Home based MFR managements for pelvic floor dysfunctions (5 Series)
Part I to V
Myofascial Release for Women’s Health Problems
(Read one by one from Part I)
Saturday, January 2, 2010
Home based MFR managements for pelvic floor dysfunctions: Part I
Myofascial Release for Women’s Health Problems
Pelvic Floor Dysfunctions and Treatments
There are thousands of women and men who believe that incontinence (loss of bowel or bladder control) and pelvic floor dysfunctions are normal part of aging. It is NOT a normal part of aging. We do not have to endure pads and medication - there are non-surgical options for retraining the bladder and pelvic floor that are proven through research as effective and efficient.
For Women, normal pelvic function also means that there is not supposed to be pain in the pelvic floor. Insertion of tampons, sexual intercourse, gynecological examinations and clothing should never cause pain. The muscles and tissues of the pelvic floor can be aggravated by many conditions including vulvodynia, vestibulitis, prolapse or cystocele/rectoceles or pudental Neuralgia. Myofascial release is a new tool to ‘down train’ the muscles of the pelvic floor, and to help restore normal flexibility and tolerance to the soft tissues both externally and internally.
Myofascial practitioners specialized in perineal, external and internal pelvic floor releases can help those sufferers retrain the muscles of the pelvic floor and assist with bladder and bowel training to return women and men to normal function.
Normal function means you can:
Allow the bladder to expand (fill) and contract (empty) normally and without pain.
Have the sensation and awareness of when the bladder is full – and be right.
Have the ability to get to the bathroom.
Have the ability to remove your clothing.
Participate in sexual intercourse without pelvic pain
Sit comfortably
Tolerate gynecological examinations
Myofascial Release Eases the Pain of Women's Health Problems
Myofascial Release has been on the forefront of health care for the past two decades particularly in the resolution of complex chronic pain problems. In that time, there has been an increasing number of women reporting problems such as urinary incontinence, pelvic pain, menstrual problems, fibromyalgia, chronic fatigue syndrome, and/or headaches. It is unclear whether this rise in these complaints is due to an increased prevalence or that women are just communicating more about their problems.
Whatever the case may be, it remains clear that the numbers are staggering in terms of the women who are affected by these problems. For instance, in 1996 the US Department of Health and Human Services reported that 13 million Americans are incontinent; 11 million of them are women. One in four women ages 30 to 59 have experienced an episode of urinary incontinence. 16.4 billion dollars are spent each year on incontinence-related care and 1.1 billion dollars is spent yearly on disposable products for incontinent adults.
How the Myofascial Release can help:
Incontinence: Some women undergo pelvic or abdominal surgery to help resolve incontinence, menstrual, or pelvic pain problems often associated with pelvic floor muscle weakness following multiple child births. This solution, however, often puts these same women at risk for developing other pelvic pain problems or reproductive dysfunction and infertility problems because of the scar tissue that forms following surgery.
Myofascial Release has been a tremendous help to women suffering with incontinence and pelvic pain. Myofascial Release techniques specific to the pelvis are helpful in decreasing the restrictions in that area that lead to incontinence and pelvic pain. This technique has also been adopted in areas such as the urology department at Stanford University, as noted in “A Headache in the Pelvis: A new understanding and treatment for prostatitis and chronic pelvic pain syndromes” by Dr. Anderson, MD.
Infertility: It is common to hear about the infertility problems that many women suffer with through the media or through family and friends. Many women go through expensive hormonal therapies and attempts at in vitro fertilization that offer no guarantees and are generally not covered by insurance. Expenses can run into the tens of thousands of dollars for the best technological advances that modern medicine have to offer in order to merely bypass what often is a structural imbalance in the body caused by myofascial restrictions.
Many women who have gone through all types of fertility treatments and had given up on ever becoming pregnant have been pleasantly surprised of the effects that Myofascial Release have had on their infertility...they became pregnant when all else failed! While they may have originally been receiving Myofascial Release for other pain problems, the effects of Myofascial Release particularly in freeing the pelvic region of adhesion has allowed for more normal reproductive function in these women.
The Myofascial system and chronic symptoms:
The myofascial system surrounds and interpenetrates every organ, nerve, blood vessel, and duct within the pelvic floor. Trauma, inflammation, surgical scars, and child birth very commonly tighten the myofascial system around these delicate and pain sensitive structures. Tightness and restriction within the myofascial system can cause or contribute to many women's health issues including pelvic floor pain and dysfunction, infertility, incontinence, vulvodynia, coccydynia, pelvic adhesion from endometriosis and surgical scars, painful episiotomy scars, interstitial cystitis, fibromyalgia and pregnancy related back pain and sciatica.
It is estimated that a large number of women experience infertility as a result of fascial restrictions from scar tissue, endometriosis or inflammatory processes. These fascial restrictions may physically interfere with fertility by compressing the reproductive structures such as the fallopian tubes or ovaries and can be helped with Myofascial Release. In addition, because the fascial system surrounds every system of the body, including the endocrine system, fertility problems related to hormonal imbalance may be helped using Myofascial Release. For example, the pituitary gland, the master gland of the body is housed within the sphenoid bone of the skull. Fascial restrictions throughout the neck, dural tube and particularly the suboccipital region often create compression of the sphenoid bone, which houses this delicate gland. Releasing fascial restrictions helps to free these structures and restore more normal function of the endocrine system thus helping to resolve fertility problems related to hormonal imbalance.
Painful or tight episiotomy scars are another common cause of pelvic floor pain and dysfunction and can be effectively treated by the therapists using this highly specialized form of Myofascial Release.
In addition to the various general and specialized myofascial release techniques for women with pelvic pain and incontinence, the therapists at the Myofascial Release Treatment Centers also address problems with back pain, neck pain, headaches and pelvic imbalance and instability that are frequently associated with these problems. Special techniques are utilized to eliminate pelvic torsions and upslips. Patients also learn valuable home self-treatment techniques to ease their pain.
Understanding the relationship between pain, anxiety, and structural changes allows trained therapists to restore the normal length and tension of the structures and connective tissues supporting the pelvic organs. Along with this, specific exercises and home care techniques are taught to correct faulty postural and movement patterns and restore function.
Don’t settle for less than health
You can contact Dr. Ajimsha through his official mail scebcaptmfr@gmail.com to discuss these treatment techniques and the possibility for you regaining control and use of your pelvic floor. Pain, loss of function for sex, inability to exercise and bladder problems are not a normal part of aging.
Pelvic Floor Dysfunctions and Treatments
There are thousands of women and men who believe that incontinence (loss of bowel or bladder control) and pelvic floor dysfunctions are normal part of aging. It is NOT a normal part of aging. We do not have to endure pads and medication - there are non-surgical options for retraining the bladder and pelvic floor that are proven through research as effective and efficient.
For Women, normal pelvic function also means that there is not supposed to be pain in the pelvic floor. Insertion of tampons, sexual intercourse, gynecological examinations and clothing should never cause pain. The muscles and tissues of the pelvic floor can be aggravated by many conditions including vulvodynia, vestibulitis, prolapse or cystocele/rectoceles or pudental Neuralgia. Myofascial release is a new tool to ‘down train’ the muscles of the pelvic floor, and to help restore normal flexibility and tolerance to the soft tissues both externally and internally.
Myofascial practitioners specialized in perineal, external and internal pelvic floor releases can help those sufferers retrain the muscles of the pelvic floor and assist with bladder and bowel training to return women and men to normal function.
Normal function means you can:
Allow the bladder to expand (fill) and contract (empty) normally and without pain.
Have the sensation and awareness of when the bladder is full – and be right.
Have the ability to get to the bathroom.
Have the ability to remove your clothing.
Participate in sexual intercourse without pelvic pain
Sit comfortably
Tolerate gynecological examinations
Myofascial Release Eases the Pain of Women's Health Problems
Myofascial Release has been on the forefront of health care for the past two decades particularly in the resolution of complex chronic pain problems. In that time, there has been an increasing number of women reporting problems such as urinary incontinence, pelvic pain, menstrual problems, fibromyalgia, chronic fatigue syndrome, and/or headaches. It is unclear whether this rise in these complaints is due to an increased prevalence or that women are just communicating more about their problems.
Whatever the case may be, it remains clear that the numbers are staggering in terms of the women who are affected by these problems. For instance, in 1996 the US Department of Health and Human Services reported that 13 million Americans are incontinent; 11 million of them are women. One in four women ages 30 to 59 have experienced an episode of urinary incontinence. 16.4 billion dollars are spent each year on incontinence-related care and 1.1 billion dollars is spent yearly on disposable products for incontinent adults.
How the Myofascial Release can help:
Incontinence: Some women undergo pelvic or abdominal surgery to help resolve incontinence, menstrual, or pelvic pain problems often associated with pelvic floor muscle weakness following multiple child births. This solution, however, often puts these same women at risk for developing other pelvic pain problems or reproductive dysfunction and infertility problems because of the scar tissue that forms following surgery.
Myofascial Release has been a tremendous help to women suffering with incontinence and pelvic pain. Myofascial Release techniques specific to the pelvis are helpful in decreasing the restrictions in that area that lead to incontinence and pelvic pain. This technique has also been adopted in areas such as the urology department at Stanford University, as noted in “A Headache in the Pelvis: A new understanding and treatment for prostatitis and chronic pelvic pain syndromes” by Dr. Anderson, MD.
Infertility: It is common to hear about the infertility problems that many women suffer with through the media or through family and friends. Many women go through expensive hormonal therapies and attempts at in vitro fertilization that offer no guarantees and are generally not covered by insurance. Expenses can run into the tens of thousands of dollars for the best technological advances that modern medicine have to offer in order to merely bypass what often is a structural imbalance in the body caused by myofascial restrictions.
Many women who have gone through all types of fertility treatments and had given up on ever becoming pregnant have been pleasantly surprised of the effects that Myofascial Release have had on their infertility...they became pregnant when all else failed! While they may have originally been receiving Myofascial Release for other pain problems, the effects of Myofascial Release particularly in freeing the pelvic region of adhesion has allowed for more normal reproductive function in these women.
The Myofascial system and chronic symptoms:
The myofascial system surrounds and interpenetrates every organ, nerve, blood vessel, and duct within the pelvic floor. Trauma, inflammation, surgical scars, and child birth very commonly tighten the myofascial system around these delicate and pain sensitive structures. Tightness and restriction within the myofascial system can cause or contribute to many women's health issues including pelvic floor pain and dysfunction, infertility, incontinence, vulvodynia, coccydynia, pelvic adhesion from endometriosis and surgical scars, painful episiotomy scars, interstitial cystitis, fibromyalgia and pregnancy related back pain and sciatica.
It is estimated that a large number of women experience infertility as a result of fascial restrictions from scar tissue, endometriosis or inflammatory processes. These fascial restrictions may physically interfere with fertility by compressing the reproductive structures such as the fallopian tubes or ovaries and can be helped with Myofascial Release. In addition, because the fascial system surrounds every system of the body, including the endocrine system, fertility problems related to hormonal imbalance may be helped using Myofascial Release. For example, the pituitary gland, the master gland of the body is housed within the sphenoid bone of the skull. Fascial restrictions throughout the neck, dural tube and particularly the suboccipital region often create compression of the sphenoid bone, which houses this delicate gland. Releasing fascial restrictions helps to free these structures and restore more normal function of the endocrine system thus helping to resolve fertility problems related to hormonal imbalance.
Painful or tight episiotomy scars are another common cause of pelvic floor pain and dysfunction and can be effectively treated by the therapists using this highly specialized form of Myofascial Release.
In addition to the various general and specialized myofascial release techniques for women with pelvic pain and incontinence, the therapists at the Myofascial Release Treatment Centers also address problems with back pain, neck pain, headaches and pelvic imbalance and instability that are frequently associated with these problems. Special techniques are utilized to eliminate pelvic torsions and upslips. Patients also learn valuable home self-treatment techniques to ease their pain.
Understanding the relationship between pain, anxiety, and structural changes allows trained therapists to restore the normal length and tension of the structures and connective tissues supporting the pelvic organs. Along with this, specific exercises and home care techniques are taught to correct faulty postural and movement patterns and restore function.
Don’t settle for less than health
You can contact Dr. Ajimsha through his official mail scebcaptmfr@gmail.com to discuss these treatment techniques and the possibility for you regaining control and use of your pelvic floor. Pain, loss of function for sex, inability to exercise and bladder problems are not a normal part of aging.
Home based MFR managements for pelvic floor dysfunctions: Part II
Myofascial Release for Pelvic Pain and Infertility
Myofascial Release has been on the forefront of health care for the past two decades particularly in the resolution of complex chronic pain problems. In that time, there have been an increasing number of women reporting problems such as urinary incontinence, pelvic pain, menstrual problems, fibromyalgia, chronic fatigue syndrome, and/or headaches. It is unclear whether this rise in these complaints is due to an increased prevalence or that women are just communicating more about their problems.
Whatever the case may be, it remains clear that the numbers are staggering in terms of the women who are affected by these problems. For instance, in 1996 the US Department of Health and Human Services reported that 13 million Americans are incontinent; 11 million of them are women. One in four women ages 30 to 59 have experienced an episode of urinary incontinence. 16.4 billion dollars are spent each year on incontinence-related care and 1.1 billion dollars is spent yearly on disposable products for incontinent adults.
One of the missions of this article series is to turn these numbers around if they can receive this. It is pathetic that the best our healthcare system has to offer incontinent women is disposable pads and adult diapers. Some women undergo pelvic or abdominal surgery to help resolve incontinence, menstrual, or pelvic pain problems often associated with pelvic floor muscle weakness following multiple child births. This solution, however, often puts these same women at risk for developing other pelvic pain problems or reproductive dysfunction and infertility problems because of the scar tissue that forms following surgery.
Myofascial Release has been a tremendous help to women suffering with incontinence and pelvic pain. Myofascial Release techniques specific to the pelvis are helpful in decreasing the restrictions in that area that lead to incontinence and pelvic pain.
Nowadays, it is common to hear about the infertility problems that many women suffer with through the media or through family and friends. Many women go through expensive homonal therapies and attempts at invitro fertilization that offer no guarantees and are generally not covered by insurance. Expenses can run into the tens of thousands of dollars for the best technological advances that modern medicine have to offer in order to merely bypass what often is a structural imbalance in the body caused by myofascial restrictions.
Many women who have gone through all types of fertility treatments and had given up on ever becoming pregnant have been pleasantly surprised of the effects that Myofascial Release have had on their infertility...they became pregnant when all else failed! While they may have originally been receiving Myofascial Release for other pain problems, the effects of Myofascial Release particularly in freeing the pelvic region of adhesion has allowed for more normal reproductive function in these women.
The myofascial system surrounds and interpenetrates every organ, nerve, blood vessel, and duct within the pelvic floor. Trauma, inflammation, surgical scars, and child birth very commonly tighten the myofascial system around these delicate and pain sensitive structures. Tightness and restriction within the myofascial system can cause or contribute to many women's health issues including but not limited to pelvic floor pain and dysfunction, infertility, incontinence, vulvodynia, coccydynia, pelvic adhesion from endometriosis and surgical scars, painful episiotomy scars, interstitial cystitis, fibromyalgia and pregnancy related back pain and sciatica.
It is estimated that a large number of women experience infertility as a result of fascial restrictions from scar tissue, endometriosis or inflammatory processes. These fascial restrictions may physically interfere with fertility by compressing the reproductive structures such as the fallopian tubes or ovaries and can be helped with Myofascial Release. In addition, because the fascial system surrounds every system of the body, including the endocrine system, fertility problems related to homonal imbalance may be helped using Myofascial Release. For example, the pituitary gland, the master gland of the body is housed within the sphenoid bone of the skull. Fascial restrictions throughout the neck, dural tube and particularly the suboccipital region often create compression of the sphenoid bone, which houses this delicate gland. Releasing fascial restrictions helps to free these structures and restore more normal function of the endocrine system thus helping to resolve fertility problems related to hormonal imbalance.
The therapists at the Myofascial Release Treatment Centers are highly trained in performing techniques specifically geared at releasing restrictions in the pelvic region. Painful or tight episiotomy scars are a common cause of pelvic floor pain and dysfunction and can be effectively treated by the therapists using this highly specialized form of Myofascial Release.
In addition to the various general and specialized myofascial release techniques for women with pelvic pain and incontinence, the Myofascial Release Therapists also address problems with back pain, neck pain, headaches and pelvic imbalance and instability that are frequently associated with these problems. Special techniques are utilized to eliminate pelvic torsions and upslips. Patients can learn valuable home self-treatment techniques to ease their pain.
NORMAL PELVIC FLOOR DYSFUNCTIONS
Myofascial Pelvic Pain
Vulvodynia
Dyspareunia
Endometriosis
Adenomyosis
Pelvic Inflammatory Disease (PID)
Abdominal Pain
Coccygodynia
Vaginismus
Vulvar Vestibulitis
Interstitial Cystitis
Anismus
Levator Ani Syndrome
Women with pelvic pain, urinary incontinence, urinary frequency, fertility problems and menstrual problems are encouraged to do these guidelines or else contact Dr. Ajimsha through his official e-mail scebcaptmfr@gmail.com with any questions. Our goal is to return you to a pain free, active lifestyle.
Myofascial Release has been on the forefront of health care for the past two decades particularly in the resolution of complex chronic pain problems. In that time, there have been an increasing number of women reporting problems such as urinary incontinence, pelvic pain, menstrual problems, fibromyalgia, chronic fatigue syndrome, and/or headaches. It is unclear whether this rise in these complaints is due to an increased prevalence or that women are just communicating more about their problems.
Whatever the case may be, it remains clear that the numbers are staggering in terms of the women who are affected by these problems. For instance, in 1996 the US Department of Health and Human Services reported that 13 million Americans are incontinent; 11 million of them are women. One in four women ages 30 to 59 have experienced an episode of urinary incontinence. 16.4 billion dollars are spent each year on incontinence-related care and 1.1 billion dollars is spent yearly on disposable products for incontinent adults.
One of the missions of this article series is to turn these numbers around if they can receive this. It is pathetic that the best our healthcare system has to offer incontinent women is disposable pads and adult diapers. Some women undergo pelvic or abdominal surgery to help resolve incontinence, menstrual, or pelvic pain problems often associated with pelvic floor muscle weakness following multiple child births. This solution, however, often puts these same women at risk for developing other pelvic pain problems or reproductive dysfunction and infertility problems because of the scar tissue that forms following surgery.
Myofascial Release has been a tremendous help to women suffering with incontinence and pelvic pain. Myofascial Release techniques specific to the pelvis are helpful in decreasing the restrictions in that area that lead to incontinence and pelvic pain.
Nowadays, it is common to hear about the infertility problems that many women suffer with through the media or through family and friends. Many women go through expensive homonal therapies and attempts at invitro fertilization that offer no guarantees and are generally not covered by insurance. Expenses can run into the tens of thousands of dollars for the best technological advances that modern medicine have to offer in order to merely bypass what often is a structural imbalance in the body caused by myofascial restrictions.
Many women who have gone through all types of fertility treatments and had given up on ever becoming pregnant have been pleasantly surprised of the effects that Myofascial Release have had on their infertility...they became pregnant when all else failed! While they may have originally been receiving Myofascial Release for other pain problems, the effects of Myofascial Release particularly in freeing the pelvic region of adhesion has allowed for more normal reproductive function in these women.
The myofascial system surrounds and interpenetrates every organ, nerve, blood vessel, and duct within the pelvic floor. Trauma, inflammation, surgical scars, and child birth very commonly tighten the myofascial system around these delicate and pain sensitive structures. Tightness and restriction within the myofascial system can cause or contribute to many women's health issues including but not limited to pelvic floor pain and dysfunction, infertility, incontinence, vulvodynia, coccydynia, pelvic adhesion from endometriosis and surgical scars, painful episiotomy scars, interstitial cystitis, fibromyalgia and pregnancy related back pain and sciatica.
It is estimated that a large number of women experience infertility as a result of fascial restrictions from scar tissue, endometriosis or inflammatory processes. These fascial restrictions may physically interfere with fertility by compressing the reproductive structures such as the fallopian tubes or ovaries and can be helped with Myofascial Release. In addition, because the fascial system surrounds every system of the body, including the endocrine system, fertility problems related to homonal imbalance may be helped using Myofascial Release. For example, the pituitary gland, the master gland of the body is housed within the sphenoid bone of the skull. Fascial restrictions throughout the neck, dural tube and particularly the suboccipital region often create compression of the sphenoid bone, which houses this delicate gland. Releasing fascial restrictions helps to free these structures and restore more normal function of the endocrine system thus helping to resolve fertility problems related to hormonal imbalance.
The therapists at the Myofascial Release Treatment Centers are highly trained in performing techniques specifically geared at releasing restrictions in the pelvic region. Painful or tight episiotomy scars are a common cause of pelvic floor pain and dysfunction and can be effectively treated by the therapists using this highly specialized form of Myofascial Release.
In addition to the various general and specialized myofascial release techniques for women with pelvic pain and incontinence, the Myofascial Release Therapists also address problems with back pain, neck pain, headaches and pelvic imbalance and instability that are frequently associated with these problems. Special techniques are utilized to eliminate pelvic torsions and upslips. Patients can learn valuable home self-treatment techniques to ease their pain.
NORMAL PELVIC FLOOR DYSFUNCTIONS
Myofascial Pelvic Pain
Vulvodynia
Dyspareunia
Endometriosis
Adenomyosis
Pelvic Inflammatory Disease (PID)
Abdominal Pain
Coccygodynia
Vaginismus
Vulvar Vestibulitis
Interstitial Cystitis
Anismus
Levator Ani Syndrome
Women with pelvic pain, urinary incontinence, urinary frequency, fertility problems and menstrual problems are encouraged to do these guidelines or else contact Dr. Ajimsha through his official e-mail scebcaptmfr@gmail.com with any questions. Our goal is to return you to a pain free, active lifestyle.
Home based MFR managements for pelvic floor dysfunctions: Part III
Self Myofascial release for chronic pelvic floor pains
In EPR we have to use some sort of semi foam rolls or some balls of different sizes. You can buy these from any shops or can order specific items (Eg:- foam rolls, myoballs etc) from e-markets.
General guidelines
Start with the ‘Adjunctive of SMFR’
Before starting the SMFR have a hot shower, or hot pad application.
Slowly palpate superficially and then deeply in areas specified by us during our successive descriptions.
Concentrate and exactly locate the pain spot and mark it. Try for some other related areas for pain spots and mark it too. (More latent pain points will be activated so that you will find out more points as treatment progresses.)
Position your ‘release device’ around the area of pain and position your self over so that gravity can release your fascial restrictions.
Roll the device or roll over the device slowly and two and fro. Stop moving when and where you feel the pain. Apply firm and tolerable pressure over the pain spot for ’90 seconds’. Start moving again and reach the pain full area (new or previous) stop again for 90 seconds.
Repeat it three times for an area then move to the next area.
Apply ice on the treated area for 7 minutes.
Practice some more aerobics or stretching programs.
CONTRAINDICATIONS
Regarding density and SMFR techniques, we have three options if we want to increase the density:
Increase the mass
Decrease the volume
Increase mass and decrease volume
Typically, the easiest option is to increase the mass. This is seen when we progress someone from a tennis ball to a lacrosse ball, or from a lighter foam roller to a heavier foam roller. We don’t necessarily increase the volume (size) of the object, but we most definitely increase the mass.
The formula for pressure is:
Pressure = Force/Area
Much like density, if you want to increase pressure, you either need to
Increase the force
Decrease the area
Increase force and decrease area
As is the case with SMFR techniques, force doesn’t necessarily change all that much. If you want to increase the force, here are a few options:
If you have both legs on the roller, take one off.
If possible, stack one leg on top of the other.
If you have a hand/foot on the ground for stability purposes, take it off (this will put more of the body’s weight on the area being rolled).
Rather than trying to increase force, it’s generally easier to decrease the area. This is accomplished by using progressively smaller (or more focal) implements. We’ll discuss the different modalities below, starting with the largest surface area and working down to the smallest surface areas.
FOAM ROLLER
A foam roller is the largest implement we would use from a pressure perspective. The foam roller is very versatile, as you can work almost every muscle group using a foam roller alone. Rollers also come in varying densities, which allows for progression as well.
Foam rollers are best used for the big muscle/fascial areas like the gluteals, quadriceps, and IT band.
MEDICINE BALL
While not as popular as the foam roller, the medicine ball may actually be a more versatile tool for SMFR purposes. Not only is it more focal when compared to the roller (the surface area being worked is smaller, which increases pressure), but it also allows you to work in a more three-dimensional fashion.
Virtually any muscle group that can be addressed with a foam roller can also be addressed with a medicine ball. Once the foam roller becomes comfortable, I generally progress my trainees to a medicine ball. The medicine ball can be progressed as well; simply moving to a smaller ball (and further decreasing surface area being rolled) will increase the pressure and intensity of the exercise.
TENNIS BALL/LACROSSE BALL
A tennis ball is generally the smallest implement we would use for SMR purposes. It’s very convenient for muscle/fascial groups with smaller surface areas (such as the plantar fascia, calves, and peroneals) as well as upper body muscles where the ball must be placed against a wall (such as the pecs and posterior shoulder capsule). Once the tennis ball becomes easy, move on to a lacrosse ball.
THE STICK
The Stick is yet another convenient tool when it comes to soft-tissue work. While it’s not necessarily better or worse than the other modalities discussed, it’s narrow diameter allows you to work on some tendons (e.g., quadriceps, hamstrings) better than a medicine ball or foam roller would. As well, the Stick is a good option for the hamstrings, which generally don’t respond that well to foam rolling since your hands/arms are supporting the majority of your body weight to hold yourself up.
MORE POINTED OBJECTS
More pointed objects are needed for perineal releases. Different trigger point release tools can be available. You can modify some house hold utensils for this too provided that all are hygienic.
Eg:-
Indexnobber
Jacknobber 
nobbers
Whatever the tools the techniques of application is always the same.
Women with pelvic pain, urinary incontinence, urinary frequency, fertility problems and menstrual problems are encouraged to do these guidelines or else contact Dr. Ajimsha through his official e-mail scebcaptmfr@gmail.com with any questions. Our goal is to return you to a pain free, active lifestyle.
AJIMSHAW’s Approach part I
Self Myofascial release (SMFR) for chronic pelvic floor pains for the easiness of description can be divided into ‘External Pelvic Release’ and ‘Internal Pelvic Release’. ‘External Pelvic Release’ focuses on pelvic release by manipulating fascia externally and ‘Internal Pelvic Release’ is via either vagina or rectum. This techniques can be practiced either yourself or by the help of your counterpart. Some of these techniques are of moderate difficulty if you will practice alone. Anyway it will take at least a month to get your result. Be patient and do it regularly. Some times there will be an exaggeration of symptoms initially because body will attempt some self healing when fascia starts releasing. Don’t worry this will be for a short time. Please don’t stop the release apply some ice over the pain full area after the release. Application of some heating pads on the painful area ‘before’ the release is also found useful. If pain is unbearable you can use some over the counter type pain medications. But please don’t stop the release.
To get the maximum effect try to combine some of the below components to your SMFR program. Descriptions for these are out of this article’s scope. Refer other citations for its details.
‘Adjunctive of SMFR’
Perineal and Pelvic Hygiene (24 Hrs)
Breathing control or Diaphragmatic breathing program.
Relaxation programs(Yoga, T.M, Tai Chi etc)
Daily aerobics (walking, jogging, cycling, swimming etc)
Twice in a week sauna bath or steam bath if possible.
If you can add these four components to your SMFR program, I can assure you will praise us later.
I. External Pelvic Release
Self Myofascial release (SMFR) for chronic pelvic floor pains for the easiness of description can be divided into ‘External Pelvic Release’ and ‘Internal Pelvic Release’. ‘External Pelvic Release’ focuses on pelvic release by manipulating fascia externally and ‘Internal Pelvic Release’ is via either vagina or rectum. This techniques can be practiced either yourself or by the help of your counterpart. Some of these techniques are of moderate difficulty if you will practice alone. Anyway it will take at least a month to get your result. Be patient and do it regularly. Some times there will be an exaggeration of symptoms initially because body will attempt some self healing when fascia starts releasing. Don’t worry this will be for a short time. Please don’t stop the release apply some ice over the pain full area after the release. Application of some heating pads on the painful area ‘before’ the release is also found useful. If pain is unbearable you can use some over the counter type pain medications. But please don’t stop the release.
To get the maximum effect try to combine some of the below components to your SMFR program. Descriptions for these are out of this article’s scope. Refer other citations for its details.
‘Adjunctive of SMFR’
Perineal and Pelvic Hygiene (24 Hrs)
Breathing control or Diaphragmatic breathing program.
Relaxation programs(Yoga, T.M, Tai Chi etc)
Daily aerobics (walking, jogging, cycling, swimming etc)
Twice in a week sauna bath or steam bath if possible.
If you can add these four components to your SMFR program, I can assure you will praise us later.
I. External Pelvic Release
In EPR we have to use some sort of semi foam rolls or some balls of different sizes. You can buy these from any shops or can order specific items (Eg:- foam rolls, myoballs etc) from e-markets.
General guidelines
Start with the ‘Adjunctive of SMFR’
Before starting the SMFR have a hot shower, or hot pad application.
Slowly palpate superficially and then deeply in areas specified by us during our successive descriptions.
Concentrate and exactly locate the pain spot and mark it. Try for some other related areas for pain spots and mark it too. (More latent pain points will be activated so that you will find out more points as treatment progresses.)
Position your ‘release device’ around the area of pain and position your self over so that gravity can release your fascial restrictions.
Roll the device or roll over the device slowly and two and fro. Stop moving when and where you feel the pain. Apply firm and tolerable pressure over the pain spot for ’90 seconds’. Start moving again and reach the pain full area (new or previous) stop again for 90 seconds.
Repeat it three times for an area then move to the next area.
Apply ice on the treated area for 7 minutes.
Practice some more aerobics or stretching programs.
CONTRAINDICATIONS
The following are several reasons you may not want to include SMFR, or areas to avoid:
Recently injured areas
Circulatory problems
Bony prominences/joints (if it is inflamed)
MODALITIES
GENERAL THOUGHTS
Like all things training related, we need to have a rationalized progression if we want to see continued progress. SMFR techniques are no different—there are multiple ways we can change pressure, density, and other factors to progress the training.
DENSITY AND PRESSURE
Before we discuss the specific modalities you can use, let’s briefly review the concepts of density and pressure from a physics sense.
The formula for density is:
Density = Mass/Volume
Recently injured areas
Circulatory problems
Bony prominences/joints (if it is inflamed)
MODALITIES
GENERAL THOUGHTS
Like all things training related, we need to have a rationalized progression if we want to see continued progress. SMFR techniques are no different—there are multiple ways we can change pressure, density, and other factors to progress the training.
DENSITY AND PRESSURE
Before we discuss the specific modalities you can use, let’s briefly review the concepts of density and pressure from a physics sense.
The formula for density is:
Density = Mass/Volume
Regarding density and SMFR techniques, we have three options if we want to increase the density:
Increase the mass
Decrease the volume
Increase mass and decrease volume
Typically, the easiest option is to increase the mass. This is seen when we progress someone from a tennis ball to a lacrosse ball, or from a lighter foam roller to a heavier foam roller. We don’t necessarily increase the volume (size) of the object, but we most definitely increase the mass.
The formula for pressure is:
Pressure = Force/Area
Much like density, if you want to increase pressure, you either need to
Increase the force
Decrease the area
Increase force and decrease area
As is the case with SMFR techniques, force doesn’t necessarily change all that much. If you want to increase the force, here are a few options:
If you have both legs on the roller, take one off.
If possible, stack one leg on top of the other.
If you have a hand/foot on the ground for stability purposes, take it off (this will put more of the body’s weight on the area being rolled).
Rather than trying to increase force, it’s generally easier to decrease the area. This is accomplished by using progressively smaller (or more focal) implements. We’ll discuss the different modalities below, starting with the largest surface area and working down to the smallest surface areas.
FOAM ROLLER
A foam roller is the largest implement we would use from a pressure perspective. The foam roller is very versatile, as you can work almost every muscle group using a foam roller alone. Rollers also come in varying densities, which allows for progression as well.
Foam rollers are best used for the big muscle/fascial areas like the gluteals, quadriceps, and IT band.
MEDICINE BALL
While not as popular as the foam roller, the medicine ball may actually be a more versatile tool for SMFR purposes. Not only is it more focal when compared to the roller (the surface area being worked is smaller, which increases pressure), but it also allows you to work in a more three-dimensional fashion.
Virtually any muscle group that can be addressed with a foam roller can also be addressed with a medicine ball. Once the foam roller becomes comfortable, I generally progress my trainees to a medicine ball. The medicine ball can be progressed as well; simply moving to a smaller ball (and further decreasing surface area being rolled) will increase the pressure and intensity of the exercise.
TENNIS BALL/LACROSSE BALL
A tennis ball is generally the smallest implement we would use for SMR purposes. It’s very convenient for muscle/fascial groups with smaller surface areas (such as the plantar fascia, calves, and peroneals) as well as upper body muscles where the ball must be placed against a wall (such as the pecs and posterior shoulder capsule). Once the tennis ball becomes easy, move on to a lacrosse ball.
THE STICK
The Stick is yet another convenient tool when it comes to soft-tissue work. While it’s not necessarily better or worse than the other modalities discussed, it’s narrow diameter allows you to work on some tendons (e.g., quadriceps, hamstrings) better than a medicine ball or foam roller would. As well, the Stick is a good option for the hamstrings, which generally don’t respond that well to foam rolling since your hands/arms are supporting the majority of your body weight to hold yourself up.
MORE POINTED OBJECTS
More pointed objects are needed for perineal releases. Different trigger point release tools can be available. You can modify some house hold utensils for this too provided that all are hygienic.
Eg:-
Indexnobber
Jacknobber
nobbers
Thera cane
Whatever the tools the techniques of application is always the same.
Women with pelvic pain, urinary incontinence, urinary frequency, fertility problems and menstrual problems are encouraged to do these guidelines or else contact Dr. Ajimsha through his official e-mail scebcaptmfr@gmail.com with any questions. Our goal is to return you to a pain free, active lifestyle.
Friday, January 1, 2010
Home based MFR managements for pelvic floor dysfunctions: Part IV
Self Myofascial release for chronic pelvic floor pains
AJIMSHAW’s Approach part II
AJIMSHAW’s Approach part II
SPECIFIC SESSIONS
I. External Pelvic Release
This session explains how to do External Pelvic Release by using SMFR. Follow the same guidelines for all releases.
(‘X’ mark in pictures indicates the pain spot or trigger points. When you are applying sustained pressure or release you will feel tenderness (pain on palpation) on these sites and pressure on this area will cause radiating or dull aching pain in particular areas shown in shades)
GRAPHIC OF PELVIC FLOOR AND REFERRED PAIN
The muscles of the pelvic floor support and raise the pelvic organs. The trigger points in the pelvic floor are in the sphincter ani, levator ani and coccygeus muscles. The sphincter ani surrounds the margin of the anus. The levator ani's contraction increases intraabdominal and pelvic pressure for defecating and straining in general. The coccygeus muscle is attached to the coccyx (the tail bone). It relates to the levator ani and the piriformis muscle (see the illustration of the piriformis).
Release of the pelvic floor. You will learn in the next part.
The Tender Muscles in Pelvic Dysfunction
THE PIRIFORMIS
Piriformis is one of the important muscles involved in chronic pelvic pain of any reason. Release of Piriformis is having its own importance in pelvic pain.
The muscles of the pelvis are made of two groups, the pelvic floor muscles and the hip-joint muscles. The piriformis muscle, which is located partly in the pelvis and partly at the back of the hip joint, is a hip rotator muscle as well as a support muscle of the pelvic floor. The piriformis is under the gluteus (buttock), and attaches the lower part of the sacrum (the triangular composite bone in the back of the pelvis) to the great trochanter (the top of the thigh). The graphic below of the piriformis illustrates the location, trigger points, and areas of referred pain. (Stars or X's represent the trigger points. The shaded areas represent the referred pain caused by the trigger points.)
Alternate Position
THE OBTURATOR INTERNUS
The piriformis often blends with the tendon of the oburator internus muscle. The oburator internus, like the piriformis muscle is a hip rotator located partly in the pelvis and partly at the back of the hip joint. It is attached to the ramus (see the illustration of the pelvic floor for location of the ramus). The anatomical graphic below illustrates the inside of the pelvic girdle at a three quarter front view. Locate the thigh bones and spine to understand the illustration. Refer to the trigger points and affected areas.
Release of the obturator Internus will be explained under the session Internal Pelvic Release.
THE GLUTEUS MEDIUS
The muscles of the buttocks work the hip joint. The gluteus medius is an important hip stabilizer, as well as a postural muscle. This muscle keeps the hips stable while walking and running. The gluteus medius is partly covered by the large buttock's muscle, the gluteus maximus. Refer to the following illustration to understand this muscle's role in pain.
THE GLUTEUS MAXIMUS
The gluteus maximus is a large buttocks muscle that relates to many of the joints and muscles of the pelvis, including the ilium, sacrum, coccyx, ischial tuberosity (sitz bone), great trochanter (top of the thigh bone), the hip rotators mentioned above, as well as some of the muscles of the thigh. The gluteus maximus assists the trunk in an erect posture. It's function helps mostly with running and climbing.
THE TENSOR FASCIA LATAE, ANTERIOR GLUTEUS MEDIUS, AND GLUTEUS MINIMUS
THE ILIOSPOAS MUSCLE
The psoas muscle runs from the 12th rib (the last rib) down along the lumbar spine to the sacroiliac joint (sometimes including the sacrum and buttock). It then follows the border of the pelvic brim and attaches to the front of the hip joint. The psoas tendon attaches to the pubic bone. The psoas muscle is a powerful hip flexor and postural muscle that assists the body when rising to a sitting position from a lying position.
ADDUCTOR COMPARTMENT
ADDUCTOR COMPARTMENT
Adductor brevis and longus: Pain from the adductor longus and brevis goes deep into the groin above and below the crease of the thigh.
Adductor magnus Trigger Points are deep in the groin and inner thigh, but go farther into the pelvis. These deeper pains are described as internal pelvic pain, but sometimes referrals are felt in the pubic bone, vagina and rectum. Occasionally patients even describe bladder pain. 
Pectineus pain is similar to the short adductors but referring pain mostly below the inguinal ligament as well as deep into the groin. Pain can feel as if it were in the hip joint itself.
Alternate technique.
Via palpation find out the painful points in your adductor area (Inner thigh area) apply 90 sec pressure to such points, repeat it for three times. Progress more deeply and incorporating more areas.
You have to concentrate more on this area as this area will be under tremendous spasm in patients with pelvic pain.
THE QUADRICEPS - I
You have to concentrate more on this area as this area will be under tremendous spasm in patients with pelvic pain.
THE QUADRICEPS - I
THE QUADRICEPS - II
RECTUS FEMORIS (2 POSITIONS)
THE QUADRICEPS - III
VASTUS LATERALIS
VASTUS LATERALIS
THE IT BAND
THE HAMSTRINGS
THE QUADRATUS LUMBORUM
GENERAL MUST DO RELEASES
Follow the next session named ‘Internal Pelvic Release’ for the complete series.
Women with pelvic pain, urinary incontinence, urinary frequency, fertility problems and menstrual problems are encouraged to do these guidelines or else contact Dr. Ajimsha through his official e-mail scebcaptmfr@gmail.com with any questions. Our goal is to return you to a pain free, active lifestyle.
Thursday, December 31, 2009
Home based MFR managements for pelvic floor dysfunctions: Part V
Self Myofascial release for chronic pelvic floor pains
AJIMSHAW’s Approach part III
SPECIFIC SESSIONS
II. Internal Pelvic Release
Fascial tightness of the perineum and its structures have major role in pelvic floor dysfunction and pain. Inorder to balance the pelvic floor it should be managed both externally and internally. This session explains the techniques of ‘Internal Pelvic Release’.
To understand the importance of ‘Internal Pelvic Release, have a look at the below picture. The “X” marked are trigger points in pelvic floor muscles and the reddish areas are the referred pain due to the trigger points. ‘Internal Pelvic Release’ is the most advanced way to release these triggerpoints.
60-80% DID NOT RECEIVE AN ACCURATE DIAGNOSIS (GPWPP 2007)
Causes of Pelvic Myofascial Trigger Points
Excessive tension on muscle fibers
Straining
Habitual tightening
Trauma as in pregnancy, injury
Inflammation
Types of Pelvic Floor Muscle Trauma
Severe trauma from accidents of falls (coccygeal injury)
Urological or gynecological surgery
Repetitive minor trauma from bicycle seats, uncomfortable chairs
Childbirth
Inflammation of the Pelvic Organs
Infections eg:- prostate, bladder, vaginal
Endometriosis
Inflammatory bowel disease/IBS
Feet position and Pelvic Dysfunction
Correct your Foot deformity and improve your pelvic floor function!
THE PERINEUM
The perineum and perineal body lies between the vagina and the anus on a female and between the bulb of the penis and the anus on a male. The Perineal body is essential for the integrity of the pelvic floor, particularly in females. Its rupture during delivery leads to widening of the gap between the anterior free borders of Levator Ani muscle (pelvic floor muscles) of both sides, thus predisposing the woman to prolapse of the uterus, rectum, or even the urinary bladder.
The following muscles converge and are attached to the perineum:
External anal sphincter
Bulbospongiosus
Superficial transverse perineal muscle
Anterior fibers of the levator ani
fibers from external urinary sphincter
Deep transverse perineal muscle
Because of different reasons myofascial dysfunctions and trigger point developments are very common and most of the time these trigger points will be unidentified and its importance is being ignored. Result; increasing pelvic floor dysfunctions and pain.
As we have discussed in the previous sessions the success of ‘Self Myofascial Release’ lies in the ability of finding the exact sites of myofascial restrictions and trigger points. Palpation with your finger tips and application of firm pressure over 90 seconds is the basics of SMFR.
The picture illustrates the techniques of palpation of myofascial restrictions and trigger points. When you reach the restricted area you can find or feel nodules, bands or thickness. Pressure on this area will produce pain over there and you will feel pain radiating to adjacent or distant areas which is called radiating pain.
Trigger points in the perineum and vulva.
The picture below is a true representation of myofascial restrictions and trigger points in the perineal area and the vulva(female external genitalia) the ‘blue’ shades represents triggerpoints which can be approached externally and ‘yellow’ shades represents triggerpoints which only be approached internally. Every person’s myofascial restriction patterns and dysfunctions vary. You have to examine each of this area using the below picture as reference. On palpation if you feel pain marks that area with a non irritant marker.
Vulva with triggerpoints
(Save this picture or take a print out for reference during SMFR)
Common Sites of Connective Tissue Restrictions in pelvis
2. Find a private, comfortable place and sit or lean back in a comfortable position. 
3. Put a lubricant such as KY Jelly, vitamin E oil, or pure vegetable oil on your thumbs and around the perineum if the skin is very dry/ scaly. Care should be taken for extra hygiene and use lubricant in a lesser quantity. For Perineal SMFR you can use the tools which we have discussed earlier (nobbers, myoballs etc)
• Lie on your back in a comfortable position
• Let your partner to sit at side of pelvis to be treated, facing your head
• Bend your knee and hip and introduce index & middle fingers medial to ischial tuberosity (the ischiorectal fossa)[when you are palpating the area as shown in the picture above you can feel a bony prominence over there]
• Take a deep inspiration and during exhalation, press fingertips superiorly as shown I the picture in a slow and sinking way.
• Maintain this position, during next exhalation, continue to follow and press fingers more superiorly (and deeply)
• Repeat several cycles
• RE-TEST
• Alternately you can use myo balls, nobbers etc for this release.
4.b. Perineal SMFR
Trigger points (which cause referred pain in persons with chronic pelvic pain/ic) in the perineum can refer pain and sensation to the rectum, vagina, and site of palpation. It is very important that you have to release this area by SMFR.
Apply pressure to the perineal body ----the technique is far gentler, for the tissue and muscles here can be very sensitive. Take it easy when applying pressure to perineal body; find out the restrictions and trigger points, apply pressure and gradually sink into the area, hold there for 90 second time, concentrate on your breathing, try to sink down during deep exhalation. Treat multiple areas as necessary. Remember you are trying to soothe pain, feed the area blood and oxygen, not beat it into submission.
You will need either of a comfortable tool as we mentioned earlier. If you don't have one apply pressure using finger tips or a dilator until you can purchase one. It is important that you find a comfortable place to lay down where you will be ensured privacy.(Note: perineal SMFR is especially helpful before and after sexual activity.)If you use gloves they should be non-latex and lubricants should be paraben-free and have no propylene glycol which can irritate the tissue. Check labels.
4. c. Vulvar SMFR
The SMFR procedure for the vulva is same as for other SMFR. But in vulva you have to check for restrictions in a systematic manner. There can be inactive or multiple fascial restrictions. So palpate areas by dividing it into multiple sections (refer the trigger point diagram above and compare)
4. d. Vaginal SMFR
For vaginal SMFR a clean hand with or without a sterile glove is enough. Our goal is stretching the pelvic floor muscles through either vagina or rectum. Use your finger (index finger, some finds comfort by using both the thumbs together for the opposite sides, select as per your convenience)
Stretch the vaginal wall with an aim to go deep and find out the restrictions at the internal pelvic floor muscle. We used to call his as “Palpation through stretching” move around the vagina while maintaining the stretch, apply firm pressure to the restrictions or trigger points for 90 seconds and repeat the treatment.
This treatment is especially useful for all type of female genital discomforts and pain especially after the menopause.
Follow the pictures
AJIMSHAW’s Approach part III
SPECIFIC SESSIONS
II. Internal Pelvic Release
Fascial tightness of the perineum and its structures have major role in pelvic floor dysfunction and pain. Inorder to balance the pelvic floor it should be managed both externally and internally. This session explains the techniques of ‘Internal Pelvic Release’.
To understand the importance of ‘Internal Pelvic Release, have a look at the below picture. The “X” marked are trigger points in pelvic floor muscles and the reddish areas are the referred pain due to the trigger points. ‘Internal Pelvic Release’ is the most advanced way to release these triggerpoints.
60-80% DID NOT RECEIVE AN ACCURATE DIAGNOSIS (GPWPP 2007)
Causes of Pelvic Myofascial Trigger Points
Excessive tension on muscle fibers
Straining
Habitual tightening
Trauma as in pregnancy, injury
Inflammation
Types of Pelvic Floor Muscle Trauma
Severe trauma from accidents of falls (coccygeal injury)
Urological or gynecological surgery
Repetitive minor trauma from bicycle seats, uncomfortable chairs
Childbirth
Inflammation of the Pelvic Organs
Infections eg:- prostate, bladder, vaginal
Endometriosis
Inflammatory bowel disease/IBS
Feet position and Pelvic Dysfunction
Inward or outward rotated feet can lead to muscle imbalance and tension in the hip rotators causing abnormal tension in the pelvic nerves (Pudental Nerve)
Correct your Foot deformity and improve your pelvic floor function!
THE PERINEUM
The perineum and perineal body lies between the vagina and the anus on a female and between the bulb of the penis and the anus on a male. The Perineal body is essential for the integrity of the pelvic floor, particularly in females. Its rupture during delivery leads to widening of the gap between the anterior free borders of Levator Ani muscle (pelvic floor muscles) of both sides, thus predisposing the woman to prolapse of the uterus, rectum, or even the urinary bladder.The following muscles converge and are attached to the perineum:
External anal sphincter
Bulbospongiosus
Superficial transverse perineal muscle
Anterior fibers of the levator ani
fibers from external urinary sphincter
Deep transverse perineal muscle
Because of different reasons myofascial dysfunctions and trigger point developments are very common and most of the time these trigger points will be unidentified and its importance is being ignored. Result; increasing pelvic floor dysfunctions and pain.
As we have discussed in the previous sessions the success of ‘Self Myofascial Release’ lies in the ability of finding the exact sites of myofascial restrictions and trigger points. Palpation with your finger tips and application of firm pressure over 90 seconds is the basics of SMFR.
The picture illustrates the techniques of palpation of myofascial restrictions and trigger points. When you reach the restricted area you can find or feel nodules, bands or thickness. Pressure on this area will produce pain over there and you will feel pain radiating to adjacent or distant areas which is called radiating pain.
Trigger points in the perineum and vulva.
The picture below is a true representation of myofascial restrictions and trigger points in the perineal area and the vulva(female external genitalia) the ‘blue’ shades represents triggerpoints which can be approached externally and ‘yellow’ shades represents triggerpoints which only be approached internally. Every person’s myofascial restriction patterns and dysfunctions vary. You have to examine each of this area using the below picture as reference. On palpation if you feel pain marks that area with a non irritant marker.
Vulva with triggerpoints(Save this picture or take a print out for reference during SMFR)
Common Sites of Connective Tissue Restrictions in pelvis
Steps to follow for Perineal SMFR
Perineal SMFR is a technique which slowly and gently releases the myofascial trigger points and restrictions around the vagina, perineum and rectum.
CAUTIONS:
Avoid the urinary opening (see diagram) to prevent urinary tract infections.
Do NOT do Perineal SMFR if you have active herpes lesions or any other infections, as you could spread the infection to other areas.
General Hints:
The first few times it’s helpful to use a mirror to find the vagina and perineum and see what they look like.
If you feel tense, take a warm bath or use warm compresses on your perineum for 5 to 10 minutes.
If you have had an episiotomy with a previous birth, concentrate part of your SMFR on that area, Scar tissue isn’t as stretchy as the rest of your skin and needs extra attention.
After Perineal SMFR, tone up the muscles in the vagina by practicing the pelvic floor (Kegel) exercises regularly.
Directions:
1. Wash your hands.
Perineal SMFR is a technique which slowly and gently releases the myofascial trigger points and restrictions around the vagina, perineum and rectum.
CAUTIONS:
Avoid the urinary opening (see diagram) to prevent urinary tract infections.
Do NOT do Perineal SMFR if you have active herpes lesions or any other infections, as you could spread the infection to other areas.
General Hints:
The first few times it’s helpful to use a mirror to find the vagina and perineum and see what they look like.
If you feel tense, take a warm bath or use warm compresses on your perineum for 5 to 10 minutes.
If you have had an episiotomy with a previous birth, concentrate part of your SMFR on that area, Scar tissue isn’t as stretchy as the rest of your skin and needs extra attention.
After Perineal SMFR, tone up the muscles in the vagina by practicing the pelvic floor (Kegel) exercises regularly.
Directions:
1. Wash your hands.
2. Find a private, comfortable place and sit or lean back in a comfortable position.
3. Put a lubricant such as KY Jelly, vitamin E oil, or pure vegetable oil on your thumbs and around the perineum if the skin is very dry/ scaly. Care should be taken for extra hygiene and use lubricant in a lesser quantity. For Perineal SMFR you can use the tools which we have discussed earlier (nobbers, myoballs etc) The techniques
4. a. Pelvic diaphragm Release
Use the below description if your partner or care giver can help you other ways apply pressure over the prescribed area by using appropriate tools.
4. a. Pelvic diaphragm Release
Use the below description if your partner or care giver can help you other ways apply pressure over the prescribed area by using appropriate tools.
• Lie on your back in a comfortable position• Let your partner to sit at side of pelvis to be treated, facing your head
• Bend your knee and hip and introduce index & middle fingers medial to ischial tuberosity (the ischiorectal fossa)[when you are palpating the area as shown in the picture above you can feel a bony prominence over there]
• Take a deep inspiration and during exhalation, press fingertips superiorly as shown I the picture in a slow and sinking way.
• Maintain this position, during next exhalation, continue to follow and press fingers more superiorly (and deeply)
• Repeat several cycles
• RE-TEST
• Alternately you can use myo balls, nobbers etc for this release.
4.b. Perineal SMFR
Trigger points (which cause referred pain in persons with chronic pelvic pain/ic) in the perineum can refer pain and sensation to the rectum, vagina, and site of palpation. It is very important that you have to release this area by SMFR.
Apply pressure to the perineal body ----the technique is far gentler, for the tissue and muscles here can be very sensitive. Take it easy when applying pressure to perineal body; find out the restrictions and trigger points, apply pressure and gradually sink into the area, hold there for 90 second time, concentrate on your breathing, try to sink down during deep exhalation. Treat multiple areas as necessary. Remember you are trying to soothe pain, feed the area blood and oxygen, not beat it into submission.
You will need either of a comfortable tool as we mentioned earlier. If you don't have one apply pressure using finger tips or a dilator until you can purchase one. It is important that you find a comfortable place to lay down where you will be ensured privacy.(Note: perineal SMFR is especially helpful before and after sexual activity.)If you use gloves they should be non-latex and lubricants should be paraben-free and have no propylene glycol which can irritate the tissue. Check labels.
4. c. Vulvar SMFR
The SMFR procedure for the vulva is same as for other SMFR. But in vulva you have to check for restrictions in a systematic manner. There can be inactive or multiple fascial restrictions. So palpate areas by dividing it into multiple sections (refer the trigger point diagram above and compare)
4. d. Vaginal SMFR
For vaginal SMFR a clean hand with or without a sterile glove is enough. Our goal is stretching the pelvic floor muscles through either vagina or rectum. Use your finger (index finger, some finds comfort by using both the thumbs together for the opposite sides, select as per your convenience)
Stretch the vaginal wall with an aim to go deep and find out the restrictions at the internal pelvic floor muscle. We used to call his as “Palpation through stretching” move around the vagina while maintaining the stretch, apply firm pressure to the restrictions or trigger points for 90 seconds and repeat the treatment.
This treatment is especially useful for all type of female genital discomforts and pain especially after the menopause.
Follow the pictures
Home program for painful intercourse
SELF TREATMENT: URGENCY/ FREQUENCY
Use the picture “Vulva with trigger” point as reference
4. e. Rectal SMFR
Rectal SMFR is indicated for those females who are having chronic pelvic/sacral/coccygeal pains and for males. The techniques of application is same like the ‘vaginal SMFR” provided that a sterile glove should be used always. Most of the clients finds it difficult , but the difficulty depends on your physique. A partner can help you in this regards.
SUMMERY
Success in the management of all painful pelvic, gynecological conditions needs multidisciplinary approach. You need to remain active. Performing some back exercises and pelvic floor exercises immediately after the release is found to hasten the improvement. So be active and be cool. Don’t forget that there will be an increase in discomfort when you are starting the SMFR, don’t give up it’s a short period after that you will praise me.
My advice is be cool, be active and be a master of pelvic SMFR. If you are having any queries please contact me via scebcaptmfr@gmail.com.
Joining/ making pelvic pain interest groups are always good. So plan for that too. Discuss these topics among you. Please inform other pelvic floor dysfunction patients about this.
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