The pelvic floor needs new PR! We need to take steps to break down the barriers for practitioners to begin to appreciate the power of this muscle group and the multi-tasking capacity that it has beyond just keeping panties dry, organs in, and sex happy.
First step, let’s expand the definition of a pelvic floor problem. Historically, a pelvic floor issue has been narrowly defined as a “women’s health issue” a.k.a. incontinence, prolapse, sexual dysfunction or severe pelvic pain issues. This narrow definition keeps the pelvic floor in “not-table talk” land far from the mainstream. It keeps non-women’s health PTs away from the pelvic floor, and leaves many patients with in-between issues outside the scope of practice of both orthopedic/musculoskeletal and women’s health practitioners. For example, many women will present to an orthopedic PT with hip or low back pain and the true source of the pain is mingled with a pelvic floor dysfunction such as core instability due in part to pelvic floor weakness after multiple deliveries. Without tools for how to integrate the pelvic floor into treatment that PT and patient will be struggling for a successful outcome for both the low back pain and the incontinence she “forgot” to mention.
Time to build the buzz… some talking points for our campaign:
1. It is critical that practitioners recognize the role of the pelvic floor as a part of the dynamic central stability system. The pelvic floor contributes to postural stability via its role in the deep inner core, supports movement (studies show it even turns on BEFORE the deltoid in an arm lift), and stabilizes the hip, pelvis and low back directly.
2. We need to build clinical models that train the pelvic floor into that dynamic stabilizing system by linking it to it’s anatomical, systemic and functional relationships in order to promote the best possible clinical outcomes. Isolation via kegels will not promote this functional ideal any more than a quad set will create dynamic stability of the knee. For some ideas check out these videos:
The Fit Floor Part 1: Training the Pelvic Floor for Fitness
The Fit Floor Part 2: Teach Your Pelvic Floor a New Trick
The Core Redefined: A Functional Model
3. Practitioners need to be comfortable enough to ask questions on their intake that might flag dysfunctions in the “down there” part of the system – Any pregnancies? How did you deliver? Do you leak urine when you laugh,
cough or sneeze? Do you leak urine when you are exercising? Is sex painful? Can you retain a tampon? (Some of these can also clue you in for issues that men experience, too).
4. Practitioners need to recognize other non-physiologic indicators of pelvic floor dysfunction such as pelvic instability, core weakness, trunk instability, balance dysfunction, postural dysfunction, and hip instability. These are red-flags that the dynamic central stability system as a whole is not functioning well, and a poorly integrated pelvic floor is a fault in that system.
5. Finally… it’s just a group of muscles people. You can and should apply the rehab and training principles you use for other muscle groups to the pelvic floor. It won’t bite. If we approach it that way, patients will be more open to discussing it, learning about it, and they will be willing to restore it along with all their other muscles.
Interested in learning more, but internal therapy not your thing? Both internal and external therapy approaches exist to help!
Internal therapy has historically been the go to for most classically defined pelvic floor dysfunction issues (incontinence, prolapse, pelvic pain, etc) through direct interventions such as internal manual care, biofeedback, etc. But if this is not the professional path you are on then you should have a great internal therapist on your rolodex. That patient we mentioned before,
the woman with core instability as a contributor to low back pain, she may also have an undiagnosed pelvic organ prolapse. It is important to know when to refer out.
External approaches integrate the pelvic floor into neuromuscular rehab and fitness programs. This indirectly intervenes for some of the classically understood pelvic floor issues alongside common musculoskeletal issues. It’s a back pain-incontinence win-win! An external approach is like a gateway drug to the pelvic floor…it’s a great way to get hooked!
The pelvic floor is now table-talk approved! The campaign has begun… are you in?
Here are some other articles you may be interested in: