Aurelie, The best hand placement anteriorly is the one that I feel the greatest connection to in my posterior hand. You can just feel the connection better between your hands in that placement versus other areas anteriorly. I hope this helps.
Do you assess the US ligs on everyone or do you go by patients symptoms and if the latter, what would they typically be feeling? Pain? Tightness? Also, how do you know if they need to be released as opposed to that is the “normal” imbalance of that person as Rachel Shapiro talks about (great interview btw!)
I do the uterine mobility testing and treat what I find is restricted or tight from that. I don’t treat what is not tight. If there is a significant different side to side, I”m treating it, also if the movements of the uterus hit a hard end range compared to a soft end range on the other side, that is a sign it needs treatment. I don’t worry too much about the imbalances that are normally in the uterus because I go with end feel. That is a sign of dysfunction.
I have a new client (63 yo with 6 children) with prolapse. She had a partial hysterectomy about 2 years ago. According to my understanding she still has a cervix so she still has working US ligaments. How would my assessment and treatment differ than the above video in this case?
It wouldn’t differ as you still want to make sure that cervix has good mobility in there! The US ligaments should still be there depending on where they actually attach into the cervix so I’d just assume they are there. You can only treat this one internally as there is no fundus to connect to externally.
Follow up question: I have a new client who is 68 yo with h/o total hysterectomy d/t having lots of scar tissue following 2 partial hysterectomies (d/t ovarian cysts) who now presents with both cystocele and rectocele. From what I understand, during a total hysterectomy, the US ligs are reattached to the top of the vaginal vault to help support it and prevent vaginal vault prolapse. So, my question is, do you have any experience with this? Is there any way to connect with the US ligs at this point? What manual tx options do I have to help her?
From what I understand most surgeons are not using the US ligament for supporting the vaginal vault. They are too low. There are different suspension options and one is to attach it to the anterior surface of the sacrum on the sacral ligaments there. It depends on how far up they attached it. I don’t believe they are using the US ligaments to support the vault. So they are flapping in the wind so to speak. This situation is challenging. A pessary may work but I haven’t found it successful for a couple of my clients. They had surgery again. 🙁
What are your perceptions to know you have a better contact on a pregnant body as you search for the best hand position ?
Aurelie, The best hand placement anteriorly is the one that I feel the greatest connection to in my posterior hand. You can just feel the connection better between your hands in that placement versus other areas anteriorly. I hope this helps.
Do you assess the US ligs on everyone or do you go by patients symptoms and if the latter, what would they typically be feeling? Pain? Tightness? Also, how do you know if they need to be released as opposed to that is the “normal” imbalance of that person as Rachel Shapiro talks about (great interview btw!)
I do the uterine mobility testing and treat what I find is restricted or tight from that. I don’t treat what is not tight. If there is a significant different side to side, I”m treating it, also if the movements of the uterus hit a hard end range compared to a soft end range on the other side, that is a sign it needs treatment. I don’t worry too much about the imbalances that are normally in the uterus because I go with end feel. That is a sign of dysfunction.
I have a new client (63 yo with 6 children) with prolapse. She had a partial hysterectomy about 2 years ago. According to my understanding she still has a cervix so she still has working US ligaments. How would my assessment and treatment differ than the above video in this case?
It wouldn’t differ as you still want to make sure that cervix has good mobility in there! The US ligaments should still be there depending on where they actually attach into the cervix so I’d just assume they are there. You can only treat this one internally as there is no fundus to connect to externally.
Follow up question: I have a new client who is 68 yo with h/o total hysterectomy d/t having lots of scar tissue following 2 partial hysterectomies (d/t ovarian cysts) who now presents with both cystocele and rectocele. From what I understand, during a total hysterectomy, the US ligs are reattached to the top of the vaginal vault to help support it and prevent vaginal vault prolapse. So, my question is, do you have any experience with this? Is there any way to connect with the US ligs at this point? What manual tx options do I have to help her?
From what I understand most surgeons are not using the US ligament for supporting the vaginal vault. They are too low. There are different suspension options and one is to attach it to the anterior surface of the sacrum on the sacral ligaments there. It depends on how far up they attached it. I don’t believe they are using the US ligaments to support the vault. So they are flapping in the wind so to speak. This situation is challenging. A pessary may work but I haven’t found it successful for a couple of my clients. They had surgery again. 🙁