title: Low back and hip pain in a postpartum runner: applying ultrasound imaging and running analysis.
abstract: METHODS
  Case report.
  
  
  BACKGROUND
  Postpartum low back and hip dysfunction may be caused by an incomplete recovery of abdominal musculature and impaired neuromuscular control. The purpose of this report is to describe the management of a postpartum runner with hip and low back pain through exercise training via ultrasound imaging (USI) biofeedback combined with running-form modification.
  
  
  METHODS
  A postpartum runner with hip and low back pain underwent dynamic lumbar stabilization training with USI biofeedback and running-form modification to reduce mechanical loading. Muscle thickness of transversus abdominis and internal oblique was measured with USI preintervention and 7 weeks after completion of the intervention. Additionally, 3-dimensional lower extremity joint motions, moments, and powers were calculated during treadmill running.
  
  
  RESULTS
  The patient's pain with running decreased from a constant 9/10 (0, no pain; 10, worst pain) to an occasional 3/10 posttreatment. Transversus abdominis muscle thickness increased 6.3% during the abdominal drawing-in maneuver and 27.0% during the abdominal drawing-in maneuver with straight leg raise. Changes were also noted in the internal oblique. These findings corresponded to improved lumbopelvic control: pelvic list and axial rotation during running decreased 38% and 36%, respectively. The patient's running volume returned to preinjury levels (8.1-9.7 km, 3 days per week) with no hip pain and minimal low back pain, and she successfully completed her goal of running a half-marathon.
  
  
  CONCLUSIONS
  The successful outcomes of this case support the consideration of dynamic lumbar stabilization exercises, USI biofeedback, and running-form modification in postpartum runners with lumbopelvic dysfunction.
  
  
  METHODS
  Therapy, level 4.
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Wisconsin, 1300 University Avenue, Room 5195 MSC, Madison, WI 53706, USA. thein@pt.wisc.edu
authors.forename: Jill M
authors.initials: JM
authors.lastname: Thein-Nissenbaum
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Thompson
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Chumanov
authors.forename: Bryan C
authors.initials: BC
authors.lastname: Heiderscheit
mesh_terms: D000009:Abdominal Muscles / Q000033:anatomy & histology / Q000000981:diagnostic imaging / Q000503:physiopathology; D000328:Adult; D001676:Biofeedback, Psychology; D005081:Exercise Therapy; D005260:Female; D006615:Hip / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D017116:Low Back Pain / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D035002:Lower Extremity / Q000000981:diagnostic imaging / Q000503:physiopathology; D049590:Postpartum Period / Q000502:physiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D012420:Running / Q000502:physiology*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography