Vol. 20 • Issue 2
• Page 18
Back pain cannot be improved with "external" techniques if internal organ and pelvic muscle descent are altering lumbosacral and sacroiliac alignment. Sacroiliac joint alignment is controlled by bladder, bowel, uterus and pelvic floor muscle attachment to the sacrum. Pregnancy, pushing during delivery, lifting heavy loads, running, jumping, coughing, curl-ups and crunches, menopause and hysterectomy can lead to pelvic organ descent. Pelvic tissue descent pulling on the sacrum leads to sacroiliac and lumbosacral dysfunctional alignment.1The common complaints of back, leg and foot pain are external symptoms of an internal problem. Sacroiliac and facet joint dysfunction, back muscle splinting and spasm are often secondary symptoms to the internal problem. No amount of treatment focusing on the joint or back muscle dysfunction can restore normal pain-free function until the internal organ and tissue descent problem is addressed.
A good history will give important clues that pelvic organ and muscle descent may be a factor in the back, leg or foot pain described by your client. Risk factors include pregnancy, vaginal delivery, menopause, constipation, urinary incontinence, weight-bearing aerobic exercise, crunches and curl-ups, running in pregnant, postpartum and menopausal women; chronic coughing, obesity, chronic lifting and surgery such as hysterectomy and spinal/back surgery. Diagnoses of cystocele, rectocele or uterine prolapse indicates pelvic organ descent with likely sacroiliac joint involvement.
A three-step program can be easily added to your existing back protocol. When history and medical information indicate possible descent, the intervention is straightforward and can be part of a client's home program. This program includes Wonder W'edge™ Inversion, Roll for Control®exercises and abdominal core power exercises.
Wonder W'edge™ Inversion
The Wonder W'edge inversion technique for realigning internal organs and pelvic muscles was developed through clinical trials with postpartum and menopausal women experiencing organ descent, back pain and bladder/bowel dysfunction. The Wonder W'edge, custom designed for this protocol, is an easily inflatable, latex-free wedge. The Wonder W'edge Inversion program involves aligning the back and hips on the wedge with the neck and head in a neutral position on the supporting surface.
A position of comfort with the hips as high on the wedge as possible allows the internal organs to realign in the pelvis. The feet can rest flat on the floor, on a wall or on a ball. A relatively short time is spent on the wedge, usually three to five minutes. During that time, diaphragmatic breathing and abdominal core exercises can be carried out.2
Roll for Control®Exercises
Roll for Control exercises rebalance the pelvic rotator cuff muscle system so the pelvic diaphragm bowl can optimally support the realigned internal organs and restore sacroiliac and lumbosacral joint alignment. This relieves facet joint compression and restores back muscle resting tone.3
Roll for Control exercises include midline hip internal and external rotation using the obturator and adductor muscles as part of the pelvic rotator cuff system in activating the diaphragm bowl. With the feet flat on the floor, on a wall or on a ball, roll the knees out from midline 3-4 inches using the obturator muscles. Then roll the knees in to midline using the adductor muscles. The pelvic rotator cuff is a system of deep, short muscles that are primarily postural support in function, so reeducation in balance of function between the obturators and adductors facilitating the pelvic diaphragm in motor planning is the goal, rather than strengthening one muscle group or another.
Abdominal Core Power Exercises
Abdominal core power exercises are designed to improve strength and motor control of the abdominal muscles. Strong, flexible abdominal muscles give power for athletic activities as well as for routine activities of daily living. It is important to optimize two important body segments while developing abdominal power.
The first is spinal alignment from the head to the sacrum. The spine needs flexible curves while maintaining dynamic stability. The second important body segment to optimize is the internal organ alignment in the abdominal cavity.4The position of organs in the abdominal cavity affects muscle function of the abdomen, pelvic floor, back and legs. It is important that the organs are not descended or prolapsed out of their normal position.5Abdominal core power exercises facilitate abdominal muscle strength while they position internal organs within the abdomen and lift pelvic muscles in position to support those organs. These exercises strengthen abdominal muscles, focusing on activation of muscles from the pelvis upward rather than the head downward. In contrast, abdominal crunches and curl ups strengthen abdominals from the head down and push internal organs into abnormal descent while increasing thoracic kyphosis and forward head position.
Five minutes a day of abdominal core power exercises strengthen and tone the deep core muscles to support the back and internal organs while improving posture, standing balance and bladder/bowel function.
Joy, 46, was a physical therapist who had two children and worked full time. She described having periodic left SI pain that would radiate down the leg at times. She treated herself as well as receiving treatment from other therapists over the five years she experienced the symptoms. Her pain, which increased when running and after lifting a heavy patient, was often worse just before her period. Additional complaints included constipation and occasional leaking with coughing or running.
Joy used the 3-Step Realign for Relief protocol twice a day for two weeks. Her last visit she reported no pain with running or lifting. She was no longer leaking with running or coughing. We recommended she continue with a maintenance program every other day.
References can be found online at www.advanceweb.com/pt.
Janet A. Hulme is a physical therapist with more than 35 years of experience. She is an international speaker on the pelvic rotator cuff and women's health. Her books, products and courses are available online at www.phoenixcore.com.