Pelvic pain is not always what it seems. I recently saw a woman in her early 30’s who had been having pain over her pubic bone region for over a year. The pubic bones are the part of the hip that meet in the front. Her pain started when she was in the third trimester of her pregnancy with her first and only child. Unfortunately over a year later, her pain had not gone away still. She had tried going to a chiropractor and physical therapist prior to seeing me.
She said that although the chiropractic treatment had helped, she felt the benefit had plateaued. She was hoping to get pregnant again, but was afraid to try again because she was worried whether or not her body could handle it. She was worried that the pain would not allow her to take care of her toddler.
As she was describing her story to me, I originally though this would be some kind of round ligament pain that often plagues pregnant women. The round ligament goes from the uterus to the pubic bone so often pregnant women describe pain there as their uterus grows. Although normally that pain goes away after childbirth.
She told me that her physical therapist found that her inner thigh muscles were really tight and sore on the left. The physical therapist had described that the muscles had pulled the left pubic bone down and that now they were not sitting symmetrically at the joint. So they had tried to massage and release the inner thigh muscles, which temporarily provided slight relief.
I have to admit that I did not see the tight inner thigh muscles on the left as having pulled down the left pubic bone, but I saw it the other way around. Something caused the left pubic bone to move down and the adductor muscles contracted simply to protect it. As I evaluated her, the left pubic bone was more dense “harder” than the one on the right. To me this is a sign that it is tender. We were still left with the question of what could have caused the pubic bone on the left to become so tender?
Initially I though it could have something to do with the uterus, but as I evaluated the uterus and the round ligament and uterosacral ligament, there was nothing there that stood out to me. She had had a C-section when she gave birth to her child so there was a scar just above the pubic bones. I explained to her that scars often act like “soft tissue black holes.” They pull all the tissue around them into them over time. Sometimes that can be a reason someone has back pain or other pains. It seemed like that could have been the answer, but I wanted to keep searching for other clues.
Recently, I published a post for professionals about how to isolate the kidneys, ureters, and bladder. In it, I describe how a problem in the bladder can cause the pubic bones to become dysfunctional. It can happen unilaterally. I definitely felt an issue in her bladder, but then I decided to check her kidneys as well. The left one felt somewhat inflamed. I decided that’s where I wanted to start.
Immediately, she said, “I feel that changing in a lot of places, including my pubic bone.”
I knew we were on the right track. Then she added, “By the way, I forgot to mention but I’ve also had kidney stones before and I had them in my 3rd trimester.”
Suddenly, it all made sense to me. It was the inflammation in her kidney that was causing a chain reaction down to the left pubic bone causing it to feel more dense and tender. That, in turn, was causing the inner thigh muscles to contract on the left.
After treating the kidney, I wanted to see what kind of a change took place from that. I wanted to know if my reasoning was right. So I went back to check the pubic bone. The pubic bone was instantly more pliable, resilient, and “softer.”
“That doesn’t hurt anymore,” commented the patient as we did that. Once she got up, she tried to recreate the motions that cause her severe pain, like holding a door open with her foot, but said she was no longer feeling the pain.
Seeing her back a week later, she remarked that her pubic pain had gone. She was amazed in disbelief at how much had changed in that one visit. Physical activities no longer caused pain. She was now hopeful that she could get pregnant and was no longer fearful that she would not be physically unable to care for her two children at the same time. She no longer felt like this was something she was going to have to “live with for the rest of her life.”
I was so grateful to be able to give this woman her life back. I will never know the full extent of it, but it is moments like this that make me extremely thankful that I can practice what I consider the most powerful manual therapy there is, osteopathy.
