History

  • 35 year old, assistant principal, 7 week post partum
  • Complaining of increased low back pain causing difficulty with returning to workout routine, sitting and walking for prolonged periods of time, 6/10 pain at worst 
  • Complaints of Stress urinary incontinence with coughing/sneezing/running and inability to control flatulence. 

Examination

  • Bilateral trendelenberg with single limb stance
  • Lumbar extension – pain with overpressure, all other motions 100%
  • Pelvic floor muscle strength 1/5
  • Hip abduction: 4 – 4 - /5
  • Hip External Rotation: 3+/5 Bilateral
  • Hip Internal Rotation: 3+/5 Bilateral
  • Diastasis Rectus Abdominis: 2 finger width separation at umbilicus with soft end feel of linea alba, 1 finger width separation above umbilicus

Summary

Patient demonstrating core weakness through Transverse abdominis, Pelvic Floor Muscle and hip girdle regions influencing primary complaints of Low Back Pain, Stress Urinary Incontinence and lack of control with flatulence.

Treatment

4 week, 5 visit program focused on soft tissue work through obliques for Diastasis Rectus Abdominis separation, specific Pelvic Floor Muscle isolation, Hip rotator and abductor strength in open and closed chain, Pelvic Floor Muscle and transverse abdominis with coughing, Pelvic Floor Muscle/Transverse rectus Abdominis coordination including planks. 

Outcome

Resulted in 100% perceived improvement with back pain (2/10 at worst, Am stiffness only), able to return to workout routine, able to run 3 miles with no leakage and return of ability to control flatulence. 

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