A Manual of Osteopathic Manipulations and Treatment
Wilfred L. Riggs, D. O.


    Our race is entitled to a healthier motherhood. In eliminating drugs and substituting a rational method of treatment, Osteopathy has contributed much to this end. In pelvic, even more prominently than in other diseases, is the rationale of osteopathic treatment brought into view.

    Take off the pressure.    Remove the stasis. Replace and strengthen the organs. Nature will restore health and vitality if she have the opportunity.  No matter what condition the disease of the pelvic organs may have assumed, there is too much blood there, for continued over-stimulation of the vaso-constrictors would soon result in a weakness of both nerves and vascular walls and a consequent engorgement. Always too much blood - hyperaemia. This results in a stasis, but still too much blood.  Moving blood is health.  Stasis reduces the nutritive properties of the blood, increases its percentage of waste products, deteriorates the vascular walls and produces transudation and oedema.

    This increase of local fluid is an irritant to the nerve endings and the organs are excited to a condition of pain. This condition now results in a morbid metabolism, either constructive as growths, enlargements, and tumors; or to breaking down of tissue through retrograde metabolism, as in ulcerations.

    In almost all cases of pelvic disturbances leucorrhoea is a preceding condition, an unmistakable sign of hyperaemia, venous stasis, and decreased vitality of vascular walls. This fluid should be returned by nature's conduits, the veins, designed to carry back the products of oxidation in the tissues. If there be pressure on the venous channels anywhere between pelvis and heart then will this exudation be present. But this pressure to the veins is not the only factor which may disturb the vitality of the pelvic organs.  Closely related as they are with the sympathetic nervous system and with the cerebrospinal, both directly and indirectly, the pelvic organs are the servants of the nervous system.  Any change in their positions may irritate an afferent nerve and reflexly interfere with their nutrition and function.

     But this is not all. Any change that may occur along the pathway of these nerves will produce the same effect. The pelvic organs are innervated by the nerves making their exit from the lumbar and from the sacral portions of the spinal canal, and from the hypogastric plexus lying over the body of the fifth lumbar vertebra.

    The nerves to the ovary come from the uterus along the Fallopian tubes while another pathway is from the ovarian plexus, derived from the aortic plexus, thus related to the lower portion of the solar plexus. The hypogastric plexus also receives fibres from the lower dorsal, thus connecting these organs with the lower dorsal and upper lumbar spinal segments.

     The arterial supply to the pelvic viscera is from the aorta via the ovarian and from the internal iliac via the uterine, drainage being effected into corresponding veins.

     In position the uterus extends from the fundus; a little below the brim of the pelvis, slightly to the rigplaht of the middle line, to the upper portion of the vagina, into which the cervix projects, meeting it normally at a rigplaht angle or greater. The condition of the bladder and rectum will affect the position of this organ.

     The Fallopian tubes extend laterally from the superior angles of the uterus, lying below the level of the sacral promontory, enwrapped in the broad ligament. They are from three to five inches  in length, lying over and around the ovaries. The latter bodies are about one and one-half inches long, one inch broad and one-half inch thick, and lie in the broad ligament. They lie just within the true pelvis at the side of the uterus and cannot normally be palpated through the abdominal wall. Their blood supply is derived from the ovarian artery, their nerves from the hypogastric plexus.

    Examination of the pelvic organs can be made in many cases and cures be affected without a vaginal examination. This is often true in cases of young girls. The examination should first be directed to the spine in the following regions: The ninth to eleventh dorsal, the first to third lumbar, the lumbosacral articulation, the sacro-iliac synchondroses and the second and third sacral nerves.

     In addition, the fifth lumbar is almost invariably affected, either primarily disturbing the hypogastric plexus or reflexly from it.

     For a local examination the patient should be on her back, the legs flexed. The body of the patient should be covered. For examination the hand should be carefully cleaned and rendered aseptic, and slightly coated with some non-irritating substance. Should it become necessary to examine a virgin the greatest care must be taken to avoid rupturing the hymen. Often an imperforate hymen may be the cause of trouble.

     The left hand should be used to depress the uterus through the anterior abdominal wall. Carefully notice the position of the uterus. In ordinary cases the index finger should, without force, reach the uterus as it extends into the vagina. Should it be too close to the vaginal entrance there is prolapse.  The direction of the os and cervix will determine whether the uterus is tipped anteriorly, posteriorly or laterally; called ante-version, retro-version and latero-version.

    Should the fundus be bent upon the cervix the corresponding  flexion prevails. An examination with speculum and sound is often necessary.

    Should any of these conditions be present it is an indication of the presence of too much blood of an inferior quality. Pain and irritation have called too much blood to the parts; stasis has caused its quality to deteriorate. Local applications are useless. Pessaries and supports are in no sense correctives. The treatment consists in correcting the disturbances in some of the following locations: The muscles, ligaments and vertebrae in the lower dorsal and lumbar regions should be made normal. An impacted sigmoid and rectum may cause trouble to the uterus itself or to the hypogastric plexus.  Overcome constipation and in many cases the cure is effected. Remove the pressure of the abdominal viscera, prevent lacing, cause patient to stand and sit with spine straight, thorax, forward and abdomen drawn backward. Control of the lower portion of the abdominal parietes so as to exert a constant lifting force on the abdominal contents will prevent many diseases and overcome the incipient stages of all.

    The pudic nerve should be stimulated as it passes over the spine of the ischium. This nerve supplies most of the perineal muscles. By maintaining their tonic condition the vaginal walls are supported, thus keeping the uterus in place. Relaxation of the perineum tends toward prolapsus.

    Good effects are secured by drawing upward the pelvic portion of the abdominal wall. This is done while the patient is lying on her back, the legs flexed; or by drawing the viscera forward, the patient occupying the genu-pectoral position. Ordinary cases of displacements may be cured by the preceding movements. A very efficient treatment for misplacement is to insert two fingers into the vagina, the patient in the genu-pectoral position, the abdominal viscera pushed forward, then spread the fingers so as to admit air to the vagina. The pressure of the atmosphere will usually replace the uterus.  The patient should remain quiet for some time after the treatment. Stimulation of the round ligament is useful should there be retro-flexion or retro-version.

     Coccygodinea should be treated by removing any irritation to the coccygeal nerve and by quieting the coccygeal gland. A dislocated coccyx may give much trouble of this nature.

    Metritis is treated through the lumbar nerves and the hypogastric plexus.  The pudic nerve is always to be treated in cases involving the vaginal walls.

    Ovaritis is often relieved at the lower dorsal or first lumbar through correction of osseous dislocation. Dysmenorrhoea can be relieved and cured by correction of these lumbar and lower dorsal vertebra, and the sacro-iliac synchondrosis, together with the correction of any uterine displacement. Amenorrhoera is relieved by building up the respiratory, circulatory and alimentary systems; by spreading the lumbar vertebrae with a "figure of eight" motion; and in addition by striking your left hand, laid across the patient's sacrum, sharply with your rigplaht closed fist. This is a powerful stimulant.