Repairing Rosie

img_4609Life as Rosie knew it literally shattered during the delivery of her son. In labor for over 2 hours and while pushing for close to two hours, Rosie heard a crack on the second to last push. The trauma of the pelvic bone region left Rosie with 3.1 centimeter public symphysis separation in addition to sacroiliac joint (SI) widening. 

The pubic symphysis joint in the very front part of the pelvic bone  has cartilage that fills the gap in the bone, however  during pregnancy certain hormones such as relaxin soften  the cartilage to increase pelvic bone flexibility for delivery. In some cases the hypersensitivity in ligaments can cause some women to experience severe pain. While 11 weeks pregnant, Rosie experienced extreme pain in SI joints in her lower back.

Ten weeks after baby Andrew's birth, an MRI revealed that there were no ligaments remaining and there was nothing but fluid between the two halves of her pelvis in the front at the public bone.  During what should have been a joyous time of new motherhood, Rosie was challenged with debilitating body pain, preventing her from doing everyday tasks.

“I went from being an active, healthy, pediatric physical therapist working full time to a woman dependent on a rolling walker with a basket, wearing an adult diaper due to complete urinary incontinence,” says Rosie.  “Every movement caused excruciating pain. My mother and husband had to support me so that I could be Andrew’s mom, even though I could not lift my own legs onto an ottoman or onto the bed.”

Six months after delivery and evaluations, Rosie sought care with Dr. Samir Metha, Chief, Division of Orthopaedic Trauma, Associate Professor of Orthopaedic Surgery at the Hospital of the University of Pennsylvania, Orthopaedic Trauma Surgeon at The Hospital of The University of Pennsylvania.  In order to treat her pain and limping, Rosie would need to undergo open reduction internal fixation (ORIF) surgery one year post-partum.  The massive surgery would insert a plate and eight screws into the pubic bone, while 2 long bolts would be inserted in the SI joints.

img_4561Both pre-operative and post-surgical pelvic floor physical therapy would be necessary for Rosie to maximize the success of her treatment.  Rosie was no stranger to the benefits of physical therapy, as a pediatric physical therapist herself with over 17 years of experience. However this was the first time she would be needing intensive physical rehabilitation for herself. Prior to her surgery, Rosie began pelvic floor physical therapy at Penn Therapy & Fitness Pennsylvania Hospital. Before focusing on strengthening her pelvic floor muscles, physical therapy sessions focused on decreasing her pain and severe muscle spasms.

Once the surgery was completed, Rosie returned to Penn Therapy & Fitness Pennsylvania Hospital to begin post-operative outpatient pelvic floor therapy. This injury is very different to other traumatic pelvis dislocations that occur during motor vehicle or motorcycle accidents.  This injury happens during birth and Rosie was simultaneously breastfeeding her son twice a day during her surgery and recovery.  In order to continue Rosie’s healing while being mindful of the emotional toll the past year had taken on her, physical therapist Lisa Sator, PT, LANA, CLT, created a customized therapy program to meet specific needs.

“During pelvic floor physical therapy, Lisa utilized pelvic mobilization techniques, advanced strengthening exercises for my core abdominals, pelvic floor and hip stabilizers to improve my ability to stand on one foot for walking and stairs,” says Rosie. “During each treatment Lisa brought new ideas and techniques to continue my progress.  What really made a difference was Lisa always offering the emotional support that a person in my fragile state needed during recovery.”

As part of Penn Therapy & Fitness’s treatment approach, Rosie’s customized treatment plan included an exercise and education plan, focused on how to independently manage symptoms to reduce discomfort. Being able to be an active participant in her own recovery empowered Rosie as she coped with a condition that had taken so much out of her control.

 “Physical therapy has taught me so much that I still use every day. How to gently contract the deep abdominal muscles, how to relieve my own pain with certain muscle energy techniques, stretches, and exercise, or how to prevent injury in the positions I work in with infants on a mat such as squatting and kneeling,” says Rosie. “When I first received mindfulness mediation to relieve pain and stress as homework on my first day of pelvic therapy , I thought it was strange. But without a method to decrease the pain and muscle spasm that was intractable, I don't think I'd be where I am today.”

img_4610Patient education was also a crucial part of Rosie’s pelvic floor therapy program in returning her to normal activities. Because of the intimacy involved in treating conditions related to pelvic floor issues, patients may feel intimidated or embarrassed. But through the dialogue with Lisa during physical therapy, Rosie was able to address the problem and work on arriving at a solution.

“During physical therapy it was important that treatment would allow me to return to work and hobbies. Discussing my sex life and making sure that part of life was also incorporated was part of my care,” says Rosie. “With  all of the other aspects of treatment, it was great knowing that my physical therapist coached with exactly how to successfully get that part of my life back   with my husband.”

After several months of weekly pelvic floor physical therapy, Rosie began to realize the impact it was having on her body, as her life began to regain a familiar activity level.  As her body continued to recover, Rosie was able to reach her goals by increasing the ability of care she was able to provide to her young son without being preoccupied with pain or fear of injury.

“I will never ever forget the day I was able to lift up my son for the first time in a standing position without fear when he was two years old. The day I was able, after so much work in physical therapy, to lift up my sweet boy and hug him in a standing position, I knew I was going to be okay,” says Rosie. “I can now do so many things I could not have dreamed of doing before.  At first, I was unable to even roll over in bed without excruciating pain. I was afraid to step off a curb the wrong way and get hurt.  I was afraid because a gentle ocean wave hitting me on the side could land me in pain. Now I can not only lift Andrew in a standing position, I can rough-house and let him ride on my shoulders and frolic in the ocean for hours.  I feel very lucky for the care I received.”rose01

Five and half years since the birth of her son, Rosie has been able to return to work, and to being a hands-on mother to her little boy without being sidelined by pain or fear.  Rosie has been able to regain her life through a successful recovery because of the collaborative care of Penn Orthopaedics and Penn Therapy & Fitness.

“Physical therapy is what got me where I am. I needed Dr. Mehta to put the bones back together with screws and plates and I will be forever indebted to him for giving me back my pelvic stability. Dealing with the extensive soft tissue injuries and chronic pain is the long road.  Only physical therapists like Lisa Sator at Penn Therapy & Fitness have the ability to heal this delicate region of the body with incredible success.”

Click here to learn more about the pelvic floor therapy program at Penn Therapy & Fitness.