Whole Organism Approach To Pelvic Floor Mobility
It’s the 100th episode of the Unreal Results podcast! As you probably know, I’m all about viewing the person in front of you as an entire organism compared to just looking at their main complaint, and this couldn’t be more true when it comes to the pelvic floor. The pelvic floor is intimately connected to the viscera, nervous system, and surrounding musculature, which can have huge effects on your client’s presentation. In this episode, you’ll hear specifics on pelvic floor anatomy and mobility, as well as specific treatments that I use for clients who need some treatment directed at their pelvic floor. Make sure to tune and celebrate 100 episodes with me!
Resources Mentioned In This Episode
Episode 3: Swelling Reduction Protocol That Works Like Magic
Episode 6: The Mysterious, Misunderstood, and Mistreated SI Joint
Episode 37: Swelling Protocol Update
Episode 38: Accessing The Parasympthetic Nervous System Without Focusing On Breath!
Episode 44: Using Weight Shifting To Improve Movement Patterns
Episode 49: A Better Way To Assess The SI Joint
Episode 65: Liver Love
FREE: Swelling Reduction Protocol
Regen Session: Lymph Love
Video: Obturator Nerve Glide
Video: Posterior and Inferior Pelvic Self Massage
Video: Sacral Float
Video: Pelvic Clocks
Video: Finding The Hip Joint
Learn the LTAP™ In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello! Welcome back to another episode of the Unreal Results podcast. I'm traveling, different background is normal, different microphone. Um, though I come here a lot, so it's not a new background by any means. Um, this is episode 100. Woohoo! Like, so exciting. 100 episodes. Um, Yeah, I mean, I love doing the podcast.
A lot of people enjoy it. So thank you so much for listening, for sharing with your colleagues, for your support. It means the world to me. It's been like such a helpful. way, a medium to share my thoughts, share my knowledge, um, and I appreciate it. Um, it's definitely better than like short form content on the gram.
So um, yeah, loving the long form content. I hope you are too. Um, I mean, I would love for you to, as like a way to celebrate is to share this. episode or your favorite episode with like three of your colleagues or on social media or write me a review on Apple or Spotify, obviously all of that really helps.
Um, and also if you don't want to, you don't have to. Uh, another way you can help me is to let me know what you like. Let me know if you have any podcast episode ideas, like things you want me to talk about, etc. Um, That is always so helpful because as you can imagine after a hundred episodes I feel like I've already talked about all the things and sometimes I'm like, what should I talk about?
So I have I recently asked on Instagram for some ideas and that I have some written down and But also, I am always appreciative of, like, requests. So, anyways, um, besides this being the hundredth episode, what else is going on in my life? I just, this past weekend, I flew up to my hometown of Eureka, California, uh, which is up in Humboldt County.
It's on the north coast of California, about a hundred miles south of the Oregon border, in the redwood trees. Um, I flew up there. I haven't been home since April of 2019, which is when my dad passed away. And, um, it was like, wow, that's crazy to me that it had been that long. And, um, you know, pandemic, that's what happened.
And then, you know, since my parents have passed away, I don't have, like, you know, I don't have, like, a home to stay at there anymore. Or, like, a real pull, reason to go back, I just, I, I do have aunts and uncles and cousins there, but I'm not, like, that tight with them and so it's not like, uh, I would go home.
I don't go home very often for that. Though, I always tell my aunt and uncle, I was like, anytime you want me to come, you just, like, let me know. Um, and that's actually why I flew up there is my aunt really wanted to go see, to drive to Sacramento to see my sister and my nieces because it's been a while since we've all seen each other.
And, um, she's just gotten to the point in her life, age, medical stuff that she doesn't feel super comfortable making the drive herself. It's about a six hour drive, six, seven hour drive from Humboldt County to Rockland, where my sister lives at just outside of Sacramento. And um, it's also not like the easiest drive.
It's not like. six hours on the interstate. It's like two lane roads through redwood trees or over the mountains and, um, you know, twisty, curvy, that kind of thing. So, um, I was like, I'm happy to drive you. So I flew up to Eureka, stayed the night with my uncle. Got to visit with him, which was great. Got to, next morning, go get my favorite food item in Eureka, which is, uh, shout out Los Bagels.
Best bagels around. Um, I had a bagel with cream cheese and carrots and Larapin sauce. Shout out the restaurant Larapin's, uh, for the best sauces in the world. Um, went to the grocery store and bought all those sauces and, um, meat seasoning. Ted and Barney's meat seasoning. Yeah, which I can only get in Eureka and um, then went to like favorite burger spot.
Uh, so it was fun. And then Friday, my aunt and I drove over to Rockland and yeah, spent a day and a half with my sister and the nieces. My five year old niece got her ears pierced that she was so brave and so cute about it. And then, um, yeah, we just played, played with her the whole time, basically. And then, um, Sunday morning, got in the car, drove all the way back to Eureka, stopped in the redwood trees, got a little redwood magic energy, and um, went to the airport, and then flew back to San Diego, and I was like, that's wild to me.
Like and it shows you just how big California is that I spent, you know, that I drove for six and a half, six and a half hours and then took two flights, you know, a little over three, three hours of flight time, plus a layover, plus lunch, stopping for lunch and like, you know, bathroom breaks and I basically was traveling for 12 hours.
I left my sister's house in Rockland at like 8:05 a.m. I got home in San Diego at 8:15 p.m. And so, 12 hours it took me to go from Northern California towards the east side, to the west side, and then all the way down south. And, uh, it wasn't a lot of backtracking, it wasn't like a lot of wasted time, so it's like, yeah, that California is that big.
Uh, California is 840 miles long, and, uh, I pretty much traveled the entire length of it, so, it was a long day. And then, um, I I slept in my bed and the next day I got on a plane and flew to the east coast from one of my athletes. So here I am on the east coast, supposed to snow today at some point. I'm over winter, but, um, now I'm here recording the hundredth episode of the Unreal Results podcast.
So crazy. Anyways, um, what I want to talk about today is the pelvic floor, uh, pelvic floor mobility, pelvic floor, just the things I want to share about it. Um, I don't know. I always think like, maybe this will be a quick episode, but then, you know, you know how I talk. Um, so let's dive in. I obviously, I get, I share this a lot.
I get a lot of pelvic floor, uh, specialists that come through my education. The nice thing about pelvic floor specialists is they kind of already understand how the viscera can affect the musculoskeletal system. So, it's like an easy sell, if you were. If you will, I'm going to grab a model real quick.
Um, but still, I think there's a lot, there's a lot to share about the pelvic floor, um, even for non pelvic floor specialists. And there's a lot of ways to treat the pelvic floor, um, externally. And not internally. Sometimes people think like if it's a pelvic floor thing, it has to be internal and I'm like, no, you can actually make a lot of headway with pelvic floor things that are totally external.
I think there is a valuable spot for internal assessment and internal manual therapy and treatment techniques, but there's also a lot you can do externally. So, um, In general, when we're talking about the pelvic floor, we're talking about the pelvis. Really, the pelvic floor, we're talking about the whole pelvis, and we're talking about all the structures related to the whole pelvis, which is going to be the muscles, the fascia, the nerves, and the visceral organs.
The visceral organs live inside the pelvic bowl, um, you know, from anterior to posterior, it's bladder, and then uterus, rectum. If it's a male pelvis, it's bladder, prostates below and behind, and then rectum. And, um, so The ligaments that hold those organs in place are very much attached to the sacrum, very much attached to all sides of the ilium.
Sorry, not the ilium, the innominate bone. So the ilium, the pubic bone and the ischium. So the mobility or function of these bones is very influenced by the visceral organs and especially when we look at at those visceral organs all of those visceral organs change in shape in size Quite frequently throughout the day throughout the month so the bladder obviously has an ability to expand. The rectum has an ability to expand, and the uterus has an ability to expand, and depending on what's going on, they are often expanding, contracting, expanding, contracting, shifting side to side, and then just like the rest of the organs that are attached to the musculoskeletal system, when we move, they move, um, and vice versa.
So, um, obviously too, the role that those organs have in reproduction and evacuation of fluids or, um, bowel movements also requires a mobile pelvis, which is another argument for like, yeah, the SI joint moves, right? I have multiple episodes that I'll have Joe link in the show notes all about the SI joint.
The influence of the viscera and the nervous system on the SI joint and how there's still people out there that believe that SI joint doesn't move. But I'm like, I'm sorry. The pelvis is made to move. That is why it's not one continuous bone. It's why it's three bones and a fibrocartilage padding in between.
So, um,
So yes, it moves, and it has things attached to it that also need to move. Uh, within, within the, so those organs fill up, like I said, the space from anterior to posterior, and then some of them are wider than others, but some of them are narrow, kind of depends on the thing, on the person. But the rest of the stuff we have in there, we also have some intestines in our pelvis that live in our pelvis.
The sigmoid colon, um, also lives in our pelvis along with the rectum. Um The small intestine loops can hang out in the, um, pelvis. But we also have just a lot of layers of fascia and, um, vascular structures. Our main vascular structures, the legs, rest inside the pelvis. Our nerves coming from the spine and, uh, the lumbar spine and the sacrum go through the pelvis.
So there is a lot of stuff there. There's a lot of fluid stuff there too. So the pelvis is an area that can easily become congested, um, when our general systemic fluid flow is, um, not optimal. And so one of the best things that you can do for pelvic organ health and pelvic mobility is Like the Swelling Reduction Protocol, um, or like the Lymph Love Regen Sessions, which I'll have Joe link in the show notes, episodes on the Swelling Reduction Protocol and on the lymph, I did, I did a whole episode on the Lymph Love Regen Session, which is basically, I think it was called Liver Love, um, but all of those will have a big influence on the pelvis and pelvis mobility because of the fluid dynamics of it all.
Not to mention some of the fascial connections of it all, but, um, most, mostly through a fluid balance timeline or standpoint. So, anyways, um, other things to think about. So we talked about the pelvic floor muscles. So the pelvic floor muscles, um, create kind of like a uh, bowl shape, they're flexible, they can lift up, they can drop down, they line the sides of the pelvis and, um, interdigitate with some of the hip rotator muscles, um, as well as hip flexor muscles, so hip function and pelvic mobility are very much integrated, very much related to each other.
So oftentimes if I'm having someone challenged in hip rotator cuff type exercises or hip stability. If I focus on pelvic floor mobility, it supports that, um, and vice versa. So, very intimately connected. Some of the pelvic, true pelvic floor muscles, so the muscles that surround the orifices of the pelvic floor, um, actually connect to the obturator internus, which is one of the hip rotators.
So, um, there is a line. of, um, like a tendinous line that goes from the, um, coccyx to the pubic bone, and you can, um, I like to think of that tailbone, the coccyx, as like a tensioner to that whole, um, muscular, um, plate, if you will, just like the xiphoid process can be to the linea alba in the, um, abdominal area.
So um, having good tailbone mobility and using the tailbone to direct movement can be a really good way to change the tensioning around the pelvic floor. So, um,
What do I want to say? What else do I want to say about that?
Well, let's go back. So the muscles of the pelvic floor and the muscles of the hip because of their connection intimate connection with those pelvic floor muscles and with the pelvic bowl itself tend to tighten up in response to When the organs are not happy, right? They go into protective mode around the organs.
Um, very easily, like very reflexively. The organs are somewhat protected in the pelvic bowl by the bones itself, but it's more exposed than like the organs of the thorax. And so, when the organs are not functioning well or not moving well, the pelvic floor muscles, the hip muscles tend to reflexively contract and hold like hypertonicity to limit mobility to protect those organs.
And so getting either doing general visceral mobility exercises or self care like manual therapy like with the Coregeous ball Declined breathing is a great way to affect the pelvic organs doing a like supported ball pelvic clock or like sacral float is a really good way to affect the organs I have a YouTube video of some of that.
I'll have Joe link in the show notes. It's called like pain on the sacrum, but these are all good ways to have a reflexive relaxation of the pelvic floor. And this reflexive relaxation of the pelvic floor is so important because the pelvic floor, in order to have full function, Needs to be able to go through its ranges of motion eccentrically and concentrically.
And most of the time when someone has a, like a stress incontinence issue, um, or pelvic floor pain, um, things associated with pelvic floor issues, it's often because they're stuck in this like hypertonus state. So improving mobility in eccentric function is often the goal. Even if they're weak, even if the muscles are weak and need to be supported in their concentric contraction, they can't go through the full, if they can't go through the full range of eccentric contraction, then they can't do the concentric contraction.
So even if you're still going to be strengthening them, A true strengthening of any muscle is to be able to fully go through an eccentric and concentric contraction. So, um, another way to address that reflexive hypertonicity and protective pattern is through visceral manipulation externally of those organs.
And then, obviously, internal work tends to do internal mobility. Of in like direct massage or techniques to address those chronic hypertonicities too.. So, um, they can be an adjunct together, um, or used, you know, depending on like what your needs are. So, um, one of the things that can be very powerful in, um, treating
a hypertonic pelvic floor or pelvic floor pain is, um, one of the things that happens commonly is a pudendal nerve entrapment. So the pudendal nerve comes off of like S2 and it comes through the pelvis here and it kind of takes a straight line down. And then innervates the, um, saddle region of our pelvis.
It's a sensory and a motor nerve. But it runs along the border of the ischial tuberosity in a little fascial canal. Um, and this is a common area of entrapment. As well as, as it comes down, as it comes down straight here. It has to cross through like a keyhole opening between the sacrotuberous ligament and the sacrospinous ligament, and so that's another common spot for an entrapment, too.
So, um, these are good treatment targets for freeing up the pudendal nerve, is treating that keyhole space between this um, sacrospinous ligament and the sacrotuberous ligament. And then along the medial border of the ischial tuberosity as it extends to the pubic bone, right, the pubic ramus here, um, as it goes through that fascial canal.
So, um, a couple of the ways to do this is that sacral float exercise I talked about in the pain on the sacrum video, as well as learning how to, um, open up or create an in flare on the innominate bones to widen the sits bones and sometimes the easiest way to experience what it feels like to widen the sits bones is to actually take a like Franklin ball which is a like four inch soft massage ball and roll around the sacrotuberous Um, sorry, on the ischial tuberosity and then bring the ball right on the inside edge of that ischial tuberosity and do like a self massage of it.
This helps to create some sensory information in the area, but also uses the ball to sort of like wedge those sits bones open, right? Wedge those sits bones opening, which essentially also brings the top of the iliums together, but it also creates a little bit of an in-flare and widens those sits bones.
So that's a really great movement experience to feel the sensation of widening in the sits bones because Oftentimes people don't even one realize they're holding tension back there and then to understand what you mean when you say widen the sits bones so being able to use a tool in that area to bring awareness to the anatomy can be very powerful and in widening those spaces and freeing up the pudendal nerve.
So it's free to, um, do its function in sensory and motor, um, innervation. So the pudendal nerve also actually anastomoses with the, um, one of the branches of the obturator nerve. And so the obturator nerve glide can be a very powerful nerve glide. to use to affect pelvic floor function. So, um, I have a video, a YouTube video of that whole pelvic floor mobility sequence, self massage with the Franklin balls that I'll have Joe link in the show notes as well as the obturator nerve glide video too.
Those become such powerful tools in this, um, pelvic floor mobility game. So, and the last one, or the last few things I'll talk about too is part of the reason also that we have so much tension in our posterior pelvic floor besides that protective pattern from the reflexively protecting the viscera or the nerves or whatever in that area is our startle reflex, our stress response.
It's a primitive reflex for us when we are in a startle state or when we're in a hypersympathetic state to literally tuck our tail, cave in our front side to protect our organs, right? You see this in, like, four legged animals quite a bit too. They tuck their tail and they kind of curl up. This is a very reflexive protective pattern.
In an upright human being, it looks like tucking our tail, sticking our head out, kind of like a turtle, right? Like real bad, like posture, you know for lack of a better way to think about it when we tuck our tail like that in that response when we have this especially posterior pelvic floor tension that brings our ischial tuberosities together and creates an out flare, which is going to create more external rotation of our legs and posterior tilt it takes our center of mass and shifts it back on our heels So what happens is we start losing our ankle dorsiflexion and losing our ankle dorsiflexion as a balance strategy.
So often times, someone who is chronically stuck in this posteriorly tilted Tucked under reflexive stress response. I can do all the pelvic floor work in the world I want, but as soon as they stand on their feet again, they're going to go right back into it because they haven't shifted their weight forward in their feet for so long.
So often times when I'm working on pelvic floor mobility, I also need to work on ankle mobility and anterior weight shift. I have a podcast episode, I'll have Joe link in the show notes as well. all about weight shifting and I talk about these patterns here too. So just know that it's really important to do both since we are standing on our feet and this can be a cause of some of that pelvic floor, um, tension as well.
So, um, stress response, Well, and so, and that takes us to like another like treatment intervention too, besides all the stuff locally at the pelvic organs, at the, um, from the swelling reduction standpoint and the fluid thing, from a like eccentric function of the pelvic floor exercises, from ankle mobility, we also have to Consider what's putting them in that hypersympathetic state in the first place.
And you may need to even backtrack one step further and go to the cranial nerves and cranial work to facilitate some of the social engagement nerves, um, that facilitate more of a parasympathetic environment. Because often times it is they're, they're adapt, their pelvis is adapting its position based on this reflex.
And so we need to take, kind of take one step back and look a little bit more at the autonomic nervous system and how we can support that and how we can support feelings of safety in order to get them out of these physical patterns. And so again, another episode that I've done, I'll have Joe link in the show notes, is all about accessing the autonomic nervous system and parasympathetic nervous system without necessarily always relying on breath exercises.
And this is important, especially in pelvic floor issues because, um, this hypertonicity sometimes in the pelvic floor can be also mirrored in hypertonicity of the diaphragm and, um, breathing things because when we're breathing we're changing the pressures in all of the cavities and the, in the pelvis, the pelvic cavity is going to take the brunt of that and so if you have a pressure problem, um, with organs, like a prolapse or stress incontinence or something like that, then your body reflexively is going to limit your breath capacity.
And so we have to go at it from a different way. We can't, that means that breath can't always be the best tool to use. It can be a tool and sometimes it's helpful, but sometimes it's not. And so having these other tools. to approach the autonomic nervous system to facilitate the safety, can change the positioning in the pelvis, which then allows the organs more space to move and like be happy.
And then you can do breathing exercises because we won't have this reflexive protective pattern of the diaphragms, both the pelvic floor diaphragm and the thoracic diaphragm. So, um, this can be really big picture. I think this is also why sometimes. Physiological pelvic organ issues are hard to deal with, um, but then also why when you're working on pelvic floor mobility, even with someone that doesn't necessarily have symptomatic visceral issues, why sometimes things don't stick.
Things don't stick because you're either missing the ankle mobility piece or you're missing the driver of the pattern in the first place, whether it be a visceral issue. Excuse me, a visceral protective pattern or a general whole organism protection pattern related to the autonomic nervous system. So Yeah, kind of related but unrelated. I talked about the importance of feeling these sits bones widen. One of the cool things also about cueing the sits bones is the sits bones, the ischial tuberosity happens to be right in line with actual anatomical hip joint. So when we cue hip hinging at the sits bones, even though that's not where the hip is actually hinging from, it's right in the same line.
So people tend to move better in their hip joint because of this cue of widening the sits bones because it centers the movement around the actual movement. area of the hip, not to mention the reflexive relationships we talked about in the first place between the pelvic floor muscles and the hip rotator cuff and hip flexors.
Getting your patients to be aware of where their sits bones is and aware of the shape of their pelvis and like how it relates to their hip joint, where the hip joint is in relationship to the pelvis, 100 percent nobody knows where the hip joint is unless they have hip pain. I have a whole video talking about how to find your hip joint too that I will have Joe link in the show notes.
But, um, part of my work with my clients as we're going all, over all of this, I, I bring them a model of the pelvis so they can appreciate the shapes of the bones because they are so different than the rest of our anatomy and because they are so covered with muscles, right? There's a lot of muscle bulk and adipose tissue around the pelvis that it's hard for us to imagine in our mind's eye the shape of the bones, the way the bones work, the way, um, our hip works in relationship to them.
So oftentimes one of the most powerful things you can do in getting people to understand what you're trying to get at with pelvic mobility things is showing them this. Let them hold it, let them explore it, let them touch it, let them turn it all around, and then encourage them to like feel those parts in themselves.
This is actually exactly to what we go over in the LTAP level one when we're learning the SI joint test. So often when someone's doing the supine SI joint mobility test, they're pressing down on the innominate bone, but they're not picturing the whole shape and size of the, the shape, size, and like the uniqueness and fullness of the anominate bone in their hand.
Because when you can appreciate the whole size of the anominate bone in your hand, now when you do a AP glide, now you're going to be more likely to be sort of like in the joint, as opposed if you're just pushing on the ASIS. And so getting to experience what it's like to like hold this this whole innominate bone in your hand in a model can give you sort of educate the feeling in your hands so that when you go on your patients and have all those layers of muscles and adipose tissues on top, you still have like a foundation of what the bones feel like in your hands and then you can apply the technique
even better. So, you know, whether it's the patient, whether it's you as a clinician, it's so important to like familiarize yourself with the bony anatomy both, you know in a model and in the body itself So lots of links in this episode for you lots of like other things to learn about but like I said It can be a really complex thing but as with everything the more we understand the anatomy The easier it is to have options for treatment that are going to significantly influence issues in that area, whether it be like traditional musculoskeletal pain or physiological complaints like organ prolapses or incontinence, um, urinary or fecal incontinence or, you know.
All the other, you know, erectile dysfunction or libido issues or pain, painful intercourse, like all of those things. There are so many ways that we could treat it through manual therapy and movement. Manual therapy being external, there's a lot of external things that we can do and show our patients even how to support themselves without necessarily always having to resort to internal work or like, finding a good pelvic floor specialist, a good pelvic floor, uh, manual therapist.
So hopefully this sort of opens your eyes to all the options and gives you something to think about, uh, pelvic, the pelvic floor, pelvic floor mobility that you haven't thought about before. So thank you for being here again. Thank you for celebrating the hundredth episode of the Unreal Results podcast.
Cheers to a hundred more.