Manual therapy assists in successful pregnancy

Hands on treatment of the viscera (internal organs), especially of the bladder, uterus, ovaries and fallopian tubes can assist in the success of implantation and pregnancy. 

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The combination of a manual therapy approach and visceral mobilization in a patient with low back pain before a second in-vitro fertilization transfer with prior failed transfer 

Racca, Jason, McKenzie, John. Ft. Worth Physical Therapy, Ft. Worth, TX, United States. 

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Abstract 

Background & Purpose : There is a growing number of women with fertility issues. Wurn et al.1,2 demonstrated that mechanical restrictions are one possibility. The profession of Physical Therapy has much to offer in the way of treating these mechanical dysfunctions contributing to infertility. The purpose of this report is to share a case in which Functional Manual TherapyTM (FMT) and Visceral Mobilization (VM) were part of the comprehensive approach used to treat and prepare a patient with low back pain for her second In-Vitro Fertilization (IVF) transfer, after a failed transfer. 

 

Case Description : This patient was referred to physical therapy for low back pain. She previously had a recent failed IVF transfer and was preparing for a second transfer, but desired to address the back pain first. In the initial evaluation, it was determined that this patient’s lower back pain was due to pelvic girdle and pelvic visceral restrictions related to scar tissue adhesion from endometriosis and a c-section scar 5 years prior. Other off site treatments included dry needling, dietary changes, and initiation of a core stabilization exercise routine. 

 

Outcomes : Initial objective findings included painful lumbar flexion and extension as well as mechanical restrictions at the coccyx and sacrum. Painful lumbar ROM was 45o flexion and 15o extension. The patient’s chief complaint of pain was localized to the lower lumbar and sacroiliac joint region, without radicular symptoms, while sitting and driving. Pelvic visceral restrictions were found in the left broad ligament of the uterus and right ovarian ligament. Initial treatment was FMTTM to the coccyx and sacrum. Subsequent treatments included VM to the uterus and ovaries as well as an organized, system-based treatment approach using FMTTM and VM to a complex history and presentation of pain. The treatment approaches were used in combination to best address the extent of the patient’s pain, extent of scar tissue adhesions, poor pelvic girdle mobility and postural awareness in sitting. After two months of treatments, this patient is pain free with lumbar flexion ROM WNL. The patient now does not experience pain with neither sitting nor driving. She is scheduled for her second IVF transfer. 

 

Discussion : There are multiple factors that can affect fertility in females. In this patient, there was a history of previous c-section scarring, as well as a mild case of endometriosis. It is not inconceivable that scarring from a previous c-section and endometriosis led to mechanical restrictions in this case. Such restrictions within the pelvis and pelvic viscera potentially led to increased pain in the lumbar spine and previous unsuccessful IVF transfer1,2,3. The treatment approaches applied focused on restoring mobility to the pelvic region as well as addressing multiple soft tissue, myofascial, joint and visceral restrictions. 

The patient successfully conceived following this IVF treatment.