Women's Health in P.

T Problem solving

Problems: Postural problems, immobilize lumbar region, weak

abdominal muscles and back ache, hyper inclination of pelvis during
labor.

Occurrence: During antenatal period, during labor, and puerperium.

Solution: Pelvic Rocking exercises

Values of Pelvic Rocking:

1-To improve posture and minimize postural problems.

2-To strength the abdominal muscles.

3-To mobilize lumbar region.

4-To prevent backache.

5-To decrease the angle of pelvic inclination during labor and make
the axis of the fetus corresponds to the axis of the mother's pelvis
which leads to easy passage of the fetus.

Upward backward Downward forward

"posterior pelvic tilting" "Anterior pelvic tilting"
The acting *Abdominal muscles *Back extensors muscles
muscles *Hip extensors muscles *Hip flexors muscles
Hip extensors
Gluteus Maximus muscle
Origin *From the gluteal surface of ilium behind the
posterior gluteal line.
*From back of sacrum.
*From back sacrotuberous ligament.
Insertion *Its superficial 3/4 inserted into the posterior border
of iliotibial tract.
*Its deep 1/4 inserted into the gluteal tuberosity.
Nerve supply Inferior gluteal nerve.
Action It is the main extensors of the hip joint.

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Women's Health in P.T Problem solving

Back extensors

Scrospinalis or erector spinae muscle

Origin From the back of the sacrum, dorsal segment of iliac

crest, spines of all lumbar and last two thoracic
vertebrae.
Insertion Into the angles of ribs, transverse processes of lumbar
and thoracic vertebrae and spines of upper thoracic
vertebrae.
Nerve supply Posterior primary rami of spinal nerves.
Action It is the main extensor of vertebral column.

Anatomy of abdominal muscles

Muscles of the anterior Muscles of the posterior

abdominal wall abdominal wall
-External oblique muscle. -Psoas major muscle.
-Internal oblique muscle. -Iliacus
-Transversus abdominis muscle. -Quadratus lumborum
-Rectus abdominis muscle.

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Women's Health in P.T Problem solving

I- Anterior abdominal wall muscles:

The muscle Origin Insertion Nerve supply

External By slips from the Its fibers pass Lower 6
Trunk flexion
oblique outer surface and obliquely thoracic and
And rotation
muscle. lower border of downwards, forward 1st lumbar
“Contralateral”
the lower 8 ribs. and medially to be nerves
inserted :
*Along the midline
from xiphoid process
along the linea alba
to the symphysis
pubis.
*To the inguinal
ligament.
*In the anterior 1/2 of
the outer lip of iliac
crest.
Internal From lateral 2/3 Its fibers pass
oblique of inguinal obliquely upward, Trunk flexion
muscle. ligament, forward and medially And rotation
anterior 2/3 of to be inserted in: “Ipsilateral”
intermediate area *lower 6 ribs and its
of iliac crest and costal region
lumbar fascia. *Pubic crest and
pectineal line
*Along costal margin
to xiphoid process
then into the linea
alba.
Transversus *Lateral 1/3 of It forms the conjoint
abdominis upper surface of tendon by fusion with
muscle. inguinal the internal oblique Trunk
ligament. muscles, also, it rotation
*Lower 6 ribs. inserts into the
*Lateral edge of middle area of linea
lumbar fascia. alba.
Rectus Pubic crest and Into 5th, 6th and 7th
abdominis anterior pubic costal cartilages
imuscle. ligament. along a horizontal
Trunk
line in front of these 3 flexion
costal cartilges

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Women's Health in P.T Problem solving

II-Posterior abdominal wall:

Muscles origin Insertion Nerve Action

supply
Psoas The sides Descends along Anterior *Hip flexion
major and bodies of the brim of the primary and medial
the pelvis medial to rami of rotation.
transverse iliacus where L2,3,4. *Forward
processes of both muscles trunk flexion
all lumbar joint together to as in sitting
vertebrae and form the from lying.
intervertebral iliopsoas muscle
discs of T12, which pass deep
L1,2,3,4,5 to inguinal
tendinous ligament to be
arches on the inserted into the
sides of lesser trochanter
lumbar of femur.
vertebrae.
Iliacus Upper 2/3 of With psoas major Femoral Main flexors
iliac fossa of tendon into the nerve. of the hip
the hip bone. lesser trochanter with psoas
of femur. major.
Quadratus Iliolumbar Inferior border of Lumbar *Unilaterally:
lumborum ligament, last rib and plexus Lateral
iliac crest transverse T12 and flexion of
and process of upper L1,2,3. lumbar
occasionally 4 lumbar vertebrae and
from upper vertebrae. depressing the
borders of last rib
transverse *Bilaterally:
process of Fix last 2 ribs,
lower 3 or 4 acting
lumbar together with
vertebrae. diaphragm in
inspiration.

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 Women's Health in P.T Problem solving

Application of exercises

Upward backward pelvic rocking exercise

From crock lying position

Therapist position: Stride standing at the level of woman's pelvis.

Grasp: Thumbs of the therapist on the anterior superior iliac spines and the fingers
fanning laterally around the pelvis.

Command: Contract glutei, abdominal muscles and press lumbar region down, hold then
relax

N.B. It is important to perform the exercise correctly, if the woman find difficulty in
performing the exercise, so ask her to raise the pelvis up slightly which leads to indirect
contraction of the glutei, then contract abdominal muscles.

From creeping position:

We must take care that in this position the :

Back parallel to the ceiling.

90° between arms & trunk, trunk& thighs, thighs & legs, and legs & ankles.

Feet outside the plinth or mat.

Eyes look forward

Then ask the woman to :

Contract glutei, abdominal muscles and try to make her back as a hump, hold then relax.
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 Women's Health in P.T Problem solving

From standing against wall

There must be a foot distance between the feet of the woman and supports the
back against the wall

Then woman grasps by her hands "thumbs" the ASIS and "other fingers" on
the pelvis, then contract glutei, abdominal muscles and press lumbar region
against the wall, hold then relax

Down ward forward pelvic rocking exercise

From crock lying position Try to make a tunnel between lumbar

region and floor through contracting back
extensors and hip flexors, hold then relax.
(therapist passes hands through this tunnel
to make stimulation of back muscles, ask
her not to touch it by her back.
From creeping position Therapist asks the woman to ↑the lumbar
curvature through contracting back
extensors and hip flexors, hold then relax.
From standing position There must be a slight distance between the
feet of the woman and supports the back
against the wall. Try to make a tunnel
between lumbar region and wall through
contracting back extensors and hip flexors,
hold then relax.

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Women's Health in P.T Problem solving

N.B. the pelvis of the woman should be in a good contact with the plinth
to prevent hip extensors from coming into action.

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 ‫‪Women's Health in P.T‬‬ ‫‪Problem solving‬‬

‫‪Command in Arabic:‬‬
‫‪- anterior pelvic tilting:‬‬

‫من كل األوضاع < قوسي ظهرك‬

‫قوسي ظهرك‪ /‬اعملي نفق بني الظهر و الحيطة اقدر اعدي إيدي منه‪-::from standing:‬‬
‫قوسي ظهرك‪ /‬اعملي نفق بني ظهرك و السرير اقدر اعدي إيدي منه ;‪- From crocklying‬‬

‫‪- posterior pelvic tilting:‬‬

‫‪ -‬من كل االوضاع < اشفطي بطنك و اضغطي بظهرك عال‪plinth‬‬

‫اشفطي بطنك و حدبي ظهرك >‪- From creeping position‬‬

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