Non-Invasive Treatment of Pelvic Pain




Mrs. R is a 28 y/o female SAHM with three children ages 4, 18 months and 7 weeks. She reports a history of pubic symphysis pain, pelvic pain and R hip/SI pain which she rated at up to 6/10 at times. Mrs. R had previously been very active with running and triathlons and was able to resume normal activities not long after her first and second children were born. However, her pain persisted following this most recent delivery.  Based on her initial exam, physical therapy using Postural Restoration was indicated. Following treatment, Mrs. R reports that she feels 95% better, has nearly lost all of her pregnancy weight, has no pain, and is back to running and working out at home pain-free. This case details how PRI treatment at Sandhills Sports Performance can be an excellent alternative to help providers successfully manage their patients with pelvic pain.


Mrs. R is a 28y/o female, mother of three. Children ages 4, 18 mo, and 7 weeks old. She reports R hip/SIJ pain, bilateral pubic symphysis pain and pelvic pain following the birth of her son 7 weeks ago.  All three of Mrs. R’s pregnancies were full term with natural vaginal delivery with no complications and with no pelvic floor tearing of episiotomies. In her previous 2 pregnancies she denies much lasting pelvic pain beyond 4 weeks. She notes that she was able to run a half marathon 10 weeks after the birth of her second child. Mrs. R is also actively breast-feeding.

Her functional limitations at the time of evaluation were pain with prolonged sitting, standing, lifting her baby or other children, bending,  walking/running, or attempTing home workouts.


Tenderness to palpation at pubic rami and symphysis

Tenderness to palpation R SI joint

Increased lumbar lordosis

Bilateral rib flares


Mrs. R’s biomechanical assessment was as follows:


Right Left
Hip Adduction( Modified Ober’s) Limited Limited
Hip Extension ( Modified Thomas) Full Limited
Hip IR (seated) 30 30
Hip ER (seated) 50 50
Trunk Rotation (supine) LIM 50% LIM 50%
SLR 70 deg 60 deg
Lumbar Forward Flexion (standing) Fingertips to Floor Fingertips to Floor


Apical Expansion Limited Limited
Posterior Mediastinal Expansion Limited Limited


Mrs. R’s examination findings indicate that she has an anteriorly tipped and externally rotated pelvis bilaterally.   As well as limited apical and posterior mediastinal expansion. This forward pelvis position is indicated by her inability to adduct or internally rotate either hip. In this forward position, the patient should not be able to fully extend their hips,  touch their toes, or have a SLR test  of 90 deg based on the anatomical structure of the lumbo-pelvic-hip complex.   On Mrs. R’s Right side she has full hip extension, greater SLR than L and she is able to touch her fingertips to the floor. This indicates that she has some pathology of the R hip indicating Illiofemoral/pubofemoral ligament laxity as well as muscles of the pelvic floor to be in a positionally descended, hypertonic and in an inefficient position.

We were also interested in Mrs R’s breathing mechanics as limited apical expansion and posterior mediastinal expansion are indicative of a descended and posturally oriented respiratory diaphragm. This position also contributes to long and weak internal obliques and transversus abdominus muscles and an increased lumbar lordosis. Research shows us that the pelvic diaphragm position mirrors the respiratory diaphragm and so in Mrs R’s case both are in a descended and weak position.


12 Postural Restoration sessions were conducted to reposition and properly stabilize her faulty pelvis and diaphragmatic position.

The 12 sessions were conducted over a 12 week period and included the development of a comprehensive, specialized home exercise program which was preformed 1-2x/day.

The objectives of the home program and PT sessions were to:

  1. Reposition her pelvis and correct respiratory mechanics using PRI manual and non-manual techniques
  2. Provide specific neuromuscular stabilization to help maintain the corrected pelvic position during all functional activities
  3. Incorporate proper ways to sit, stand, sleep, carry/lift her children without shifting back into her dominant pelvic /respiratory position.


Following PRI therapy Mrs. R reports significantly reduced hip, pubic symphysis and pelvic pain. As well as dramatic improvement in function

  • Pain decreased to 0-1/10
  • Pt reports 95% functional improvement
  • Functional improvements noted as an ability to stand, run and workout without pain, as well as lifting and carrying young children without pain
  • Pt returned to pre-pregnancy weight

Upon re-examination findings included:

No pain upon palpation of SIJ, Symphysis pubis or R hip/SIJ

Hayley Todd MPT

Contact Hayley at


SHSP adds Woodway Force Treadmill to it’s arsenal

In a continuing effort to offer the highest level physical therapy and sports performance programs in the Pinehurst area we’ve added the Woodway force treadmill to our facility. This treadmill is used by the most professional sports teams and elite military groups worldwide. This treadmill is unique in that it has no motor but rather a breaking system that forces the operator to optimally use ground reaction force to move the belt.

Force TreadmillForce Treadmill Display

Please check out the videos below of a mentor and former football coach of mine, Paul Robbins, demonstrate the use of the force.




One of the most epidemic movement dysfunctions in golf is the inability for the right handed player to rotate around their lead hip. I have had the pleasure of working with hundreds of professional and amateur players over my 20 years focusing on golf specific strengthening and let me assure you this is normal.

You see, over 92% of the world is right hand dominate and an even greater number of left hand dominate players like Henrik Stenson are left handed yet play golf right handed. I have taken hundreds of hours of continuing education and the only organization that I’ve come across that teaches you to treat left and right handed individuals differently is the Postural Restoration Institute (PRI).  Through my work with PRI I have come to realize how handedness, eye dominance and malocclusion all affect how we swing a golf club. I will be writing a series of articles that will break down in layman’s terms what I have learned over the past 20 years of treating golfers. The purpose will be to give our patients and clients an easy to understand explanation of how to improve their golf bodies.
In the clinical setting they will typically demonstrate that their pelvis is tipped forward on the left side

Printed with permission from the Postural Restoration Institute

Printed with permission from the Postural Restoration Institute

The right handed patterned golfer has a tendency to rely on their right side more than their left to do things like lining up a drive, read a putt, picking a ball out of the hole, teeing a ball up, and wait for another player to hit or swing the club. Watch Tiger Woods and you will see the best example of this. The habit of using your right side while neglecting your left makes people asymmetrical.  Sprinkle on top of that the thousands of times right handed golfers turn their shoulders to the right to make a backswing and it is predictable that their body will take on a new form.

This is the start of what is driving them to bear weight more on their right side.  They will have muscles in their abdomen and hips adapt to the new position and then make adjustments in the thorax to compensate. When this happens the right shoulder will usually tip forward and they excessively side bend to the right, and stay side bent throughout their swing.  As you can see in the young golfer below, the spine becomes twisted and the right side of the neck has increased demands placed on it.

Right handed patterned golfer

Right handed patterned golfer

When performing our assessment of the golfer they will demonstrate more pelvis rotation in the backswing to the right and very little pelvic rotation to the left at impact. They will struggle balancing on their left leg compared to the right and show a flat shoulder plane in the backswing because of the over dominate right abdominals. We use K-vest to capture this data to offer the objective numbers that help guide our corrective program. The k-vest data that is typical of this program is seen below.

K-vest pelvis rotation

When assessing the video analysis we use a down the line view that will show the pelvis has moved towards the golf ball at impact compared to where it was at address.  This swing characteristic is called early extension and is often coupled with increased flexion of the lead knee as seen on the right. Flexed left knee

Ideally we would like to see the hips still on the line drawn behind the body and the left knee generally straight. The following exercises are designed to correct the physical limitations that are the possible cause for this swing fault.



The golfer with a forward pelvis is more likely to injure their back and lose distance. The following program will help most golfers who struggle with low back pain and are the short hitters in their group. It is not by any means a comprehensive program and please perform these exercises after obtaining permission from your physician.


  1. Lie on your back with your feet flat on a wall and your knees and hips bent at a 90-degree angle. Place a 4-6 inch ball between your ankles and a band around your knees.
  2. Place a 4-8 pound weight in your right hand and straighten your right arm towards the ceiling.
  3. Inhale through your nose and as you exhale through your mouth, perform a pelvic tilt so that your tailbone is raised slightly off the mat. Keep your back flat on the mat. Do not press your feet flat into the wall instead dig down with your heels.
    PGA tour Pro Darron Stiles

    PGA tour Pro Darron Stiles

  4. Shift your left knee down or your right knee up so that your left knee is slightly below your right knee.
  5. Rotate your right thigh out against the band. You should feel the muscles on your right outside hip (buttock) engage.
  6. Inhale through your nose and as you exhale through your mouth, reach your right hand up towards the ceiling as you rotate your palm so it is facing toward your feet.
  7. Inhale through your nose as you maintain the reach with your right arm. You should feel the muscles underneath your right shoulder blade engage. Exhale through your mouth and reach further.
  8. Repeat this breathing sequence for 4-5 deep breaths, in through your nose and out through your mouth.
  9. Relax and repeat 4 more times.


Restore: It is imperative to restore normal function of the left hip after repositioning it to its neutral position. Your body will likely find this extremely challenging. The purpose of this exercise is to train the inner thigh and outside hip to properly stabilize the pelvis as your hip rotates over a stable leg.


Sidelying left hip strengthening

Sidelying left hip strengthening

  1. Lie on your right side with your right hip and knee bent at a 90-degree angle and your right foot placed on the wall.
  2. Keep your left hip neutral and place your left knee on a bolster so that it is below the level of your left hip.
  3. Place your right arm or a pillow under your head and keep your back and neck relaxed.
  4. Press your right foot into the wall.
  5. Press your left knee down into the bolster feeling your left inner thigh engage.
  6. With your right foot pushing into the wall and your left knee down, slowly raise your left lower leg up towards the ceiling. You should feel the muscle on your left outer hip (buttock) engage.
  7. Slowly lower and raise your left lower leg 10 times while keeping your left outer hip (buttock) muscle engaged.
  8. Relax and repeat 2 more times.


Retrain: Once your body is in the proper position and you are aware how to properly activate the muscles needed to incorporate an efficient golf swing it is time to train it.

  1. Stand facing a table, desk or a counter top.
  2. Place a 2-inch block underneath your left foot.
  3. Place your right foot on the ground ahead of your left.
  4. Round out your back and place forearms on the surface.
  5. Shift your left hip back so that your pant zipper is towards your left big toe. You should feel a stretch in your left outer hip (buttock). The majority of your weight should be on your left leg, through your left mid-foot/heel.
  6. Keeping your left hip back, inhale through your nose as you slightly squat by bending both knees.
  7. Exhale through your mouth as you push through your left mid-foot/heel and straighten both knees. You should feel the muscles on the front of your left thigh and left outer hip (buttock) engage.
  8. Repeat this breathing sequence for a total of 4-5 deep breaths, in through your nose and out through your mouth, slightly squatting with each inhalation and returning to the starting position on exhalation.
  9. Relax and repeat 4 more times.
Printed with permission from the postural restoration Institute

Printed with permission from the postural restoration Institute

The next time you struggle with low back pain or lack of distance understand that you may be fighting a strong pattern that can be corrected with the right approach.  Keep it in the fairway.

Postural Restoration for MMA and boxing

Postural Restoration for MMA and boxing


From the moment I arrived at BWI and was greeted by my driver Ratioender Melo, I knew it was going to be a great trip. I’ve been fortunate in my career to work with some elite athletes but never has one of those elite athletes been the driver for the car service that picked me up at the airport. This is the life of professional MMA fighters.

My trip is being funded by a group called Maxxfit Professional Management run by Ed Porter and Chris Miller. This group manages and supports fighters like Melo who work real jobs during the day and night in order to do what they really love which is train to fight.  In their quest to become champions.

Adductor pullback

Adductor pullback

Standing right glute max

sidelying right glute max

Sidelying right glute max

First up was Myron Baker. I had worked with Myron back in July and at the time he presented as a patho-PEC (visit for more info) pattern. This pattern was determined based on the objective testing that is consistent with the postural restoration methodology. Myron was concerned with not only his ability to balance his physical insufficiencies but his ability to rest. When you fight your sympathetic nervous system is alive and well but when you stop your body should be able to come back to a parasympathetic state for proper rest and recovery. Myron didn’t have that.
I was pleased that the exercises that I gave him in July turned Myron from a patho-PEC pattern to a left AIC pattern. The exercises consisted of abdominal strengthening aimed at opposing the diaphragm muscle to facilitate proper timing and sequence of respiration. Our job was to now get him to restore a left hemi-pelvis which will give him better striking power with his right hand. These exercises are an example of how we accomplish that.

Elija Gbollie was next on the list. Elija is an obviously strong and powerful dude that spent his early years lifting weights for football. As I see with most Olympic weight lifters, he has maximized his end range of his hips and back for strength and power. This is not a good strategy for injury prevention and performance.


As you will notice in the photo, Elija stands with his right foot turned out. Interesting later in the day I was fortunate to be able to watch Elija train at his gym Conquest BJJ, and he shows the same tendencies. His right hip is maximally externally rotated limiting the strength and power that he can produce out of his legs. For as much as he had going on in his hips our main focus for Elija was to reposition his ribcage to make him a better diaphragmatic breather and use less accessory muscles of the neck and back for respiration. His home program consists of the following exercises and help him become part of the exhalation nation.


All 4 belly reach

All four belly reach

stdg resisted alternating reach

Resisted wall reach

stdg afir and balloon

Balloon squat with internal rotation



Our final stop of the night was at Club One.  This is where amateur boxer and golden gloves champion Amelia Moore trains.  Amelia’s goal is to compete in the 2016 Olympics in Rio and given her attitude I expect to see her there.  In talking with Amelia it’s hard to ignore that her passion for boxing is hard to suppress….ever!  With a big fight coming up this weekend she reveals a plethora of physical issues that she is currently dealing with but the one that stands out the most is her inability to exhale.  I will not reveal the details of our conversation other than she wants to knock more people out and to help her accomplish this she will need to breathe better in her upper left back. This patterned asymmetry is expected in patterned right handed fighters.  We talked at length about the form and function of the ribcage and how it relates to aerobic vs anaerobic metabolism.  The video below is a technique that she will use to open up her left back and help her knock more fighters out.


Thank you for creating

Florida Institute of Performance July Visit

I would like to thank David Donnatucci and his staff at Florida Institute of Performance for their kind hospitality and willingness to learn more about the science of Postural Restoration and how it is applied to golfers.

Michelle demonstrates a very challenging exercise that requires her left hamstring to remain active while she activates her right posterior glute medius.

Michelle demonstrates a very challenging exercise that requires her left hamstring to remain active while she activates her right posterior glute medius.

On July 29th I flew to West Palm Beach Florida to consult with Donnatucci.  It did not take long before I knew that I had colleague as passionate about golf biomechanics, neurology and respiration as I am.  David

works with two rising stars in the golf fitness arena Barrett Stover and Isabelle Lyndl.  Together they are responsible for the physical health and fitness for several top LPGA and PGA tour players and accomplished amateur players as well.

David has a business that is located at PGA national and caters to those individuals who want to use exercise to increase their longevity in the game and to help them play better golf.  David reached out to Jennifer Poulin and me to help him process and apply the science of Postural Restoration and how it relates to helping his players.

My first day was spent mostly evaluating players with David, Barrett and Isabelle keenly observing and taking notes.  This proved to be invaluable because I was able to communicate with them how to perform the PRI tests correctly and how to avoid some of the common pitfalls with the tests. All of the players that we evaluated were patterned right handed golfers who we simply needed to test the integrity of their hip and lumbar ligaments and then prescribe the correct ligamentous muscle to help support the overstretched non-contractile tissue.

A great post impact drill

A great post impact drill

As predicted, every golfer fell into one of two categories, a patho-PEC or patho-Left AIC.  Patho-PEC players are those individuals that due to occupational demands have jeopardized soft tissue in order to perform their job with a pelvis that was not in the proper position to do so.  This process of over stretching ligaments usually takes place early

in their development and can be traced as far back as their teen or pre-teen years.  Luckily postural restoration provides a solution to help these players by prescribing exercises to inhibit muscle tone that is driving them into this pattern and then facilitating muscle to support the joints that have overstretched ligaments.

DSC_0288Day 2 continued to be a day of assessing new players and following up with the players who were already evaluated.  This was an off-week for the LPGA tour so we were able to get some consistent work done with most of the ladies.  Day 2 was rewarding in that we were able to review many of the Postural Respiration manual techniques to establish better rib position and mechanics.  For those athletes that needed a left zone of apposition the results were immediate and we were able to undo years of bad patterning that may or may not have been causing pain.

My last day at the Florida Institute of Performance was spent integrating some of the concepts of what we doing as part of their PRI repositioning program and integrating it in the strength and conditioning programs of the players.

This is an effective to strengthen the lead hip in the golf swing in the proper hip position at impact.

This is an effective to strengthen the lead hip in the golf swing in the proper hip position at impact.

Both professional and amateur players were able to appreciate a new, better more efficient position of their body.  I hope with consistency these players continue to develop into the best most injury resistant athletes that they can be.

A special thanks to the athletes for being open to trying new things.  Being around professionals like this makes me demand more out of myself so thank you and thank you David for the opportunity to help your team.


Getting Cindy into her hip

Getting Cindy into her hip




Right trunk rotation with TRX

This exercise will benefit golfers looking to maintain abdominal stabilization in their backswing. It is best applied after repositioning the pelvis using PRI techniques.

TRX Back swing

Coaching keys are to maintain a slightly backward rotated pelvis, inhale with good opposition through the left abdominal wall, exhale and move your arms to the right. Inhale again as your arms move further to the right while feeling your left front ribs stay down. Continue this sequence for 5 breaths.

Working with Duffy Golf Fitness in Great Britain

Chris Poulin’s recent trip to St. Andrews, Scottland was more for work than pleasure, although he would probably claim both.

Chris has been consulting with Duffy Golf Fitness and helping them integrate the concepts of Postural Restoration in the training and reconditioning of their athletes.  Staying competitive in professional golf means to be sure that your body is working correctly for you.  Postural restoration is being utilized to do just that for these talented group of players.

Stephen Gallacher, Tommy Fleetwood, Danny Willet, Lee Slattery, Brett Rumford, Alejandro Canizares, Matt Baldwin, Paul Waring and Dave Horsey

Most Golfers Need This Exercise

Most of my golfers need this exercise regardless of their ability level.  The “Unresisted Wall Reach” is an exercise example to help golfers who struggle with maintaining their spine angle in their backswing.

Spine angle is the angle between the thighs and the back (generally about 110-130°).  It is a key factor in enabling you to turn efficiently, and to swing powerfully and consistently, while protecting your back and avoiding back pain and injury.

Remember, as with all postural behavior exercises, it is important that this exercise is performed under the direction of a trained clinician.

Working with MLB Pitcher Burke Badenhop

Working with MLB Pitcher Burke Badenhop

Pitcher Burke Badenhop sought out  Sandhills Sports Performance to properly train in the off-season.  Years of wear and tear pitching in the major leagues had created movement pathologies that he wanted to address.

Chris and Jen Poulin worked through the 2013 off-season with Badenhop to correct his physical asymmetries, which ultimately corrected his posture and helped him feel better.

“Properly feeling certain muscles is an important step in executing good pitching mechanics. For a right handed pitcher this means feeling the arch of the right foot contacting the rubber and being able to push off with the right sequence can mean a big difference to any pitcher,” says Poulin.

“I felt that I needed a different approach to my off season training, one that emphasized restoring a better body position to allow me to throw the baseball

more efficiently,” Badenhop says.  “Chris and Jen are a great Athletic Trainer/Physical Therapist team and I would recommend any professional or amateur athlete looking for improved performance and longevity in their sport to check them out.”