I have a young man with pelvic pain. He initially complained of groin and abdominal pain. Now he primarily has left pelvic pain (piriformis and left inner thigh). The patient has huge lower rib cage flares, poor sitting posture and sensitivity in the left ilioguinal nerve above the inguinal ligament. My questions are: 1) How significant are the flares to the left pelvic pain? 2) What is the ideal treatment frequency to affect a change in the flares and how much change should we expect?
The ability for your patient to breathe and get his ribs down with his abdominals is related to his pelvic floor dysfunction. They work together to support the “egg” that we are trying to re-establish in PRI. I would work with your patient to re-establish his abdominals and mediastinum opening in supine, sitting, or sidelying. Once he has lift scores of 2/5 I would get him in sidelying and inhibit his obturators to get more IR as this will lift his pelvic floor. I would encourage activity that promotes AF IR/FA IR with hip extension on the left as he can tolerate with the correct inhalation and exhalation phase.
Rib flares are bony changes to the ribs secondary to torque…like a rib hump in scoliosis. These flares won’t go away, however, you can still get the patient in anterior rib IR and a ZOA with abdominal control.