By Rosaleen Gnoffo, PT, MS, DPT, PCS, and Lisa Sator, PT, DPT, WCS, CLT
Life as Rosaleen “Rosie” Gnoffo knew it literally shattered during the delivery of her son. In labor for more than a day, and while pushing for several hours, Rosie heard and felt a crack on the second to last push.
The pubic symphysis joint, composed of cartilage and ligaments, is typically 4 to 5 mm wide. During pregnancy, hormones such as relaxin increase flexibility for delivery. Rosie’s pain began when she was 10 weeks pregnant in both of her SI joints. She was working full-time as a pediatric PT throughout her pregnancy, and nobody could have predicted what was to come with baby Andrew’s arrival.
Two months after her son’s birth, an MRI revealed the bad news that no ligaments remained, and there was nothing but fluid between the two halves of her pubic bone. During what should have been a joyous time of new motherhood, Rosie felt mostly debilitating pain that prevented her from doing everyday tasks.
“I went from being an active, healthy pediatric physical therapist working full-time to a woman dependent on a rolling walker with a basket and wearing an adult diaper due to complete urinary incontinence,” says Rosie. “Every movement caused excruciating pain. My mother and husband had to support me, so I could be Andrew’s mom. I could not lift my own legs onto the bed.”
Six months after delivery, with no change in the width of the 3.1-cm gap, she sought surgical consultation. When Andrew turned age 1, Rosie underwent open reduction internal fixation (ORIF) surgery of the pubic bone and bilateral SI joints.
Lisa Sator, DPT, WCS, CLT, became Rosie’s PT during her post-operative care. Mindful of the emotional toll the past year had taken on her patient, Lisa created a customized therapy program. As Rosie improved, she began to realize the effect the therapy was having on her body.
“I will never forget what happened one day when Andrew was 2 years old. After so much work in physical therapy, I was finally able to lift up my sweet boy and hug him in a standing position. I knew I was going to be okay,” she says.
If you are interested in complex cases, join this dynamic duo in a discussion of Rosie’s journey to recovery during the “Complex Cases in Women’s and Men’s Health” session February 16 at 11 a.m. at the 2017 APTA Combined Sections Meeting in San Antonio, Texas. To register for CSM, visit www.apta.org/CSM/registration.
AUTHORS: Lisa Sator is a women’s health physical therapist and a board-certified women’s health specialist at Good Shepherd Penn Partners Penn Therapy and Fitness on the Pennsylvania Hospital campus. Rosie Gnoffo is a pediatric physical therapist and board-certified pediatric specialist currently working as an independent contractor, seeing children ages 4 to 20 at their schools or homes via Kaleidoscope agency or private hire. For the original full version of Rosie’s story, visit http://blog.pennpartners.org/repairing-rosie.