Hi Melanie
Sorry to seek your assistance so soon again. If you can find the time to give me some help on this client would again be very grateful.
One of my clients has has osteitis pubis. She has now had this for 2 years, bought on in her second pregnancy. She played hockey upto 14/15 weeks of this pregnancy. She had no pain at that time, but did in the later stages of her pregnancy. Unfortunately, she didn’t say anything about the pain to her midwife and no pelvic support was used. After the birth, she pushed herself quite early, and has suffered since. She saw a PT for quite a long time, but found that she was worse after these sessions so has stopped. I have seen her 4 times. I am only doing half hour sessions with her as she tires quickly. I have been working with her to not overdo her lift and contraction of pelvic floor and TA. Initially, at times, 20% would cause pull in the area, so we dropped it back to 10%. Now that shearing/pull doesn’t hit until 30-40%, so we are working at about the 20%. I have been doing supine, sitting, sidelying and today some standing work with her.
Supine – very small lateral leg openings with flex band behind leg, also medial leg mvmts, foot on toning ball, scap isolations, light adductor with mini ball, focus on left/right side pc
Side lying – small ext hip rotation, scap isolations
Sitting – I have some gliding discs – on raised mat, small sgl leg presses, then dbl leg presses and today small alt/reciprocal mvts, arm raises and today small swimming arm mvts (at chest height)
Standing – Cadillac push through bar – sgl lat pull and dbl then with roll down bar(small mvmt just until she felt core connection
She saw a specialist at the hospital this week who has suggested surgery. She is not keen to undertake this option and was disappointed they offered her nothing else. Am I heading in the right direction with Rachel? What else should I do.
My other client with TMJ is currently off on school hols so I will let you know how we get on in a few weeks.
Thank you so much
Sonia, Progressive Pilates, New Zealand
Response from Melanie Byford-Young:
Hi sonia!
Great question. Osteiitis pubis can be very debilitating and hard to figure out. You are doing good exercises already.
Essentially you have to imagine that the pubic symphysis can get pulled apart very easily, even just via the contraction of the hip adductors. Your goal is to try to work the myofascial slings to hold her together- the anterior and posterior slings. You need to get the external control adn the internal control of the local stabilizers.
There are several other things you can try
1) breathing- see if she can tolerate breathing like she is sucking in through a straw, and gently lifts the pelvic floor as she does (i.e. uses the breathe to lift the pelvic floor) instead of focusing on contracting the pelvic floor (PF) muscles specifically. It can be a more gentle way and uses the diaphragm with the PF. If she can, use this technique then have her hold the PF up while she exhales. If this works, repeat hourly through the day.
2) swimming prep on hands and knees to get the posterior oblique sling supporting the pelvis and spine
3) footwork on teh reformer- probably 2 springs starting with the stopper out at position 6. Progress range first then weight and rhythm. Running can be very effective at beginning to tolerate weight shifting. Then, progress to shifting weight from on leg to the other.
4) sleeper on the reformer/ V2Max with the spring from above (flexband supporting the leg)
5) standing arm work on the rotational discs, bosu or just on the floor. Light to moderate weight, bilateral first then unilateral. Eventually you want to do it standing on one leg.
6) sitting on a stability ball and doing imprint and release, arm circles, spine twist etc. Vary her leg positions as able.
That should keep you busy.
Let us know how it goes!
Melanie
