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Mar 18, 2014

Pop Quiz

 

  1. Can a pelvic rehabilitation provider help a male patient who has erectile dysfunction (ED)?
  2. Is there research to support a claim that rehab helps with ED?
  3. Are there any medical conditions a pelvic rehab provider should suspect when a patient complains of ED?
  4. Are there any screening tests a pelvic rehab provider can complete to rule out medical causes of ED?
  5. Are there any pelvic rehabilitation courses that discuss ED in men? 
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If you answered "yes" to all of the above questions, well done. A pelvic rehabilitation provider can indeed help a patient who presents with complaints of erectile dysfunction, and the highest level of evidence (randomized, controlled clinical trial) has been completed to support this claim. Medically, a patient with ED may be suffering from heart disease, diabetes, metabolic syndrome, or even multiple sclerosis and should be screened by a medical provider prior to working with a pelvic rehabilitation provider. Skilled listening, and screening tests such as blood pressure, balance, and medication screening can be utilized in the clinic to alert the therapist to a medical issue.


Mar 14, 2014

A recent article titled "Pain, Catastrophizing, and Depression in Chronic Prostatitis/Chronic Pelvic Pain Syndrome" describes the variations in patient symptom report and perception of the condition. The article describes the  evidence-based links between chronic pelvic pain and anxiety, depression, and stress, and highlights the important role that coping mechanisms have in reported pain and quality of life levels. One of the ways in which a provider can assist in patient perception of health or lack thereof is to provide current information about the condition, instruct the patient in pathways for healing, and provide specific care that aims to alleviate concurrent neuromusculoskeletal dysfunction. 

 

 

Most pelvic rehabilitation providers will have graduated from training without being informed about chronic pelvic pain syndromes. And as most pelvic rehabilitation providers receive their pelvic health knowledge from continuing education courses, unless a therapist has attended coursework specifically about male patients, the awareness of male pelvic dysfunctions remains low. If you are interested in learning about male pelvic health issues, the Institute introduces participants to male pelvic health in the Level 2A series course. The practitioner who would like more information about male patients can attend the Male Pelvic Floor Function, Dysfunction, and Treatment course that is offered in Torrance, CA at the end of this month.

 


Mar 10, 2014

Does wearing a pelvic belt affect the activation of the gluteus maximus and gluteus medius muscles in healthy males? Recent research asked this question, and the results, although difficult to extrapolate to other patient populations, are interesting. Surface electromyography (sEMG) amplitude was measured in 20 male patients during 6 exercises, and the amplitude during the exercise was compared to a maximum voluntary contraction. The findings demonstrated that muscle activation increased in the gluteus maximus when a pelvic belt was worn. Activation in the gluteus medius was unchanged for all exercise except during the clam exercise when the gluteus medius was noted to be more active. 

 

 

Mean age in the study was 23 years, and all participants reported a lack of disease or injury. All were able to complete the exercises without pain. The 6 exercises that were instructed by an experienced physical therapist included hip clam, side lying hip abduction, single limb squat, single limb deadlift, frontal planar lunge, and frontal planar hop. Each exercise was performed 3 times, the order of exercise was randomized, and the dominant limb was used. 

 


Mar 07, 2014

Postpartum mothers are often juggling intense schedules: infant feeding, mealtimes for other family members, work both in and outside of the home, and there is scarce time for self-care. Throw in the typical postpartum fatigue, potential for postpartum depression, adjustment to parenting or adding another child to a family, risk for weight retention, and the ability of a new mom to resume or begin exercises can be beyond daunting. An additional complication arises when a woman has been on bed rest, as she has lost muscle mass and cardiorespiratory function and endurance. How can we best set up a new mother for success? 

 

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Research published in the journal Clinical Sciences reports that regardless of exercise intensity, women receiving postpartum intervention experience health benefits. If a woman is unable to reduce the weight gain that occurs in pregnancy, by 6 months postpartum she will have increased risk factors for developing chronic disease, according to the authors. In the study, 20 women were instructed in nutrition advice and low intensity (30% heart rate reserve (HRR)) and another 20 women women were instructed in nutrition advice and moderate intensity(70% HRR) exercise. A group of controls (n = 20) was included and matched for BMI, age and parity. 


Mar 05, 2014

In a study conducted in Western Sydney, Australia, researchers aimed to discover the barriers and enablers to attending preoperative pelvic floor muscle training for men scheduled for a radical prostatectomy. Semi-structured interviews were completed with referral sources (urological cancer surgeons, nurses, and general practitioners), pelvic rehabilitation providers (physical therapists and continence nurses), and male patients having surgery at a public and a private hospital. 

 

 

Key factors that encouraged men to attend pelvic muscle training included having a referral from a provider that was for a specific therapist or center. Barriers to attending rehabilitation included potential cost of private pelvic floor muscle training, and lack of awareness about pelvic muscle rehab among both providers and patients. The providers were often not aware of public sector providers of pelvic muscle training, and patients were unaware of potential benefits of rehabilitation. 

 


Mar 01, 2014

Postpartum depression is a very real, frequently occurring phenomenon that has potentially serious adverse effects on the mother, the child, and on the family as a whole. Serious consequences can include, according to McCoy et al, marital disruption, child neglect or abuse, and suicide. While there are many factors including hormonal shifts that can influence a woman in the postpartum period, strong predictive risk factors can include age less than 25, readmission to the hospital, inability to breastfeed, and lower self-reported health of the mother.  A rehabilitation professional is uniquely poised to monitor a postpartum woman over an episode of care and can screen for changes in mood, behavior, or identify risk factors. 

 

 

Screening for postpartum depression is often completed clinically utilizing the Edinburgh Postnatal Depression Scale. There is a shortened version, the EPDS-3, that asks about self-blame, states of anxiety, and feeling scared, and the shortened version has been documented to have excellent sensitivity. Postpartum psychosis and postpartum post-traumatic stress disorder can also negatively impact a woman's health and a provider needs to be alert for concerning symptoms. 

 


Feb 24, 2014

Within the evaluation process for pelvic muscle health, a woman is often asked to "bear down" so that the examiner can assess muscle coordination. This maneuver is also utilized during assessment for prolapse or pelvic organ descent. Clinically, the patient's ability to perform a lengthening or bearing down is quite varied, depending upon many factors such as levator plate resting position, strength and coordination, childbearing status, and comfort with the maneuver. What are the implications of not being able to bear down? An interesting study published in 2007 concluded that women, when asked to perform a Valsalva maneuver (a forced expiration against a closed glottis), frequently co-contracted the levator ani muscles. 

 

 

Participants included 50 nulliparous women between 36-38 weeks gestation and they were assessed with translabial 3D/4D ultrasound following emptying of the bladder. In almost half of the subjects, a pelvic floor muscle contraction was noted during the attempted Valsalva. Patients were provided with visual biofeedback to train the levator muscles to avoid a concurrent contraction, and despite the training, 11 of the 50 women were still unable to avoid a co-activation. (Keep in mind that for purposes of assessment, the prolapse would be best imaged or viewed if the levator muscles were not tightening.) For this reason, the study concludes that levator muscle co-activation is a significant confounder of pelvic organ descent. While a contraction of the pelvic floor muscles may be a positive, protective action when thoracic pressure is increased, a woman's degree of prolapse or pelvic organ descent may appear diminished during an examination. The authors of the study conclude that a clinician may have a false-negative finding for prolapse in the presence of strong, intact pubovisceral muscles. 

 


Feb 21, 2014

Lumbopelvic pain is a common diagnosis in pregnancy that can be challenging for both the patient and the provider. A recent study assessed the effectiveness of 10 weeks of Hatha yoga in women between 12-32 weeks of gestation. 60 pregnant women ages 14-40 were divided into two groups, with the intervention group being guided in yoga exercises, and the control group instructed in postural activities. Nine pregnant women in the yoga group and six women in the control group were lost to withdrawal, obstetric complications, or refusal to participate. Excluded were women with twin pregnancies, medical restrictions, women using analgesics or those participating in physical therapy. Outcomes included a Visual Analog Scale (VAS) to measure pain intensity, and tests of lumbar and posterior pelvic pain. Lumbar provocation tests used in the study included trunk flexion and circumduction, paraspinal muscle palpation, and pelvic tests included the posterior pelvic pain provocation test.

 

 

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Feb 19, 2014

 

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A recent article published in the Evidence Based Women's Health Journal reports on the use of transcutaneous electric nerve stimulation (TENS) for labor pain. The study was carried out in a teaching hospital in Cairo, Egypt, and involved 100 subjects divided into a treatment group (TENS application) and a control group (intramuscular pethidine 50-100 mg.) Pain assessment was completed by a visual analog scale (VAS) and a postpartum satisfaction questionnaire 48 hours after birth. Outcomes included relief of labor pain, duration of first stage of labor, labor augmentation, mode of delivery, fetal outcome, and adverse event reports. Patients were excluded in the following cases: cephalopelvic disproportion, multiple gestations, presence of a cardiac pacemaker, known congenital abnormalities, in the presence of complications such as preeclampsia, antepartum hemorrhage, and fetal asphyxia. 

 


Feb 14, 2014

 

 

 

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Upcoming Continuing Education Courses

Pelvic Floor Level 1 - Durham, NC (SOLD OUT)
Apr 25, 2014 - Apr 27, 2014
Location: Duke University Medical Center

Myofascial Release for Pelvic Dysfunction - Portland, OR
Apr 25, 2014 - Apr 27, 2014
Location: Legacy Meridian Park Medical Center

Finding the Driver in Pelvic Pain - Milwaukee, WI
May 01, 2014 - May 03, 2014
Location: Marquette University

Visceral Mobilization of the Urologic System - Winfield, IL
May 02, 2014 - May 04, 2014
Location: Central DuPage Hospital Conference Room

Rehabilitative Ultrasound Imaging: Women's Health and Orthopedic Topics - Seattle, WA
May 03, 2014 - May 05, 2014
Location: Swedish Hospital - Issaquah campus

Rehabilitative Ultrasound Imaging Orthopedic Topics - Seattle, WA
May 03, 2014 - May 04, 2014
Location: Swedish Hospital - Issaquah campus

Pelvic Floor Level 1 - Scottsdale, AZ (SOLD OUT)
May 16, 2014 - May 18, 2014
Location: Womens Center for Wellness and Rehabilitation

Pelvic Floor Level 2A - Maywood, IL (SOLD OUT!)
May 16, 2014 - May 18, 2014
Location: Loyola University Stritch School of Medicine

Pelvic Floor Level 3 - San Diego, CA
May 30, 2014 - Jun 01, 2014
Location: FunctionSmart Physical Therapy

Pelvic Floor Level 1 - Arlington, VA (SOLD OUT)
Jun 06, 2014 - Jun 08, 2014
Location: Virginia Hospital Center

Care of the Postpartum Patient - Houston, TX
Jun 07, 2014 - Jun 08, 2014
Location: Texas Children’s Hospital

Bowel Pathology and Function - Minneapolis, MN
Jun 07, 2014 - Jun 08, 2014
Location: Park Nicollet Clinic--St. Louis Park

Oncology and the Female Pelvic Floor - Orlando, FL
Jun 21, 2014 - Jun 22, 2014
Location: Florida Hospital Sports Medicine and Rehabilitation

Myofascial Release for Pelvic Dysfunction - Dayton, OH
Jun 22, 2014 - Jun 23, 2014
Location: Southview Hospital

Pelvic Floor Level 2A - Derby, CT
Jun 27, 2014 - Jun 29, 2014
Location: Griffin Hospital