A woman in her 20s residing in Yokohama visited my clinic due to left pelvic pain that persisted since immediately after childbirth.

She began to experience discomfort in her left pelvis (sacroiliac joint) a few days after returning home from the hospital, one month after giving birth. Although she had occasionally experienced lower back pain in the past, this was the first time she felt this particular type of pain. The pain was localized in the pelvis rather than the lower back and confined to a small area.

Since she could not take a break due to childcare responsibilities, the pain gradually worsened day by day. At a postpartum checkup, she mentioned her symptoms to the staff at the maternity clinic. However, because she was breastfeeding, she was prescribed acetaminophen and medicated patches to manage the pain while monitoring her condition. Unfortunately, her symptoms did not improve.

In an effort to address the issue, she attempted pelvic exercises she found online, but they only exacerbated the pain, leaving her feeling helpless. During this time, her husband researched treatment options and came across chiropractic care. After searching for “chiropractic Yokohama,” he found my website. Upon discovering that one of my specialties is “pregnancy/postpartum pain,” he suggested, “Why not give it a try?” This led her to visit Spine Chiropractic.

[Initial Symptoms]

Interview:

The patient reported that sitting for extended periods caused a gradual increase in a dull pain. When she placed her weight on the left side, the pain intensified, leading her to sit leaning more towards the right. Over time, she began to feel as though her pelvis was misaligned. Additionally, she mentioned that when wearing jeans or other stiff-material pants, she experienced a sensation of rubbing on the left side of her lower back while walking.

Visual Inspection:

While standing, a noticeable difference in the position of the hip joints and pelvic height was observed. During the seated interview, she was visibly leaning to the right, consistent with her reported discomfort.

Static Palpation:

Increased tension was noted in the right lumbar and gluteal muscles, along with outward displacement of the right hip joint. Furthermore, heightened tension was detected in the left gastrocnemius and soleus muscles. Significant positional differences were observed in the ilium and sacroiliac joint.

Motion Palpation:

During standing hip flexion and extension movements, discomfort was reported in the left side when weight-bearing on the left leg during right hip motion. For movements of the left hip, both flexion and extension elicited discomfort in the sacroiliac joint area.
In the prone position, applying pressure to the sacroiliac joint caused pain on the left side.

Orthopedic Tests:

DLR Test: (-) Slight discomfort on the left side.
Ely’s Test: (-) When left knee flextion, limited and hip raise up
Nachlas Test: (+) Pain in the sacroiliac joint.
Gaenslen’s Test: Pain in the sacroiliac joint.

Muscle Strength Examination:

Quadratus Lumborum: 5/5
Tensor Fasciae Latae: Left 5/5, but posture destabilized.
Gluteus Maximus: Left 4/5
Gluteus Medius and Minimus: Left 4/5

[Initial Treatment Plan]

Initial Focus of Treatment
The primary issue to address was correcting the pelvic misalignment. At Spine Chiropractic, I prioritize joint mobility; however, due to the strong relationship between muscles and joints, I carefully consider whether to improve muscle conditions first and then approach the joints, or to address joint issues first before tackling muscle-related problems.

In this case, the source of the pain was clearly localized around the left sacroiliac joint, indicating that the muscles were not the primary cause. It was evident that pelvic misalignment caused by pregnancy and postpartum changes was triggering the symptoms. Since no pain was experienced during the adjustment posturing, the initial treatment focused on pelvic correction and adjustments to the related lumbar spine.

At this point, the patient was asked to perform postures and movements that previously caused discomfort, such as sitting, standing, and bending and straightening her legs. It was notable how surprised she was at the significant reduction in discomfort.

Next Focus: Muscular Imbalances
The subsequent issue to address was the muscular imbalance. A disparity in the surrounding pelvic muscles was observed: the left pelvic muscles exhibited reduced tone, while the right side was excessively tense. While relaxing the overly tense right-side muscles was necessary, it was also critical to introduce therapeutic exercises aimed at activating the underperforming muscles on the left side.

Relaxing tense muscles tends to be more effective in younger individuals. This patient responded well, quickly regaining flexibility. However, the main issue lay in the left muscles being weaker compared to the right. To address this, she was provided with instructions for exercise therapy to incorporate into her daily life.

Patient Response and Progress
The patient’s response after treatment was as favorable as seen during interim checks. However, the correction of her body’s balance to its proper alignment caused a new sensation of unfamiliarity.

At Spine Chiropractic, I recommend all patients return for their second visit within one week of the initial session, regardless of the condition. This ensures accurate monitoring of symptom progression. In this case, the patient was scheduled to return five days later.

[Prognosis]

Second Visit
The patient reported that the symptoms improved for about two days following the first session but then returned to their usual state. Since the initial treatment was effective, the same approach was applied, with instructions to continue monitoring within a week. The patient was reminded to persist with the strengthening exercises for the weaker muscle groups as instructed during the first visit.

Third Visit
The patient again noted that the relief lasted for approximately two days before the pain returned. However, the intensity of the pain had slightly decreased compared to the first visit. The patient expressed concern about the recurring discomfort.

The core treatment approach remained unchanged, focusing on the dysfunction of the left sacroiliac joint. However, it became apparent that the patient’s habitual load patterns in daily life, particularly their center of gravity balance, needed broader adjustments. To address this, the treatment was expanded to include the knee and ankle regions.

This broader approach proved effective, and by the fourth visit, the patient reported that the pain had been reduced to less than half of its original intensity and was maintained for a week. This noticeable improvement left the patient feeling optimistic.

Fourth Visit
With the reduced pain persisting for a week, the same treatment was applied, and the interval between visits was extended to two weeks.

Fifth Visit
The patient reported that by the middle of the second week, the pain began to worsen but remained about half as severe as it had been initially. Additionally, the sensation of rubbing on the left side when wearing jeans was no longer present. The same treatment was provided, and the patient was advised, “Let’s observe for another two weeks. If the symptoms return at the same level, we’ll adjust the treatment approach. However, if they continue to improve, it may simply indicate that more sessions are required.” The patient was instructed to continue with their home exercise routine and monitor their condition.

Sixth Visit
The patient reported noticeable improvements, likely due to their consistent adherence to bodyweight training exercises targeting the weakened muscles on the left side. By the sixth visit, their discomfort had significantly diminished, with an average pain scale rating of 2–3/10.

Given the progress, the patient transitioned out of the “treatment phase to maintenance phase”.

Maintenance Phase
At the patient’s request, treatment shifted to a maintenance phase. To prevent recurrence, a regular monthly “reset” session was scheduled. This patient, who has been receiving care for four years (initially from a previous clinic I was working), continues to maintain their improvements through this maintenance routine.

[Practitioner’s Opinion]

The patient’s symptoms were distinctly localized to the left sacroiliac joint. During the second trimester of pregnancy and beyond, as the uterus enlarges with the growth of the fetus and amniotic fluid, intra-pelvic pressure increases, causing the pelvis to expand. This physical change leads to notable alterations in posture, resulting in changes in muscle usage. Consequently, walking, standing, and sleeping habits are also affected, creating variable stress points depending on the individual.

In this case, the patient likely had pre-existing pelvic misalignment influenced by their body structure and habitual patterns. This imbalance was exacerbated during pregnancy due to the uneven distribution of weight associated with a pregnant body. Over time, this led to concentrated stress on specific areas. After childbirth, the added physical demands of activities like breastfeeding and carrying the baby further accentuated the postnatal pelvic misalignment, creating a textbook case of postpartum symptoms.

Postpartum changes in body structure and pelvic alignment require proper chiropractic treatment and adjustments in daily habits to achieve long-term improvement. Without addressing these factors, even effective treatments may fail to maintain results over the long term.

With this understanding, each session emphasized the importance of muscle strengthening to the patient, helping them stay motivated and reducing the likelihood of recurrence.

Following the primary treatment phase, the patient transitioned to regular maintenance visits once a month as a preventive measure against recurrence. This proactive approach has allowed the patient to sustain their progress and maintain an improved quality of life.

Over the past four years, starting at a previous clinic, this patient has consistently entrusted me with her care. Moreover, she has referred many others to my practice, a gesture I deeply appreciate and value.

At Spine Chiropractic, I address a wide range of musculoskeletal conditions directly impacting daily life, not merely as a form of relaxation therapy.

Conveniently located within a one-minute walk from Bashamichi Station, an eight-minute walk from Nihon-Odori Station, a seven-minute walk from JR Kannai Station, and a 12-minute walk from JR Sakuragicho Station, my clinic is well-suited for residents and workers in the Yokohama area.

If you are experiencing similar symptoms, please feel free to visit Spine Chiropractic. I am committed to providing care with sincerity and professionalism.