Case report: Physiotherapy strategies for a woman with symphysis pubis diastasis occurring during labour

Abstract

This case report demonstrates a therapeutic exercise program as a noninvasive functional treatment for symphysis pubis diastasis (SPD) and reports its results. A 32-year-old primigravida with SPD during labour received a specific functional exercise program, which consisted of abdominal stabilization and strengthening of the pelvic floor muscles, hip adductors, and extensors; training for bed mobility; and walking training with suitable aids. The program was performed for 1-hour per session, twice a day, for 2 weeks. Before the intervention, the patient was totally dependent on others for performing her daily activities owing to severe pain in the pelvic region. After the 2-week intervention, however, the interpubic distance was reduced by 36% (from 22 mm to 14 mm), and pain and functional disability were remarkably improved. Moreover, the patient could walk independently for 30 m with a pelvic corset. Our results suggest that a systematically designed functional rehabilitation program may be beneficial in the functional recovery of patients suffering from SPD related to pregnancy.

Diastasis of symphysis pubis and labor: Systematic review

“…The present systematic review found use of physiotherapy as the main component of conservative treatment for the majority of women with SPD [1,4,7,10,12,[18][19][20][21]24,[27][28]. Most of the studies employed physiotherapy for walking reeducation, mobilization under supervision, and/or strengthening the core muscles, although only two studies detailed the stabilizing and/or strengthening exercises [10,15].…”

“…Most of the studies employed physiotherapy for walking reeducation, mobilization under supervision, and/or strengthening the core muscles, although only two studies detailed the stabilizing and/or strengthening exercises [10,15]. However, the start of the physiotherapeutic treatment varied from the 2nd to the 14th day after labor [1,[24][25].…”

“…However, the studies that included exercise intervention reported good results in terms of pain and functionality after 2 wk when the exercise program consisted of strengthening and stability exercises [10]. Because very few studies included exercise programs in their conservative approach, a recommendation for specific exercises as part of SPD treatment is difficult to justify.…”

“…The authors reported that after 2 wk of these exercises, the pain significantly decreased from 9.0 to 4.0 points (on a 10-point visual analog scale), the difficulty of performing an activity decreased from 8.0 to 3.3 points, and the interpubic gap improved by 36 percent, although ascending and descending stairs remained difficult. In this study, the lack of follow-up prevented the determination of the time to complete resolution [10]. Nitsche and Howell analyzed and treated a woman with SPD (route of delivery: vaginal, single child of 4.8 kg) including reeducation on walking after bed rest and showed that the interpubic gap decreased from 1.1 to 0.5 cm after 6 wk, but the woman continued to have pain while walking with aids [18].…”

“…Conservative methods suggest lateral decubitus bed rest, a pelvic girdle, walking aids, and progressive mobilization [9][10], although some clinicians also use pelvic traction [7]. Physical exercise seems to play a role in the prophylaxis of SPD [11].…”