CASE REPORT: 28 y/o FEMALE WITH POST-PARTUM PELVIS 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:
|Hip Adduction( Modified Ober’s)
|Hip Extension ( Modified Thomas)
|Hip IR (seated)
|Hip ER (seated)
|Trunk Rotation (supine)
|Lumbar Forward Flexion (standing)
||Fingertips to Floor
||Fingertips to Floor
|Posterior Mediastinal Expansion
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:
- Reposition her pelvis and correct respiratory mechanics using PRI manual and non-manual techniques
- Provide specific neuromuscular stabilization to help maintain the corrected pelvic position during all functional activities
- 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 firstname.lastname@example.org