The ThoracoAbdominoPelvis

Coming from background of musculoskeletal physiotherapy, I have from the start of working with pelvic dysfunction been cognisant of the relationship between the pelvis and the rest of the musculoskeletal body. I have been mindful of pain referral patterns and fascial connections. I have issued from the view that pelvic wellbeing is really whole body wellbeing. However, it wasn’t until I started doing dissections that I was introduced to the central role of the viscera in understanding both pelvic and whole body wellbeing.

The viscera was never something that was covered in our training as physios – in fact, the abdomen wasn’t really included at all. The lungs were considered in relation to pulmonary diseases, the heart in relation to cardiovascular disease and exercise, but not as intricate parts of the whole body. I first realised the value of treating the abdomen when I started working myofascially – the back has a front, surprise surprise! But this was initially only from the focus of muscles and referred pain. When I started learning about fascia, this added a whole new aspect to the 3-dimensionality of the body. And then I was introduced to the viscera. All of a sudden, there was a whole new world under my hands; my previous ideas of what I thought I was feeling became obsolete. Having seen the insides of the pelvic, abdominal and thoracic cavities, many of my ideas were challenged, my palpation and my clinical practice has changed considerably.

The thing with the thoracoabdominopelvis (TAP) is that it is the seat of so many crucial functions that are essential for us to survive. The pelvis is a hub, both in terms of movement but also in terms of it’s functions. The viscera has an array of highly complex functions, which go beyond simply absorbing nutrients and water, providing us with oxygen, or sending blood around the body. When things don’t work as they should in this region, enigmatic pain and dysfunction can be a result, in any part of the body. The range of problems that can arise are beyond the scope of this short piece of writing. But essentially, any dysfunction in the TAP will be related to the rest of the body – physically, physiologically, psychologically, emotionally. The TAP will impact how we move, breathe, function, feel, behave and socialise; how we move, breathe, function, feel, behave and socialise will impact the TAP. So if we want to solve problems of the TAP, we need a greater understanding of this complexity.

We thus cannot view pelvic dysfunction only in relation to the pelvis, abdominal problems only in relation to the guts or breathing difficulties only in relation to the lungs. The TAP is connected to the rest of your body, and should function together with the rest of your body. Our bodies are part of us as individuals that are part of larger social, cultural and environmental contexts. We need to stop viewing the body as separate units, and instead treat it as the complex, dynamic functional whole that it is! And we need to work together. No one professional or therapist can address all the needs of this complex region, and no one treatment technique has all the answers. What works for one individual might not work for the next. Similar symptoms will have very different underlying causes in different people.

This TAP is the focus of ongoing exploration, which keeps opening up to more and more fascination. Every dissections adds new dimensions. Every client challenges my preconceived ideas. Every paper or article adds another piece to the puzzle. It’s a fascinating journey to be on!

Jenny Wickford