Mulberry Whale PTM

Shared with the client’s consent. Some details have been altered to protect her identity.

Background

The client is a woman in her 30s who works in education. She gave birth several years earlier and later returned to strength training, including deadlifts above 50 kg. She also reported intermittent yoga and Pilates during the postpartum period, along with moderate home-based exercise.

Presenting concerns

She presented with lower back and pelvic pain, with symptoms radiating to the lateral thigh. She also reported a dull ache in the pelvic and sacral region, neck pain, and recurrent lightheadedness when moving from lying to upright. She had previously sought medical evaluation for possible cervical instability. A self-administered Beighton score suggested generalized joint hypermobility. This is a screening tool only and not a diagnosis.

[She was under the care of (doctor or specialty) and was cleared to take part in exercise. Add any precautions used, such as modified neck loading or gradual position changes.]

Imaging and assessment findings

The following findings were reported from her medical investigations. They are listed for context only, and no claim is made that they explain her symptoms, as incidental imaging findings are common.

• Bilateral hip MRI: benign-appearing sclerotic foci in the right ischial tuberosity, the right iliac wing adjacent to the sacroiliac joint, and the inferior right femoral neck.
• Lumbar spine MRI: degenerative disc changes at T11/12 and an intraosseous disc herniation (Schmorl’s node) at T11/12 extending into the superior endplate of T12.
• Cerebral blood-flow measurement: reduced flow in the left vertebrobasilar arterial system.

Movement assessment observed pelvic asymmetry, reduced core control, instability, knee locking, and features consistent with diastasis recti following pregnancy. It also observed scapular dyskinesis, weakness of the neck and shoulder musculature, impaired coordination, muscular imbalance, and altered breathing mechanics.

Exercise programme

The programme aimed to address muscle imbalance, improve breathing mechanics, and train the deep core, diaphragm, and pelvic floor musculature. Balance training was included to support postural control and movement stability.

Outcome

After five to seven initial sessions, together with regular home practice, the client reported reduced pain, improved endurance, and increased general strength. She was advised to continue the home programme and return for follow-up as needed.

Discussion

Pelvic joint motion has been found to be greater in women with pregnancy-related pelvic and low back pain than in those without pain, although the overlap between groups is too large for motion to be used diagnostically [1]. Evidence on whether generalized hypermobility raises the risk of pelvic girdle pain is mixed: one prospective cohort found no increased risk overall, but higher pain intensity in early pregnancy among women with hypermobility [2].

Low back pain in people with hypermobility is considered multifactorial and not purely anatomical, which supports addressing movement, breathing, and load management together [3]. Orthostatic symptoms such as lightheadedness on standing are also reported more often in people with hypermobility disorders [4]. No autonomic or hypermobility-spectrum diagnosis was made in this case, and these symptoms were a matter for her medical team.

This case may therefore illustrate a possible contribution of generalized hypermobility to postpartum pain and movement difficulty. It also suggests a possible interaction between core stability, pelvic control, breathing mechanics, and postural symptoms, although the relationship with the cerebral blood-flow findings remains unclear. Further research is needed to clarify the relationship between generalized hypermobility and low back pain.

Limitations

This is a single case. The client also exercised at home during this period, outcomes were self-reported, and there was no comparison or control, so the improvement cannot be attributed to the programme alone. Postpartum pain can also change over time on its own.

References

1. Mens J, Pool-Goudzwaard A, Stam H. Mobility of the pelvic joints in pregnancy-related lumbopelvic pain: a systematic review. Obstet Gynecol Surv. 2009;64(3):200-208. doi:10.1097/OGX.0b013e3181950f1b
2. Generalized joint hypermobility and the risk of pregnancy-related pelvic girdle pain: is body mass index of importance? A prospective cohort study. Acta Obstet Gynecol Scand. doi:10.1111/aogs.14664
3. Eseonu KC, Payne K, Ward S, Fakouri B, Panchmatia JR. Chronic low back pain occurring in association with hypermobility spectrum disorder and Ehlers-Danlos syndrome. Int J Spine Surg. 2021;15(3):449-457. doi:10.14444/8067
4. Association of postural orthostatic tachycardia syndrome, hypermobility spectrum disorders, and mast cell activation syndrome in young patients; prevalence, overlap and response to therapy depends on the definition. Front Neurol. 2025;16:1513199. doi:10.3389/fneur.2025.1513199