PT - 510 Pelvic Floor

What can you affect with modalities?

* muscle contraction/relaxation (tone)
* proprioception/coordination
* blood flow to the tissues
* pain mechanisms / nervous system input
* CT tension

What are sphincteric dysfunctions?

* urinary incontinence
* urgency/frequency

What are sexual dysfunctions?

* dyspareunia
* sexual dysfunction

What is a support dysfunction?

pelvic organ prolapse

What are stability dysfunctions?

* chronic low back pain
* pelvic girdle pain
* dysmenorrhea

Decreased tension can lead to what issues?

* stress incontinence
* pelvic organ prolapse
* decreased stability = low back pain
* sexual dysfunction

What does decreased tension require?

* muscle strength
* muscle endurance
* muscle coordination

Increased tension leads to what issues?

* urge incontinence/urgency/frequency
* overactive bladder
* dyspareunia
* pelvic girdle pain
* dysmenorrhea

What does increased tension require?

* relaxation
* lengthening of the tissues
* linked to issues with upregulation of the sympathetic nervous system

What are the grades for pelvic floor strength testing?

* 0 = no contraction
* 1 = flicker
* 2 = weak (just squeeze)
* 3 = moderate (with lift)
* 4 = good (with lift)
* 5 = strong (with lift)

When is electrical muscle stimulation used?

when a pt gets less than a grade 3 of muscle strength and lacking proprioception despite manual cueing

What does electrical muscle stimulation utilize?

internal sensor

What are contraindications for electrical muscle stimulation?

* fear
* pregnancy
* metal implant
* sensory deficit
* cardiac pacemaker
* active vaginal or UTI
* active carcinoma in the area
* cognitive impairment
* menstruation

Describe the feedback from and EMG biofeedback machine.

* muscles under increase tension will show an elevated EMG
* shortened muscles are dysfunctional but will not show elevated EMG
* concentric contractions are discouraged until the pelvic floor muscles have been lengthened and have the ability to relax

What are the benefits of using an EMG biofeedback machine?

* enables the pt to visualize muscular contraction
* on its own
* motivation for some pts
* can use when tone is too high to give feedback on letting go of muscle tension
* research shows the effectiveness of biofeedback is dependent on treatment frequency

What are the benefits of a TENS unit for this therapy?

* help manage symptoms of dysmenorrhea
* treatment of overactive bladder
* urgency and frequency

Describe the different pulse rates and pulse durations that are used.

* rate 125-150 Hz, 0.2 msec
* rate 10 Hz, 0.2 msec

When do we use precutaneous tibial nerve stimulation (PTNS)?

* treatment for OAB
* stimulate specific nerve in the ankle responsible for pelvic floor function
* electrical pulses are sent to the tibial nerves which then travel to the sacral nerve plexus - this can change bladder activity
* recommended after behavior modifications have been tried and kegel exercises

What are contraindications for PTNS?

* pregnancy
* pacemakers
* nerve damage impacting the tibial nerve/pelvic floor

Where do and don’t place heat?

* on the tissues around the pelvis (abdomen, low back and adductors)
* not directly on the genitalia

Heat is used in the treatment of what conditions?

* dysmenorrhea
* working with tender spots
* Vaginismus (spasm of the vagina) and dyspareunia (painful intercourse)
* painful bladder syndrome (PBS) / interstitial cystitis (IC)

Heat is used to do what?

* relax muscle tension
* promote relaxation

What are contraindications for heat?

* impaired circulation
* areas of recent bleeding or hemorrhage
* lack of local thermal sensation / nerve damage
* open wounds / healing tissue
* malignancy
* pregnancy

When is ice used?

* post - painful intercourse
* IC/ PBS
* post-partum to help with swelling, hemorrhoids and general pain with immediate recovery
* post-radiation treatments for gynecological cancers

What are contraindications for using ice?

* local areas of impaired peripheral circulation
* extensive scar tissue
* subjects with impaired understanding
* acute skin conditions
* vasospasm