Myofascial pelvic pain is a major component of the chronic pelvic pain that is often not properly diagnosed by health care professionals. To fully understand the nature and function of the pelvic floor, it must be studied it in its most global aspect, taking into account numerous activities other than urological, gynecological, and intestinal ones: pelvic stabilization, participation in breathing, walking. It is necessary to consider the pelvic floor as a muscular-fascial unit with synergistic and antagonistic activity of muscle bundles, including more or less intertwined ones, with multiple functions, and not only with the function of closing the pelvic cup. Also, the pelvic floor muscles are connected to distant parts of the body, such as the feet and neck, through myofascial connections. Therefore, functional disorders in distant sites, such as flat feet, spasm of the respiratory diaphragm, or tension of the dura mater of the spinal cord, can lead to pelvic floor dysfunctions and musculofascial pain. In turn, pelvic floor dysfunctions will also affect the statics and dynamics of the body.

The goal of the review is the systematization of the main factors influencing on the appearance of clinical signs of carpal syndrome of median nerve. In this lecture, an emphasis is placed on the problem of dynamic carpal tunnel syndrome, the symptoms of which are provoked by physical exertion and/or a certain position of the limb, due to compression and/or overstretching, as well as abnormality of longitudinal and transverse sliding of the median nerve. These symptoms subside with the termination of the action of the provoking factor and return when the movements are repeated. Neurological examinations and nerve conduction tests performed at resting state usually do not reveal changes. This lecture also discusses the features of clinical biomechanics and pathophysiology of the median nerve. For topical diagnosis of the level of nerve compression and in order to accurately understand whether there is an abnormality of the mobility of the nerve tissue, it is necessary to carry out manual testing of the muscles innervated by the median nerve, with the arm and neck of the patient being examined in a neutral position, and during provocative neurodynamic tests. According to clinical neurodynamics therapeutic measures should be directed to all interdependent components of the peripheral nervous system in the following sequence: osteopathic treatment of the nerve trunk interface (tissues surrounding the nerve trunk); osteopathic treatment of innervated tissue; osteopathic treatment of the connective tissue of the median nerve. During this sequence of treatment, we carry out manual correction of the functional blocks of the joints of the hand and the radiocarpal joint, inactivate trigger points in the muscles surrounding the median nerve (round pronator, flexors of the fingers of the hand, etc.), carry out fascial release directly to the nerve bed itself. Then we perform passive and active mobilization of the nerve trunk in the longitudinal and transverse directions. After the end of osteopathic treatment, it is necessary to prescribe special neurodynamics exercises to mobilize the median nerve.

Dynamic suprascapular nerve neuropathy is a cause of shoulder pain and weakness that is often overlooked. The difficulty in diagnosing the nerve dynamic damages is conditioned by the fact that the symptoms are provoked by physical exertion(s) or a certain position of the limb due to compression and(or) overstretching as well as violations of the longitudinal and transverse sliding of the nerve. These symptoms subside when the provoking factor ceases to act and return when movements repeat. Neurologic examinations and nerve conduction studies performed at rest usually show no change. The suprascapular nerve dysfunction is closely related to rotator cuff pathology. The nerve damage is often caused by a dynamic microtrauma during repetitive arm movements over the head with maximum deflection and external rotation of the arm. Suprascapular neuropathy can be caused by the nerve compression or traction in the suprascapular notch or spinoglenoid region. The nerve damage in the suprascapular notch causes weakness in both the supraspinatus and infraspinatus muscles, while damage under the spinoglenoid ligament affects only the infraspinatus muscle. Diagnostics should include manual testing of the supraspinatus and infraspinatus muscles with a neutral position of the arm and neck of the patient being examined and during provocative neurodynamic tests of stretching the suprascapular nerve. Therapeutic measures should be directed to all interdependent components of the peripheral nervous system in the following sequence: osteopathic treatment of the nerve trunk interface (tissues surrounding the nerve trunk); osteopathic treatment of the innervated tissue; osteopathic treatment of the connective tissue of the suprascapular nerve.

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