The pelvic floor needs new PR! We need to take steps to break down the barriers for practitioners and patients 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 a lot of the 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 pelvic floor dysfunction such as core instability due in part to pelvic floor weakness after multiple births. 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 pain and the incontinence.
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 inner core, supports movement (studies show it turns on BEFORE even the shoulder muscles to lift the arm), and stabilizes the hip, pelvis and low back directly.
2. We need to build clinical models that trains 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, and 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? (Some of these can also clue you in for issues that men experience, too).
4. Practitioners need to recognize other indicators of pelvic floor dysfunction related to non-physiologic functions: pelvic instability, core weakness, trunk instability, balance dysfunction, postural dysfunction, hip instability, etc.
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.
Speaking of patients….time for the pitch to women (and men):
1. Let’s educate them about their pelvic floors, particularly the next generation of women. Let’s discuss it in a normalized way, educate them on the role it has not only in their postural stability, but their referring diagnosis (shoulder, hip, knee, low back). “Oh and by the way, it will help clear up the incontinence you keep hinting at.”
2. Let them know about the options that are out there to get help when they need it. 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.
3. External approaches indirectly intervene for some of these classically defined pelvic floor issues alongside common musculoskeletal issues, such as shoulders, hips, knees, low backs, etc., by integrating the pelvic floor into neuromuscular rehab and fitness programs. An external approach is like a gateway drug to the pelvic floor…let’s get ‘em hooked!
The pelvic floor is now table-talk approved! The campaign has begun…are you in?