I’ll never forget this case study about a client experiencing low back pain after two cesarean births because, although the pattern I discuss isn’t as common as others, it will give you a good idea behind my reasoning of how I work with the body. Knowing the pelvic mechanics of birth makes so much sense and will help you get to the root cause of pain!

Client History

A 37-year-old client caring for her two young children, a 2.5-year-old and an 8-month-old, came into my clinic complaining of low back pain. She had been experiencing pain for the past 2 – 3 months and was having difficulty caring for her children. The worst of her pain occurred when she was going from sitting on the ground to standing. She also was experiencing challenges in going from sit to stand in other situations and reported that she, occasionally, could not get off of the couch by herself. She was unable to pick up her kids from the floor and get them into the car in their car seats. She was having stiffness at work with the occasional feeling that her back was giving out. She reported that her pain was 5/10.

Her birth history consisted of two cesarean births. The first birth 2.5 years ago was a 36-hour labor where she got to 6 cm of dilation and then had to have an emergency cesarean.  She didn’t have any complaints or problems afterward.  Her second birth was a planned cesarean.

With this type of birth history, I usually go straight to releasing the c-section scar tissue as that can be a big factor in creating low back pain. In this case; however, it felt like there was more going on in her body, and I got a hunch that her first labor may be contributing to her back issue.  So, I tested it out being the curious person I am!

Evaluation and Assessment

I evaluated her pelvic bones and found her right ischium was splayed and her right side sacral base was elevated with decreased mobility. Her coccyx was off midline to the right. The sacral base was less mobile anteriorly to PA mobilizations than the lower sacrum. Internally, her pelvic floor muscles were a 2/5 on the right and 2+/5 on the left. She had increased muscle tone on the right side of the levator ani and coccygeus muscles.  

She was presenting with the common birth pattern I see in a lot of my postpartum clients; however, having decreased anterior mobility in her sacral base at S1-2 indicated that she was also stuck in sacral extension and not the typical sacral flexion pattern that occurs with vaginal births. This discovery made complete sense because when you think about the baby’s head coming into the pelvic inlet, but not coming through the pelvic outlet, it could cause her sacrum to get stuck in extension not flexion. She also presented with a right lateral side bending or sheering of the sacrum, which I commonly see in postpartum clients. 

Treatment

During treatment, I corrected the immobility of the pelvic bones.  I encouraged more flexion at the sacral base, brought the sacrum more into the midline, and then rebalanced the ischiums and ilial bones into the midline as well.  After only correcting her pelvic bones I had her get off my table and get down on the floor.  She was amazing when she could stand up without any back pain! This was an indication that the cause of her pain was from her sacral extension in her pelvis and not due to scar tissue from her cesarean birth.

I continued treatment to address any restrictions in her scar tissue as well and did the intravaginal protocol I teach in the Holistic Treatment of the Postpartum Body course.  

Treatment Results

I only saw her one time, but I had her fill out two surveys before and one month after treatment. Her Pelvic Girdle Questionnaire went from 45% to 6.6%. The Oswestry Disability Index went from 26% pre-treatment to 0% one month later. 

After treatment, her core was activating measurably better. Her pelvic floor muscles went from 2 and 2+ to 3+ and 4 after just one session. She had good core automaticity again. She left with instructions on how to continue to work on her core automaticity at home.

Working With The Postpartum Pelvis

All the pelvic mobilizations I utilized in this case study are taught in the Treating the Postpartum Pelvis course. In this course, I teach you the 4 most common patterns that occur in the postpartum pelvis. You will learn the complaints for each pattern, the signs and symptoms, and how to assess and treat these patterns, including 9 treatment techniques. Plus, this online course is less than 3.5 hours of coursework. This is our quickest course for efficient and effective pelvis treatment.

This education can be done used for any person with a pelvis to help address low back pain and pelvic pain. These techniques should be applied to anyone before doing intravaginal work as we need to ensure the pelvic bones are functioning well before addressing the pelvic floor muscles internally.

Conclusion

Through this case study, we can see how understanding the pelvic mechanics of birth is critical information for getting to the root cause of our clients’ pain and dysfunction. Understanding that during this client’s first birth her pelvic inlet opened, but the outlet never did was essential information for knowing what to look for to address her pain. Her sacrum was stuck in extension, which was confirmed with the pelvic mobilizations, and by knowing what to look for, this client was able to get out of pain quickly, so she could focus on the important job of caring for her children.

About the Author: Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com