Blog Post written by Dr. Marnie Hansen, DC, Chiropractic Physician in Salt Lake City, UT
April 5th, 2024
Chiropractic is most often equated with treatment for back pain or neck pain. But did you know it can also be beneficial for Pelvic Health?
According to the NIH, 1 in 4 women will suffer from a Pelvic Floor Disorder at some point in her life. More recent research points to 1 in 3, which suggests it may be more common than we think. Some common causes include birth trauma, obesity, postural stress, PID, and other pelvic disorders.
So wait.... what is the Pelvic Floor anyway?
The pelvis creates a bowl, if you will, with the pelvic bones, muscles and fascia being the base of the bowl, holding everything up and in. Fascia, is the paper thin sheath that encases and connects the muscles and organs together. It attaches to boney prominences to hold everything in their place, and plays a large role in the encasement and suspension of the pelvic organs.
There is a plethora of research being done on fascia and the dynamic, connective role it plays in the entire body, but to keep it simple, we will refer to it's anatomical role in the pelvic region of the body. (Side note: we are obsessed with fascia) Let's call this Pelvic Fascia. Google it, it's quite fascinating.
Now on to Chiropractic.
Chiropractic is a movement therapy that is best known for treating neck and back pain. The foundations of Chiropractic, however, aren't derived from a pain or symptom based model. The basic principles of the profession stem from removing interferences from the nervous system ("un-pinching nerves, resolving movement issues in the spine, restoring nerve flow) through providing proper spinal mobility, therefore improving the systems of the body as a whole, improving overall wellness. New research comes out quite frequently validating the health benefits that Chiropractors have known for over a hundred years.
So, what does this have to do with Pelvic Floor Therapy?
Well, basically EVERYTHING!
Take a good look at an anatomical chart. Specifically the chart of the nerves that exit the spine and and branch out from it like branches of a tree throughout the entire body. You will see that the nervous system technically starts at the brain, travels through the narrow canal of the spine, exit small holes in the side of the spine called intervertebral foraminae (IVF's), and travel out to the rest of the body where they direct the function of every nerve, cell, tissue and organ of the body.
Conversely, your nerves pick up on messages from the body in terms of sensation, motor function, temperature, fine touch, and pressure. These messages are sent back to the brain from the body, through the spine in what we know as nerve impulses, signaling, firing or messaging. This information has to travel back through these highways and networks of branchlike nerves, through the little boney passageways of the spine (IVF's) back to the spinal chord, which travels like a multi-lane highway back to the brain to tell it what the body is experiencing.
Phew! That's a lot of work for those delicate nerves! And a lot of passageways to travel through that could entrap the nerves at any time. Sounds kind of like an episode of Game of Thrones, right?
Usually the entrapment, or "pinching" happens with arthritic development, disc bulges and herniations, inflammation, trauma, poor posture, and more. The nerve entrapment theory is well known, and there are many causes and effects.
Basically... everything is connected! And the whole-ism of the body is a beautiful thing. It is a dynamic organism that does not work in independent parts. The same goes with the pelvis.
So, you ask... how does all this relate to the pelvis? And how can Chiropractic help with
Pelvic Floor issues?
Optimizing Nerve Function
The nerves that exit the lumbar (low back) and sacral (tailbone) regions of the spine travel directly to every part of the pelvis, including the fascia, muscles, organs and related tissues, which can affect how the pelvis functions as a whole. When there is an interference or interruption to normal nerve functioning, this can lead to pain or dysfunction of the pelvis.
Some ailments that can be connected to impaired nerve function of this area can include incontinence, constipation, fertility issues, bowel or bladder issues, back or tailbone pain, sciatica and other nerve issues.
So why does this matter?
As the spine encases and protects the nervous system, it is directly related to nerve health. And as the nerves operate the organs, there is also a direct connection between spinal health and organ health. Eastern Medicine has been privy to this miraculous connection for thousands of years. All you have to do is look at their dermatome charts and mapping of meridians to see how well they understood this connection.
Chiropractors have noted for decades the interconnection of spinal health and overall wellness, including noted changes in blood pressure, pain, neurologic improvements, digestion, fertility and immune function to name a few well known patient presentations. Sometimes is just takes Western Medicine a bit to catch up to the natural therapies.
If, by mobilizing the spine and reducing inflammation and entrapment around the nerves, helps to "unkink" the nervous system and allow the nerves more breathing room, so to speak, then imagine what Chiropractic can do for the pelvis!
Chiropractic, has the ability to improve the nervous system's ability to function through proper spinal and joint mobility therapies such as adjustments, exercise and soft tissue therapies. Nervous system input, output and neuroplasticity (learning and relearning of the nervous system) all play a role and are fabulous key words to remember!
In my practice, women and men both have come in reporting to pelvic floor pain and dysfunction, and I've witnessed the pain levels immediately or gradually decrease over the course of care, with a most of these cases. With work, TLC and great dedication to their health, these patients were able to regain their strength, balance, coordination, mobility and flexibility. All these play a role in nervous system function.
This in turn, may have the ability to improve the function of other systems in the body. In the pelvic bowl, as the nervous system runs these organs, improving nerve health through Chiropractic adjustments may have an effect on bowel or bladder habits, reduction of PMS or painful periods, fertility and menopausal symptoms, to name a few things.
How does this work? Some bodies of evidence suggest the theory of the "pinched nerve," or bone pressing on the nerve. Very much like a garden hose, this has the ability to reduce the flow of nerve signaling to or from the targeted organ or tissue, when "pinched."
Other bodies of evidence are more in favor of neuro-plasticity, or nerve firing theories which suggest that movement, or the lack thereof will dictate the learning or unlearning of nerve firing patterns in the body. For example, you learn an activity by repetition, which creates new circuits of memory in the body and how it functions.
Many theories have been proposed and debunked, but the gist is, we are learning more about the nervous system and it's functions on a daily basis. At lightening speed, you could say. I myself have sorted through thousands of pages of papers on neurology and it's complexities, and this is the best way for me to distill and impart the knowledge on this vastly growing body of evidence. Google it and you will see!
The nervous system is truly incredible as it directs the function of every cell, organ, and tissue in the body. By improving the overall environment the nerves have to travel through with spinal mobility and adjustments, there is a good possibility you are improving how your nerves tell your body what to do and vice versa! This, in turn can have a life changing effect on pelvic health and function.
Improving Lumbo-Pelvic Posture
When it comes to Pelvic Floor Dysfunction, posture matters! Postural stress can create pressure to the nerves and organs of the pelvic bowl, which can feed into dysfunction.
Imagine all the intricate patterns of muscles and fascia attaching to the spine and pelvis. It's like complex web of tissues connecting and communicating with all the structures in the pelvic bowl. If you look at a muscle chart of the pelvic floor you will see the numerous attachment points of the muscles and fascia, and how the nerves of the lower back and sacrum innervate these muscles.
Now, imagine twisting and misaligning the low back and pelvic bones. This will stretch and put a lot of tension on the pelvic floor muscles, tissues and fascia, right? Right.
The implications of this are numerous. This stretching and tension of the tissues can lead to reductions in proper circulation, nerve firing, balanced pelvic strength and muscle tone, inflammation, postural issues that travel up the spine, painful and dysfunctional movement patterns, to name a few!
But not to fear! The more you know, the more you know what to do. Go look at your posture in the mirror. Do your hips align at the top of each hip, or are they hiked or lowered on one side?
What a Chiropractor does is assess posture and gait in order to best determine where to specifically adjust the posture deficiencies or misalignments. Due to muscle memory patterns (which is neuroplasticity or nerve firing patterns) it is very common for corrected spinal or pelvic posture to "slip out of alignment" and revert back to it's old movement patterns over the course of days.
Good posture is not created overnight and one adjustment is not a "quick fix" to posture.
Posture is a process of your body learning new movement patterns. And sometimes your body needs a little help with body work in the learning process.
As I tell my clients, energy flows where attention goes, and it takes time, attention and repetition when changing your posture. As the nervous system is an electro-chemical, or energy based system the 'firing and rewiring' of it often takes time, assistance and objective guidance.
When your Chiropractor adjusts your spine or pelvis, your body is learning a new way of moving. When you improve mobility of the pelvis, it can have a positive effect on the posture, and vice versa. It can also take pressure off those delicate organs in the pelvic bowl.
In short, your Chiropractor can assess your posture for any pelvic posture insufficiencies arising from habits, traumas or injuries, and begin to address the postural issues with proper alignment and movement.
Reducing Pelvic Pain
With the improvement of movement, function, muscle tone and nerve firing, typically comes a reduction in pain. Reducing the fascial tension of the pelvic bowl can lead to an improvement in how you feel. As the body is a holistic, vital organism, pain reduction can be predictable when you improve circulation, reduce inflammation, and optimize nerve functioning and functional strength. All of this is a product of movement.
I tell my patients that spinal mobility is similar to the function of wringing out a wet towel. Certain movements like safe spinal twists, can help the circulatory system flush out toxins and waste products that interfere with the health of the spine down to the cellular level. The movement of an adjustment can also encourage circulation to flush back into the spine, nourishing muscles, nerves and tissues that support the spine and pelvis.
Some of these movements can be achieved with yoga or exercise, which are excellent for pelvic pain. Sometimes more precision and deeper mobilization is needed. Precise adjustments from a trained professional, to objectively guide the joints back into proper movement and alignment is often what it takes.
Again, every body requires a basic set of tools or therapies, but they are not all the same. Often times, when used all together (adjustments, yoga, exercise) you can see the best results!
Improving Myofascial Health
Addressing the soft tissues of the pelvis has numerous benefits ranging from pain relief to improvement of strength, circulation reduction of inflammation and adhesions/scar tissue. A practitioner can address the external musculature of the abdominal and pelvic regions by external abdominal massage, low back fascial release and other external fascial work. However, there are numerous muscles and attachments that can only be accessed internally through internal pelvic floor therapy work.
This means, the trained practitioner has to access the deep pelvic floor muscles that rest and insert on the inside of the pelvic bowl. With women, this can be best accessed gently through the vaginal canal. The internal base of the pelvic bowl myofascial attachments are best reached with this technique.
Similar to releasing and relaxing the muscles of the back and hips through trigger point work and myofascial release, this profound inner-body work, often termed gyno-fascial release, has the ability to reduce pelvic floor tension and dysfunction by improving muscle tone and reducing adhesions of the pelvic floor fascia.
Not many Chiropractors practice this technique and not all states credential Chiropractor's in this technique. Be sure to check your Chiropractor's credentials, including the post graduate course work they have taken to do this internal work, and if this work is allowed in their state.
The good news is, is that all Chiropractor's have had extensive training in pelvic floor anatomy, physiology and biomechanics. In some schools, gynecology, proctology and obstetrics is taught. Internal pelvic floor therapy is typically known to be a branch of Physical Therapy, but there is a growing number of Chiropractic Professionals (like Moi) who are pioneering this branch of Chiropractic. The work is so dearly needed, and Chiropractic is the perfect compliment to Pelvic Floor Therapy. In fact, you could say it is one in the same, depending on the methods.
Optimizing Hormone Health
Research has shown that fascia can transmit, store and assist in the production of hormones. The pelvic floor fascia is no different, and in fact a very important location for the hormone production process. The reduction of circulation from tissue tension and postural stress, can affect the production process of hormones and the elimination of stored hormones from the tissues.
Improving fascial tension around the ovaries and uterus can be linked to improving hormonal function. By improving spinal mobility and posture, you can take the tension out of the pelvic bowl tissues.
Healthy fascia=healthy hormones!
Improving Circulation
Movement patterns can play a big role in our circulation patterns. Too little moment such as prolonged sitting can affect how much circulation is directed to and from the pelvis. Too much movement with improper posture can put unnecessary tension onto the tissues, and can also affect circulation patterns.
Aligning the posture, spinal movement and fascial manipulation has been shown to have positive effects on circulation and often times patients can feel the difference right away.
Improving circulation in the pelvic bowl brings more blood flow to the cells, tissues and organs which in turn may affect sexual health, fertility, incontinence, PMS and painful periods, peri-menopause and menopause symptoms, maternity, ovarian, colonic and bladder function. Not to mention painful pelvic issues.
Improving circulation can have a direct effect on tissue tone. Better circulation brings more nutrients to the tissues, therefore more nourishment and healthier fascia. Therefore, you may see more hydrated, supple tissues.
Proper circulation can also whisk away waste products, toxins and heavy metals which can accumulate in the pelvis and affect cellular health. Improving circulation through myofascial work, postural alignment and healthy movement can have a direct effect on tissue health.
Improving Pelvic Floor Strength
From birth, we began to learn how to move our bodies. Our movement patterns were learned step by step, and altered by falls, spills and traumas.
Think about it. If you sprain your ankle, what happens? You will use the other side of your body to compensate and protect the injury. Shift your weight to the other foot, and have it do the walking for a while. We all know that injuries don't heal over night. As we go about these new movement patterns, our body learns new postures.
Some of these postures will be asymmetrical and put more tension on certain tissues. This can affect nerve and muscle firing. Therefore, it can affect symmetrical strength from side to side as one leg will now be working harder than the other to protect the ankle sprain, for instance, if not retrained.
Not only can Chiropractic help with Pelvic Floor Strength by encouraging more symmetrical muscle firing patterns due to more balanced posture, but by improving nervous system tone, it has the potential to connect the brain to the body, therefore bringing more awareness to the body part. And the more awareness, the more usage. The more use, typically the more strength!
It's simple!
And that brings us to...
Improving Movement Patterns
Like this previous example, from birth, your body is living evidence of poetry in motion. As you learn to crawl, your physiology learns how to move, hold your head up, and your spine begins to develop its curvatures, your nervous system participates in the process of neuroplasticity as it learns what movement is.
This continues through life, and never stops.
The systems of the body constantly respond to too much movement and too little movement as it continually participates in the process of homeostasis, or balance.
Just like the ankle sprain example earlier, the pelvis can learn faulty movement patterns through the kinetic chain of movement. An ankle sprain can affect how the pelvis moves, just as tightened fascia in the pelvic bowl can effect it.
As you work on the posture of the pelvis through spinal and pelvic mobility and proper alignment, you also retrain the nervous system how to develop healthier movement patterns for the pelvis, which in turn can improve overall pelvic function.
Movement is life!
Improving Pelvic Organ Function
As mentioned before, the organs that sit deep in our abdomen and pelvis are surrounded by a web of fascia. They are innervated and function because of the nervous system, and receive nourishment from the circulatory system.
It makes sense to say that they need room to move, breathe, and function.
When an organ or organs are under stress due to postural issues, it can affect how they function. Reducing postural stress through gentle realignment may help give these precious organs more wiggle room, so to speak.
By improving postural function, you in turn are helping to improve the overall function to the nervous system. This in turn may affect how the organs can function in relation to the rest of the body.
Everything is connected!
Addressing Anxiety and Depression
Our fascia has the ability to hold emotions. Often times, our bodies hold old traumas and deeply embedded emotions that we have not processed or fully dealt with. Pelvic floor therapy can be profound for many women, and may bring up many unprocessed emotions.
It can also be distressing having to deal with pelvic pain, which can be downright debilitating. This can bring up feelings of anxiety, depression and deep grief. Old traumas can arise. Because of this, it is often important to do this work alongside a trained counselor or therapist.
Improving nervous system function can have an effect on mental distress, anxiety, and depression. Improving pain can help you feel better overall. Pelvic floor therapy and Chiropractic, by any means, is not a quick fix pill for anxiety and depression. Many Doctors, including myself, have seen the benefits Chiropractic and physical medicine have had on mental health issues.
To wrap it all up...
There is no such thing as a quick fix pill when it comes to physical and natural medicine. Developing proper nerve function, muscle tone, strength and reducing pain typically takes time. Changing how the body works takes time, and is not a one size fits all process.
Chiropractic alone can help with Pelvic Floor Dysfunction, however, seeking out a Chiropractor who is also trained in gynofascial release and proper movement therapies for the pelvis may provide a deeper level to therapeutic relief to pelvic floor issues.
There is a dynamic relationship between the bony anatomy of the pelvis and the pliability and circulation of the fascia and soft tissues that connect it all together. By addressing the pelvis as a whole with a practitioner who is trained in these techniques, you can help your body holistically thrive in ways you may have never expected!
Dr. Marnie Hansen is a Licensed Chiropractic Physician in Salt Lake City, UT. Certified in Chiropractic Medicine and Physiotherapy by the National Board of Chiropractic Examiners, she has over fifteen years clinical experience in diagnosing and treating complex musculoskeletal conditions and injuries, including pelvic floor dysfunction. She takes a balanced approach to her patient centered care by infusing multiple evidence based therapies with time honored holistic treatments. She is an avid hiker, snowboarder, reader, writer and artist. She can be found at:
Commentaires