Keywords: Female runner, Pelvic floor dysfunction, PT Management spectrum
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1 Management of Pelvic floor dysfunction in Female runners Combined Sections Meeting 2017 New Orleans, LA February 23, :00 am 12:00 pm We have no relevant financial disclosures or conflicts of interest to report with respect to this presentation. Course description: Pelvic floor dysfunction among female runner is said to be an epidemic by some sports medicine experts. Statistics show at least one in every four women reports having one or more pelvic-floor disorders, defined as urinary incontinence, fecal incontinence, and pelvic organ prolapse. But these are only the reported cases. Much research has noted the importance of a strong core for female athletes, but the pelvic floor musculature is not often included in this need. The pelvic floor musculature can play a major role in core stabilization, injury prevention and performance enhancement for the female runner. Keywords: Female runner, Pelvic floor dysfunction, PT Management spectrum Speakers Kari Brown-Budde PT, DPT (Board certified specialist in Sports Physical Therapy) Angela Dukaric-Page PT Phil Page PhD, PT, ATC (Fellow, American College of Sports Medicine) Teresa L. Schuemann PT, DPT, ATC (Board certified specialist in Sports Physical Therapy) General Outline 10:00 10:05 am Introduction of the Session: Teresa Schuemann 10:05 10:25 am The role of the core for postural stability: Phillip Page 10:25 10:45 am Evaluation & Assessment of the Female Runner: Kari Brown-Budde 10:45 11:10 am Pelvic Floor Screen & Preliminary Management techniques: T Schuemann 11:10 11:30 am Pelvic floor evaluation & Complicated management: Angela Page 11:30 11: 50 am Return to running management: Kari Brown-Budde 11:50 12:00 pm Questions & Answers - whole panel Session Objectives Upon completion of this session, the participant will be able to: 1. Understand the role of the core musculature in providing intra-abdominal pressure and postural stability 2. Complete an evaluation of a female runner. 3. Complete a pelvic floor musculature screen and provide preliminary management techniques. 4. Understand the necessity for a referral for a more complete pelvic floor evaluation and management by qualified physical therapy colleagues. 5. Design a complete rehabilitation program for a female to address all components of her needs and allow full return to running.
2 The role of the core for postural stability (Phil Page) What is core stability? Historical Global Perspectives US Australia Canada Europe The Core System : from Structure to Function Muscular Anatomy Sensorimotor Function The Role of the Core in the Movement System Developmental Perspective Chain Reactions The Role of the Core System in Dysfunction Stability vs. Mobility Are Core Stability & Athletic Performance related? Evaluation & Assessment of the Female Runner (Kari Brown-Budde) Key Female-Specific factors / red flags from history / examination: Pregnancies Childbirth type of birth (caesarian or vaginal) Urinary or fecal incontinence and type h/o low back or hip pain Other Mobility Spine Pelvis LE Stability Trunk Pelvis LEs Tissue Trunk Pelvis LEs Functional Special testing
3 Screening Work and ADL specific Sitting, standing, caretaking, lifting Sport specific running analysis If Appropriate / When Appropriate Video Running Gait Analysis Potential Gait Retraining Pelvic Floor Screen & Preliminary Management techniques (Teresa Schuemann) Screening Questions Do you: (Yes/No) Accidently leak urine when you exercise, play sport, laugh, cough or sneeze? (muscular tone) Need to get to the toilet in a jury or not make it there in time? (urgency) Constantly need to go to the toilet? Find it difficulty to empty your bladder or bowel? Accidently loose control of your bowel or accidently pass wind? Have a bulge or feeling of heaviness, discomfort, dragging or dropping in the vagina? (prolapse) Suffer from pelvic pain or experience pain during or after intercourse? Surface Palpation Landmarks Regions Anal triangle Urinary triangle Musculature Adductors Adductor magnus Adductor brevis Gracilis Adductor longus Pelvic floor (PF) musculature (mimic of Piriformis syndrome) Obturator Internus Gemelli Objective Measures Muscular Contraction Palpable - Yes/No Resultant movement (anal winking, genitalia nodding) Symmetry Look for buttock grippers Lateral rotation by OI Increased tone/contraction of PF Resultant Anterior hip pain and possible impingement (Lee & Lee) Soft Tissue Techniques Deep Tissue Massage Instrumented Assisted Soft Tissue Mobilization (IASTM) Dry Needling
4 Neuromuscular training Contract/relax Sustained contraction Flicking Biofeedback (contraction/pooching) Pelvic floor In-depth evaluation & management (Angela Page) Pelvic Floor History Births Trauma Gynecological conditions Bowel and Bladder History Urine/Fecal leakage Constipation Family History Pain External Assessment Tissue health atrophy, errythema, discharg Painful palpation Prolapse Transverse Abdominus coordination Intravaginal Assessment Superficial vs. Deep Tissue bulk Painful palpation Hypertonus/Muscle spasms Numbness Scarring Pelvic Floor Strength Laycock scoring system Strength and endurance Pelvic Floor Dysfunction Incontinence Prolapse Dyspareunia Vaginismus/Levator Ani Syndrome Physical Therapy Intervention Neuromuscular Re-education Intravaginal electrical stimulation Manual therapy Pelvic Floor/Transverse Abdominus coordination
5 Bladder Retraining Return to running management (Kari Brown-Budde) How and When? Heal Tissue Move Well Retrain Movement / Return to Running Factors for Return to Running Prior Level of activity / mileage Type and severity of injury / dysfunction Stage of Injury Event and Distance Running - Specific Needs Risk Factors for Reinjury Must address due to high rate of recurrence in runners Extrinsic Training Errors Inadequate Equipment Intrinsic Metabolic Musculoskeletal Timelines Injury / Dysfunction type dependent Current Physical Status Isolated Work Combined Movements / Joints / Power Progress Length, Velocity, Load, Complexity Surface, Speed, incline Running Specific Kinematic / Functional Tests Running Gait and Technique through Gait Analysis Progression through Return to Running Program References Frank C et al. Dynamic neuromuscular stabilization and sports rehabilitation Int J Sports Phys Ther : Feb;8(1): Pel, et al. Biomechanical Analysis of Reducing Sacroiliac Joint Shear Load by Optimization of Pelvic Muscle and Ligament Forces Ann Biomed Eng Mar; 36(3): Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. Postural function of the diaphragm in persons with and without chronic low back pain. J Orthop Sports Phys Ther. 2012;42(4):
6 Shamrock et al. A pilot study of core stability and athletic performance: is there a relationship? Int J Sports Phys Ther Jun; 6(2): Blyhoder L, Chumanov E, Carr K, Heiderscheit B. Exercise behaviors and health conditions of runners after childbirth. Sports Health (Epub ahead of print) Borello-France DF, Downey PA, Zyczynski HM, Rause CR. Continence and quality-of-life outcomes 6 months following an intensive pelvic-floor muscle exercise program for female stress urinary incontinence: a randomized trial comparing low- and high-frequency maintenance exercise. Phys Ther. 2008; 88: Constantinou CE. Dynamics of female pelvic floor function using urodynamics, ultrasound and magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol. 2009; 144(1): S
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FEMALE SYMPTOM MONITOR
FEMALE SYMPTOM MONITOR Name: Occupation: Date: Age: Complaints: 1. 2. 3. GYNECOLOGICAL HISTORY: # pregnancies: # live births: Wt. heaviest baby: lbs oz Length pushing stage: hours Forceps? Yes No Episiotomies?
Women's physiotherapy
The women s health physiotherapy outpatient team treats a variety of conditions affecting women: chronic pelvic pain urinary incontinence birth-related perineal trauma antenatal and postnatal musculoskeletal
Advanced Care for Female Overactive Bladder & Urinary Incontinence. Department of Urology Kaiser Permanente Santa Rosa
Advanced Care for Female Overactive Bladder & Urinary Incontinence Department of Urology Kaiser Permanente Santa Rosa Goals Participants will: Review normal urinary tract anatomy and function Understand
Provenance Rehabilitation Pelvic Intake Form
Patient Name: Age: Weight: Gender: Male Female Provenance Rehabilitation Pelvic Intake Form Date: DOB: Occupation: Relationship Status: Hobbies / Leisure Activities: Exercise Routine: Briefly describe
Pelvic Floor Exercises
Pelvic Floor Exercises Information for service users and carers RDaSH leading the way with care Pelvic Floor Muscles The pelvic floor muscles are a sling of muscles across the floor of the pelvis. The