Fascia of the pelvic floor

Fascia of the pelvic floor

A little history

Fascia has long been considered the “forgotten” part of our musculoskeletal system.  As Physiotherapists, we learn in minute detail every part of the bone and every ligament that attaches two bones together.   We learn every part of each muscle and how it attaches to the bones via tendons.  We learn how each tendon attaches and transfers load of a muscle to produce human movement.  We learn the details of every nerve and how they travel from brain, via spinal cord, out to the periphery of our body and bring messages back from the world to be processed by the brain to enable us to function.  We learn about the organs of the body: the brain, the heart, the liver, the kidneys,  the lungs, the reproductive organs  and so on and on. 

Admittedly I trained as a Physiotherapist a while ago, graduating in 1993, but I have spent every year of my career attending professional development which is a prerequisite of being a Registered Physiotherapist.  Every year we attend conferences, workshops, lectures to keep learning as new things about the human body are found out and researched.  We have to keep up to date….

But rarely have I learnt updates on FASCIA!!   It took me until now to find the first “Australian Fascia Symposium” which I attended recently. 

Years ago,  we were taught it existed, it was there almost as a rather inert structure around muscles: it was almost described like the packaging of the muscles: just surrounding them and holding them all together.  But fascia is so much more. 

Myofascial Techniques

We know that when we do manual therapy to the muscles we call this “myofascial techniques” .   It was long considered  that the muscles were the main area responding.  Traditionally we massage muscles don’t we?  Have you ever asked for a massage to your fascia?   But it is most likely that what we do to fascia, is as important as what we do to muscles, to gain relief from aches and pains, tightness and stiffness.

Luckily there are scientists and researchers who are finding out so much more about this fascinating tissue:

What do we know now about Fascia

To quote Leon Chaitow from his textbook on muscle energy techniques, fascia is the “ubiquitous elastic-plastic, gluey, component that invests, supports and separates, connects and divides, wraps and gives cohesion, to the rest of the body”….it is the “fascial, connective tissue network”.  For those that eat meat, it is the thin, see-through, sliding tissue that surrounds bundles of meat (muscle fibres).  In the human body, this tissue travels through and around in undulating pathways around the muscles so facilitating passage of nerves and blood vessels from brain to toes, to fingers and all in between.  It is very complicated in terms of all the amazing things it does in terms of passing messages round the body, being part of our immune system of healing, contracting in response to movement and so on, facilitating well-being in the body.  And it needs to be addressed in rehab of musculoskeletal pain and disfunction and plays a bigger part in recovery than we have thought before.  

What about the pelvic floor?

I believe it must play a bigger part in pelvic floor problems because the pelvic floor is right in the centre and there are many fascial super-highways passing through the pelvic floor, connecting the pelvic floor with other muscle groups in the body.  Those other muscles become directly connected with the pelvic floor via the fascia.

There are fascial layers in and around all parts of the pelvic floor muscles.  The obturator internus muscles and piriformis muscles are in direct contact with the pelvic floor on the inside of the pelvis leading to the outside so via their fascial sheaths they interconnect to the outer pelvis into and around hips and thighs at the sides, and back into the glutes at the back.  At the front, abdominal fascia passes from pelvic floor up and around the abdominal muscles to the diaphragm and beyond.  Have you ever noticed how you want to take a big breath in to make your pelvic floor contract when muscles are weak?  

At the back of the pelvis, there is a huge fascial sheet called the thoraco-lumbar fascia which crosses and connects all the muscles from your pelvis, to back, right up to the arms via the latissimus dorsi muscle in particular.  Below the pelvis across the sacrum and gluteal muscles the fascia links into the hamstrings and back of the thighs, and lower legs to the feet. 

Why does this matter?  Well, because what happens on the outside of the pelvis may just be affecting what goes on inside.  So when you see your pelvic floor Physio for say, a pelvic pain problem, your Physio will most likely look at the bigger picture to broaden the rehab and gain better outcomes.   Your pelvic floor can be treated with myofascial techniques just like any other muscle in the body to overcome pain and dysfunction.   

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