Study Guide Q's: Pelvic Health

Question 1

pelvic anatomy region bony landmarks

Answer 1

• Ilium
• Sacrum
• Coccyx
• Pubic symphysis
• Ischial tuberosity
• Ischial spine

Question 2

pelvic anatomy ligamentous support

Answer 2

• Sacrotuberous ligament
• Sacrospinous ligament
• Numerous visceroskeletal ligaments

Question 3

fascial support for pelvic anatomy (4)

Answer 3

• Urogenital diaphragm
• Obturator fascia
• ATLA
• ATFP

Question 4

coccyx

Answer 4

• Small triangular bone
• 3-5 rudimentary vertebrae

Question 5

sacrococcyx joint normal position and available movements

Answer 5

• Normal position in standing: 20-45 degrees of flexion at the sacrococcygeus joint
• Available movement at the sacrococcygeus joint
  
  • Flexion/extension: 30 degrees
  • Sidebending: 1cm to each side
  • Rotation: 10-20 degrees
• Sacrococcyx joint
  
  • Fibrocartilaginous joint
  • Movement occurs during:
    
    • Defecation
    • Labor and delivery
    • Breathing
    • Positional changes

Question 6

first layer of superficial perineal muscles

Answer 6

• Bulbocavernosus
• Ischiocavernosus
• Superficial transverse perineals
• External anal sphincter

Question 7

second layer (deep urogenital diaphragm) muscles

Answer 7

• Compressor urethrae
• Sphincter urethrae

Question 8

third layer (pelvic diaphragm) muscles

Answer 8

• Levator ani
  
  • Pubococcygeus
  • Iliococcygeus
  • Coccygeus
• Piriformis
• Obturator internus

Question 9

risk factors for urinary incontinence (9)

Answer 9

• Childbirth
• Obesity (abdominal girth)
• Smoking
• Caffeine/alcohol
• High impact physical activity
• Menopause
• Neurological conditions
• Pelvic surgery
• Pelvic floor muscle weakness/prolapse

Question 10

pudendal neuralgia definition

Answer 10

• Definition: pain along the distribution of the pudendal nerve; pain is of a severe throbbing or stabbing character in the course or distribution of a nerve

Question 11

activities associated with pudendal neuraliga

Answer 11

tension: straining from constipation, strenuous squatting, childbirth

compression: cycling, horseback riding, prolonged sitting

surgical insult: pelvic reconstruction, hysterectomy

visceral somatic interaction: chronic UTI, yeast infections, chronic bacterial protastitis

Question 12

common symptoms of pudendal neuralagia (8)

Answer 12

• Pain with sitting (decreases with standing)
• Urinary dysfunction (urgency/frequency, hesitancy, pain)
• Bowel dysfunction
• Sexual dysfunction
• Genital/anal pain
• Feeling of fullness in the rectum/vagina
• Burning, shooting, stabbing pain
• Decreased pain when sitting on the toilet

Question 13

treatment for coccydnia

Answer 13

• External coccyx mobilization
• Internal coccyx mobilization
• Glute max strengthening to self-mobilize the flexed coccyx
• EMG biofeedback for hypertonus of the coccygeus
• Seating support
• Posture education

Question 14

presentation of coccydynia

Answer 14

• Pain with sitting directly over the coccyx
• Pain moving from sit to stand
• Pain with bowel movements
• Tenderness on internal and external palpation

Question 15

What treatments are contraindicated during pregnancy?

Answer 15

• Estim in pelvic region
• Therapeutic US in the area of the pelvis
• High impact activities
• Aggressive manipulation or stretching
• Heat over abdomen in 1^st trimester

Question 16

exercise and pregnancy

Answer 16

• Exercise is recommended provided there are no medical or OB complications
• Moderate intensity of 20-30 min/day
• Should include:
  
  • Balance
  • Stability
  • Strength
  • Lower body
  • Pelvis
  • PF
  • TA
• Goal is to maintain fitness
• Benefits of exercise
  
  • Reduced fatigue
  • Reduced varicosities
  • Reduced peripheral edema
  • Improved aerobic capacity
  • Improved BP
  • Helps counteract IAP
  • Helps counteract hormonally mediated reduction in urethral closure
  • Counteracts laxity
  • Reduced risk of gestational diabetes in obese women
  • 35-43% reduction in risk of preeclampsia in first 20 weeks
  • Lower incidence of depressive symptoms

Question 17

diastasis recti abdominis treatment and assessment

Answer 17

• Definition: separation of the linea alba at the midline of the rectus abdominis
• Measurement
  
  • Finger width above and below the umbilicus
  • 3 fingers is considered clinically significant
  • Check for separation during abdominal contractions
• Exercise considerations: bracing with a towel or sheet and use taping or an abdominal binder during exercise

Question 18

reccomendations for SI joint dysfunction

Answer 18

• Use the concepts of motor control to treat the SIJ
  
  • Pressure systems and load transfer
    
    • Trunk and pelvic pressures are constantly changing and managed in quiet posture and movement
      
      • Pressures change in response to internal and external factors (BMI, cough, atmosphere)
    • Breathing has effects on the spine, pelvis, organs, cardiorespiratory function, neurologic system, and more
    • How each person manages movement is critical to evaluate
    • Specific muscles work in synergy to modulate intrathoracic and intraabdominal muscles
      
      • Intrinsic laryngeal
      • Intercostal
      • Respiratory diaphragm
      • Abdominal wall
      • Paraspinals
      • Pelvic floor muscles
    • Anterior and posterior systems work in coordination
• Utilize specific SIJ examination
• Treatment:
  
  • Manual techniques
  • Motor control retraining

Question 19

true ligaments

Answer 19

Sacrospinous, Sacrotuberous

Question 20

Bladder ligaments

Answer 20

Pubovesical, Pubourethral, Urachus

Question 21

Fascial attachments

Answer 21

ATFP (Arcus Tendineus Fasciae Pelvis) – more superior, visceral support, attaches on the ischial spine and pubic bone

ATLA (Arcus Tendineus Levator Ani) – more lateral, muscular support, “white line”, broad thickening of fascia across the obturator internus from the pubic symphysis to the ischial spine, attachment for the deepest layer of the PFMs