CHRONIC PELVIC PAIN AND DYSFUNCTION

Edited by Leon Chaitow. Editorial Elsevier. 2010

14.5.2. Fascial continuity model The continuity of the fascial system and its links to the pelvic bones, through tendons and ligament connections, facilitate the interaction with the aponeurosis of the pelvic floor muscles and the neurovascular packages. Particularly, with the hypogastric plexus, that turns over the endopelvic fascia, and form the complex fascial squeleton that control theuterine, vaginal, bladder and urethral vessels. Thus, the myofascial system joins the viscerofascial system creating the more complex functional integretion unit (Santos 2009). Therefore, the altered load transfer through the pelvis may affect the musculoskeletal dynamic createing multiple disorders such as the low back/pelvic girdle pain, pelvic adhesions, intestinal and urologic disorders, endometriosis, prolapse, orgasm difficulties, dyspareunia and nerve injuries (Hodges & Richardson 1996, Hodges et al 2001, Hungerford 2003, Mens et al 1999, Snijders et al1993a,b, Vleeming et al 1996, Lee &Lee 2004, Lee & Vleeming 2004, Lee & Vleeming 1998, Peters & Carrico 2006, Wurn at al 2006, Occelli 2001, Delancey 1993). Pool-Goudzwaard (2003) reported a combination of pelvic girdle pain along with pelvic floor dysfunction, including the voiding dysfunction, urinary incontinence, sexual dysfunction and/or constipation, in 52% of studied patients. Of these 52%, 82% (statements, percentage o que?) stated that their symptoms began with either low back or pelvic girdle pain (Lee & Lee

2004a). This interaction in the manifestations of pain and/or dysfunction in the pelvis girdle makes difficult the diagnosis and clinical decisions. Which functional model can joint all this requirements? In 1997 Ingber proposed the intercommunication systems based on the tensegrity principles (Ingber 1998, Pilat & Testa, 2009). The tensegrity theory determines a system of shared tensions in the distribution of the mechanical forces at multiple body levels, which can also explain the global reaction of the fascial system when it receives a mechanical stimulus (Chicurel Chen & Ingber 1998, Khalsa et al 2000). Different studies (Ingber 2003, Ingber 2006, Parker et al 2007, Stamenovic et al, 2007, Ingber 1998, Wang et al 2009) have shown that cell dynamic and active response of the cytoskeleton, receiving the action of mechanical forces from the extracellular matrix, induce tissue into the remodelation of both cell and sub-cell levels. Taking in account, that the construction of the body follows the principles of hierarchical assembly, which is widely demonstrated at the cellular and subcellular level, the above process is not limited to cells, but also involves tissues, organs and finally the whole body (Huang & Ingber 1999, Huang & Ingber 2000). Petres and Carrico (2006) states that the pelvic floor therapies should be a first line of treatment for those women with chronic pelvic pain related to pelvic floor dysfunction. Jarrell (2000) states that there is a increasing interest in alternative therapies, particularly using the principles of the treatment of myofascial dysfunction in CPP syndromes. Lukbane at al (2001) reported a 94% improvement associated with urination in patients with chronic interstitial cystitis after the application of direct myofascial release, muscle energy and stretching exercises.

Santos (2009) established the tensegrity conextion between the changes in pelvic gridle myofascial dynamic and the endopelvic fascia (Fig.14.5.1).
Preponderant of muscle pelvis floor vs endopelvics fascia lygament s is a long data discussion.. New discovery about 3-D net endopelvic fascia how tensegrity structures and interaction of myofascia and viscerofascia of female pelvis floor, with fascial connections on I-II-II De Lanceys level Diagnosis of the early damage of these ,by a new clinic find Santos s sign to finger examination and compression allows detect in female whit back pain and pelvis weight ,hiperlordosis or pelvic anteversion, myofascia perineal weak , episiorraphy defects , paraurethral ,paravagynal 2/3 upper third and Douglas cul de sac of endopelvic fascia damage. (Santos 2009)

The careful observations in fresh cadavers dissections confirm the hypothesis of the fascial continuity (Pilat, 2008). At the superficial level, just under the skin, we can appreciate the superficial fascia that contains considerable amount of fat, varied in different body regions (Fig.14.5.3 trough Fig.14.5.7). This fascial structure is characterized by great elasticity. Similarly the deep fascia is a continuous path and represents a more fibrous and dense structure. (Fig.14.5.5 trough Fig.14.5.11). At the intermuscular level we can appreciate for example, the fascial envelopment (Fig. 14.5.13) and tendon ligament fascial connections (Fig. 14.5.14 and Fi.14.5.15).