Surf the Wave - Visceral Mobilzation of the Reproductive System

Pelvic Rehab Report from Guest Blogger, Jillian Beaulieu, DPT, CYT

OK, before I discuss the inspiration for the title of this blog, a brief anatomy and physiology lesson:

In terms of anatomical location, the ovary is deeply embedded and protected within the ovarian fossa in the crowded lateral wall of the pelvis on either side. Each ovary is fairly small, each one being only approximately 3-5 cm during childbearing years. Female ovaries are analogous to male testes in that they are both gonads and endocrine glands that play a big role in reproductive function. Several paired ligaments support the ovaries. The ovarian ligament on either side connects the uterus directly to the ovary. The posterior portion of the broad ligament forms the mesovarium, which supports the ovary and houses its arterial and venous supply. The suspensory ligament of the ovary (infundibular pelvic ligament) attaches the ovary to the pelvic sidewall. Nerve supply to the ovaries runs via the suspensory ligament of the ovary provided through the ovarian, hypogastric, and aortic plexuses. Superior to the ovary lies the small intestine and cecum (right) or sigmoid (left). The bladder and round ligament reside anterior to each ovary. Inferiorly there is the broad ligament and parametrium. The rectum and ureters are behind each ovary. Laterally, the suspensory ligament, obturator nerve, ureters, iliac vessels are found and medially the fundus of the uterus. Wow!

Physiologically, the two small ovaries have a big job to accomplish every month in two phases, follicular and luteal. The follicular phase involves follicle development and growth with the goal of releasing a mature follicle to be fertilized within the uterine tube. Additionally, the ovaries are responsible for the production of female sex hormones estrogen and progesterone. They are busy factories that are constantly in movement and require a significant amount of organ mobility within the pelvic cavity. Given the latter information and without discussion of the many possible underlying causes of ovarian pain, there is no wonder that connective tissue and mechanical tightness or adhesion in the periovarian and surrounding structures may cause ovarian pain and dysfunction.

Thank goodness Ramona Horton, MPT recently taught me how to address these issues through Mobilization of Visceral Fascia for the Treatment of Pelvic Dysfunction: Level II!

Recently I found myself with quite a few patients with diagnoses involving ovarian pain and dysfunction that led to an endless list of other concerns for them. For three of my patients I have found the techniques that I learned in this course to be particularly valuable, and that is only in the three weeks since I took the course! For the patients I first ruled out kidney, bladder, small intestine, and large intestine involvement and treated with techniques such as pubovesical ligament mobilization and ileocecal valve induction as appropriate. I also looked at the kidneys, obturator nerve, and uterus/cervix due to their direct connections. I found techniques such as broad ligament mobilization and cervical-ovarian mobilization profound for freeing the periovarian structures. Finally, I have been concluding each treatment with tubo-ovarian induction for establishing motility of the periovarian structures by “surfing the wave.” Interested and intrigued? I cannot recommend taking this course enough!