Wednesday, December 16, 2015

Dec Pelvic PT Distance Journal Club recording

Listen to experts in the field discuss conservative POP treatment and anatomy of pelvic support.
Next call Jan 6 - post prostatectomy UI treatment

Tuesday, December 15, 2015

Postpartum pelvic floor muscle training and pelvic organ prolapse- a randomized trial of primiparous women

Kari Bo, et al. Am J Obstet Gynecol. 2015; 212: 38.e1-7
MJ Strauhal, PT, DPT, BCB-PMD

Pelvic Physiotherapy Distance Journal Club   December 9, 2015

Primary Aim:  evaluate the effectiveness of a 4 month postpartum PFMT program on stage of pelvic organ prolapse (POP), bladder neck position, and POP symptoms in primiparous women following vaginal delivery


  • POP is common and distressing
  • Prevalence of POP differs when based on clinical exam (>30%) versus symptom “bother” (5-10%)
    • When symptomatic, POP causes discomfort, reduced QOL, limitation of ADL’s
  • Lifetime cumulative risk for POP surgery is 7-11%,  reoperation is common, and complications associated with mesh can be severe, warranting early nonsurgical prevention and treatment
  • 3-6 months postpartum occurrence rate of POP > stage II is 18-56%
    • 15-40% of primip wm have a mj. LA defectà when detected by US imaging, postpartum wm with LA defect were 2x as likely to have POP stage II or > than those with intact LA
  • RCT’s have shown that PFMT is effective in reducing POP symptoms and/or stage in middle-aged wm
    • Systematic review concluded Level 1, grade A evidence for PFMT in treatment of POP
    • Assessor blind RCT found that PFMT improved PFM strength and thickness, lifted the bladder neck (BN) and rectal ampulla, narrowed the UGH and reduced mm length in wm with POP

Three-Dimensional Modeling of the Pelvic Floor Support Systems of Subjects with and without Pelvic Organ Prolapse.

 Ren S, Xie B, Wang J, Rong Q.  BioMed Research International. 2015; Article ID 845985: 1-9.

Pelvic PT Distance Journal Club December 9, 2015 MJ Strauhal

Purpose and Background:

·         Develop three-dimensional finite element models of the whole pelvic support systems of subjects with and without pelvic organ prolapse (POP) that can be used to simulate anterior and posterior wall prolapses

o    Prevalence of POP by symptoms report and “bother” is 3-6%; by clinical exam is 50% (different reference than Bo et al, but similar #’s)

o    Subtle injuries of the pelvic floor support system may lead to POP

o    Numerical simulations provide a tool to study pelvic function and the effect of support defects

o    Previous studies did not take into account the vaginal cavity which is of “great significance” when evaluating the mechanical behavior of POP

§  Previous studies oversimplified the structure of the ligaments and the vagina

Wednesday, November 11, 2015

November Pelvic PT Distance Journal Club

Diastasis Recti.

Recording here

Next call Dec 9, 2015

The Immediate Effects on Inter-rectus Distance of Abdominal Crunch and Drawing-in Exercises During Pregnancy and the Postpartum Period

Mota PGF, Pascoal AGBA, Carita AIAD, Bø K.  JOSPT October 2015, volume 45, number 10

Pelvic Distance Journal Club November 2015     
Trisha Jenkyns PT, DPT, WCS            

Study Objective/Purpose

Primary goal

·         To look at 2 abdominal-strengthening exercises,

o   Drawing-in and the abdominal crunch

·         The effect of these 2 exercises on the Inter Rectus Distance (IRD) at certain time points:

o   Gestational weeks 35 to 41

o   Postpartum at 6-8, 12-14, and 24-26 weeks

Prevalence and risk factors of diastasis recti abdominis from late pregnancy to 6 months postpartum, and relationship with lumbo-pelvic pain

Mota PGF, Pascoal AGBA, Carita AIAD, Bø K. Manual Therapy 2015; 20, 200-205
Pelvic Distance Journal Club November 2015
Trisha Jenkyns PT, DPT, WCS

Study Objective/Purpose

The aim of this study was to investigate the prevalence of DRA at gestational week 35 and three time-points postpartum, possible risk factors, and the relationship between DRA and lumbo-pelvic pain. 

Brief Background: Authors note that there are no high quality clinical studies to support theories about DRA causing long term sequelae  like lumbo-pelvic pain and abnormal posture

Study Design: Longitudinal observational study following first time pregnant women from gestational week 35 till 6 months postpartum.

Wednesday, October 21, 2015

Pelvic Floor Muscle Activation and Strength Components

Helena Luginbuehl, et al, Neurourology and Urodynamics 34:498–506 (2015)

Elizabeth Lewis, PT, OCS, WCS
Oct. 14, 2015
Pelvic Physical Therapy Distance Journal Club
Description: This systematic review had a stated purpose of developing a better understanding of PFM activation and strength components in order to develop more specific PFM training regimens for female SUI patients.  The aim of this systematic review was to summarize/evaluate existing studies investigating PFM activation/strength components which influence female continence and SUI.

Effects of walking speeds and carrying techniques

Tanner J. Coleman, Nadia M. Hamad, Janet M. Shaw, Marlene J. Egger, Yvonne Hsu, Robert Hitchcock,  Huifeng Jin,  Chan K. Choi, Ingrid E. Nygaard
Received: 24 September 2014 /Accepted: 27 November 2014 /Published online: 20 December 20

Elizabeth Lewis, PT, OCS, WCS
Oct 14, 2015
Pelvic Physical Therapy Distance Journal Club

Clinical Question: What is known about any specific functional activities and their impact on intra-abdominal pressure?  Similar topic was discussed June 2013, see outline here.

Clinical Bottom Line: IAP can be monitored in women outside of a lab during functional activities of lift/carry and walking.  Mean IAP increases with walking speed and the most common ways of carrying a baby in a car seat (front, side or awkward carry) had significantly higher associated IAP’s than back pack carry.

Sunday, September 13, 2015

September Pelvic PT Distance Journal Club Recording
Next call October 14, 2015

“Vaginal Shape at Resting Pelvic MRI: Predictor of Pelvic Floor Weakness?”

Tillack AA, et al. Clin Imag 2015;39:285-288.
Cora Huit
Pelvic PT distance journal club Sept 2, 2015

Aim: The goal of this study was to determine if vaginal shape was related to pelvic floor weakness.

Design: Population: This study was done retrospectively using images from a radiology database of 32 women who were referred for pelvic floor imaging between 1998 and 2007. The same data was collected from the radiology database for a control group of 44 women who were referred for pelvic floor imaging for the following health concerns: fibroids, adnexal mass, nongynecological caner or mass, pelvic pain, endometrial evaluation, gynecological caner and retrovaginal fistula. 

Review of: Postpartum Recovery of Levator Hiatus and Bladder Neck Mobility in Relation to Pregnancy

Starr-Jensen J, et al. Obstetrics and Gynecolgy2015;3:531-539.
Cora Huit
Pelvic PT Distance Journal Club Sept 2, 2015

Aim: To determine the changes in pelvic floor morphology, specifically of the levator hiatus and the bladder neck, during and after pregnancy for women delivery vaginally and having cesarean sections.

Design: An observational, longitudinally study using ultrasonography to exam women’s pelvic floor changes at 21 and 37 weeks pregnant and 6 weeks, 6 months and 12 months postpartum.

Friday, August 28, 2015

Update your approach to Male UI

Here are a few new articles on the PFM recruitment patterns of continent males.  Hoping there will be similar info soon for patient UI but this is the best we have now.  All are free full text articles.

Dynamics of male pelvic floor muscle contraction observed with transperineal ultrasound imaging differ between voluntary and evoked coughs. -

A new method to quantify male pelvic floor displacement from 2D transperineal ultrasound images. -

Novel insight into the dynamics of male pelvic floor contractions through transperineal ultrasound imaging. -

Wednesday, August 12, 2015

August Pelvic PT Distance Journal Club recording and outlines

Guided imagery for IC and IBS check out the outlines on this blog and the recording here.  Next call Sept 2

Gut-directed guided affective imagery as an adjunct to dietary modification in irritable bowel syndrome.

Boltin, D, Sahar N, Gil E, et al. Journal of health psychology. 2015; Volume 20. Issue 6. Page 712 - 20.
Laura Scheufele, PT, DPT, WCS
August 5, 2015
Pelvic PT Distance Journal Club

Aim: Study the effect of guided affective imagery on the irritable bowel symptom severity and quality of life when combined with lifestyle modifcations in patients with IBS.
“Guided affective imagery (GAI) is a form of psychotherapy, which involves focusing on the mental images to induce relaxation. The principle behind GAI is the interruption of stress-provoking thoughts with a relaxing image, thereby inducing relaxation. “

Guided imagery for women with interstitial cystitis: results of a prospective, randomized controlled pilot study.

Carrico D, Peters K, and Diokno, A. Journal of alternative and complementary medicine. 2008. Volume 14. Issue 1. Page 53 - 60.
Laura Scheufele, PT, DPT, WCS
August 5, 2015
Pelvic PT Distance Journal club
Aim: Explore the effects of guided imagery on pelvic pain and urinary symptoms in women with IC.
Design: Prospective, randomized, controlled pilot study. Authors decided that 30 subjects (15 in each arm) would adequately provide preliminary data to decide if larger-powered study would be warranted.
“Guided imagery uses words to direct one’s thoughts and attention to imagined visual, auditory, tactile, or olfactory sensations to elicit the psychologic and physiologic response of relaxation. “
Several theories for how the physiological effect is achieved with guided imagery including Gate Control Theory of pain and endorphin release.

Saturday, July 18, 2015

Morrissey, D, et al. Botulism Toxin A Injections Into Pelvic floor Muscles Under Electromyographic Guidance for Women with Refractory High-tone Pelvic Floor Dysfunction: A 6-Month Prospective Pilot Study.


Female pelvic med and reconstruct surg 2015, March 18 Epub ahead of print
Additional article for discussion
July 8, 2015 Pelvic PT Distance Journal Club
Jane Franczak

Objective: to examine the efficacy of EMG guided botox for pain and increased QoL for high tone pelvic floor dysfunction (HTPFD).

OnabotulinumtoxinA ( botox) is a neurotoxin which inhibits the release of acetylcholine and leads to ms paralysis. May last 3-6 months. Guidance from EMG can lead to precise location of high tone or TPs to ensure accurate delivery and lead to improved QoL.

A pilot randomized trial of levator injections versus physical therapy for treatment of pelvic floor myalgia and sexual pain

Zoorob, D. et al,
Int Urogynecol J (2015) 26:845-852. 

Question investigated: Are PT and Levator Trigger point Injections (LTPI comparable as treatment for improving chronic pain and sexual function (PFM Pelvic floor myalgia )?

Materials and methods: ramdomized trial btw a course of vaginal injections of triamcinolone and bupivacaine vs. pelvic floor PT for treatment of PFM.

Patients: chosen by 1 of 2 MDs, with self-reported pelvic pain and evidence of MTPs in pelvic floor ( PR, PC, IC, C and OI). No prior pelvic rehab or LTPI .Randomized to either group.

Aged 18+, sexually active, pain with intercourse, Excluded if: pregnant, used aspirin within a week of study, hx untreated pelvic absess, cardiac arrhythmia,  bladder pain syndrome, current pelvic rehab or LTPI.

The Relationship Between Incontinence, Breathing Disorders, Gastrointestinal Symptoms,

Michelle D. Smith, PhD,* Anne Russell, MMedStat,w and Paul W. Hodges, PhD
Clin J Pain, Vol 30 (2), Feb 2014, 162-7.
July 8, 2015 Pelvic PT Distance Journal Club
Jane Franczak

Question asked: Does the presence of 1 disorder increased the risk for another?
Current data suggests/assumes causal pathway from resp. disorder,  incontinence, and GI leads to back pain ,
But it IS POSSIBLE that BP may contribute to development of other disorders.

Sunday, June 7, 2015

Jue 3, 2015 Pelvic PTDistance Journal Club Recording

Next call July 8, 2015

Comparison of the sonographic features of the abdominal wall muscles and connective tissues in individuals with and without lumbopelvic pain

Whittaker JL, Warner MB, Stokes M. JOSPT 2013; 43(1):11-19.
Ann Dunbar PT, DPT, MS, WCS
June 3, 2015


  • Muscles of the abdominal wall, multifidii, pelvic floor, and respiratory diaphragm function to pressurize the abdominopelvic cavity for load transfer.
  • Researchers have identified functional deficits in abdominal mm in persons with lumbopelvic pain (LPP) however, most studies consider only the transverse abdominis and internal oblique.  Morphologically the 4 layers are different.
Primary Aim: “ to measure and compare the resting thickness of the 4 abdominal wall muscles and their perimuscular connective tissue (PMCT) planes, as well as interrecti distance (IRD) in persons with and without lumbopelvic pain, using ultrasound imaging.

Functional gastrointestinal disorders are associated with the joint hypermobility syndrome in secondary care: a case-control study

Fikree A, Aktar R, Grahame R, Hakim AJ, Morris JK, Knowles CH, Aziz Q; 2015 Neurogastroenterol 27: (569-579).

Ann Dunbar PT, DPT, MS, WCS
June 3, 2015


  • Functional gastrointestinal disorders (FGID) account for 40% of visits to GI clinics.
  • Despite increasing focus on research, diagnostic biomarkers and etiology are not well established.
  • It is well established that inflammatory connective tissue disorders are associated with GI dysfunction and evidence is increasing that non-inflammatory disorders (such as joint hypermobility disorders) may also be related.
  • Due to lack of distinct biomarker, current gold standard for diagnosing joint hypermobility syndrome (JHS) is 1998 Brighton classification for JHS (see Table 1 in article).
  • It has been recognized more recently that JHS is a disorder of multiple systems (eg chronic pain syndromes, dysautonomia, urinary symptoms, GI symptoms, and anxiety disorders). GI sx such as globus, bloating, reflux, postprandial fullness, and early satiety have a high prevalence in rheumatology and genetics clinics. In GI clinics, 1/3 of pts have undiagnosed JHS suggesting association between GI symptoms and this syndrome however, conclusive evidence is limited due to lack of controlled studies.

Friday, May 29, 2015

Adherance in PFM training

5 landmark papers written by internationally known PTs on adherence in PFM training
Scoping review of adherence promotion theories in pelvic floor muscle training - 2011 ICS State-of-the-Science Seminar research paper I of IV
Doreen McClurg, Helena Frawley, Jean Hay-Smith, Sarah Dean, Shu-Yueh Chen, Pauline Chiarelli, Frances Mair and Chantale Dumoulin
Article first published online: 21 MAY 2015 | DOI: 10.1002/nau.22769
Pelvic-floor-muscle training adherence: Tools, measurements and strategies—2011 ICS State-of-the-Science Seminar research paper II
Chantal Dumoulin, Dianne Alewijnse, Kari Bo, Suzanne Hagen, Diane Stark, Marijke Van Kampen, Julia Herbert, Jean Hay-Smith, Helena Frawley, Doreen McClurg and Sarah Dean
Article first published online: 21 MAY 2015 | DOI: 10.1002/nau.22794
Pelvic-floor-muscle-training adherence “modifiers”: A review of primary qualitative studies—2011 ICS State-of-the-Science Seminar research paper III of IV
Jean Hay-Smith, Sarah Dean, Kathryn Burgio, Doreen McClurg, Helena Frawley and Chantale Dumoulin
Article first published online: 21 MAY 2015 | DOI: 10.1002/nau.22771

Health professionals’ and patients’ perspectives on pelvic floor muscle training adherence—2011 ICS State-of-the-Science Seminar research paper IV of IV
Helena C. Frawley, Doreen McClurg, Aishath Mahfooza, Jean Hay-Smith and Chantale Dumoulin
Article first published online: 21 MAY 2015 | DOI: 10.1002/nau.22774
2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar
Chantale Dumoulin, Jean Hay-Smith, Helena Frawley, Doreen McClurg, Dianne Alewijnse, Kari Bo, Kathryn Burgio, Shu-Yueh Chen, Pauline Chiarelli, Sarah Dean, Suzanne Hagen, Julia Herbert, Aishath Mahfooza, Frances Mair, Diane Stark and Marijke Van Kampen
Article first published online: 21 MAY 2015 | DOI: 10.1002/nau.22796

Saturday, May 9, 2015

May #PelvicPTjournalclub recording

May #PelvicPTjournalclub  recording

 Vulvodynia and labrial tears, male PFM ex instructions

Outlines posted on this blog

 Next call June 3

Vulvodynia and Concomitant Femoro-Acetabular Impingement: Long-Term Follow-Up After Hip Arthroscopy. Coady, D et al. J Lower Gen Tract Dis 2015;19).

Michelle Spicka, DPT
May 6th, 2015
Pelvic Physical Therapy Distance Journal Club

Description: The researchers hypothesized that in patients with vulvodynia and femoro-acetabular impingement, vulvar pain may actually be generated by the effect of femoro-acetabular impingement on pelvic floor structures and treatment with arthroscopy may improve vulvodynia.
Vulvodynia affects 8-16% of women but effective treatment is often difficult due to inadequate understanding of the causes. 
Close relationships between intra-articular hip disorders, pelvic floor and chronic pain in the pelvis in proximity to the hip have recently been recognized.  Femoro-acetabular impingement can refer pain into the pelvic floor via the obturator internus and other shared muscles and connective tissues and leads to the development of nonoptimal movement patterns.

Pattern of Activation of Pelvic Floor Muscles in Men Differs With Verbal Instructions. Stafford R, et al. Neurourol Urodyn. 2015 March 1. Doi: 10.1002/nau.22745.

Michelle Spicka, DPT
May 6th, 2015
Pelvic Physical Therapy Distance Journal Club
Description: Pelvic floor muscle exercises have been found to help with post-prostatectomy urinary incontinence in men but there is a lack of consistency of the instructions used to teach men to activate the pelvic floor muscles.  Because the efficacy of a pelvic floor muscle exercise program for treatment of incontinence after prostatectomy is likely to depend on if and how the muscles of urinary continence are activated, optimal methods to achieve activation have received limited attention.
The aim of this study is to investigate the effect of instruction on activation of pelvic floor muscles in men as quantified by transperineal ultrasound imaging and to validate these measures with invasive EMG recordings.

Friday, April 10, 2015

April 8, 2015 Pelvic PT Distance Journal Club


Outline is posted on the blog

Next call is May 6,2015

A pilot randomized controlled trial to evaluate pelvic floor muscle training for urinary incontinence among gynecological cancer survivors, Rutledge TL, et al, Gynecol Oncol 132(2014)154-158.

Cindy Neville
Pelvic PT Distance Journal Club, April 8, 2015


Same authors previously reports high rates of UI (67% of 200) and sexual dysfunction among gynecological cancer survivors

Rutledge TL, Heckman SR, Qualls C, Muller CY, Rogers RG. Pelvic floor disorders and sexual function in gynecologic cancer survivors: a cohort study. Am J Obstet Gynecol 2010;203(5):514e1–7 [Epub 2010/09/28].

·         effectiveness of PFMT and behavioral therapy, has not been evaluated in gynecologic cancer survivors.
·         effectiveness of these interventions may differ in cancer survivors since radiation, chemotherapy and radical pel-vic surgery can result in significant anatomical functional changes in the pelvis and lower urinary tract, including damage of nerve fibers and compromise of vascular supply with resultant fibrosis.

Sunday, March 15, 2015

New articles on Pub med

Cadeddu F, Salis F, De Luca E, Ciangola I, Milito G.
Tech Coloproctol. 2015 Mar 6. [Epub ahead of print]
PMID: 25744688 [PubMed - as supplied by publisher]


Egger MJ, Hamad NM, Hitchcock RW, Coleman TJ, Shaw JM, Hsu Y, Nygaard IE.
Female Pelvic Med Reconstr Surg. 2015 Feb 27. [Epub ahead of print]
PMID: 25730430 [PubMed - as supplied by publisher]


Stafford RE, Ashton-Miller JA, Constantinou C, Coughlin G, Lutton NJ, Hodges PW.
Neurourol Urodyn. 2015 Mar 1. doi: 10.1002/nau.22745. [Epub ahead of print]
PMID: 25727781 [PubMed - as supplied by publisher]


Lin YH, Yang HY, Hung SL, Chen HP, Liu KW, Chen TB, Chi SC.
Eur J Cancer Care (Engl). 2015 Feb 12. doi: 10.1111/ecc.12292. [Epub ahead of print]
PMID: 25684312 [PubMed - as supplied by publisher]


Coleman TJ, Nygaard IE, Holder DN, Egger MJ, Hitchcock R.
Int Urogynecol J. 2015 Feb 12. [Epub ahead of print]
PMID: 25672647 [PubMed - as supplied by publisher]


Kao HT, Hayter M, Hinchliff S, Tsai CH, Hsu MT.
J Clin Nurs. 2015 Feb 7. doi: 10.1111/jocn.12783. [Epub ahead of print]
PMID: 25662587 [PubMed - as supplied by publisher]


MacArthur C, Ismail K.
BJOG. 2014 Dec;121 Suppl 7:67-72. doi: 10.1111/1471-0528.13150. No abstract available.
PMID: 25488091 [PubMed - indexed for MEDLINE]


Wood LN, Anger JT.
BMJ. 2014 Sep 15;349:g4531. doi: 10.1136/bmj.g4531. Review.
PMID: 25225003 [PubMed - indexed for MEDLINE] Free Article

Friday, March 6, 2015

Pelvic PT distance journal club March recording

Outlines posted on the blog

Next call April 8