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Pelvic Floor: the missing piece of the puzzle?

When I am evaluating a new injury and/or pain complaint, many times part of my questioning will be about a patient’s pelvic health. Do you suffer from any incontinence… urinary or bowel? Do you leak when you sneeze, cough, or exert yourself? Do you have pain with urination or intercourse?

I have gotten used to those perplexed looks I get. Why are you asking if I leak when I sneeze, when I’m here for knee pain while running? I’ll quickly explain the impact of your pelvic floor muscles on your core stability and how that can impact how well you can absorb impact or move.

What is your pelvic floor?

Your pelvic floor muscles are essentially a hammock in your pelvis that help support some of your organs (bladder, uterus, bowels, etc). Like all muscles you can injure your pelvic floor, they can be weak, they can be overactive or what some call “tight”.

Your pelvic floor muscles work in conjunction with your deep abdominal muscle, transverse abdominis, and diaphragm to create your core. The analogy of a can is generally helpful to visualize how they work together. Imagine a soda can. The wall of the can is your transverse abdominis. The top of the can is your diaphragm. The bottom of the can is your pelvic floor muscles. You need all 3 walls to hold pressure within the can. If you pop the tab open or puncture a hole in the side, you lose the pressure that was stored within the can.

What does my pelvic floor have to do with my injury?

If you have weak pelvic floor muscles, you can imagine that as a hole in the bottom of the can. That means you will not have the strongest core in which to operate. If your core is not strong enough, then it does not stabilize your trunk as effectively, so other muscles or joints have to pick up the slack. This is why I ask about someone’s pelvic floor function when they have knee pain.

Movement does not happen in isolation, so we need to assess all component parts in order to better understand why this part, this joint, this muscle, this ligament was overworked.

I’ve never been pregnant, how can I have pelvic floor dysfunction?

Any person can have pelvic floor dysfunction regardless of having been pregnant and/or delivering a baby. We all develop different movement habits overtime that can lead to either weakness or overactive pelvic floor muscles. And like all injuries, many people have no pelvic floor issues. However, for the people that do suffer from leaking or painful intercourse, or other pelvic floor symptoms, you do not have to live with this. These individuals would benefit greatly from a pelvic floor therapist’s evaluation.

Pelvic Floor Therapy

A physical therapist has to obtain additional training in order to evaluate someone’s pelvic floor function. An assessment will entail questions to get a better sense of your symptoms and general pelvic floor function. These questions can provide a lot of insight before any physical exam is performed. A pelvic floor examination will be performed only if indicated and if you feel ready. Pelvic floor therapy then looks alot like physical therapy for other issues! You’ll work on exercises to strengthen what’s weak, work on coordination, and stretches to help what’s tight.

If you feel like there’s something missing in your rehab plan or you suspect you may have some pelvic floor dysfunction, Dr. P.J. is ready to help! Dr. P.J. obtained post-doctoral training in pelvic floor therapy from the American Physical Therapy Association in order to address pelvic floor dysfunction.


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