FILEX 2012 Pelvic Floor 3 ways. SUI in female athletes. Stresses on PFM funcbon 4/3/12.

Transcription

1 FILEX 2012 Pelvic Floor 3 ways Marie:a Mehanni Shira Kramer Michelle Wright 1 in 3 women who have had a baby (NCMS 2003) Ie more than diabetes (6.2%), asthma (12.7%), arthribs (21.2%), osteoporosis (4.8%) (Avery et al 2004) 50% over 50 will suffer prolapse (Tinelli A et al 2010) 46.2% of women have some major PFD (MacLennan et al 2000) Urinary InconBnence 12.8% 36.1% 35% 38 %(Bo et al 1994) GymnasBcs 67% Basketball 66% SUI in female athletes Tennis 50% Hockey 42% (Nygaards et al 1994) All 35 Swedish elite trampolinists > 15 years!! (Eliasson et al 2002) Stresses on PFM funcbon Can t Change Low oestrogen states - Childbearing years - Menopause - Ageing Birth/Delivery Can Change IAP - ConsBpaBon/chronic cough - Obesity - OccupaBons that require increased physical acbvity - Heavy lifing - Strain - Breath hold Exercise - Isometric/ durabon - Load - JolBng, bouncing - High impact exercise - Global > local abdominals DE- CONDIITONED INADEQUATE REST (OVERUSE) POOR PFM TECHNIQUE COMPROMISED PFM FUNCTION CAUSED BY POOR EXERCISE SELECTION FOCUS ON QUANTITIY > QUALITY 1

2 Fitness industry can stop this cycle Physio See those aware of the problem and how to fix it Assessment Diagnosis Individual management program Specific muscle retraining Fitness Industry Assist in iden<fying issues Stop women from suffering in silence Empower the rest to seek help Large exposure Normalise that things can go wrong General introduc<on to muscle group Break down barriers to lack of compliance Pelvic Floor DysfuncBon InacBvity Fear- avoidance HumiliaBon Future health problems Weight Gain Muscle weakness Depression Co- morbidibes Anatomy Clients/ parbcipants WITHOUT pelvic floor problem Program should address all muscle groups including the pelvic floor Cue core and floor prior to movement Clients/ parbcipants WITH pelvic floor problem Program should address all muscle groups including the pelvic floor Modify to include pelvic floor safe exercises Cue core and floor prior to movement Consider risk factors WholisBc team approach Educate and empower Educate and empower FuncBons 1. Maintains conbnence 2. Protects the spine 3. Supports the pelvic organs 4. Sexual funcbon 5. Controls emptying POOR Pelvic Floor Cues Tighten the abdominals Suck in Harder Brace Pull belly bu:on in Navel to spine 2

3 Cues To AcBvate Pelvic Floor Imagine a lif closing and lifing up Imagine stopping the flow of wind (in polite company) Imagine your mother in law walks in about to let one go Imagine your in a public toilet and friends have a juicy conversabon so you a:empt to quieten down your wee flow Imagine sucking a pea into the vagina Imagine stopping a tampon from coming out Imagine a plane taking off from the anus, vagina and urethra, up and above through the pubic bone at the front 1/3 OF WOMEN GET IT WRONG!! (BUMP ET AL 1996) Connect with your local women s health physio Invite them to present at your venue Devise program together Invite to your class Invite for PT session Refer your clients with a le:er or phone call A:end for an ultrasound / assessment Understand what each other does Referral Screening form Pelvic floor First When to refer - Accidentally leak urine when you exercise, play sport, laugh, cough or sneeze? - Need to get to the toilet in a hurry - or not make it there in Bme? - Constantly need to go to the toilet - Find it difficult to empty your bladder or bowel? - Accidentally lose control of your bowel or accidentally pass wind - Have a prolapse (e.g. a bulge or feeling of heaviness, discomfort, pulling, dragging or dropping in the vagina)? - Suffer from pelvic pain? Mish s 3 E s! educate exercise empower 3

4 educate Yourself to be the best possible trainer you can be to - create posibve difference in your clients - to be a client magnet Your clients - to train to their weakest link - asking the tough quesbons layering the exercises The exercise The breathing Pelvic floor acbvabon Exercise Use of visualisabon Pulling on a pair of 1950 s knickers they always have their crutch! Inhale and just think of your pelvic floor visualise it Exhale and visualise the pelvic floor is pushing the air out as it draws up Empower yourself your client 4

5 High and low impact Classes Body A:ack Body Combat Aerobics Boot Camp Crossfit Outdoor training Step workouts Barbell and weight training programs Cycling Water exercise 5

6 Abdominals Hovers and planks Your Client s RelaBonship with Fitball Pilates Yoga and other classes Referral Screening form Pelvic floor First When to refer - Accidentally leak urine when you exercise, play sport, laugh, cough or sneeze? - Need to get to the toilet in a hurry - or not make it there in Bme? - Constantly need to go to the toilet - Find it difficult to empty your bladder or bowel? - Accidentally lose control of your bowel or accidentally pass wind - Have a prolapse (e.g. a bulge or feeling of heaviness, discomfort, pulling, dragging or dropping in the vagina)? - Suffer from pelvic pain? Thank you for your Bme Want to promote pelvic floor safe exercise? Order Pelvic Floor First free resources I Sign up for Pelvic Floor First e- newsle:er Find out about news and events fitness@conbnence.org.au 6

7 Links CFA APA Australian conbnence FoundaBon PF First project screening tool h:p:// Pelvic_Floor_First/ pelvic_floor_screening_tool_for_women.pdf References Waetjen LE et al (2009): AssociaBon between menopausal transibon stages and developing urinary inconbnence. Obstet Gynecol 114 (5): Menopause and bladder and bowel control. ConBnence FoundaBon of Australia. The physiological basis of pelvic floor exercises in the treatment of stress urinary inconbnence. BriBsh Journal of Obstetrics and Gynaecology 105: Simard C and Tu le M (2010): Long Term Efficacy of Pelvic Floor Muscle RehabilitaBon for Older Women With Urinary InconBnence. J Obstet Gynaecol Can 32(12): Burger H (2008): The menopausal transibon- endocrinology. J Sex Med 5(10): References Polotsky HN and Polotsky AJ (2010): Metabolic implicabons of menopause. Semin Reprod Med 28(5): Most important ebological factors in the development of genital prolapse (2010): Srp Arth Celok Lek 138 (5-6): Bernstein I T (1997): The Pelvic Floor Muscles: Muscle Thickness in Healthy and Urinary- InconBnent Women Measured by Perineal Ultrasonography with reference to the Effect of Pelvic Floor Training. Estrogen Receptor Studies. 7