The Abdominopelvic region Flashcards
Why is the lumbopelvic region considered important and complex?
It connects the pelvis and thorax, where three long levers (spine and both lower limbs) meet. It creates motion and bears a high load, requiring multi-planar stability.
What is the role of the sacroiliac (SI) joint in motion and load management
Although not highly mobile, the SI joint allows opposing motion between the sacrum and innominates during gait and helps disperse forces from high loads and long levers.
What musculoskeletal problems can result from improper SI joint movement?
Increased lumbar spine loading, facet joint irritation, disc herniation, spinal nerve compression, and degeneration.
What muscles make up the core musculature contributing to lumbopelvic stability?
• Deep portion of Quadratus Lumborum
• Transversus abdominis
• Multifidi
• Pelvic floor
• Diaphragm
What are additional lumbopelvic stabilizers beyond the core?
• Gluteus medius and minimus
• Deep lateral rotators
• Iliopsoas
• Internal and external obliques
What is required for proper lumbopelvic stability beyond muscle strength?
Proper joint mechanics that support the function of stabilizing muscles.
Why is hip and thoracic spine mobility important for lumbar spine protection?
Adequate ROM, especially in extension and rotation, spares the lumbar spine from excessive load and motion, and supports pelvic position for ideal muscle length-tension relationships.
How do proper rib mechanics influence core function?
They allow for proper diaphragm function and core engagement, enhancing overall stability in all ranges of motion.
How can visceral pathology or surgery in the abdominopelvic region affect the MSK system?
Visceral fascia connects to musculoskeletal structures, so dysfunction (e.g., constipation, inflammatory bowel disease, reproductive conditions, fibroids, cesarean or surgical scars) may present as low back, SI joint, or pelvic pain.
What SC levels refer to the head and neck?
T1–4
What SC levels refer to the heart?
T1–5
What SC levels refer to the respiratory system?
T2–7
What SC levels refer to the esophagus?
T2–8
What SC levels refer to the upper GI?
T5–9
What SC levels refer to the middle GI?
T9–12
What SC levels refer to the lower GI?
T12–L2
What SC levels refer to the kidney?
T11–L1
What SC level refers to the adrenal medulla?
T10
What SC levels refer to the ureters?
T10–L2
What SC levels refer to the bladder?
T11–L2
What SC levels refer to the gonads?
T10–11
What SC levels refer to the uterus and cervix?
T10–L2
What SC levels refer to the erectile tissues?
T11–L2
What SC levels refer to the extremities (arms and legs)?
T5–7 and T10–L2
How is constipation medically defined?
Fewer than 3 stools per week, though normal bowel patterns vary among individuals.
What typically characterizes constipation?
Less frequent than normal bowel movements and hard stools.
Why is understanding a client’s digestion clinically relevant?
Digestive issues may contribute to or explain MSK presentations.
What is the pathway of digested food through the large intestine?
Ileocecal valve → Ascending colon (right side) → Hepatic flexure → Transverse colon (right to left) → Splenic flexure → Descending colon (left side) → Sigmoid colon → Internal sphincter → Rectum → External sphincter → Anus
Where does most nutrient and water absorption occur?
In the small intestine.
What is the normal transit time from ingestion to elimination?
12–48 hours (12–24 hours is ideal).
What happens with increased transit time?
More water is absorbed, resulting in hard, often smaller stools.
What happens with decreased transit time?
Less water is absorbed, resulting in loose, watery stool.
What societal factors can influence transit time?
• Stress
• Diet (fiber, fat, protein)
• Caffeine
• Dehydration
• Nicotine
• Sedentary lifestyle
• Exercise
• Ignoring defecation reflex
• Defecation posture (squatted vs. seated)
What MSK factors can influence transit time?
• Scoliosis
• Prolonged postures
• Pelvic floor dysfunction
What food can help you observe your own transit time?
Beets — their deep red color is easily recognizable as it moves through the digestive tract.
What is functional constipation?
Functional constipation is constipation with no underlying medical condition, often caused by delayed transit time. It’s usually linked to stress, poor diet, dehydration, and a sedentary lifestyle.
When is constipation considered chronic?
Constipation is considered chronic when symptoms have been present for more than approximately 3 months.
What are some causes of chronic constipation?
Chronic constipation can be caused by colonic disorders (e.g., IBS) and pelvic floor dysfunction.
What are some causes of secondary constipation?
Secondary constipation can be caused by:
• Colon cancer
• Endocrine conditions (e.g., diabetes, hypothyroidism)
• Medications (e.g., opiates, CNS depressants)
• Neurological diseases (e.g., Parkinson’s disease, multiple sclerosis)
What is fecal impaction?
Fecal impaction is the retention of hard or putty-like stools in the rectum that interferes with normal feces passage. It may be masked by diarrhea and usually includes pain and abdominal distension.
What muscle helps maintain continence and must relax for defecation?
The puborectalis (part of the levator ani) creates a kink in the anorectal angle to prevent defecation and must relax to allow bowel movements.
How does posture affect defecation?
Squatting with hips flexed beyond 90 degrees (knees above hips) helps relax the puborectalis, reduces strain, and shortens time spent defecating.
What is pelvic floor dysfunction?
It is a condition involving problems with the muscles of the pelvic floor, which can be both a cause or result of chronic constipation.
What muscles make up the deepest layer of the pelvic floor?
• Levator ani (pubococcygeus, puborectalis, iliococcygeus)
• Coccygeus
What are the functions of the deepest pelvic floor muscles?
They support pelvic organs, withstand intra-abdominal pressure, and assist in breathing by allowing descending and ascending movements.
What do the more superficial pelvic floor muscles do?
They surround sphincters, help maintain continence, and contribute to sexual function via a puckering action.
Why is pelvic floor dysfunction more common in females?
The female pelvic floor is less stable due to anatomical differences (e.g., passage for urethra, vagina, rectum), making dysfunction twice as common in females.
What is low resting tone in the pelvic floor?
It is a weakness or low activity in pelvic floor muscles, possibly caused by neurological impairments, pregnancy, or inhibition. It can lead to incontinence, organ prolapse, pain, and constipation.
What is prolapse in relation to the pelvic floor?
Prolapse is the descent of pelvic viscera from their normal position due to muscular, fascial, or ligamentous weakness and increased abdominal pressure.
What symptoms are associated with pelvic organ prolapse?
Perineal pressure, heaviness, low back pain, abdominal pain, voiding difficulties, and worsening with constipation or straining.
How can childbirth affect the pelvic floor?
• Neurological stretch and compression (pudendal nerve)
• Extreme stretching of tissues
• Muscular tearing or episiotomy (perineal incision)
What is high resting tone (Increased MRT) in the pelvic floor?
A tight pelvic floor that can lead to symptoms like:
• Frequent urination (>8x/day), urgency, hesitancy
• Constipation and straining
• Pain during/after urination, bowel movements, or intercourse
• Painful menstruation and pelvic dyssynergy
• Uncoordinated muscle contractions or spasms
Are the symptoms of high pelvic floor tone normal?
No. They are common but not normal, and pelvic floor treatment can help those suffering from these symptoms.
What is pelvic dyssynergy?
A combination of tight and weak pelvic floor muscles. Chronically constipated patients often can’t coordinate relaxation of the puborectalis and external anal sphincter during defecation.
Can people who haven’t given birth still have pelvic floor dysfunction?
Yes. Risk factors include:
• Excessive straining
• Smoking
• Chronic cough
• Obesity
• Hysterectomy
• Stress
• High-strain ADLs or sports
Why is pelvic floor activation important during trunk strengthening?
To avoid excessive downward forces that could aggravate or cause prolapse. The pelvic floor helps stabilize the spine and ensures proper breathing mechanics.
What happens if the inner core is not engaged during movement?
More pressure is placed on superficial core muscles, which can lead to or worsen low back pain.
Are Kegels always appropriate for pelvic floor dysfunction?
No. Since dysfunction is not always due to low tone, Kegels or reverse Kegels can worsen symptoms if misapplied. A proper pelvic floor assessment is necessary first.
Why might someone with chronic low back or hip pain need a pelvic floor exam?
Because pelvic floor dysfunction can contribute to or result from low back and hip dysfunction.
