Login / Create an Account

Phone646.355.8777

Tags >> Male Pelvic Floor
Apr 10, 2015

Blog by Holly Tanner

Among the challenges in research for chronic pelvic pain is the lack of consensus about diagnosis and intervention. Prominent researchers and physicians J. Curtis Nickel and Daniel Shoskes describe a methodology for classification of male chronic pelvic pain using phenotyping, which can be simply described as “a set of observable characteristics.” The authors point out in this article that men with complaints of pelvic pain have historically been treated with antibiotics, even though now it is known that most cases of “prostatitis” are not true infections. With most patients having chronic pelvic pain presenting with varied causes, symptoms, and responses to treatment, Nickel and Shoskes acknowledge that traditional medical approaches have not been successful.

 

In an attempt to improve classification of patients and subsequent treatment approaches, the UPOINT system was developed. The domains of the system include urinary, psychosocial, organ specific, infection, neurological/systemic conditions, and tenderness of skeletal muscles, and are listed below. Within each domain, the clinical description has been adapted from the original study (which can be accessed full text at the link above.)

 

UPOINT Domains

 


Apr 02, 2015

This post was written by Elizabeth Hampton PT, WCS, BCIA-PMB, who teaches the course Finding the Driver in Pelvic Pain: Musculoskeletal Factors in Pelvic Floor Dysfunction. You can catch Elizabeth teaching this course in April in Milwaukee.

 

Blog by Elizabeth Hampton

Chronic pelvic pain has multifactorial etiology, which may include urogynecologic, colorectal, gastrointestinal, sexual, neuropsychiatric, neurological and musculoskeletal disorders. (Biasi et al 2014) Herman and Wallace faculty member, Elizabeth Hampton PT, WCS, BCB-PMD has developed an evidence based systematic screen for pelvic pain that she presents in her course “Finding the Driver in Pelvic Pain”. One possible origin of pelvic pain as well as chronic psoas pain and hypertonus may arise from genitofemoral, ilioinguinal or iliohypogastric neuralgia, the screening of which is addressed in the “Finding the Driver” extrapelvic exam.

 

The iliohypogastric nerve arises from the anterior ramus of the L1 spinal nerve and is contributed to by the subcostal nerve arising from T12. This sensory nerve travels laterally through the psoas major and quadratus lumborum deep to the kidneys, piercing the transverse abdominis and dividing into the lateral and anterior cutaneous branches between the TVA and internal oblique. The anterior cutaneous branch provides suprapubic sensation and the lateral cutaneous branch provides sensation to the superiolateral gluteal area, lateral to the area innervated by the superior cluneal nerve. (10)

 


Mar 18, 2015

This post was written by Steven Dischiavi, MPT, DPT, ATC, COMT, CSCS, who teaches the course Biomechanical Assessment of the Hip and Pelvis. You can catch Steve teaching this course in May at Duke University in Durham, NC.

 

Steve Dischiavi

One thing that jumps out at me when treating a professional athlete, is that they have “a guy or gal” for everything! Most high profile athletes have a physical therapist, athletic trainer, acupuncturist, nutritionist, massage therapist, personal trainers for speed, power, cross fit, and pretty much “a guy or gal” for anything that has something to do with athletic performance or injury prevention. In most recent years I have been hearing more and more that athletes use someone that can analyze their movement and develop corrective exercises for them. These professionals are not just physical therapists, but some are personal trainers, exercise physiologists, chiropractors, and so on…

 

This has clearly been leading to a paradigm shift in not only evaluation of the athlete, but more specifically how we treat our athletes and clients. The Functional Movement Assessment is a tool that is gaining more and more popularity. It identifies “movement dysfunction” and then sets out to manage these movement patterns. I am a firm believer in functional movement assessment, and I believe it does need a larger role in our profession…I believe this so strongly I have recently changed gears professionally and have accepted an assistant professor position on the Physical Therapy faculty at High Point University. I want to affect change from within!

 


Feb 24, 2015

Blog by Holly Tanner

Results from a national survey of surgeons published in 2010 offers insights into the challenges that providers and patients face in addressing the complications caused by post-surgical adhesions. The survey included 55 multiple-choice questions, four open-ended questions, and four optional questions. The questions were posed to Dutch surgeons and trainees and included information about awareness of adhesions, use of anti-adhesive agents in surgery, informed consent, and benefits versus risks of adhesions. The survey also included items with "correct" answers containing data from evidence-based information about post-surgical adhesions including the following:

-postoperative adhesions are the cause of 70% of small-bowel obstructions-there is a 5% readmission rate after colorectal surgery related to postoperative adhesions

-there is approximately a 30% readmission rate following abdominal surgery due to adhesions

-adhesiolysis poses a 20% risk of accidental enterotomy

-a colonic total resection has highest rate of adhesion-related morbidity compared with partial small-bowel resection, appendectomy, or rectal resection

-being older than 60 is associated with less adhesions


Feb 23, 2015

Today the Pelvic Rehab Report caught up with instructors Bill Gallagher PT, CMT, CYT and Richard Sabel MA, MPH, OTR, GCFP to talk about their Integrative Techniques for Pelvic Floor & Core Function: Weaving Yoga, Tai Chi, Qigong, Feldenkrais and Conventional Therapies course being presented in Boston, MA this March 28 – 29. Check out their discussion of these awesome treatment techniques, including a free exercise regimen!

 

Bill Gallagher

Richard Sabel

Resurrecting the Dead Zone

When considering the board range of health issues that fall under the umbrella of pelvic dysfunction, we’ve observed that too many of our clients have PPA - poor pelvic awareness. Sure they’re cognizant of the pain, discomfort or distress associated with their particular issue, but in reality the pelvic region is, as Imgard Bartenieff described it, “the dead seven inches in most Americans’ bodies.” We’ve taken creative license here and call it “the dead zone.”

 


Jan 27, 2015

This post was written by H&W instructor Heather S. Rader, PT, DPT, BCB-PMD, who authored and instructs the course, Geriatric Pelvic Floor Rehab. She will be presenting this course this June in Florida!

 

Heather Rader

“I have never heard of pelvic floor rehab before.”

 

This comment poses an added job requirement for us, my fellow pelvic rehab practitioners! You have a responsibility to make this specialty understandable to your patients, referring providers, and the community at large. Therefore, marketing and education become interchangeable.

 


Sep 23, 2014

male sling

Surgery for prostate cancer can impair urinary function, and in the case of persistent urinary incontinence, patients may progress to surgical interventions. In order for physicians to conduct optimal patient counseling and surgical candidate selection for post-prostatectomy urinary incontinence (UI), the records of 95 patients were reviewed in this study. The patients were retrospectively placed into "ideal", n = 72, or "non-ideal", n = 23, categories based on chosen characteristics, and the results of their outcomes and satisfaction were consolidated. Men in the "ideal" group had the following characteristics: mild to moderate UI, external urethral sphincter that appeared intact on cystoscopy, no prior history of pelvic radiation or cryotherapy, no previous UI surgeries, volitional detrusor contraction with emptying of the bladder, and a post-void residual of < 100 mL. Patients who did not meet all listed criteria for the "ideal" group were placed into the "non-ideal" classification.

 

A cure for the surgery was considered total resolution of post-prostatectomy incontinence with the sling. Of the patients fitting into the ideal classification, 50% reported cure, and of the non-ideal group, 22% reported a cure. Satisfaction rates within the ideal group for the procedure were 92%, whereas the non-ideal group reported a 30% satisfaction. Although uncommon, complications occurring in both groups included prolonged pelvic pain and worsened urinary incontinence. The authors describe the importance of placing the correct amount of tension through the sling, and of leaving as much of the external urethral sphincter in place as possible. Another complication that occurred more frequently is that of acute urinary retention. In the ideal cohort, the 11 cases of urinary retention resolved within 6 weeks of surgery. Of interest is that 12 of the 23 men in the "non-ideal" category had to undergo further surgery with an artificial urethral sphincter.

 

This information can assist surgeons in guiding and advising patients about operative procedures for post-prostatectomy incontinence. (Ideally, every patient would "fail" a trial of pelvic rehabilitation prior to progressing to a surgery!) If a patient wishes to proceed with a sling surgery despite being in a "non-ideal" category, he could be advised of the known potential outcomes. This article offers support for pre-operative investigation techniques such as urodynamics. Our role as pelvic rehabilitation providers may allow us to discuss such research with patients and providers, and participate in discussions about the role of rehabilitation pre-operatively or post-operatively. If you would like to learn more about working with men who have pelvic floor dysfunctions, you still have time to book a flight to Orlando for the Male Pelvic Floor Function, Dysfunction, & Treatment course, where you can learn about male pelvic pain, incontinence and BPH, and male sexual dysfunction. This is the last opportunity to take this course this year!


Sep 04, 2014

This post was written by H&W instructor Allison Ariail PT, DPT, CLT-LANA, BCB-PMD. Allison will be instructing the Pelvic Floor Level 1 course Boston this October.

 

Allison Ariail

Several weeks ago some of my fellow faculty members and I were discussing the resting tone of the pelvic floor. These days we take it for granted that we know there is constant low-level activity in the pelvic floor and anal sphincter in order to provide continence. However, how did this information come about? I took it upon myself to do some research to find out the beginnings of this knowledge. What I found was interesting and thought I would share.

 

In the late 1940’s and early 1950’s the belief was held that the pelvic floor and external anal sphincters were inactive at rest, like other striated muscle throughout the body. Activity was believed to be initiated by afferent impulses from the rectal ampulla and anal canal. In 1953 Floyd and Walls found activity in the external anal sphincters at rest, even during sleep. In 1962 Parks, Porter, and Melzak published a study examining the pelvic floor muscles and the external anal sphincters using electromyography recordings. They also found activity in these muscles at rest. They hypothesized the activity was maintained by spinal reflex. These researchers looked at the activity in a healthy population, a paraplegic population, and a population that had undergone a rectal excision. When examining the paraplegic population (all subjects had complete SCI injuries above L3), they did identify activity of the pelvic floor at rest.

 


Aug 26, 2014

In an article describing vascular dysfunction in women with chronic pelvic pain (CPP), Foong and colleagues describe the common finding of pelvic venous congestion. This study aimed to determine changes in microcirculatory function in women with chronic pelvic pain compared to controls. Eighteen women presenting with chronic pelvic pain of at least 1 year and 13 women without pelvic pain or congestion were evaluated for isovolumetric venous pressure, miscrovascular filtration capacity, and limb blood flow. All women were of reproductive age, menstruating regularly, and measurements were made during the mid follicular and the midluteal stages of the same 28 day cycle. The 18 women with CPP fit previously established criteria for pelvic congestion.

 

The women in the patient group were re-evaluated at 5-6 months following treatment for pelvic congestion, with treatment including medication-induced suppression of ovarian function for 6 months, and in 4 patients, hysterectomy and bilateral salpingo-oopherectomy. All of the patients received daily hormone replacement therapy (Premarin and Provera) "…to minimize the hypo-oestrogenic effects of treatment."

 

Findings of the research include an elevation in isovolumetric venous pressure, or Pvi in women with CPP compared to controls. Interestingly, there were no changes related to menstrual cycle in measures of microvascular filtration capacity and and limb blood flow. The conclusion of this study is that women with chronic pelvic pain may present with systemic microvascular dysfunction. The noted increase in Pvi "…may be attributable to systemic increases in post capillary resistance secondary to neutrophil activation." Following treatment for pelvic congestion, the value changes in isovolumetric venous pressure were no longer present.

 

This research highlights the noted changes in microcirculatory function in women with chronic pelvic pain. The obligatory chicken and egg conversation weighs in: does pelvic congestion lead to pelvic pain, or does pelvic pain always precede pelvic congestion? While the answer is probably that either condition can cause and perpetuate the other, as pelvic rehabilitation providers, our first thought might be: what would the research outcomes be if the treatment were not medication-induced ovarian suppression or surgery, but therapy directed to the pelvic pain and congestion? The Institute offered, for the first time last year, a course that allows the therapist to address pelvic pain through treatment of pelvic lymphatic drainage. The Lymphatic Drainage for Pelvic Pain continuing education course is a 2-day class instructed by Debora Hickman, a certified lymphedema therapist. Sign up now to save your seat in October in San Diego, and if you can't make this course, contact us to let us know you are interested in this special topics course, and we will keep you informed of any new course bookings!


Aug 15, 2014

baby

Concepts in "core" strengthening have been discussed ubiquitously, and clearly there is value in being accurate with a clinical treatment strategy, both for reasons of avoiding worsening of a dysfunctional movement or condition, and for engaging the patient in an appropriate rehabilitation activity. Because each patient presents with a unique clinical challenge, we do not (and may never) have reliable clinical protocols for trunk and pelvic rehabilitation. Rather, reliance upon excellent clinical reasoning skills combined with examination and evaluation, then intervention skills will remain paramount in providing valuable therapeutic approaches. 

 

 

Even (and especially) for the therapist who is not interested in learning how to assess the pelvic floor muscles internally for purposes of diagnosis and treatment, how can an "external" approach to patient care be optimized to understand how the pelvic floor plays a role in core rehabilitation, and when does the patient need to be examined by a therapist who can provide internal examination and treatment if deemed necessary? There are many valuable continuing education pathways to address these questions, including courses offered by the Herman & Wallace Institute that instruct in concepts focusing on neuromotor coordination and learning based in clinical research. 

 

 


  • «
  •  Start 
  •  Prev 
  •  1 
  •  2 
  •  3 
  •  4 
  •  5 
  •  Next 
  •  End 
  • »

Upcoming Continuing Education Courses

Pelvic Floor Level 1 - Los Angeles, CA (SOLD OUT)
May 01, 2015 - May 03, 2015
Location: Mount Saint Mary’s University

Pelvic Floor Level 2A - Seattle, WA (Sold Out!)
May 01, 2015 - May 03, 2015
Location: Swedish Medical Center Seattle - Ballard Campus

Oncology and the Female Pelvic Floor - Torrance, CA
May 02, 2015 - May 03, 2015
Location: HealthCare Partners - Torrance

Care of the Postpartum Patient - Boston, MA
May 02, 2015 - May 03, 2015
Location: Marathon Physical Therapy

Pediatric Incontinence - Minneapolis, MN
May 16, 2015 - May 17, 2015
Location: Mercy Hospital

Biomechanical Assessment of The Hip & Pelvis - Durham, NC
May 16, 2015 - May 17, 2015
Location: Duke University Medical Center

Special Topics in Women's Health - Maywood, IL
May 30, 2015 - May 31, 2015
Location: Loyola University Stritch School of Medicine

Sacroiliac Joint Evaluation and Treatment - Middletown, CT
May 30, 2015 - May 31, 2015
Location: Middlesex Hospital

Pelvic Floor Level 2B - Seattle, WA (Sold Out!)
Jun 05, 2015 - Jun 07, 2015
Location: Swedish Medical Center Seattle - Ballard Campus

Pelvic Floor Level 3 - Atlanta, GA
Jun 05, 2015 - Jun 07, 2015
Location: One on One Physical Therapy

Visceral Mobilization of the Urologic System - Madison, WI
Jun 05, 2015 - Jun 07, 2015
Location: Meriter Hospital

Nutritional Perspectives for the Pelvic Rehab Therapist - Seattle, WA
Jun 06, 2015 - Jun 07, 2015
Location: Pacific Medical Center

Rehabilitative Ultra Sound Imaging: Orthopedic Topics - Baltimore, MD
Jun 12, 2015 - Jun 13, 2015
Location: Johns Hopkins Bayview Medical Center

Rehabilitative Ultra Sound Imaging: Women's Health and Orthopedic Topics - Baltimore, MD
Jun 12, 2015 - Jun 14, 2015
Location: Johns Hopkins Bayview Medical Center

Pelvic Floor Level 1 - Boston, MA (SOLD OUT!)
Jun 12, 2015 - Jun 14, 2015
Location: Marathon Physical Therapy