Pelvic floor muscle training is a valuable modality regardless of a patient’s presentation or cause of symptoms. The majority of women are unfamiliar with the presence of the pelvic floor muscles, and even less aware of their function and role in daily activities. Intervention is slowly becoming more common during the childbearing years owing to the stress of pregnancy, labor, and delivery on the pelvic floor. Pelvic floor anatomy, function, and dysfunction are described in the first section of this chapter.

Begin pelvic floor exercise training with an empty bladder. Gravity-assisted positioning (hips higher than the heart, such as supported bridge or elbows/knees position) may be indicated initially for some women with extreme weakness and proprioceptive deficits. Positional changes are introduced as strength and awareness improve (supine, side-lying, quadruped, sitting, standing).

Contract-Relax
Instruct the woman to tighten the pelvic floor as if attempting to stop urine flow or hold back gas. Hold for 3 to 5 seconds and relax for at least the same length of time. Repeat up to 10 times (if performed with proper technique). With significant coordination dysfunction or fatigue, substitution with the gluteals, abdominals, or hip adductors may occur. To maximize proprioception and motor learning, it is important to emphasize isolation of the pelvic floor and avoid the substitute muscle actions. In addition, watch for Valsalva; if necessary, have the woman count out loud to encourage normal breathing patterns.

Quick Contractions
Have the woman perform quick, repeated contractions of the pelvic floor muscles while maintaining a normal breathing rate and keeping accessory muscles relaxed. Try for 15 to 20 repetitions per set. This type II fiber response is important to develop in order to withstand pressure from above, especially with coughing or sneezing.

“Elevator” Exercise
Instruct the woman to imagine riding in an elevator. As the elevator goes up from one floor to the next, she contracts the pelvic floor muscles a little more. As strength and awareness improve, add more “floors” to the sequence of the contraction. Another way to increase difficulty is by asking the woman to relax the muscles gradually, as if the elevator were descending one floor at a time. This component requires an eccentric contraction and is very challenging.

Pelvic Floor Relaxation
• Instruct the woman to contract the pelvic floor as in the strengthening exercise, then allow total voluntary release and relaxation of the pelvic floor. Use of the “elevator” imagery should also be emphasized, with particular attention to taking the elevator to the “basement.”

• Pelvic floor relaxation is closely linked with effective breathing and relaxation of the facial muscles. Instruct the woman to concentrate on a slow, deep breath and allow the pelvic floor to completely relax. Relaxation of the pelvic floor is extremely important during stage 2 of labor and vaginal delivery.

• Chronic inability to relax the pelvic floor muscles may lead to impairments such as hypertonus, pain with intercourse, or voiding dysfunction. Please refer to the earlier information on pelvic pain syndromes. If the patient presents with these symptoms, increase the rest time between pelvic floor contractions and sets; also use submaximal contractions to improve awareness of tension vs relaxation. Use of surface EMG for muscle re-education is invaluable with these impairments for increasing awareness of holding patterns, pain inhibition, and resting tone.

Buy the Book that holds this excerpt: Therapeutic Exercise: Foundations and Techniques (Therapeutic Exercise: Foundations & Techniques)

Related Articles