Pelvic Health Flashcards
1
Q
What is the lumbo-pelvic-hip complex and what does it do?
A
Interplay of trunk structures that assist in load transfer while meeting movement objectives/tasks, ensuring safety to structures, supporting organs, and maintaining optimal respiration
2
Q
supporting musculature of the lumbo-pelvic-hip complex
A
- glute med/max
- hamstring
- QL
- thoracolumbar fascia
- hip adductors
- etc
3
Q
Structures in the pelvic girdle
A
- SIJ
- hip joint
- pubic symphysis
- pelvic floor musculature
4
Q
common insertion points
A
- sacrum
- thoracolumbar fascia
- ilium/iliac crest
- lumbar vertebrae
- coccyx
- ischial tuberosity
- ischial pubic ramus
- perineal body
5
Q
role of the pelvic floor musculature
A
- supports pelvic organs
- sphincteric
- aids in sexual appreciation/function
- provides stability of SI joints
- possibly aids in lymphatic drainage
- posture and breathing
6
Q
layer 1 of pelvic floor muscles
A
- superficial transverse perineal
- bulbospongiosus/bulbocavernosus
- ischiocavernosus
- external anal sphincter
7
Q
layer 2 of pelvic floor muscles
A
- deep transverse perineal
- external urethral sphincter
- sphincter urethrovaginalis
- compressor urethra (f)
8
Q
layer 3 of pelvic floor muscles
A
- levator ani
- pubococcygeus (puborectalis and pubovaginalis)
- iliococcygeus
9
Q
Pt Evaluation - history
A
- chief complaint
- surgeries
- ob/gyn history
- last pelvic/ prostate exam
- medications
- bowel/bladder history
10
Q
PT evaluation - bladder habits
A
- urine stream
- emptying
- frequency (day and night)
- urge
- volume
- fluid intake
- stop test
- position
11
Q
PT evaluation - Bowel Habits
A
- Sensation present
- urge delay
- frequency
12
Q
PT evaluation - QoL
A
- social activities
- diet/fluid intake
- physical activity
- work
13
Q
PT Evaluation - Urinary and fecal incontinence symptoms
A
- leakage - # of episodes, amount
- form of protection
- symptom aggravators
14
Q
Outcome Questionnaires
A
- PFDI 20
- PFIQ 7
- Pelvic Girdle Questionnaire
- NIH CPI
- Marinoff Scale
- Colorectal Functional Outcome Questionnaire
- Other lumbar/LE measures
15
Q
MSK Exam/Screen considerations
A
- external to internal
- strength, flexibility, ROM, joint mobility, pelvic asymmetries, structural deficits
- neuromuscular control
– relationship between TrA, LM, and PFM
– Not just a co-contraction
– Also need to coordinate continence, breathing, spinal stability
16
Q
Transverse abdonimus and pelvic floor muscles
A
hallowing with PFM contraction improved TrA thickness by >15%
17
Q
Transverse abdominus + multifidus
A
type types of abdominal contraction (draw in and bracing) both improve LMM activation
18
Q
Diaphragm + Pelvic floor muscles
A
PFM relax on inhalation and contract with exhalation
19
Q
diaphragm and multifidus
A
“diaphragm training” may increase thickness of LMM and TrA
20
Q
Lumbo-Pelvic stability considerations
A
- stability via co-contraction, neuromuscular control of musculature, and generation of intra-abdominal pressure
- Stability of SIJ –> force closure, form closure
21
Q
2 Tests for load transfer
A
stork test and active straight leg test
* psychometrics improve with cluster, poor individually
22
Q
stork test
A
- typical movement in single limb stance: posterior rotated innominate relative to scars on stance side
- Positive test: anterior rotating innominate
23
Q
active straight leg raise
A
- supine with both legs extended flat
- raise single limb 5 -20 cm
- repeat on contralateral side
- positive test: pain or “heaviness”
24
Q
LE considerations in MSK exam/screen
A
- Hamstring and sacrotuberous ligament
- adductor Magnus trigger point can be described as diffuse/internal pelvic pain
- THA/Hip fx- possible effects to PFM function
- piriformis syndrome and obturator interns
- labral tears and hip impingement
25
External/Visual Perineal Exam
- Skin integrity
- Scar
- Contraction response
- Bear down response
- External palpation of musculature - refer to time on a clock (see the picture)
26
Internal Pelvic Exam
- Vaginal or Rectal: through the canal
- 3 layer palpation
- palpation: tone, trigger points, relaxation after contraction
27
Which layer do you do MMT of the PFM?
3rd layer
28
Grading contractions of PFM
0: No palpable contraction/squeeze
1: Trace/Flicker or pulsation of contraction
2: Poor/Squeeze pressure asymmetrical or felt at various points (no lift/displacement)
3: Fair/Squeeze pressure and lift or displacement
4: Good/Squeeze pressure and lift or displacement from anterior, posterior, and side walls
5: Strong/ Full circumference of finger compressed, displaced with an inward pull
29
Biofeedback Evaluation
- SEMG biofeedback
- Indicator of skeletal muscle recruitment
- Surface or internal electrodes
- Evaluate endurance and quick contractions
30
Biofeedback
- Establish a base line
- Neuromuscular re-education
- Monitor progress
- Can use internal or external surface electrodes
- Internal sensors can be placed rectally or vaginally
31
Examples of pelvic dysfunction for males and females
- urinary incontinence
- fecal incontinence
- pelvic pain
- sexual dysfunction
- voiding dysfunction and constipation
32
Examples of pelvic dysfunctions for females only
- Prolapses: pelvic relaxation
- Dyspareunia: pain with intercourse
- Vulvodynia
- Vaginismus
33
Pelvic Dysfunctions in men only
Prostadynia
Prostatitis
34
What should a healthy pelvic floor muscle be able to do?
fully contract, relax, and bulge
35
Dealing with LBP and SIJ dysfunction and treating pelvic dysfunction are the same thing -
failed load transfer though the lumbopelvic region, manifested through a loss of effective force closure of the joints of the low back and pelvis or loss of effective force closure of the urethra
36
What is stress urinary incontinence
- involuntary loss of urine with physical exertion (cough, sneeze, physical activity)
- Common, but not normal
- Not a natural result of aging
37
Fecal incontinence
- involuntary loss of fecal matter and/or flatus
- often the result of injuries with childbirth
- 1 in 4 women within 6 mo of childbirth
38
Sexual Dysfunction/ Appreciation
- Weak pelvic floor musculature contributes to decreased orgasm in both men and women
- Possible contributor to ED
- Stronger musculature = more blood flow
- Also contributes to decreased contract with partner or device
39
Strengthening or Neuro re-education of the pelvic floor
- Kegels
- Endurance and quick
- Vaginal weights
- Functional activities
- Biofeedback
40
How to eliminate gravity when treating weak pelvic floor musculature
feet up/Trendelenburg
41
Kegels (pelvic floor contraction)
- stop the flow of urine and the passage of gas
- use elevator image
- pull the underwear in
- bring your sit bones together, tailbone to your pubic bone, lift your perineum off the chair
- TESTICLES TO YOUR SPECTACLES lolol
- hold it 10 sec
42
Kegels - Quick Flicks
Tighten and relax your pelvic floor quickly
Come back to “neutral” – fully relax- before the next muscle contraction
43
Conditions that are influenced by Overactive Pelvic Floor Musculature
Urinary Urgency/Frequency
Urge Incontinence – is leakage of urine due
to bladder muscles that contract inappropriately; regardless of the amount of
urine in the bladder.
Can have mixed incontinence – urge + stress
Urinary Retention – lack of ability to urinate
or fully empty bladder; post void residual
Pelvic Pain – vulvodynia, vestibulodynia. Prostadynia, pudendal neuralgia, other
Constipation – infrequent BMs/hard to pass
Pudendal neuralgia
44
Dyspareunia
Pain with intercourse
45
Vaginismus
- spasm of muscle surrounding the vagina
- unable to tolerate vaginal penetration (pelvic exam, tampons, sexual activity)
46
Constipation
2 or fewer bowel movements each week
Without laxatives you:
Strain
Feel incomplete emptying
Hard stools
Feel “blocked” up
47
Anterior pelvic floor trigger point
likely to refer pain to genital structures
48
posterior portion of pelvic floor trigger points
patients are uncertain of symptom location either hip, back, or tailbone
49
Concept of shortened pelvic floor
If a muscle is in a shortened position it cannot generate as much tension and therefore may appear weak
Strengthening of musculature already in a shortened position can lead to further hypertonicity and a delay in progress
50
Types of PT treatment
Connective tissue mobilization
Scar tissue mobilization – abdomen, perineum
Visceral Mobilization
Myofascial release
Lengthening tissues
Inter-vaginal and/or inter-rectal trigger point
& myofascial release
51
Relaxation of pelvic floor
Diaphragmatic breathing
Biofeedback
Sub-max contract/relax
Visualization
Train bulging
52
Bowel Health
Regular evacuation (varies)
Most often 20 – 30 minutes after eating
Soft, formed consistency- easily passed
Fiber intake – 25 to 30 grams per day
Fluid (water) intake – 6-8 glasses
Go when you get the urge
No straining
Should only take a few minutes
Exercise
53
Pelvic Floor and Anal Sphincter Functions
Continence requires contraction of
puborectalis, maintenance of anorectal
angle, normal rectal sensation, and contraction of sphincter.
Defecation requires relaxation of puborectalis, straightening of anorectal angle, and relaxation of sphincter
54
Bladder Health
Average bladder holds 2 cups of urine before it needs to be emptied
Normal to pass urine 5 –7 times in a 24-hour period
Normal – urinate 0-1 times per night
Urge is a signal felt as the bladder stretches – not commands to go
Good bladder habits – don ’t strain, fully empty, go at least every 4 –5 hours, avoid just in case urinating
Maintain good fluid intake
Limit caffeine
Limit alcohol
Limit artificial sweeteners
Avoid constipation
Use of a bladder diary
