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Topics in PT > Pelvic Health > Flashcards

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

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2
Q

supporting musculature of the lumbo-pelvic-hip complex

A
  • glute med/max
  • hamstring
  • QL
  • thoracolumbar fascia
  • hip adductors
  • etc
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3
Q

Structures in the pelvic girdle

A
  • SIJ
  • hip joint
  • pubic symphysis
  • pelvic floor musculature
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4
Q

common insertion points

A
  • sacrum
  • thoracolumbar fascia
  • ilium/iliac crest
  • lumbar vertebrae
  • coccyx
  • ischial tuberosity
  • ischial pubic ramus
  • perineal body
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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
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6
Q

layer 1 of pelvic floor muscles

A
  • superficial transverse perineal
  • bulbospongiosus/bulbocavernosus
  • ischiocavernosus
  • external anal sphincter
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7
Q

layer 2 of pelvic floor muscles

A
  • deep transverse perineal
  • external urethral sphincter
  • sphincter urethrovaginalis
  • compressor urethra (f)
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8
Q

layer 3 of pelvic floor muscles

A
  • levator ani
  • pubococcygeus (puborectalis and pubovaginalis)
  • iliococcygeus
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9
Q

Pt Evaluation - history

A
  • chief complaint
  • surgeries
  • ob/gyn history
  • last pelvic/ prostate exam
  • medications
  • bowel/bladder history
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10
Q

PT evaluation - bladder habits

A
  • urine stream
  • emptying
  • frequency (day and night)
  • urge
  • volume
  • fluid intake
  • stop test
  • position
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11
Q

PT evaluation - Bowel Habits

A
  • Sensation present
  • urge delay
  • frequency
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12
Q

PT evaluation - QoL

A
  • social activities
  • diet/fluid intake
  • physical activity
  • work
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13
Q

PT Evaluation - Urinary and fecal incontinence symptoms

A
  • leakage - # of episodes, amount
  • form of protection
  • symptom aggravators
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14
Q

Outcome Questionnaires

A
  • PFDI 20
  • PFIQ 7
  • Pelvic Girdle Questionnaire
  • NIH CPI
  • Marinoff Scale
  • Colorectal Functional Outcome Questionnaire
  • Other lumbar/LE measures
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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
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16
Q

Transverse abdonimus and pelvic floor muscles

A

hallowing with PFM contraction improved TrA thickness by >15%

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17
Q

Transverse abdominus + multifidus

A

type types of abdominal contraction (draw in and bracing) both improve LMM activation

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18
Q

Diaphragm + Pelvic floor muscles

A

PFM relax on inhalation and contract with exhalation

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19
Q

diaphragm and multifidus

A

“diaphragm training” may increase thickness of LMM and TrA

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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
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21
Q

2 Tests for load transfer

A

stork test and active straight leg test
* psychometrics improve with cluster, poor individually

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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
Q

External/Visual Perineal Exam

A
  • Skin integrity
  • Scar
  • Contraction response
  • Bear down response
  • External palpation of musculature - refer to time on a clock (see the picture)
26
Q

Internal Pelvic Exam

A
  • Vaginal or Rectal: through the canal
  • 3 layer palpation
  • palpation: tone, trigger points, relaxation after contraction
27
Q

Which layer do you do MMT of the PFM?

A

3rd layer

28
Q

Grading contractions of PFM

A

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
Q

Biofeedback Evaluation

A
  • SEMG biofeedback
  • Indicator of skeletal muscle recruitment
  • Surface or internal electrodes
  • Evaluate endurance and quick contractions
30
Q

Biofeedback

A
  • 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
Q

Examples of pelvic dysfunction for males and females

A
  • urinary incontinence
  • fecal incontinence
  • pelvic pain
  • sexual dysfunction
  • voiding dysfunction and constipation
32
Q

Examples of pelvic dysfunctions for females only

A
  • Prolapses: pelvic relaxation
  • Dyspareunia: pain with intercourse
  • Vulvodynia
  • Vaginismus
33
Q

Pelvic Dysfunctions in men only

A

Prostadynia
Prostatitis

34
Q

What should a healthy pelvic floor muscle be able to do?

A

fully contract, relax, and bulge

35
Q

Dealing with LBP and SIJ dysfunction and treating pelvic dysfunction are the same thing -

A

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
Q

What is stress urinary incontinence

A
  • involuntary loss of urine with physical exertion (cough, sneeze, physical activity)
  • Common, but not normal
  • Not a natural result of aging
37
Q

Fecal incontinence

A
  • 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
Q

Sexual Dysfunction/ Appreciation

A
  • 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
Q

Strengthening or Neuro re-education of the pelvic floor

A
  • Kegels
  • Endurance and quick
  • Vaginal weights
  • Functional activities
  • Biofeedback
40
Q

How to eliminate gravity when treating weak pelvic floor musculature

A

feet up/Trendelenburg

41
Q

Kegels (pelvic floor contraction)

A
  • 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
Q

Kegels - Quick Flicks

A

 Tighten and relax your pelvic floor quickly
 Come back to “neutral” – fully relax- before the next muscle contraction

43
Q

Conditions that are influenced by Overactive Pelvic Floor Musculature

A

 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
Q

Dyspareunia

A

Pain with intercourse

45
Q

Vaginismus

A
  • spasm of muscle surrounding the vagina
  • unable to tolerate vaginal penetration (pelvic exam, tampons, sexual activity)
46
Q

Constipation

A

 2 or fewer bowel movements each week
 Without laxatives you:
 Strain
 Feel incomplete emptying
 Hard stools
 Feel “blocked” up

47
Q

Anterior pelvic floor trigger point

A

likely to refer pain to genital structures

48
Q

posterior portion of pelvic floor trigger points

A

patients are uncertain of symptom location either hip, back, or tailbone

49
Q

Concept of shortened pelvic floor

A

 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
Q

Types of PT treatment

A

 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
Q

Relaxation of pelvic floor

A

Diaphragmatic breathing
Biofeedback
Sub-max contract/relax
Visualization
Train bulging

52
Q

Bowel Health

A

 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
Q

Pelvic Floor and Anal Sphincter Functions

A

 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
Q

Bladder Health

A

 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

Topics in PT (9 decks)

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