This post was written by H&W faculty member Elizabeth Hampton, who will be debuting her course, Finding the Driver in Pelvic Pain, in May at Marquette University.
Your client presents with a referral from an OBGYN for evaluation and treatment of vulvodynia. During your evaluation, you confirm that she has pubic symphysis instability and that her vulvar pain reduces by 90% with use of a pelvic compression belt. How do you screen for musculoskeletal dysfunction as well as specific urogyn/colorectal and pelvic floor issues in these complex clients? How do you develop the clinical reasoning methods to prioritize evaluation and treatment interventions? If you send a report back relating her pain to pubic symphysis instability, will the physician think that they sent this client to a PT who doesn’t understand the pelvic floor?
Your next client presents with stress urinary incontinence during box jumps and running, however she has no pelvic floor laxity and her strength is 4/5 bilaterally. She denies leaking with coughing, sneezing, lifting, bending. You notice that she has failed load transfer with jumping, weak abductors and marked anterior pelvic tilt that becomes more exaggerated with jumping. Her thorax is rigid and her habitual breathing method is with full abdominal wall relaxation. She demonstrates that a ‘core contraction’ means to her and she holds her breath and bears down. Is this an unstable urethra due to fascial incompetence, poor motor control or is it driven by her poor shock absorbtion with plyometrics?
Part of the joy of working with clients with pelvic floor dysfunction is the ability to sleuth out musculoskeletal dysfunctions as a contributor and (at times) the primary driver of pelvic floor dysfunction. How do you assess a client who may have much co-morbidity that contributes to her pain? It can feel like there is so much to do and it is hard to know where to start.
The good news is that Herman Wallace has many educational resources to fill your toolbox relating to this topic. In the new course I am debuting through H&W, Finding the Driver in Pelvic Pain, fundamental screening tests for spine, pelvic ring, hip tests are integrated with direct PFM assessment to determine all factors in the evaluation of pelvic floor dysfunction.
Clinical Reasoning is an essential tool in the evaluation and treatment of clients with pelvic floor dysfunction as it enables differential diagnosis and prioritization of treatment interventions. The majority of clients with pelvic floor dysfunction have associated co-morbidities which may include labral tear, femoral acetabular impingement (FAI), discogenic low back pain (LBP), altered respiratory patterns, nerve entrapments, fascial incompetence or coccygeal dysfunction. These complex clients require the clinician to have a comprehensive toolbox to screen both musculoskeletal as well as pelvic floor dysfunctions in order to design an effective treatment regimen. This intermediate- level, 3-day course is designed for rehabilitation professionals treating pelvic pain and elimination disorders who seek additional skills in the evaluation and treatment of musculoskeletal co-morbidities as well as clinical reasoning with prioritization of interventions. Participants will be provided with differential diagnosis and clinical reasoning that can be applied to their clients immediately. Internal and external pelvic floor assessment is critical for evidence based evaluation and treatment of pelvic pain and elimination disorders. This data, along with the musculoskeletal screening, can determine if the pelvic floor dysfunction is the outcome or the cause of the problem. This intermediate level course is an excellent adjunct for clinicians interested in learning how to evaluate and prioritize the treatment interventions of clients with pelvic floor associated musculoskeletal dysfunction.
Want more from Elizabeth? Join us at Marquette University in Milwaukee, WI in May!