Patient's question:
Dear expert,Around 37 weeks of pregnancy, I experienced pain in my right hip joint, especially when walking, which also radiated to my outer genital area. Now that I have given birth, I still have some pain. I read some books and personally think it might be the pubic symphysis diastasis mentioned in them. Therefore, I would like to ask the expert if I have this condition. If so, how should it be treated? Thank you!!!
Doctor's answer:
Hello: Based on your symptoms, it is very likely that you have symphysis pubis diastasis.During pregnancy, especially as delivery approaches, hormonal changes cause the sacroiliac joints and the cartilage and ligaments of the pubic symphysis to become loose. During childbirth, mild separation occurs at both the pubic symphysis and the sacroiliac joints, 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 recover. However, in 0.05%–0.1% of cases, excessive secretion of hormones (progesterone) leads to excessive ligament relaxation, making it easier for the sacroiliac joints and pubic symphysis to separate during labor. Prolonged labor, a large baby, improper or posture during delivery, and cold exposure to the lumbar-sacral area are other factors that can disrupt the balance of pelvic contraction during or after labor, potentially causing misalignment of the sacroiliac joint cartilage. Due to the rough surface of the sacroiliac joint and its varied morphology, minor joint misalignments are 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 symphysis pubis diastasis.
The patient lies prone, and the therapist stands on the affected side, applying the "Gun" method to the sacroiliac and lumbar-gluteal regions. This is combined with massage and kneading at points such as the eight lower back points (Ba Liáo), Huantiao, Dazhongshu, and Guanyuanshu, along with passive movements for the posterior extension of the lower limbs. The technique should be 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 performs downward traction for 1–2 minutes.
The patient then lies on the healthy side, with the healthy leg straight and the affected leg bent 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 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. The therapist then flexes the hip and knee to the maximum extent and performs rapid knee extension and lower limb traction.
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, 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. Then, both hands apply opposite-directional pushing and pulling.
The patient lies prone once more, and the therapist stands on the affected side. One hand presses downward on the affected sacroiliac area, while the other hand supports the front of the affected knee. Both hands apply opposing force to extend the lower limb to the maximum extent, followed by a sudden, opposite-directional rotation, often producing a popping sound as the joint realigns. The therapist then uses massage, kneading, tapping, and scraping techniques to align the muscles around the sacroiliac area and then applies heat to the affected sacroiliac region.