Pelvic Health Physical Therapy Anne Clark, DPT NovaCare Rehabilitation Derby, KS
Anne Clark, DPT ⚫ Doctorate in Physical Therapy from Wichita State University in 2014 ⚫ Pelvic Health training from Herman and Wallace Pelvic Institute and American Physical Therapy Association Section in Women’s Health 2017 and 2018
Pelvic Health topics ⚫ Incontinence/overactive bladder ⚫ Stress, urge and mixed ⚫ Dyspareunia ⚫ Diastasis Recti ⚫ Low back pain ⚫ Coccyx pain ⚫ Rectocele/Cystocele/Apex prolapse ⚫ Pubic pain/pelvic pain ⚫ Vaginismus ⚫ Pregnancy/postpartum ⚫ Constipation
Statistics 1 in 4 US Women Report moderate to severe symptoms of urinary incontinence, • pelvic organ prolapse, or fecal incontinence. 3 About 80% of people will suffer from low back pain throughout their lifetime. 1 • Up to 33.1% of women will had diastasis Recti During and after pregnancy. 3 • Nearly 3 out of 4 women will report pain with intercourse at some time during their • lives. 2 References: 1https://www.ninds.nih.gov/Disorders/ Patient-Caregiver-Education/Fact-Sheets/ Low-Back-Pain-Fact-Sheet 2https://www.acog.org/Patients/FAQs/ When-Sex-Is-Painful 3https://hermanwallace.com
Anatomy
Examination ⚫ Subjective history ⚫ Lumbar screen: ⚫ ROM ⚫ Flexion, Extension, Sidebending ⚫ LE Strength: hip flexion, abduction/adduction, knee flexion and extension ⚫ Pelvic alignment: Ilium alignment, ASIS, PSIS ⚫ SI joint provocation tests: compression, distraction, thigh thrust, sacral compression
Examination Diastasis Recti test Have patient supine • Place 2-3 fingers into umbilicus • Have patient raise head off • table Determine width and length •
Examination (vaginal) ⚫ Observe perineal area for asymmetry, incisions/scars, irritation, vitality of tissue, ability to bulge (bear down) and lift (kegal) ⚫ Palpation of pelvic clock externally checking for sensation and/or pain ⚫ Palpation of muscles: ⚫ First layer: Bulbocavernosus, Ischocavernosis ⚫ Second layer: Levator ani: puborectalis, pubococcygeus, iliococcygeus ⚫ Third layer: Coccygeus ⚫ Obterator internus ⚫ MMT: PERF scale: Power, Endurance, Repetition, Fast Twitch ⚫ Checking for circumferential contraction and full relaxation ⚫ Assessment of prolapsing: cystocele, rectocele, apex prolapse
Examination ⚫ MMT: PERF scale: Power, Endurance, Repetition, Fast Twitch − Checking for circumferential contraction and full relaxation ⚫ Assessment of prolapsing: cystocele, rectocele, apex prolapse
Treatment(s) ⚫ Varies depending on patient symptoms ⚫ Typically include: − Pelvic floor awareness: − pelvic clock − bulge and lift on washcloth
Treatment(s): Patient Education ⚫ Bowel Health No straining, Bristol stool chart ⚫ • Squatty Potty How does it work? Relearn the first thing you learned Your body relies on a bend in the colon (where your poop lives) and the anus (where your poop says hi) to keep everything stored until showtime. Your Puborectalis Muscle helps keep your poop in place by kinking your colon (like a garden hose) while you’re standing or sitting. This is helpful when you are sitting and don’t want t o poop but unhelpful when you do want to poop. If only there was a way to tell your body to unkink that hose… Your colon’s sweet spot comes with the squat. This is the only position in which the Puborectalis Muscle fully relaxes which straightens the kink and allows for complete elimination without straining. Bombs away!
Treatment(s): Patient Education ⚫ Bladder Health ⚫ Should be able to hold urine for 2-3 hours ⚫ Urinating 5-8/day, 0-2/night ⚫ Urinating for 8-15 seconds each time ⚫ Need to sit down ⚫ “Key in the door syndrome” ⚫ “Just in case” ⚫ Standing up and sitting back down to fully empty bladder
Stretches ⚫ Hamstring ⚫ Adduction ⚫ SKTC ⚫ DKTC ⚫ LTR
Stretches Piriformis • Calf • Soleus • Quads • Hip flexors •
Treatment(s) − Diaphragmatic breathing: ⚫ Teach how to use transverse abdomenis (TA) muscle ⚫ Inhale=expansion/relaxation ⚫ Exhale=contraction
Treatment (cont) ⚫ Progression of diaphragmatic breathing/TA contraction − Bent Knee Fall out (BKFO) - Heel Slides - Bridging with − Straight Leg Raise (SLR) pelvic tilt
Treatment (cont) Monsterwalks and Sidesteppers • with pelvic floor awareness • Jumping •
Treatment (manual) Pelvic floor trigger point/ soft tissue mobilization •
Treatment/ home use Dilators and pelvic floor trigger point • ⚫ (pelvic floor massage tool- Serenity TMT)
Home use Ohnut for deep dyspareunia •
Thank you Questions? • Anne Clark DPT P:316-788-6734 F:316-788-4529 awclark@novacare.com
References • Herman and Wallace Pelvic Institute • APTA Section on Women’s Health • HEP2go.com • Squatty potty
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