Do you find it difficult to examine a pregnant woman past her fith or sixth month when she may have difficulty lying supine? How do you alter or perform some of the special tests at that stage?
Answer
It definitely is difficult to examine a pregnant woman at this point when she cannot get onto her back. I would right away thinking of what tests I can do that are not in the supine position. I look at what I can do in standing. How does she look when she stands on one leg? Does she have the Trendelenberg? Does she have a positive Stork test? Does she have pain across the SI joint? In that one test, having her stand on a leg, you could get all three positive tests and make your diagnosis of pelvic girdle pain. You can get her into side-lying to do the SI Joint Compression and Distraction tests, or the Gaenslen’s test. The first part of our approach is to make the diagnosis. Once we make the diagnosis, we do not have to feel compelled to continue examination. I think that is one of the interesting things about us physical therapists. We think we have to do all the muscle testing and all the palpation. If we think about it, if we have made the diagnosis of this pelvic girdle pain, and you have someone who is in so much pain that she cannot lie on her back, we could begin treatment right away, right then and there. What I want to encourage you to do is move past the idea that you need to do every examination that you were taught. Make your diagnosis and start your intervention as soon as you possibly can with these patients. I think that will be very helpful for you. You might not be able to get her onto her back even after a couple of visits.
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Cynthia Neville, PT, DPT, WCS, BCB-PMD
Dr. Neville is a board-certified Women’s’ Health Clinical Specialist (WCS) and President of her consulting and education firm, Neville Know-How, Inc. She is currently providing clinical patient care as a pelvic health physical therapist and is an Associate Professor of Physical Therapy at Mayo Clinic, Jacksonville, Florida. A highlight of her career was developing the first credentialled Women’s Health Physical Therapy Residency Program in the state of Florida at Brooks Rehabilitation in Jacksonville. She has published several peer-reviewed research articles and textbook chapters. She has been practicing and teaching pelvic health physical therapy courses for over 30 years.
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