One of my friends called me recently to ask about her rehabilitation that she is doing for her injured shoulder.  She called to tell me that she noticed that she has more pain free range in her shoulder when she engages her pelvic floor first when doing her shoulder exercises.  She asked me if she is cheating by doing this. I said, “Heck no!” As a pelvic floor therapist, I was then able to easily explain to her why the pelvic floor should be engaged (ideally automatically) with any shoulder movements. 

My friend is not a PT, she is a dancer.  So, she has not read any of the research published by Paul Hodges which shows that the inner core muscles, including the pelvic floor muscles, engage in anticipation of movement, including movement of the arms or movement of the legs or prior to impact such as during gait.  She did not read the 2007 study by Hodges, Sapsford & Pengal, which showed that the pelvic floor muscles were active prior to arm movements performed by the participants in the study.

While it makes sense that my friend, being a dancer, has a good understanding of how inner core control ideally precedes movement, I couldn’t help being impressed with how much she understood about her motor recruitment patterns when doing her shoulder rehabilitation.   Her experience as a dancer taught her what we PTs know after years of school and ongoing learning of evidence about core control. Thanks to the extensive research of Paul Hodges and other great researchers for over 20 years, PTs now understand and can teach their patients about the inner core, and how to improve movement patterns with less pain.  

As evidence evolves, so do we as PTs.   With this evidence, we now know that we need the inner core muscles, including the diaphragm, transverse abdominis, deep multifidi and the pelvic floor muscles to “anticipate” movement.  Ideally, our inner core activates prior to movement in order to provide a stable base or anchor, from which the outer core muscles and limbs can move off of.  

As my career led to my becoming a pelvic health therapist, I have had the opportunity to become very well acquainted with the evidence that supports enhancing inner core control for improved function.  Since I now do both internal and external palpation of the muscles “down there,” the pelvic floor muscles, I am seeing how much I can help a patient improve their function with better pelvic floor control.  Yes, I am often working more with complaints of bowel and bladder dysfunction and pelvic pain, but a lot of these patients have other complaints and impaired function (back pain, hip pain and balance issues to name a few) and these do often improve when my patients gain more functional mobility and strength of the pelvic floor. 

It is very encouraging to see that there are so many PTs, not just the ones with a pelvic health specialty, who want to keep learning more about the pelvic floor muscles.  Obviously I have a bias towards wanting everyone to see how much the muscles of the pelvic floor have such a BIG impact on our activities of daily living. I want to give these little muscles all of the attention that, I feel, they clearly deserve. 

I want to continue to provide more education to all PTs, not just pelvic health PTs, about the impact that we can have on any dysfunction when we at least consider the pelvic floor muscles in treatment.   This is why I was so excited to have Michelle Nesin, PT, OCS, FCFMT, FAAOMPT agree to teach a Pelvic Health course in Montana. The goal of Michelle and her co-founders of the Pelvic Education Alliance, has been what I was imagining for a Pelvic Health course: the goal of bridging the physical therapy orthopedic and pelvic health worlds.  

I have taken a course from Michelle many years ago, a course that was not geared to the pelvic health therapist at all.  I took her Functional Gait course with the IPA, with a PNF course being a pre-requisite. Michelle’s experience as an orthopedic therapist and teacher of all things orthopedic is extensive.  She earned an Orthopedic Manual Therapy Fellowship, studying with Gregg Johnson of all people! With her experience with teaching orthopedic and gait concepts, in addition to her experience teaching pelvic health courses and her experience as a Pelvic Health therapist, Michelle’s course is expected to provide new skills and treatment ideas, for Montana PTs treating a variety of populations.  

Lucky for Montanans, Michelle is interested in developing her course, “Treating Pelvic Girdle and LE Dysfunction using Pelvic Health and Orthopedic Concepts,” such that it appeals to therapists, serving a variety of populations.  In her course, therapists will learn how to evaluate the pelvic floor muscles, and enhance pelvic floor function, with external techniques only. At the end of this course, Michelle will be able to give a demonstration of how a pelvic health trained PT does an internal pelvic assessment to any interested participants.  However, internal pelvic floor assessment will not be part of this course’s objectives. Instead, the objective of the course is to provide tools for all Montana PTs, not just pelvic health therapists, to help them treat patients, by maximizing the function of their inner core muscles, including the pelvic floor muscles.   

By Kimberlee Raynovich, PT, PCS

Programming Director, APTA Montana

To register or to find out more information about Michelle Nesin’s course, Treating Pelvic Girdle and LE Dysfunction using Pelvic Health and Orthopedic Concepts, a 2 day course hosted by APTA Montana in Bozeman February 1-2, 2020 go to:  http://www.mapta.com/mapta_events

PLEASE GO TO THE ABOVE WEBSITE FOR ALL UPCOMING APTA MONTANA EVENTS