- Postpartum Diastasis Rectus Abdominis - Considerations For Exercise
- Understanding Your Back Pain
- Myths and Facts and the SacroiliacJoint What does the Evidence Tell Us?
- Pelvic Stability & Your Core
- Stress Urinary Incontinence & The Pelvis
- Are you Really Contracting Your Pelvic Floor?
Postpartum Diastasis Rectus Abdominis - Considerations For Exercise
Written by Diane Lee BSR, FCAMT, CGIMS
Pregnancy-related pelvic girdle pain (PRPGP) has a prevalence of approximately 45% during pregnancy and 20 - 25 % in the early postpartum period. Most women will become pain free in the first 12 weeks after delivery however; 5-7% will not. In a large postpartum study of prevalence for urinary incontinence (UI), Wilson et al (2002) found that 45% of women experienced urinary incontinence at 7 years postpartum and that 27% who were initially incontinent in the early postpartum period regained their continence while 31% who were continent became incontinent. Clearly, for some women, something happens during pregnancy and delivery that impacts the function of the abdominal canister either immediately, or over time. There are many things that can explain these statistics, diastasis rectus abodminis or separation of the abdominal wall, is one. Download this article to read more about this topic and to learn when to refer your client for a complete examination of their abdominal wall.
Understanding Your Back Pain
Written by Diane Lee BSR, FCAMT, CGIMS
Back pain happens to everyone and for some is a life changing occurrence. The causes are as many as there are structures capable of producing pain; and every tissue in the body is capable of giving us pain. Help from the health care profession is sought when the pain is severe enough to interfere with activities we need, or want to do. What happens next depends on who you choose to consult. There are many health care practitioners who treat back pain - the family doctor, chiropractor, physiotherapist, massage therapist, acupuncturist, orthopaedic surgeon, neurosurgeon, anesthetist, rheumatologist, psychiatrist and psychologist to name but a few. Each approaches your problem from a very different perspective which is based on their formal training and their clinical experience. Their training/experience helps them to develop models some of which are based on scientific principles and some on long time common thought.
Back pain has been subjected to scientific research, so what does the research tell us. First of all consider the questions we have asked in the research. It's important to understand the question because it ultimately directs the answer. If one is interested in understanding "What structure is responsible for an individual's pain?" then the research will focus on specific anatomical parts capable of generating pain. Entire models for both assessment and treatment of the low back have been developed following this line of questioning. Highly sophisticated imaging techniques and surgical procedures have been developed to address this question - "What is hurting?". This would be useful clinically if only one structure was responsible for an individual's pain. Unfortunately, multiple structures are often the problem and it is not possible to identify them individually. So we see diagnoses such as 'non-specific low back pain". In other words, the pain is not specific to any identifiable structure however, your low back pain is acknowledged. Even if we did know what structure was responsible for the pain, this would not help us in treatment unless all we wanted to do was cut it out or numb it with an anaesthetic - sometimes this is necessary but rarely is this all that is needed.
What information would be gained if the initial research question was "Why is the low back or pelvis painful?" "Why is the back no longer able to sustain or transfer the loads, stand, sit, lift or twist?" To answer these questions, the research must explore how the region functions in order to appreciate why breakdown and pain have occurred. Much research has been done with these questions in mind and today we have a new model which considers both function and how emotional factors such as stress and anxiety can influence the pain experience. Download this article to learn more about the functional model we use at Diane Lee & Associates to treat back pain.
This article can be listened to as a video cast by clicking here.
Myths and Facts and the SacroiliacJoint What does the Evidence Tell Us?
Written by Diane Lee BSR, FCAMT, CGIMS
Modified from a Chapter Published 2007 in: Vleeming A et al eds. 2nd edn. Movement, Stability & Lumbopelvic Pain: Integration of Research and Therapy
The pelvic girdle is a source of mystery to many health practitioners and yet amongst some there is a long held belief that it plays a significant role in low back pain. In the past, models for assessment and treatment of the pelvic girdle were taught by experienced clinicians whose protocols and techniques were accepted without scientific evidence of reliability or efficacy. Recently, some of these long held beliefs have been challenged for their apparent lack of reliability, sensitivity and specificity. This article will outline the evolution of some of these myths and what the recent research has revealed regarding them. In addition, some of the conclusions from this research will be challenged in the hope of preventing the perpetuation of more myths. The gap between what we know about the function of the pelvic girdle and what we need to know as clinicians treating pelvic girdle pain will be outlined and suggestions for future research offered.
Pelvic Stability & Your Core
Written by Diane Lee BSR, FCAMT, CGIMS
Presented in whole or part at the: American Back Society Meeting - San Francisco 2005 BC Trial Lawyers Meeting - Vancouver 2005 Japanese Society of Posture & Movement Meeting - Tokyo 2006
Introduction
A primary function of the pelvis is to transfer the loads generated by body weight and gravity during standing, walking, sitting and other functional tasks. How well this load is managed dictates how efficient function will be. The word 'stability' is often used to describe effective load transfer and requires optimal function of three systems: the passive (form closure), active (force closure) and control (motor control) (Panjabi 1992). Collectively these systems produce approximation of the joint surfaces (Snijders & Vleeming 1993a,b). The amount of approximation required is variable and difficult to quantify since it depends on an individual's structure (form closure) and the forces they need to control (force closure). The following definition of joint stability comes from the European guidelines on the diagnosis and treatment of pelvic girdle pain (Vleeming et al 2004).
Definition of Joint Stability
"The effective accommodation of the joints to each specific load demand through an adequately tailored joint compression, as a function of gravity, coordinated muscle and ligament forces, to produce effective joint reaction forces under changing conditions. Optimal stability is achieved when the balance between performance (the level of stability) and effort is optimized to economize the use of energy. Non-optimal joint stability implicates altered laxity/stiffness values leading to increased joint translations resulting in a new joint position and/or exaggerated/reduced joint compression, with a disturbed performance/effort ratio."
(Vleeming A, Albert H B, van der Helm F C T, Lee D, Ostgaard H C, Stuge B, Sturesson B).
Based on this definition, the analysis of pelvic girdle function will require tests for excessive/reduced joint compression (mobility) as well as tests for motion control of the joints (sacroiliac (SIJ) and pubic symphysis) during functional tasks (one leg standing, active straight leg raise). Motion control of the joints requires the timely activation of various muscle groups such that the co-activation pattern occurs at minimal cost (minimal compression or tension loading and the least amount of effort) to the musculoskeletal system. Analysis of neuromuscular function will require tests for both motor control (timing of muscle activation) and muscular capacity (strength and endurance) since both are required for intersegmental or intrapelvic control, regional control (between thorax and pelvis, pelvis and legs) as well as the maintenance of whole body equilibrium during functional tasks. Treatment protocols should include techniques to reduce joint compression where necessary, exercises to increase joint compression where and when necessary and education to foster understanding of both the mechanical and emotional components of the patient's experience.
Stress Urinary Incontinence & The Pelvis
Written by Diane Lee PT & Linda-Joy LeePT
Presented at the 5th World Congress on Lumbopelvic Pain in Melbourne Australia 2004
The research in the last decade has led to a clearer understanding of how load is transferred through the low back and pelvic girdle and from this research it is evident that low back pain and stress urinary incontinence have components in common. Recently, a multi-centered study in Holland investigated how common a combination of the two conditions (low back pain and stress urinary incontinence) was. In a study of 66 patients, 52% reported a combination of low back pain along with some form of pelvic floor dysfunction (voiding dysfunction, urinary incontinence, sexual dysfunction and/or constipation). Of these 52%, 82% stated that their symptoms began with either low back or pelvic girdle pain.
We now recognize that the factors which must be optimal for stability of the low back and pelvic girdle and those which must be present for closure of the urethra are the same. The goal of restoring motor control for the low back and pelvis is to ensure movement patterns that optimize the transference of loads through all the joints and organs. The result is stability with mobility, where there is stability without rigidity of posture, without episodes of collapse, and with fluidity of movement. In addition, the strategy used for stabilization should not induce excessive intra-abdominal pressure leading to bladder/uterus descent.
Your therapist at Diane Lee & Associates will give you a very thorough examination of the joints and muscles of your low back and pelvis as well as an assessment using real time ultrasound imaging to see what strategy you are using to transfer loads through your pelvis. An individual treatment program will be developed that is specific to your needs. Hopefully, you will learn to support the organs of your pelvis and keep them for a lifetime avoiding what we believe is NOT inevitable with time - stress urinary incontinence.
Are you Really Contracting Your Pelvic Floor?
Written by Diane Lee PT for Stott Pilates
The muscles of your pelvic floor are critical for optimal function of your low back, pelvis, uterus and bladder; yet according to Bump et al (1991) 50% of women do not know how to contract these muscles when given either a verbal or written command. This finding is not surprising since every vaginal delivery causes some soft tissue damage to the muscles of the pelvic floor and damage to their nerve supply in 80% of women, (Allen et al 1990). However, through the use of real time ultrasound imaging (see clinical services), it can be seen that even women who have not had children often have difficulty effectively contracting this muscle group. Ashton-Miller, Howard & DeLancey (2000) note that the prevalence of urinary incontinence is as high as 38% in women over the age of 40. It is unknown how many women undergo hysterectomy due to loss of function of their pelvic floor. We should all know how this muscle group functions and how to use it properly. Download this article to learn more about how to see if your pelvic floor is functioning effectively. If you are still not sure, come for an assessment where you can watch your pelvic floor work in real-time.
