Study Guide Q's: Pelvic Health Flashcards
pelvic anatomy region bony landmarks
- Ilium
- Sacrum
- Coccyx
- Pubic symphysis
- Ischial tuberosity
- Ischial spine
pelvic anatomy ligamentous support
- Sacrotuberous ligament
- Sacrospinous ligament
- Numerous visceroskeletal ligaments
fascial support for pelvic anatomy (4)
- Urogenital diaphragm
- Obturator fascia
- ATLA
- ATFP
coccyx
- Small triangular bone
- 3-5 rudimentary vertebrae
sacrococcyx joint normal position and available movements
- 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
first layer of superficial perineal muscles
- Bulbocavernosus
- Ischiocavernosus
- Superficial transverse perineals
- External anal sphincter
second layer (deep urogenital diaphragm) muscles
- Compressor urethrae
- Sphincter urethrae
third layer (pelvic diaphragm) muscles
- Levator ani
- Pubococcygeus
- Iliococcygeus
- Coccygeus
- Piriformis
- Obturator internus
risk factors for urinary incontinence (9)
- Childbirth
- Obesity (abdominal girth)
- Smoking
- Caffeine/alcohol
- High impact physical activity
- Menopause
- Neurological conditions
- Pelvic surgery
- Pelvic floor muscle weakness/prolapse
pudendal neuralgia definition
- 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
activities associated with pudendal neuraliga
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
common symptoms of pudendal neuralagia (8)
- 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
treatment for coccydnia
- 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
presentation of coccydynia
- Pain with sitting directly over the coccyx
- Pain moving from sit to stand
- Pain with bowel movements
- Tenderness on internal and external palpation
What treatments are contraindicated during pregnancy?
- Estim in pelvic region
- Therapeutic US in the area of the pelvis
- High impact activities
- Aggressive manipulation or stretching
- Heat over abdomen in 1st trimester
exercise and pregnancy
- 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
diastasis recti abdominis treatment and assessment
- 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
reccomendations for SI joint dysfunction
- 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
- Trunk and pelvic pressures are constantly changing and managed in quiet posture and movement
- Pressure systems and load transfer
- Utilize specific SIJ examination
- Treatment:
- Manual techniques
- Motor control retraining
true ligaments
Sacrospinous, Sacrotuberous
Bladder ligaments
Pubovesical, Pubourethral, Urachus
Fascial attachments
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
