Pubic Diastasis and Post-Partem Hip/Back Pain

[fozzy40]

I'm a physiatry resident and saw a patient in my outpatient clinic that brings up this question...

32 yo G1P1 SPVD at 40 wks c/b 3rd degree perineal laceration with pregnancy related RT hip and back pain. She had a signficant amount of pain post-partem but was able to walk. She was found to have a 3.96cm pubic diastasis. She was seen by ortho who felt it should be best managed non-surgically. She was discharged to home after one week.

Is there a protocol (imaging, consults) for severe post-partem hip or back pain in the OB literature? I did a Pubmed search and did not come up with much in terms of a protocol.

Thanks for your help!

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[fozzy40]

Any thoughts or suggestions?

 

[fozzy40]

Can a moderator move this question to the PM&R forum? If I get responses there I will make sure to come back and post my findings. Thank you!

 

[wannabeOBGYN]

I can't tell you about any particular protocol, but as a DO student it was discussed in an OB/GYN OMM lecture. There are manipulative treatments that can be quite effective if there is a skilled OMM-practicing DO in the area. The doctor who gave the lecture had a purely OMM practice for a while and said she dealt with a TON of postpartum patients who had a lot of relief from her treatments. Just a thought. I hope someone else has some more substantial info for you.

 

[fozzy40]

Yeah, I did try some of the techniques that I was taught. The muscle energy techniques I did try did seem to help approximate the gap. However, the gap is too large at this point for basic manual techniques to be effective in my opinion. She's doing well with hip and pelvic stabilization techniques thus far. However, prolonged standing and transitional movements still give her a good amount of discomfort.

 

[axm397]

refer to the RIC pelvic pain clinic - prescribe pelvic PT

You brought back 6 months of bad memory - PTSD - from my pelvic pain continuity clinic days as a PGY2.