Physical Therapy Pelvic Floor Evaluation and Treatment

A medical provider or friend may have recommended that you see a physical therapist for evaluation and treatment for your pelvic floor and you may be wondering why. Many people are familiar with physical therapy, but not physical therapy for the pelvic floor. The intent of this blog post is to help answer common questions and concerns regarding physical therapy for this region by introducing you to its anatomy, identifying typical problems related to pelvic floor dysfunction, summarizing the purpose and components of the physical therapy evaluation, and reviewing common treatment techniques for pelvic floor muscles.

Many muscles comprise our pelvic floor, which spans the bottom of the pelvis between the pubic bone and tail bone (coccyx). It is similar to a hammock, consists of three layers of muscle, and helps to support our pelvic organs (bladder, bowel, and uterus) as well as the spine and pelvic bones. The pelvic floor muscles help with bowel and bladder control and enhance sexual pleasure. For more information regarding these muscles, please see other posts on this blog: “Pelvic Floor Muscle Dysfunction” and “Postpartum Abdominal Wall and Pelvic Floor Muscle Dysfunction”.

Postpartum Abdominal Wall and Pelvic Floor Muscle Dysfunction: Related Complications, Physical Therapy, and Safe Return to Exercise

Part I: Abdominal Wall and Pelvic Floor Muscle Dysfunction and Related Complications

Abdominal wall and pelvic floor muscle dysfunction is common in pregnancy as well as in the postpartum stage. However, once a mom is postpartum, she is always postpartum and abdominal and pelvic floor problems can continue for years. As many women can attest to, problems with these muscles can cause pelvic girdle and low back pain, pelvic organ prolapse, urinary and fecal incontinence, and rectus diastasis abdominis. This raises the questions, “What can go wrong with our abdominal wall and pelvic floor muscles during pregnancy and after delivery?” “How does the new mom safely return to exercise and fitness after childbirth?”

To have a better understanding of postpartum barriers for safely returning to exercise, let’s first review our anatomy. The top picture is looking at our belly while the bottom picture shows a side view:

Pelvic Guru.com

By OpenStax College - https://cnx.org/contents/FPtK1zmh@8.108:y9_gDy74@5, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=64291130

Pelvic Floor Muscle Dysfunction: Associated Pelvic Girdle, Low Back, Buttock, and Hip Pain and Stress Urinary Incontinence

May is Pelvic Pain Awareness Month, in which organizations strive to raise and improve public awareness of issues in the area of chronic pelvic pain. As a physical therapist with a special interest and years of experience in the treatment of patients with pelvic girdle related pain, I hope you find that this blog article increases your knowledge of the role our pelvic floor muscles play in pelvic girdle, pelvic, buttock, low back, and hip pain and stiffness and stress urinary incontinence (urinary leakage).

Men and women have a pelvic floor. It is not really a floor, but a collection of muscles, ligaments, nerves, tendons, blood vessels, fascia, and connective tissue at the bottom of the pelvis. Several layers of muscles make up our pelvic floor muscles (“PFM”). Some of these muscles connect the tailbone to the pubic bone while others spread outward and connect to pelvic bones and the hips. Thoracolumbar fascia connects these muscles to the low back. The deeper layer of muscles supports the vagina, bladder, uterus, and rectum. The outer, or more superficial layer, surrounds the bladder, vagina, and anal openings.

Training and Strengthening the Deep Muscle System ("Inner Core")

The transversus abdominis, pelvic floor, deep lumbar multifidi, and diaphragm muscles form our deep muscle system, known by many as the inner core. For more information on these muscles, please refer to my blog post, “The Deep Muscle System (“Inner Core”). The transversus abdominis, pelvic floor, and deep lumbar multifidi muscles have been found in research studies to stabilize our spine before movement of the legs and arms occur. However, their activation is often delayed or absent and the muscles may contract too much or too little. They may also fail to work together as they should. If these co-contraction patterns aren’t corrected, they may lead to degeneration of the underlying joints due to loss of stability and control of motion. The activation patterns of these muscles generally won’t change without guidance from a trained professional such as a physical therapist.

The Deep Muscle System ("Inner Core")

The terms, "inner core muscles", "inner core", and "the deep muscle system", are often used interchangeably in rehabilitation, fitness, and wellness settings. However, what does one really mean when he or she refers to this group of muscles? A Google search shows many different descriptions, lists, and explanations of muscles that make up our deep muscle system.

Many physical therapists refer to the deepest muscles located in the region between our pelvis and diaphragm as "the inner core" muscles. When we help patients train and strengthen these muscles, we focus on the following: the breathing diaphragm in the upper most part of the core; the deep and superficial muscles of the pelvic floor located in our pelvis; the transversus abdominis in the front abdominal muscle wall; and the deep lumbosacral multifidi in the low back.

The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) for Back and Neck Pain

Do you know of someone who had back, neck, or extremity pain and worked with a physical therapist who helped resolve their pain using the McKenzie Method? Did this leave you wondering what the McKenzie Method of Mechanical Diagnosis and Treatment entailed? The McKenzie Method, also known as Mechanical Diagnosis and Therapy (MDT), is an evidenced based assessment and treatment program for neck, back, and extremity pain. It is used world-wide by physical therapists and their patients. The approach involves a comprehensive and logical process to evaluate the patient’s problem. It begins with a thorough patient history and proceeds with testing of postures, sustained positions, and repeated movements to identify distinct patterns of pain and movement responses that are objective, reproducible, and reliable.

Introduction to the McKenzie Method of Mechanical Diagnosis and Therapy (MDT)

Without doubt, no one likes to be in pain. Every year, Americans and their insurance companies spend billions of dollars on back pain diagnosis and treatment, much more than on most other procedures for musculoskeletal pain. The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) is one of the world’s most effective physical therapy approaches to help people with musculoskeletal disorders become pain-free. As an alternative to medical interventions such as MRIs, spinal injections, x-rays, and in some cases, surgery, MDT can save you money by potentially eliminating the need to pay high co-pays and co-insurances for unnecessary diagnostic testing and procedures.

Studies have proven MDT eliminates back, neck, and arm / leg pain in as little as three visits. Evidence also suggests MDT intervention helps patients skip surgery altogether. An excellent resource for those interested in this novel approach is the McKenzie Institute USA's website. Watch Danny’s story describing how he used the McKenzie Method to recover from acute neck and arm pain while avoiding surgery. View a short video describing the McKenzie Method and watch an interview with the late Robin McKenzie. If you’re wondering if you or someone you know is a candidate for this approach, view the section, “Patient Briefs: Is MDT for me?”