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How to Treat Low Back Pain and Urinary Incontinence in Female Clients Using the Epiglottal Complex
By: Nataliya Zlotnikov, MSc, HBSc


In the literature surrounding pelvic health, intra-abdominal pressure (IAP) is often discussed regarding the effects it can have on the pelvic floor, causing dysfunction when the pressure system is not coordinated properly with movement. While it is important to work with this pressure for optimal central stability or proximal control, we cannot forget to discuss intra-thoracic pressure, how it is intertwined with IAP and how they work together to maintain musculoskeletal and pelvic floor health.

IAP and how stabilization occurs

We all know about the inner core unit. It consists of the transverse abdominus, multifidus, diaphragm and pelvic floor and is often thought of as a closed pressure system.

The transverse abdominus muscle is the primary muscle activated for stabilization – in fact, it is recruited prior to the initiation of any movement of the upper and lower extremity. The multifidus muscle runs along the spine and serves as one of the primary supports for the spine, pelvis and hips.

When the diaphragm and pelvic floor contract simultaneously – the diaphragm descending on an inhale and the pelvic floor ascending - this creates the most effective stabilization, compressing the abdominal cavity cranially and caudally which then increases the IAP. When these four muscles contract in a coordinated manner it causes increased stiffness of the lumbar spine which creates the stabilization needed for movement.

During higher load activities, the body requires more stability. These muscles of the inner core help to reinforce and stabilize the pelvis because of the attachments they have to the thoracolumbar fascia and to the ligament of the pelvis. The stabilization effect that they have on the pelvis includes creating compression forces around the articular surfaces, pulling on connective tissue and increasing the amount of nutation creating a locking mechanism.

But what if the inner core is not a closed system? What if instead of closing off at the abdominals and diaphragm, that it works in unison with the glossopharyngeal unit and is affected by the opening and closing of the glottis? What are the effects this can have on the diaphragm and pelvic floor?

What is the glossopharyngeal unit? The pharynx is part of the throat behind the nasal and oral cavity leading to both the lungs and the stomach. Within this area, the epiglottis is located and points up towards the pharynx. The epiglottis is a flap located in the throat that opens and closes to prevent food from entering the respiratory tract and glottis. During respiration, it opens to allow air to enter the lungs, and when we eat it closes to prevent food from entering when swallowing.

The larynx, which is part of the respiratory tract, houses the vocal folds which we use to help manipulate our pitch and volume which is essential for speech. The glottis is the narrowest part of the larynx which also helps to produce sound and can be useful in practice to change compensatory patterns and allow for appropriate central stability.

Julie Wiebe and Susan Clinton will introduce this concept and the ones discussed below in their 2.75-hour course and how to optimize these systems to improve client function. Help your clients reconnect to their bodies with the strategies you will learn in this course!

Click Here for the Full Course


About the course

The inner core unit is the anticipatory core that sets up proximal control to help us complete the purposeful movement with our limbs. These purposeful movements that are used when completing our activities of daily living should be done with little difficulty. For example, lifting objects, climbing stairs and standing up from a chair. Often with these activities that throughout the day we give little thought to, can actually be quite difficult and taxing on our body when there is an imbalance in our muscles, or in the systems mentioned above.

Breath-holding is often used as compensation to help increase central stability. These compensatory patterns can develop for example from weakness in the pelvic floor after giving birth.

Our breathing patterns are SO important. It can calm down the nervous system when it is in overdrive, which is often a constant state of the human race. The fight or flight system is often turned on causing a constant state of stress reactions, which is not supposed to be active all the time and has negative effects on the human body when it is. By controlling our breathing patterns, we can turn on the parasympathetic nervous system which is interconnected with the vagal trigeminal system, which also has connections to the epiglottis and surrounding areas.

When we hold our breath, it creates tension in our body, and specifically the pelvic floor. When there is tension all the time, we cannot create the proper tension to complete activities which will then affect proximal stability.

Faulty breathing patterns are discussed further in the course and the neuroanatomy behind their connections to help you understand what techniques can be implemented into your practice to help address these issues.

From top to bottom the body is working together. The respiratory system and alimentary tract have anatomical, neurophysiological, neuromuscular and structural connections. You may find yourself wondering how so? How do these systems relate to the very common dysfunctions of the lumbopelvic, cervicothoracic region, pelvic floor and gut systems? How do they affect proximal control and what contributors and links may be drawn when discussing alignment, breathing mechanics, pressure systems, chemical contributors, cranial and autonomic nervous systems? Click below to find out!

Learn more with Julie Wiebe and Susan Clinton

Julie Wiebe
PT, MPT, BSc.

Julie Wiebe, PT, DPT has over twenty-four years of clinical experience in Sports Medicine and Pelvic Health, specializing in pelvic/abdominal, pregnancy and postpartum health for fit and athletic females. Following her passion to revolutionize the way women recover from pregnancy and injury to return to high levels of fitness and performance, she has pioneered an integrative approach to promote women’s health in and through fitness. Her innovative concepts and strategies have been successfully incorporated by rehab practitioners and fitness professionals into a variety of populations (ortho/sports medicine, pelvic health, neurology, and pediatrics). A published author, Julie is a sought after speaker to provide continuing education and lectures internationally at clinics, academic institutions, conferences and professional organizations. She provides direct care to female athletes through telehealth and her clinical practice in Los Angeles, California.

Susan Clinton
PT, DScPT, OCS, WCS, COMT, FAAOMPT

Susan Clinton completed her Doctor of Science degree at Andrews University in Berrien Springs, Michigan and graduated with her NAIOMT fellowship in orthopedic manual therapy in 2013. She was accepted as a Fellow by the American Academy of Orthopedic Manual Therapists in 2014.

As a Board Certified Clinical Specialist in Manual Therapy, Orthopedics and Women’s Health, she has been actively treating patients with pelvic floor, urinary, bowel, reproductive, oncology, persistent pain, sports injuries and post-surgical diagnoses.

Susan is active with the American Physical Therapy Association, serving in governance as a local delegate and alternate delegate, and as the Chair of the Clinical Practice Guidelines steering committee for the Section on Women’s Health and the Women’s Health Global Initiative. She is the past secretary on the Section on Women’s Health Board of Directors and the former President of the Performing Arts Special Interest Group of the Orthopedic Section of the APTA.

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