fiddle leaf photography
May 27, 2017
It started when I was less than 20 weeks pregnant with my second baby. A constant pain in my pubis symphysis joint that was made worse by the simplest daily activities. Walking for any amount of time, lifting, turning over in bed….they all became painful. During my first pregnancy I taught group fitness classes until I was 35 weeks pregnant, but during my second pregnancy I wasn’t even able to put my pants on standing up by 20 weeks due to pain.
It has taken me more than 3 years to be able to fully process what happened and to finally be in a place where I feel like I can share my experience. And I share solely for the purpose of reaching one other person out there who is going through this. As I continually meet new mothers at their photo sessions, I’ve realized that so many of us feel alone in this motherhood journey. But, the real truth is that we aren’t. There’s always another mother out there going through the same struggles, but connecting with each other is where the challenge lays. There is SO little information on pubis symphysis pain (especially after pregnancy) available and I spent endless nights scouring Google for any advice or suggestions, so if one little piece of my story resonates with another mom then this journal entry has done its job.
In my early 20s, after my Dad died from a heart condition, I came to the realization that I needed to take control of my health, and so I started on a journey to become more fit. I had attended group fitness classes for years and knew that teaching them was the next logical step (plus, getting paid to work out is a good deal!). Just prior to my wedding in 2009 I was teaching an average of 5 times a week and was also working with a personal trainer. It was big part of my life, and was also my stress release. After we moved to Edmonton I continued to teach, although not at the frequency I had been.
In 2010 I became pregnant and we were ecstatic. My first pregnancy went off without a hitch. I was low risk, barely slowed down my exercise, travelled, and had no problems sleeping. I struggled with pregnancy as the loss of control over my own body was much more challenging than I had anticipated, but aside from some minor back pain when sitting, I didn’t have any real issues.
In early July of 2011 I was induced at 38 weeks as my water had broke and I wasn’t in labour. With a lot of help, I managed to have a birth without an epidural, and although it was insanely intense, it was without any complications. We forged ahead in parenthood. It took us more than 2 years to feel refreshed (and rested!) enough that we were ready to try for another baby. I was back in shape, was at a weight lower than my pre-pregnancy weight, and other than not sleeping through the night, things were good.
My second pregnancy started out much the same as the first, and I was confident that the next 37 or so weeks would again be uneventful. Right around 16 weeks though, I started to notice a lingering pain in my pubic bone after I exercised. It was right in the centre, towards the front, on the bony part – basically where a bike seat would hit if you leaned forward. I ignored it for a while, thinking I’d just tweaked something and it would pass. It didn’t. I’d ice it after exercise, which did nothing but make everything cold, but I kept doing it anyway thinking it must be helping somehow. A few weeks later I made an appointment with the chiropractor to see what she could do. She’d helped me with my back pain throughout my first pregnancy, so was pretty sure that with a few adjustments it would be gone. I went multiple times a week for adjustments, and even had micro adjustments using the clicker right on my pubis symphysis, but nothing was helping. The pain continued to get worse, and was intensified with any asymmetrical movements (strenuous walking, balancing, lunges).
At around 20 week I had my first appointment at the maternity care clinic. I was being seen at a Primary Care Network staffed by family physicians who had a special interest in obstetrics. Each visit I saw a different physician, depending on who was working that day, and whomever was on call when I went into labour would deliver the baby. I mentioned the pain in my first appointment and the doctor told me that it was probably just my pelvis growing and shifting, and that it would go away. I left feeling a bit deflated, but hopeful that this wouldn’t last the whole pregnancy.
Over the next few months, the pain got worse until I could no longer do cardio at the gym. Running was instantly painful, the cross trainer caused pain if I had any resistance, and the upright bike was horrible as it placed pressure right where the pain was. I could do weights, but only upper body as anything involving squatting or lunging also caused pain. I’d sit on the stretching mats at the gym and hold back tears as I watched other people push their bodies. I’d never been injured to a point that I couldn’t do what I wanted and I didn’t handle it well. Yes, I was pregnant, and I needed to watch what I did and not push it too hard, but the fact that I couldn’t even do a squat was killing me. (For the record, squats are my favourite!). Fitness had been such a large part of my life for the last 15 years and now the fact that I couldn’t even do a squat was too much for me to process. Every time I’d step trough the gym doors I’d feel worse about my situation, so I eventually decided to put my gym membership on hold and instead focus on walking around my neighbourhood for the remainder of the summer.
The pain had gotten bad enough that I brought it up again at my next pre-natal appointment, this time with the Resident who was doing my check up. He said he wasn’t sure what the pain was, but would check with the physician he was working with. He left the room and I waited. Then I heard him talking to the physician in the hallway right outside my door. He explained my pain and how it was affecting my daily activities. She responded to him that he should tell me that is just what happens in second pregnancies, and that I’ll have to deal with it. Had I heard her right? She couldn’t possibly be telling me that I need to just suck it up? I cried. Hard. Right there on the exam table, hoping that it would be a few minutes before he came in. Thankfully it was, and by the time he came in and told me (in a slightly nicer way), I just nodded my head and left the appointment, to again cry more in the car on the way home. I couldn’t believe I’d been dismissed like that. I was disappointed in my caregivers but also in myself. Looking back, I wish now that I’d stood up for myself more and insisted that my pain wasn’t normal.
Throughout this time I continued to go to the chiropractor, and although it wasn’t really helping, it made me feel like I was at least doing something. My husband urged me seek out help from other practitioners, as he was sure there must be something that could be done. He saw that I was spiralling, and quickly. Exercise was my release, and now that was gone. The summer came and I was at the point of not being able to walk to the playground, which is less than 2 blocks away, with my daughter.
I researched pelvic floor physiotherapists and made an appointment with one near my house. I had such high hopes that she was going to help. I only had a month or so left in my pregnancy, but I was at the point where I couldn’t stand on one leg at all, or even turn over in bed without excruciating pain. I was miserable, and was becoming someone who wasn’t pleasant to be around. The day of the physio appointment I woke up feeling like this was going to be it – the last day I’d be without answers. Unfortunately, it didn’t turn out that way. The physio therapist did a full assessment and told me that although the pain was bad, there wasn’t anything that could really be done while I was pregnant. I’d need to live with it and once I delivered, the pain would go away. She suggested the use of an SI belt around my hips to put pressure on my hips and basically push them together (think a giant velcro corset but around your hips). Fuming inside, I bought the belt, but barely wore it as having a belt pulled tight right over your bladder when your 36 weeks pregnant is a deal breaker. I left that appointment almost ready to drive straight to the doctor and ask for an induction as I needed this baby out.
During this whole time I had to significantly slow down my business. Following small kids around during a session wasn’t doable and if I did attempt it, I’d pay the price for days afterwords with amplified pain. I even remember telling a potential client that I could do her session outside as long as they were cool all just staying in one place. It’s hard to admit that now, that I’d actually say that to someone, but I did. I was desperate to hang onto the momentum my business was gaining, but at the same time balance my physical predicament.
I started to panic about the delivery and that my hope of an unmedicated birth wasn’t going to happen, as I wouldn’t be able to handle the pain in my pubis symphysis as the baby passed through the birth canal. I brought my concern up at another pre-natal appointment (with yet another physician) and she assured me that the pain wouldn’t be an issue and that as soon as I delivered the pain would go away. I can’t say that I believed her.
I hung in there for the last few weeks of my pregnancy, hoping each day that our daughter would make her appearance and I’d be able to move onto life with a new baby and no pain. The day before my due date I called my doula crying (there was a heck of a lot of crying!) and begged her to help me get this baby out of me as I couldn’t be pregnant for one day longer. We tried a bunch of tricks, and thankfully my daughter went along with it! I was in labour for only a few hours and had a very fast, un-medicated and uneventful birth (in the assessment room on a gurney as all of the rooms were full, but I didn’t care!).
It took a few days to feel like I was up to walking any distance, but once I did, the pain was gone. GONE!!! I couldn’t believe it. The doctors had been right. I was incredibly relieved and basically filed the last 6 months away into the back of my brain, never to be lived again.
Boy, was I wrong.
Around the 3-4 month mark, post delivery, I noticed the pain starting to creep in again. It wasn’t as bad as it had been, but it was definitely back. Again, being the stubborn person I am, I ignored it and figured it would go away once I got stronger. Again, I was wrong.
The heavier my daughter got and the more I tried to increase my exercise, the worse it got. This time though, I knew I had to take matters into my own hands as it wasn’t just going to go away. I had no baby to deliver and therefore no relief or end-date in sight.
I made an appointment at another pelvic floor physio clinic. I was pretty sure this wasn’t an actual issue with my pelvic floor, but figured that someone with a specialty in post-natal issues would be able to help me. Again, I went in hopeful. After multiple appointments, it was clear that the therapist and I weren’t gelling. There was never any hands on manipulation of the actual bone, no muscle release techniques and no stretches. As I’d already gone over my health benefits allotment and was now paying for all these treatments out of pocket, I couldn’t afford to keep going to things that I didn’t feel were working.
I made an appointment with my family doc – who I love and have been seeing for years. For some strange reason, I hadn’t actually seen her about this issue yet. Looking back, I wish I’d gone to see her so much earlier. This was now summer – almost a year after my daughter was born. When she asked me why I was there, I completely broke down. It had been almost 2 years of pain and I was feeling so alone. I hadn’t met a single other soul who’d experienced this and I felt like I’d wasted so many times at appointment after appointment, getting no results. She listened and passed me tissue after tissue as I let all of it out in her tiny little exam room. She actually mentioned to me that I didn’t at all seem like myself anymore. She said she’d always thought I was strong and could handle the world, and this had changed me….I was unsure and hopeless. We decided we needed to make a concrete plan, and that I was to check back in with her after each referral to make sure things were working.
I was sent for x-rays and then referred to the Glen Sather Sports Medicine Clinic at the University of Alberta Hospital, in hopes that a physician there would be able to refer me to the appropriate physiotherapist. The referral came through quickly, and within a few weeks I had an appointment. The doctor and I looked a the x-rays together and could see that yes, there were some bone spurs and a slight imbalance with my pubis symphysis joint. He explained that he often sees this injury in soccer and hockey players due to the repetitive nature of the sports – he’d never treated someone who’d had the injury due to pregnancy. The official diagnosis was Osteitis Pubis, which basically means inflammation of the pubis symphysis joint and surrounding muscle insertions. He was very honest with me and said that it was going to take a lot of work and a very long time for it to get better. I was prescribed some strong anti-inflamatories and a requisition for a cortisone shot if I should want it. I did NOT want it. A cortisone shot into that joint did not sound like fun. He also gave me some notes to provide to a physiotherapist. I left hopeful that at least now I knew what was wrong, so I could set on a path to fix it.
I wanted to try everything I could before resorting to the cortisone, so I started seeing a new phsyiotherapist. This one was very sports focused and worked on strengthening supporting muscles in hopes that it would provide the stability my pelvis needed. After we’d worked together for a few months I went on vacation with my husband without kids. I decided that for the first time ever, I wasn’t going to bring my running shoes on vacation. If I only brought flip flops, then I couldn’t even try to exercise. My job for a whole week was to sit and relax and to not exert myself at all. Guess what? The pain went away completely. I couldn’t believe it. Maybe it was all the fancy poolside drinks…..but more likely it was the fact that I was just being lazy. No lifting kids hundreds of times a day and very little walking. I was really hopeful that when I came home the pain wouldn’t return, but I was being a bit too optimistic. Within days of being home I was right back where I’d been, but now with the knowledge that it was what I was doing that was aggravating things. Although any real exercise was aggravating, the biggest culprit was my kids. Lifting them into their carseats, onto the slide at the playground, into my arms when they were hurt was putting too much pressure on that joint, which meant it was in a constant state of inflammation. I spoke to the physiotherapist very honestly and he said he didn’t feel there was anything more he could do. Deflated, again.
I decided it was time for the cortisone shot. The shot had to be administered by a radiologist under fluoroscopy at a medical imaging clinic. I’ll spare you the details except to say that the few minutes of pushing the cortisone in through the needle into my pubic bone was comparable to child birth. There is very little space for the fluid to be inserted into, so the pressure is incredible. I crossed my fingers that it was going to work, as I really did not want to go through the procedure again. About a week later, I was back in the same pain I’d been in and was convinced the injection hadn’t worked.
Around the same time, I started seeing a new chiropractor, Dr. Clayton Pilling at Core Wellness & Chiropractic in Sherwood Park . He’d treated a few of my husband’s friends for back issues and had helped my Mom with a severe neck issue and I was hopeful he might have a different approach. He did! Instead of doing traditional adjustments, he worked on pressure points on my inner thighs and hip flexors, while also ensuring that my hips were level. Within only a few treatments it was clear that it was working. I wish I could explain to you what it felt like at this point to feel relief. I still do this day do not know if it was solely him, or a combination of chiropractic and the cortisone finally kicking in (I was told it could take a month for the full effect of the cortisone to be noticed), but I was actually feeling better. After going multiple times a week for a few months I was pain free in my day to day activities. Any exertion still caused pain, but at least just living became pain free. This was huge success in my books.
If you’re still reading this, I commend you, as now that I’m typing it all out I can’t believe how many practitioners I saw over such a span of time!
Although the chiropractic care was doing magic, we both decided I should still go see a pelvic floor physiotherapist to ensure that there weren’t any underlying problems due to my delivery. I’d called to make an appointment Christina Ammann at Propel Sports Physio in Edmonton, a highly sought after therapist and had to wait a few months for an appointment. I met Christina in May 2016 (almost 2 years since giving birth) and again knew almost instantly that I was in the right hands. She listened so intently as I rambled off my very long history and said that it meant this time around we just needed to try things that hadn’t been tried yet. She agreed that this wasn’t a specific pelvic floor issue as much as it was a muscle issue. My adductors (inner thighs) were extremely tight, causing uneven pulling on my pelvis. I also had a small recti-diastases (separation of the abdominals) that hadn’t been diagnosed by any past practitioners. We worked on strengthening certain muscles and releasing others, while also trying to give me safer way to do some of my daily activities. I can remember so clearly having a conversation about how all I wanted to do was be able to lift my now 2 year old onto the playground equipment, and so we spent a whole session figuring out ways I could do that safely without causing pain. I continued to gain strength and now went days and days pain-free. By August, Christina said I was probably ready to cease treatment with her and see how things went. I went into the car and texted my husband, “I’m DONE!!!”. It felt like a graduation of sorts.
I carried on for the next 6 or so months mostly pain free. I was going to the gym 3-4 times a week, but was half-assing it. I was SCARED. So, so scared of doing something that was going to set me back right to where I’d been. I was at my heaviest weight in years and was feeling pretty unhappy with my body. I was also completely stressed out with my business and 2 young kids, and was taking on too much. We went to Hawaii over Christmas and I spent 2 weeks complaining about how tight all my summer clothes were. While on that trip I did some research and found a personal trainer, Christy Amason of Empowerfit, who specialized in post-natal fitness. I sent her what I am sure is the longest inquiry email ever, explaining my whole situation and asking if she could help. She said she had many ways of helping and that we’d take it really, really slow to ensure I don’t re-injure.
At the end of January 2017 I had my first session with Christy in her home studio in Sherwood Park. First off, she’s lovely, but more importantly, she’s so incredibly knowledgeable. We tried many exercises, some which worked and some which didn’t, but she kept trying to find thing that were going to make me feel successful and not aggravate the joint. By the end of our first session I was tired and shaking, and again, I started to cry. I explained that I hadn’t been able to work out hard enough to shake in more than 3 years and that just getting to this felt like the biggest milestone. Christy and I continue to work together and I’m now proud to say that I can squat 55 lbs! It’s not even close to where I want to be, but it’s so much further than I was even a year ago. But even more than the ability to lift weight again, my mental state has completely shifted. I’m confident again and I feel strong. My mood swings have stabilized a bit more and I feel like I can handle the demands of parenting and running a business from home so much better. I hadn’t realized how much exercised helped me with my mental state until I didn’t have it.
There were many points in my journey that I didn’t think I’d ever get to this point. That I’d have my life back without restrictions, or that I’d be able to pick my girls up and spin them around in the air without paying for it with pain the next day. I can honestly say that having Osteitis Pubis has been one of the hardest personal struggles I’ve had to overcome in my life. It has made me have such an appreciation for people who deal with chronic pain, and has also made me such a stout proponent of self-advocacy in our healthcare system. As I’ve spoken to so many of these practitioners, I now know that more could have been done while I was pregnant to prevent this. We’ll never know the root cause of why this happened to me, but if I’d started working on correcting it while I was still pregnant I could have probably saved myself years of therapies. If you’re reading this and have similar pain to what I had, I encourage you to not give up. Keep fighting until you find someone who will listen and take action. And if you’re in a situation that you’re dealing with this, please reach out as I’m happy to chat in more detail about what I think worked for me and what didn’t – nobody should have to go through this alone.
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