Saturday, June 7, 2008

The Pelvic Floor and an Unexpected Lesson...
It's been six months since starting this blog and I'm amazed what the process has taught me to this point. Sitting down in front of a computer has given me numerous opportunities to learn more about our profession, enhance my clinical skill, and in this case, grow up a little.

If you know me personally, I tend to be a pretty fun-loving and somewhat irreverent guy who is prone to cracking wise about a variety of topics. In most settings, this characteristic is simply what makes me "me". In the context of a public discussion on a physical therapy website, it could transform "me" into a bit of a jerk.

I recently made a pretty insensitive comment regarding pelvic pain on the Rehab Edge forums. I won't delete the post as accountability and transparency is something I believe in and don't think running away from what I said is the right approach. In response to my comments, two ladies associated with a blog called Pelvic Pain Matters descended upon me with what turned out to be understandable mix of outrage and disappointment.

With a strange sense that I really might have stepped in it with my comments, I ran them by my wife, mother, and academic mentor from physical therapy school. The result of my informal poll was unanimous and a bit humbling: I was a total jerk for what I said. Not the easiest things to hear from three people who you respect and admire, but the consensus struck a chord nonetheless.

Pelvic floor dysfunction is not an area I have previously held any interest in addressing as a orthopedic clinician. In fact, it is not likely to ever be an area I develop a strong skill set in assessing or managing. However, it is worth noting that pelvic floor dysfunction is a distinct clinical issue that can be present in a broader population than I had previously understood.

JOSPT: Lumbopelvic dysfunction, Incontinence, and the use of Rehabilitative Ultrasound

In keeping with the theme of this blog, today's entry comes to us from JOSPT on the topic of lumbopelvic dysfunction and stress urinary incontinence. The paper is a case study on a 35 y/o female soldier presenting with stress urinary incontinence and left buttock pain. These symptoms were limiting her tolerance for physical activity necessary to complete basic training.

The study's authors utilized a multimodal approach to managing what was determined to be an SIJ dysfunction coupled with active pelvic floor insufficiency contributing to stress incontinence. Of particular focus in the study was the use of rehabilitative ultrasound as a biofeedback device to retrain the pelvic floor musculature.

At a six-week follow up, the patient had no subjective or objective signs of SIJ dysfunction or stress urinary incontinence. This allowed her to complete all the requirements of basic training without limitation. A six month telephone follow up was equally positive with no evidence of lumbopelvic dysfunction or incontinence.

What can this study tell the orthopedic therapist?

While I wasn't bowled over with the methodology or outcomes of this particular study, I did learn quite a bit regarding pelvic floor dysfunction. Firstly, I discovered just how prevalent pelvic floor pain and/or dysfunction can be in both men and women. Secondly, I got a better appreciation for the biomechanics of the pelvic floor and its possible role in low back pain. Lastly, I gained an appreciation for another clinical syndrome physical therapists may be able to benefit.

What has this process taught me?

Well...that remains to be seen! Some might say you can take the boy out of the locker room but it's hard to take the locker room out of the boy. I might agree with this statement. However, there comes a time when us boys have to realize we are professionals and people do read what we say on blogs and internet forums. I make no guarantees of future perfection. In fact, I'm more prepared to guarantee future imperfection. That doesn't mean I can't grow up along the way. Have a great day.

Painter, E.E. (2007). Lumbopelvic Dysfunction and Stress Urinary Incontinence: A Case Report Applying Rehabilitative Ultrasound Imaging. Journal of Orthopaedic and Sports Physical Therapy DOI: 10.2519/jospt.2007.2538

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