Sacral Slope, Parity & The Overlooked Pelvic Outlet

In this episode, Lynn breaks down why the pelvic outlet – not just the sacroiliac joint – may be a key contributor to postpartum pain, heaviness, and persistent pelvic floor tension. She explores the biomechanics of birth, how the inlet and outlet function as a reciprocal system, and why most traditional treatment approaches only address the top half of the pelvis. She shares clinical examples of pregnant and postpartum clients whose pain, tailbone tension, and pelvic heaviness resolved quickly once the ischial tuberosities and sacrum were mobilized and brought back toward midline. She also shares emerging research on sacral slope changes with parity and why sacral flexion often remains long after delivery – even decades later.

Episode Highlights ✨

• The inlet and outlet function as a seesaw
• Sacral flexion & widened ischial tuberosities drive symptoms
• Mobility matters more than position
• Rebalancing bones + resetting muscles changes outcomes fast

If we want faster recoveries and truly resolved postpartum symptoms – we have to start treating the pelvic outlet.

Have a comment or question about today’s episode? Message Lynn on Instagram or Facebook, or Email Lynn.

If you enjoyed today’s podcast and are interested in more topics to support your clinical practice and treating your clients, find us on your favorite podcast app and subscribe so you don’t miss an episode.

To learn more visit: InstituteforBirthHealing.com

YouTube: 

To learn more about the Mommy Monitor visit: https://operationmist.org/

Message me on Instagram: https://www.instagram.com/instituteforbirthhealing/

Message me on Facebook: https://www.facebook.com/InstituteForBirthHealing/

Email Me: support@instituteforbirthhealing.com

If you enjoyed today’s podcast and are interested in more topics to support your clinical practice and treating your clients, find us on your favorite podcast app and subscribe so you don’t miss an episode. 

Visit Institute for Birth Healing to learn more about how to care for the pregnant and postpartum body: CLICK HERE

Transcript

Hello, everybody, and welcome to this podcast episode. Today, we're going to be talking about the pelvic outlet. But before we dive into that, I just want to make everyone aware that the Birth Healing Summit this year is going to be live online May 2nd and 3rd.

So I invite you to save the date and know that registration is opening soon. So please be looking out for that.

You can check the show notes to see if there's a link. The link will be probably generated next week, maybe, for you to be able to register for that.

So I look forward to having you join us for the Birth Healing Summit this year, where we are focusing in on you, the practitioner.

be doing Koints. And you And we want to help you to be more grounded, centered, embodied in yourself so that you can better support your clients.

So know that our focus this year is on you and healing you. And I'm super excited. We've got a great lineup of speakers this year that are going to take you through visualizations, contemplations, meditations, and teach you how to not only hear yourself, but in doing so, you're going to learn how to better support your clients in the process as well.

So that is our intention this year. I'm super excited for it and would love to have you join us.

So let's go ahead and dive in to today's podcast topic, which is the pelvic outlet. And what I want to talk about, so let's first define what the pelvic outlet is.

And that is the lower part of the pelvis. So from tip of tailbone to ischial tuberosities to inferior part of.

Pubic symphysis, all that entails the pelvic outlet. So the inlet is at the top of the pelvis. That's bordered by the base of the sacrum, the iliac crest, the top part of the pubic bone, and so that's all the pelvic inlet.

And if you've studied birth for a while, you know that the pelvic inlet needs to widen for a baby to come in.

So the ilia go into an external rotation. They outflare. The sacral base goes into extension to help increase the diameter of the pelvic inlet.

And then once the baby's head encounters the pelvic floor muscles, that's a signal to the body that the pelvis needs to go into the opposite direction, which is to open up the pelvic outlet.

We do that by going into sacral flexion where the tailbone moves backwards and the ischial tuberosity. arm. the leg with arm.

first And what I want us all to be aware of is that I'm not exactly sure what they're teaching in PT school these days, but when I was in school and what I keep hearing most PTs, OTs talk about in their treatment of the pelvis is really just the sacroiliac joint, possibly the symphysis pubis joint if we have some SPD going on, symphysis pubis dysfunction.

The sacroiliac joint is really only addressing the pelvic inlet. If you think about the location of those joints at the top, near the sacral base, near the iliac crests, the PSISs in the back, that is all dealing with the pelvic inlet.

So in most traditional pelvic health treatments or even chiropractic treatments were mainly only a Addressing the pelvic inlet, and the effect of that from birth really isn't as important as the outlet because when the inlet opens, it widens, the pelvic outlet reciprocally closes.

But then when the outlet opens, the pelvic inlet reciprocally closes. So it's a seesaw. One opens, the other closes, the other opens, the other one closes.

And what is not being addressed in most postpartum sessions is the pelvic outlet. If you are only doing anterior and posterior rotations of the ilium or in flare out flare of the ilium, you're only addressing the top part of the pelvis.

We haven't been taught, unless you've taken one of my courses, you haven't been taught how to address the ischiums and the sacrum, especially from the impact of birth.

Now the pelvic outlet could also be kid Blasie. And I'll see you So from a fall, or the way we sit can influence the pressures of the ischium, although that causes more, if we sit on one side, that ischium can get pushed in than the iliac crest outflares.

I like to think of the ilium and the ischium as one bone, because really it is, we just call it different parts.

So the top part where the iliac crest is, is just the top part of the same bone where the ischium is the bottom part.

So if we put pressure on that ischial tuberosity immediately, because this, and this happened to me, everybody, I have a bench at my table in my kitchen.

And sometimes I'll just kind of slide in. And when I slide in, I'm sitting with more pressure on, it was my right ischial tuberosity.

And I was kind of sitting cockeyed on it and was putting way more pressure. On the ischium, pushing it medially.

Well, what does that do to the iliac crest? Was it was pulling it into an outflare. And I must have stayed like that for 20, 30 minutes or whatever.

And even in my brain, I'm like, you know, this probably isn't the best for your pelvis. You should probably move positions.

But I didn't. And I went to go play tennis later on that night. And my low back was just aching.

And it was aching on that right side. And I was like doing pelvic tilts and going, it's not my sacroiliac joint that's hurting.

I'm arching my back and flexing my spine and my lumbar spine. And I'm like, it's not that either. So what is causing this ache there?

And then I remembered that how I was sitting on my bench, pushing my ischial tuberosity medially. And I realized how that was pulling my iliac crest laterally.

And my iliac crest. The lumbar ligament that attaches to the top of the iliac crust in the back was just being on stretch.

So I just grabbed the iliac crust with my hand and just pressed it medially, and that's going to bring the ischium laterally a bit, and my ache went away, and it took the strain off the ilial lumbar ligament on that side.

So recognize that this ischium and ilium really are one bone, and in both the holistic treatment of the pregnant body, postpartum body, and even the treating the postpartum pelvis, I teach how to rebalance the ischium and the iliums, because it's so important that we have good balance between the top of the pelvis and the bottom of the pelvis.

But the pelvic outlet is not being addressed in our clients, and that is what helps to take away the heaviness, the pressure, the weakness.

Weakness in the pelvic floor muscles. I can't tell you the number of clients that come to see me, and they're complaining of pelvic heaviness, but this heaviness doesn't get worse at the end of the day.

It's just kind of constant, and I just worked with two pregnant clients today who were complaining of pelvic pain, pelvic heaviness, like the baby, and these were subsequent pregnancies, and they both had been seen by a pelvic health PT after their first births, but nobody addressed the pelvic outlet, and one gal pushed for eight hours.

Eight hours. She had a vaginal birth, but that is a lot of strain on the pelvis and pelvic floor muscles.

She did see pelvic floor PT for quite a while after birth, but she said, you know, I never really felt like I was back together again.

Like, I never really I never, I never felt like I did. And before, you know, pregnancy, like there was still just something always going on.

And that's because the person did not address the pelvic outlet and the pelvic outlet. We need to bring the ischial tuberosities to the midline.

We need to get the sacrum out of flexion. I'm super excited that research is actually starting to show there's, there's a couple of papers out that are showing that the greater number of kids you have, the greater the sacrum slope in your body, which means sacral flexion, they're, they're measuring the sacral slope, which is sacral flexion.

And if you've had, so Nulli Paris have a lesser sacral slope, one babies have a little bit more, three plus babies have a lot greater sacral slope.

And this, this client that I had seen that had pushed for eight hours was so stuck. Both of them were stuck in sacral flexion and both of them were complaining of tailbone pain when they sat.

And if you think about what happens with that sacrum being stuck in flexion, and the tailbone is in tug of war with sphincter muscle, I did a podcast and episode and a blog post on the tug of war of the tailbone that puts a lot of strain, both of their inferior sphincter muscles had massive tension on the inferior half and bringing that out of sacral flexion, bringing it more into extension, releasing the inferior half of the sacral of the EAS and IAS, so the sphincter complex, really helped to relax the pelvic floor muscles.

was one gal that I just got done treating that when I went to evaluate her ischial tuberosity distance. There two There

It really felt like it was normal. It really felt like, you know, it would be had she never had kids.

So she had, you know, they're pretty good distance apart, but yet the mobility was restricted. And so that's telling me because I never treat just positional differences, I treat immobility.

And because her ischiums weren't moving medially, that I knew she was still stuck in a nail flare, even though it appeared in my hand that she was like good, like normal.

But her, the narrowness of her shield tuberosities and the lack of mobility let me know that she was still stuck in a nail flare.

In fact, I did external mobilization with her. And then when I went internally and I was working, she had a lot of tension on the left.

Is she left levator anise and left side pelvic floor muscles. And as I was working with those muscles, I was just doing a massive medial compression of that ischial tuberosity.

And she's just like. I was wow, that feels so good. And both of them were like, oh, this feels like what my body's needed for so long.

And I just really would love for more PTs, even chiropractors, to be addressing the outlet, the pelvic outlet, and bringing the ischial tuberosities together, bringing the sacrum towards the midline, and really helping to bring those bones back together.

And then it's super important that we continue that with internal work because we need to reset the muscles in a more shortened position.

We have to release the tension. Those muscles are in tension because they're trying to hold the bones together. And both of these clients had increased tension in the pelvic floor muscles.

They had pain with because of the tension in the muscles, pain with thrusting, and even insertion. And all of that is because the bones are being held.

they're to body. So please, let's all start looking at the pelvic outlet. Let's address the ischial tuberosities, and let's make sure they have good mobility toward the midline.

Let's make sure that the sacrum can move out of flexion and into extension. And for those of you that have taken my holistic treatment of the postpartum body course, please check out the advanced postpartum online course, because I teach a sacral MOBE in there that is really, really good.

I just wish everybody could do that in the postpartum clients. It really identifies that sacral flexion and how to treat it.

So, um, there's one sacral technique in the advanced postpartum course that I highly recommend you guys all check out because that is, um, I use it every day on my postpartum clients and, um, and even my pregnant clients too.

So both of my pregnant clients that I saw. that had the open birthing pattern. They were both in a subsequent pregnancy.

One was in her third, one was only in her second. Both complained of heaviness, pelvic pain, back pain, and they were in 26 and 35 weeks of pregnancy.

They both, after closing up the bones, bringing the bones back together, getting them out of sacral flexion, releasing the pelvic floor muscles, they both stood off at the table and like, wow, I feel lighter.

There's no more heaviness in the pelvic region because the pelvic floor muscles don't have to work so hard to try to hold everything together.

Okay? So please, please, if you're not already, start looking at the pelvic outlet. Look at those ischial tuberosities. Look at that sacrum and help bring those bones back together again.

And you can learn how to do that in pretty much almost every course that I teach. But the treating the postpartum pelvis will help you do that.

Holistic treatment of the pregnant or postpartum body will help you to be able to approximate the bones back to midline and teach you how to help look at and assess and treat the pelvic outlet.

Please, please, please share this episode with all your colleagues, even orthopedic colleagues that are working with women, because it doesn't matter how long it's been since they've had a baby, their pelvis is still stuck.

In fact, the research that I'm quoting were images, x-ray images of women in their 70s that had had babies, and they looked at the number of parity and how many babies they've had, and they looked at the sacral slope, and the greater number of babies they had, the greater the sacral slope.

They also looked at C-section versus vaginal birth, and there was a huge difference in the sacral slope, significantly different in those that gave birth.

Vaginally compared to those that have had C-sections. So, yay, the research is starting to catch up with me. So I'm very excited about that and very excited to be sharing that with you all.

So thank you so much for listening in, everybody. Please check out the Pelvic Outlet, address the Pelvic Outlet, treat the Pelvic Outlet, and let's spread the word so that more people are doing this and we can get moms out of pain more quickly after birth.

Both of them, both of those clients I was talking to you about, one session, no pain. One session, everybody, no pain by just addressing the Pelvic Outlet and doing some intravaginal work.

So I want you to be able to do the same. So thank you, everybody, for listening. Thank you for spreading the word.

And here is to smoother births and faster recoveries for all of our clients. Take care, everybody. We'll see you on the next episode.

Bye-bye. Bye-bye.