Over the past few years, I've been introduced to symphysis pubic dysfunction a handful of times. Yes, I've read about it and been tested on SPD in school, but I must say the real life version sucks a whole lot more. None of the cases were the same except for the patient's description of discomfort and loss of function- burning, shooting, stabbing pain in the groin with the inability to spread legs wider than 6 inches and walk normally.
Most recently, I had a very dear client, who has agreed to allow me share her story in regard to symphysis pubic dysfunction. She just so happens to be the BIRTHFIT South Bay Affiliate. Nicole was active throughout her entire pregnancy. She is a personal trainer and continued to do so throughout her pregnancy. Nicole’s life is full of movement. She leads Yoga & Beer groups, offers private training sessions, and leads goal setting groups in the South Bay. To say that she is a go-getter would be a serious understatement. Nicole did functional strength and conditioning plus yoga throughout her entire pregnancy. She came to see me for chiropractic care quite often, and she did all of her homework. Nicole was an A+ BIRTHFIT student.
Fast forward to the big day, a little early at 39 weeks, Nicole went into labor. To save her full birth story for another time and to allow her to tell you, I will jump to conclusions. Nicole had an intense, powerful labor and received an epidural quite close to the actual birth of her baby. Now, Nicole is not one that even takes ibuprofen, so asking for an epidural was a big deal. Upon receiving her epidural, Nicole noticed that she couldn't feel things. She knew that legs would feel like they were asleep with an epidural, but this feeling was super weird and almost like she couldn't move or feel her own body. It felt a bit off to her. Labor progressed and without feeling the urge to push, Nicole was instructed to push by the medical staff. With her legs and feet being held up and back (pull your knees to your chest), Nicole pushed with all her might to get her baby boy out.
Time out. I mentioned that Nicole trained. But, she is not one to know her 1 rep max deadlift or max back squat and she would probably laugh at me if I asked her what her GRACE time was. Nicole gets movement and more importantly she understands mindset training, which is one of the biggest reasons she's on the BIRTHFIT affiliate team. Based on everyone's actions within the room, Nicole knew to push with all her strength for however long it would take to get her baby boy out. Nicole knows how to work.
Congratulations, Nicole! I can honestly say you rocked it!
However, just like in any marathon, World Cup, or even CrossFit Games, there are injuries that happen. There are risks and benefits to everything in life. That's just part of the gig.
Nicole suffered an injury from birth. No her body did not fail her. The system failed her. Her body did the work asked of it.
Out of all the women that I have seen that have experienced and suffered with SPD, I can honestly say that Nicole is the first active woman that I've seen experience SPD. No other woman that I have seen with SPD led a BIRTHFIT lifestyle in her pregnancy. Nicole is our first. Congratulations, my dear!
To keep moving forward, Nicole messaged me after birth to let me that she could not walk. Even though her doctor said, "You just had a baby"; I knew there was room for more concern knowing Nicole. Within 3 days of her giving birth and returning home from the hospital, I was at her house providing chiropractic care. We immediately diagnosed her with symphysis pubic dysfunction (and possibly diastasis of the pubis, which is confirmed via MRI). We started with what we had and built from there. Both her husband and I had to help Nicole on and off the chiropractic table for our first session at her house. Nicole needed assistance getting in and out of bed, using the bathroom, and for sure taking a shower. This is the video of her walking after our first session.
Notice her right hip. This would display a positive Trendelenburg’s sign. There is obviously no stability and very little motor control. Also, notice Nicole's posture, lop-sided shoulders, and overall lack of confidence.
We started with muscle work, belly breathing, and mobilizations of the pelvis. Her initial homework was Posture Awareness, Belly Breathing, and Modified Box Squats. All movements were to Nicole's comfort level. For instance, she used assistance for the first few days of modified box squats (to a kitchen chair) and kept her legs directly under her hips. By the next session, Nicole was moving around a little better, but her husband and I still had to help her on and off the chiropractic table.
Fast forward to 20 days postpartum and at least 4 sessions into care, Nicole can go for a slow, leisurely walk on her own. Her exercises include the movements previously mentioned, without a doubt, but they also include functional progression part 1 with minimal leg involvement, pallof press supine with knees bent, and modified functional progression 3 (Nicole only lifts her leg to the point just before discomfort).
Nicole suffered from a birth related injury. It was not her fault. In fact, her body is pretty freaking intuitive and strong, and her body was probably protecting her from a more severe injury and/or risk. Yes, Nicole was a bit down and depressed. She’s never been immobile in her life. However, she refuses to play the victim card. Nicole continues to progress forward, one day at a time.
Nicole is the only woman I’ve ever treated immediately after birth to tell that she cannot wait to give birth again. WHAT?! She is already brainstorming about how to evolve for baby #2 and help women along the way.
Nicole will recover and be stronger than ever before. She is a motivator and inspiration to many women. Stay tuned for more to come from BIRTHFIT South Bay leader Nicole Foster.