Sunday, February 24, 2013

Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain. A randomized controlled study

Balthazard P, et al. BMC Musculoskelet Disord. 2012;13(162).

This is a well documented paper and well worth the 27 pages (Email for a copy). 42 patient randomized to receive manipulation / mobilization (including muscle energy to the pelvic and PA mobilizations to the spine) followed by active exercise or detuned ultrasound followed by active exercise.  Exercise included: mobility, passive stretching, motor control, stability, and strengthening. 8 sessions over 4 to 8 weeks. Manual therapy group had better immediate analgesic effect, lower disability and a trend toward lower pain. 

Conclusion - manual therapy is beneficial

Wednesday, February 13, 2013

Sensory Retraining Is Key to Biofeedback therapy for Formed Stool Fecal Incontinence

Chiarioni G, Bassotti G, Stegagnini S, Vantini I, Whitehead WE. The American Journal of Gastroenterology. 2002;97(1):109-117.

Pelvic Physical Therapy Distance Journal Club; February 6, 2013

Prepared by Pamela Downey, PT, DPT, WCS, BCB-PMD & Kendra Boyce, SPT ’13 University of Miami School of Medicine, Department of Physical Therapy

Primary Aim: To evaluate the efficacy of biofeedback in patients with severe solid stool incontinence, assess the importance of sensory training and strength training to the success of biofeedback, and to identify patient characteristics that predict who will respond to biofeedback.

Developing a Validated Urinary Diary: Phase 1

Elizabeth Bright, Nikki Cotterill, Marcus Drake, and Paul Abrams

Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom

Neurourology and Urodynamics 31:625–633 (2012)

Pelvic Physical Therapy Distance Journal Club: February 6, 2013

Prepared by Pamela Downey, PT, DPT, WCS, BCB-PMD & Kendra Boyce, SPT ’13

University of Miami School of Medicine, Department of Physical Therapy

Primary Aim: To develop and validate a urinary diary (UD) applicable to the adult population. Described here the first developmental stage of the UD, that of topic exploration (Phase 1a) and content validation (Phase 1b). Content validity is an assessment of whether the diary makes sense to those that are asked to complete it.

Monday, February 11, 2013

Counting PFM exercises

One of the things my patients complain about the most is the difficulty in counting the number of seconds holding and resting while keeping track of how many PFM exercises they have done. “In the old day” I would pull out my little cassette player and sit in the back room recoding my voice counting and instructing specifically for a patient. With the departure of cassette I have been able to create electronic files with some of the instructions (3 second hold, 5 second hold and 10 second hold) available for free on my web site. Scroll down to the center of the page – files take a bit to load so be patient. (PS I am looking for someone with audio skills to help combine the files into sets. Contact me by email at if you know of someone who could help).

Smart phone technology can also be helpful. I have little experience myself but have heard of several patients and PTs who find these programs helpful. Some have a small cost and some are free. There may be more so keep searching – key words “Kegel exercises”, “Pelvic floor exercises”. Would love to hear your feedback and how patients are using them.


• MK – this is the one my patient likes best. It is actually a timer and can be programmed

• Pelvic Health – just information and not helpful for completing PFM exercises


• Kegel muscle – visual for contraction and basic home program which can be customized

• Kegel counter – not very user friendly

Thanks to Jenn Davia for reviewing Android apps. Hope to add more. Post your comments.

Friday, February 8, 2013

Pessary Fitting Guidelines

New guidelines on the fitting of pessaries. PT is a suggested profession however long term follow up is necessary and reimbursement in the US may limit access. Authors also note a certificate program now in development in Australia.  Very well written document.