Pelvic Floor Dysfunction

Question 1

Pelvic floor innervation + nerve roots

Answer 1

Pudendal nerve
S2, S3, S4
Branches off sacral plexus

Question 2

How do you assess pelvic floor function

Answer 2

Digital 
EMG 
Menometer 
Dynamometer 
Real time US 
MRI 
Biofeedback

Question 3

Definition of chronic pelvic pain

Answer 3

Pain for >3months between diaphragm & knees

Question 4

Cause of Chronic pelvic pain

Answer 4

MSK
Neuro
Gynecological
urogenital

Question 5

Typical age for chronic pelvic pain

Answer 5

25-35 years

Question 6

Ax for chronic pelvic pain

Answer 6

Urogenital s&s
Lumbar/pelvic/groin mechanical presentation
Core activation difficulty

Question 7

Rx for chronic pelvic pain

Answer 7

• Decrease pelvic floor resting tone
• Increase pelvic floor proprioception
• Increase motor control
• decrease pain sensitizationi

Question 8

Pelvic girdle pain occurs in ____% of pregnancies

Answer 8

50%

Question 9

What is the cause of pelvic girdle pain following/during pregnancies

Answer 9

Weakness/laxity of PFM during pregnancy/childbirth

Question 10

risk factors for pelvic girdle pain

Answer 10

Previous Hx of back pain/trauma

Question 11

Causes of pelvic girdle pain

Answer 11

• laxity
• Asymmetry
• inadequate motor control

Question 12

Pelvic girdle pain symptoms

Answer 12

• Pain: ant/lat/post pelvic, groin, ant/post thigh, abdomen, coccyx
• Pain With sustained positions (prolonged sitting/standing) OR
• Pain With transitional movements: rolling, sit-to-stand, walking, stairs, dressing

Question 13

Pelvic girdle pain signs

Answer 13

• Posture : locked knees, L-spine lordosis, thoracic kyphosis, FHP
• Asymmetry: standing & supine
• Gait: shuffling, waddling, leg drag

Question 14

Pelvic girdle pain Ax

Answer 14

o	ASLR with force/form closure 
o	Hip quadrants (ER/IR)
o	SIJ stability  P4, Gaenslen’s, FABERS, palpation (long dorsal ligament)
o	TOP spinous processes 
o	TOP piriformis 
o	Resisted Hip ADD/ABD

Question 15

Pelvic girdle pain Rx

Answer 15

o Education  positions to avoid, movement strategies
o Posture
- Standing – lift chest, soften knees, equal weight distribution
- Sitting – lumbar support, knees at hip height or lower
- Sleeping – pillow to maintain neutral neck, offer support
o Manual therapy
o Exercise  stabilize, symmetry
-PFM ex’s (overload mm w/ longer holds, shorter rest, w/ fx movements)
- Maintenance – 8-12 contractions, 2x/wk
o Movement strategies
- Use glutes (NO rotation

Question 16

Pelvic girdle pain may progress into what other conditions

Answer 16

• Cystocele - Herniation of bladder into vagina
• Rectocele - Herniation of rectum into vagina
• uterine prolapse - Herniation of uterus into vagina