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Physical Therapy Indications • Urinary and Fecal Incontinence • Pelvic Floor Pain • Pelvic Organ Prolapse Physical Therapy Specialists in Pelvic Floor Dysfunction & Rehabilitation • Pre and/or Post-Partum Pain • Low Back Pain including Sacroilliac Joints • Hip Pain • Abdominal Dysfunction (Diastasis Recti) • Thoracic/Rib Pain Related to Pregnancy • Post C-Section Pain • Constipation and Rectal Muscle Dysfunction • Breastfeeding Difficulties • Coccyx Pain • Pudendal Neuralgia • Post-Mastectomy Lymphedema • Post-Urogynocological Surgery • Dyspareunia • Adolescent Pelvic Pain or Incontinence • and many more... Physical Therapy Contraindications • Lack of Patient or Physician Consent • Under 6 weeks Post-Partum • Under 6 weeks Post-Op • Severe Atrophic Vaginitis • Acute Vaginal Infection • Without Prior Pelvic Examination • Sexual Abuse • Vaginal Treatment during Pregnancy without Physician Consent Staff Jessica Thornton, PT, DPT Doctor of Physical Therapy / Director of Women’s Health Herman & Wallace Pelvic Institute Certifications [email protected] There is a Difference Located at Renue Physical Therapy 4616 State Street • Saginaw, MI 48603 Ph: (989) 355-1010 • Fax: (989) 355-1011 www.renuept.com Pelvic Anatomy & Function Pelvic Floor History • Extensive Questionnaire • Consent Form • Bowel and Bladder Diary (over 3 days) 3 Layers of the Pelvic Floor SUPERFICIAL LAYER • Superficial Transverse Perineal Muscles • Bulbocavernosus Muscles Observation & Manual Techniques • External Assessment • Palpation and Internal Assessment • Complete Assessment of Vaginal Tone, Size, Contractility, Muscle Symmetry, Reflexes, Sensation, Pain and Strength • Observe for Cystocele and Rectocele • Ischiocavernosus Muscles Perineal membrane LAYER • Deep Transverse Perineal Muscles • Compressor Urethra • Sphincter Urethra Muscle deep Layer • Levator Ani Muscles •Pubococcygeus Muscles •Pubovaginalis Muscles •Puborectalis Muscle •Iliococcygeus Muscles • Coccygeus Muscles Functions • Supports the Pelvis • Supports Organs • Assists Abdominals Stability vs Mobility Due to the nature of the structure-layers of muscles surrounded by fascia, a balance of stability versus mobility is needed for the pelvic floor to function properly. Pliability is needed to allow urine and stool to pass, as well as, reproduction purposes. Additionally, there needs to be adequate tone for stability, support, maintain continence, and allow for sexual appreciation. • Sphinteric Control • Sexual Appreciation Other Key Muscles • Gluteus Maximus/Medius • Obturator Internus • Piriformis • Transverse Abdominus • Hip Adductors Physical Therapy Evaluation Process Located at Renue Physical Therapy 4616 State Street • Saginaw, MI 48603 Ph: (989) 355-1010 • Fax: (989) 355-1011 www.renuept.com Manual • • • • • Muscle Test Power Graded 0-5 Symmetry right to left Fast Contraction Ability Endurance Repetitions Clearance of Spine and Sacroiliac Joint Example Treatment Protocols Chronic Pelvic Pain • A variety of diagnoses fit this protocol • Primarily address high muscle tone, trigger points, urinary frequency and urgency Techniques • Modalities • Muscle Re-Education • Soft Tissue Mobilizations, Trigger Point Technique • Dialators • Perineal Massage • Pelvic Alignment • Exercise Program • Scar Mobility
