Alignment: The Sequel

Another bad guy to vanquish! Alignment took on the high, tight pelvic floor, but now an inquiring Internal Physical Therapy Specialist wants to know…how can it impact a pelvic floor with a nerve injury?

The Question: What if a patient’s left levator ani group was knocked out by nerve injury during childbirth? Is there evidence that the posture correction you suggest can address this damage to the levator ani?

My response: Great question! We do have studies that demonstrate a non-specific pelvic floor response to alignment changes (Sapsford et al 2006, Sapsford et al 2008). The studies indicated an improved resting activation of the pelvic floor as alignment moved more towards neutral in “normals”. Of course we have to do studies first on “normals’’ before we can study specific abnormalities. So no, I do not know of a study that has looked specifically at the variable of alignment on a unilateral nerve injury to the levator ani group.

However, can we extrapolate the use of alignment in a functional intervention to get the pelvic floor to fire better based on how we apply functional training in other areas of the body? Perhaps. For example, if a quad isn’t firing well after surgery or injury, we know that creating an isolated contraction like a quad set is often difficult for patients to perform. Even simple strengthening exercises like short arc quads aren’t always fruitful. But if you “force” or “trick” the quad to activate in a functional activity-like a step down, you often get more bang for your buck. Patients can and do cheat: bend forward, bend backward, stick their hip out, drop their pelvis. Unless you make them hold their alignment. Performing the step down while maintaining alignment forces the right sequencing and improved quad activation.

So we can apply this principle to a pelvic floor with nerve injuries by restoring the functional sequencing of the pelvic floor by linking its action with the ascent and descent of the diaphragm (pistoning). This could send new messages to the intact neural paths or muscles and maximize overflow activation into injured areas. Achieving that in standing to maximize proprioceptive influences of gravity and the vesitibular influences of upright postures…might also give a nerve damaged muscle more input or the patient more awareness to assist with better activation.

However, if you try to promote these inputs in poor standing alignment, i.e. without the ribs stacked over the pelvis, this will reduce the interaction between the diaphragm and pelvic floor. This reduces the functional influence of the diaphragm on the pelvic floor and limits the potential benefit of the non-specific optimization a pelvic floor engagement.

In my mind combining those concepts with other cues or methodologies in the arsenal of a pelvic health specialist to engage a unilaterally damaged pelvic floor has serious potential to enhance the response from the muscle.

Stay tuned….next alignment will turn a frog into a prince!

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