The Who, What, and Why of Manual Therapy for the Pelvic Basket

by guest blogger, Michelle Herbst, MPT, DPT

The pelvic basket is an intricate weaving of muscles, tendons, and ligaments that support our pelvic and abdominal organs and  assists in bowel and bladder control.  As discussed in Tasha’s blog post, The Positive Side Effects of Pelvic Floor Muscle Weakness, “the pelvic basket incorporates the front, back, sides, and floor of your pelvis and lower spine that provide the deepest layer of stability to your body.”  Muscle tissue is normally pliable but poor postural habits, trauma to the pelvic basket or chronic tension of the pelvic basket muscles may lead to the development of shortened tissues, scar tissue, and tender points.  Normally the  muscles of the pelvic basket contract and relax resulting in the basket moving up and down.  However tissue changes within the pelvic basket may inhibit normal muscle function resulting is a pelvic basket that is less mobile.

So, what can be done to restore normal pelvic basket muscle function?  One option is manual therapy.  All tissues – including those of the pelvic basket – need hydration or fluid flow.  The goal of manual therapy is to improve fluid flow, stimulate repair, and elongate tissues.  Most tissue restrictions within the pelvic basket are related to poor postural habits or the result of poor tissue repair.  In these types of cases there is a shortening of the muscle and connective tissue resulting in a loss of pliability or movement.  Effective manual therapy techniques for pelvic basket conditions of involve techniques that stimulate fluid flow and provide for gentle stretching.  Once the precise areas of shortened tissue, tender points, or scar tissue of the pelvic basket have been identified gentle manual forces can be used to stimulate healing.

The use of manual therapy is difficult and challenging.  However, the rewards gained are well worth the effort.  Manual therapy can be self-applied or performed by a skilled women’s health physical therapist.  If seeing a women’s health physical therapist is not an option, it is a good idea to ask your family physician, OB/Gyn or midwife to assist you in identifying the precise location(s) of your muscle injury.  Once that has been identified, one manual technique that may be used is a gentle press and manual stretch technique.  The application of gentle pressure to the pelvic basket muscle tissues will stimulate fluid flow and begins the healing process.  Yes, it is normal to be hesitant and feel initial embarrassment.  But remember, these are muscles, muscles that need the gentle application of pressure to start fluid flow and healing.

Specifically, the gentle pressure and manual stretch technique uses a one to two fingertip pressure.  The gentle fingertip pressure may be applied for 90 seconds or until the tissue softens or relaxes.  Once the tissue has softened, maintain gentle pressure and follow that with a manual gentle stretch along the injured muscle.  Manual therapy of the pelvic basket may be minimally to moderately painful but should be stopped if the pain is approaching severe.  If the gentle pressure and stretch technique is applied externally, a water based lubricate can assist with the stretch or sliding on the skin surface.  If you are using the gentle pressure and stretch technique internally to the pelvic basket, it is a good idea to use non-latex gloves.  Repeated application of the gentle pressure and stretch may be applied to one area for up to 10 minutes, 1 to 2 times per week.

Who does manual therapy to the pelvic basket?  Ideally, manual therapy should be performed by a physical therapist trained in women’s health physical therapy since this specialty involves further study in the evaluation and treatment of conditions affecting the pelvic region.  Another option is to do it yourself although depending on the location of the tissue injury, the application of manual therapy to the pelvic basket may be too difficult to complete yourself.  Spouses or significant others may also be able to apply the gentle pressure and manual stretch technique when they are educated on the location of injury and manual therapy techniques.

Reference: Lederman E.  The Science and Practice of Manual Therapy. 2^nd ed. Edinburgh:  Elsevier Churchill