Muscle (n): a fibrous tissue with the ability to contract, producing movement in or maintaining the position of an animal body.
Fascia (n): a thin casing of connective tissue that surrounds and holds every organ, blood vessel, bone, nerve fibre and muscle in place. Scientists think it may have even more nerves than your skin. It is intelligent, and ubiquitous!
Welcome to the ocean of myofascial connections in the human body.
Come and dip your toes with Glide Physio & Pilates boss Ellie Parnell as she wades through the muscle groups and fascia of your amazing pelvis to bring you the most essential info.
Wondering about skeletal terms? Check out our previous blog Pelvic Health: Anatomy & Physiology.
Let’s begin with everyone’s fave.
PELVIC FLOOR
Deep, connecting the inner borders of your pelvic bones.
A complex sling of muscles, ligaments and fascia that hold your pelvic organs in place and control their functions, your pelvic floor is connected to your pubic bones & coccyx, some deep hip muscles, organs including your uterus, vagina, rectum & urethra, and the nerves of your sacrum.
There are layers upon layers of myofascial tissue within the Pelvic Floor.
Deep
Levator Ani (puborectalis, iliococcygeus, pubococcygeus) – LA spans almost the whole width of the pelvic basin and is the primary muscular support for your pelvic organs, holding them in optimal position. When you feel the “lift” during pelvic floor exercises, this muscle is the star of the show.
Superficial
Bulbospongiosus, ischiocavernosus & the transverse perineal muscles – superficial front half of the pelvic floor muscles, these provide extra closure pressure for the vagina and urethra and are important for sexual function. The external urethral sphincter is not technically part of this crew (it sits deeper), although it is supplied by the same nerve.
External anal sphincter – superficial back half of the pelvic floor muscles, provides extra voluntary closure pressure of the anus.
Fascia & ligaments
Endopelvic fascia – a complex network of connective tissue which connects, supports and suspends the pelvic organs in their correct anatomical position. When talking pelvic health, you want to be aware that there are sections important sections of fascia between the vagina and the bladder (pubocervical fascia) and the vagina and the rectum (rectovaginal fascia).
Fascia is also intertwined through and between the pelvic floor muscles, and into the side walls of the pelvis.
Cardinal, pubocervical & uterosacral ligaments – suspend the uterus, cervix & vagina from the sacrum, lateral inner walls of the ilium bones and pubic bones. Keeping these ligaments strong and healthy helps prevent pelvic organ prolapse.
Round ligaments – your mostly hear about round ligament pain in pregnancy as the uterus grows heavier, and ligaments strain under pressure. The anterior RL attaches your uterus to the fascia above your pubic bone and the posterior ligament connects uterus to sacrum.
Phew. Let's move along.
ADDUCTORS
Inner thighs.
Three of them attach your pubic bone to the inner seam of your thigh bone. One fans out from ischium to inner thigh and another trundles from pubis down over the inner knee joint to catch your tibia. Their job is to adduct your femur, drawing it in toward your midline.
ABDUCTORS
High outer-side butt cheek.
Gluteus medius & minimus. They connect the back of your iliac crest to your upper outer thigh bone and, as the word would suggest, draw your leg away from your midline.
HIP FLEXORS
Front of hip & thigh (sorta).
The famous five originate everywhere. Three of them insert on your thigh bone but begin in different places: lumbar spine, inner border of the iliac crest and ASIS. One tracks from the ASIS to your tibia (shin bone) and another from the AIIS to insert at your kneecap (it’s also a quadricep, extending your knee).
HIP EXTENSORS
Peach.
Gluteus maximus and hamstrings. Glute max connects some spinal muscle fascia, the back of the iliac crest bone, sacrum and coccyx to your iliotibial band (ITB) and femur. Your hammies all originate from the ischium (bum bone) and cross the knee joint to insert on the back of your lower leg. This means they extend your hip joint and are also the main knee flexion crew.
INTERNAL ROTATORS
Front side of hip (mostly).
It's a group thing. Your tensor fascia latae, anterior fibres of glute med & min, and adductors all help roll rotate the head of your femur inwards. So some of the most vital muscular connections here are from:
the back of the iliac crest to the outer femur and also into the iliotibial band, and
the pubic bone to the inner femur.
EXTERNAL ROTATORS
Back of hip, in deep.
These muscles attach your sacrum and the back of the pelvis to your femur, and outwardly rotate the ball & socket joint. You got piriformis & a swag of other very small but powerful muscles, along with some of the fibres of glute max.
ABDOMINALS
So much more than the abdomen is involved here!
Oof. There are layers upon layers of abdominals. You got rectus abdominis & transversus abdominis, plus your internal & external obliques. They attach everywhere from your sternum to pubic bone to the back crests of your hip bones, ribcage and thoracolumbar fascia.
QUADRATUS LUMBORUM
The QLs.
A small but mighty four-sided muscle. You have one on the back of each hip bone that attaches the iliac crest to the back of your 12th rib and has little shoots that click onto the transverse processes of each of your lumbar vertebrae. Short read: the QLs attach the back of your hip to your spine and ribcage.
Your Breath
A cool sidebar to the QL spiel here is that your psoas muscle (a hip flexor) also attaches to the transverse processes of your five lumbar vertebrae then threads through your ilium to insert on your thigh bone. Your diaphragm (main breathing muscle) has tendrils that fasten to your top 3 lumbar vertebrae.
How you breathe can influence the health of your lower back and pelvis, and vice versa.
THORACOLUMBAR FASCIA
Not a muscle.
This is a stabilising or “girdling” structure on your mid-lower back, which helps the lumbar spine and sacrum carry and transmit your body’s weight!
Two of your abdominal layers wrap around your midsection and connect to the thoracolumbar fascia and iliac crests on the back of your body (these abdominals also attach to the anterior part of your ribcage and the pubic bone).
Hydrated and supple thoracolumbar fascia is vital to comfortable posture and helps you breathe well.
Tight fascia compresses your muscle tissue and restricts blood flow and makes everything tight, including your breath, which as we know influences your pelvic health; this works in reverse as well – lack of regular movement, shallow breathing and stress can make fascia sticky.
Remember...
Every single muscle or train of fascia dances in concert with other tissues and hormones in the organisation of your bones and organs, and often has multiple talents.
Are you a visual learner?
Check out this 3D interactive female pelvis diagram via Healthline.
