Background: Physiological and biomechanical changes must be considered when evaluating and treating musculoskeletal impairments in a perinatal female athlete, whether or not these impairments are directly related to their pregnant or postpartum state. Case Description: This case report describes a 34-year-old woman active in high-intensity functional conditioning, recreational volleyball, and running, seeking care for shoulder and thoracic back pain from birth to 1 year postpartum. Her primary complaint of shoulder pain was exacerbated by overhead activities. She also presented with a secondary complaint of "weakness" through her core, preventing return to sport. Treatment focused on joint mobilizations, neuromuscular reeducation, and core strength using biotensegrity principles throughout the postpartum journey of return to sport. Outcomes: The patient was highly motivated and met her desired goals to (1) compete in recreational sand and indoor volleyball starting at 6 weeks postpartum, (2) participate in a relay trail race at desired pace, and (3) compete in a weightlifting competition at 8 months postpartum without an increase in shoulder pain. Discussion: This case demonstrates the importance of addressing the entire kinetic chain in the postpartum athlete while addressing what may be considered a "straightforward" orthopedic condition. Understanding birth and postpartum healing is essential for physical therapists working with active mothers. Knowledge of the physiological and biomechanical changes during and after pregnancy is essential to appropriate treatment of these patients.