Women's Health [Guest Lecture] Flashcards
4 Parts of the Pelvic Girdle
- Bony pelvis (ilium, ischium, pubis)
- Sacrum
- Spine
- Femur bones
List the 3 layers of the Pevlic Floor Musculature
Layer 1 = bulbospongiosus, ischiocavernosus, superficial transverse perineal
Layer 2 = sphincter urethrae, compressure urethrae, deep transverse perineal
Layer 3 = iliococcygeus, puporectalis, pubococcygeus (leavator ani), obturator internus
List the muscles included in the posterior musculature of the pelvic girdle
- Glute max/med/min
- Piriformis
- Obturator internus/externus
- Quadratus femoris
- Adductor magnus/longus
- HS
- Superior/Inferior gemelli
Muscle: Prime mover of the sacrum
Piriformis
List the muscles included in the anterior musculature of the pelvic girdle
- Psoas
- Iliacus
- Rectus abdominus
- Internal/External oblique & Abdominals
- TA
- Adductor longus/brevis
- Gracilis
- TFL
Describe the 2 ways that iliopsoas has a close relationship with the pelvic floor
- By fascia connections
- By innervation
Muscle Type: controls intra-abdominal pressure and is important for proper body mechanics, breathing, and voiding
Core muscles (pelvic floor, TA, multifidus, diaphragm)
Describe the movement of the pelvic floor and diaphragm with breathing
Inhalation: both move down
Exhalation: both recoil, move up
List the 5 Functions of the Pelvic Floor Muscles
- Supportive
- Sphincteric
- Sexual
- Stability
- Sump-pump
Pelvic floor function: helps to support organs and forms the bottom of the core
Supportive
Pelvic floor function: controls openings of the urethra, rectum, and vagina
Sphincteric
Pelvic floor function: Assists the SI, pubic symphysis, lumbosacral, and hip joints
Stability
Pelvic floor function: assissts venous and lympathic movement
Sump-pump
Describe when the sacrum is held tightest and why
Held tighter during WB due to the self locking characteristics of the sacrum itself
Term: Two structurally separate joints that act as one functional unit
Bicondylar
ex. TMJ, Hip, Knee
Term: Movement accompanied by a correlative movement at another location
Bicondylar Joints
They can move in opposite directions and still be bicondylar
Biomechanics of Gait – What’s going one when…
- L Swing Phase
- L Heel Strike
- Sacrum rot R; L-Spine rot OPPOSTIE
- L Piriformis contraction, Sacrum rot L
Type of Pelvic Floor Dysfunction: Leads to incontinence, LBP, joint instability, prolapse, pelvic congestion, mm imbalance
Weakness
Type of Pelvic Floor Dysfunction: Leads to pelvic and LBP, SI and hip imbalances, often incontinence and voiding dysfunction, pelvic congestion
Hypertonus
Clinical Presentation:
- Leaking urine
- Voiding dysfunction
- Heavy feeling in abdomen
- LBP, SI, Hip/Pelvic pain
- Poor posture and force closure
Core Mm Weakness
Clinical Presentation:
- Pain in back, low abdomen, posterior thigh, coccyx
- vulvar/clitoral or testicular/scrotal/penile burning
- pain with intercouse, defecation, sitting
- incontinence/voiding dysfunction
- constipation
- poor posture
- over use of global mm
- hip ROM decreased
Hypertonus Dysfunction
Describe pelvic girdle pain
Pain in 1+ of the joints of the pelvic girdle (SI, LS, Symphsis, Hip)
Clinical Presentation:
- occurs post-partum or 24-36 wks gestation
- posteriorly located pain or in groin or over pubis
- lacks specific NR distribution
- difficulty with change of position
- prolonged walking, stairs, carrying
Pelvic Girdle Pain
Describe the changes with pregnancy
- rib angle becomes more perpendicular
- diaphragm elevates
- center of gravity is shifted
- abdominal wall distended
- core function limited
- hormones cause ligamentous laxity
The following are things to avoid with what complication:
- Valsalva
- Trunk stabilization/ab work
OB – obstertic complications
List the things to be concerned with when treated pregnant women
- HR below 140
- Heat over the belly
- Estim over belly/LB
- Supine positioning
List signs of post partum depression
- not sleeping
- losing/gaining wt rapidly
- can’t get out of bed
- ignoring basic grooming
- seems hopeless, feel helpless
- lack of feeling for the baby
- extreme anxiety or obsession for baby safety
Describe how the speed of delivery can cause pelvic floor trauma
Too slow = like running a marathon for pelvic floor mm
Too fast = like a MVA for pelvic floor mm
Term: Leaks with increased abdominal pressure
Stress incontinence
Term: Leaks with strong urge to go
Urge incontinence
Term: Separation of the rectus abdominus mm along the linea alba
Diastasis Recti
Condition: Inflammatory response at pubic symphysis and ischial rami caused by susatined or repetitive trauma to the pubic symphysis
Osteitis Pubis
Condition: separation of the pubic bones anteriorly leads to outflaring of the iliac bones; sacrum is less tightly held and can move anteriorly
Pubic symphysis dislocation
Describe women’s health related issues that can occur in the femal athlete
Eating disorders and over exercising results in low weight which can lead to irregular menstraution or amenorrhea which can lead to poor bone health
Term: Endometrial tissue grows outside of the uterus
Endometriosis
Describe the larger effects of endometriosis
It primarily affects the ovaries, bowel, and bladder can results in inflammation and scarring which can cause pain and impact fertility
List the 5 pain provocation tests
- Thigh thrust
- Sacral thrust
- SI Distraction
- SI Compression
- Gaenslen
Desribe where you palpate the sacroiliac ligaments
Just below the PSIS
Describe how neuro testing presents with SIJ dysfunction
Neuro tests will be negative for SIJ dysfunction but may coexist likely due to mm tension, inflammation, and/or joint immobility
Desribe how you identify diastasis rectus abdominus (DRA)
In hooklying pt. lifts head to engage RA
Place two fingers above and/or below umbilicus, if the mm separates to allow 2+ fingers in the gap it’s considered DRA
Describe the tx for DRA
- Teach how to engage core WITH OUT RA
- Strengthen TA, multifidus, pelvic floor mm
Condition: Pain for the coccyx or tail bone
Coccydynia
List the important parts of the pelvic floor assessment
- Systems review
- Voiding patterns (should be able to pee for 8-10 mississippi)
- Diet/fluid intake
- MSK exam
- External/Internal exam
- EMG
Describe the make up of the pelvic floor muscles
80% slow twitch, 20% fast twitch fibers
Condition:
- Increased tone of pevlic floor mm and mm of hip and trunk
- Mm imbalance/incoordination of hip and trunk
- Mobility impairment of scar/CT in perinuem, inner thight, abs
- Diaphragm tightess/poor use
- Dysfunction of pelvic joints
- poor posture
Hypertonus dysfunction
Condition:
- poor posture: hangs on ligaments/posterior pelvic tilt
- weak or hypermobile hip/spine
- weak gluteals and abdominal wall
- prolapse
Weakness of pelvic girdle
Describe normal bladder habits
- void 5-7 times in 24 hours or every 2-3 hours
- shouldn’t have to get up at night to void
- shouldn’t have to strain to start flow
- should never go “just in case” – trains bladder it can’t wait
- shouldn’t ignore urge for more than 4-5 hours
Describe normal bowel habits
- 1-3x/day or every other day
- Bristol consistency 3-4
- No straining
Protocol:
- Strengthen pelvic floor mm, abd, multifidus
- Discourage overfiring of rectus abdominus
- Start with prone gluteal work
- Coordinate pelvic floor with diaphragm
- Work on diaphragmatic breathing
- Address mm imbalances and posture
Weakness/Stability protocol
Protocol:
- Relaxation/down training pelvic floor muscles
- Contract/relax to fatigue
- Diaphragmatic breathing
- Soft tissue mobilization
- Posture
Hypertonus/Mobility protocol
Describe the benefits of diaphragmatic breathing
- Calms SNS and brings in PNS
- Lowers HR
- Boost immune system
- Decreased inflammation
- Boost happiness
