Going Beyond Pregnancy in Pregnancy Pain Treatments: Hidden Structural Patterns in Prenatal Clients

This episode pulls you into two pregnant client case studies that seem straightforward at first – until the bodies start telling a very different story. A 35-week first time pregnant client arrives with pelvic pain, leg symptoms, and nighttime disruption, and what unfolds reveals a layered map of old surgical history, a snowboarding injury, and a spine that never developed typical curves. Each piece of her history quietly shapes how her pregnancy is unfolding. Then a second case at 25 weeks looks like “typical” postpartum carryover and hypermobility … until subtle clues in the sacrum, ischium, pelvic floor, and even whiplash history begin pointing to a much deeper structural narrative than expected. As each layer is uncovered, what initially looks like isolated pelvic dysfunction turns into a full-body story spanning cervical spine, cranium, pelvis, and past trauma – none of which would be obvious from standard assessment alone. This episode leaves you questioning how many of your own clients are carrying hidden layers you have not been taught to see yet.

✨ Key Takeaways for Practitioners:

• Two prenatal case studies that unravel far beyond typical pregnancy presentations
• Hidden impacts of past trauma (surgery, whiplash, birth injury) on current symptoms
• Unexpected full-body connections between cervical spine, pelvis, and pelvic floor
• How subtle bone and tissue cues completely shift clinical reasoning in real time
• A challenge to rethink what you’re missing when you “follow protocol” too closely

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Transcript

 Hello everybody, and welcome to this episode. Today I wanna share with you two case studies of two pregnant clients that came into my practice last week. And the theme here is while I teach you different structures, patterns to look for, um, common patterns that might show up in our postpartum clients that may be still in our pregnant clients, and different things to look at in pregnancy, what these two case studies have in common is what a person brings in their body to their pregnancy, and how that may be impacting their comfort level during a pregnancy. So the first client that I saw, she's... She was 35 weeks. This was, uh, pregnant with number one. And she had had prior endometriosis surgery that they noted in the surgery that she had some bladder damage, like the endometriosis had grown in and caused problems with the bladder. Um, she also was a snowboarder, so she had an accident that involved her neck and right shoulder. And she was waking, um, hourly at night. Um, she, um, had- has pain in her whole pelvis. She's got shooting pain down her left leg to her knee, um, and more pain in her body when the baby is actually moving. And, um, when I listened to her body in standing, I definitely got drawn into the left shoulder or right shoulder and neck from it- what may have been that, that snowboarding accident. Um, I also found that her, uh, C spine, the- her cervical spine was... C2 was really, really prominent and more on the right-hand side, and that that C curve was actually a little bit, you know, she was, um, instead of having a lordosis, she was more kyphotic with it. Um, she also had a lot of, uh, thoracic spine restrictions, and her left shoulder actually connected into her left rib cage. So in releasing the left shoulder by compressing in the left rib cage, that allowed the l- uh, right shoulder to release. Um, her lower sacrum and tailbone were really hard and less mobile. Um, all of her uterine ligaments were good though, which was really surprising because of that one complaint that she said that she has more pain when the baby is moving more But I didn't find any restrictions in her uterine ligaments at all. But internally, she had a right-side pelvic floor muscle tension, right coccygeus tension. Um, I did a release of her coccyx muscles, and her pelvic floor muscles were definitely better. There was a lot of tension on the right side of her, uh, f- uh, fascial wall there. The endopelvic fascia there was tight on the right side. But after some good releases there, um, that all felt better, and her pelvic floor muscles were ever- were able to relax more afterwards. And, um, she... When she got up off the table, she definitely felt more... Her back was loose, and, um, it felt a lot better. And for this case, you know, that shoulder complaint was the snowboarding accident that was jamming up her ribcage. Her ribcage was really tight on the left posterior aspect, which was tied into the right shoulder. So that may have been a preexisting pattern from that snowboarding accident in her body. And so I... You know, it... the more we can listen to what a person is carrying in their body, see where we're getting drawn in, listen to what those tissues want to do energetically, and then as we're working on an area to get a hit as to where else it might be connected to, that can all help us in treating any client that walks in the door for us. So another client that came in last week is 25 pregnants with number two. She has a two-year-old that had a vaginal birth, and it was a great birth. It was only seven hours long. She was squatting in the water when the baby came out, and she had a second-degree tear. But she had a ton of pelvic pain a- afterwards and couldn't walk on her own for two weeks. She reports that genetically she has a low bladder like her sister does, and she leaks every time she sneezes, or when she squats, pee comes out She's also complaining of deep thrusting pain with her partner for, with sex. And, um, and so with just that little intake, there is so much to unpack. Okay? First off, she's pregnant with number two, so we know that her pelvis has undergone a vaginal birth, so I wanna check and see if she's stuck in the open birthing pattern and see what's happening there. She was squatting in the water, so I'm curious to see if we might find that her ischiums are equally, you know, um, splayed apart or if one is still more splayed than the other, and we'll see what we find. Um, the tearing means that when she wa- she was squatting and standing so that both of her legs were weighted. And we do know that when we can unweight in a squat, it actually is, the pelvic floor muscles can relax more and stretch more, so there's less likelihood of tearing in birth, in labor with a supported squat versus a unsupported one. And the fact that she had a lot of pelvic pain afterwards really tells me that this wa- the way the baby came through may have really impacted her pelvic bones. So I'm gonna get curious with what I'm going to find in her body. But then also the other big red flag was genetically low bladder, like her sister and her, and I think her mom even, has had issues with bladders afterwards. So, um, I did fi- and then the fact that she's leaking urine, we know that there's pelvic floor dysfunction stuff going on there, and then the pain, deep thrusting pain with sex. Whenever there's deep thrusting pain with sex, I always think cervical mobility is compromised somehow, some way, that the cervix can't move like it needs to for thrusting to happen. I did find, when I went to palpate her pelvic bones, I did find that, um, her, uh- Um, she did have the common birth pattern with the sacrum she- sheared off to the right. She was stuck in sacral flexion, and she did have a left ischial splay. And so when I found this, I did ask her a more, um, clarifying question about her squatting and did she feel like she was... had equal weight on both of her legs as she was squatting, and she said, no, she had more weight on her right side, which confirms why that left side is more splayed out to the side, um, because the weight bearing on the right is going to anchor that in place more, and then the baby's gonna push more on that left side there, and that's what we found. Um, she did have some tightness in lower abdominal fascia. Um, both sides were restricted. Her broad and round ligament and right uterosacral ligament were all tight. So everything on her right side was super tight with her uterine ligaments, and so we did some release work and really helped soften that, that uterus as well. Internally, when I went to examinate her, examine her, um, her left or her right levator ani muscles had increased tone and her right coccygeus had increased tone, which goes along with that common birth pattern in the shearing of the sacrum to the right. We always find that coccyg- whatever side the shear of the sacrum is to, that coccygeus tends to be tight. I did find her external anal sphincter muscle to have in- tension in the inferior half, which tells us that that sacrum was stuck in flexion, pulling on the inferior half of that sphincter muscle. And after I released that, then I checked out her IRF, the ischiorectal fossa, and it was restricted on the left. And when I went to release that, a- um, compressing the adductors is, um, really helped that IRF to release. I will be updating and, uh, revamping the holistic postpartum body course, and I will be adding this technique into that. So if you've already purchased that course, you'll get that in the new release. So I encourage you to please go back and, and watch the newer videos because I will be adding this because it's so important that we've got to work with the adductors while we're working with the, the ischiorectal fossa. Okay? So now the other thing that was really interesting with her is that she also told me that she had been in a bunch of car accidents, like five whiplash car accidents, several of them when she's stopped still, which is actually more force imparted on the body when you're at a dead stop and you get hit versus if you're actually moving and then get hit. Um, so she's had several whiplashes in her body. And, um When I went to listen, I think one of the first things that I got drawn into was her right side sternum was really restricted, and it was really connected into her lower cervical spine, and that her occiput, her OA point, um, joint was pulling down on the right-hand side. And then C2 and 3 were restricted and posterior, and so that, you know, her whole cervical neck could have used a ton more work. I could have spent the whole hour just working on her sternum and, and, and cervical area. But I did just a little bit of work to help sh- you know, free that up a bit. And, um, and then went to her, um, you know Think about, like, so I worked on this area, and then I went to the pelvis and really ... or uterine ligaments, released the uterine ligaments, especially on the right side. And then I went to the pelvis and really helped get her out of that open birthing pattern, and then worked internally to release the, the tension there internally with the muscles and the EAS and the IRF. And then, um, the other thing that, that came up, um- As I was working on her pelvis, besides the postpartum patterns, as I was tuning into her sacrum, I could feel the right side sacrum being jam- pulled upward, and it wasn't happening on the left. And this is that tuning into the tissues to see what do these tissues want to do. And as they were pulling up on that left, uh, right side, I could feel it going up into the cranium, and so I felt like there was a dural tube release that needed to happen. And I connected those two and released that dural tube on that right side, and then I came back down, and the sacrum was more neutral. So whenever I feel a bone wanting to move in a certain direction, that is its hint to me, "Hey, this is what I want to do." So let's encourage that. Let's take it into that pattern more, and then let's see if it wants to release and come back out of it after it's released, and that's what it usually does. So her sacrum did that, which that is not a common postpartum pattern. That was in her body probably from one or all of those car accidents that she has ... that she's dealing with in her body. And so it's just so important that we listen to the body and figure out what the body and the tissues actually want to do and see if it correlates with what we know about the history of that body. Because when, say, someone falls, I wanna understand what happened during the fall. Like, where did they land? What forces were imparted into the body during that fall? If they can remember. Sometimes falls happen so quickly that they're like, "Ah, I don't know. I don't remember." And if you tune into the tissues, you may feel some upwardly directed pull of the tissues, whether it's on the ischium, whether it's on the sacrum, and you may get a sense of like, oh, you really landed on this left ischium. I can feel it being pulled up towards your head. Or oh, your left side of your sacrum is really drawing up towards your head. That's the energy from the fall that we can tune into. Um, now the other thing, um, I did work on pushing with this person, um, in all positions, and guess what? She could not push in supine. She was best in side-lying. We brought her into tall kneeling and s- hands and knees and, um, did the, the, um, protocol that I teach in the, the pregnant body course. Um, and side-lying truly was best for her. And, um, so, you know, she can still work on it. She's only 25 weeks at this stage of the game. And then I did, because she is hypermobile and I could feel that in her tissues, and I kinda got a sense of that from when she said her, her sister and her bladders are low I actually discussed with her the use of using a pessary early postpartum to help support her bladder early on. And, um, and she was pretty open to that idea. She really liked the idea of having that support in there. And, um, you know, we know she has hypermobile tissues. However, if we can support those tissues and keep them upright, remember the first eight weeks is when that collagen is shifting to a more stiff collagen. If, if it can do that in a more supported position, that might be super helpful for her. Now, with the hypermobility, we do know that she lacks more type, um, type one fibers, which are the stiffer fibers, so she's more stretchy. But I'm just a, a big fan of trying to get in that, that early postpartum pessary so that we can support those tissues and maybe help them, help them to heal in a more shortened position. And then I also talked to her about strengthening and keeping all of her abs stro- as strong as possible throughout the, the pregnancy. And, um, I do plan on following up with her and, um, and seeing what stays in her body and what other support she needs throughout this pregnancy, so. But the, the reason for me sharing these two case studies because they're, they're similar but yet different, and that they both presented with issues in their body from accidents and incidences that they've had in their past. And, um, and the first one, the 35-week-old, she also had a spinal condition where she was born without the, the nice S curves of the spine. She was born with a more flat um, uh, spine. And I could feel that in her cervical spine. It was really lacking any PAs. It was more straight and was missing that lombardic, lo- lombardic, uh, lordosis in the cervical spine. Um, and so I did work on just trying to get her some more mobility, and I could really feel it in her sacrum and tailbone. It just felt really hard. And I was like, "Have you fallen on this?" And she's like, "Yes." And I'm like, "Okay, I can feel that in here." So I worked on compressing that lower sacrum and that coccyx bone to help release that tension in that bone and get more mobility in those structures. And she felt much bet- both of them felt much, much better in getting off the table and just having more freedom of movement in their bodies. So, um, I just wanted to highlight this point that while I teach you these patterns to look for in postpartum clients and, and even in pregnant clients, these are some of the techniques we can do. We also need to take into account what has happened to that body, what injuries, what impacts have they, um, experienced, and work with whatever patterns those experiences have imparted into their body. And that can also help bring greater relief to our pregnant clients, okay? So keep that in mind. Thanks so much for listening in, everybody, and we will see you all on the next episode. Please share this with any colleagues to help get them thinking outside of the box a little bit more. All right, thanks. Take care everybody. Bye-bye.