The human pelvic floor is the “floor” of a manometric cavity, in
which the diaphragm is the “ceiling” and the abdominal muscles
are the “walls”.
Since the diaphragm is attached to the ribs differently in the
ventral side than in the dorsal side it’s not horizontal , but
inclined backward . For this reason any thoraxo-abdominal effort
( e.g. - cough ; or abdominal muscle exercise ) will create a vector of
forces towards the abdominal wall .
If the deep abdominal muscles ( Transversus Abdominis - TAbd )
contracts correctly , without latency , this vector will be reflected
towards the coccyx . But if the abdominal wall is damaged / weak /
or has a delay reaction - it will be ejected forwards during efforts
and the vector of forces will be reflected towards the urogenital
hiatus , encouraging by that - prolapsus of genital organs and urinary
stress incontinence .
A good TAbd provides stability to the pelvic organs and to the spine.
The characteristics of a healthy TAbd are :
1. Slow twitch muscle fibers ( endurance )
2. Postural active ligament ( not fatigable )
3. Active 1st with unexpected trunk load .
4. Cocontraction with the paravertebral muscles ( protection of joints
from excessive forces , stress absorption , prolong cartilage and
connective tissues serving time ) .
Unfortunately most exercise program for the trunk do not take those
facts under consideration and trains mostly the phasic contraction ,
with fast ballistic movements , in unidirectional exercises .
Loads the articulation and the connective tissues of the internal organs
with high short asymmetric load instead of low long symmetric load .
The understanding of the abdominal cavity biomechanic , and the
integrity and the correct function of each component gives the basis
to a therapeutic exercises program which will help prevent and treat
pelvic floor dysfunction and low back pain patients.
*Uro-gynecology Clinic , “LIS” Maternity
Hospital, TEL-AVIV Medical Center .
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