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

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changing life 1997-2001 Ten Drugs 1997-2001 Ten Drugs 8 Primarily Due To 8 Primarily Due To Women Are Not Women Are Not Withdrawn From U.S. Withdrawn From U.S. TAKE AWAY ? TAKE AWAY ? Negative Effects on Women Negative Effects on Women Little Men !! Little Men !! Market Market US GAO 01-286R knowledge changing life 2

4/4/2019 Every Cell Has A Sex Sex Begins In The Womb Sex Affects Behavior/Perception Sex Affects Our Health NIH - 2015 knowledge changing life Exploring The Biological Exploring The Biological Contributions To Human Contributions To Human Health: Does Sex Matter ? Health: Does Sex Matter ? IOM National Academy Press 2001 knowledge changing life 3

4/4/2019 Sex is Endocrine .. & Genetic/Cellular ! knowledge changing life SABV Is Frequently Ignored Incomplete Understanding Of Potential Sex-Based Differences NIH - 2015 knowledge changing life 4

4/4/2019 NIH Expects That SABV Will Be Factored Into Research knowledge changing life NIH - 2015 Showing Differences Representing Both All Human Research Last 3 Months JSMS 2018 (21) 5 knowledge changing life 5

4/4/2019 Mayo Sex/Gender-Based Medical Education Summit 71% No Or Occasional Education “Essential” To Equip Physicians [ Open] Biology Of Sex Differences 2016 knowledge changing life Suppl 1:38 Epidemiology knowledge changing life 6

4/4/2019 Higher Risk Chronic MSK & Spine Disorders knowledge changing life Incidence Consistently Incidence Increases Higher For Women Post Menopause knowledge changing life . US HHS/CDC 7

4/4/2019 Facet Arthritis [Worse PM] Disc Degeneration Degenerative Spondylolisthesis Kyphosis & Scoliosis knowledge changing life 8

4/4/2019 Sex Variables in MSK & Spine An Overview knowledge changing life Sexual Dimorphism  Tissue Modeling  Anatomical Structure  Biomechanics  Pain Perception JBJS 2005, 87-A knowledge changing life 9

4/4/2019 Dimorphism in Tissue JBJS 2005, 87-A  Mesenchymal Cells  Osteoblastic Response  Ligament Laxity  Response to Trauma knowledge changing life Structural Dimorphism PLoS One 2017 12 (2) ESJ 2018 (27) 2 J Orth Res 2011; 29 (3)  Vertebral X Sectional Area J Anat 2012; 221  Cervical/Lumbar Lordosis  Hip Morphology/ROM  Sacroiliac Joint knowledge changing life 10

4/4/2019 SI Joint  Mobility 30-40% > Women  TA Stabilizes SI Motion  Moves Less Under Load  Asymmetric Motion  Densely Innervated Movement, Stability & Lumbopelvic Pain Churchill Livingstone/Elsevier – 2007 knowledge changing life Stability Differences JBJS 2005, 87-A  Muscular Recruitment  Tissue Stiffness/Laxity  Proprioception  Alignment Under Load knowledge changing life 11

4/4/2019 Evidence Mounting That The Burden Of Pain Is Greater For Women Across Most Disorders knowledge changing life 12

4/4/2019 Pain Sensitivity/Summation Different Cortical Processing life Higher Trait Anxiety Chronic & Comorbid Pain J Pain 2009; 10(5), 447-85 & PAIN 2011; 152(9) knowledge changing life Differences In Pain Sensory & Emotional knowledge changing life 13

4/4/2019 PR Back & Pelvic Pain  Prevalence All Adults ~ 9%  PRLBP/PP ~ 70%  30% “Significant”  Subsequent PPBP ~ 90%  Severity & Type Predictive SPINE 2005; 30(8) J Women’s Health 2018; 27(4) knowledge changing life 14

4/4/2019 Profound Change  Pelvic Laxity  Sagittal Balance  Abdominal Wall [66% DR]  PF Stress  Gait Kinematics  Foot Structure AM J PMR2013; 92(3) knowledge changing life Ann Rev Biomed Eng 2009;11 Cost to Posture 60% Increase Lordosis Nature 2007 450 (13) 1075-78 knowledge changing life 15

4/4/2019 Sacral Slope Pelvic Tilt 5:1 Degenerative Spondylolisthesis 5:1 Female to Male Am J Phys Anthropology 2001; 116 (4) knowledge changing life 16

4/4/2019 FORM CLOSURE FORCE CLOSURE PRLB/PP Pain Classification Spine 2002; 27(4) 17

4/4/2019 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) knowledge changing life NM Compensations In Pain  ↑ Abdominal/CW Bracing  ↓ Diaphragmatic Excursion  ↑Pelvic Floor Descent  ↑ Intrabdominal PP  EPC Reverses Changes Spine 2002; 27(1) knowledge changing life 18

4/4/2019 Significant Reduction Pain & Disability 24-28W to 33W GA  BPS Model  Education, CMT & Exercise  AJOG 2013; 208 (4) 295 knowledge changing life EPC “Moderate Evidence”  Decreases SI Laxity  Improves LP Kinematics  Facilitates Axial Stability  Reduces Pain Manual Therapy 2012; 17(4) knowledge changing life 19

4/4/2019 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) knowledge changing life 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) knowledge changing life 20

4/4/2019 “A Lifelong Price For a Baby’s Birth” Ann Rev Biomed Eng 2009;11:163-76 knowledge changing life Postpartum Rehab  Supervised Feedback  Specific Muscles 1st  Global Stability 2nd Am J PMR 2018; 97(12) knowledge changing life Manual Therapy 2006; 11(4) 21

4/4/2019 “Striking”Fall Risk  Rates 40-60% Higher  75% Standing/Walking  81% More Hospitalization  220% Greater Fracture Risk Injury Prevention 2005; 11 (2) knowledge changing life 22

4/4/2019 Inevitable?  Ask s  Educate  Monitor [Activity & MH]  Moms-To-Be:  ASLR/ROM @ 20W GA & PP  Referral For Specialty Care knowledge changing life 23

4/4/2019 The Contingent Smile: The Contingent Smile: A Meta-Analysis of A Meta-Analysis of Sex Differences in Smiling Sex Differences in Smiling Psych Bulletin 2003; 129 (2) knowledge changing life Thank You MCW OB/Gyn gwhitcomb@mcw.edu 24