Patient Case Study - Pelvic Floor Therapy
Many people with pelvic-related conditions feel isolated by their symptoms - leaking urine while running or lifting weights, pain with sex, or difficulty returning to the level of activity prior to becoming pregnant can be a lonely experience. Today’s post is a gentle reminder that you are not alone and we are here to help!
A recent patient generously offered to be a case study to illustrate my approach to treatment. The patient is a 35 year old female who is just under 9 months postpartum with her first baby with complaints of low back, hip, and tailbone pain. When she tried to return to running about 6 months postpartum, she was leaking some urine. She also noticed that when she uses her baby carrier with her now 20# baby, she experiences a significant increase in urinary urgency. During her delivery, she experienced vaginal tearing which caused her pain while sitting for the first few months postpartum. Although this is now healed, she has been worried that her sitting posture throughout the healing process contributed to the pain she has in her low back and hip.
During our first pelvic floor physical therapy session, I asked her so many questions! Spending the time to get a comprehensive history of each patient is imperative to proper treatment. Some of those questions and answers included:
urinary and bowel history: leaking with running, urgency with walking with her baby carrier
daily fluid intake: 30-60 oz of water/day
location of her pain and when exactly this was occurring: low back, tailbone, right hip
if she is experiencing any pain with intercourse or vaginal insertion: yes, as well as mild pain initially with insertion of tampons
what her goals are: returning to running and improving her core strength
One of the most important things I want to know is what you are looking forward to getting back to doing, whether that is running without leaking, lifting your baby without pain, or having pain-free sex with your partner. All of these (and more) are goals that we will work together on achieving.
After gathering her history, I moved on to assess her movement. Here are a few things I found:
one-sided hip weakness, hip tightness and decreased hamstring flexibility
difficulty with pelvic stability, meaning that her muscles surrounding the pelvis, hips, and spine were not all working together to maintain proper coordination during movement
diastasis rectus abdominis (separation of the abdominal muscles) - noticeable with a “crunch” movement
With breathing an inability to contract deep abdominal muscles voluntarily -- This is really common for postpartum moms!
It can feel overwhelming to rehab and so many patients don’t know where to start, but your therapist will guide you. Oftentimes, it comes down to the basics: teaching your body the foundational exercises including breathing and activating those deep transverse abdominals, before moving on to squats and running!
This is exactly the path I took with our case study patient. In order for her to move on to standing exercises and eventually progress to running, it will be optimal for her to demonstrate the ability to properly breathe and manage her deep core muscles first!
That means her homework included fundamental exercises such as breathing with the focus on abdominal and rib movement, some gentle deep abdominal contractions, and finding her pelvic neutral in a sitting position. Next appointment I will review these exercises and progress or modify them as necessary. I can then take a look at other potential contributors with a pelvic floor muscle assessment, which includes her ability to coordinate her pelvic muscles, as well as if there is any tension or tenderness present, especially with her history of tearing vaginally during her delivery. This will help to streamline our treatment plan!
It can be difficult to restart movement and activity after a break, and even more so as a new mom! Hopefully the spotlight on our wonderful patient will resonate with you, and help you realize that no problem is too small or large to start retraining, and that there is help available!
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