Pelvic Floor Rehabilitation

Hello. My name is Janev Alvarez. I am a physical therapist at Spirit Winds Physical Therapy here as a guest contributor. As a practicing physical therapist, I enjoy empowering our community with knowledge. Today I am expanding on the topic of pelvic floor rehabilitation.

Physical therapy treats the musculoskeletal system, taking into account the whole patient. This system is comprised of muscles and their tendons which attach to the bony joints they operate. There are also bursa (coverings) which protect the tendons from irritation as they move over bone, the nervous tissue that signals muscles to move the joints, the ligaments that hold the bony joints together, the soft tissue structures that protect the bony joint surfaces (menisci, labra), and the skin and fascia that envelop and protect these layers of tissue.

There are other less commonly referenced anatomical structures that physical therapists assess and treat. The pelvis and pelvic diaphragm are also comprised of all the above structures. Rehabilitation of the pelvic floor muscles is as important as it is for muscles in other regions of the body.

The job for muscles in any region is to contract and relax. Some muscles do this quickly and with great force. Other muscles are built for more enduring, lower intensity contractions. The muscles of the pelvic floor are in this endurance category and perform unique functions.

The pelvic diaphragm is a sling-like floor muscle that supports the organs of the pelvic cavity. The pelvic diaphragm is at the mercy of the alignment of the bony structures it attaches to. If the pelvic bones, which include the sacrum and coccyx (tailbone), are misaligned, the pelvic diaphragm is pulled unevenly in effect impairing efficiency for contracting and relaxing.

What most people associate with pelvic floor rehabilitation are Kegel strengthening exercises, which have been shown to decrease muscular weakness. Kegel exercises are not always appropriate however. With any muscle group, if the pelvic floor is in a resting state of higher tone and restriction, then exercise and increased toning is not the best answer. I would promote stretching to help the muscle do a better job of relaxing. The relaxation component includes manual muscle work, self-stretching, and strengthening the opposite muscle group.