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Topics In PT > Pelvic PT > Flashcards

Pelvic PT Flashcards

1
Q

What is the canister model?

A

Interplay of trunk structures to assist in load transfer while meeting movement objectives, ensuring safety to structures, supporting organs, all while maintaining optimal respiration.
Top of the canister is diaphragm - bottom is the pelvic floor.

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2
Q

What are the supporting muscles of the canister

A

Glute med/max
Hamstrings
quadratus lumborum
Thoracolumbar fascia
Hip Adduction

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3
Q

What is the role of the pelvic floor muscles

A
  1. Support the pelvic organs
  2. Sphincters
  3. Aids in sexual appreciation/function
  4. Provides stability to SIJoints
  5. Possible aids in lymphatic drainage
  6. Posture and breathing.
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4
Q

What are the muscles in first layer of pelvic floor

A
  1. Superficial transverse perineal
  2. Bulbospongiosus (bulbocavernosus)
  3. Ischiocavernosus
  4. External anal sphincter
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5
Q

What muscles are in the second layer of pelvic floor

A

Deep transverse perineal
External urethral sphincter
Sphincter urethrovaginalis - in females
Compressor urethra - in females

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6
Q

What muscles are in third layer of pelvic floor

A
  1. Levator Ani
  2. Pubococcygeus
  3. Puborectalis
  4. Pubovaginalis - in females
  5. Iliococcygeus.
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7
Q

What do we ask in history during PF PT eval

A

Chief complaint
Surgeries
OBGYN history
Last pelvic/prostate exam
Medications
Bowel and bladder history

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8
Q

What bladder habits do we want to know

A

Urine stream
Emptying
Frequency at night time and during day
Urge
Volume
Fluid intake
Stop test
Position

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9
Q

What urinary and fecal incontinence symptoms should we ask

A

Leakage and number of episodes, how much
Form of protection
Symptom aggravators

looking for red flags item that point to neural involvement and cauda equina

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10
Q

What are the neuromuscular controls of the pelvic floor exam we look for

A
  1. Relationship b/w TA, Multifidis, and pelvic floor muscles
  2. Not simply a co-contraction
  3. Also need to coordinate continence, breathing, and spinal stability.
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11
Q

Describe co-contraction between TA and PF muscles

A

Hallowing with pelvic floor muscle contraction improved TA thickness by >15%

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12
Q

Describe co-contraction between TA and Multifidis muscles

A

Two types of abdominal contraction (draw in and brace) both improve lumbar Multifidis activation.

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13
Q

Describe co-contraction between diaphragm and PF muscles

A

PFM relax on inhalation and contract along with TA with exhalation

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14
Q

Describe co-contraction between Diaphragm and lumbar Multifidis muscles

A

Diaphragm training may increase thickness of lumbar multifidis and TA

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15
Q

What are the considerations of MSK exam/screening for stability of SIJ

A
  1. Force closure
  2. Form closure
  3. Any asymmetries
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16
Q

What are the special tests you can use for load transfer assessment

A
  1. Stork test
  2. Active straight leg test
    psychometrics of tests improve with cluster, tests are poor individually
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17
Q

What is the stork test

A

Typical movement during single limb stance — posterior rotation innominate relative to sacrum on stance side (as weight is shifted onto the stance side)

+ve test — anterior rotating innominate.

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18
Q

What is the active straight leg raise

A
  1. Supine with both legs fully extended - raise single limb about 5-20 cm - repeat on contra side.

+ve test — pain or heaviness

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19
Q

Differential diagnosis/MSK considerations for the LE during exam

A
  • Hamstring and sacrotuberous ligament
  • Adductor magnus trigger point can be described as diffuse/internal pelvic pain
  • THA/hip function — possible effects to PF function
  • Piriformis Syndrome and obturator Internus
  • Labral tears and hip impingement.
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20
Q

What are the external/visual perineal componentes of the PT exam

A
  1. Skin integrity
  2. Scar
  3. Contraction response
  4. Bear down response
  5. External palpation of musculature (clock thing)
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21
Q

What are the internal pelvic exam componentes of the PT exam

A
  1. Go in through vagina or rectal canal. Can access the 3 layer palpation
  2. During palpation - assessing tone, trigger points, tender or painful points.
  3. Assessing relaxation after contraction
22
Q

Describe MMT of pelvic floor muscles

A

ONLY AT 3RD LAYER OF PFM
Grading contractions on a scale of 0-5
0 - zero 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 - fiar Squeeze pressure/contraction and LIFT or displacement
4 - good Squeeze pressure/contraction and LIFT or displacement from anterior, posterior, and side walls
5 - strong Full circumference of finger compressed, displaced with an inward pull.

— can also grade endurance

23
Q

What does SEMG biofeedback eval do

A
  • Indicator of skeletal muscle recruitment
  • Surface or Internal electrodes used
  • Evaluates endurance and quick contractions.
24
Q

What are some examples of male and female pelvic dysfunctions

A
  1. Urinary incontinence
  2. Fecal incontinence
  3. Pelvic pain
  4. Sexual dysfunction
  5. Voiding dysfunction and constipation
25
Q

What are examples of female only pelvic dysfunction

A
  1. Prolapses - pelvic relaxation
  2. Dyspareunia - pain with intercourse
  3. Vulvodynia
  4. Vaginismus
26
Q

What are examples of male only pelvic dysfunctions

A

Prostadynia
Prostatitis

27
Q

Considerations of pelvic muscle function

A
  1. Healthy pelvic floor muscle should be able to fully contract, relax, and bulge
  2. Contractions are subtle and difficult to feel and difficult to judge the quality of contraction.
28
Q

What is the overview of PT treatment for pelvic floor dysfunction

A
  1. Exercise/Neuromuscular re-education - balancing musculature, strengthening, flexibility, coordination
  2. Manual therapy
  3. Education — on normal function of bowel and bladder
  4. Bowel and bladder retraining.
29
Q

Things that can happen with an under active PF

A
  1. Urinary Incontinence
  2. Stress urinary incontinence
  3. Fecal incontinence
  4. Sexual dysfunction
30
Q

What is stress urinary incontinence?

A
  • Involuntary loss of urine with physical exertion - like a cough, sneeze, physical activity.
  • Common but not normal and NOT A NATURAL RESULT OF AGING.
31
Q

What is fecal incontinence

A
  • Involuntary loss of fecal matter or flatus
  • Often a result from injury during childbirth
32
Q

What is sexual dysfunction and how does it relate to underactive PFM

A

Weak PFM contribute to decrease orgasm in men and women.
- Potentially contribute to erectile dysfunction
- Stronger muscles = more blood flow
- Contributes also to decrease contact with partner/device.

33
Q

What PT treatment can help with underactive PFM

A
  • Strengthening/Neuromuscular re-education
    (Metals, endurance and quick contractions, vaginal weights, functional activities, biofeedback)
34
Q

Recommendations for PFM strengthening

A

During strengthening period — 6 weeks with 24 contractions/day
During maintenance period — 10 contractions/day

35
Q

What conditions are associated with an overactive PF

A
  1. Urinary frequency
  2. Urge incontinence
  3. Urinary retention
  4. Pelvic pain
  5. Constipation
  6. Pudendal neuralgia
  7. Dyspareunia
  8. Vaginismus
  9. Trigger points in PFM
36
Q

What is difference between urge incontinence and stress incontinence

A

Stress — involuntary loss BECAUSE OF PHYSICAL EXERTION
Urge — leakage due to BLADDER MUSCLES THAT CONTRACT INAPPROPRIATELY

patients can also have mixed - stress and urge incontinence

37
Q

What is urinary retention

A

Lack of ability to pee or fully empty bladder
POST void residual

38
Q

What falls under pelvic pain

A

Anything with -dynia ending

39
Q

Define constipation

A

2 or less bowel movements per week
Without laxitives — staring, feel incomplete empty thing, hard stools

40
Q

What is Dyspareunia

A

Pain with sex

41
Q

What is Vaginismus

A

Spasm of muscles surrounding the vagina
Patient cant tolerate vaginal penetration — so tampons, sex, pelvic exams

42
Q

What are trigger points in PF

A

Can happen in any layer of pelvic floor muscles
Anterior PF TrigPts — refer pain to genital structures
Posterior PF TrigPts — pt’s may say they are uncertain of symptom location either hip back or tailbone area

43
Q

What happens when PFM are shortened

A

Healthy muscles need to be able to fully contract or relax so if it’s short needed it can’t generate tension and may “appear” weak.

Strengthening when they are already short may cause more hypertonicity and delay progress.

44
Q

What PT treatment can help with over active PFM

A

Connective tissue, scar tissue, visceral mobilizations
Myofascial release
Lengthening tissues
Intervaginal or inter rectal TrigPts/myofascial release
Relaxation of PFM

45
Q

How do you promote relaxation of PFM

A
  1. Diaphragmatic breathing
  2. Biofeedback
  3. Sub max contract/relax
  4. Visualization
  5. Train bulging
46
Q

What topics can we educate and retrain patients on

A
  1. Bowel health
  2. Pelvic Floor Anal Spincter function
  3. Bladder health
47
Q

What do we teach with bowel health

A
  • Regular evacuation — usually 20-30 minutes after eating
  • Soft, formed consistency and easily passed
  • Fiber intake = 25-30g/day
  • Fluid intake = 6-8 glasses/day
  • go when you get the urge!! No straining should only take a few minutes
  • Exercise
  • bowel massage — follow path of Large Intestine
48
Q

What does continence require

A

Contraction of puborectalis
Maintenance of anorectal angle
Normal rectal sensation
Contraction of sphincter

49
Q

What does defication require

A

Relaxation of puborectalis
Straightening of anorectal angle
Relaxation of sphincter

50
Q

What do we teach with bladder health

A
  • Average bladder holds 2 cups of urine before it needs to be emptied
  • Normal to pee 5-7 times in 24 hour period and normal to pee 0-1 time at night
  • Urge is a signal felt as bladder stretches
  • GOOD Bladder habits include - no straining, full emptying, go at least every 4-5 hours, and don’t go “just in case”
  • Maintain good fluid intake and avoid caffeine, alcohol, artificial sweeteners
  • Use bladder diary

Topics In PT (4 decks)

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