The physiological changes that occur in a woman’s body during pregnancy can lead to various dysfunctions and discomforts that interfere with normal functioning in daily life. Postural problems, respiratory problems, lack of physical activity, and pain before pregnancy can lead to worsening of symptoms during pregnancy. There is currently no scientific evidence to support this, although many physical therapists would likely agree that postural alignment should be an important component of perinatal care. However, questions remain that limit our ability to effectively intervene in postural alignment, particularly at the individual level. The most basic of these questions concerns what constitutes “good” or “correct” postural alignment. Other questions concern whether “correct” posture differs among and/or between individuals, how incorrect posture occurs, and how it can be improved. Regardless of whether the definition of good posture is based on theoretical or empirical principles, there is insufficient evidence to prefer one alignment pattern over another, other than avoiding patterns that have historically been associated with negative outcomes (e.g., scoliosis).

What is the importance of posture and its diagnosis? According to the European Urology Association guidelines, an additional diagnostic tool in pelvic floor dysfunction is the assessment of the musculoskeletal system as well as the urological, gynecological, digestive, nervous, and psychological systems (1). In this case, the assessment consists of examining skeletal muscle overload and posture while standing. According to King (2), the typical posture that leads to chronic stress and weakening of the pelvic floor muscles is characterized by increased lumbar lordosis, anterior pelvic tilt, and deepened thoracic kyphosis. In addition, maintaining such a posture leads to weakening and stretching of the abdominal muscles and shortening and weakening of the iliopsoas and pear muscles. Another example of the influence of posture and muscle tone on pelvic floor function is the inferior crossing syndrome described by Janda (3). According to this author, when posture is incorrect, such as an excessive forward tilt of the pelvis or a deepening of the lumbar lordosis, a muscular imbalance occurs via the anatomical myofascial connections, consisting of a shortening and hypertonic tension of the tonic muscles and a weakening of the phasic muscles. Muscular imbalance associated with the described abnormal posture in the sagittal plane can lead to the formation of so-called skeletal muscles. Trigger points (TrPs) – excessively irritable, painful sites when pressure is applied that can impair the motor functions of the pelvic floor muscles and reduce their flexibility, strength, and depth sensation (4,5).

Martyna Kasper-Jędrzejewska

References:

1. Nambiar AK, Bosch R, Cruz F, Lemack GE, Thiruchelvam N, Tubaro A, i in. EAU Guidelines on Assessment and Nonsurgical Management of Urinary Incontinence. Eur Urol. kwiecień 2018;73(4):596–609.
2. King PM, Myers CA, Ling FW, Rosenthal RH. Musculoskeletal factors in chronic pelvic pain. J Psychosom Obstet Gynecol. 1 wrzesień 1991;12(sup1):87–98.
3. Izraelski J. Assessment and Treatment of Muscle Imbalance: The Janda Approach. J Can Chiropr Assoc. czerwiec 2012;56(2):158.
4. Behm DG, Wilke J. Do Self-Myofascial Release Devices Release Myofascia? Rolling Mechanisms: A Narrative Review. Sports Med Auckl NZ. sierpień 2019;49(8):1173–81.
5. Moldwin RM, Fariello JY. Myofascial trigger points of the pelvic floor: associations with urological pain syndromes and treatment strategies including injection therapy. Curr Urol Rep. październik 2013;14(5):409–17.