Non-invasive Female Pelvic Floor Rehabilitation Practitioner

Individualized approaches for the maintenance and management of women’s pelvic health are increasingly in demand. As pelvic floor dysfunction is multifactorial and origins vary, it is essential as a clinician, to be familiar with available interventions to address each of these dysfunctions and their causes.

This course is a 2-day online webinar that aims to teach participants about the role of physical therapy in the management of female patients presenting with pelvic floor dysfunction related to bowel, bladder and sexual health with focus on non-invasive pelvic floor assessment, diagnosis and rehabilitation techniques. Each segment of the course will address a specific type of pelvic floor dysfunction, discusses the methodology for management, as well as the efficacy of the physical therapy intervention related to treatment of each diagnosis.

General and Specific Objectives:

• Detailed functional anatomy and physiology of different pelvic organs and pelvic floor muscles – different layers, ligaments, joints, pelvic fascia
• Physiology of micturition, defecation, menstruation
• Detailed pathophysiology of the conditions affecting the pelvic organs like interstitial cystitis, inflammatory bowel disease, endometriosis, etc.
• Integration of Diaphragm, Multifidus, Transversus Abdominis, Pelvic Floor Muscles for maintaining core stability and IAP
• Nervous control of pelvic floor organs, pelvic floor muscles and perineal area
• Different pelvic floor dysfunctions and pathology with their causes
• Different presentation of hypotonus and hypertonus dysfunction like urinary retention, burning/difficulty emptying bladder, constipation, piles, hemorroids, pelvic floor dyssynergia, Vaginismus, dyspareunia, chronic pelvic pain etc.
• Discussion and understanding of different conditions like – pudendal neuralgia, Vulvodynia, Vestibulitis, Tension myalgia, levator-ani syndrome, anismus, proctalgia fugax, urethral syndrome, urethral constrictor etc.
• Details of Female Sexual Response cycle and Female Sexual Dysfunctions
• Subjective, objective and general assessment
• General observation of gait, posture, spine, SI Joint, Feet, Hip rotation etc.
• Perineal observation – static and dynamic, reaction to cough, reaction to command of contraction and relaxation, difference between hypotonus and hypertonus presentation, perineal movement, relfexes
• External palpation
• Planning the pelvic floor rehab based upon Het’s RR Scale which gives ultimate goal and standardised progression
• Assessment level for customised sexual health rehab by using Het’s Female Sexual Function Scale for Hypotonus and Hypertonus, Het’s Male Sexual Function Scale, Female Sexual Health Dysfunction Rehab Stages
• Objective assessment and it’s interpretation for hypotonus and hypertonus pelvic floor muscles, EMG, Perineometer, Vaginal Dilators, V-Ease, US, Uroflowmetry, Defectogram etc.
• Pelvic floor Rehab for Different pelvic floor dysfunction through Standardised protocol which are individualised according to dysfunction
• Evidence based management - Correct coordination between all core muscles, breathing, posterior pelvic tilt, PFM contraction etc.
• Pelvic Floor Rehab for hypotonus dysfunction: use of biofeedback like EMG, perineometer, vaginal cones, V-Fit. Modalities like IFT, WOW PF 360 for isolated muscle fibre exercise/activation like paraurethral, paravaginal, paraclitoral etc.  PNF techniques, Het’s ring clock wise manual strengthening, resisted exercises
• Therapeutic exercises integration of PFM with other exercises progression through identification & facilitation, movement training, plyometric training and finally functional training – Het’s Exercise Protocol of PFDs
• Pelvic Floor Rehab for hypertonus dysfunction: Technique sweet spot release-wise anderson, paradoxical relaxation, minimal static pressure, Trigger point release, myofascial release, ICT, Thiele technique, strain counter strain technique, positional release technique, etc. 
• Use of WOW PF 360 for pelvic floor muscle relaxation, Bartholin gland activation, etc.
• Progressive use of vaginal dilators in different positions etc.
• Individualised Home Exercise Plan: Bladder-Bowel retraining, bladder diary, life style modification, stress management, KNACK technique, do’s and don’ts etc.