Physical Therapy Anne Clark, DPT NovaCare Rehabilitation Derby, KS - - PowerPoint PPT Presentation
Pelvic Health Physical Therapy Anne Clark, DPT NovaCare Rehabilitation Derby, KS Anne Clark, DPT Doctorate in Physical Therapy from Wichita State University in 2014 Pelvic Health training from Herman and Wallace Pelvic Institute
Anne Clark, DPT NovaCare Rehabilitation Derby, KS
⚫ Doctorate in Physical Therapy from Wichita State University
in 2014
⚫ Pelvic Health training from Herman and Wallace Pelvic
Institute and American Physical Therapy Association Section in Women’s Health 2017 and 2018
⚫ Incontinence/overactive bladder ⚫ Stress, urge and mixed ⚫ Dyspareunia ⚫ Diastasis Recti ⚫ Low back pain ⚫ Coccyx pain ⚫ Rectocele/Cystocele/Apex prolapse ⚫ Pubic pain/pelvic pain ⚫ Vaginismus ⚫ Pregnancy/postpartum ⚫ Constipation
pelvic organ prolapse, or fecal incontinence. 3
⚫ Subjective history ⚫ Lumbar screen:
⚫ ROM
⚫ Flexion, Extension, Sidebending
⚫ LE Strength: hip flexion, abduction/adduction, knee flexion and extension ⚫ Pelvic alignment: Ilium alignment, ASIS, PSIS ⚫ SI joint provocation tests: compression, distraction, thigh thrust, sacral
compression
Diastasis Recti test
table
⚫ Observe perineal area for asymmetry, incisions/scars, irritation, vitality of tissue,
ability to bulge (bear down) and lift (kegal)
⚫ Palpation of pelvic clock externally checking for sensation and/or pain ⚫ Palpation of muscles: ⚫ First layer: Bulbocavernosus, Ischocavernosis ⚫ Second layer: Levator ani: puborectalis, pubococcygeus, iliococcygeus ⚫ Third layer: Coccygeus ⚫ Obterator internus ⚫ MMT: PERF scale: Power, Endurance, Repetition, Fast Twitch ⚫ Checking for circumferential contraction and full relaxation ⚫ Assessment of prolapsing: cystocele, rectocele, apex prolapse
⚫ MMT: PERF scale: Power, Endurance, Repetition, Fast Twitch
− Checking for circumferential contraction and full relaxation
⚫ Assessment of prolapsing: cystocele, rectocele, apex prolapse
⚫ Varies depending on patient symptoms ⚫ Typically include:
− Pelvic floor awareness:
− pelvic clock − bulge and lift on washcloth
⚫ Bowel Health ⚫
No straining, Bristol stool chart
How does it work? Relearn the first thing you learned
Your body relies on a bend in the colon (where your poop lives) and the anus (where your poop says hi) to keep everything stored until showtime. Your Puborectalis Muscle helps keep your poop in place by kinking your colon (like a garden hose) while you’re standing or sitting. This is helpful when you are sitting and don’t want to poop but unhelpful when you do want to poop. If only there was a way to tell your body to unkink that hose… Your colon’s sweet spot comes with the squat. This is the only position in which the Puborectalis Muscle fully relaxes which straightens the kink and allows for complete elimination without straining. Bombs away!
⚫ Bladder Health
⚫ Should be able to hold urine for 2-3 hours ⚫ Urinating 5-8/day, 0-2/night ⚫ Urinating for 8-15 seconds each time ⚫ Need to sit down ⚫ “Key in the door syndrome” ⚫ “Just in case” ⚫ Standing up and sitting back down to fully empty bladder
⚫ Hamstring ⚫ Adduction ⚫ SKTC ⚫ DKTC ⚫ LTR
− Diaphragmatic breathing:
⚫ Teach how to use transverse abdomenis (TA) muscle ⚫ Inhale=expansion/relaxation ⚫ Exhale=contraction
⚫ Progression of diaphragmatic breathing/TA contraction
−Bent Knee Fall out (BKFO)
− Straight Leg Raise (SLR)
pelvic tilt
⚫ (pelvic floor massage tool- Serenity TMT)
Anne Clark DPT P:316-788-6734 F:316-788-4529 awclark@novacare.com