Previous Page
SPORTS MEDICINE PELVIC FLOOR MUSCLES
TOTAL BODY FITNESS – ARE WE FORGETTING SOMETHING?
THE ROLE OF THE PELVIC FLOOR MUSCLES IN CORE STABILITY AND BLADDER AND BOWEL HEALTH
BY JULIA HERBERT, SPECIALIST PHYSIOTHERAPIST CONTINENCE AND WOMEN’S HEALTH
ANATOMY AND PHYSIOLOGY OF THE PELVIC FLOOR COMPLEX The pelvic floor muscles form a “hammock-like” structure at the base of the pelvis. At the front they are attached to the pubic bone, and at the back they are attached to the coccyx. Their name is based on the fact that they literally form a “floor” for the pelvic bones. The pelvic floor is actually a combination of structures that
provide a dynamic and supportive base to the entire pelvis and thus contribute to core stability. Strictly speaking, when we talk about the pelvic floor we are usually referring to the muscular part of this complex, but other structures are equally important. Intact nerve and vascular supplies, for example, are essential for good function. Diseases such as unstable diabetes causing peripheral neuropathy and multiple sclerosis, or a cerebrovascular accident or trauma sustained during vaginal delivery can compromise one or both of these systems. Recently great interest has been given to the endopelvic fascia. The advent of magnetic resonance imaging means anatomists can study the functional anatomy of the pelvic floor complex to a degree that was not possible with cadavers. It is clear that this fascia, in the form of ligaments, not only gives support to the pelvic organs but also provides much of the attachment for the deep and superficial layers of the pelvic floor muscles. Of particular importance to pregnant women is the
arcus tendineus levator ani (ATLA). Recent three-dimensional ultrasound studies have shown that this important fascial band can become damaged during vaginal deliveries, and sometimes avulsion injury can occur (1). For people taking part in sports and fitness activities, the
pelvic floor muscles play an important role in protecting the endopelvic fascia from excessive loading. Any connective tissue within the body may be stretched by subjecting it to a tensile
There is a substantial body of evidence relating to the symptoms of pelvic floor muscle dysfunction among people taking part in sport and fitness activities. The pelvic floor muscles are often forgotten about in the rigorous training programmes of athletes, yet they have many important roles – in supporting the pelvic organs (the bladder, bowel and uterus), in controlling bladder and bowel emptying, and in sexual activity. It is essential that practitioners who work with athletes appreciate just how important these muscles are. This article looks at the structure of the pelvic floor muscles and reviews evidence with regard to sport and fitness. It explains which activities are particularly harmful to the pelvic floor muscles and recommends a number of management and treatment strategies.
force. If the pelvic floor muscles are weak or damaged and fail to protect the fascia, the fascia will stretch and the pelvic organs will descend. This will destabilise the core support. The attachment of the pelvic floor muscles into the
perineal body – a fibromuscular body situated within the perineum between the vagina and anus – is also important to their functioning. In a recent study (2), this structure was damaged during delivery in up to 20% of first-time mothers. For this reason, among others, it is worth considering core stability training with particular reference to pelvic floor muscle training when planning a training regimen.
PELVIC FLOOR COMPLEX The pelvic floor comprises the following structures (3): n Endopelvic fascia
23