Unraveling 19 Years of Postpartum Hip Pain

In today’s episode, Lynn shares an extremely complex clinical case with a client who was 19-years postpartum. The work done on this client unraveled layers of unresolved hip pain, bladder dysfunction, and abdominal rigidity that standard care had never been able to resolve.

With a history of forceps delivery, multiple C-sections, abdominoplasty, hysterectomy, roller-skate falls, and chronic sacral imbalance, this client presented with a highly complex pelvic history. But through skilled, methodical pelvic-health evaluation, both external and internal, Lynn identified the true driver of her long-standing symptoms: a significant right ischial splay combined with fascial tension patterns from surgical scar tissue that were pulling the bladder posteriorly and overstretching the anterior vaginal wall.

This episode highlights the level of clinical precision, palpatory skill, and whole-body listening required to treat postpartum clients with chronic symptoms. And most importantly – it shows how quickly clients can shift when the right structures are addressed and when the body is listened to.

After one comprehensive session, this client experienced:

 • Pain-free criss-cross sitting for the first time in years
 • Restored hip mobility
 • Improved pelvic floor-TA coordination
 • Reduced bladder urgency and leakage
 • A softening and normalization of pelvic tissues that had been restricted for nearly two decades

Lynn also shares why it’s essential to treat what shows up in the body in that moment as that is what the body is ready to address. In this case, the physical system was fully ready to release, creating dramatic change without any need to dig for something more.

Episode Highlights ✨

• Long-term postpartum hip pain: what clinicians often overlook
• The crucial role of ischial splay in hip mobility and femoral rotation
• How abdominal wall surgeries influence bladder mechanics
• Assessing the anterior vaginal wall for tension patterns affecting continence
• Sacral shear + coccygeus tone in the common postpartum pattern
• When to stay physical—and when to explore deeper layers
• The clinical power of a single, well-targeted session

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Transcript

 Today I'd like to... I share with you a case study of a client of mine.

She is 19 years postpartum and she had coming in to me complaining of right hip pain that she's had since the birth of her baby, 19, 17, 19 years ago.

She complains that both hips are really tight. She also has some bladder leakage. She has to wake at night to go pee, to go to the bathroom.

She feels like she does urinate frequently. She has a history of low back pain and she reported that she had a fall on her stairs.

I forget how long ago that was. She landed on a step and she severed her right gluteal muscle with a partial tear.

She also fell on roller skates 15 years ago, complaining of numbness and difficulty with intravaginally. She had an abdominal plasty.

She Back in 2013, because she had really bad DRA, diastasis rectus, and also to fix a bad C-section scar.

So she's had three kiddos. They're 19. That was a vaginal birth that was forceps delivered or forceps assisted. And then she had a labored C-section with her 17-year-old and baby had a big head and got stuck.

And then she had a planned C-section for her 14-year-old. And she also had a hysterectomy in 2020. They left her ovaries, but took out the uterus.

And I believe that was done vaginally, not abdominally. And when they did do the hysterectomy, they did have a hard time releasing the uterus from the abdominal wall because it was attached from all the scar tissue from the C-section.

And she She's also complaining of insane periods with lots of gushing blood. She reports that is okay, but it is dry.

And she does have a history or has been diagnosed with a bulging disc on her right side, but there's no symptoms from it.

And she did complain of sciatica in her first pregnancy. And let's see, what else did she? Her babies were pretty big.

Her second baby was over 10 pounds, and her main complaint is the low back and pain in the right hip.

She says she can't sit down and do crisscross applesauce, so she can't sit in that position because the right hip just hurts.

And then the leakage with her bladder. And so what was interesting about this case is that because of all the surgical procedures procedures and everything, her, uh.

Abdominal tissues were super tight, both the left side, left lower abdominal fascia, the right lower abdominal fascia, there was just the typical abdominoplasty restriction throughout the abdominal wall.

And what we need to remember is that we have those three ligaments that go up on the inside of the abdominal wall that support the bladder, the umbilical ligament and the two median uterine, not sorry, uterine bladder ligaments are on that abdominal wall.

And so what I found, um, I'm going to go back and forth from internal and external here, but just because it's, um, what I found internally with the bladder was that it was really pulled posteriorly, which makes sense from that abdominoplasty and possibly from the scar tissue, from the C-sections.

And there was just a lot of tension on. The anterior vaginal wall that, you know, is pulling the bladder back.

So we need that anterior vaginal wall to be nice and soft and saggy so that that bladder has space and room to expand.

So it didn't surprise me that she was having bladder symptoms and having to pee a lot because there was just a lot of tension on that vaginal wall.

I also found that she was in the common birth pattern with the sacrum shifted off, sheared off to the right-hand side, stuck in sacral flexion.

She did have a right ischial splay, which I hope by now, if you've been listening to me for a while, even if you just started listening to me, please start looking for this, though.

So whenever we have hip pain postpartum, look for an ischial splay, depending on what position they were in as that baby came out will determine how much more pressure is on one side versus the other.

And I do tend to find that the right ischial splay is... It's more common in my practice in the clients that I work with, but it can be left side, so it just depends on how baby comes on out, but correcting that ischial splay and bringing the bones back into midline really does take the tension off of the hip rotators and the pelvic floor muscles and just allows that hip to function more freely in the acetabulum.

She did have a lot of left sided pubic bone and rami bone hardness. Her obliques were super tight and her recti fascia were tight on both sides as well.

She also had internally now, as I go internally, remember I said the anterior vaginal wall was pulled posteriorly, her right coccygeous muscle has increased tone, which is that consistent with that right sacral shear pattern, that common postpartum pattern in the sacrum.

And she did have tension at her sphincter muscle, external sphincter around the four or five o'clock, so more on the left hand.

And so after I worked on mobilizing her bones, working with her abdominal wall, and then working intravaginally with that anterior vaginal wall, that bladder tissue, releasing the coccygeous muscle, working with the scar tissue internally from the hysterectomy, all of that just softened everything.

And she had a much better pelvic floor muscle contraction afterwards, and it was automatically connected to the transverse abdominus muscle when she contracted pelvic floor, TA kicked in, and so I just re-patterned more of that and worked on that with sit to stand and lifting exercises to just make sure that her core is kicking back in.

And I did check back in with her a couple of weeks when I knew I was going to do this podcast.

And she did report that her bladder's been much better. She hasn't been able to fully test it yet, but she didn't feel like she was leaking as much with what she was doing currently.

And we did test it right after she got off the table. She was able to sit down on the ground and cross her legs, sit in that crisscross applesauce position, and she had no right hip pain with that.

So that did stay, and she was super happy about that result as well. So I only saw her one time and kind of said, you know, because her core was automatic and was strong and working well, I just had her check, you know, keep checking back in if any of her symptoms returned to have her come back in.

But I didn't feel like I needed to keep seeing her over and over and over again because there was such beautiful releases.

Now, her births did seem pretty traumatic and listening to her from her report, her intake form. She had lost her dad shortly after having one of her kiddos, so there was some grief going on, but it just didn't come up in the session.

And for those of you that have taken the Birth Healing Intensive program, you know that I don't go digging, that we shouldn't go digging for this stuff, that I work with what is showing up in the body in the moment because that's what the body's comfortable with working with.

And everything released beautifully on that physical level, and there was no need to dive deeper. If any of the techniques that I was doing with her were resistant to releasing, that's when I get curious and dive in deeper.

But if everything is releasing beautifully and there's no resistance to the tissues letting go, then I work on that physical level.

So that is all she needed. Sometimes that surprises me. Sometimes it doesn't. So that's what she needed. So I think it's really important for you to remember that whenever we're dealing with hip pain in pregnancy or in postpartum, to please check the ischial splay of the ischiums.

And when you correct that, if you are lacking internal rotation of the femur, there's an ischial splay there. That ischium not being in its proper position is preventing that femur from being able to internally rotate.

As soon as you correct that ischial splay, you have full range of motion of that femur bone. So please keep that in mind.

Also, any bladder issues, you need to be assessing that anterior vaginal wall and working with the bladder and seeing what's going on with that.

Any anterior vaginal wall that is not soft and saggy and has zero tension in it is a happy bladder in there.

If you find any tension in the anterior vaginal wall, that is the bladder needing some help and support in there and releasing that tension in that tissue will allow that bladder to expand more fully and help people be able to urinate less frequency and hopefully hold their urine a little bit better too because we do know that, or I do know, that when the bladder's not happy, the pelvic floor muscles aren't happy.

And they're not able to contract as well. So please keep that in mind, everybody. I hope this case study was helpful for you and I will be sharing more in the season to come.

So please continue to listen. Please share this information with other practitioners and help them to understand these different concepts and ideas because when we start addressing the entirety of the pelvic region, we get better results.

So thank you so much for listening, everybody. Here is to smoother births and faster recoveries. Take care, everybody. We'll see you on the next episode.

Bye-bye.