L7 Pelvic Health Flashcards
Remember that the pelvic floor affects
bowel, bladder, sexual function
Indications for internal exam
cozean pelvic dysfunction (3+ score) screening protocol
incontinence or voiding dysfunction
pelvic pain
prolapse
sexual dysfunction
baseline strength for PFM
Contraindications for internal pelvic floor exam
lack of patient consent
<6 weeks postpartum or post op
severe vaginal atrophy
current infection
severe pelvic pain
children, lack of pelvic exam
sexual abuse
pregnancy in 1st trimester
Observation during pelvic exam
seated posture
standing posture
gait assessment
breathing pattern
external perineum
ROM, joint, nerve scan
Squatting
diaphragmatic breathing
Breathing assessment
first in sitting
then instruct to take deep breath in through nose, out through mouth
should be looking for front, side, back expansion
Factors that decrease diaphragm expansion
flared rib cage
poor core coordination
poor posture
Breathing pattern
- take breathe in
- diaphragm lowers
- 360° expansion of abdomen, pelvic floor lengthens
- diaphragm moves up. belly sides, low back retract and pelvis naturally recoils
Cough test
sit up tall and cough
–if lower abdomen inflated/ bulged out, indicates abdominal/pelvic floor weakness or coordination deficit of pelvic floor and intra-abdominal pressure management
Stop the flow of urine test
unable to fully stop the flow of urine mid-stream
indicates pelvic floor muscle weakness
Cues for no leaks
don’t squeeze the abs
squeeze upwards, to prevent pressure from pressing down on pelvis
Rectus abdominius test (DRA)
+ if greater than 2+ finger width
assess width and depth
also note doming, invagination, tension or bogginess
ASLR
assessing load transfer when lifting one leg 20cm off ground
rate amount of effort to lift, from 0 to 5
test is positive for any score > 0
repeat with passively applied compression to pelvis
testing to evaluate the load transfer
One leg stand test
note balance, postural strategy, significant shift, pain
testing for load transfer and postural strategy
Internal palpation
vaginal tone, contractility, muscles symmetry, sensation, pain, strength, coordination, A/P vaginal wall laxity with bear down
Pelvic floor lengthening
stretching = happy baby, child’s pose, deep yoga squat
standing kickstand deadlift to lengthen the post glute, deep rotators
Breath coordination with movement
indicated for LBP with stabilization deficits, S/S of weak or overactive pelvic floor
squats, deadlifts, bed mobility
Squat breathing
inahle and slowly lower, causing eccentric lengthing of pelvic floor
forced exhale and contract PFM as they come upright
Levator Ani Anterior
suprapubic region, urethra, bladder, perineum
increased urinary urgency/frequency, painful urination
Levator Ani Posterior
deep vaginal, rectal, perineal
pain with defacation, painful urination, thrusting pain
Coccygeus
buttock pain
pain with sitting, during defecation, intestinal fullness
Obturator internus
anal, coccyx, vulvar, urethral, vaginal, post thigh pain
burning or aching pain
Piriformis
ipsilateral hip, post thigh, sacroiliac region, buttock
Adductors
can refer to groin, bladder, anteromedial thigh, down to knee
Modified oxford scale for internal pelvic floor
0 = no contraction
1 = trace
2 = not symmetrical, no lift
3 = moderate contraction w/lift
4 = good contraction with lift
5 = strong contraction with strong lift
PERF rating
Power = grade 0-5
Endurance = 0-10 s
Repetition = # of repetable contractions
Fast contraction = 0-10 reps
documented as P/E/R/F
LBP and pelvic floor dysfunction
urinary incontinence, 78% of women with LBP reported incontinence
higher risk with breathing problems, obesity, lack of PA
Exercise and incontinence
49% of gym exercising women experienced incontinence
constipation, family hx of UI, associated with incontinence
Prolapse
worse as the day goes on, standing, better in the AM, weakness or overactivity
SI or coccyx pain
attachements of PFM, deep hip rotators, referred pain from PFM, weakness, overactivity piriformis overactivity
