At Back in Business Physiotherapy, we view the pelvis and spine as sitting in a sling of muscles, like a hammock evenly balanced with tension to allow multiple directions of movement without compromising it's stability. Pelvic girdle and low back pain have fallen under the diagnostic umbrella of non-specific low back pain (NSLBP).
Importantly, determine whether the person is inherently a 'floppy', 'stiffy' or 'flippy-floppy'.
Restricted abduction test : the subject is positioned in supine with the leg fully extended and abducted to 30degrees. Standing flexion test : is performed by palpating the PSISs whilst the subject is bending forward from the standing position. One leg standing : is a very useful test for ascertaining Intra Pelvic Torsion (IPT) where weight shift onto one leg is accompanied by anterior shift of the head of the femur. Gillet Test : is performed in 1 leg standing whilst the subject pulls their knee up to their chest.
Stork test : is performed standing on 1 leg as the subject moves the 90 degree flexed knee into hip flexion and hip extension.
Active Hip Extension test : involves the client prone and extending their straight leg at the hip.
Therefore ideally, gluteal activation occurs prior to or simultaneously with hamstring activation. Gaenslen's Test : useful test for psoas major length and with some adaptation rectus femoris length.
Generally there is little evidence to support the use of the Gillet test, standing flexion test, sitting flexion test, or supine-to-sit test to differentiate between subjects with and without static innominate torsion (Pamela K Levangie 1999, PHYS THER Vol.
Assessment of peripheral strength and flexibility is essential before commencing any Swiss Ball exercises or any other training regime. An adapted Geoff Maitland approach to stability and function, incorporating a modified concept of 'degrees of freedom', where the clients reaction to pain determines functional ability.
Any movement discrepancy observed , should be confirmed using special tests such as one leg standing - pelvic control.
Additionally, the ilium should be examined for outflares and a tight piriformis, or inflares and a tight iliacus. Sacral nutation and counternuation are considered normal events during flexion and extension in standing.
Anterior innominate rotation with hip extension coincides with ipsilateral pelvic rotation, ipsilateral spinal flexion and contralateral spinal rotation. The sacrotuberous ligment also has strong connections with the posterior thoracolumbar fascia, and muscular attachments of gluteus maximus and piriformis.
L4 rotation can be tested during 'the stork' test through palpation of the spinous process of L4 and sacral sulcus during long striding.
Frequently, these people present with an apparent or real leg length discrepency and are sometimes confused for an upslip. Upslips: can be the result of a sudden vertical force through the outstretched leg for example when stepping into a pot hole, landing awkwardly during a jump or when running. It should be noted that the attachment of the biceps femoris muscle is intimately linked with the continuation of the sacrotuberous ligament and hence can be considered a stabilizer of the SIJ. Downslips: are generally the result of a traction injury such as a rider falling off a horse with the foot caught in the stirrups. Anterior rotation of the innominate may also occur as a result of adductor muscle tension shifting the head of the femur forward. The piriformis originates on the anterior aspect of the sacral base and creates a posterior rotation relative to the ilium, whereas the iliacus rotates the ilium anteriorly relative to the sacrum. Shamberger (2002) described these as 'backward rotations' where the base rotates back instead of forwards.
People with sacral torsions may have increased force closure in one SIJ and reduced forced closure on the contralateral side. Since pelvic tilt plays an integral role in the oblique torsions during weight bearing it would make sense that the anterior, posterior and medial fibres of the gluteus medius are activated to control the movement of the ilia on the hip. Bilateral tightness of the piriformis may reduce sacral nutation, whereas asymmetrical piriformis action can axially rotate the sacrum resulting in excessive compression in the contralateral SIJ. Do the opposite femoral nerve (neural dynamics), external rotators (sacral torsion or ilial outflare) and rectus femoris (anterior innominate rotation) create excessive pressure on the opposite SIJ? If there is an ipsilateral anterior innominate rotation with jamming up of the SIJ concommitant with contralateral hip internal rotation tightness with some adverse neural dynamics of the femoral and sciatic nerves then METs of the hamstrings and external rotators may reposition the innominate and sacrum. Upslips and Downslips of the ilium are also possible, which maybe accompanied by symphysis pubis shearing (osteitis pubis). Do active SLR and check symphysis pubis, then reassess with anterior or posterior ilia compression to ascertain the affect of improved force closure. Do active straight leg raise (ASLR) with or without anterior or posterior compression of the ilia to ascertain 'force closure'. The effects of manual pelvic compression on trunk motor control during an active straight leg raise in chronic pelvic girdle pain subjects. A sub-group of pelvic girdle pain (PGP) patients with a positive active straight leg raise (ASLR) responds positively to the application of external pelvic compression during the test.
Compressor Belts for the pelvis may also be useful for some people, however they should only be seen as a means to an end i.e.
The use of pressure through the thorax and ilia can be also be used whilst assessing the clients specific relevant movement problem.
Altered motor control strategies in subjects with sacroiliac joint pain during the active straight-leg-raise test. O'Sullivan PB, Beales DJ, Beetham JA, Cripps J, Graf F, Lin IB, Tucker B, Avery A., Spine (Phila Pa 1976). STUDY DESIGN: An experimental study of respiratory function and kinematics of the diaphragm and pelvic floor in subjects with a clinical diagnosis of sacroiliac joint pain and in a comparable pain-free subject group was conducted.
OBJECTIVE: To gain insight into the motor control strategies of subjects with sacroiliac joint pain and the resultant effect on breathing pattern. SUMMARY OF BACKGROUND DATA: The active straight-leg-raise test has been proposed as a clinical test for the assessment of load transfer through the pelvis. METHODS: In this study, 13 participants with a clinical diagnosis of sacroiliac joint pain and 13 matched control subjects in the supine resting position were tested with the active straight leg raise and the active straight leg raise with manual compression through the ilia. RESULTS: The participants with sacroiliac joint pain exhibited increased minute ventilation, decreased diaphragmatic excursion, and increased pelvic floor descent, as compared with pain-free subjects. CONCLUSIONS: The study findings formally identified altered motor control strategies and alterations of respiratory function in subjects with sacroiliac joint pain. Motor control patterns during an active straight leg raise in chronic pelvic girdle pain subjects. OBJECTIVE: To investigate motor control (MC) patterns in chronic pelvic girdle pain (PGP) subjects during an active straight leg raise (ASLR). SUMMARY OF BACKGROUND DATA: The ASLR is a test used to assess load transference through the pelvis. RESULTS: Performing an ASLR lifting the leg on the affected side of the body resulted in a predominant MC pattern of bracing through the abdominal wall and the chest wall. CONCLUSION: This MC pattern, identified during an ASLR on the affected side of the body, has the potential to be a primary mechanism driving ongoing pain and disability in chronic PGP subjects. The effect of increased physical load during an active straight leg raise in pain free subjects. PURPOSE: It has been proposed that pelvic girdle pain (PGP) subjects adopt a high load motor control strategy during the low load task of the active straight leg raise (ASLR). METHOD: Trunk muscle activation, intra-abdominal pressure, intra-thoracic pressure, pelvic floor motion, downward pressure of the non-lifted leg and respiratory rate were compared between resting supine, ASLR and ASLR+PL. RESULTS: Incremental increases in muscle activation were observed from resting supine to ASLR to ASLR+PL. CONCLUSION: Pain free subjects respond to an ASLR+PL by a general increase in anterior trunk muscle activation, but preserve the pattern of greater activation on the side of the leg lift observed during an unloaded ASLR. Changes in pelvic floor and diaphragm kinematics and respiratory patterns in subjects with sacroiliac joint pain following a motor learning intervention: a case series. Altered breathing patterns during lumbopelvic motor control tests in chronic low back pain: a case–control study Nathalie Roussel, Jo Nijs, Steven Truijen, Liesbet Vervecken, Sarah Mottram, and Gaetane Stassijns Abstract The objective of the study was to evaluate the breathing pattern in patients with chronic non-specific low back pain (LBP) and in healthy subjects, both at rest and during motor control tests. Is the thoracic spine mobile enough to allow localised movements without placing excessive movement on the lumbar spine? These exercises are designed for people with an anterior pelvic tilt or Posterior Pelvis (PPXS). Both in APXS and PPXS the thoracic biomechanics and myo-mechanics needs to be assesed and treated. These high threshold loading exercises should only be done when control over the diaphragm and pelvic floor is achieved in low threshold scenarios. Connell AT (2008) Concepts for assessment and treatment of anterior knee pain related to altered spinal and pelvic biomechnics: a case report. Grindstaff TL et al (2009) Effects of lumbopelvic joint manipulation on quadriceps activation and strength in healthy individuals.
When dealing with diaphragm dysfunction which is located in the regions T7-L3 and thoracolumbar dysfunction the innervation of these regions should be considered. The pelvic floor can be considered as the base of the cylinder which incorporates the pelvis, abdominal muscles, back muscles, the thoracolumbar fascia and diaphragm.
We routinely use transabdominal Real Time Ultrasound as an assessment and biofeedback tool for training the synergistic role of the pelvic floor and transverse abdominis muscles.
Lee D, Lee L-J (2004) Stress Urinary Incontinence - a consequence of failed load transfer through the pelvis? Smith et al (2006) Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity. Sapsford RR et al (2000) Co-activation of the abdominal and pelvic floor muscles during voluntary exercises. Kelly M et al (2007) Healthy adults can more easily elevate the pelvic floor in standing than in crook-lying: an experimental study. Stuge B et al (2006) To treat or not to treat postpartum pelvic girdle pain with stabilizing exercises? These latter investigators concluded that effective treatment of postpartum pelvic girdle pain may be achieved when exercises for the entire spinal musculature are included, individually guided and adpated to each individual. Retroversion of the acetabulum can lead to increased ROM of internal rotation with a conommittant loss of external rotation which in turn affects pelvic rotation during activitis such as ambulation.
Pfirrmann et al (Radiology, 240, 3, 2006 pp778-785) used MRI measurements of alpha angles and the depth of the acetabulum to determine the risk and incidence of CAM and Pincer lesions in the hip. Lateral hip pain should always be assessed in terms of internal corset versus external corset stability as outlined by Vleemings muscular 'slings' or neuromuscular vectors. Muscle energy techniques as developed by British - Canadian physiotherapist, the late David Lamb, used the priciples of contract relax technqiues from PNF to restore pelvic-hip-lumbar spine functional symmetry. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Integrated Dry Needling with new concepts of myofascial pain, muscle physiology and sensitization.
Uncovering the biochemical milieu of myofascial trigger points using in vivo microdialysis: an application of muscle pain concepts to myofascial pain syndrome. An in-vivo microanalytial technique for measuring the local biochemical milieu of human skeletal muscle. Prosta-Qs patent - pending blend of active ingredients have been clinically shown to address the symptoms associated with Chronic Non-bacterial Prostatitis as well as improve overall prostate health. Prosta-Q was tested in a randomized placebo controlled clinical trial by the Institute of Male Urology (IMU) and was led by Dr.
The Prosta Q complex is a proprietary combination of clinically proven ingredients including Quercetin, a bioflavonoid with anti-inflammatory and antioxidant effects, Saw Palmetto, Cranberry, Bromelain and Papain, to aid digestion, as well as zinc. A Chronic nonbacterial prostatitis or inflammatory chronic pelvic pain syndrome is the inflammation of the prostate not due to bacterial infection. Treatment with antibiotics and drugs that relax the muscles of the prostate gland is often tried and commonly fails. Chronic pelvic pain syndrome is another name for Chronic nonbacterial prostatitis (or close medical condition association). Doctors understand very little about why some people - often young, otherwise healthy men - develop this problem. The main symptom is pain in the pelvis or perineum (the area between the scrotum and the anus.) However, many of the nonbacterial prostatitis symptoms may be present, such as fever, pain in the lower back, pain in genital area, general body aches, burning or pain on urination, increased urinary frequency, urgency, pain or discomfort during or after ejaculation, decreased libido, and occasionally visible blood in the urine. A Prostatitis is a term used to describe inflammatory conditions or infections of the prostate gland. Prostatitis can affect men of any age and it is estimated that 50% of men experience the disorder during their lifetime. A Early studies with bioflavonoids for prostatitis treatment were disappointing because of their low and inconsistent absorption rates. The results of the research in Chronic Non-Bacterial Prostatitis patients using Prosta-Q have been dramatic and compelling in significantly and rapidly addressing the symptoms associated with Category III Prostatitis (Chronic Pelvic Pain Syndrome).
Other studies suggest that bioflavonoid intake can be linked to "protection against coronary heart disease" and a "reduction of the increased capacity for signal transduction in human cancer cells".
A OBJECTIVES: The National Institutes of Health (NIH) category III chronic prostatitis syndromes (nonbacterial chronic prostatitis and prostatodynia) are common disorders with few effective therapies.
A RESULTS: Two patients in the placebo group refused to complete the study because of worsening symptoms, leaving 13 placebo and 15 bioflavonoid patients for evaluation in the blind study. A CONCLUSIONS: Therapy with the bioflavonoid quercetin is well tolerated and provides significant symptomatic improvement in most men with chronic pelvic pain syndrome. Factors such as pregnancy, childbirth, aging and being overweight, and abdominal surgery such as cesarean section, often result in the weakening of the pelvic muscles. Controlling ejaculation is a huge issue for many men, one that they are often too embarrassed to bring up.
Control and Prevention (CDC) recently released a status report of the national effort to reduce smoking to no more than 12% of the population by 2010. The use of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) is significantly associated with lower PSA levels, especially among men with prostate cancer, say researchers at Vanderbilt University.


Sexuality after SCI William McKinley MD Associate Professor PM&R Director SCI Rehab Medicine Virginia Commonwealth University. Female Sexual activity post SCI §Most individuals who were sexually active prior to SCI remain so.
Prenatal & Perinatal Pregnancy Issues §Prenatal: l constipation (decreased gastric motility) l UTIs (?
Parenting Issues in Females §Most did NOT feel well informed §70% satisfied with post-SCI sexual exp. T6)" title="Parenting Issues in Females §Most did NOT feel well informed §70% satisfied with post-SCI sexual exp. Neuro-innervation of erection §Psychogenic erection - SNS (T12-L2) via hypogastric N §Reflexogenic erection - PNS (S2-4) via Pelvic N penile sensation - pudendal N.
SCI & Male HSR: Overview (cont) §Complete UMN SCI l 90% reflex erections (lesions above T-10), poorly sustained no psychogenic erections (above T-10) l 40% successful for intercourse l 5-10% ejaculation §Complete LMN SCI l 25 % erections psychogenic l 10-25% successful for intercourse l 15-20% ejaculate (many retrograde due to dec opening of ext sph. Hence, we use a comprehensive analysis with muscle energy techniques, movement analysis, joint mobilisations, soft tissue manipulation and taping to optimise home and gym based exercise regimes.
The deeper the foundations of motor learning the stronger and greater the scope of adaptation during recovery. The goal with stiff people will be to improve range of motion and acquire control of global muscle timing. The examiner brings the ipsilateral hip into flexion, abduction, external rotation so the heel is on the contralateral knee. The examiner flexes the hip and knee so that the hip is at approx 90degrees flexion and slight adduction and the thigh is at right angles to the table with the knee remaining relaxed. The test is negative where both PSISs move the same amount and positive where one PSIS moves further cranially than the other which means limited movement of the sacrum on the ilium on the side of the superior PSIS (Potter & Rothstein.
Frequently, an anterior position of the head can be seen in biped standing when palpating from the side. Frequently, clients with LBP and PGP present with reversed gluteal : hamstring timing whereby the hamstrings are dominant. The knee is bent to 90degrees and the hip is rotated externally, the hip can also be abducted and finally a combination of abduction and external rotation can be made with the knee at 90degrees flexion. The patient is aided to sitting by puling up with their outstretched hands, so as not to involve the abdominal muscles and to avoid pelvic twisting. When considering neuro-linguistic programming (NLP), this tautology of words presents an interesting aspect of communication and goal setting for the physiotherapist. Additionally, manual muscle testing as well as muscle energy techniques, myofascial dry-needling and joint mobilisations can confirm or negate the 'working hypothesis' of what is causing the dysfunction. Although clinically, MET's to the iliopsoas can be very useful for restoring lumbar range of movement, there is little evidence to suggest that the iliosoas is tight, too strong or too weak. It should be noted that counternutation of the sacrum generally occurs beyond 45degrees flexion (some variation between individuals and pathology) and is a movement of the innominates relative to the sacrum. Anterior innominate rotation encourages contralateral L4 rotation through attachments of the ilio-lumbar ligaments, which is in turn accompanied by the posterior ilial rotation on the opposite side.These movements occur around an oblique axis. Additionally, control over lateral pelvic tilting on the stance leg can also be tested in various positions of flexion and extension whilst palpating the L4 in order to ascertain any mal-rotation suggesting some unstable L4 element. However, activation of the iliacus which is an important hip stabiliser will also anteriorly rotate the ilium.
Either of these movements would create a wedging of the anteriorly wider sacrum against the ilium and would under normal conditions help stabilise the SIJ. Whereas forward rotation accentuates a lumbar lordosis, backward rotations reduce it and may even create a segmental low lumbar kyphosis. Furthermore, they may present with poor form closure on either side (more likely on the side of counternutation) resulting in pain and load transfer dysfunction. If the ilium is in anterior rotation it is very difficult for the gluteus maximus to contract. If the ilium goes into anterior rotation (counternutation) then the acetablum may contact the superior-anterior surface of the head of femur resulting in anterior hip pain.
Inflammation of the the bone leads to softening of the bone and cartilage leading to considerable disability. Reduced pain or easier elevation with anterior compression may be indicative of the need to train the transverse abdominis and horizontal fibres of internal oblique (inner core). Combinations of anterior and posterior compression on opposite sides is also extremely useful where a sacral torsion is involved. This study investigated the effect of this phenomenon on electromyographic (EMG) activity of the trunk muscles and intra-abdominal and intra-thoracic pressures in subjects with a unilateral sacroiliac joint (SIJ) pain disorder (n=12). This again gives immediate diagnostic relevance as well as giving immediate awareness to the client of the existence of a problem. Clinical observations show that patients with sacroiliac joint pain have suboptimal motor control strategies and alterations in respiratory function when performing low-load tasks such as an active straight leg raise. Respiratory patterns were recorded using spirometry, and minute ventilation was calculated. The changes observed appear to represent a compensatory strategy of the neuromuscular system to enhance force closure of the pelvis where stability has been compromised by injury. Electromyography of the anterior abdominal wall, right chest wall and the scalene, intraabdominal pressure, intrathoracic pressure, respiratory rate, pelvic floor kinematics, and downward leg pressure of the nonlifted leg were compared between an ASLR lifting the leg on the affected side of the body versus the nonaffected side. This was associated with increased baseline shift in intraabdominal pressure and depression of the pelvic floor when compared with an ASLR lifting the leg on the nonaffected side. This study investigated this premise by observing the motor control patterns adopted by pain free subjects during a loaded ASLR (ASLR+PL). During the ASLR+PL there was a simultaneous increase in intra-abdominal pressure with a decrease in intra-thoracic pressure, while respiratory fluctuation of these variables were maintained.
This contrasts to findings in PGP subjects who, despite having a high load strategy for performing an ASLR on the symptomatic side of the body, display equal bilateral activation of the anterior abdominal wall during the ASLR.
The objectives of the study were to investigate the ability of a motor learning intervention to change aberrant pelvic floor and diaphragm kinematics and respiratory patterns observed in subjects with sacroiliac joint pain (SIJP) during the active straight leg raise (ASLR) test.
Ten healthy subjects and ten patients with chronic LBP participated at this case–control study. Additionally, lack of lateral chest expansion will affect the role of the diaphragm in respiration and stabilisation.
They should be proceeded by low threshold diaphragmatic and pelvic floor exercises which enhance low loading IAP (intra abdominal pressure). There should NOT be an increase in erector spinae tension in the thoracolumbar regions nor should there be an inhibition of diaphragmatic movement.
It is important to assess their anterior abdominal wall for excessive tightness and reduce this for optimal diaphragmatic expansion.
Don't forget that the diaphragm is innervated by C3,4,5 whilst the latissimus dorsi is innervated by the low cervical spine, let alone the inferior trapezius which has an upper cervical spine innervation.
Frequently, people presenting with low back and pelvic pain also describe weakness of the bladder. In particular during Active SLR we examine whether there is pelvic floor descent and whether this changes with manual pelvic compression and whether these people can be trained to maintain or raise the pelvic floor during this manouvre.
Application of perineometer in the assessment of pelvic floor muscle strength and endurance: a reliability study. They concluded that a deep acetabulum and posteroinferior acetabular cartilage lesions were a characteristic finding of pincer impingement. The contract relax technique uses the principle of autogenic muscle relaxation post isometric contraction.
Shah JP In : Contemporary Pain Medicine, Integrative Pain Medicine, The Science and Practice of Complementary nd Alternative Medicine in Pain Management. It refers to a condition affecting patients who present symptoms of prostatitis without a positive result after urine culture or expressed prostate secretion (EPS) culture. It is a persistent discomfort or pain that you feel in your lower pelvic region - mainly at the base of your penis and around your anus. Sometimes called noninflammatory chronic pelvic pain syndrome, it is the occurrence of prostatitis symptoms, without inflammation or bacterial infection. Theories to explain prostatodynia include an abnormal buildup of pressure in the urinary tract, irritation resulting from an autoimmune or chemical process, or pain generated in the nerves and muscles within the pelvis. While there are several types of prostatitis diagnosed in men, including bacterial prostatitis (acute and chronic), non-bacterial prostatitis and prostatodynia account for 95% of all prostatitis diagnoses. It is a very common condition, affecting hundreds of thousands of men, causing millions of doctor's office visits each year. Bioflavonoids have recently been shown in an open-label study to improve the symptoms of these disorders in a significant proportion of men.
Both the quercetin and placebo groups were similar in age, symptom duration, and initial symptom score. Emission - SNS innervation (T12-L2) contraction of vas def, seminal vesicle & prostate sends emissions to posterior urethra closure of bl. Ejaculatory dysfunction l LMN > UMN, incomplete > complete l anejaculation l retrograde ejaculation §3. Ejaculatory dysfunction l LMN > UMN, incomplete > complete l " title="Overview: SCI & male HSR §1. Altered proprioceptive input can result in an inaccurate 'virtual body concept of self' resulting in inaccurate feedback during the execution of motor tasks. Remember there are 3 stages of learning, where the first stage is the cognitive stage in which fundamental movement patterns need to be learnt in the most basic positions of neutral.
The examiner fixates the contralateral ASIS and applies pressure on the subjects flexed knee.
The test is positve when similar pain is produced over the SIJ below L5 (Broadhurst & Bond, J Spinal Dis, 1998, 11, 4, 341-5). The leg lengths are compared by examining the left and right soles of the feet in the prone extended and flexed positions. With the hip moving into flexion, inferior movement of the PSIS and ipsilateral rotation of the L4 is expected.
Also don't invoke 'fear' in your clients by using 'instability' without adequate explanations.
The physiotherapist needs to engage the client, thereby educating them to a point where they are able to do their own assessment of the efficacy of any exercise regime or treatment intervention. Similarly, in the abscence of an 'upslip' there is little evidence to suggest it's involvement in anterior pelvic tilt, rather it is more likely to be a posterior pelvic tilter.
In the above example rotation around the right oblique axis results in a 'counter-rotation' action whereby the right anterior ilial rotation is accompanied by a 'counterlocking' left posterior ilial rotation.
The L5 can almost be considered the 'meat in the sandwich' of sacral torsions (especially backward ones : left on right, right on left), ilial anterior rotations and L4 mal-rotations affect the bood vessels, nerves and articular processes of the L5. Upslips are generally accompanied by counternutation of the sacrum (anterior rotation of the innominate) which results in tension of the long dorsal sacroiliac ligament. In theory these are accompanied by sacral nutation (posterior rotation of the innominate) and tension on the sacrotuberal, sacrospinal and interosseous ligaments. Therefore, it may be equally important to have the counterbalancing stabilising muscles such as the horizontal fibres of internal oblique and transverse abdominis acting to stabilising the anterior aspect of the SIJ through compression.
This can result in compression of the SIJ on the opposite side and hence localised pain there. Improvements with anterior compression may mean the need for transverse abdominus training. Enhancement of pelvis stability via manual compression through the ilia reversed these differences. The ASLR+PL also resulted in increased pelvic floor descent and greater downward pressure of the non-lifted leg.
This differentiates PGP subjects from pain free subjects, supporting the notion that PGP subjects have aberrant motor control patterns during an ASLR. The ASLR test is a valid and reliable tool to assist in the assessment of load transference through the pelvis. The breathing pattern was evaluated at rest (standing and supine position during both relaxed breathing and deep breathing) and while performing clinical motor control tests, i.e. Suggestions have been made that people who hyperventilate create respiratory alkalosis which results in metabolic acidosis and therefore creates excessive tension in the soft tissue through the sympathetic innervation of the blood vessels.
Low threshold function needs to be continually emhasised even after achieving a stage where high threshold loading exercises are required. Theoretically, this is based on Ib tendonous, golgi tendon organ, autogenic inhibition or gate control theory, involving type III muscle afferents. The urine and fluid from the prostate show no evidence of a known infecting organism, but the semen and other fluids from the prostate contain cells that the body usually produces to fight infection. There may be a link between prostatodynia and increased stress, because this condition is often found in men with "Type A" personalities in high-stress situations.
Symptoms can include perineal pain, reduced urine flow and possibly impotence and pain before, during and after ejaculation.
It is thought that most cases of prostatitis result from bacterial infection, but evidence of infection is not always found. Shoskes, in association with his colleagues, recognized this and structured a formula specifically designed to increase bioavailability. The aim of this study was to confirm these findings in a prospective randomized, double-blind, placebo-controlled trial. Attention, stress and fear can inpact motor planning through altered perceptions of task demand and the environment where the execution of the task is to take place.
Then comes the associative stage whereby more dynamic activity or prolonged static postures can be practiced before arriving at the autonomous stage of learning (Fits & Possner 1967, Gentile 1972).
The goal with floppy people will be to enhance stability through co-ordination and improved endurance. The axial pressure applied is directed through the long axis of the femur, which causes anterior ot posterior shear to the SIJ.
With the hip moving into extension, superior movement of the PSIS and contralateral rotation or no movement of the L4 is expected. A positve result would be improved timing of contraction of the Gluteus Maximus over the hamstrings.


When separating the two muscles, the iliacus has an anterior rotation affect on the ilium (counternutation), whereas the psoas major has a posterior rotating affect on the ilium.
During extension in sitting, initially the ilia do not rotate whilst the sacrum nutates until all the slack is taken up by the ligaments and pelvic floor muscles at which point the ilia will begin to rotate anteriorly.
As the right hip moves into extension, anterior rotation of the right ilia results in contralateral left sacral torsion (whilst the pelvis is still rotating to the right). Also be certain which is your dominant eye - use the photographers square fingers technique and determine with which eye there is least movement from the centre of the square when both eyes are open compared to one eye shut. Clinically, improving SIJ stability by inhibiting tonically active muscles and activating tonically inhibited muscles (eg multifidus, transverse abdominis) usually improves lateral hip rotator strength. Check quadratus lumborum, external oblique, adductor longus and latissimus dorsi-thoracolumbar fascia for length, strength and 'timing'. However, visual inspection of the data revealed two divergent motor control strategies with the addition of compression. Trunk muscle activation was comparable between sides during ASLR+PL in all muscles except lower obliquus internus abdominis, which was more active on the leg lift side.
Irregular respiratory patterns, decreased diaphragmatic excursion and descent of the pelvic floor have been reported in subjects with SIJP during this test. Finally, lack of low thoracic spine mobility may affect the nutrition to the nerves innervating the muscles and blood vessels of the abdominal and pelvic region.
When a person coughs, the urethra usually contracts with the abdominal muscles thereby avoiding embarrassment. Progression from supine to side lying and to standing with weight shifting are also carried out using R-T US. In the PNF concept, this isometric contraction can be up to 100% max, whereas when using MET's the contraction level is usual low and may represent only 10%max when using it to make pelvic and back adjustments.
Have you confronted penile dysfunction due to pain or are you experiencing an uncomfortable throbbing sensation in your genital or rectal areas? An infected or inflamed prostate can cause painful urination and ejaculation, and if left untreated, serious complications.
METHODS: Thirty men with category IIIa and IIIb chronic pelvic pain syndrome were randomized in a double-blind fashion to receive either placebo or the bioflavonoid quercetin 500 mg twice daily for 1 month. The answer is working out your pubococcygeus muscles (PC) muscles, by doing Kegel exercises.
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Activation of low threshold muscles first, small movements and lots of cognitive motor control.
Furthermore, during the standing lumbopelvic flexion test, palpation for anterior positioning of the head whilst simulataneously palpating for counternutation of the SIJ can be useful in determining which comes first - the IPT or the anterior position of the head of femur.
However, these tests in my opinion are easy to do and may provide some useful information when examined in the context of the entire clinical picture. This is frequently the case in hamstring dominant people or people with an anterior iliac rotation whereby counternutation of the SIJ seems to inhibit the gluteus maximus.
Additionally, the iliacus muscle and posterio-medial aspect of the psoas major are more linkley to have stabilising functions as they are close to the joint and hence axis of rotation, whereas the antero-lateral psoas major may have a largely mobilising-power generating function. The posterior rotation of the left ilia stabilises the left SIJ joint in preparation for heel strike through the tightening of the right sacrotuberous, sacrospinous and interosseous ligaments. Additionally, try to glide the hip anteriorly and posteriorly with more and less weight bearing. Additionally, the contralateral external oblique may be important during intermittent and high loading. However, don't ignore lower limb mechanics such as excessive pronation of one foot and supination of the other. Improvements with posterior compression may indicate the need for deep Multifidus muscle training. Seven subjects displayed characteristics of a decreased EMG profile, while in the other five subjects the EMG profile appeared to increase. A blinded observer analyzed the breathing pattern of the participants using visual inspection and manual palpation. If using a Swiss Ball the person can move it gently from side to side whilst maintaning the isometric contraction.
Investigations, comparing static stretching, isometric contractions and contract-relax have demonstrated "a broader adaptive response that likely explains its (C-R) superior efficacy in acutely increasing ROM" (Kay et al 2015, Med Sc Sp Ex, 47, 10, 2181-2190).
The NIH chronic prostatitis symptom score was used to grade symptoms and the quality-of-life impact at the start and conclusion of the study. Twenty percent of patients taking placebo and 67% of patients taking the bioflavonoid had an improvement of symptoms of at least 25%.
Additionally, deactivation of global muscles and improved timing are frequently early priorities. Don't get trapped by exacerbating a persons condition, who appears to be stiff, yet has an underlying functional instability.
Finally, attempts at improved motor control through horizontal fibres of internal oblique & transverse abdominis activation with lateral weight shifting should result in spontaneous improvements in gluteus medius activation, whilst adductor tone should remain low. Certainly, in some sports such as cycling and rowing the supine -> sit may provide very useful information when exmined in that context. On the other hand posterior pelvic tilt may be the result of excessive hamstring and rectus abdominis - external oblique activity and a dysfunctional kyphotis low lumbar spine (flexion impairment) whilst anterior pelvic tilt is the result of excessive erector spinae activity (active extension impairment).
If this is the case, then the iliopsoas may be involved with functional synergies which involve the superficial abdominal muscles in maintaining the pelvic neutral position.
The continuation of the biceps femoris mechanism with the sacrotuberous ligament may also act as a mechanical stabiliser.
The hip will appear to glide further posteriorly on the side of anterior innominate rotation.
There may also be a role for Psoas Major in the prevention of excessive anterior ilial rotation?
Imbalances between the adductors and the contralateral gluteus medius and the internal and external obliques can play a significant role in poor recovery and may have been part of the aetiology. Combinations of anterior and posterior compression resulting in improvements may indicate the need for combined deep MF and Transverse Abdominus training. As such this study provides preliminary evidence of two disparate patterns of motor control in response to the addition of pelvic compression to an ASLR.
Respiratory patterns, kinematics of the diaphragm and pelvic floor during the ASLR test and the ability to consciously elevate the pelvic floor in conjunction with changes in pain and disability levels were assessed in nine subjects with a clinical diagnosis of SIJP. The third exercise above should only be undertaken once lateral weight shifting and OLS (one leg standing) control are optimal. Clinically, hip flexor C-R are used to improve the ROM of both flexion and extension when used in the Gaelsens position (see previous).
It occurs in association with other diseases such as Reiter syndrome (arthritis, conjunctivitis [eye inflammation] and inflammation of the genital and urinary systems).
While regular ejaculation and prostatic massage are helpful for some patients many patients with post-ejaculatory pain can exacerbate their symptoms with repeated ejaculations, thereby creating no long-term relief. In a follow-up unblind, open-label study, 17 additional men received 1 month of a supplement containing quercetin, as well as bromelain and papain (Prosta-O), which enhance bioflavonoid absorption.
In the 17 patients who received Prosta-Q in the open-label study, 82% had at least a 25% improvement in symptom score.
Later goals may include performance enhancement for return to sport, whereby intramuscular and intermuscular control between and deep stabilising and superficial ballistic muscles is trained using functional exercises which may include the Swiss Ball. Ask them whether they used to be really flexible as a child or prior to the onset of dysfunction.
Besides LBP and Pelvic Girdle Pain (PGP), this can also be an important consideration in someone presenting with lateral hip pain whereby lack of deep core activation and hence gluteus medius activation results in excessive use of the ITB and Tfl. Adductor longus and contralateral external oblique form a functional sling (Diane Lee 1999). Alternatively, it may be that the sacrotuberous ligament provides powerful proprioceptive input for the biceps femoris. Inferolateral abdominal wall hernias or weaknesses may have also be the cause of osteitis pubis. The findings may reflect different mechanisms, not only in the response to pelvic compression, but also of the underlying PGP disorder.
Subjects filled in visual analog scales for the assessment of pain intensity during the tests.
A discrepancy in pulse rate and pressure may suggest that the iliopsoas is restricting blood flow. The aim is to combine the internal corset stability (tr abdo, hori fibres int oblique, diaphragm and pelvic floor) with the external slings. Cyclists can also have pelvic floor dysfunction and neuropathies as a result of direct presure on the pudendal nerves with an incorrect saddle or saddle position.
When used in side-lying an isometric contraction of the hip flexor which is on the lower side can be used to improve contralateral (upper side) rotation as well as reduce SIJ counternutation. The urethra, a tube that passes urine from the bladder, runs through the middle of the prostate.
Also screen for trauma which could have resulted in some functional (and even structural) instability such as lumbar - thoracic spine hyper-flexion-extension from a 'whiplash type' injury such as high speed skiing, marshal arts, etc.
In terms of motor control it is important to recognise that the muscles which contract prior to the onset of movement should be the stabilizers = muscle of anticipation. With anterior rotation on the right and posterior rotation of the innominate on the left, the pelvis rotates in the transverse plane to the right creating an apparent shorter right leg in sitting.
Similarly, reduced erector spinae and enhanced superficial abdominal activity may reduce the amount of compressive forces (excessive force closure) generated on the lumber intervertebral discs.
Don't forget that the adductor muscles have trigger points which can refer pain into the anus and genital areas (see Travel & Simmons). Furthermore, in cases of dysfunction, mechanical hyperalgesia of the sacrotuberous ligament may contribute to reflexogenic muscle spasms in the biceps femoris. Urinary continence relies on the support of the sphincter closure system and the urethral support system. The same position and contraction can be used whilst placing the fingers on the upper side Psoas Major (in the anterolateral abdominal cavity) whilst asking the client to use lateral diaphragmatic breathing to release the myofascia which envelops the hip flexor and diaphragm. If a 'prime mover' muscle initiates the movement then it will become the dominant muscle in that synergy of movement. Improvements with posterior compression may indicate the need for deep Multifidus (MF) muscle training. However, more ideally, it is the non-torque producing muscles of the abdominal cavity such as the horizontal fibres of interanl oblique and transverse abdominis as well as the deep fibres of multifidus which maintain lumbar spine neutral posture. Results showed that abnormal kinematics of the diaphragm and pelvic floor during the ASLR improved following intervention. In contrast, significantly more altered breathing patterns were observed in chronic LBP-patients during motor control tests (P = 0.01). Essentially, the urethra sits inside a hammock of muscular and fascial and liagmentous support. Met's can also be performed on the piriformis whilst in Prone Knee Bend to reduce sacral torsion and ilial outflares. Combinations of anterior and posterior compressionon the ilia resulting in improvements may indicate the need for combined deep MF and Transverse Abdominus training. By reducing the activation of both superficial abdominals and erector spinae it may be possible for the low threshold muscles to function during postural and endurance activities. This can create additional problems elsewhere such as the posterior lateral knee, peroneal nerve, both SIJ's and in the spine. Moreover, reduced lateral diaphragmatic movements and reduced inferior thoracic spine mobility may be affecting sympathetic nervous system blood vessel tone and hence the patency of the pulse.
Ischiococcygeus releases use a similar principle of isometric contraction with finger pressure, whilst applying a medial pressure to the ASIS to reduce outflares. Additionally, the adductor may rotate the pelvis ipsilaterally in the horizontal plane, inhibit the glutues medius resulting in reduced lumbo-pelvic rhythm. During high threshold dynamic exercise such as running, transverse excursion of the diaphragm becomes essential to efficient movement as abdominal expansion may lead to loss of pelvic control.
It could be envisaged that reduced blood flow would affect the deep endurance stabilising muscles of the leg. Whereas, the previous examples involve muscle contractions to improve the ROM in the direction opposite to the muscles normal functional pull, the hamstring is used to improve ilial counter-nutation in the same direction as it's pull. Whether the adductor is responsible for anterior rotation of the ilium (counter-nutation) (anterior hip pain resulting in muscle spasms of the ilicus) and hence intra-pelvic torsion or is a result of counter-nutation can be assessed clinically by palpation of the SIJ-Ilia and the anterior hip-adductor and determining which occurs first.
Since the oblique abdominal muscles arise from the lower 6 ribs, the oblique abdominal muscles require adequate length for inferior lateral chest expansion to take place.
This technique is done in side-lying, where a pressure is applied by the therapist to the lower part of the clients posterior thigh, whilst the client pushes their leg into the therapists hand, the therapists other hand is applying a pressure on the sacral tuberosity in a manner which opposes counter-nutation. Notably, the low thoracic spine is covered by the pars thoracic aspect of the erector spinae and hence these muscles require sufficient relaxation for rib excursion to take place. This study provides preliminary evidence that aberrant motor control strategies in subjects with SIJP during the ASLR can be enhanced with a motor learning intervention.
Having performed these techniques since the late 1980's I can attest to their clinical efficacy, especially when they are combined with manual therapy joint mobilisations, myofascial releases, dry needling and an appropriate exercise regime. Positive changes in motor control were associated with improvements in pain and disability. Despite these paradoxes, it is highly likely that the clinical effect of MET's on the iliopsoas is a proprioceptive one, rebalancing the stabilising synergies of the hip and lumbar spine.
Importantly, by including inferior lateral breathing in an iliopsoas release, the therapist will be able to glean the importance of incorrect breathing to the dysfunction. Realistically, the clinical reasoning process allows for such areas of uncertainty by using the correlation between the impairment and disability measures to assess the validity of involving the iliopsoas muscle in the treatment process.



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