CASE STUDY: Building a Foundation for Healing
Client History: Rachel (not client’s real name) requested an in-home evaluation 1-week postpartum. We spoke prenatally through a video discovery call. Her biggest concern was returning to her pre-pregnancy exercise routine. She described her pre-pregnancy workout routine as running and weightlifting 5x/week and a necessity for her mental well-being. Rachel works in a fast-paced high-power job and gives talks to tens of thousands of people at conferences in her field. Rachel is in her early 40s, has gone through IVF x2-3 rounds. Maddie (not baby’s real name) is Rachel’s first child. Rachel shared that her pregnancy was fairly easy, but the labor/delivery experience was long and challenging. She had a vaginal delivery with multiple interventions including Pitocin and an epidural. She pushed for over 5 hours and eventually gave birth on her right side with her left leg being held by a nurse or her partner. She had a grade 2 perineal and labial tear. While not discussed at initial evaluation, perinatal anxiety and depression symptoms were shared later on.
Assessment and Findings: As an in-home evaluation I noticed immediately that there were 3 flights of stairs with no hand rails. There were single step-ups to enter the living room and again the kitchen. Rachel reported back pain going up and down the stairs and reported intense back and pelvic pain throughout her day. She had significant trouble lying in supine. She also had difficulty initiating a urine stream.
While she wanted a series of exercise ‘to do’ lists, during the interview and initial postural/hands on assessment, I could sense that her body was still processing the birth experience. I kept reassuring her of the timeline for healing. When assessing posture and listening in standing, her L PSIS was lateral and elevated. Her R IT was splayed. Other observations included shoulders rounded, neck forward, pelvis tucking under, glute gripping.
As much as she wanted to push for recovery, her body was not ready for exercise. Her body needed balance.
Treatment: After performing the close the bones sequence and balancing the pelvis (sacral corrections part 1&2, sacral sheer, ichium/ilium corrections), Rachel reported decreased back pain. I observed improved postural changes from pre to post. Lying on her back was still uncomfortable and required props and cues for core engagement during transitions. She had difficulty breathing into her rib-cage, rotating between shallow breathing to abdominal breathing.
Rectus abdominis release, gentle endopelvic release, and oblique release resulted in improvements in access to breath.
In the next follow up visit, Rachel reported increased bleeding with the gentle release work to the abdomen. Hands-on work included ileum compression, sacral corrections, and closing the bones muscle energy techniques. I provided her “exercises” through breathing, pelvic tilts, and postural check-ins. I encouraged her to check in with her provider about the bleeding. Her pain subsided unless she was flat on her back.
I saw her again about 9 weeks postpartum. This is when she opened up about the increasing anxiety and depression. She reported trying to run and felt awful afterwards. We discussed participation in lower impact exercise, and refitted her Peloton bike to temporarily position her more upright to decrease stress through the abdominal wall and pelvis.
With external release to the pelvic bones, she felt better connected to the movement of her pelvic floor and her core. By the end of the session, we were able to work on glute eccentric lengthening and deep core activation.
Client Outcome: Together we brainstormed what brings her pleasure, and found ways to integrate pleasure into her day/week – including movement – and continuing to address rebalancing of the pelvis, while reconnecting her to her physical and emotional body.
Conclusion: Sometimes our roles are to give permission to slow down, counter to what the client expects. Rachel’s perception of her healing timeline paired with her anxiety was making everyday tasks challenging, and when she was exercising she was not enjoying it. Supporting tissues and bones around the pelvis, and addressing the emotional body through the nervous system and identifying simple pleasures in her day were foundational steps to healing.
About the Author: Dana Solomon is a pelvic health OT, owner of Triangle Pelvic Health & Wellness, and creator of the Pelvic Health Clubhouse. What lights her up is helping empower people feel safe in their bodies to do the things they love. She has spread this passion by creating a digital platform for pelvic health professionals, to support their communities with accessible professional pelvic health materials.
For more information about the Institute for Birth Healing visit our website at: https://instituteforbirthhealing.com