The Hidden Layers to Unlocking Pain in the Body: A Postpartum Pelvic Health Case Study

What if your client’s symptoms weren’t what they seemed? In this episode, Lynn unpacks a session working with a postpartum client whose orthopedic complaints—leg weakness, knee irritation, constipation, and squat pain—led to surprising discoveries deep in the pelvis. Each release revealed new layers: from sacral flexion and a tucked cervix to a bound utero-sacral ligament that instantly shifted motor control and pelvic floor function. Just when the picture seemed complete, the body exposed one last twist—an old ankle sprain still holding tension from high school. This episode is a powerful reminder that the body always tells the story— when we’re willing to listen to it.

✨ Episode Highlights:

• Identifying sacral flexion and ischial splaying patterns postpartum
• Releasing a tight utero-sacral ligament for better pelvic mobility
• Restoring pelvic floor balance and effortless activation
• Resolving orthopedic symptoms (knee tracking, squat pain) through pelvic alignment
• Discovering how old injuries and stored energy show up in postpartum recovery

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Transcript

@0:08 - Lynn Schulte, PT (lynnschultept@gmail.com)

Hello, everybody. Welcome to this episode. And today I'd like to share with you a case study of a client that just came to see me and she is 14 months postpartum, 14 or 15 months postpartum.

She is a pelvic health PT and has come to me with complaints of her right leg feeling weaker. And she's aware that like the motor control and coordination on her left leg is not like the, or on her right leg is not like the left leg and her right knee, she's thinking like medial meniscus is getting irritated and her ankles getting irritated on that right side.

And she just feels uncoordinated on that right side. She also is complaining of having. In constipation and rectal pain with bowel movements, and also feeling a deep pull when she's in a deep squat.

So the pull is near her anus when she's in that deep squat, and she also feels like she has hemorrhoids.

So those are some of the main complaints. So she had a baby 15 months ago, and when the baby came out, she was in the stirrups, but slightly rotated to the left, she remembered.

And she said her labor felt bad, she was in the hospital, her cervix was swelling, and she couldn't pee, and so they gave her an epidural, and she rested, and then she was able to fully dilate.

But she did report that she didn't feel fully connected with the pushing, and she didn't feel like she could create great power.

She did, she was like amazed that she had a walking epidural, and she was able to move and get into all different positions, so that was, they did a great job there.

be doctor there. I But she did need help with the baby to the baby needed to be vacuumed out.

And the doctor was successful on the second pull. And she didn't feel like the birth was very traumatic in the sense that she felt very supported.

But she did feel like not being able to connect her body was was pretty scary for her. So when I evaluated her in standing, I could feel a slight collapse and collapse is too strong of a word, but just like her right shoulder was just being pulled down on the right side of her body.

And and then energetically, her left hip was there's no flow going down her left leg, but the right side actually had some flow going in standing energetically.

Her sacrum was lifting backwards and her issues were splaying so energetically she She presenting with the open birthing pattern.

And when I went to assess her in supine, I was noticing, trying to remember what I noticed in her legs.

I always lift the heels of my clients and hold their legs in my hand. I don't think there's anything too significant that I noticed there.

And then when I went to assess her, let's see. Oh, she did have just a slight like two finger width separation at the umbilicus.

So we did some rectus and oblique release work. And then I went to her sacrum. Actually, I think diaphragms.

I checked her diaphragm, respiratory diaphragm and pelvic diaphragm. And on the left side, there just wasn't a really great connection there.

So I worked on that. And then went to her pelvis and her sacrum was midline, but she's an Stuck in flexion, and so I addressed that, and then her ischium, her right ischium, was more out to the side and just had decreased mobility medially, and so we addressed that, and she could really sense and feel when that ischium got more midline and had more springy mobility, mobility-ness, that's mobility in it, sorry.

And then I did some intravaginal work with her, and I found that her left pelvic floor muscles, when she went to contract, her left levator, know, like there was one band of muscle that just like came to the party and was just this band of muscle on the left side, so coccygeus really wasn't coming to the party at all.

And this one band of the levator group. I was like working overtime on that left side, and then right side was okay, pretty good strength, normal tone, but definitely more tone on the left side, and then her bladder was actually all good, didn't have to really address her bladder at all, and then I found her cervix a little tucked, it was posterior and to the left, and so I, reaching around, I found the left utero sacral ligament tight, so I released that, and she could really feel the beautiful release that happened, I also, sorry, before I went internally, I also checked the, the mobility of the uterus and the bladder in supine, with her knees bent up, and her left utero sacral ligament was also tight externally, so I worked on it externally, but I also needed to release it internally, so I really feel that utero sacral ligament is so important, that if you find it tight externally, please make sure you look for it, and try to treat it internally as well, because it's if you

Super helpful. Super important too. And so then after releasing her cervix, it had more mobility. There was a slight decrease in the tone of her pelvic floor muscles, but the, and, and I had her do another contraction, but it still wasn't a hundred percent.

And then I went to, so I did some release work of the pelvic floor muscles. And I also drew in that right ischium because that ischium had been splayed out for over a year, almost a year and a half.

And, um, I wanted to reset the right side pelvic floor muscles with the ischiums more medial. So I did that.

And then, um, then I assessed the sphincter muscle and her entire inferior half of her sphincter was tight and had tension in it.

But especially at seven, eight o'clock on the right side. And, um, So I worked on releasing that, and that is a huge indicator that she was stuck in sacral flexion.

So if you all miss sacral flexion, and you didn't treat it externally, and you go internally, and you find bilateral coxageous tension, and then inferior tension of the EAS, that is your sign that sacrum is stuck in flexion.

So please work on that. And I released the sphincter muscle, and I had to do internal sphincter as well, because that was also restricted.

And her sphincter muscle was open, like the door was open, I could stick in, there was a little resistance on the internal sphincter muscle, but external was wide open.

And once I released the internal, then I got that good reflexive closing of the sphincter, and it was nice and closed now.

So now I had to knock to go in, and that's what we want with our clients, we want that sphincter to be held closed, and...

And... And... And then to allow the muscle to be able to function better. So then I had her practice another contraction after I did the, oh, and then I, after I did that, then I went to the IRF.

So the issue of rectal fossa, and I released that left side of the, um, the IRF, and it was very resistant to wanting to go up towards her head.

So I worked on releasing that using the Schulte hold. That's super important on that same side. And then, um, and the Schulte hold is a hand placement I use on the pelvic bones that I teach in my courses.

So if you haven't taken one of my courses, please check that out. It is an absolute game changer in, um, releasing this tissue in the pelvic space.

Um, and so after I released the IRF, then I felt like, okay, we got everything here. So I put my fingers in internally and, um, had her do another contraction and man, was that so much.

She had, I mean, she was pulling my fingers in with that contraction and had her blow up the balloon and automatic automaticity there.

And it was just easier. On the initial assessment of her pelvic floor muscles, it just felt like the muscles she had to effort to get those muscles to turn on and get them to relax.

And it wasn't very smooth. It was very effortful. And after the treatment, it was like, boom, on, off. And she could just feel the improved strength in there.

So it was incredible. We did a standing assessment. Everything, you know, there's no prolapsing of the tissues. Pelvic floor was turning on.

We did a squat internally and checked and everything was working well. And so then I had her get dressed.

I went and washed my hands, came back. And then I had her assessing that right hip and that right lower extremity.

And what she was saying is like, she had much better motor control of the femur. She said, what What was happening in the before treatment is that her femur couldn't find midline like her knee kept going out to the side as it was tracking as she was going into she was doing a reverse squat step back and the right knee when she would step back with her left and go down into the squat, her right knee kept wanting to track laterally, and she couldn't get it.

She was trying to force it to stay more medially, but if you think about what we found in her body her ischium was splaying out to the side more than the left and so with that ischium splaying out that femur can't track in midline it's got to go out to the side and that's what her body was trying to do and now with the ischium in more midline position that femur was able to track but she was weak like her you know hip internal external rotators weren't used to having to balance her out but she could do it.

And so with greater strength and greater training, those muscles are going to be able to really allow that femur to track smoothly and keep it in midline.

And then she went into a really deep squat and she was like, wow, that deep pulling is no longer there.

My anus feels normal now. And I told her, I'm like, you didn't have any hemorrhoids that I was aware of in the evaluation.

They weren't prominent when I was working with that sphincter muscle. But the tension from that sacrum being pulled backwards.

And remember, there's an anocaxageal raphe that connects the tip of the tailbone to the anus muscle itself. And if you find that inferior tension in there, that sacroflexion is pulling that posterior.

And then as you go into a full squat, that sacrum is pulling back more, and you're going to feel more of that tension in that anus.

And that's exactly what And so it really makes sense when you listen to what your clients are complaining of, and then you find what's happening with the bones of the pelvis and the structures being attached to those bones, it, it, most of the time, it makes perfect sense of why the client is complaining about what they're complaining about.

So I thought this was a perfect example of being able to take their complaints, find what we find in the body, correct that, and then those complaints were gone.

And so she asked me like, where, you know, what do I need to do next? And I was like, you're good.

Your core is automatic. You know, like being a pelvic health PT, you know how to keep this strong and how to work with your body.

So I don't feel like I need to see her again. I told her if any of that stuff comes back, she might, might need a tune up, but I really don't think she's going to.

So that is the gold in understanding and knowing what to look for and how to approach this postpartum body.

And so it was just a really, really fun, cool session. And she was so grateful. Oh, the other thing that remember in standing, she had blocked flow down her left side, her left leg.

was no flow going down that left leg. So internally, after I did all that release work, I had her tune in because I was sensing there was still that blockage on the left side.

And so I had her tune into her pelvis. I'm like, what do you notice? And she goes, yeah, she said, I think the analogy she brought was like, the right side felt like it was above water and above on top of the road.

And the left side felt like it was in a tunnel. That's the imagery she had. And so I just had her get curious and tune into what that left side, what was going on in there, what came up for her.

And actually. I, she was just kind of quiet, and I felt this nice softening of her, of her tissues on that left side.

And she said, I said, so what was that thought you just had there? And she's like, oh, it was an ankle sprain that I had when I was in high school, and I went to an away camp for basketball.

And so I just had her talk more about that, what, you know, what was coming up for you. And, and it wasn't anything big.

It was, I think, a fear of hers. And she was just able, like her adult self was able to think back to what that teenager needed to understand.

And I don't think it was anything really big. It was kind of like, hey, you know, you don't have to worry about your performance on the team, just the being a part of the team and the effort and discipline that it takes to be a part of this team is really going to serve you well in your life.

And I do find that with athletes and being an athlete myself, I feel like that competing, growing up does create a discipline in us that like, I love exercising, I love running, I love keeping my body strong.

And, and so that was the answer to that blockage on her left side, it had nothing to do with her birth, and nothing about feeling disconnected as she went through birth.

That's not what came up in this session. So that wasn't what needed to be addressed. But by a listening to the body and feeling for that shift in the tissue, when she had that thought about basketball camp, that's what was being held in that tissue.

And as she just kind of talked to that teenager inside of her and gave her that insight, the energy was flowing, and she could feel the flow going down that left leg and, and then it worked great.

So you never know what's going to show up. And that's why you want to set aside everything that you hear in that intake.

When your client comes in and tells You don't want to be biased and bring that bias to your sessions.

You want to allow the body to guide you and let the client get curious with their body to see what wants to come up.

Because had I guided her towards the birth, we might have missed the mark. But what wanted to come up was this healing of this ankle injury when she was a teen.

So body's amazing, you guys. It's absolutely amazing. So this work is amazing. And I'm so grateful to each and every one of you that is interested in learning.

And I encourage and need your help in spreading the word about my work, about my classes, and getting other therapists interested in learning this material.

You guys are my greatest advocates and greatest marketers for me. I would really appreciate any and all help that you can give to encourage other pelvic health therapists to take my courses so that they can.

And appreciate all the help that you can give me in getting the word out about this. So thank you, everybody, for listening in.

Thank you to this client that came to see me and for her willingness to allow me to share her case with you all.

I found it very interesting because it wasn't your traditional leakage with cough, laugh, sneezing, and pelvic pain and all this kind of stuff.

It was really more orthopedic. And how orthopedics does, the birth does impact how our hip and our knee and our ankle all work.

So please keep that in mind. Thanks so much for listening in, everybody. We will see you all in the next episode.

Here is to smoother births, faster recoveries, and better function for our moms. Take care, everybody. Bye-bye.