Newsletter & Blog

The sacrotuberous ligament is a structure that is under-recognized as important to assess and treat during pregnancy. The ligament runs from the sacrum to the ischial tuberosity and has connections into the tailbone and hamstrings muscles via connective tissue. It crosses posterior to the sacrospinous ligament creating an "x" or "t" depending on orientation.When taut the sacrotuberous ligament can cause the pelvis to become posteriorly rotated, cause tension in the same side pelvic floor muscles, inhibit needed coccyx or tailbone mobility for birth, be a source low back pain, and delay or prev[...]

Our elderly patient, who is an avid bike rider in NYC, reported having a bike crash and got up to continue riding a few days ago. Instead of starting treatment to help her with her chronic constipation via pelvic rehab as planned, we put on our athletic training hats and proceeded to evaluate this contusion. We held off on sEMG biofeedback, visceral mobilization, intestinal massage, and pelvic floor muscle rehab to assess her limb. Ruling out a possible fracture began: Fractures present with deformity, swelling, black and blue (ecchymosis), and pain. She was fully weight bearing and not antalg[...]

Patients with unabating or chronic low back pain sometimes have sacroiliac joint misalignment. This patient has been dealing with a pelvic organ prolapse since delivery of her daughter 5 years ago and has been seeing another PT for her chronic low back pain. She comes to us from out of state for our expertise. Her evaluation revealed a sacral torsion or rotation (misalignment) to the left, pelvic floor muscle weakness, Grade 2+ cystocele, anterior innominate rotation right sided, generalized weakness/deconditioned and true hypermobility syndrome. We have used manual therapy techniques to i[...]

Rectus Abdominus Diastasis (RAD) is a separation of the linea alba, greater than 2 centimeters is considered abnormal. The linea alba is a thick connective tissue that connects the two rectus abdominus muscles together, down the center. With RAD a separation of the abdominal wall occurs because of stretch or sealing of the linea alba. Diastasis rectus abdominus is commonly seen in women during and after pregnancy, in overly fit men and women who focus on excessive abdominal strengthening, and in adults who are overweight with abdominal central obesity. In this image we are evaluating a 40 [...]

Pregnant women may complain of lower abdominal, pelvic, groin, hip, or pubic pain. A common cause of this may very well be the stretch sensation of the round ligament which can provoke pain in these areas. The round ligaments are two of the suspensory ligaments of the uterus (there's one on each side). It originates at the lateral wall of the uterus on either side, passes through the inguinal canal, and inserts into the mons and pubic symphysis. As the baby and uterus grows and lengthens so must the suspensory ligaments. The round ligament is initially about 2 inches in length and can stretch [...]

We sometimes use this device to apply mild heat and vibration to help relax the muscles. Using small strokes at high frequency this device can induce relaxation of the painful muscle rapidly. It has several different treatment "heads" designed for either treating bony contours, myofascial trigger points, or larger muscle bellies. In this image we are utilizing the Rapid Release on the hip adductors. This is a large inner thigh muscle group comprised of 5 muscles: the pectineus, adductor magnus, brevity, longus, and gracilis. There is a shared connection with the obturator externus. Thi[...]

In this photograph Dr. Morrison is giving an in-house lecture to the staff, and community childbirth practitioners, on manual physical therapy for improving pelvic alignment and mobility for labor and delivery. Addressing imbalanced pelvic joints, pelvic and uterine ligaments, hip and lumbopelvic muscles can help improve pelvic balance and allow for the baby to move to an optimal position for successful vaginal delivery. We evaluate to see which combination of techniques - massage, joint mobilization, muscle energy techniques, strain/counterstrain, positional releases, neuromuscular re-educati[...]

Diastasis recti in a postpartum patient, shown in the top photo below, is 3 finger width. The test being performed is a standard manual measurement whereby the patient curls their head up off the surface (as in a classic mini crunch) and the therapist measures the distance between the rectus abdominus muscles. The botttom image is showing the recti edges delineated via manual palpation, so one can confirm the findings. We also measure the inter-recti distance via rehabilitative ultrasound. The linea alba, the thick connective tissue structure that connects the left and right abdominal recti mu[...]

In this photo we are measuring post residual void using rehabilitative ultrasound in our office! Post residual void is the amount of urine left in your bladder after you have urinated. Believe it or not there usually is a small amount of urine left in the bladder after emptying it, which is considered normal. In other words, it does not completely empty when you urinate. The volume of post residual void which is normal in patients over 65 is less than 50 mL; less than 100 mL is considered acceptable, but is considered abnormal in younger patients. Patients sometimes feel bladder pressure, the [...]

Low-level laser therapy (LLLT) is a form of cold laser which uses only light energy to stimulate healing at the cellular level. Here you see expert pelvic physical therapist, Luba Starostiak, treating a patient who has an acute flare of mid back pain after receiving chiropractic manipulation in another clinic. Cold laser can quickly calm a painful area. The patient does not feel any heat from its use hence the term "cold laser". Clinical applications include use in wound healing, tissue regeneration, and pain reduction. LLLT promotes vasodilation which improves blood supply and stimulates coll[...]