The Pelvis-Neck Connection Every Postpartum Therapist Needs to Know

Could your postpartum client's neck pain actually begin in the pelvis?

In this episode, Lynn Schulte, PT, explores the often-overlooked relationship between pelvic stability, upper cervical mechanics, shoulder function, and the physical demands of caring for a newborn. Learn why headaches, neck pain, thoracic outlet symptoms, and shoulder tension may be driven by postpartum compensation patterns – not just local tissue dysfunction.

You'll discover how birth biomechanics influence the entire body, why first rib mobility and scalene function matter, and practical assessment strategies you can immediately integrate into your postpartum evaluations.

If you're a pelvic health therapist, physical therapist, occupational therapist, bodyworker, or birth professional looking to improve outcomes for postpartum clients, this episode offers valuable clinical insights you won't want to miss.

Subscribe for more evidence-informed education designed to help you transform the way you practice and help your clients recover more completely after birth.

About The Speaker

Lynn Schulte, PT is a pelvic health physical therapist with more than 30 years of experience helping practitioners understand the biomechanical, myofascial, and nervous system influences affecting pregnancy, birth, and postpartum recovery. Through the Institute for Birth Healing, she teaches evidence-informed continuing education courses focused on practical techniques that help clinicians achieve meaningful outcomes for their clients.

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Transcript

@0:09 - Lynn Schulte, PT (lynnschultept@gmail.com)

Hello everybody and welcome to this episode. And today we're going to be talking about the different part of a body that I normally talk about because you know my focus has mainly been down in the pelvis, pelvis, but today we're going to be talking about our head and our shoulders and our neck because they are greatly influenced by what's actually happening in the pelvis.

Our body is so flipping amazing and that when something is off kilter down below, the body adjusts and makes changes to help us to be able to see and move and create balance in our system.

So there's a lot going on that we don't even have to think about, thank goodness. And as pelvic health therapists, we need to understand these kind

And so today in this episode, I really want to highlight the connection between our head and neck and shoulders to our pelvic space, and especially in the postpartum period, because the head and the neck and shoulders take on so much strain from caring for a baby that I really do hope that you are addressing this area in all of your postpartum clients.

I don't cover this area in my holistic treatment of the pregnant body or postpartum body courses, but I do have a couple of techniques that I teach in the advanced postpartum techniques course that I would love for you to check out because it is a really, really important area, especially if our clients are coming in complaining of headaches, neck pain, shoulder pain, carpal tunnel, even thoracic outlet issues.

A lot of that can be from this postpartum. Fathom caregiving that happens, and our moms get in these postures, and they don't realize how much stretching and work they need in their upper body, in their upper neck and head and shoulders area, and so that's what I really want to highlight today with you, and you know, I'm sure if you've been listening for a while, you know about the open birthing pattern in the pelvis, how the pelvic bones widen for a baby to come on out vaginally, and if the baby comes out asynclitic or OP, or it's a really challenging, challenging birth, getting that baby through the pelvis, there is a chance that the pelvis can get stuck in what I coined the open birthing pattern of the pelvis, and that creates an instability in the pelvic space, and our body needs to create weight bearing, okay?

So the weight needs to transfer, the load, the... The the... Gravity needs to transfer from the legs up into the trunk somehow, some way, and when the side of the pelvis is more unstable and it's not able to create good weight-bearing through it on that side, actually our shoulders become the weight-bearing force.

Now, when I first heard about this, I was like, what are you talking about? But I have seen it over and over and over in my clients that one of the first things I do in my sessions is I, in standing, after I do my intake, in standing, I will place my hands on a person's shoulders and read their body in standing.

And when I place my hands on the shoulders, one of the first things I'm feeling for is that tension, that musculoskeletal tension in the shoulders, in the scapula, or in the scalenes, the other S-word there, and the upper traps and everything.

Wherever my hands are in contact, I'm just... Just tuning in to see what is that tension and is that tension even side to side, or does it feel increased on one side?

If I notice, because my fingers are kind of draping over the clavicles at this point, and if I notice there's a lot of tension on one side, I do a gentle inferior mobilization to the shoulder blade.

And if it moves and it's got a little bit of sponginess and give to that clavicle and scapula area, then I'm like, okay, but then I compare it to the other side.

And if it's really stiff and it doesn't move on one side and it moves on the other side, the side it doesn't move on, I'm wondering if it is more unstable, maybe that ischium is more splayed out to the side on that side, or there's something about the pelvis on that side that is not able to effectively weight bear in the SI joint on that side.

And so the shoulders have to take up some of that action in there. So that can create stiff. We can also have an elevated first rib and think about what's happening with the caregiving there with moms caring for babies.

They're usually holding the baby on one side, so their shoulder might be elevated, maybe protracted a little bit, and we've just got increased tension in the TC junction and in that whole upper trap area, scalenes, all that in there is just working overtime, just holding the baby.

And so we want to address that tension in those muscles and also really assess and look for that first rib.

That first rib can get elevated on one side with caregiving. And also please keep in mind what your clients were doing during pushing.

If they spent hours and hours pushing a baby on out, like what position were they in? What was their head?

What were their arms doing? That can also impact the tension that we're finding in their body. But going back to caregiving as well, the head is looking down a lot at baby.

And for people who are less endowed with breast tissue, they really have to crane their necks down to be able to see baby, especially while breastfeeding.

More endowed women, that's not as challenging for them. And that can create a lot of strain on the upper cervicals in that suboccipital area.

And also, we also must remember the ocular motor reflex that our body has actually includes three different reflexes in the body.

It is the ocular motor system, which is cranial nerves three, four, and six. And these help to move our eyes so that our eyes stabilize on a target.

And then we have the vestibular ocular reflex that helps to move the eyes in the opposite direction of the head movement so it keeps our vision clear as we're moving our head and looking and turning and bending and things.

And then we have the head writing reflex or the vestibulospinal reflexes that address the, they adjust the neck and the trunk muscle tone so that the head stays roughly aligned with gravity.

And all three of these work together to stabilize our visual world and our balance. And if the pelvis is off, this system is going to maybe create some curvature in the thoracic or lumbar spine and it's also going to tilt our head one direction and then our eyes are going to write.

So you've seen, I wonder if you've seen those clients that come in and you look at them and their head is tilted one direction, but their eyes are level and then you try to write their head and they go, but that feels crooked.

So And you have to explain this writing mechanism, this reflex in our body that like, yep, your body's always going to try to keep your eyes level, no matter what your head is doing.

And this system is intimately connected with our pelvis. And whenever you make changes in the pelvis, we must address this upper cervical area for how our head is sitting on our neck.

And the OA, the occipital atlas joint, is critical for this. That's how the head sits on that first vertebrae of the cervical spine, and that can get tilted or in dysfunction, and sometimes it can cause a lot of headaches for moms, a lot of tension in the upper neck area, and then think about them trying to look down at their baby, it's just increasing that tension.

So a lot of the early and even long-term caregiving modes that moms go into caring for their babies and their infants.

time, right atlas? That Creates a lot of extra tension on this system that might already be tense from just the birth itself.

So please make sure that when you are working with your postpartum clients, especially when we address any pelvic changes that we find in our clients, we must address that upper cervical area, how the head is sitting on the spine.

And I teach the suboccipital release in the advanced postpartum techniques course. I also teach the dural tube. I really love the dural tube.

If you've taken craniosacral classes, you know about the dural tube. It's the connective tissue that holds the cerebral spinal fluid that coats our brain and our spinal cord.

If I were to draw it on a board, it would look like a tadpole. So big head with this long tail.

And that's the connective tissue that holds the cerebral spinal fluid that coats our nervous system. don't tail. of since here, So

And it attaches in at the sacrum and at the cranial base. And whenever I make big adjustments in the body, I always like to go to that dural tube at the end of a session and just release that dural tube.

Sometimes I'll find on the right-hand side that that dural tube feels more restricted and compressed compared to the other side.

So then I work on lengthening that side that's tight. And I feel like that dural tube is the deepest part, like our deepest core structure that dural tube coats every single nerve in our body.

And when we do beautiful release work externally somewhere in the periphery of the body, even if it's in the trunk, I want to go to that dural tube and release it from the deep part of that structure in our body so that the pattern is released not only in the periphery, but also in our deep core as well.

And . And these are, you know, just some of the techniques that are so important. Also, first rib. If you're not mobilizing first rib, please check that out.

I do talk about that a little bit in the postpartum body course if you come live. But being able to mobilize and release that first rib is really, really helpful, especially if your moms have any scalene tightness, any thoracic outlet symptoms, nerve compression, any changes in their upper extremity, we need to be addressing that first rib in there and mobilizing it to increase mobility and decrease some of the tension in those tissues, okay?

So the suboccipital area, getting those muscles to release, and also assessing the OA, we can work through it through the cranium to adjust it and help it to sit so that the cranium sits better on that first vertebrae.

And then mobilizing the first rib and of course, making sure the pelvis is stable. That's always my first go-to is the pelvis and adjusting that and then going up to the neck and head and shoulders and releasing all that.

So please, this is your reminder to make sure that you are addressing the head and the neck and the shoulders in your postpartum clients because of what they experienced during the birth, but also all the caregiving roles.

I love being able to instruct my mamas in a scalene stretch and the way I like to instruct it is to have them sit upright and hold on to the seat that they're sitting on.

We want to anchor the upper extremity down because the scalenes attach into that rib cage and if we, as we're moving our head, if our shoulder...

So comes along with it, we're not stretching that scalene muscle out. And so I want them to anchor their shoulder down by holding onto something.

And then I just have them turn their ear behind their shoulder. So let's say our left ear is going to go behind our left shoulder.

And then we're going to side bend back at a diagonal. And once they find they go into that diagonal motion, I ask for them when they start to feel a stretch in their neck and in their scalenes.

And from there, I instruct my clients to fine tune until they feel the stretch that feels the most intense.

And they may rotate a little bit more, they may side bend a little bit more, but it's the nuances that we want to guide them through in finding the best stretch.

Because there's a lot of scalene muscles in there. And we're not quite sure which muscle needs the most attention.

me, going do And so I'm that's let's And if you just have them kind of shift their head and neck with more rotation or more side bending and find that area that's like, oh yeah, that's the good spot that needs the most stretching, and then holding there.

And I always encourage my moms, my clients, to just start with a gentle stretch that when you hold that stretch, it goes away.

And to me, that's the muscles, actually those circumeters, actually lengthening and letting go. If we go too heavily into a stretch, I feel like that's the muscle fighting itself and it doesn't let go freely enough.

And I want the muscles to lengthen. So I don't want to go too extreme into a stretch where the muscle's fighting itself and it's not actually lengthening.

So if we start with a gentle stretch to where the stretch actually goes away, then we could add a little bit more to that motion and take it into a stretch again, gentle one.

And have it go away and wait and keep stretching it that way. To me, that's a more respectful way of trying to stretch a muscle versus taking it to its end range, and the muscles are going, eh, and they're hanging on for dear life, and they're not really letting go to lengthen.

So that's the way I like to instruct that. And then having them do it on both sides just really gets that, oh, oh, and then the other piece that I like to add to my scalene stretches is, once they find a good position that feels like a really good stretch on that scalene, I have them hold that there, and then I have them jut their lower jaw forward, and that increases the stretch on the scalene, okay?

So that jutting of the jaw forward, as in an underbite, they're creating an underbite with their mandible, and that intensifies the stretch there.

So that's another great way to just get different fibers in. Okay, so that's my tidbit on stretching your scalenes and really helping this whole upper area.

And then it's so important that we instruct our moms. I love moms to get a exercise ball. When I have a pregnant mom come in, I'm like, do you have a big exercise ball?

And they're like, no, I don't. I go, please go make that purchase because you'll love it when baby comes.

You can bounce on the ball with baby and that helps soothe baby, but you can also use it to stretch your upper body afterwards.

So I love my moms to just lay back on the ball, roll themselves back, and then putting their arms up straight up above their head as in an I formation and then out to the side in a Y formation and then directly at 90 degrees out from their side and in a T formation.

So I talk about the I, Y, and T formation to just really stretch out those pec muscles. And it also stretches out that anterior neck a little bit as well.

Um, post. Fathom, stretching the anterior neck is super, super helpful because of all the looking down. Whenever we get tension in our upper traps or in the back of our neck and head and shoulders, everybody wants to stretch that area first because that's where we're feeling it.

But it's actually because there's tightness in the anterior part of our neck. And when we stretch out the scalenes or the anterior cervical tissues, that's what releases the tension in the upper traps and levator scapula and all that.

Okay. So the other stretch I like to help my moms do is just looking straight up and back. However, I have them look up, but I tell them I don't want them to collapse their spine as they do that.

I want them to try to keep their neck as elongated as possible as they go to look up and then feel the stretch.

In the front of their neck and hold that there. And once they hold that there, again, doing that underbite, jutting that jaw forward, will just help intensify all those tissues in the anterior neck.

So those, the looking up, but not collapsing and letting the head just fall backwards, but keeping it engaged so that the spine stays lengthened is key.

And then once they feel a good stretch on the front of the neck, doing a jutting of the mandible forward can help intensify that stretch and holding that there and then doing scaling stretches, I just think are really, really nice for postpartum clients.

And then having the exercise ball to be able to back bend over and stretch out the shoulders and everything is just such beautiful care, self-care that moms can do for themselves to take care of their upper neck.

Second body, upper body, after having babies and caring for babies for months and months and months after. So I hope this was helpful.

Please know that we shouldn't just be focusing in on the pelvis, but we need to balance the upper body with the effect and works that we've done in the pelvis postpartum as well.

All right. I hope you found this episode helpful. Please share this work with other practitioners. Let them know about this podcast.

And I would so appreciate your help in sharing this work with the world. So thank you so much for listening in, and I will see you all on the next episode here is to smooth the bursts and faster recoveries.

Take care, everybody. Bye-bye.