Evaluation of the spine and pelvis

Evaluation of the spine and pelvis

I have been treating pelvic floor dysfunction for over 20 years.  My initial training came from a Myofascial Release prospective, which is whole body approach, as well as my own personal journey as a pelvic floor patient.   The pelvic floor muscles are a group of muscles that span from the tail bone to the pubic bone and across both sit bones.  They have 3 primary functions.  They support the pelvic organs, which include the digestive and reproductive organs.  They provide sphincter control for the bladder and rectum which affects continence.  They also provide sensation for the pelvic floor.  Pelvic floor dysfunction occurs in both men and women and includes problems such as: urinary and fecal incontinence, pelvic pain, sexual dysfunction and infertility.  Over the past 20 years, I’ve seen much greater awareness of this chronic problem.  However, although treatment is becoming more commonly prescribed, it’s focus tends to be a very narrow focus with the practitioner only looking at the imbalances of the pelvis and not including the connections above and below.  This is the 2nd article in our series on pelvic floor dysfunction.  The first article, Pelvic Floor Dysfunction and The Problem with Kegels,  focused on a very important component of effective pelvic floor muscle function which involves proper breathing.  This article will look at the whole body connection with pelvic floor dysfunction.  Why is our posture important if we are looking to correct urinary incontinence or pain with intercourse?

In order to answer that question, we first have to quickly review what fascia is and why it’s important to us.  Fascia has become a hot topic now due to the predominance of chronic pain in our society.  Fascia is connective tissue that runs continuously from head to toe without interruption.  It covers every muscle, every nerve, every organ, all the way down to the cellular level.  It provides a fluid network that supports us and gives us a resilient, mobile, adaptable structure.  This fluid medium provides cell to cell communication.  When fascia becomes shortened such as in accidents, injury, daily repetitive stresses, it becomes dehydrated or loses it’s fluid medium.  The mobility and resilience of our structures are now compromised and cellular communication is altered which affects our overall health.  So why not just drink water to rehydrate?  If you have a root bound plant and you pour water in it, the water will just run through without hydrating the dry, brittle roots.  You have to give those roots space so they can absorb water.  The same thing applies to our body.  We have to get that space back for our cells to rehydrate.  Stretching will only stretch the elastic component of our muscles.  Opening up the fascia requires a low load, long held position- usually at least 2 minutes but sometimes up to 3-5 minutes.  How many of us actually take that time with our stretches?  Stretching feels good in the moment but without opening the surrounding fascia, that muscle will resume it’s shortened position when we go back to our regular activities.   It’s why we only get a temporary relief of our pain.  It’s also the reason why our pain will move around our body and why pain patterns will increase when we try to “exercise them out”.

The pelvis is our center of gravity and it’s position affects the position of our head, neck, shoulders and lower extremities.  Unfortunately, our primary activity these days is sitting.  We sit long hours for work, play games and balance our home finances on our PC’s, tablets and mobile devices.  A compressed sitting position will generally cause compression of the upper spine and neck and affect the activity of our respiratory diaphragm, which is our primary breathing muscle.  Part 1 of this series explained how the respiratory diaphragm and pelvic diaphragm work together and are necessary for proper function of the pelvic floor muscles.  Remember, the pelvic floor muscles need to not only contract and lift, but also relax and drop in order to have complete function.

Here are some examples of how problems away from the pelvic floor can actually cause pelvic floor problems.

Poor Posture: Poor posture is more common then not.  We are usually rounded in our trunk with a more forward head posture.  This causes a decrease of mobility of the head and neck and compromises proper breathing.  This posture often causes a predominance of upper chest breathing with minimal activity of the abdomen and pelvic floor.  This can lead to pelvic floor weakness, incontinence and prolapse because the pelvic floor muscles become rigid from lack of use.

Tight hamstrings: This is also common with poor posture and a lot of sitting.  Because the hamstrings attach to the back of the sit bones, they affect the position of the pelvis as well as bending the knee.  That forward head, rounded shoulder posture often causes the pelvis to be tipped back and adds to the shortening of the already shortened hamstrings from increased sitting times.  Proper mobility of the pelvis is essential for getting proper hamstring length.  Without it, all the hamstring stretching in the world can still leave you with tight hamstrings.

Tight gluteals: The gluteal muscles have an attachment into the tailbone.  If the gluteals are not equally balanced, which can happen with  exercise or improper standing, the tighter side will pull into the tail bone causing tailbone and/or pelvic floor pain.

Sciatica or Piriformis syndrome: Sciatica is often caused from tightness of the piriformis muscle.  The piriformis muscle is one of the deep hip rotators located within the pelvic floor.

I also have a contrasting example of how a pelvic floor issue can cause symptoms away from the pelvis.   This client presented with difficulty breathing and fatigue.  She had actually been to another treatment facility for intensive treatment of chronic myofascial pain.  The pelvic floor muscle tone was addressed, however, strength was not addressed.  She had a very weak pelvic floor and was not activating her pelvic floor muscles at all.  She also had a lot of tightness in her upper chest and respiratory diaphragm.  When I addressed the weak pelvic floor and had her start activating her pelvic diaphragm with proper breathing, her breathing difficulty was reduced by over 50% immediately.  In her case, the weak pelvic floor muscles were like a weight pulling down on her trunk and made it difficult for her to activate her breathing muscles properly causing her symptoms of weakness and fatigue.

In summary, fascia is continuous through the whole body and causes twists and kinks that may cause symptoms away from the area of discomfort.  We have to look at the whole body connection with pelvic floor dysfunction if we want to have a good outcome with symptom resolution.  Many people think that they can exercise out a muscle imbalance.  No matter how good the exercise, it will not release restricted fascia if you are not maintaining a position for 2 to 5 minutes.  If you have pain or are experiencing any pelvic floor symptoms add Myofascial Release treatment to your exercise plan.  You may be surprised at what you learn about your body!

 Verde Valley Myofascial Release in Sedona/Cottonwood, AZ and Hands On-Austin in Round Rock, TX are both dedicated to providing the highest quality of Myofascial Release treatment.  Good Myofascial Release treatment integrated with other forms of manual therapy as well as postural correction, body mechanics correction and appropriate exercise progressions are essential for correcting muscle imbalances, decreasing pain and maintaining overall wellness.

Jody Hendryx, PT