A case study by J. Kurz and Diane Borello-France (1) followed a 31-year-old woman with Pelvic Organ Prolapse (POP) and mixed urinary incontinence who began PT 53 days postpartum. The authors used a Sahrmann movement system approach to assess her pelvic floor dysfunction—looking at posture, hip strength, and movement patterns.
Her symptoms included:
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Feeling like a tampon was falling out
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Constipation and straining
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Vaginal dryness
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Lower abdominal pain
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Incontinence and dribbling
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Incomplete bladder emptying
She had low fiber/water intake, minimal caffeine use, and was breastfeeding while taking a daily prenatal vitamin.
Objective findings included:
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Swayback posture, posterior pelvic tilt, and knee hyperextension
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Weak hip external rotators and glutes
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Overuse of psoas, DRA (3-finger width)
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Positive left SI joint tests
Movement diagnoses:
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Underactive pelvic floor
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Pelvic tissue impairment
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Movement coordination deficit
Treatment included:
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Education: toileting posture, hydration, childcare positioning
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Manual therapy: colon massage, pelvic floor facilitation, fascial mobilization
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Exercises: pelvic floor holds (5–20s), DRA-focused core work, hip strengthening
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Functional training: diaphragmatic breathing, resisted sit-to-stand, step-ups, trampoline jumping
Results:
After 14 sessions over 18 weeks, her PFDI-SF-20 score improved by 56 points, surpassing the 45-point MCID—showing significant reduction in symptom distress.
💡 This case highlights the value of a movement-system-guided approach in shaping effective postpartum treatment. With so many systems impacted during pregnancy and delivery, assessing both structure and movement is critical to lasting improvement.
1. Kurz J. Borello-France D. Movement system impairment-guided approach to the physical therapist treatment of a patient with postpartum pelvic organ prolapse and mixed urinary incontinence: case report. Phys Ther. 2017;97:464-477.
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