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

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 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

THE QUADRICEPS - II

RECTUS FEMORIS (2 POSITIONS)


THE QUADRICEPS - III
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.

No comments: