Clinical Specialist Physiotherapist www.gillianmccabe.co.uk - PowerPoint PPT Presentation

Gillian McCabe Clinical Specialist Physiotherapist www.gillianmccabe.co.uk info@gillianmccabe.co.uk

Session Plan • How to activate the pelvic floor muscles • Pitfalls to avoid • Principles of pelvic floor muscle training

Start from the back passage As if stopping wind Squeeze up and forwards As if stopping wee Release in the opposite direction Correct Pelvic Floor Movement

Pelvic Floor Exercises Practice • Try it out: – Lying – Sitting – Standing – Moving • How does it feel? • Is it different in different positions?

Pelvic Floor Muscle Exercise Pitfalls to Avoid • Holding breath or sucking in breath • Squeezing inner thighs • Buttock Clenching • Abdominal pull • Valsalva or straining

Pelvic Floor Muscle Exercise Coordinate with the breath • Inhale to prepare • Exhale to squeeze • Coordinate and then build on holds or faster squeezes • Exhale and squeeze with effort

Pelvic Floor Muscle Exercise Activate the slow and fast twitch fibres • Slow Twitch (70%) – Squeeze & hold – Same direction – Same technique • Fast Twitch (30%) – Squeeze & release – Same direction – Same technique

Pelvic Floor Muscle Exercise Where to Start • Technique • More than 30% of women are unable to voluntarily contract their pelvic floor on first consultation even after thorough instruction! • Get a specialist involved in the first place – especially where symptoms are present • Avoid the ‘ valsalva ’ or straining technique

Pelvic Floor Muscle Exercise How and When to progress • As with all skeletal muscle • Be specific – Keep with the same technique • Overload the muscles – Push the parameters with increased holds and reps • Progress difficulty and complexity – Gradually progress and use gravity to load up the muscles with effort and multitasking movements • Maintain strength and endurance through mindful use during training and every day activities

Pelvic Floor Muscle Exercise Dosage and prescription • There is no ‘one size fits all’ • ACSM Recommendations: – Target major muscles – Perform 8-12 slow and moderate velocity, close to maximum contractions (fewer reps will optimize strength and power) – Perform 1-3 sets per exercise – Exercise 2-3 times per week – Manipulate the program over 6 months plus to encourage improvement and maintenance (American College of Sports Medicine, 2009)

Pelvic Floor Muscle Exercise Overview – Strength Training • Ensure correct contraction • Ask for maximal contraction • Progress with sustained contractions and add contractions with a high velocity as a progression • Holding time should be 3-10 seconds • Recommend PFMT everyday • Use strong verbal encouragement to motivate patients to contract fully • Work harder to achieve further improvement in future training sessions (Bo, et al., 2016)

Useful Links • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997838/ – An article from 2010 about the status of pelvic floor muscle training in women • http://www.squeezyapp.co.uk/info/index.html – The Squeezy app – a great way for clients to keep on top of their pelvic floor muscle training • http://www.csp.org.uk/your-health/find-physio/physio2u – Use the Chartered Society of Physiotherapy page to find a local women’s health physiotherapist or ask the GP to refer to an NHS specialist

References • American College of Sports Medicine, 2009. Position Stand. Progression models in resistance training for healthy adults. Med. Sci. Sports Exerc. 41 (3) 687-708. • Bo, K., Morkved, S. 2016. Pelvic Floor and Exercise Science. Chapter 6. In Evidenced based physical therapy for the pelvic floor: Bridging science and clinical practice. Churchill Livingstone Elsevier. London.