Blow the Whistle on the Silent Epidemic

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Examine and diagnose pelvic floor dysfunction confidently

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Rockstar Pelvic Floor Examination Strategies

Anatomy

 The pelvic floor consists of striated muscles, ligaments, and connective tissues that support the pelvic organs against gravity and intraabdominal pressure. The musculoskeletal structure has been vastly overlooked in the past in terms of diagnosis and treatment and as a primary and secondary source of pelvic floor dysfunction. In the past, it was thought that the pelvic diaphragm is composed of the coccygeus muscle posteriorly and the levator ani anterolaterally. Emerging evidence and focus on anatomy has identified a much more complex interrelationship between several individual muscles; each with their own distinct function, action and susceptibility to injury. The components of the female levator ani consist of the iliococcygeus, the pubococcygeus, pubovaginalis and the puborectalis. Superficial muslces include bulbocavernosus, ischiocavernosus and transverse perioneal.

The pelvic floor must allow relaxation of this support at the urogenital hiatus during voiding and parturition while maintaining the anatomic position of pelvic structures. 

The complex mechanics of its bimodal function and frequent insults to the integrity of the pelvic diaphragm from altered biomechanics, pregnancy, athletics, menopause, sexual trauma and obesity contribute to the pelvic musculature’s vulnerability to damage and injury.  

Lying within the pelvic cavity are the piriformis, and obturator muscles, which are not elements of the pelvic diaphragm but may contribute to pelvic pain when injured. These muscles are easily accessible from an intravaginal perspective. Many underlying hip, low back and sacroiliac pain syndromes begin with PF dysfunction. This is why it is critical to consider more than just the levator ani and coccygeus muscle groups.

Rockstar Exam

A quick, easy, reproducible, MSK exam can be incorporated into an internal exam by simply rotating your hand 180 degrees following the bimanual exam. This will enable medical providers and specialists to palpate the MSK features of the pelvic floor.

1. Describe the steps of the manual exam and get consent.
2.Begin the unidigital transvaginal examination by inserting a gloved, lubricated index finger into the vaginal introitus
3. Utilize clock face orientation with the pubic symphysis at 12 o clock and the anus at 6 o clock to localize pelvic floor muscles
4. Start with unidigital palpation of superficial pelvic floor musculature and then proceed to deep pelvic floor musculature.
5. Use the following clock face positions to palpate the superficial and then deep PFM.
Superficial Layer: Bulbospongiosus (2 and 10 o clock), Ischiocavernosus (1 and 11 o clock)
Superficial transverse perineal muscles (3 and 9 o clock)
Deep Layer: Pubococcygeus (7 and 11 o clock for left side; 1 and 5 o clock for right side)
Iliococcygeus (4 and 8 o clock)
Coccygeus (5 and 7 o clock; requires deeper digital insertion)

6. Then palpate obturator internus at 2 and 10 o clock
7. Examine the piriformis with the finger pressed posterolaterally and superior to the ischial spine at 11 and 1 o’clock
8. During palpation, apply pressure to specific sites predefined on each of the pelvic floor muscles and obturator internus.
9. Use a graded scale (either NRS or VAS) to assess patient reported pain after palpation of each site and notate any trigger points palpated

Spasm of a portion of the levator ani is often detected as a palpable band resembling a guitar string within the muscle or focal trigger points. In the patient with normal pelvic floor musculature, palpation of the levator ani and piriformis typically elicits a sensation of pressure, whereas a patient with pelvic floor myalgia will report significant pain.

Another typical finding during examination is a distinct asymmetry between the right and left elements of the pelvic diaphragm.

10. Assess for general strength of pelvic floor musculature. Ask the patient to squeeze their pelvic floor muscles as if they were trying to stop urinating and hold for 3 seconds. Is the patient able to do a contraction against the pressure of your finger and sustain it for 3 seconds in the different regions of the pelvic floor. Notate general areas that the contraction feels weaker to initiate or that weaken before 3 seconds. During this musculoskeletal assessment, muscles can easily be identified as flaccid and unresponsive; instead of a taut guitar-string like band, the global musculature will be soft, without fiber distinction with an absence of pain.

ACADEMY NEWSLETTERS

VOL. 1 | ISSUE 1

NEW THIS ISSUE

Rockstar Manual Pelvic Floor Exams

“Turn that Hand Upside Down”

Key Questions:

  1. Which two muscles are the most important to palpate for spasticity?
  2. Which three muscled make up the levator ani complex?

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VOL. 1 | ISSUE 2

NEW THIS ISSUE

When Kegels Harm

Spastic Versus Flaccid Plevic Floor

Key Questions:

  1. Which component spastic/flaccid is essential to address first?
  2. Does one ever exist without the other?

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VOL. 1 | ISSUE 3

NEW THIS ISSUE

Manual Versus Mechanical Biofeedback

Key Questions:

  1.  Which biofeedback technique is more specific? Manual or Mechanical?

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VOL. 2 | ISSUE 1

NEW THIS ISSUE

Key Risk Factors for Pelvic Floor Dysfunction

Key Questions:

  1.  What are the seven primary risk factors of female pelvic floor dysfunction?

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SPECIAL ISSUES

ACADEMY NEWSLETTERS

SPECIAL ISSUE 1

NEW THIS ISSUE

Pelvic Power Release 

Key Questions:

  1. Can pelvic power release be utilized to diagnose and treat both spastic and flaccid muscles within the pelvic floor?

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SPECIAL ISSUE 2

NEW THIS ISSUE

ChiroQueen Concierge Model of Care

Key Questions:

  1. What model of care provides the highest respect for the sensitive nature of pelvic floor treatment?

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SPECIAL ISSUE 3

NEW THIS ISSUE

FloorRehab

Key Questions:

  1. What are the three primary muscles and one primary muscle group that define the true “lower core”?

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PATIENT EDUCATIONAL TOOLS

PATIENT EDUCATIONAL HANDOUTS

PELVIC FLOOR

Screening Tool

Evidence-based Cozean Pelvic Floor Dysfunction Screening Tool

Click on the Cozean Screening tool to download a copy!

Feel free to download and print handouts for educational purposes.

You can also contact us at info@chiroqueen.com or call (833) 797-8336 and we will ship you color copies for free

ChiroQueen Concierge Model of Care

The ChiroQueen Concierge model of care empowers women to achieve their greatest potential with confidence, security, passion, happiness and pleasure.  ChiroQueen Concierge respects the private, intimate nature of pelvic floor dysfunction and offers treatment in the safety and security of our female patient’s home. Evidence-based medicine and collaborative care with medical physicians and specialists guide our examination and treatment protocols.

ChiroQueen Concierge Chiropractic Physicians will bring their own treatment table and supplies. They will be accompanied by a virtual assistant who will be available to help them in whatever way is needed. 

The virtual assistant will work with you before the first visit to ensure that the provider is fully prepared to examine and treatment you by collecting pertinent past medical information, medical referral notes and explaining the process as well as answering any questions or concerns that you may have. 

ChiroQueen chiropractic joint motion examination assesses for proper joint motion of the pelvic and back joints.

 

ChiroQueen Concierge treatment consists of a combination of Pelvic Power Release, chiropractic joint manipulation, manual biofeedback, patient activity of daily living education and modification and lumbopelvic and pelvic floor rehabilitative strengthening and conditioning. ChiroQueen Concierge Providers also work collaboratively with medical providers or specialists when necessary for such treatments as intravaginal valium, botox injections and other treatments.

History

Your female Chiropractic Physician will ask you detailed questions to try to determine your individual contributing factors to your symptoms or risk factors for symptoms in the future. They will ask about a history of sexual trauma, participation in athletics with particular attention to running and jumping movements, pregnancy, obesity, menopause, pelvic surgery, gait disturbances, prolonged sitting and avoiding or holding urination or defecation.  

Treatment

ChiroQueen Concierge treatment consists of a combination of Pelvic Power Release, chiropractic joint release, manual biofeedback, patient activity of daily living education and modification and lumbopelvic and pelvic floor rehabilitative strengthening and conditioning. ChiroQueen Concierge Chiropractic Physicians also work collaboratively with Medical Providers and Specialists when necessary for such treatments as intravaginal valium, Botox injections and other treatments. 

 

Your Chiropractic Physician will discuss with you how to change your lifestyle to promote pelvic floor health on an individual basis. They will identify risk factors from your history and try to give you strategies to mitigate those factors. They will discuss modifications in the way you function throughout the day to better promote pelvic floor health. 

 

In any pelvic floor therapy, it is particularly important that all spastic muscles are released before beginning to strengthen the pelvic floor. 

Pelvic Power Release is a highly specific way of intravaginally, manually diagnosing and treating any spastic muscles or portions of muscles within the pelvic floor such as trigger points and adhesions. Pelvic Power Release is also used to provide manual biofeedback to help women mentally connect with their pelvic floor muscles and teach them how to contract and relax the global pelvic floor as well as individual parts of the pelvic floor.

 

Chiropractic joint manipulation restores normal function to the joints of the back, pelvis, and hips to aid in their coordination with the pelvic floor muscles and decrease stress upon the pelvic floor muscles.

 

Lumbopelvic and pelvic floor muscle strengthening, and stabilization exercises are the last step in normalizing the function of the pelvic floor once all spastic muscles have been released with Pelvic Power Release Techniques. You may qualify for one-on-one live virtual rehab sessions with one of our ChiroQueen Certified Rehab therapists.

They will address deficiencies in the “true core” which includes your pelvic floor, transverse abdominus, internal obliques and diaphragm.

They will also gear exercises towards your daily functional tasks such as bending, lifting, carrying and recreational routines whether that is running, tennis, golf, dancing, or something else.

Treatment Plan Dosing

ChiroQueen Concierge evidence-based treatment dosage guidelines are twice weekly for three weeks initial trial of care with reexamination to determine you are meeting clinically significant improvement and then a progressive taper of dosing to once weekly for three weeks and then a final treatment three weeks later. Most women will experience a near complete resolution of symptoms and will graduate to begin the ChiroQueen Concierge virtual pelvic floor strengthening and rehab program.

Some women with complicated cases involving altered anatomy due to damage may require an additional 4-6 treatments before graduating to rehab. ChiroQueen Concierge Virtual Rehab program is twice weekly for the first week and then once weekly for four more weeks. Once your rehab protocol has been completed then patients are offered optional ongoing supportive care at an interval from every 2-6 months depending upon their individual circumstances. This is determined by you, your ChiroQueen Concierge provider, and your referring medical provider.

Come join the revolution and Blow the Whistle on the Silent Epidemic!

Currently serving the Naples Florida area with expansion to the Miami, Tampa and Jacksonville Florida regions in the coming months and throughout the US in the coming years.

ChiroQueen Concierge Chiropractic Physicians will bring their own treatment table and supplies. They will be accompanied by a virtual assistant who will be available to help them in whatever way is needed. 

The virtual assistant will work with you before the first visit to ensure that the provider is fully prepared to examine and treatment you by collecting pertinent past medical information, medical referral notes and explaining the process as well as answering any questions or concerns that you may have. 

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