic control during engaging of the skeletal muscle pump that was most likely due to improvement of structural impediments to venous return. The gait data fail to elucidate a significant effect of OMM on gait parameters during the third trimester of pregnancy.