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OMT in Special Situations
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OMT in Special Situations

Pregnancy, hospitalized, post-op, pediatric — indications and contraindications.

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◆Pregnancy

  • •Indications: low back pain, sciatica, edema, constipation, nausea (with caution), preparation for labor
  • •Common dysfunctions: pubic shears, sacral torsions, lumbar hyperlordosis, upper crossed syndrome
  • •Safe techniques: counterstrain, BLT, MFR, ME (gentle), articulatory, lymphatic
  • •AVOID: HVLA in pelvis in 3rd trimester (risk of premature labor), prone positioning after 20 weeks (use left lateral)
  • •Pedal pump can help edema (contraindicated if DVT)

◆Hospitalized patients (inpatient OMT)

  • •Pneumonia: rib raising T2–T7 + thoracic lymphatic pump + paraspinal release → improves lymphatic clearance and reduces hospital stay in some studies
  • •Postoperative ileus: rib raising at T5–T12 + sacral rocking + mesenteric release
  • •CHF: lymphatic techniques (cautiously — start small, monitor BP)
  • •ICU/intubated: gentle MFR, indirect techniques, lymphatic pump if appropriate
  • •Goal: improve homeostatic function, not necessarily 'fix' all dysfunctions

◆Post-operative

  • •Counterstrain, BLT, indirect MFR — gentle, well-tolerated
  • •Avoid direct techniques at the surgical site for 6 weeks
  • •Lymphatic pump for post-op ileus (avoid if recent abdominal surgery to incision site)
  • •Address ileus + atelectasis + pain with appropriate OMT

◆Pediatrics

  • •Indications: torticollis, plagiocephaly, otitis media (with antibiotics if bacterial), colic, GERD, constipation, asthma
  • •Cranial techniques very useful in infants (sutures not yet fused)
  • •Use gentle indirect techniques — BLT, MFR, cranial
  • •Newborns with birth trauma → cranial OMT can address strain patterns

◆Elderly

  • •Avoid HVLA if osteoporosis (DEXA T-score <-2.5), vertebral compression fractures, atherosclerotic vessels (vertebrobasilar)
  • •Counterstrain, BLT, MFR, ME (gentle) are preferred
  • •Address polypharmacy effects on tissue (e.g., bisphosphonate osteonecrosis)

◆Sports medicine

  • •Acute injuries: counterstrain, BLT, MFR (indirect)
  • •Subacute/chronic: ME, HVLA (if appropriate)
  • •Return-to-play decisions should incorporate OMT findings
  • •Common areas: shoulder, lumbar, sacrum, ribs, ankle

OMT contraindications by technique

TechniqueAbsolute contraindications
HVLAFracture, dislocation, instability, malignancy at site, infection at site, severe osteoporosis, Down syndrome (AA instability), RA (transverse ligament), vertebrobasilar insufficiency, anticoagulation (relative)
Lymphatic pump (pedal, thoracic)DVT, abscess (could spread), bone fracture, recent abdominal surgery (for thoracic pump)
CranialAcute intracranial bleed, ↑ICP, recent skull fracture, severe coagulopathy
Soft tissueAcute fracture or severe inflammation at site
ME, counterstrain, BLT, MFRFew absolute; tailor to patient — generally very safe

High-yield pearls

  • ◆Pregnant patient: AVOID prone after 20 weeks (uterocaval compression); use LEFT LATERAL position
  • ◆Pneumonia + OMT (rib raising + lymphatic pump) has evidence for reduced length of stay (MOPSE study)
  • ◆Newborn cranial: sutures unfused, very gentle technique, excellent results for plagiocephaly, otitis
  • ◆Always document dysfunctions found, technique used, and patient response
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