The title should read “Externally rotate the femurs (if your femurs are internally rotated) and align your pelvis to support your uterus,”  But that would be too long a title.

An oversimplified explanation of how the femur position affects the pelvic floor and uterus. Even the feet collapse in (pronate) when the femurs are internally rotated.  I can actually feel my organs being dragged downward!

Slack muscles will respond by shortening, but short doesn’t equate to strong.  In fact, muscles that have shortened are weaker. This can be demonstrated on an EMG.

Ligaments of the uterus and ovaries aren’t just for support, but they also are pathways for blood, lymph, and nerve flow to and from the reproductive organs.  It’s important to remember, in order for the femur, sacrum, and pelvis to be neutral, the connecting muscles need to be at their correct length.  If the muscles aren’t at the correct length, blood, lymph, and nerve flow are negatively affected.

Here is a brief overview of the uterine ligaments and their attachment points:

Round ligaments are thin fibro-muscular cords that run from the lateral aspect of the fundus of the uterus and travel anterolaterally through the inguinal ring and canal and connect to the superficial perineal fascia at the labia majora. The round ligaments pass through the two layers of the broad ligament. The round ligaments lengthen from 4-5 inches to up to 18 inches or so during pregnancy! The round ligaments help maintain the anteverted position of the uterus.

Broad ligament: connects the uterus to the lateral walls of the pelvis.  The broad ligament is an extension of the peritoneum and envelops the uterus in its folds, so it appears as two flat wide ligaments extending outward laterally.  From the picture below you can see how the position of the rib cage and motility /mobility of the digestive organs can affect the ligaments of the organs below via the peritoneum.  Everything is connected!

Utero-sacral ligaments: The name implies that the uterosacral ligaments attach the uterus directly to the sacrum, but that is the case only 7% of the time.  This study shows, “the origin of the uterosacral ligament from the genital tract extends from the cervix to the upper vagina. The insertion on the pelvic sidewall occurs to the sacrospinous ligament (see image below) and the coccygeus muscle in 82% of all cases, but in only 7% do the uterosacral ligaments insert on the sacrum and 11% the piriformis muscle, the sciatic foramen, or the ischial spine.  This suggests that the uterosacral ligaments exhibit greater anatomic  variability than their name implies, and this might be an important insight for the understanding of the pelvic organ support mechanism.”  This ligament prevents the cervix from moving forward toward the bladder and from prolapsing.   Given the attachment points, it makes sense that the position of the femur, sacrum, and pelvis play a supportive role.  Can you see the importance of the squat and posterior push-off (using the gluteus while walking) for optimal sacral positioning? The gluteal muscles are the main force keeping the sacrum from moving anteriorly.  Remember the puppeteer image… sacrum=puppeteer handle thingy,  uterosacral ligaments=strings, and the uterus=puppet

It’s obvious to see how the position of the sacrum and coccyx can affect the uterosacral ligament, and therefore the uterine position

The obturator internus muscle can be accessed through the vaginal wall so pelvic floor PTs who do intravaginal manipulation can be very helpful to women with obturator internus problems. I learned a couple of ways it can be accessed externally in my training in Visceral Manipulation™ and in Maya abdominal therapy. And pelvic/femur/thoracic alignment is very important to the health of these muscles.  Issues with the obturator internus can cause vaginal, hip, and back pain, it can also mimic bladder pain, cause painful intercourse upon penetration, and refer pain to the abdomen.

Side note: A very important pelvic nerve called the Pudendal nerve travels through the obturator internus fascia. The pudendal nerve branches are unique to every woman, some have more branches to the mouth of the cervix or to the vagina. Some women have more nerve branches to the clitoris or the perineum. This accounts for different sexual responses in women! No, nothing is wrong with you if you don’t have vaginal orgasms! Something all women and men should know, don’t you think?

Cardinal ligaments:  Are known as the main supporting ligaments of the uterus, upper vagina, and cervix.  It attaches in a circular pattern around the cervix and moves laterally to the obturator fascia along the pelvic sidewalls.  Inferiorly it is continuous with the fascia on the upper surface of the levator muscles! The obturator internis attaches to the medial aspect of the greater trochanter (see image above), so this leads me to believe that a neutral femur would help support the cardinal ligament.  It also, makes me wonder if “incompetent cervix”  has to do with a disruption of flow through the ligament to the cervix due to poor alignment or tight pelvic floor.

Yeah, alignment matters!  Does it seem natural that we have such a high incidence of uterine prolapse in the US? Our bodies are beautifully designed to hold our organs in place without the help of mesh, pessaries, and 1000 Kegels a day. Recent estimates are around 24% of women in the US have pelvic organ prolapse. I’m guessing it’s even higher because many women with stages one and two don’t seek medical attention. We sit in chairs most of the day, we no longer squat, we wear positive heeled shoes and we don’t use the correct muscles for the most natural task….walking.

Getting Help:

I offer an online Womb Care course where you can learn self abdominal massage and other supportive therapies including pelvic alignment for reproductive health.

uterine massage online course

 

 

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