4/4/2019 knowledge changing life 1 4/4/2019 Women And Spine Care: - - PDF document

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4/4/2019 knowledge changing life 1 4/4/2019 Women And Spine Care: - - PDF document

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4/4/2019 knowledge changing life 1 4/4/2019 Women And Spine Care: An Emerging Perspective Greg Whitcomb, DC Assistant Professor Department of Neurosurgery Medical College of Wisconsin knowledge changing life 1997-2001 Ten Drugs 1997-2001

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Women And Spine Care: An Emerging Perspective

knowledge changing life

Greg Whitcomb, DC Assistant Professor Department of Neurosurgery Medical College of Wisconsin

knowledge changing life

US GAO 01-286R

1997-2001 Ten Drugs Withdrawn From U.S. Market 1997-2001 Ten Drugs Withdrawn From U.S. Market 8 Primarily Due To

Negative Effects on Women

8 Primarily Due To

Negative Effects on Women

TAKE AWAY ? TAKE AWAY ? Women Are Not Little Men !! Women Are Not Little Men !!

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Every Cell Has A Sex Sex Begins In The Womb Sex Affects Behavior/Perception Sex Affects Our Health

NIH - 2015

knowledge changing life

IOM National Academy Press 2001

Exploring The Biological Contributions To Human Health: Does Sex Matter ? Exploring The Biological Contributions To Human Health: Does Sex Matter ?

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.. & Genetic/Cellular ! Sex is Endocrine

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NIH - 2015

SABV Is Frequently Ignored

Incomplete Understanding Of Potential Sex-Based Differences

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NIH Expects That SABV Will Be Factored Into Research

knowledge changing life

NIH - 2015

JSMS 2018 (21) 5

All Human Research Last 3 Months Representing Both Showing Differences

knowledge changing life

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Mayo Sex/Gender-Based Medical Education Summit 71% No Or Occasional Education “Essential” To Equip Physicians

[Open] Biology Of Sex

Differences 2016 Suppl 1:38

Epidemiology

knowledge changing life

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Higher Risk Chronic MSK & Spine Disorders

knowledge changing life

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Incidence Consistently Higher For Women

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US HHS/CDC

Incidence Increases Post Menopause

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Facet Arthritis [Worse PM] Disc Degeneration Degenerative Spondylolisthesis Kyphosis & Scoliosis

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Sex Variables in MSK & Spine

An Overview

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Sexual Dimorphism

  • Tissue Modeling
  • Anatomical Structure
  • Biomechanics
  • Pain Perception

JBJS 2005, 87-A

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Dimorphism in Tissue

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  • Mesenchymal Cells
  • Osteoblastic Response
  • Ligament Laxity
  • Response to Trauma

JBJS 2005, 87-A

Structural Dimorphism

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  • Vertebral X Sectional Area
  • Cervical/Lumbar Lordosis
  • Hip Morphology/ROM
  • Sacroiliac Joint

PLoS One 2017 12 (2) ESJ 2018 (27) 2 J Orth Res 2011; 29 (3) J Anat 2012; 221

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Movement, Stability & Lumbopelvic Pain Churchill Livingstone/Elsevier – 2007

  • Mobility 30-40% > Women
  • TA Stabilizes SI Motion
  • Moves Less Under Load
  • Asymmetric Motion
  • Densely Innervated

SI Joint

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Stability Differences

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  • Muscular Recruitment
  • Tissue Stiffness/Laxity
  • Proprioception
  • Alignment Under Load

JBJS 2005, 87-A

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Evidence Mounting That The Burden Of Pain Is Greater For Women Across Most Disorders

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Pain Sensitivity/Summation Different Cortical Processing Chronic & Comorbid Pain

J Pain 2009; 10(5), 447-85 & PAIN 2011; 152(9)

Higher Trait Anxiety

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Differences In Pain Sensory & Emotional

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PR Back & Pelvic Pain

J Women’s Health 2018; 27(4)

  • Prevalence All Adults ~ 9%
  • PRLBP/PP ~ 70%
  • 30% “Significant”
  • Subsequent PPBP ~ 90%
  • Severity & Type Predictive

SPINE 2005; 30(8)

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Profound Change

  • Pelvic Laxity
  • Sagittal Balance
  • Abdominal Wall [66% DR]
  • PF Stress
  • Gait Kinematics
  • Foot Structure

Ann Rev Biomed Eng 2009;11 AM J PMR2013; 92(3)

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Cost to Posture

60% Increase Lordosis

Nature 2007 450 (13) 1075-78

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Sacral Slope Pelvic Tilt

5:1

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Degenerative Spondylolisthesis

5:1 Female to Male

Am J Phys Anthropology 2001; 116 (4)

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FORM CLOSURE FORCE CLOSURE

PRLB/PP Pain Classification

Spine 2002; 27(4)

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Active SLR

  • Lift Leg ~ 10-15 Degrees
  • Observe R/L Variation
  • Leg “Feels Heavy”
  • Pain Elicited [SI, PS, Groin]
  • No Sciatic Tension Sx

Spine 2009; 34(9)

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NM Compensations In Pain

  • ↑ Abdominal/CW Bracing
  • ↓ Diaphragmatic Excursion
  • ↑Pelvic Floor Descent
  • ↑ Intrabdominal PP
  • EPC Reverses Changes

Spine 2002; 27(1)

knowledge changing life

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Significant Reduction Pain & Disability

AJOG 2013; 208 (4) 295

  • 24-28W to 33W GA
  • BPS Model
  • Education, CMT & Exercise

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EPC “Moderate Evidence”

  • Decreases SI Laxity
  • Improves LP Kinematics
  • Facilitates Axial Stability
  • Reduces Pain

Manual Therapy 2012; 17(4)

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Exercise In Pregnancy

Most Exercise MSKTL Safe Targeted Better For PRBP/PP Protective For Mom & Baby Reduces Pain & Disability

Spine 2004; 29 (4) Current Sports Med Rep 2009; 8 (3)

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PP Impairments

  • PG/L&D Negative Impact
  • Stability Compromised PP
  • Effects Persisting To 6 Mos!
  • Cesarean Greater Impact
  • PP Rehab Warranted

Med & Sc In Sports & Ex 2018; 50 (8)

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“A Lifelong Price For a Baby’s Birth”

Ann Rev Biomed Eng 2009;11:163-76

knowledge changing life

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Postpartum Rehab

  • Supervised Feedback
  • Specific Muscles 1st
  • Global Stability 2nd

Am J PMR 2018; 97(12) Manual Therapy 2006; 11(4)

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“Striking”Fall Risk

Injury Prevention 2005; 11 (2)

  • Rates 40-60% Higher
  • 75% Standing/Walking
  • 81% More Hospitalization
  • 220% Greater Fracture Risk
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Inevitable?

  • Ask
  • Educate
  • Monitor [Activity & MH]
  • Moms-To-Be:
  • ASLR/ROM @ 20W GA & PP
  • Referral For Specialty Care

s

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Psych Bulletin 2003; 129 (2)

The Contingent Smile: A Meta-Analysis of Sex Differences in Smiling The Contingent Smile: A Meta-Analysis of Sex Differences in Smiling

gwhitcomb@mcw.edu

Thank You MCW OB/Gyn