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 was 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 women are pregnant, especially close to delivery, the effects of endocrine factors cause the sacroiliac joints and pubic symphysis cartilage and ligaments to become loose. During delivery, mild separation occurs in the pubic symphysis and both sacroiliac joints, temporarily expanding the pelvis to facilitate fetal 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) causes excessive ligament relaxation, making it easier for the sacroiliac joints and pubic symphysis to separate during labor. Prolonged labor, a large fetus, improper use of force or poor posture during delivery, and cold exposure to 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 morphology, subtle joint misalignment is prone to occur. 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 return spontaneously after a period of time and symptoms worsen, it develops into postpartum pubic symphysis diastasis.The patient lies prone, and the therapist stands on the affected side, applying the "Gun" method to the sacroiliac and lumbar-gluteal regions, combined with massage and kneading at points such as the eight lower back points (Baoli), Huantiao, Dazhui, and Guanyuan. Passive extension movements 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 grasps 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, one hand pressing the front of the patient's shoulder to stabilize the body backward, while the other hand presses the affected hip, pushing it forward to the maximum extent, concentrating the twisting force on the sacroiliac area. Then, both hands apply 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. Then, rapid knee extension and lower limb traction are performed while in the flexed hip position.
The patient then lies on the healthy side again, with the healthy leg straight and the affected knee bent at 90°. The therapist stands behind, one hand pressing the sacroiliac joint forward, while the other hand grips the upper part of the affected ankle and pulls backward to the maximum extent. Then, both hands push and pull in opposite directions.