Saturday, December 22, 2012

Pelvic Physiotherapy Distance Journal Club 2013

Purpose - To provide a forum for discussion of current research and new ideas in the field of pelvic physiotherapy.  Research in this area is occurring at a fast pace.  It is nearly impossible to stay up to date alone.  This format allows structured discussion of research and its application to practice.  This forum is not structured to allow for discussion of individual patient questions unless they relate to the articles discussed.  Discussions include clinical application.

 Timing of meeting
Wednesday of the first full week of each month 8:30 PM EST for one hour. In some cases the meeting is moved to the second Wednesday to avoid holidays. 
Schedule for 2013 is as follows:

January 9 – Cindy Neville
February 6 – Pam Downey
March 13 – Beth Shelly
April 3 – Ann Dunbar
May  8 - Jane O’Brien
June  5 – Beth Shelly
July 10 - Michelle Spicka
August 7  - Laura Scheufele
September 11- Ann Dunbar
October 9 - MJ Strahaul
November 6 - Trisha Jenkyns
December 4 – Michelle Spicka

Monday, December 17, 2012

Pelvic Physiotherapy Distance Journal Club 2012 Summary

Listen as experts in the field present and lead discussions of the latest research in the field of Pelvic Dysfunction.  Free to all PTs.  Outlines available on the blog

Recordings available Top right corner – “log in”, Access code – 436790, Dial-in number – (209) 647-1000, Subscriber PIN – 883352.

The entire year outlines and records will be available on CD for $10.00 – email Schedule for 2013 available soon. 

Saturday, December 15, 2012

International Continence Society Debate on the terms “OAB” and “urgency”

This debate occurred at the ICS Annual meeting in Beijing China October 2012. Seven YouTube videos - most 9 to 12 minutes each.  This is a fascinating discussion of some of the issues with the term “OAB”.  Firstly there is evidence that a drop in urethra pressure precedes urgency and detrusor contraction so is it really the bladder which is overactive or is it the urethra which is underactive.  I very strong case for why PFM exercises help OAB.  The role of the nervous system is also discussed as are the influence of the pharmaceutical industry and the needs of the patients.  As you can image, in the end, there is no final answer but the discussion really highlights what is being researched and discussed in the field of bladder dysfunction.  Check it out.

Wednesday, December 12, 2012

Overactive Bladder in Middle Age Women: The Frustration of Baby Boomers with OAB Symptoms

by Nancy Muller. Affiliation: National Association For Continence (NAFC), Charleston, South Carolina, USA. AoU 2010; 1:(1). September 2010

In 2009, NAFC sponsored a nationwide survey of women aged 40 to 65 with overactive bladder (OAB). The purpose was to learn more about what drives women to seek treatment for OAB symptoms and what factors might precipitate stopping or changing treatment.  Results show women are annoyed and frustrated about their symptoms of OAB rather than embarrassed or stigmatized.  The study sheds light on the need for better access to treatment. Read the full paper at


Saturday, December 8, 2012

Diaphragmatic breathing exercises and pelvic floor retraining in children with dysfunctional voiding.

Zivkovic, et al. Eur J Phys Rehabil Med. 2012 Sep;48(3):413-21.
Michelle Spicka, DPT Pelvic PY Distance Journal Club Dec 5, 2012
Primary Aim: To investigate the role of abdominal and pelvic floor muscle (PFM) retraining in children with dysfunctional voiding (DV).
Subjects: 43 patients (65% girls) aged 5-13.  All patients had a diagnosis of dysfunctional voiding and were treated by pediatricians in primary care with timed voiding, hydration and constipation management for 3 months with no significant success. 
Methods: The patients underwent the following treatment program (therapy sessions were monthly for up to 12 months):

Are Transversus Abdominus/Oblique Internal and Pelvic Floor Muscles Coactivated During Pregnancy and Postpartum?

Pereira L, et al.  Neurourol. Urodynam. 2012 Oct 15. Doi: 10.1002/nau.22315.
Michelle Spicka, DPT Pelvic PT Distance Journal Club Dec 5, 2012

Primary Aim: The aim of this study was to simultaneously evaluate both transversus abdominis/internal oblique (Tra/IO) and pelvic floor muscles (PFM) during isometric exercises in nulliparous, pregnant and postpartum women.

Subjects: 81 women divided into 4 groups:
1.       Nulliparous women without urinary symptoms
2.       Primigravid pregnant women at least 24 weeks gestational age
3.       Primiparous postpartum women after vaginal delivery with right mediolateral episiotomy
4.       Primiparous postpartum women after cesarean delivery with 40-60 days of postpartum

Study Design:  A clinical, controlled, prospective study was conducted.

Wednesday, November 21, 2012

Pelvic muscle strength after childbirth

Friedman S, Blomquist JL, Nugent JM, McDermott KC, Munoz A, Handa VL. Obstet Gynecol 2012;120:1021-28.
Laura Scheufele PT, DPT, WCS
November 7, 2012

 Primary Aim: To estimate the effect of vaginal delivery and other obstetric exposures on pelvic muscle strength measured 6-11 years after first delivery and to investigate the relationship between pelvic muscle strength and pelvic floor disorders.

Subjects: 666 parous women who were originally recruited 5-10 years after first delivery for Mothers’ Outcomes after Delivery study returned for their second annual visit (thus 6 -11 years after first delivery). Enrolled participants plan to return annually for assessment of pelvic floor disorders.

Exclusion criteria: Maternal age younger than 15 or older than 50 years, delivery at less than 37 weeks of gestation, placenta previa, multiple gestation, known fetal congenital anomaly, stillbirth, prior myomectomy, latex allergy, and abruption. Women who developed these events during subsequent pregnancies not excluded.

 Study Design: A prospective cohort study.

Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial.

Braekken IH, Majida M, Engh ME, Bo K. Am J Obstet Gynecol 2010;203:170e1-7.

Laura Scheufele PT, DPT, WCS
November 7, 2012

Primary Aim: To evaluate whether PFMT can (1) reverse and prevent further development of POP and (2) reduce symptoms related to POP.

Subjects: 109 women at least 1 year post-partum with POP stages I, II and III as determined by POP-Q regardless of symptoms.

Exclusion criteria as follows:  POP stage 0 or IV, inability to contract the PFM, breastfeeding, previous POP surgery, radiating back pain, pelvic cancer, neurologic disorders, psychiatric disorders, untreated urinary tract infection, planning to become pregnant during the next 6 months, or to be away for more than 4 weeks during the intervention period.
Study Design: An assessor-blinded, randomized, controlled, parallel group trial with stratification on severity of POP.

                Stratified into 2 groups by severity of prolapse: (1) maximal vaginal descent at or above the hymen, and (2) maximal descent below the hymen. Within each strata randomization proceeded.  

Monday, November 19, 2012

Pelvic Physiotherapy Blog 2012 Summary

Views on the blog continue to increase.  Page views for January to September average 600 to 800 per month (last year it was 400 to 600 per month).  The month of October had over 2,000 page views and November is also very busy with over 1,500 page views.  Visitors to the blog come from all over the world: Israel, Netherlands, Latvia, Australia, Canada, United States, France, Russia, United Kingdom, Germany, India, Brazil, Ukraine, and South Korea. Thirty two “members” receive email notification when a blog post is loaded.  You can “join” the blog to receive email notification on the home page – scroll down under the blog archive on the right and click “join this site”. 

 There have been 62 posts this year averaging 2 per week.  Posts include announcements about the journal club, journal club outlines, reviews of current research, new clinical guidelines / position statements, and the occasional event and new product. Goal of posts is to keep busy clinicians updated on current research and other information important for clinical practice.  Till now I have created all posts however, I would like to invite one or two other PTs to join me in monitoring the literature and posting summaries.  I can email journal announcements and will help with editing posts. Must be fluent in English.  Interested PTs should email me at

 I would like to make this site user friendly and functional. Please email suggestions or comments also. Thanks for your support.  Stay tuned for more.

 Beth Shelly

Sunday, November 18, 2012

International Continence Society - October 2012 Beijing, China -Presentations by Physiotherapists



RESEARCH PRIORITIES FOR ELDERLY WOMEN WITH URINARY INCONTINENCE: RESULTS OF A CITIZENS JURY. Dumoulin C, Gareau A, Morin M, Tang A, Jolivest M, Lemieux M, Liberman D, Jadin M, Élliott V, Faro-Dussault V, Pontbriand-Drolet S, Bergeron J (podium poster)

Thursday, November 15, 2012

The Canadian Urological Society

The Canadian Urological Society has just released an updated guideline for adult urinary incontinence which supports the use of conservative management before medication in all patient groups.  This is a well done summary of current literature and can be an adjunct to marketing efforts of PTs.

Therapists might also be interested in the 2011 guideline on prostatitis.  It summarizes the 4 categories, diagnosis and treatment.  It does include category 3 CPPS and recognizes the possibility of massage of trigger points.  However, it also points out that there is not enough high level research to fully support the treatment.  Keep those research projects going!

Thursday, November 8, 2012

Two products you might want to check out

Stop Your Drip! An exercise program for male bladder control.  Daniel J. Kirages, PT, DPT, OCS, FAAOMPT, 2012 $49.99.

  This program includes a DVD and manual outlining a progressive exercise program for men undergoing prostate procedures, especially prostatectomy.  The created, Dr Daniel Kirages DPT, has several orthopedic credentials and has participated in research related to pelvic floor muscle exercises in the post prostatectomy population published in the Journal of Urology.   The program is written for the lay public and includes pre and post operative stages.  Pictures and video are very clear and professionally created.  Exercises incorporate isolated PFM exercises, overflow exercises, and functional PFM exercises.  There is quite a good variety and I can pick and choose which ones I use for each patient at each stage of recovery.  Good resource if you treat this patient population.

 The Pelvic Floor Therapy Pad by Babette Gray - Pelvic Pain Solutions retails for $39.99.

Wearable, perineal heat / cold pack for patients with pelvic pain.  Created by a patient with pudendal neuralgia. All pads are made locally. Wholesale pricing possible or patients can order off the web site.  Pad covers the entire perineal area and is held on by waist strap.  Web siote has other shapes and products.  One of my patients just loves it. 

Saturday, November 3, 2012

Urinary incontinence in neurological disease: Management of lower urinary tract dysfunction in neurological disease

 This guideline lists a comprehensive patient approach and background for the treatment of UI in patients with neurological disease. It also includes a small amount about possible treatments including bladder training and pelvic floor muscle exercises.  Several nurses sat on the panel that created these guidelines – no PT.

National Institution for Health and Clinical Excellence issues the NICE Guidelines.  They develop evidence-based guidelines on the most effective ways to diagnose, treat and prevent disease and ill health. Patient-friendly versions of the guidelines can help educate and empower patients, carers and the public to take an active role in managing their conditions. Highest evidence is used to create guidelines along with medical professional consensus.

Wednesday, October 31, 2012

The Journal of Sexual Medicine

New Device for Simultaneous Measurement of Pelvic Floor Muscle Activity and Vaginal Blood Flow: A Test in a Nonclinical Sample

Multilevel Local Anesthetic Nerve Blockade for the Treatment of Generalized Vulvodynia: A Pilot Study

Saturday, October 13, 2012

Newly published

Does improved functional performance help to reduce urinary incontinence in institutionalized older women? a multicenter randomized clinical trial. Tak EC, Van Hespen A, van Dommelen P, Hopman-Rock M. BMC Geriatr. 2012 Sep 6;12(1):51. [Epub ahead of print] Free Article

Biofeedback and/or sphincter exercises for the treatment of faecal incontinence in adults. Norton C, Cody JD.  Cochrane Database Syst Rev. 2012 Jul 11;7:CD002111. Review.

Exploring the association between lifetime physical activity and pelvic floor disorders: study and design challenges. Nygaard I, Shaw J, Egger MJ. Contemp Clin Trials. 2012 Jul;33(4):819-27. Epub 2012 Apr 12.

 Nonsurgical management of pelvic organ prolapse. Culligan PJ. Obstet Gynecol. 2012 Apr;119(4):852-60. Review.

Thursday, October 11, 2012

Managing Pregnancy and Delivery in Women with Sexual Pain Disorders.

Rosenbaum TY, Padoa A.  J Sex Med 2012; 9: 1726-1735.
MJ Strauhal, PT, BCB-PMD
Journal Club 10-10-12

This journal club involved discussion of the following topics related to the article.  There is a lot more on the recording. 

Listening / downloading recordings

  • Meetings will be recorded so they can be shared with others who were not able to attend
  • Top right corner – “log in”
  • Access code – 436790

Dial-in number – (209) 647-1000

Subscriber PIN – 883352

  • Choose the date you want to access – you can playback or download in several formats.  If you want to save it to your computer you click “wav” and choose “save” – name the file and choose the location to save it. 

 Application to pelvic floor (PF) physical therapy:

·         The PF physical therapist may be the first (or one of many) provider to have a discussion regarding the desires or fears associated with pregnancy and labor/ delivery with the patient suffering from a sexual pain disorder (SPD)

·         The PF PT should be knowledgeable about the practical concerns of their SPD patients regarding pregnancy and labor/ delivery

·         The PF PT should be knowledgeable about the safety of PT interventions for women with SPD that are either trying to conceive or are currently pregnant

Friday, October 5, 2012

Predictors of a favorable outcome of physiotherapy in fecal incontinence: secondary analysis of a randomized trial. Bols E, Hendriks E, de Bie R, Baeten, Berghmans B. Neurourol and Urodynam 2012;31:1156-1160.

PT treatment of fecal incontinence (FI)  has not enjoyed as much attention and many feel is not as successful.  This article is a secondary analysis of a RCT adding rectal balloon training to PFM exercises.  Overall 46.3% had some improvement.  Multivariate analysis showed predictors of success where: use of constipating medication (like Imodium to thicken stool, it is a must in my book), experiencing minor embarrassment (I guess more motivated?), and “any obstetrical factor” (this included large baby weight, episiotomy, long labor, breech delivery, theory is that these would probably traumatize tissues which can benefit from PT).  Those less likely to benefit had a longer time since FI onset.  Good to see more research in this area.

Tuesday, October 2, 2012

Treatment of UI in NH residents - free article

2012;7:45-50. Epub 2012 Feb 8.

Effect of physical training on urinary incontinence: a randomized parallel group trial in nursing homes.



Residents in nursing homes (NHs) are often frail older persons who have impaired physical activity. Urinary incontinence (UI) is a common complaint for residents in NHs. Reduced functional ability and residence in NHs are documented to be risk factors for UI.

Saturday, September 29, 2012

10-10-12 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

  • 209-647-1000 access code 436790#
  • Email Beth if you are having trouble accessing the call -
  • Please keep background noise to a minimum (see below for more details)
This month’s discussion

Rosenbaum TY and Padoa A. Managing pregnancy and delivery in women with sexual pain disorders. J Sex Med 2012;9:1726–1735.

 Outline with thought provoking questions also provided.  Please review and be ready to discuss.

Monday, September 24, 2012

Two resources for pelvic pain classification and treatment

European Association of Urology (EUA) has published guidelines on chronic pelvic pain with a useful classification system and suggestions for treatment. (Engeler 2010)

o   Axis 1

§  Specific disease associated pelvic pain

§  Pelvic pain syndrome

o   Axis 2 – System

o   Axis 3 – end organ pain syndrome

o   Axis 4 - referral characteristics

o   Axis 5 – temporal characteristics

o   Axis 6 – character

o   Axis 7 – associated symptoms

o   Axis 8 – psychological symptoms

Sunday, September 16, 2012

The association between pelvic floor muscle function (PFM) and pelvic girdle pain (PGP)---A matched case control 3D ultrasound study. Britt Stuge*, Kaja Sætre, Ingeborg Hoff Brækken Manual Therapy 17 (2012)

Ann Dunbar PT,DPT,MS WCS
September 5, 2012

Primary Aim: To investigate the difference in voluntary pelvic floor muscle function in women with and without clinically diagnosed PGP.

Subjects:  49 consecutive women who were at least 6 months postpartum and were patients of physical therapists (diagnosis criteria listed in article) in Oslo, Norway, matched with 49 controls for age, number of vaginal deliveries and age of her children.

Study Design: 0ne-to-one matched case-controlled study



  • Completed a questionnaire of sociodemographic data, gynecological health status, and functional status (see pg 151 for instruments used)
  • PFM function assessed by visual observation and vaginal palpation with subject in supine.
  • Vaginal manometry with middle of balloon placed 3.5 cm internal from vaginal introitus
  • Vaginal 3D ultrasound with probe on perineum in sagittal plane as per recommendations of Dietz (2004)
--Participants performed 3 PFM contractions in supine and each recorded

 --In 18 participants this was repeated immediately for test-restest analysis

Searching for pelvic floor muscle exercises on YouTube: what individuals may find and where this might fit with health service programmes to promote continence.

Ann Dunbar PT, DPT, MS, WCS
September 5, 2012                                              

Primary Aim: to increase awareness of the type of video clips available to the public on pelvic floor muscle exercises (PFME) by investigating, categorizing/characterizing the clips from the perspective of the ‘wisdom of the crowd’ and to assist in developing information used for continence education.

Data Focus: used ‘snow ball’ technique for search and navigation protocol; used terms “Pelvic Floor Exercise” in YouTube search

                Excluded: clips only mentioning PFME or providing pelvic floor anatomy, clips with sexual focus,

                                clips used only to advertise a product

                Inclusions: clips useful in supporting or motivating women toward PFME
Study Design: Descriptive

Maternal Position and Other Variables: Effects on Perineal Outcomes in 557 Births. Meyvis I, Rompaey BV, Goormans K, Truijen S, Lambers S, Mestdagh E, Mistiaen W BIRTH 39:2 June 2012

Trisha Jenkyns 8-8-12

Primary Aim: To investigate the effect of the maternal position (lateral vs lithotomy) and other variables (demographic characteristics, gravidity, parity, duration of pregnancy, reason for admission, and mode of labor) on perineal outcomes or the occurrence of perineal damage

Study Design:  retrospective cross-sectional design


Hospital records were collected & examined from a regional hospital in Belgium from November 2008 to November 2009 of all women (between 37 and 42 weeks gestation) who were delivering vaginally.  Exclusion criteria: premature delivery & any kind of operative delivery because these conditions could necessitate episiotomy.

Does the Epi-No® Birth Trainer reduce levator trauma? A randomized controlled trial Shek, KL, Chantarasorn V, Langer S, Phipps H, Dietz HP

Trisha Jenkyns 8-8-2012

Primary Aim:
To evaluate whether antepartum use of a birth trainer (Epi-No®) may reduce levator trauma.

Null hypothesis was: “Antepartum use of the Epi-No® device does not reduce the incidence of trauma to the puborectalis muscle”.


“The Epi-No® Birth Trainer (Starnberg Medical, Tecsana GMBH, Muenchen, Germany) was designed by a German doctor, Wilhelm Horkel. He designed an inflatable silicon balloon coupled to a pressure display hand pump to gradually stretch the vagina and perineum in late pregnancy to reduce the risk of perineal trauma during vaginal birth. To date, the limited data available in the literature seem to support his observation.”

Study Design: Randomized controlled pilot study

Sunday, August 19, 2012

NICE Guidelines on management of urinary incontinence in patients with neurological disease.

40 page guide looks at all aspects of management.  I am looking for a guest blogger to write a summary / review of these guidelines for posting on this blog.  Review would have to be completed by 8/27.  I know we have lots of good therapists, it’s not hard.  Please email me directly at

Friday, August 10, 2012

Pelvic pain classifications

There have been several classifications proposed in the past, many of which do not include musculoskeletal dysfunction.  These two are more inclusive.  The EAU documents is quite inclusive and a good read. 

European Association of Urology  (EAU) Guidelines on chronic pelvic pain (Engeler 2010)
o   Axis 1
§  Specific disease associated pelvic pain
§  Pelvic pain syndrome
o   Axis 2 – System
o   Axis 3 – end organ pain syndrome
o   Axis 4 - referral characteristics
o   Axis 5 – temporal characteristics
o   Axis 6 – character
o   Axis 7 – associated symptoms
o   Axis 8 – psychological symptoms
IUGA / ICS terminology (Haylen 2010)
o   Bladder pain  - suprapubic or retropubic pain, pressure or discomfort, usually increasing with bladder filling, may persist or be relieved by voiding
o   Urethral pain - inside urethra
o   Vulval pain – in and around vulvar
o   Vaginal pain – within vagina above introitus
o   Perineal pain – between posterior fourchette and anus
o   Pelvic pain – pain in pelvis
o   Cyclical (mentraul) pelvic pain
o   Pudendal neuralgia – burning anus to clitoris, pain associated with tenderness over course of pudendal nerve, Nantes criteria
§  Pain in the region of pudendal nerve
§  Pain worse with sitting
§  No night pain
§  No sensory deficit
§  Relief with pudendal block
o   Chronic lower urinary tract and / or other pelvic pain syndromes

Friday, August 3, 2012

August 8, 2012 Pelvic Physiotherapy Distance Journal Club

Time - 8:30 PM EST for one hour

  • 209-647-1000 access code 436790#
  • Email Beth if you are having trouble accessing the call -
  • Please keep background noise to a minimum (see below for more details)

This month’s discussion

Shek KL, Chantarasorn V, Langer S, Phipps H, Dietz HP. Does the Epi-No® Birth Trainer reduce levator trauma? A randomised controlled trial.  Int Urogynecol J (2011) 22:1521–1528

 Meyvis I, Rompaey BV, Goormans K, Truijen S, Lambers S, Mestdagh E, Mistiaen W Maternal Position and Other Variables: Effects on Perineal Outcomes in 557 Births.   BIRTH 39:2 June 2012

Monday, July 30, 2012

Predictors of care seeking in women with urinary incontinence. Minassian VA, et al. Neurourol and Urodyanm 2012;31:470-474.

Researchers at Brigham and Women’s hospital surveyed 4,064 women and found 40% self reported UI.  Of those women only 25% had received the official diagnosis of UI according to the medical records.  In other words 75% of women with symptoms of UI do not receive the official diagnosis – did not tell MD, told MD and did not receive the dx????  After several calculation factors associated with receiving the dx were noted.  Does not seem to be too much surprise, those with higher bother, impact on behavior and urgency type UI are more likely to receive the dx.  Also those who seek more care overall, older women, and women with one or more deliveries.  The take home message for me is the people who do not receive the dx – presumably younger women with more mild symptoms, especially those who have not had a child.  The key is to develop strategies on how to reach these women.  Please post your ideas.  How do you reach women who might otherwise not seek care for UI?

Friday, July 20, 2012

Short-term hormone replacement therapy

Short-term hormone replacement therapy (HRT) is acceptable and relatively safe for healthy, symptomatic, recently postmenopausal women, according to a new consensus statement endorsed by 15 leading medical organizations involved in women's health.

Specific recommendations in the consensus statement include the following;

  • The decision to use HRT must be individualized based on specific patient factors and anticipated risks and benefits. These include quality-of-life priorities, age, time since menopause, and risk for blood clots, heart disease, stroke, and breast cancer.
  • For healthy, relatively young women (younger than 59 years or within 10 years of menopause) with moderate to severe menopausal symptoms, systemic HRT is an acceptable option and is the most effective treatment.
  • Low-dose vaginal estrogen is the preferred treatment for women who have only vaginal dryness or discomfort with intercourse.
  • To prevent uterine cancer in women who still have a uterus, HRT should include progesterone or a similar progestogen, as well as estrogen. Women who have undergone hysterectomy can be given only estrogen.
  • Estrogen-only and estrogen-progestogen HRT are associated with increased risk for stroke and of venous thromboembolism (deep venous thrombosis and pulmonary embolus), as are hormone-based contraceptives. However, the risk is rare in women aged 50 to 59 years.
  • Use of continuous estrogen with progestogen therapy for at least 5 years, and possibly even for shorter duration, is associated with an increased risk for breast cancer. When HRT is discontinued, this risk decreases.

Friday, July 13, 2012

Pelvic Physiotherapy Distance Journal club July 11, 2012.

We had a small group this month (7 on the call).  Expect many are away on vacation or enjoying the nice weather.  Still the discussion was rich with clinical application and ideas.  Outlines are available on the blog and  Recording is also available

Listening / downloading recordings

  • Meetings will be recorded so they can be shared with others who were not able to attend
  • Top right corner – “log in”
  • Access code – 436790
  • Dial-in number – (209) 647-1000
  • Subscriber PIN – 883352
  • Choose the date you want to access – you can playback or download in several formats.  If you want to save it to your computer you click “wav” and choose “save” – name the file and choose the location to save it. 
Looking forward to next month August 8th.  

The Relationship between urinary bladder control and gait in women

Booth J, Paul L, Rafferty D, MacInnes C. Neurourology and Urodynamics 2012, Article first published online: 12 JUN 2012 | DOI: 10.1002/nau.22272

Pelvic Physiotherapy Distance Journal Club July 11, 2012
Beth Shelly PT, DPT, WCS, BCB PMD

What question did the study ask?
Is there a difference in temporal gait parameters during a strong desire to void?

Addressing anxiety in vivo in physiotherapy treatment of women with severe vaginismus: a clinical approach.

Rosenbaum T, J of Sex and Marital Ther 2011;37:89-93.

 Pelvic Physiotherapy Distance Journal Club July 11,2012.
Beth Shelly PT, DPT, WCS, BCB PMD

Progress in cases of sever anxiety
At each step the patient is asked to rate their anxiety on a scale of 0 (none) to 5 (sever). Then she is asked what needs to happen to get her anxiety to a 0 or 1 (possibly reverting to an earlier stage or using “lower anxiety” tools such as breathing).  She can always go back to a stage where she feels safe.  Progress when anxiety is 0 to 1.
·         Step one – lying on the table with cloths on covered with a sheet
·         Step two – as above with legs bent and knees apart
·         Step three  – as above without sheet
·         Step four – as above with shorts on first with sheet and then without sheet
·         Step five – as above with underwear only, with and without sheet
·         Step six – as above without underwear, with and without sheet