Pelvic Alignment and the Pelvic Floor
The pelvis is made of 3 bones: the ilium, ischium, and pubis which are fused together. The front bones form the pubic symphysis joint, just above the genitals, and in the back they form the sacroiliac joint. All the joints move very little to produce movement during functional activities. There are 45 muscles that attach to the pelvis, including the pelvic floor. If your pelvic alignment is off, then the entire foundation that your pelvic floor muscles, nerves and ligaments are lying on is off. The pelvic floor muscles have specific attachments, yet in females, it is more on to ligaments. So the female pelvis is more mobile in order to perform the function of child birth. But more mobility brings more instability at the same time, which can cause pain.
Pelvic floor muscle tightness or weakness can pull the pelvis to one side and affect the alignment. In medical terminology, the pelvis is the innominate bone. In chiropractic care, you often hear about alignment and adjustments to correct this. Pelvic floor muscles along with abdominals and back muscles make up our core muscles that are used for stabilization. Usually the abdominals and back muscles are addressed for stabilization, and the pelvic floor muscles are often missed. Pelvic floor muscles along with spine stability provide support to the urethra, rectum, and uterus. So these are responsible for control of urination, defecation, and sexual function. The pelvic floor is made up of slow and fast twitch muscle fibers for these functions.
Next, I am going to talk about both muscle fibers in more detail. Fast twitch muscle fibers are our quick reacting, higher contractile force muscles that fatigue rather quickly. Slow twitch muscle fibers are our less explosive muscles that are much longer lasting than their counterpart. Fast twitch muscle fibers help with urination, passing gas, and defecation, while slow twitch muscle fibers work to provide stability. Fast twitch fibers have the tendency to tighten up, that is one cause of pelvic floor muscle trigger point and tightness on one side. This tightness can even affect urination, defecation and sexual function. At times this tightness may even cause burning in urination which might falsely be diagnosed as a UTI. Slow twitch muscle fibers have a tendency to become weakened. This decrease to provide stability to the organs, as well as the spine, may cause incontinence, organ prolapse, and imbalance in core function which might lead to back pain. Altered pelvic alignment affects the other muscles around the pelvis which attach to the hip and spine. Ultimately these changes affect the bio-mechanics of the hip, spine, knee and ankle joints. This can produce pain at any of the lower extremity joints which are under stress. Ultimately both fibers can affect pelvic alignment. So it is important to work on pelvic alignment while addressing pelvic pain/dysfunction or lower extremity pain. The patient needs to perform exercises at home which might help to re-educate the tight muscle to relax or the weak muscle to strengthen. This allows pelvic floor and other muscles around the pelvis to work efficiently.
Thank you to Neha for her post!
Neha Golwala is a PT who works in Warrensburg at Adirondack Physical Therapy and Fitness. She earned her Bachelor’s Degree in India and her DPT from A.T. Still University. She is certified in MDT and is a CKTP.
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