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.
Cynthia Neville, PT, DPT, WCS, BCB-PMD
Dr. Cynthia (Cindy) Neville, PT, DPT, WCS is Assistant Professor of Physical Therapy, Mayo Clinic Alix College of Medicine, in Jacksonville, Florida. She is a Women’s Health Certified Specialist (WCS), board certified by the American Board of Physical Therapy Specialties. She serves on the faculty of the Mayo Clinic Florida Orthopedic Physical Therapy Residency Program, and advises multiple medical specialty programs at Mayo Clinic Florida. Her outpatient clinical practice at Mayo Clinic Florida serves women and men with pelvic floor disorders. Dr. Neville has authored and co-authored several research articles and book chapters on the topics of pelvic health rehabilitation, pelvic pain, and urinary incontinence. She has presented her research and provided rehabilitation and medical education nationally and internationally. She has developed successful Pelvic and Women’s Health Rehabilitation Programs at premier healthcare organizations including the Rehabilitation Institute of Chicago (now the Shirley Ryan Ability Lab) and Mayo Clinic Florida. At Brooks Rehabilitation in Jacksonville, Dr. Neville developed the first institutional pelvic health rehabilitation program across all levels of care, and the first credentialed physical therapy women’s health residency program in the state of Florida. She has trained more than a thousand physical therapists, occupational therapists, physical therapist assistants, and physicians in pelvic floor examination and pelvic health rehabilitation.
Related Courses
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MRI studies show that with the performance of correct pelvic floor muscle contraction, the coccyx should move cranially, and with adequate pelvic floor muscle relaxation, the coccyx should move causally. This course examines the importance of the coccyx to the function of the pelvic floor muscles, discusses how coccyx impairments may contribute to pelvic floor muscle disorders, and explore physical therapy treatment options for coccyx impairments. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.
2https://www.physicaltherapy.com/pt-ceus/course/physical-and-occupational-therapy-treatment-4757Physical and Occupational Therapy Treatment Of Abdominal Scars, Adhesions, And Abdominal Cutaneous Nerve Entrapments. Quit Your Belly Aching!Abdominal scars, adhesions, and nerve entrapments are a source of abdominal and pelvic musculoskeletal pain symptoms. This course will examine and discuss physical and occupational therapist examination and treatment of musculoskeletal symptoms that may be caused by or associated with abdominal scars, adhesions, and abdominal cutaneous nerve entrapments.auditory, textual, visual
Abdominal scars, adhesions, and nerve entrapments are a source of abdominal and pelvic musculoskeletal pain symptoms. This course will examine and discuss physical and occupational therapist examination and treatment of musculoskeletal symptoms that may be caused by or associated with abdominal scars, adhesions, and abdominal cutaneous nerve entrapments.
3https://www.physicaltherapy.com/pt-ceus/course/physical-therapist-management-pelvic-floor-4358Physical Therapist Management of Pelvic Floor Tension Myalgia: When Your Patient Has Pain Down TherePelvic floor tension myalgia can cause a range of symptoms including pain in the vagina and rectum, feeling of sitting on a ball or stick, and pain during intercourse. This course will explore why and how pelvic physical therapy is first line treatment for pelvic floor tension myalgia. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA. Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 1 hour of general and 1 hour of Direct Access CE credit.auditory, textual, visual
Pelvic floor tension myalgia can cause a range of symptoms including pain in the vagina and rectum, feeling of sitting on a ball or stick, and pain during intercourse. This course will explore why and how pelvic physical therapy is first line treatment for pelvic floor tension myalgia. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.
Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 1 hour of general and 1 hour of Direct Access CE credit.
4https://www.physicaltherapy.com/pt-ceus/course/ehlers-danlos-syndrome-and-hypermobility-4151Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders in Women's Health Physical Therapy: Look For the ZebraWomen with Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders (HSD) have a high rate of pelvic floor disorders, and EDS and HSD are highly prevalent in women with pelvic health impairments. This course provides physical therapists with an evidence-based update on EDS, HSDs, and pelvic health and will explore clinical reasoning in pelvic physical therapy treatment for this diverse patient population. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.auditory, textual, visual
Women with Ehlers-Danlos Syndrome (EDS) and Hypermobility Spectrum Disorders (HSD) have a high rate of pelvic floor disorders, and EDS and HSD are highly prevalent in women with pelvic health impairments. This course provides physical therapists with an evidence-based update on EDS, HSDs, and pelvic health and will explore clinical reasoning in pelvic physical therapy treatment for this diverse patient population. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.
5https://www.physicaltherapy.com/pt-ceus/course/basic-physical-therapy-treatment-constipation-3737Basic Physical Therapy Treatment of ConstipationThis basic course will introduce clinicians to the physical therapy treatment of constipation. Participants will gain skill and knowledge in simple interventions to improve bowel evacuation that they will be able to apply immediately in the clinic. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA. Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 1 hour of general and 1 hour of Direct Access CE credit.auditory, textual, visual
'Many patients have been constipated before and I have never thought of exercise to help with this since we're always focused on mobility, strength, and balance to allow them to return home'Read Reviews
This basic course will introduce clinicians to the physical therapy treatment of constipation. Participants will gain skill and knowledge in simple interventions to improve bowel evacuation that they will be able to apply immediately in the clinic. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.
Editor's Note: Regarding Pennsylvania credits, this course is approved by the PA State Board of Physical Therapy for 1 hour of general and 1 hour of Direct Access CE credit.
