pelvic health physiotherapy women’s health what’s … · 2018-05-22 · developed by birgit...
TRANSCRIPT
PELVIC HEALTH PHYSIOTHERAPY
WOMEN’S HEALTH
WHAT’S WE KNOW?
WHAT’S NEW?
WHAT WILL YOU DO
TO IMPROVE PELVIC HEALTH?
MARY WOOD
CURA PHYSICAL THERAPIES
SESSION OUTLINE
Overview of pelvic health conditions ( incontinence and
pelvic pain) costs of conditions
Techniques all physiotherapists can do to promote pelvic
health
New Information
I took this webinar because:
I already do pelvic health physiotherapy
I am interested in expanding my practice into pelvic health
physiotherapy
I want to learn what a general physiotherapist can do about
pelvic health conditions
Other:
WHAT WE
KNOW
CANADA IS LEADER IN PELVIC HEALTH
RESEARCH , TREATMENT AND
EDUCATION
-Incontinence
-Sexual health
-POP ( Prolapse)
-International Health – Lois Hole Hospital , Dianna
MacDonald
-Pelvic Pain
-Pelvic Health Education
-Diastasis Recti Abdominus Nadia Keshwani
PELVIC FLOOR
MUSCULATURE
CURA Physical Therapies 6
PELVIC FLOOR MUSCLE
FUNCTION
Sphincters – Bladder and Bowel
Supports – Musculoskeletal and Visceral
Stabilizers – core engagement
Synergists
Sexual
Sump-pump - lymphatics
pSychological
Pelvic Floor Muscles are Primarily Tonic Type 1
7
one in three women wet themselves
stress incontinence has about an 80% cure rate
IN SPITE OF GOOD EVICENCE
We are NOT Doing a good job…
Vaginal prolapse can be managed with physio
About 50% of women over 50 have a vaginal prolapse
FASCIA
PF IS NOT A HAMMOCK
9
WE KNOW
30% of women have leakage problems
PFMT can cure symptoms (short term) in 80%
Female Athletes are leaking
PFMT improves symptoms
50% of women over 50 have signs of pelvic organ prolapse
Physiotherapy and PFMT improves symptoms
Pelvic Pain
Physiotherapy is number one recommended conservative treatment requires a biopsychosocial approach
WE KNOW
Pregnancy and Birth
45% of women have pelvic girdle pain
30% will have leakage
Physiotherapy is first line treatment to improve symptoms
and function
PFMT in group settings prevents incontinence
COMMON MYTHS PERSIST
Bladder leakage (i.e. urinary incontinence) is a normal part of
aging
Only women have bladder leakage
Constipation is normal
Only Specialist physiotherapists can treat pelvic health
symptoms.
12
PREVALENCE -ALBERTA
Women Leaking ? 500000 tween 15-80
Women with POP? 140,000 ( 50 % of women over 65)
Men 23,000 ( 10% over age 65)
Women with cyclical pelvic pain ~ 400,000
Women with PGP 22,000
COST OF INCONTINENCE
Canadian Continence Foundation
(2012) $2.5 BILLION on products ( IE pads,etc) for moderate to severe incontinence
Total cost for female incontinence Extropolatedfor Canada from Australian 2010 research
( excluding
$65 BILLION per year
COST OF CYCLICAL PELVIC PAIN
(ENDOMETRIOSUS)
Australian Paper looking at costs of cyclical pelvic pain -
endometriosus
$ 6 Billion dollar woman - $600,000 Girl ( additional $600,000
if including parental time off, etc)
Canadian Estimate
$9 Million Dollar Woman - $1 million dollar girl
WHAT ARE WE MISSING?
Irish Study 2014 PRE PREGNANCY status n= 827
19 % had leakage symptoms
12 % had frequency and urgency
10 % bothered by bladder problems
50 % had constipation problems
30% had pain with intercourse ( 10% bothered)
>5% Prolapse symptoms
16
“It is indeed astonishing, that
given the high prevalence of incontinence,and the
physical, social and financial burdens of this problem,
that so many people experiencing incontinence
cannot find appropriate treatment”
© 2001 The Canadian Continence Foundation
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COCCYGEAL MOVEMENT TEST
PELVIC FLOOR SCREENING TOOL
Sensitivity = 97%, Specificity = 77% (Stensgaard et al., 2014)
Useful for assessing pt’s ability to locate PFMs
difficult to assess PFM relaxation post-contraction
COCCYGEAL MOVEMENT
TEST
Start Position on Sacrum
And bottom of PSIS
Slide hand down until you are
on coccyx
Index and ring finger in space
below and lateral to Inferior
Lateral Angle ILA of sacrum
ALWAYS LOWER THAN YOU
THINK
COCCYGEAL MOVEMENT TEST
Patient - Sitting with feet support
PT Standing facing patients side, posterior hand palpating
Base of palpating hand on sacrum, tip of middle finger on
tip of coccyx, index & ring fingers spread apart monitoring
gluteals
Instruct patient to “pull pubic bone and tailbone together and feel
a lift inside”
Should feel subtle coccyx flexion during contraction with middle
finger. Should NOT feel large contractions with Index or ring
fingers (on gluteals)
CALL TO ACTION
After this explanation would you use the coccygeal
movement test in your practice/ assessment :
Yes
Already use this technique
No, Need more training
No- not applicable to my practice
SACROCOCCYGEAL MOBILIZATIONINDICATION Poor Coccygeal movement test
Decreased Extension compared to flexion in standing and
sitting.
POSITION:
Patient position: Prone, ~20° hip abduction, IR
PT position: facing pt’s side,
-cranial hand thenar eminence on sacrum to stabilize,
- caudal hand thenar eminence on coccyx
Technique : apply gentle PA with caudal hand, continuing to
stabilize sacrum using gentle counterpressure with cranial
hand
Test/re-test task: lumbar extension
CALL TO ACTION
After this explanation would you do
sacrococcygeal mobilizations in your practice:
Yes
Already use this technique
No, Need more training
No- not applicable to my practice
EDUCATION PROGRAMS
Dr Wagg (Glenrose Continence Program)
Research on group education programs throughout Alberta
Simple Information sessions about bowel and bladder habits
PROGRAMS AVAILABLE:
AHS Incontinence Program has Mandatory sessions for
those seeking treatment for incontinence
CURA opens these sessions to the public to attend
AHS Teleconferences from Lois Hole
PFMT PELVIC FLOOR MUSCLE TRAINING
BEYOND KEGELS’
“IUGA and ICS Joint report on the terminology for the
conservative management for female pelvic floor
dysfunction” ( 2016) strongly recommends to not use
“Kegel” for Pelvic Floor Training
PFMT Pelvic floor muscle training better terminology as
exact form of exercises will vary with person and
condition
GROUP PROGRAM AT CORBETT HALL
FOR POST PROSTATE RECOVERY
Group exercise program for men post prostatectomy
Sponsored by Movember project
780-492-6007
GROUP CLASSES FOR
PFMT IN ALBERTA
APPS12 Found online
Which one???
Reminders for PFMT
eg Pelvicfloorfirst Australia
Squeezy NHS UK
PFMT with Pressure apparatus
(Virtual Reality Games being tested)
FUNCTIONAL PFMTPelvic Floor contractions have long been part of yoga and
pilates
Hypopressive Low Pressure Fitness
Developed by Belgian Physiotherapist
Marcel Caufriez
CORE ENGAGEMENT
Ultrasound Biofeedback for
assessing
SUPPORTS- PESSARIES
Alberta Physiotherapists being trained to fit pessaries - Red
deer course 2016
Impressa – poise for incontinence
BLADDER AND BOWEL
HABITS
Incontinence Products
Constipation - Squatty Potty.
GUIDED IMAGERY
Pelvic Health Solutions Imagery for Urgency
POSTERIOR TIBIAL
NERVE STIMUMLATIONMACHINE $2000
LEADS $50 EACH TIME
OFFICE VISIT
TENS MACHINE $80 -100
LEADS REUSABLE
HOME TREATMENT
KTAPING FOR PELVIC AND
WOMENS HEALTH
Developed by Birgit Kumbrink and Ktaping Academy
Germany
Next Course Oct 21-22 Edmonton
Instructor Lois Pohlod
Contact
PREGNANCY
BIRTH AND
POSTPARTUM45% have PGP = 22500 women per year
Birth Injury 18% Instrument Birth 9900
30% Caesarean Birth = 15000 women
Post partum Prolapse
Post Partum Dyspareunia
Increased Incontinence
PREGNANCY
REDUCE FEAR
Coccygeal Movement test PFMT Focus on relaxation
If leakage
Check for DRA if present –PF hypertonic focus on relaxation
Implications???
PFMT in pregnancy
KTAPING
BIRTHINGPain education
Birthing Positions _ Sidelying best for reduced trauma
Perineal Massage in last 5 weeks Cochrane review 2013
Epino not superior to massage
DIASTASIS RECTUS
ABDOMINUS (DRA)
CURA Physical Therapies 42
Separation of the rectus abdominus at the linea alba
Clinical Implications:
Unsure from research results
SCREENING FOR
DIASTASIS RECTI
•Patient in hook lying
•Physiotherapists sssessing fingers are horizontal.
• Check (1) superior border of the umbilicus, (2) 1 hand width above umbilicus and
(3) 1 hand width below umbilicus
•Request head lift and check for width and depth of separation just as head lifts
•Palpate down midline from xiphoid to pubis
•Any gap greater than 2 fingers is considered clinically significant
•To check if functional DrA: Request gentle core contraction and retest – should
feel more tension at the midline (i.e. not as “deep” of a separation as before)
43
CALL TO ACTION
After this explanation would you do
DRA Screening in your practice:
Yes
Already use this technique
No, Need more training
No- not applicable to my practice
POST PARTUM
CAESAREAN BIRTH
Scar Massage with Dycem
Initially with induction
Ktaping or Crosstape
POST PARTUM
Ktaping for DRA
Ktaping for Breast Engorgement
Ktaping Course for women
Oct 21-22 Edmonton Lois Pohlod
www.k-taping.ca
COLLABORATION WITH
Other Physiotherapists
Personal Trainers
Industry
REFERRING TO PELIVC
HEALTH PHYSIOTHERAPY
I have good collaboration with pelvic health physiotherapists
I don’t know who to refer to
Service is too expensive for patients
Service is too far for patients to travel
Patients report the service did not meet their needs
PELVIC PAIN
Biopsychosocial Approach
• Vandyken CV Hilton S/ Physical Therapy in the
Treatment of Central Pain Mechanisms for Female Sexual
Pain Sexual Medicine Review 2017
2016 2015
Book DVD
COURSES TO BECOME A PELVIC HEALTH
PHYSIOTHERAPIST
• Medbridge online courses http://www.medbridgeeducation.com/
• Dianna MacDonald Edmonton RAH –[email protected] Introductory courses in spring and fall
• www.pelvichealthsolutions.ca Carolyn VanDyken and Nellie Faghani, Ontario and across country Introductory to advanced
• http://www.physiourosante.com Marie Josee Lord and Claudia Brown – Quebec and across country Introductory to advanced , French and English
• hermanwallace.com Leaders in PH education in USA
• www.womenshealthapta.org/credentialing/opportunities.cfm APTA Women’s Health Division
• Australia – certificate courses available at Curtin University
50
RESOURCES
www.physiofloorfirst.org.au
Your body after Baby PABC Handout Will be in resource
package
CALL TO ACTION
After this webinar I will:
Ask questions about pelvic health symptoms
Use Coccygeal Movement Test
Use Sacrococcygeal Mobilizations
Screen for DRA
Treat Pregnant women
Interested in Ktaping course
