Saturday, January 2, 2010

Home based MFR managements for pelvic floor dysfunctions: Part III

Self Myofascial release for chronic pelvic floor pains

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

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.


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)

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.

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.


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.


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.


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 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 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.




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 with any questions. Our goal is to return you to a pain free, active lifestyle.

No comments: