Pelvic Floor 101 Class 3 - Pelvic Diaphragm Muscles

Hello Students,

Before we learn about the functions of the pelvic diaphragm muscles, let's identify them by locating them in the figure below.

Identify the following muscles:

1. pelvic diaphragm
2. pubococcygesu
3. puborectalis
4. iliococcygeus
5. coccygeus
6. piriformis
7. ilacs
8. psoas major

Upon learning location and function we begin to understand our pain and why relaxation exercises, stretching, lengthening and strengthening is a must if we want to begin resolving our pain. As different and unique as we all are we are very much alike.

IC patients often focus solely on diet when the FACT is strengthening muscles is just as if not more important than diet. Diet should should consist of foods that are easy to digest and that are fast existing which, we will talk more about in future lessons. If you think that food does not affect your pelvic area think again.

Male Pelvis

Female Pelvis





The pelvic diaphragm is the largest muscle group in the pelvic floor and is responsible for most of the function or dysfunction of this area.


This layer is divided into the coccygeus muscle and the levator ani muscles.



The coccygeus muscle originates at the spine of the ischium, inserts on the anterior portion of the coccyx and S4, and is innervated by the ventral rami of sacral nerves 4 and 5. The coccygeus flexes the coccyx and may help stabilize the sacrum through its scarococygeal attachments.



The levaotor ani muscle is further divided into the ilococygeus and the puboccoccygeus muscles. The iliococcygeus originates from the pubic ramus and arcus tendentious ligament (an extension of the obturatior internus fascia) and inserts on the coccyx.


The puboccoccygeus muscles is divided into the pubovaginalis and puborectalis muscles. The pubovaginalis originates at the posterior aspect of the os pubis and inserts on the perineal body and vaginal walls, forming a sling around the vagina.


The puborectalis originates from the pubic bone and obturatio internus fascias and inserts onto the coccyx and lateral walls of the rectum, similarly forming a sling around the rectum.


The innervation of the levator ani muscles is from the inferior rectal branch of the pudendal nerve of S2 through S4 and ventral rami of S2 through s4. The function of the levator ani muscles is to support the pelvic viscera.


The pelvic diaphragm muscles are approximately 70% slow-twitch muscles fiber (type1) and 30% fast-twitch muscles fibers (type 2). Both types of muscles fibers have specific functions in the pelvic floor, and a complete exercise program should train both types of muscles fibers. The physiology of these muscles is similar to that of other skeletal muscles. Sensation in the region is limited and may be decreased with surgery or childbirth. The PFM responds to quick stretch and has extensive fascia throughout the muscle layer.


The PFM contract as a unit to achieve various functions. Impairments can occur in a single layer or throughout the entire skeletal muscle layers.


Related Muscles


The piriformis and the obturator internus (the intrapelvic hip rotators) are located within the pelvis and can affect the function of the PFMs. The piriformis originates on the anterior surface of S1 to S4. (See The Anterior Sacroiliac ligament in the figure below)

It's inferior border is close to the superior border of the coccygeus muscle and it inserts at the great trochanter of the femur. (See Greater Trochanter in the figure below)

The obturator internus originates at the inner rim of the obturator foramen and inserts onto the great trochanter.

The levator ani muscles attach to an extension of the obturator internus fascia (i.e. the arcus tendinous, also called the white line). (see white line in the figure below)

This muscles is best envisioned three dimensionally. Impairments in length, strength, endurance, and patterns of recruitment of the piriformis and obturator internus muscles often contribute to PFM impairments and vice versa. Hip function may need to be considered with pelvic floor dysfunction and pelvic floor dysfunction with hip dysfunction.

The adductor muscles group also may participate in PFM pain syndromes. The muscle originate at the pubic ramus and ischial tuberosity, inserts on the posterior femur and medial femoral condyle, and is innervated by the obturator and sciatic nerves. Adductor fascia at the pubic rami is in close proximity to the superficial perineal muscle fascia.

The psoas minor and major muscles originate form vertebral bodies and disks of T12 through L5. The iliacus muscle originate at the medial iliac fossa. Both muscles fuse and travel in an anteroinferior direction under the inguinal ligament to insert onto the lesser trocanter of the femur.

The iliopsoas muscle is innervated by the L2 , L3 and L4 spinal nerves. It is a key muscle to treat in lumpbopelvic dysfunctions. Travell and Simons Call it the hidden prankster and stress its importance in pelvic function.

Trigger points in the psoas muscles are a common cause of pain in both the lower back and the groin. They can also contribute to gynecological symptoms . Despite their seeming inaccessibility, psoas muscles are actually very easy to massage. Psoas trigger points refer pain to low back. When the trigger points are really bad, back pain can extend from the lower shoulder blade area to the upper gluteal region. Pain is worse when you're standing. Sit-ups are impossible and you may have difficulty getting up out of a chair. Severely troubled psosas muscles may prevent you from standing or walking so it is very important to exercise these muscles.

How to exercise Psoas trigger points can be found HERE

Deep Tissue massage for Psoas Muscle can be found Here

Psoas Muscle Exercise can be found Here

Your assignment is is the read this material and re-read it again. Locate the different muscles that are shown on the pics/figures and to do watch the three videos and try out these exercise. Don't be afraid to have your partner watch the video's with you or teach him/her how to do these exercise so they can help you. This also helps to bring the two you closer together.

Next we will return to this same page and begin learning the definition, functions etc.......

PS: Sorry I am late posting the class, we had a few family crisis this week.

Gloria Prater, Wellness Educator

Feel free to ask questions or make comments.

MAKE FRIENDS WITH YOUR PELVIS

(Benefits)

We can be friends with our pelvis!

Why is it that we can have empathy for another IC patient but we find it hard to have empathy for ourselves. I cannot speak for everyone but in the last fifteen years I have come across so many IC patients that feel guilty that they are unable to participate fully in life, their children's lives, have spontaneous intercourse with their partner, work outside the home, go to a movie with a friend, or be able to help their aging parents.

The guilt I felt was as chronic as the pelvic discomfort and pain. I hated my body, my life and I wanted to die.

After suffering for more than twenty-five years I finally realized that I had to let go of the things that were nor serving me. I had to learn to live in the moment and accept that I had painful bladder syndrome and chronic pelvic pain. I also realized that it was time for to stop solely relying on my doctors (i mean after 25 years my syndrome progressively got worse not better) and take responsibility for my health care.

As a child I was taught "it is better to give than receive" and I gave to everyone but myself. I remember thinking to myself, why is it so difficult to open up to myself?

I mean it is typical to feel resentful, or at least frustrated when we're faced with chronic pelvic pain that interrupts not only your activities of daily living but your relationships too.

I remember my counselor saying "We all have options regarding how to respond to physical and emotional health"! My first reaction was "defensive", I wanted to rip her head off and scream "I don't have a choice over this chronic pain" but I stopped myself, I listen to what she was saying and she was absolutely right. I had a choice over how I reacted to the pain.

My counselor went on to say " have you ever thought about making friends with your pelvis"? She, recommend that begin doing so by enrolling in a beginners yoga class.

My reply - " how am I going to do yoga with the pain I am in and I cannot afford to have another bill". My counselor pointed out the obvious to me which was if I didn't try I would know and she kindly referred me to a free beginners yoga class that took place on the beach (less than 1 mile from my front door) every morning at 7AM and the public library were I could rent a beginners DVD for free.

I was fresh out of excuses so, I made the phone call and registered for the yoga class on the beach.

Over the years I had developed a negative thought pattern so before attending my first class I became very critical of myself. I was so nervous that I wouldn't fit in or be able to do the poses, and that the other students would have these perfect yoga bodies. I walked into the beach and saw a whole range of people - big and small, young and old, fit and not so fit. I remember thinking, dam-it, I fit in.

After three months of practicing three times a week, I felt stronger and my pelvis was more at ease. My pelvis was no longer in a chronic state of tension, but more important, the critic in my head began to quiet down. I began learning to take the focus off my pelvis and to focus on my breathing and the yoga poses.

I was experiencing the beginning of a longer process: accepting my pelvis as it was in that moment.

Yoga was the beginning of my healing journey and it can be yours too.

Millions of IC patients - most of them women - struggle each day with feelings of shame and inadequacy about their bladder and pelvic pain. In fact, studies have shown that most patients develop clinical depression and or anxiety.

In recent studies we have learn that yoga can help women feel better about their bodies.

Yoga makes a difference because it emphasizes self-acceptance, something that's largely missing for those of us who live with chronic pain. Odd as it seems, the pelvis which gives life, begins to get nothing but our scorn which intensifies our pain both physically and emotionally.

Start retraining your focus and thoughts and make friends with your pelvis.

I highly recommend making yoga part of your lifestyle and if you are practicing yoga at least 3 x per week for 30 Min's you may want to take the next step by practicing meditation.

Caution:

If you are under a doctors care for specific health problems or you are pregnant please consult with your physician before starting any type of exercise program.

Much Love

Gloria Prater, Whole Health Educator and IC Patient

Join the IC Anonymous Fellowship HERE!

YOGA BENEFITS

The Pelvic Floor 101 Class - Review of Anatomy & Kinesiology

Outline


We will be focusing on the Anatomy and Kinesiology ( the science of human movement) over the next 4 weeks, this class will be continuous until you know this stuff inside and out.



Skeletal Muscles

Pelvic Diaphragm Muscles

Related Muscles (very important and helps you to make sense of other pain you feel in hips, thighs, lower back, etc.)

Pelvic Floor Function

Physiology (the function of living organisms) of Micturition (micturition simply means peeing, voiding) the physiology of micturition involves coordination between the central, autonomic and stomactic nervous systems. (You can see that your central nervous system has a lot to do with what is going on with your condition which should tell you that bladder retraining is very important, in simple terms it help to retrain the central nervous system so it is not signaling your brain that you have to pee every 5 minutes thus causing annoying bladder spasms.

Next months we will learn about Anatomic Impairments such as Birth Injury and Neurol0gic Dysfunction. We will also learn ways to improve our injuries. This class will be more than learning about the pelvis it will also include learning how to care for the pelvis and begin healing.

Are you guys excited, I am! Don't worry we are going to start off slow so, no one gets overwhelmed.

We will begin with the Skeletal Muscles of the Pelvic Floor but first please read this important information and write the key notes down in your note pad.

Physiologic impairments of the gynecologic, urinary, and gastrointestinal systems are often treated with medications or surgery that have little to no success. Today, however, more and more doctors are recognizing the benefits of education and various physical therapies.

Pelvic floor muscle rehabilitation involves the skeletal muscles located at the base of the abdominal cavity. The Pelvic floor refers collectively to tissues that span from the pubic bone to the coccyx. This area includes skeletal muscles under voluntary control, which responds to the same training techniques as other skeletal muscles in the body.

You will be introduced to the anatomy and kinesilogy of the pelvic floor, physiology of micturiton, and anatomic and physiologic impairments of the pelvic floor.

Management of common physiologic impairments of the pelvic floor, pelvic floor-related diagnoses, and their impact on other areas of the body will be discussed, and clinical applications will be provided/explained - If I am lucky my son will help me do some video's so I can show you guys the applications.

Note: If your seeing a physical therapist for Pelvic floor issue they should screen you for pelvic floor impairments and provide basic instruction in strengthening these skeletal muscles and at the same time you need to be doing pelvic stretches at home on a daily basis otherwise your experience more pain than usually with PT. We will discuss more about exercises and the order of their application a bit later.

Class: Skeletal Muscles

• The skeletal muscles of the pelvic floor can be divided into four layers, from superficial to deep: (1) The anal sphincter, (2) Superficial perineal muscles, (3) urogenital diaphragm, and (4) the pelvic diaphragm.
• The Anal Sphincter is the most superficial skeletal muscles.
• The Anal Sphincter includes the internal anal sphincter (smooth muscle) and the external anal sphincter which is the skeletal muscle. These sphincter fuse superiorly with the puborectalis component of the pelvic diaphragm muscles. These three muscles function together to provide fecal continence. Neurologic innervation is provide form the forth sacral nerve and interior branch of the pudendal nerve.
• Neurologic innervations involves your central nervous system which provides the pathway to the sacral nerve and the interior branch of the pudendal nerve so you can see why you have so much pain when the signals are not functions properly.
• The superficial perineal muscles aid in sexual functioning of the pelvic floor, and the urogenital diaphragm is part of the continence mechanism.
• The three superficial perineal muscles are the bulbocavernosus, the ischiocavernosus, and the superfical transverse perineal. The three muslces of the urogenital diaphragm are the urethrovaginal sphincter (pertains to a fistula between the urethra and the vagina), the compressor urethrae (formely known together as the deep transverse perineal), and the sphincter urethrae.
  
  Assignment: Well I looked up all the terms for you, you just click on them and write down the meaning and write in the shortest form, no need to write a book for each meaning. We will have a multiple choice quiz next Wednesday.

Please take a close look at this pic and all the different muscles.

See sensor insert - this can be use to do kegels and your physical therapist uses this to measure your pelvic muscle strength.

You Can Retrain Your Bladder

Retraining your bladder takes work and commitment!

Unfortunately, people like you and I have confused central nervous system (CNS. Our CNS signals the brain when we have to urinate and our is stuck on GO! To get it unstuck you need to retrain the bladder! It can feel like tug of war at times but if your consisting you will win the frequency war!

Depending upon the type and seriousness of your problem, one or more may be right for you. But many doctors recommend trying bladder control training, which means learning to urinate on a schedule, strengthening the pelvic muscles (Kegel exercises), and sometimes biofeedback. Bladder control training can be especially helpful with urge incontinence — the sudden and overwhelming need to urinate, sometimes accompanied by involuntary loss of urine on the way to the bathroom.

These exercises are good for everyone. You don't have to have frequency, urgency or even leakage to do these exercises. Kegels are use d as preventive measures as well.
Don't be afraid to teach your children these exercises (boys too)! We are all susceptible to pelvic syndromes.

You CAN retrain your bladder

There are many approaches to treating urinary incontinence. Depending upon the type and seriousness of your problem, one or more may be right for you. But many doctors recommend trying bladder control training, which means learning to urinate on a schedule, strengthening the pelvic muscles (Kegel exercises), and sometimes biofeedback. Bladder control training can be especially helpful with urge incontinence — the sudden and overwhelming need to urinate, sometimes accompanied by involuntary loss of urine on the way to the bathroom.

Learn to “go” on schedule

The mainstay of bladder control training is timed voiding, which means that you urinate at a set time, not when your bladder tells you to. Here’s what to do:

• Determine your pattern. For a day or two, keep track of what times during the day you urinate or leak urine.
• Choose an interval. Figure out how long you typically wait between urinations during the day. Choose a starting time that’s 15 minutes longer. For example, if you usually go every hour, your starting interval will be 1 hour, 15 minutes.
• Go by the clock. On the day you start, empty your bladder first thing in the morning and not again until after the interval you’ve set. If that time arrives before you feel the urge, go anyway. Remember, you’re training your bladder to keep a schedule. If the urge hits first, do everything you can to hold off going. This can be difficult at first, but usually improves with practice. If the urge is great, try to distract yourself. Practice Kegels (described below), cross your legs, stand still, or breathe slowly in and out for counts of four. Remind yourself that your bladder isn’t really full. If you can’t wait the full 15 minutes, try to manage another 5 minutes before walking slowly to the bathroom.
• Increase your interval. Once you’re comfortable with your initial interval and aren’t having any leakage — this may take anywhere from a few days to a few weeks — increase the time by another 15 minutes. Repeat this process, increasing your time by 15-minute increments. After several weeks or months, you may find that you’re able to wait for 3–4 hours between trips to the bathroom and that the feelings of urgency and episodes of incontinence have greatly diminished.
• Don’t train at night. Get up in the night whenever you need to urinate. Your day training should eventually begin to influence your entire voiding pattern, so that you get up less frequently at night.

Learn how to do Kegels

Pelvic floor muscles are the muscles you use to hold back urination and thus are important to urinary continence. You can strengthen and condition these muscles with pelvic floor exercises, also known as Kegels (named for Arnold Kegel, the physician who first described them).

To perform Kegels, you first need to find your pelvic floor muscles. Pretend you’re trying to avoid passing gas. You should feel the contraction more in the back than the front. Don’t contract the muscles of your stomach, leg, or buttocks. Once you’ve located the pelvic floor muscles, you need to repeatedly contract and relax them. Practice both short and long contractions and releases.

Short contractions are quick squeezes and releases. Mastering long contractions will take more practice. Start by holding each contraction for 3–5 seconds, resting for the same number of seconds between contractions. Build up to 10-second contractions with 10 seconds of rest between contractions. Try to do 30–40 long Kegels every day, divided into groups of 10 contractions each. You may want to do 10 before getting out of bed in the morning, 10 standing after lunch, 10 in the evening while sitting, and another 10 before going to sleep.

Some individuals may benefit from biofeedback using a device that can help monitor progress in learning and doing Kegels. Patches placed over the muscles are connected to a video

Yoga Workout Tips For Starting Yoga Asanas

These yoga workout tips will be useful for starting yoga practice at home. These tips include essential guidelines for maximizing benefits from yoga practice. Yoga is more than a physical exercise. Your mental make up while doing Asanas also matters. Start yoga with faith and determination, it has the potential to change your life and personality.

Time For Yoga

• Early morning, one to two hours before sunrise is best time for yoga as preferred by yogis. Bowels must be passed before doing yoga. You may take bath before yoga practice. Be patient, it takes time to set to new routine.

• Otherwise there is no sacrosanct time for yoga. You can practice yoga anytime of the day. Only precaution is that your stomach must be empty at time of doing yoga. Meals should be taken 3 hours prior to yoga practice, but you can drink water if thirsty.

• Preferably fix a particular time of the day for yoga, it will help you to maintain regular yoga practice.

• All Yoga exercises should be performed on the hard floor, using a rug or mat for support.

• Ideal place for doing yoga is outdoors, if weather permits. For indoors practice, place for doing yoga should be spacious, well ventilated and without any disturbances.

• To get better results, earmark about 30 minutes to one hour daily for yoga practice.

Yoga Workout Tips For Making Up Your Mind For Starting Yoga Poses

• The yoga asanas must always be approached in a peaceful state of mind.

• Fill your mind with thoughts of peace and serenity, turn your thoughts inward and away from materialistic world.

• Make sure you are not tired to the extent that you are unable to concentrate on asanas.

During The Pose

• Concentrate deeply on the asana you are doing. Focusing your concentration on the body part being affected by a particular asana will bring maximum benefit.

• While doing an asana, your breathing is very important. Follow the specific instructions for breathing if applicable for a given asana. Otherwise, practice normal breathing which must be rhythmic.

Yoga Workout Tips For Beginners

• In the beginning, you may start with rhythmic breathing and pranayama.

• Practice shavasana for relaxation.

• Approach your task with patience and perseverance. If your body is not flexible, you may find it difficult to do most of the asanas. Do not worry if at first you cannot the asanas properly, it will become easier with repetition. Stiff muscles and joints will gradually ease up.

• Always remember to rest between two asanas.

Upavesasana - Squat Sitting Down Pose

This pose is beneficial to IC Patients who have Pelvic and rectum pain.

The pelvic floor can be contacted easily in this position, where it works synergistically to initiate exhaling, and releases some tone in response to the downward pressure exerted by the thoracic diaphragm when inhaling.


Working
Pelvic floor: Obturator internus, levator ani. Isometrically: piriformis, obturator externus, two gemelli, quadratus femoris, biceps femoris, semitendinosus, semimembranosus, adductor magnus (long head). The legs should stay active; otherwise the deep fexion tend to collapse the hip joints, making it more challenging to activate the pelvic floor.


Foot: Lumbricals, quadratus plantae, adductor hallucis, flexor hallucis brevis flexor digitorum brevis, opponens and flexor digiti minimi, abductor digiti minimi.


Lengthening
Adductor longus, adductor brevis, hamstrings, gastrocnemius, soleus, and plantaris.


Obstacles and Notes: The inability to dorsiflex the ankle deeply enough to keep the heels on the floor can be due to shortness in Achilles tendon (specifically the soleus, in this position); however, restriction can also be in the front of the ankle. A quick fix is available by using support under the heels, but it's important not to become too reliant on it, because it will prevent activation of the intrinsic muscles of the feet, which stabilizes the arches, allows deeper flexion in the ankle, and aligns the bones of the foot and knee joint.

Remember to breathe while performing your pose(s). This pose offers opportunity to powerfully lengthen all three curves of the spine. By definition this usually engages the deep support in the arches of the feet which energetically feeds into the lifting action of the pelvic floor and lower abdominal muscles. The bracing of the elbows against the knees allows for the strong lengthening of the spine and lifting of the base of the rib cage and respiratory diaphragm.

Before you get into a squatting pose practicing some deep breathing.

Next practice a standing pose.

Standing Pose

• While inhaling, clasp your hands as shown and raise both hands slowly upwards. Both the palms are facing upwards.

• Retain breath, slowly lift your heels so that you stand on your toes. Stretch all of your body upwards as far as possible. Keep your legs and arms straight (no bending).

• While exhaling, slowly bring your hands down. Bring your heels on the floor as in starting position.

Practice

• Repeat this asana 2 to 3 times. Try to increase the duration you can stay in this asana.

• After sufficient practice, while you are standing on your toes, take 4 steps forward and 4 steps backwards. This will improve your grace while walking.

Benefits

• This asana increases height.

• The vertebral column and heart are strengthened. Good for regulating the menstrual cycle.

• Cures indigestion.

• Strengthens arms and legs and helps to remove lethargy.

If your pregnant or you have a physical issue it is best to use pillows to squat.


Instructions

1. From a standing position with the feet 3 feet apart, bend the elbows at shoulder height and turn the palms facing each other. Turn the feet out 45 degrees facing the corners of the room, and as you exhale bend the knees over the toes squatting down.

2. Press the hips forward, press the knees back. Drop the shoulders down and back and press the chest toward the front of the room. Keep the arms active, as if they were holding a big ball over your head. Look straight ahead with the chin parallel to the floor.

3. Breathe and hold for 3-6 breaths.

4. To release: inhale and straighten the legs, reaching the fingertips to the ceiling, then exhale the arms to the sides.

Benefits + Contraindications

Benefits: Goddess Squat pose opens the hips and chest while strengthening and toning the lower body. Goddess pose stimulates the uro-genital, respiratory and cardiovascular systems.

Contraindications: Recent or chronic injury to the legs, hips or shoulders.

Yoga Benefits

You've probably heard that yoga is good for you. Maybe you have even tried yoga and discovered that it makes you feel better. But what are the specific health benefits can you expect to enjoy from doing yoga regularly?

Physical Benefits
Flexibility: Stretching your tight body in new ways will help it to become more flexible, bringing greater range of motion to muscles and joints. Over time, you can expect to gain flexibility in your hamstrings, back, shoulders, and hips.

Strength: Many yoga poses require you to support the weight of your own body in new ways, including balancing on one leg (such as in Tree Pose) or supporting yourself with your arms (such as in Downward Facing Dog). Some exercises require you to move slowly in and out of poses, which also increases strength.

Muscle tone: As a by-product of getting stronger, you can expect to see increased muscle tone. Yoga helps shape long, lean muscles.

Pain Prevention: Increased flexibility and strength can help prevent the causes of some types of back pain. Many people who suffer from back pain spend a lot of time sitting at a computer or driving a car. That can cause tightness and spinal compression, which you can begin to address with yoga. Yoga also improves your alignment, both in and out of class, which helps prevent many other types of pain.

Better Breathing: Most of us breathe very shallowly into the lungs and don't give much thought to how we breathe. Yoga breathing exercises, called Pranayama, focus the attention on the breath and teach us how to better use our lungs, which benefits the entire body. Certain types of breath can also help clear the nasal passages and even calm the central nervous system, which has both physical and mental benefits.

Mental Benefits
Mental Calmness: Yoga asana practice is intensely physical. Concentrating so intently on what your body is doing has the effect of bringing a calmness to the mind. Yoga also introduces you to meditation techniques, such as watching how you breathe and disengagement from your thoughts, which help calm the mind.

Stress Reduction: Physical activity is good for relieving stress, and this is particularly true of yoga. Because of the concentration required, your daily troubles, both large and small, seem to melt away during the time you are doing yoga. This provides a much-needed break from your stressors, as well as helping put things into perspective. The emphasis yoga places on being in the moment can also help relieve stress, as you learn not to dwell on past events or anticipate the future. You will leave a yoga class feeling less stressed than when you started.

Body Awareness: Doing yoga will give you an increased awareness of your own body. You are often called upon to make small, subtle movements to improve your alignment. Over time, this will increase your level of comfort in your own body. This can lead to improved posture and greater self-confidence.