pelvic floor

Question 1

coccydynia what

Answer 1

Ligamentous/ bony injury involving coccyx
Coccygeal flexion > 25 deg or extension > 20 deg

Question 2

hx coccydynia

inc likelihood of this

Answer 2

Trauma (often direct trauma/ impact from falling) vs. idiopathic
Pelvic floor Sx/ injury with muscle scarring
Female (4x more likely)
Higher BMI (3x more likely)

Question 3

s/s coccydynia

Answer 3

Pain in area of coccyx
Aggravated by transitions, sitting without weight-shift (prolonged worse), defecation, intercourse

Question 4

PE coccydynia

Answer 4

TTP coccyx
Sitting posture: weight-shifted
Painful provocation testing (anterior from external force, posterior from internal force)

Question 5

intervention coccydynia

Answer 5

Medical: Surgical Excision, guided steroid injection
Manual therapy: coccyx mobs
Pt education/ activity modification
Pelvic floor exercises

Question 6

PPPP what is it

Answer 6

Pain that begins during pregnancy or within 3 weeks following delivery
Incidence of peri-partum posterior pelvic pain reported 4-78%
Severe pain reported 33%
Not well understood, theorized to be related to
Hormone-related ligamentous (intra- & extra- capsular) laxity
Increased lordosis (paraspinal muscles, sacrum positioning with loading)

Question 7

risk factors PPPP

Answer 7

Risk factors: multiple births, hypermobility, increased BMI, history of trauma to the pelvis

Question 8

PPPP PE

Answer 8

Physical Exam:
Pain in lumbar region and over SIJs
Findings consistent with mechanical SIJD
Positive Active SLR test

Question 9

PT during pregnancy for PPPP

Answer 9

limited evidence supporting may be beneficial in postpartum

Question 10

edu PPPP

Answer 10

posture and body mechanics

Question 11

incontinence stress

Answer 11

Primarily related to urethral or pelvic floor weakness
Pressure applied to bladder from coughing, sneezing, laughing, lifting, or physical exertion that increases abdominal pressure

Question 12

urge incontinence

Answer 12

Commonly called “overactive bladder”
Involuntary contraction of the detrusor muscle with a strong desire to void
often idiopahtic
high prevalence in female elite athlete

triggers.:; cold running water key in the door

Question 13

Mixed incontinence

Answer 13

Combination of urge and stress

Question 14

overflow incontinence

Answer 14

Overdistention of the bladder and the bladder cannot empty completely
Urine leaks or dribbles out
Client does not have any sensation of fullness or emptying
Caused by acontractile or deficient detrusor muscle

Question 15

functional incontinence

Answer 15

Occurs when bladder is normal but mind and body are not working together
Occurs secondary to mobility or access deficits
Ie Confined to wheelchair, altered mentation

Question 16

behavior techniques for UI

Answer 16

Bladder re-training
Treating constipation (hydration, health fiber, toileting techniques)
Weight reduction
Fluid management
Medication Review

Question 17

pelvic organ prolapse what

Answer 17

The descent of pelvic organs into the vaginal wall or uppermost portion of vagina

Question 18

s/s pelvic organ prolapse

Answer 18

Symptoms: bulging or pressure, altered urinary stream, difficulty with bowel movements, need for splinting, discomfort with sex, low back pain, functional concerns with lifting/exercise

Question 19

tx pelvic organ prolapse

Answer 19

Treatment: depends on history and exam findings
Pelvic muscle training, pressure system regulation, pessary
Instructions: avoid Valsalva, address constipation, pre-contract pelvic floor and lower abdominals, exhale on exertion

Question 20

diastasis recti what

Answer 20

Split between the two rectus abdominis muscles to the extent that
the linea alba may split under the strain
Common in pre- and post-partum women
Size can vary (width, length, depth)

Question 21

risk factors diastasis recti

Answer 21

Risk factors: obesity, narrow pelvis, multipara, multiple births, excess uterine fluid, large babies, and weak abdominals prior to

Question 22

impact diastasis recti

Answer 22

Impact: Posture, trunk stability and strength, respiration, visceral support, diminished pelvic floor activation, and delivery of the fetus

Question 23

can contribute to - diastasis recti

Answer 23

Can contribute to chronic pelvic and low back pain

Question 24

diastasis recti assessment

Answer 24

Patient in supine or hooklying position
Palpate at midline with patient at rest
Instruct patient to raise their head and shoulders while reaching toward their feet
Palpate change in gap at level of umbilicus, 2 inches above, 2 inches below
Normal: 1-2 finger width