Episode 1789 - Treating the hypertonic pelvic floor

Dr. Jess Gingerich // #ICEPelvic // www.ptonice.com

In today's episode of the PT on ICE Daily Show, ICE Pelvic faculty member Jess Gingerich defines hypertonicity as it relates to the pelvic floor and the role of the pelvic floor in the body as contractile tissue.

Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.

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EPISODE TRANSCRIPTION

JESSICA GINGERICHGood morning PT on ICE podcast. My name is Dr. Jessica Gingerich, and I am on faculty with the Pelvic Division here at ICE, and I am coming to you today to talk about the hypertonic pelvic floor. We got a great question in our online course about hypertonicity in the pelvic floor around pregnancy. And so before I dive into this, when we talk about hypertonicity in the pelvic floor, we really don't care necessarily if it's prenatal, pregnant, postnatal, really anywhere in the lifespan. We're gonna treat it relatively the same. there may be some factors that we think about at each stage of life but relatively we're treating it the same.

DEFINING A HYPERTONIC PELVIC FLOOR So first and foremost the definition of a hypertonic pelvic floor and the reason I put that in air quotes is because we will hear so many different things overactive pelvic floor tight pelvic floor is when the pelvic floor muscles are in a contracted state um or a spasm And so, the symptoms of this can be leakage, heaviness, pressure, a dragging sensation in the vagina, painful insertion, whether that is during intercourse, a tampon insertion, vaginal exam, or anything else. urinary urgency, frequency, constipation, incomplete emptying that could be of the bladder or of the bowels, coccyx pain, pelvic pain, low back pain, and hip pain. So when you have your client that comes in and they say, oh my pelvic floor is so weak because I pee all the time I just can't control it. recognize that that could be their pelvic floor sitting in a contracted state with the inability or I want to say inability or awareness to relax. And so when we think of that contracted state with the inability to drop, recognizing that with that could come weakness as well. So there's a lot of different bubbles that we want to make sure that we are not missing when it comes to a tight pelvic floor.

THE ROLE OF THE PELVIC FLOOR The role of the pelvic floor is to contract. So if you can kind of conceptualize my shoulders as the pelvic floor, we want to close the holes and lift and we want to also be able to open the holes and drop. We want to be able to do this during a lot of different tasks and that can be toileting, intercourse, achieving an orgasm, lifting weights during daily tasks, so that's your laundry basket, the kiddos, or even your body weight, lifting your body weight up off the floor or out of a chair. And then as well as just the gym, being able to do things in the gym and having the ability to essentially tension your pelvic floor to the tasks in front of you. When we think of a tight pelvic floor, we kind of have, as a pelvic floor profession as a whole, have kind of gotten into this, the Kegel, you know, not doing the Kegel, it's kind of like lost its meaning in our space, right? If you have a tight pelvic floor, stop doing Kegel, stop, stop, stop, stop, stop. Really, that's not what we want to do. We often hear to not do the Kegel because you're in that contracted state. So if I'm already here and I do a Kegel, I'm not getting much range of motion. I'm not going anywhere. However, we need to know how to do a Kegel for a couple of reasons. A, when you cough or sneeze, the reflexive nature of your pelvic floor should be to squeeze. We want that reflex, we want that ability to be able to do that. We want to train that. But the other thing that we can do is we can utilize the Kegel to improve our proprioceptive awareness, right? So if I am in this contracted state and then I go and do a maximal Kegel, I might be able to then now, okay, here, that's where I'm in that down or relaxed position. It can help improve your proprioceptive awareness. So key goals should absolutely be a part of the plan of care. Teaching the person what a pelvic floor contraction feels like, so what does it feel like when they are closed and up, as well as what does it feel like when they're open and down. So we call that the attic and the basement. We've said this before, it's really nice to use those terms. So if you're out in the gym or out in public, you can ask your client, are you in the attic? Are you in the basement? Rather than asking them whatever cue you gave them during their pelvic floor exam, you're not out there asking if they're squeezing their buttholes. That's really kind. Teaching them how to do this can be done with internal cues or external cues, recognizing that someone may respond better to one or the other. And so you're gonna need to be able to do both. If you are a therapist who does not do internal exams, that's fine. You can refer or you can take our live course and learn how to do the internal exam. and teach this person how to do a Kegel with right there feedback, there's your tactile cue, squeeze my finger. That can be so so helpful and remembering that this is going to create awareness and just teaching them where they are in space. Now, we talked about the kegel. Other passive interventions are gonna be that diaphragmatic breathing. We talk about this all the time. Using that big belly breath as the diaphragm descends, it's gonna take the pelvic floor with it. It is a passive range of motion of the pelvic floor. They can do this in different positions. They can do this in child's pose. They can do this in a happy baby. They can do this in a supported squat. And then also lastly is the functional dry needling. We can use dry needling to help calm down the pelvic floor. Now, the last bits around what we wanna do in the plan of care for a hypertonic pelvic floor is not discharge once this person says, oh my gosh, I know I'm in the basement, I can feel it, I just know I'm there. Or I'm in the attic, my holes are closed, I know that. We want to load them. We want to make sure that when this person comes in symptomatic, that we are teaching them where they are in space, we are changing their symptoms, but now we are loading them. We are getting them back to where they were, ideally beyond where they were. We want them to not have symptoms, but we want them to not need us, really. So getting them stronger, so getting them into a gym, whether you are teaching them about, or I guess really learning what their love language is around exercise, and then leaning into that. And showing them the type of programming that they may want, encouraging them to certain gyms. I know here in Greenville, we have a ton of gyms. I've got a lot of options with a lot of wonderful coaches that I can essentially push these people towards. once they are symptom free and feeling a little more confident in the gym. So that is what I've got for you today. Join us online or on the road. So head over to PTOnIce.com to look at where we are next and we look forward to having you.

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