Patient's question:
I started experiencing pain in my left thigh root when I was about 9 months pregnant, which affected my ability to walk. Later, after the doctor massaged it once, I couldn't lift my left leg at all. I couldn't even get into the car or into bed. After giving birth, I had a CT scan, and the result showed a separation of the pubic symphysis. Now that my child is 17 months old, could the pubic symphysis possibly heal on its own? I am currently taking calcium supplements.Doctor's answer:
When a woman is pregnant, especially close to delivery, the endocrine system causes the sacroiliac joints and pubic symphysis cartilage and ligaments to become loose. During childbirth, mild separation occurs at both the pubic symphysis and the sacroiliac joints on both sides, temporarily expanding the pelvis to facilitate the baby's delivery. In most cases, after delivery, the secretion of progesterone returns to normal, and the relaxed ligaments and cartilage also return to normal. However, in 0.05%–0.1% of cases, excessive secretion of endocrine (progesterone) leads to excessive ligament relaxation, making it easy for the sacroiliac joints and pubic symphysis to separate during labor. Prolonged labor, a large fetus, improper exertion or posture during delivery, and cold exposure in the lumbar-sacral area are various factors that can disrupt the balance of pelvic contraction during or after delivery, potentially causing misalignment of the sacroiliac joint cartilage. Due to the rough joint surface of the sacroiliac joint and its varied morphological changes, subtle joint misalignment is common. As a result of these factors, postpartum sacroiliac joint misalignment occurs, preventing the pubic symphysis from returning to its normal position. If it does not resolve on its own within a certain period and symptoms worsen, it develops into postpartum pubic symphysis diastasis.The patient lies prone, and the therapist stands on the affected side, applying the Guan method to the sacroiliac and lumbar-gluteal regions, combined with massage at points such as the eight lower back points (Baoli), Huantiao, Dazhui, and Guanyuan. Passive movements for the extension of the lower limbs are also performed, with the technique being gentle.
Next, the patient lies supine, and the therapist stands on the affected side (taking the right side as an example). The therapist uses the right armpit to hold the patient's right ankle, with the right elbow bent and the back of the forearm supporting the back of the patient's lower leg. The left hand is placed on the front of the affected knee, while the right hand is placed on the middle third of the left forearm. The therapist then firmly holds the affected leg and pulls downward for 1–2 minutes.
The patient then lies on the healthy side, with the healthy leg straight and the affected leg flexed at the hip and knee. The therapist stands in front, using one hand to press the front of the patient's shoulder and stabilize the body backward, while the other hand presses the affected hip forward to the maximum extent, concentrating the twisting force on the sacroiliac region. The therapist then applies simultaneous, symmetrical diagonal force.
The patient then lies supine again, and the therapist stands on the affected side. One hand supports the back of the affected lower leg, while the other hand holds the affected hip, flexing the hip and knee to the maximum extent. The therapist then performs rapid knee extension and lower limb traction while in the flexed hip position.
Finally, the patient lies on the healthy side, with the healthy leg straight and the affected knee bent at 90°. The therapist stands behind, using one hand to press the sacroiliac joint forward and the other to hold the upper part of the affected ankle, pulling backward to the maximum extent. The therapist then applies opposite-direction pushes and pulls with both hands.