12/05/2020
CLINICAL PILLS - THE HIDDEN ROLE OF THE PELVIC FLOOR: THE POSTURAL CONTROL🧐
🔺INTRODUCTION
The pelvic floor has many functions, to support the pelvic organs, to contribute to closure mechanisms of urethra and a**s, to resist to increasing of intra-abdominal pressure (IAP), to support sexual functioning, but there are 2 other important roles: to partecipate in breathing and in postural control (Bordoni B, Zanier E 2013; Messelink B et al. 2005; Bok K 2004). In this article I summarize the role of the pelvic floor in maintaining postural control with other muscles, before and during a movement or perturbation.
🔺PELVIC FLOOR and ABDOMINAL MUSCLES
A lot of research focused on the importance of muscle activation for stability and motor control of the lumbopelvic region (Hungerford B et al. 2003; Vleeming A et al. 2012). The muscles surrounding the abdominal cavity have been found to play an important role for controlling the spine stability (Cresswell AG et al. 1994; Hodges PW, Gandevia SC 2000; Hodges PW, Richardson CA 1996, Hodges PW, Richardson CA 1997a).
Many studies have shown a pre-activation of the transversus abdominis muscle, internal oblique muscle, diaphragm muscle before an increased intra-abdominal pressure (IAP) or an expected perturbation, which indicates a feed-forward postural strategy designed to increase the stability of the spine (Hungerford B et al. 2003; Cresswell AG et al., 1994; Hodges PW, Richardson CA 1996; Hodges PW, Richardson CA 1997a; Marshall P, Murphy B 2003; Hodges et al. 1997; Hodges PW, Gandevia SC 2000; Hodges PW, Richardson CA 1997a).
The pelvic floor muscles (PFM) are a part of lumbopelvic muscles of the sacroiliac joints, and should therefore contribute to stabilize the sacroiliac joints as well as the spine (Snijders et al.1993a,b).
In the study of Sjödahl J et al. (2009) the findings suggest a feed-forward response also in the pelvic floor muscles during leg and arm lifts.
Feed-forward responses in the PFM should not occur only in response to a sudden rapid single movement or repetitive movements, but also to other types of external loadings (Sjödahl J et al. 2009).
Some studies demonstrated that contraction of the PFM muscles occurs before the movement of the deltoid muscle (the perturbation movement) and in association with a rise in intra-abdominal pressure (IAP) during rapid arm movements, which challenge postural control. This finding is consistent with the contribution of the PFM muscles to the postural adjustment that prepares the spine and pelvis for a perturbation (Hodges PW et al. 2007; Smith MD et al. 2007).
🔺CONCLUSION
The feed-forward response of pelvic floor in association with other muscle such as diaphragm, transversus abdominis and internal oblique before a postural perturbation suggest that it’s important for medical doctors and manual therapists evaluate this myofascial system in patients have back pain, incontinence, visceral pain, pulmonary diseases, sacroiliac joint pain and many other disfunctions. Thanks to the countless studies on the fascia and the many fascial methods, we can do other myofascial correlations to to achieve the best results for our patients.
HAVE A NICE JOB 🙂
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