AJIMSHAW’s Approach part II
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
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.)
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.
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 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.
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 QUADRATUS LUMBORUM