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Hi guys, Welcome to a new
episode of The Factor podcast. I'm your
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host, Jessica Riddle. If this
is your first time tuning in, welcome
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and thank you for listening. Today. I'm actually recording from Tokyo, Japan,
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on the final leg of an amazing
trip working with the Japan Chiropractic Association,
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So I apologize if my audio is
a little less than perfect. Travel
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microphones don't always have quite the same
studio sound quality that you may be used
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to. Today we kick off a
new training called Let's Hear It for the
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Boys Pelvic floor dysfunction Diagnosis and Treatment
Options for Men with Brittany Sudbrook, a
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Fellowship trained orthopedic manual physical therapist.
Now, please note that in this episode
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and an episode's sixty three, where
we complete part two of this training,
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when we refer to men and women, were specifically talking about cis gender men
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and women. There's no refuting that
there are some distinct anatomical differences between the
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two groups, the cis gender men
and women, but there hasn't been a
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great deal of public awareness brought to
the fact that both groups can actually develop
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pelvic pain. Usually, when you
hear about pelvic pain or pelvic floor dysfunction.
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Specifically, it often surrounds postpartum or
post hysterectomy care, but studies have
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found that at least one in six
CIS gender men are dealing with persistent pain
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in the pelvis, making chronic pelvic
pain syndrome the most common neurological diagnosis in
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men under fifty. In this two
part series, we will learn common pelvic
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floor diagnoses for men. We'll learn
how to properly screen and identify pelvit floor
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dysfunction and winter to a pelvic floor
physical therapist. We'll also talk about why
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it is important to establish a mutual
relationship with a pelvic floor physical therapist and
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how it can benefit your patients.
Our featured instructor is Brittany Sudbrook, owner
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of Empower Pelvic Health, a practice
based in Southeast Houston, Texas. Brittany
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received her Masters of Science and Physical
Therapy at Texas State University, then went
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on to complete a fellowship in Orthopedic
manual Therapy. She's a faculty member of
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the Manual Therapy Institute, a postdoctorate
fellowship program teaching physical therapists advanced problem solving
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and hands on manual therapy skills and
is taught continuing education courses to hundreds of
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physical therapist nationwide. This is a
fascinating topic and one that can be incredibly
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helpful to better understand for your patients. Let's cue the intra music and get
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started. Thank you, Thank you
so much, Jessica, and thank you
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to all of you who have made
time to be on this webinar with me
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today. I'm super excited to present
with you about pelvic floor and more importantly
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public floor in men. Let me
go ahead and give you a little background
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information on myself and kind of how
I got here into pelvic health. I
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actually have originally started in orthopedics physical
therapy, and I was doing this for
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about twelve years and I had nothing
to do with pelvic floor at that time.
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And it wasn't until the birth of
my daughter about four years ago that
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I experienced for the first hand of
having my own pelvic floor dysfunction, and
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I thought, oh my goodness,
what am I going to do about this?
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Went to Public Floor PT and it
was fantastic. It was great,
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but it was definitely more looking at
like the local segment versus kind of global
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and what was going on both locally
and globally. So I decided to bridge
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the gap between my orthopedic knowledge and
learn more about the pelvic floor and integrate
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both of those. So I do
think that we do have some stuff in
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common that we're going to be able
to talk about today of both local factors
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and then global factors that influence pelvic
floor. And what are some red flags
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that you can look for when you
were with a patient that may be having
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more global things going on, but
not recognizing that they may be impacting the
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pelvic floor. And so went to
got all my certifications for pelvic floor,
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decided to open up my own practice, and so now today I treat the
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pelvic floor dysfunctions. It is still
a very much a topic that is generally
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not discussed. It's not something that's
on the forefront. Definitely is for more
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women than it is for men.
But men's health, I definitely feel like
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it's on the rise and men are
definitely getting more attention in this area that
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is needed. And so I'm going
to be with you today to share with
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you some things that you could be
looking at in your own patients to help
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you to recognize win A referral to
a public floor physical therabusiness indicated and then
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ask and also how you can help
those patients as well. So during this
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topic here, we're going to have
some objectives that I'm going to try to
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stick by. Teach a little bit
of things, but try to stick by
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these things because this is why you're
here. So what is the pelvic floor?
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I know when I went to PT
school many many many moons ago,
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it was like a special topic that
we could do in PT school. It
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wasn't really like an area like orthopedics
or neuro that we really just took a
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lot of time and discussed the pelvic
floor. If you were interested into pelvic
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floor with stethree that they're a subspecialty
or you could do a clinical rotation in
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it. So not a lot of
information was given at that time. What
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is its function and what is its
impact on my patients? We're going to
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discuss the most common pelvic floor dysfunctions
and men Men do carry a lot of
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common pelvic floor dysfunctions just like women
do. But then there are some differences
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as well, so we'll discuss those. We're going to also learn how to
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properly screen your patient and identify when
a pelvic floor dysfunction is present, and
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then how to refer that patient to
a pelvic floor therapist, And then why
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is it essential to be able to
establish a mutual relationship between both a pelvic
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floor physical therapist and yourself and how
does that ultimately benefit the patient. So
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we're going to do a little bit
of an overview here. So pelvic floor
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dysfunction is actually quite prevalent and meant
surprisingly enough, the research shows that about
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one in every sixth man will actually
have a pelvic floor dysfunction. We pelic
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floor therapists think that that number is
probably a little bit on the higher end.
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We think maybe one in four,
maybe even one and five men do
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suffer from a public floor dysfunction.
Fortunately for men, it's not necessarily a
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topic that they can go to the
bar and like discuss with their buddies.
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Right, Not like us women,
Right, we would be like put it
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on a billboard, let everybody know
that we have a public floor dysfunction and
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paying on ourselves is something that we
just accept as common and in normal.
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But men don't often talk about these
issues, and so they kind of let
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it go for months, for years, and then finally when they've had enough,
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and it really has to be a
bigger driver, right, it's changing
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their their life in some capacity for
them really to seek care. And by
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that time, by the time they
do actually make it to a position or
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what so, maybe it's generally about
four years until they are referred to a
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public floor physical therapist. I know
that's really astonishing four years for a man
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to struggle with something that a woman
can go to an ob with and say,
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hey, I have your narring continence
and send me tell a public floor
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PT. But it definitely is something
that I think is on the rise,
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so more and more help is going
to be on the way. But definitely,
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one in six men do suffer from
pelvic floor dysfunction. So that's just
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a little picture showing you really have
majority of the superficial muscles of the pelvic
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floor, and the pelvic floor it
is made up of approximately about fourteen muscles.
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Honestly, it really depends on what
textbook that you look in somewhere and
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say somewhere between fourteen and seventeen muscles
make up the pelvic floor. Men and
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women have very smaller pelvic floors,
but you can see they're the picture of
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the pelvic floor muscles. Majority of
these that are shown here are going to
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be the superficial layer of the pelvic
floor. So let's they'll talk about that.
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That the pelvic floor is actually collection
of muscles, like I just indicated,
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depends on what anatomy textbook you look
at fourteen to seventeen of them muscles
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that make up the pelvic floor.
There are also ligaments, nerves, and
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connected tissue that creates a natural hammock
that attaches the front of the pelvis to
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the back of the pelvis. So
majority of these muscles do run from the
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pubic bone and they sling all the
way back to the coxics and at some
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capacity, either they have direct attachment
to the coxics or they attach themselves to
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other muscles or other connective tissue that
also comes in and attaches themselves to the
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coxics as well. And so that's
very very important to kind of think about
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the forefront as we work through this
module here of how can that impact my
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patients because of the pelvic floor attaching
back to the coxics. So we'll get
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through that here in just a second. And then there are major nerve contributions
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to the pelvic floor, and that's
derived from the podental nerve, and the
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podental nerve comes from S to S
through S four. That's a really cool
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way to remember. It is S
two, S three, S four keeps
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pm poop off the floor. This
nerve here, though the indicated in pelvic
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health, is probably the nerve that
has to take one of the most tumultuous
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pathways through the pelvis to enervate the
pelvic floor. So if you can kind
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of nerve out with me for just
a moment on anatomy, is that the
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podental nerve is derived, like I
said, from the sacred roots of S
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two S four and as it exits
out of the sacrum. But here is
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a model of the pelvis, and
this right here as obviously the sacrum.
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These are the sacral roots. It's
going to come out from the sacrum here
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and then it's gonna actually dive.
One thing you don't see here are two
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major ligaments between the sacrum and the
ilium here, which is the sacral spinus
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ligament, which is going to go
obviously from here to here, and then
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you have that sacro tubrius ligament.
So they kind of have that little criss
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cross connection like this and that nerve
that podental nerve is actually going to pierce
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through and it's going to go between
those two ligaments as it comes into the
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pelvis here, and then it's going
to go through what we call ALCS canal.
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And then as it dives through ALCS
canal, which is inside the pelvis
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here, it's gonna then branch.
And it actually has three branches that's going
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to go through to the rectum,
to the perennial area, and to the
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also the shaft of the penis.
And so you just wanted you to know
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that there is a major nerve contribution
to the pelvic floor and it does come
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from the podental nerve. And we'll
talk a little bit here a little bit
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more about what does that mean for
my patients and how do I know if
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my patient is potentially suffering from podendal
neuralgia. So we'll go into that just
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a second. Have you ever thought
about teaching or launching a podcast, maybe
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creating online courses for your patients or
a YouTube channel to gain exposure, or
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maybe you want to pass on your
expertise and knowledge to the next generation of
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healthcare providers, but don't really know
where to get started. If this sounds
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like you, then we would love
to have a conversation. Southeast Professional Education
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Group has helped healthcare providers, national
organizations, and product companies create and launch
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content for the purpose of educating and
engaging their target audience. Whether you want
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to establish your credibility in your hometown
as a means to grow your practice,
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or if you're looking to enter into
the exciting world of continuing education, we
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would love to talk to you.
The great W. B. Yeats said,
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education is not the filling of a
pot, but the lighting of a
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fire. And I guarantee you there's
someone out there waiting for you to light
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that spark. Simply fill out the
interest form linked in the show notes and
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let's have a conversation. Who knows, maybe a few months from now,
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you're the one that our podcast subscribers
are tuning in to learn from. So
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click the link to request a time
to chat. Let's have a conversation and
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see how we can help you launch
something great and also to the pelvic floor
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is actually divided into three layers.
There's a superficial layer, there is a
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middle layer or intermediate layer, and
then there is a deep layer. The
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first layer is primarily for sexual function, and it allows for the penis to
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achieve full erection. The second layer
and the pelvis is for sphincter control right
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to start and stop the flow of
urine or also for bowels. And the
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third layer is to help to stabilize
the pelvis, the low back, and
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the hips. And so what I'm
going to do is I do feel like
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we'll talk a little bit about the
first and second layer and how that affects
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your patients, But I think for
the majority of who is on this webinar
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here, we really would like to
stop and talk more about the layer,
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because I think the third layer has
probably a bigger impact for the types of
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patients that you see in your clinic
and that could be suffering from a pelvic
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floor dysfunction. So I'm gonna pause
here a little bit and then show you
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this pelvic the deepest layer of the
pelvic floor. It doesn't matter whether you're
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male or female. It is the
zac same makeup of muscles when you get
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here into the third layer. So
I'm going to show you the n side
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here so you can see how these
muscles do very much sling back from the
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frontier of the pubic bone and they
go all the way back here towards the
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tailbone and that sacral coxygeal area,
so they do sling back like that natural
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hammock. And so you could see
where if you were treating a patient that
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had something going on with a tighter
pelvic floor, the contributions could be that
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the pull of these muscles here could
create it changes in both the coxics and
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the sacrum and kind of pull them
more into like an extended while the sacred
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would go into extended position, so
the pelvis gets tucked up underneath you.
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And it can also change how the
lumbar spine is in maybe potentially less lore
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doses and more in achyphotic position.
So it can change the orientation of the
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strong pull from the pelvic floor and
how that directly impacts both the coxics,
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the sacredrum, and also the lumbar
spine. Another really cool thing that is
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just quite fascinating in pelvic floor.
Every time that I treat this, and
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I promise you, every time someone
will come in with symptoms and I'm like,
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oh, I know exactly what that
is. That is this and it
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happens to be this darn opturator in
turnist So I'm going to put my finger
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right here, just laterally, so
you can see this right here, this
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particular muscle is actually the operator in
turn Well, what does the opturator in
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turn is having to do with the
pelvic floor, because we all know by
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our anatomy that the opturator in turnus
the muscle is actually a muscle of the
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hip. It helps to externally rotate
the femur. The really cool thing,
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though, is anteriorly here the fibers
of the opturator in turnus sit inside the
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pelvis, and right in through this
area is actually what we call the atla,
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which is like a ligamentus fibrous band
that connect the opturator in turnus to
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the deep layer we call the vader
ani of the pelvic floor muscles. And
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so oftentimes a problem with the pelvic
floor or an issue with the opturator in
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turnus can create pelvic floor issues one
way or another. They are married together,
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and so oftentimes pelvic floor problems can
also create issues with the opturator in
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turnus. An opturator in turn is
generally speaking, it can give rise to
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many factors of referral patterns. One
of the main ones it can cause deep
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butteck pain. That's one of the
primary factors that the operator in turnus.
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The referral site for a opterator in
turnus muscle that may be insfunction is it
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can refer to deep buttet pain.
Oftentimes the patient might say like they feel
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like they're sitting on like a ball
or golf ball or something like on their
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one side or their butter even honestly
into the rectum. This can refer into
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the rectum as well. Another thing
that we normally see that you're going to
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have to use your differential diagnosis with
is also hamstring insertional tendinopathy. Is that
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it looks like, smells like acts
like insertional hamstring tendinopathy when and really it
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is the opterator in turnus that is
referring pain to the area as well.
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So those are kind of the three
major things that we typically see with the
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opturator in turnus. I'll add a
fourth one on there too, just why
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I'm thinking about it is also pedental
neuralgia because if we look at this here,
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is that nerve is going to come
through here and it has to actually
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pierce through alcox canal that's opturator.
This is pelvic floor, so a little
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bit of increased tone or tension in
this area is going to tug on that
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nerve, and that can also create
rectal pain, it can create perennial pain,
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and can also create pain to the
shaft of the penis as well.
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So that's a major factor of that
third layer of the pelvic floor. And
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how does that impact the patients that
you particularly see. And that's the importance
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of this third layer is to help
to stabilize both the pelvis, the hip,
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and also the low back. Awesome, And so we're going to move
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away for just a second of kind
of talking about the anatomy and really talking
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about the function of the pelvic floor. I love to use this analogy with
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my patients when talking about the pelvic
floor because in general, first off,
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when we think about pelvic floor,
the first thing we think about is a
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postpartum woman. Right, let's be
honest. That's kind of honestly how this
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all got started. We're back in
the nineteen sixty where the term Keegel came
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from, which is a pelvic floor
contraction. It was from doctor Keegel,
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who is an obgi n physician,
that termed this as a pelvic floor contraction.
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And so that's the first thing that
we think about with pelvic floor dysfunction
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is someone who has given birth.
We know now if you come up to
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the twenty first century, as that
everyone has a pelvic floor and there is
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a function of the pelvic floor.
So in general, the pelvic floor needs
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to be able to do three things. The first thing that it needs to
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be able to do is it needs
to be able to contract. So these
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muscles do need to be able to
pull up into the pelvic cavity to contract,
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and that is with two variations,
either in isolation with a pelvic floor
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contraction aka a key goal, or
these muscles need to be able to also
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function with what we call global muscles
that are also associated with the pelvic floor
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00:20:33.359 --> 00:20:40.799
like your transfer subdominus and your gluten
max muscles. Your diaphragm also is very
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important for pelvic floor as well,
and so these muscles you can see an
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isolation of doing a key goal,
or they need to be able to contract
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with utilization of global muscles as well. The next thing that the pelvic floor
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needs to be able to do is
it actually needs to be able to rest.
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We know that this theory that all
muscles and the body have a normal
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resting tone. And normal resting tone
is when you're not doing a public floor
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contraction or you're not doing a global
activation of other muscles that influence the pelvic
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floor. Just naturally, the pelvic
floor should have what we call resting tone.
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00:21:25.400 --> 00:21:30.319
That's its baseline, and then what
happens from there is whether it goes
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00:21:30.599 --> 00:21:36.039
up and contracts but then comes back
down to that resting tone. Or the
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third thing is that pelvic floor actually
needs to be able to bold, which
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means the pelvic floor needs to be
able to relax and go the opposite direction,
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00:21:45.680 --> 00:21:51.400
and so things like pe and poop
can come out. I love this
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00:21:51.400 --> 00:21:55.640
little diagram here of what we call
a dimmer switch. I always give my
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patient the dimmer switch analogy, and
so if you can look at the dimmer
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00:22:00.559 --> 00:22:03.240
switch here, don't worry about the
little button. And the dimmer switch is
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00:22:03.279 --> 00:22:10.440
actually perfect because it's halfway up of
come being completely on and it's halfway down
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00:22:10.559 --> 00:22:14.559
of being completely off. So if
you can just for the sacause of this
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00:22:14.640 --> 00:22:17.720
example, just think about if the
dimmer switch was all the way to the
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bottom, it's completely off. That
means that's resting tone for the pelvic floor.
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00:22:22.359 --> 00:22:29.519
That's it's natural baseline resting nothing's happening. And then what happens if you
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decide to do a pelvic floor contraction
or use your global muscles, that dimmer
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00:22:33.599 --> 00:22:38.640
switch needs to rise to the on
button, right, so it starts to
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00:22:38.759 --> 00:22:41.079
rise, it gets brighter, it
gets brighter, it gets brighter. We've
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00:22:41.119 --> 00:22:45.559
got full contraction, and then it
needs to be also be able to the
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00:22:45.599 --> 00:22:52.200
opposite of that and come down and
go back to the resting baseline of what
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00:22:52.359 --> 00:22:56.839
is normal for that tension or tone
of that muscle. The issues that happen
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00:22:57.079 --> 00:23:03.880
oftentime is that ninety percent scent of
the patient population actually have their dimmer switch
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00:23:04.240 --> 00:23:07.960
on, whether that beyond a quarter
of the way, whether that be on
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00:23:08.240 --> 00:23:14.720
halfway. Regardless of that, there's
too much tone in the system, which
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00:23:14.839 --> 00:23:21.119
can drive to have other issues like
urinary in continence, telbone pain, low
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00:23:21.200 --> 00:23:25.559
back pain, hip pain. And
so when that dimmer switch stays on,
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that muscle only has a small available
range to be able to contract. And
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we know that when muscles are contracted
in a shortened range, eventually in that
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00:23:38.400 --> 00:23:44.960
short range they are weak and no
longer able to do their job and to
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00:23:45.119 --> 00:23:49.400
stabilize the pelvis as they should,
so they get stuck more in the on
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00:23:49.799 --> 00:23:56.000
portion of this dimmer switch instead of
allowing the dimmer switch to come back down
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00:23:56.440 --> 00:24:00.759
and be at its resting baseline and
tone. And so that is a great
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00:24:00.799 --> 00:24:04.799
example if you're trying to tell your
patients a little bit about the pelvic floor,
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00:24:04.920 --> 00:24:07.440
to say, hey, I want
to refer over to pelvic floor and
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00:24:07.480 --> 00:24:11.920
this is kind of what I'm thinking. You're more than welcome to use the
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00:24:11.039 --> 00:24:15.079
dimmer switch analogies, just so people
can wrap their brains around, like what
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00:24:15.119 --> 00:24:21.079
does that mean, Because ultimately we
always thought that when you have a pelvic
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00:24:21.119 --> 00:24:25.559
floor issue dysfunction, that the pelvic
floor is weak, and at the pelvic
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00:24:25.559 --> 00:24:30.640
floor is weak, that must mean
that the muscles themselves are in a elongated
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00:24:30.720 --> 00:24:36.559
position and they don't have the the
ability to fully contract to stabilize, and
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00:24:36.640 --> 00:24:40.440
so then they go back to this
elongated position. But we know ninety percent
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00:24:40.480 --> 00:24:44.680
of the time that's not really true. We actually have too much tension in
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00:24:44.720 --> 00:24:48.799
the system. We lose the ability
for that muscle to go through its full
296
00:24:48.000 --> 00:24:52.759
range of available motion, and something
that is shortened only has a smaller range
297
00:24:52.799 --> 00:24:57.000
therefore creates weakness too. So you
can give your patient that analogy as well.
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00:24:57.240 --> 00:25:00.960
So that is in a nutshell,
so to speak, is that is
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00:25:02.000 --> 00:25:06.240
the three things that the pelvic floor
needs to be able to do, contract,
300
00:25:06.720 --> 00:25:11.920
live in its resting position, and
be able to bulge down to allow
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00:25:12.039 --> 00:25:18.039
p and poop to come out.
So that's the local level. So now
302
00:25:18.039 --> 00:25:21.759
what we're going to look at is
a little bit more on a global level.
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00:25:22.079 --> 00:25:26.480
And I think this is super important
to understand because this is where we
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00:25:26.519 --> 00:25:30.720
can really help our patients who may
not be presenting with you with a direct
305
00:25:30.839 --> 00:25:37.720
pelvic floor problem, but could be
having a pelvic floor issue that is not
306
00:25:37.920 --> 00:25:44.680
resolving the reason that the patient is
coming in to see you. So the
307
00:25:44.720 --> 00:25:49.519
global system that does have a an
effect of the pelvic floor is going to
308
00:25:49.599 --> 00:25:53.400
be the pelvic floor itself, which
we've already just talked about. That that's
309
00:25:53.440 --> 00:25:57.440
the bottom of the hammock. You
can see here on the diagram if you
310
00:25:57.559 --> 00:26:02.640
look down, says muscles of the
pelvic floor. So that's the bottom of
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00:26:02.680 --> 00:26:07.480
what we call the container. Oftentimes
you might hear this terminology of these four
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00:26:07.599 --> 00:26:11.480
muscles as the piston, but you
have the pelvic floor on the bottom.
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00:26:11.680 --> 00:26:18.799
On the top of that you have
the diaphragm. The diaphragm is a muscle
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00:26:18.960 --> 00:26:25.720
that really does play well with the
pelvic floor if the diaphragm is working in
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00:26:25.759 --> 00:26:30.599
its full capacity, and so when
you breathe in, so the diaphragm is
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00:26:30.640 --> 00:26:33.759
the major muscle for inspiration. So
when you take a breath in, that
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00:26:33.839 --> 00:26:38.480
diaphragm is going to contract. When
the diaphragm contracts, it is going to
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00:26:38.519 --> 00:26:45.240
push down upon the container space and
the pelvic floor is going to naturally expand
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00:26:45.480 --> 00:26:48.079
and open. So this is one
thing that you can work with your patients
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00:26:48.119 --> 00:26:55.000
if you're suspecting a little bit of
high tone or hypertinicity and the pelvic floor
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00:26:55.200 --> 00:26:59.880
is just generally breathing or maybe looking
at the way they are breathing and making
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00:27:00.079 --> 00:27:04.119
sure they're getting that really good diaformatic
breathing. We call it breathing three sixty
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00:27:04.119 --> 00:27:10.200
eight, so good ribcage breathing all
the way around, and they're not taking
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00:27:10.240 --> 00:27:15.880
shorts, shallow breaths or breathing up
into their shoulders this way because if that's
325
00:27:15.880 --> 00:27:18.720
the case, that's going to create
more tone into the pelvic floor. So
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00:27:18.759 --> 00:27:23.640
the diaphragm and the pelvic floor work
hand in hand. Another muscle that works
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00:27:23.640 --> 00:27:29.079
hand in hand with the pelvic floor
is the transverse subdominous muscle. We have
328
00:27:29.119 --> 00:27:36.039
done so many AMG studies that indicate
that in order to properly recruit and activate
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00:27:36.039 --> 00:27:41.960
the pelvic floor musculature, transverse subdominous
activation needs to happen as well, that
330
00:27:42.039 --> 00:27:51.799
transverse subdominous activation has a better capacity
to build strength within the pelvic floor than
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00:27:52.000 --> 00:27:57.200
just an isolation of keygels only.
So we have research that indicates that transverse
332
00:27:57.240 --> 00:28:03.720
subdominous helps to strengthen pelvic floor better
than just isolation of keegels alone. And
333
00:28:03.759 --> 00:28:07.440
then you can look at the backside
of this diagram and then you have the
334
00:28:07.519 --> 00:28:14.160
multipitous and that is going to round
out our container space. And so we
335
00:28:14.279 --> 00:28:19.519
know the transverse abdominus comes back,
goes into reps around posterially through the thrackle
336
00:28:19.599 --> 00:28:26.359
lumber fashion can increase stability or content
in the area. And then we know
337
00:28:26.440 --> 00:28:33.920
that has an effect great effect on
the transverse abdominus and the multipitous coactivation together.
338
00:28:33.440 --> 00:28:38.119
So you can see here these four
muscles work hand in hand with the
339
00:28:38.160 --> 00:28:44.240
pelvic floor. Those are more of
the global system. Some of the other
340
00:28:44.319 --> 00:28:48.759
associated muscles that can also have an
effect of the pelvic floor are going to
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00:28:48.799 --> 00:28:56.039
be the gluten Maximus because of its
direct attachment into the coxics into the sacral
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00:28:56.200 --> 00:29:03.039
area. That's can play in big
time with the external anal sphincter as well.
343
00:29:03.440 --> 00:29:08.039
And then also that optuator in turnus
or your hip external rotators can affect
344
00:29:08.119 --> 00:29:23.440
the pelvic floor as well. That's
it for today's episode. Be sure to
345
00:29:23.480 --> 00:29:27.559
tune in for part two in episode
sixty three, where we will continue this
346
00:29:27.640 --> 00:29:33.079
discussion and dive deeper into the important
role of proper breathing mechanics in correcting pelvic
347
00:29:33.119 --> 00:29:37.599
floor dysfunction. We will also touch
on the impact these conditions can have on
348
00:29:37.640 --> 00:29:42.079
the mental health of your patients,
as well as best practices for collaborating with
349
00:29:42.160 --> 00:29:48.319
other healthcare providers. You won't want
to miss it. Episode sixty three drops
350
00:29:48.359 --> 00:29:52.599
in two weeks, and be sure
to visit our show notes, where you'll
351
00:29:52.599 --> 00:29:56.240
find a link to a free Yes
I Said, free online course, the
352
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link to the full recorded webinar replay
from this episode, as well as a
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link to sign up to get notified
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so be sure to check those out.
1
00:00:14.480 --> 00:00:18.519
Hi guys, Welcome to a new
episode of The Factor podcast. I'm your
2
00:00:18.519 --> 00:00:22.760
host, Jessica Riddle. If this
is your first time tuning in, welcome
3
00:00:22.839 --> 00:00:27.760
and thank you for listening. Today. I'm actually recording from Tokyo, Japan,
4
00:00:28.359 --> 00:00:32.880
on the final leg of an amazing
trip working with the Japan Chiropractic Association,
5
00:00:33.679 --> 00:00:37.679
So I apologize if my audio is
a little less than perfect. Travel
6
00:00:37.759 --> 00:00:42.399
microphones don't always have quite the same
studio sound quality that you may be used
7
00:00:42.439 --> 00:00:46.439
to. Today we kick off a
new training called Let's Hear It for the
8
00:00:46.479 --> 00:00:53.000
Boys Pelvic floor dysfunction Diagnosis and Treatment
Options for Men with Brittany Sudbrook, a
9
00:00:53.079 --> 00:00:59.159
Fellowship trained orthopedic manual physical therapist.
Now, please note that in this episode
10
00:00:59.200 --> 00:01:02.799
and an episode's sixty three, where
we complete part two of this training,
11
00:01:03.159 --> 00:01:07.079
when we refer to men and women, were specifically talking about cis gender men
12
00:01:07.280 --> 00:01:14.439
and women. There's no refuting that
there are some distinct anatomical differences between the
13
00:01:14.480 --> 00:01:18.680
two groups, the cis gender men
and women, but there hasn't been a
14
00:01:18.680 --> 00:01:23.519
great deal of public awareness brought to
the fact that both groups can actually develop
15
00:01:23.799 --> 00:01:29.480
pelvic pain. Usually, when you
hear about pelvic pain or pelvic floor dysfunction.
16
00:01:29.560 --> 00:01:36.280
Specifically, it often surrounds postpartum or
post hysterectomy care, but studies have
17
00:01:36.319 --> 00:01:41.480
found that at least one in six
CIS gender men are dealing with persistent pain
18
00:01:41.519 --> 00:01:47.359
in the pelvis, making chronic pelvic
pain syndrome the most common neurological diagnosis in
19
00:01:47.439 --> 00:01:52.719
men under fifty. In this two
part series, we will learn common pelvic
20
00:01:52.760 --> 00:01:57.040
floor diagnoses for men. We'll learn
how to properly screen and identify pelvit floor
21
00:01:57.120 --> 00:02:04.560
dysfunction and winter to a pelvic floor
physical therapist. We'll also talk about why
22
00:02:04.599 --> 00:02:08.879
it is important to establish a mutual
relationship with a pelvic floor physical therapist and
23
00:02:08.919 --> 00:02:15.560
how it can benefit your patients.
Our featured instructor is Brittany Sudbrook, owner
24
00:02:15.639 --> 00:02:20.840
of Empower Pelvic Health, a practice
based in Southeast Houston, Texas. Brittany
25
00:02:20.919 --> 00:02:24.919
received her Masters of Science and Physical
Therapy at Texas State University, then went
26
00:02:24.960 --> 00:02:30.960
on to complete a fellowship in Orthopedic
manual Therapy. She's a faculty member of
27
00:02:30.000 --> 00:02:38.120
the Manual Therapy Institute, a postdoctorate
fellowship program teaching physical therapists advanced problem solving
28
00:02:38.199 --> 00:02:43.919
and hands on manual therapy skills and
is taught continuing education courses to hundreds of
29
00:02:43.919 --> 00:02:49.759
physical therapist nationwide. This is a
fascinating topic and one that can be incredibly
30
00:02:49.840 --> 00:02:53.680
helpful to better understand for your patients. Let's cue the intra music and get
31
00:02:53.719 --> 00:03:07.319
started. Thank you, Thank you
so much, Jessica, and thank you
32
00:03:07.360 --> 00:03:10.520
to all of you who have made
time to be on this webinar with me
33
00:03:10.680 --> 00:03:16.479
today. I'm super excited to present
with you about pelvic floor and more importantly
34
00:03:16.599 --> 00:03:21.560
public floor in men. Let me
go ahead and give you a little background
35
00:03:21.599 --> 00:03:24.680
information on myself and kind of how
I got here into pelvic health. I
36
00:03:24.759 --> 00:03:31.039
actually have originally started in orthopedics physical
therapy, and I was doing this for
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about twelve years and I had nothing
to do with pelvic floor at that time.
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And it wasn't until the birth of
my daughter about four years ago that
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I experienced for the first hand of
having my own pelvic floor dysfunction, and
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I thought, oh my goodness,
what am I going to do about this?
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Went to Public Floor PT and it
was fantastic. It was great,
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but it was definitely more looking at
like the local segment versus kind of global
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and what was going on both locally
and globally. So I decided to bridge
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the gap between my orthopedic knowledge and
learn more about the pelvic floor and integrate
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both of those. So I do
think that we do have some stuff in
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common that we're going to be able
to talk about today of both local factors
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and then global factors that influence pelvic
floor. And what are some red flags
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that you can look for when you
were with a patient that may be having
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more global things going on, but
not recognizing that they may be impacting the
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pelvic floor. And so went to
got all my certifications for pelvic floor,
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decided to open up my own practice, and so now today I treat the
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pelvic floor dysfunctions. It is still
a very much a topic that is generally
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not discussed. It's not something that's
on the forefront. Definitely is for more
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women than it is for men.
But men's health, I definitely feel like
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it's on the rise and men are
definitely getting more attention in this area that
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is needed. And so I'm going
to be with you today to share with
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you some things that you could be
looking at in your own patients to help
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you to recognize win A referral to
a public floor physical therabusiness indicated and then
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ask and also how you can help
those patients as well. So during this
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topic here, we're going to have
some objectives that I'm going to try to
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stick by. Teach a little bit
of things, but try to stick by
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these things because this is why you're
here. So what is the pelvic floor?
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I know when I went to PT
school many many many moons ago,
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it was like a special topic that
we could do in PT school. It
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wasn't really like an area like orthopedics
or neuro that we really just took a
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lot of time and discussed the pelvic
floor. If you were interested into pelvic
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floor with stethree that they're a subspecialty
or you could do a clinical rotation in
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it. So not a lot of
information was given at that time. What
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is its function and what is its
impact on my patients? We're going to
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discuss the most common pelvic floor dysfunctions
and men Men do carry a lot of
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common pelvic floor dysfunctions just like women
do. But then there are some differences
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as well, so we'll discuss those. We're going to also learn how to
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properly screen your patient and identify when
a pelvic floor dysfunction is present, and
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then how to refer that patient to
a pelvic floor therapist, And then why
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is it essential to be able to
establish a mutual relationship between both a pelvic
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floor physical therapist and yourself and how
does that ultimately benefit the patient. So
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we're going to do a little bit
of an overview here. So pelvic floor
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dysfunction is actually quite prevalent and meant
surprisingly enough, the research shows that about
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one in every sixth man will actually
have a pelvic floor dysfunction. We pelic
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floor therapists think that that number is
probably a little bit on the higher end.
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We think maybe one in four,
maybe even one and five men do
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suffer from a public floor dysfunction.
Fortunately for men, it's not necessarily a
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topic that they can go to the
bar and like discuss with their buddies.
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Right, Not like us women,
Right, we would be like put it
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on a billboard, let everybody know
that we have a public floor dysfunction and
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paying on ourselves is something that we
just accept as common and in normal.
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But men don't often talk about these
issues, and so they kind of let
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it go for months, for years, and then finally when they've had enough,
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and it really has to be a
bigger driver, right, it's changing
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their their life in some capacity for
them really to seek care. And by
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that time, by the time they
do actually make it to a position or
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what so, maybe it's generally about
four years until they are referred to a
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public floor physical therapist. I know
that's really astonishing four years for a man
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to struggle with something that a woman
can go to an ob with and say,
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hey, I have your narring continence
and send me tell a public floor
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PT. But it definitely is something
that I think is on the rise,
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so more and more help is going
to be on the way. But definitely,
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one in six men do suffer from
pelvic floor dysfunction. So that's just
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a little picture showing you really have
majority of the superficial muscles of the pelvic
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floor, and the pelvic floor it
is made up of approximately about fourteen muscles.
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Honestly, it really depends on what
textbook that you look in somewhere and
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say somewhere between fourteen and seventeen muscles
make up the pelvic floor. Men and
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women have very smaller pelvic floors,
but you can see they're the picture of
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the pelvic floor muscles. Majority of
these that are shown here are going to
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be the superficial layer of the pelvic
floor. So let's they'll talk about that.
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That the pelvic floor is actually collection
of muscles, like I just indicated,
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depends on what anatomy textbook you look
at fourteen to seventeen of them muscles
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that make up the pelvic floor.
There are also ligaments, nerves, and
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connected tissue that creates a natural hammock
that attaches the front of the pelvis to
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the back of the pelvis. So
majority of these muscles do run from the
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pubic bone and they sling all the
way back to the coxics and at some
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capacity, either they have direct attachment
to the coxics or they attach themselves to
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other muscles or other connective tissue that
also comes in and attaches themselves to the
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coxics as well. And so that's
very very important to kind of think about
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the forefront as we work through this
module here of how can that impact my
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patients because of the pelvic floor attaching
back to the coxics. So we'll get
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through that here in just a second. And then there are major nerve contributions
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to the pelvic floor, and that's
derived from the podental nerve, and the
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podental nerve comes from S to S
through S four. That's a really cool
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way to remember. It is S
two, S three, S four keeps
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pm poop off the floor. This
nerve here, though the indicated in pelvic
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health, is probably the nerve that
has to take one of the most tumultuous
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pathways through the pelvis to enervate the
pelvic floor. So if you can kind
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of nerve out with me for just
a moment on anatomy, is that the
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podental nerve is derived, like I
said, from the sacred roots of S
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two S four and as it exits
out of the sacrum. But here is
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a model of the pelvis, and
this right here as obviously the sacrum.
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These are the sacral roots. It's
going to come out from the sacrum here
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and then it's gonna actually dive.
One thing you don't see here are two
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major ligaments between the sacrum and the
ilium here, which is the sacral spinus
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ligament, which is going to go
obviously from here to here, and then
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you have that sacro tubrius ligament.
So they kind of have that little criss
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cross connection like this and that nerve
that podental nerve is actually going to pierce
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through and it's going to go between
those two ligaments as it comes into the
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pelvis here, and then it's going
to go through what we call ALCS canal.
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And then as it dives through ALCS
canal, which is inside the pelvis
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here, it's gonna then branch.
And it actually has three branches that's going
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to go through to the rectum,
to the perennial area, and to the
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also the shaft of the penis.
And so you just wanted you to know
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that there is a major nerve contribution
to the pelvic floor and it does come
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from the podental nerve. And we'll
talk a little bit here a little bit
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more about what does that mean for
my patients and how do I know if
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my patient is potentially suffering from podendal
neuralgia. So we'll go into that just
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a second. Have you ever thought
about teaching or launching a podcast, maybe
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00:11:50.360 --> 00:11:54.399
creating online courses for your patients or
a YouTube channel to gain exposure, or
146
00:11:54.480 --> 00:11:58.559
maybe you want to pass on your
expertise and knowledge to the next generation of
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00:11:58.559 --> 00:12:03.639
healthcare providers, but don't really know
where to get started. If this sounds
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00:12:03.679 --> 00:12:09.240
like you, then we would love
to have a conversation. Southeast Professional Education
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00:12:09.320 --> 00:12:16.320
Group has helped healthcare providers, national
organizations, and product companies create and launch
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00:12:16.440 --> 00:12:22.360
content for the purpose of educating and
engaging their target audience. Whether you want
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00:12:22.360 --> 00:12:26.799
to establish your credibility in your hometown
as a means to grow your practice,
152
00:12:26.320 --> 00:12:31.039
or if you're looking to enter into
the exciting world of continuing education, we
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00:12:31.080 --> 00:12:35.519
would love to talk to you.
The great W. B. Yeats said,
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education is not the filling of a
pot, but the lighting of a
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00:12:39.679 --> 00:12:45.600
fire. And I guarantee you there's
someone out there waiting for you to light
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00:12:45.679 --> 00:12:50.080
that spark. Simply fill out the
interest form linked in the show notes and
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00:12:50.159 --> 00:12:52.879
let's have a conversation. Who knows, maybe a few months from now,
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00:12:54.080 --> 00:12:58.519
you're the one that our podcast subscribers
are tuning in to learn from. So
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00:12:58.639 --> 00:13:01.440
click the link to request a time
to chat. Let's have a conversation and
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00:13:01.480 --> 00:13:09.720
see how we can help you launch
something great and also to the pelvic floor
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00:13:09.840 --> 00:13:15.080
is actually divided into three layers.
There's a superficial layer, there is a
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middle layer or intermediate layer, and
then there is a deep layer. The
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first layer is primarily for sexual function, and it allows for the penis to
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achieve full erection. The second layer
and the pelvis is for sphincter control right
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to start and stop the flow of
urine or also for bowels. And the
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third layer is to help to stabilize
the pelvis, the low back, and
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the hips. And so what I'm
going to do is I do feel like
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we'll talk a little bit about the
first and second layer and how that affects
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your patients, But I think for
the majority of who is on this webinar
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here, we really would like to
stop and talk more about the layer,
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because I think the third layer has
probably a bigger impact for the types of
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patients that you see in your clinic
and that could be suffering from a pelvic
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floor dysfunction. So I'm gonna pause
here a little bit and then show you
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this pelvic the deepest layer of the
pelvic floor. It doesn't matter whether you're
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male or female. It is the
zac same makeup of muscles when you get
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here into the third layer. So
I'm going to show you the n side
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here so you can see how these
muscles do very much sling back from the
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frontier of the pubic bone and they
go all the way back here towards the
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tailbone and that sacral coxygeal area,
so they do sling back like that natural
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00:14:43.919 --> 00:14:48.559
hammock. And so you could see
where if you were treating a patient that
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had something going on with a tighter
pelvic floor, the contributions could be that
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the pull of these muscles here could
create it changes in both the coxics and
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the sacrum and kind of pull them
more into like an extended while the sacred
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would go into extended position, so
the pelvis gets tucked up underneath you.
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And it can also change how the
lumbar spine is in maybe potentially less lore
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doses and more in achyphotic position.
So it can change the orientation of the
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strong pull from the pelvic floor and
how that directly impacts both the coxics,
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the sacredrum, and also the lumbar
spine. Another really cool thing that is
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just quite fascinating in pelvic floor.
Every time that I treat this, and
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I promise you, every time someone
will come in with symptoms and I'm like,
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oh, I know exactly what that
is. That is this and it
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happens to be this darn opturator in
turnist So I'm going to put my finger
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right here, just laterally, so
you can see this right here, this
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particular muscle is actually the operator in
turn Well, what does the opturator in
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turn is having to do with the
pelvic floor, because we all know by
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our anatomy that the opturator in turnus
the muscle is actually a muscle of the
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hip. It helps to externally rotate
the femur. The really cool thing,
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though, is anteriorly here the fibers
of the opturator in turnus sit inside the
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pelvis, and right in through this
area is actually what we call the atla,
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which is like a ligamentus fibrous band
that connect the opturator in turnus to
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the deep layer we call the vader
ani of the pelvic floor muscles. And
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so oftentimes a problem with the pelvic
floor or an issue with the opturator in
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turnus can create pelvic floor issues one
way or another. They are married together,
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and so oftentimes pelvic floor problems can
also create issues with the opturator in
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turnus. An opturator in turn is
generally speaking, it can give rise to
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00:17:03.799 --> 00:17:10.400
many factors of referral patterns. One
of the main ones it can cause deep
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00:17:10.640 --> 00:17:15.160
butteck pain. That's one of the
primary factors that the operator in turnus.
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The referral site for a opterator in
turnus muscle that may be insfunction is it
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can refer to deep buttet pain.
Oftentimes the patient might say like they feel
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like they're sitting on like a ball
or golf ball or something like on their
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one side or their butter even honestly
into the rectum. This can refer into
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00:17:36.200 --> 00:17:40.839
the rectum as well. Another thing
that we normally see that you're going to
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00:17:40.920 --> 00:17:48.240
have to use your differential diagnosis with
is also hamstring insertional tendinopathy. Is that
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it looks like, smells like acts
like insertional hamstring tendinopathy when and really it
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00:17:55.640 --> 00:18:00.640
is the opterator in turnus that is
referring pain to the area as well.
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00:18:02.160 --> 00:18:04.920
So those are kind of the three
major things that we typically see with the
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00:18:04.960 --> 00:18:08.240
opturator in turnus. I'll add a
fourth one on there too, just why
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I'm thinking about it is also pedental
neuralgia because if we look at this here,
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is that nerve is going to come
through here and it has to actually
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00:18:17.960 --> 00:18:23.319
pierce through alcox canal that's opturator.
This is pelvic floor, so a little
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00:18:23.319 --> 00:18:26.839
bit of increased tone or tension in
this area is going to tug on that
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00:18:26.920 --> 00:18:33.920
nerve, and that can also create
rectal pain, it can create perennial pain,
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00:18:34.000 --> 00:18:40.039
and can also create pain to the
shaft of the penis as well.
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00:18:40.400 --> 00:18:45.240
So that's a major factor of that
third layer of the pelvic floor. And
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00:18:45.480 --> 00:18:51.440
how does that impact the patients that
you particularly see. And that's the importance
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00:18:51.480 --> 00:18:56.240
of this third layer is to help
to stabilize both the pelvis, the hip,
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00:18:56.680 --> 00:19:00.960
and also the low back. Awesome, And so we're going to move
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away for just a second of kind
of talking about the anatomy and really talking
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about the function of the pelvic floor. I love to use this analogy with
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my patients when talking about the pelvic
floor because in general, first off,
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00:19:18.000 --> 00:19:21.920
when we think about pelvic floor,
the first thing we think about is a
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postpartum woman. Right, let's be
honest. That's kind of honestly how this
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00:19:26.519 --> 00:19:30.480
all got started. We're back in
the nineteen sixty where the term Keegel came
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00:19:30.559 --> 00:19:34.119
from, which is a pelvic floor
contraction. It was from doctor Keegel,
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00:19:34.240 --> 00:19:41.039
who is an obgi n physician,
that termed this as a pelvic floor contraction.
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And so that's the first thing that
we think about with pelvic floor dysfunction
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00:19:45.039 --> 00:19:48.920
is someone who has given birth.
We know now if you come up to
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the twenty first century, as that
everyone has a pelvic floor and there is
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a function of the pelvic floor.
So in general, the pelvic floor needs
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to be able to do three things. The first thing that it needs to
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be able to do is it needs
to be able to contract. So these
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muscles do need to be able to
pull up into the pelvic cavity to contract,
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and that is with two variations,
either in isolation with a pelvic floor
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contraction aka a key goal, or
these muscles need to be able to also
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function with what we call global muscles
that are also associated with the pelvic floor
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like your transfer subdominus and your gluten
max muscles. Your diaphragm also is very
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important for pelvic floor as well,
and so these muscles you can see an
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isolation of doing a key goal,
or they need to be able to contract
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with utilization of global muscles as well. The next thing that the pelvic floor
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needs to be able to do is
it actually needs to be able to rest.
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We know that this theory that all
muscles and the body have a normal
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resting tone. And normal resting tone
is when you're not doing a public floor
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contraction or you're not doing a global
activation of other muscles that influence the pelvic
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floor. Just naturally, the pelvic
floor should have what we call resting tone.
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That's its baseline, and then what
happens from there is whether it goes
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up and contracts but then comes back
down to that resting tone. Or the
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third thing is that pelvic floor actually
needs to be able to bold, which
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means the pelvic floor needs to be
able to relax and go the opposite direction,
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and so things like pe and poop
can come out. I love this
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little diagram here of what we call
a dimmer switch. I always give my
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patient the dimmer switch analogy, and
so if you can look at the dimmer
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switch here, don't worry about the
little button. And the dimmer switch is
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actually perfect because it's halfway up of
come being completely on and it's halfway down
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of being completely off. So if
you can just for the sacause of this
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example, just think about if the
dimmer switch was all the way to the
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bottom, it's completely off. That
means that's resting tone for the pelvic floor.
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That's it's natural baseline resting nothing's happening. And then what happens if you
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decide to do a pelvic floor contraction
or use your global muscles, that dimmer
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switch needs to rise to the on
button, right, so it starts to
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rise, it gets brighter, it
gets brighter, it gets brighter. We've
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got full contraction, and then it
needs to be also be able to the
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opposite of that and come down and
go back to the resting baseline of what
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is normal for that tension or tone
of that muscle. The issues that happen
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oftentime is that ninety percent scent of
the patient population actually have their dimmer switch
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on, whether that beyond a quarter
of the way, whether that be on
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halfway. Regardless of that, there's
too much tone in the system, which
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can drive to have other issues like
urinary in continence, telbone pain, low
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back pain, hip pain. And
so when that dimmer switch stays on,
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that muscle only has a small available
range to be able to contract. And
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we know that when muscles are contracted
in a shortened range, eventually in that
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short range they are weak and no
longer able to do their job and to
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stabilize the pelvis as they should,
so they get stuck more in the on
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portion of this dimmer switch instead of
allowing the dimmer switch to come back down
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and be at its resting baseline and
tone. And so that is a great
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example if you're trying to tell your
patients a little bit about the pelvic floor,
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to say, hey, I want
to refer over to pelvic floor and
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this is kind of what I'm thinking. You're more than welcome to use the
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dimmer switch analogies, just so people
can wrap their brains around, like what
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does that mean, Because ultimately we
always thought that when you have a pelvic
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floor issue dysfunction, that the pelvic
floor is weak, and at the pelvic
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floor is weak, that must mean
that the muscles themselves are in a elongated
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position and they don't have the the
ability to fully contract to stabilize, and
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so then they go back to this
elongated position. But we know ninety percent
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of the time that's not really true. We actually have too much tension in
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the system. We lose the ability
for that muscle to go through its full
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range of available motion, and something
that is shortened only has a smaller range
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therefore creates weakness too. So you
can give your patient that analogy as well.
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So that is in a nutshell,
so to speak, is that is
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the three things that the pelvic floor
needs to be able to do, contract,
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live in its resting position, and
be able to bulge down to allow
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p and poop to come out.
So that's the local level. So now
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what we're going to look at is
a little bit more on a global level.
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And I think this is super important
to understand because this is where we
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can really help our patients who may
not be presenting with you with a direct
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pelvic floor problem, but could be
having a pelvic floor issue that is not
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resolving the reason that the patient is
coming in to see you. So the
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global system that does have a an
effect of the pelvic floor is going to
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be the pelvic floor itself, which
we've already just talked about. That that's
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the bottom of the hammock. You
can see here on the diagram if you
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look down, says muscles of the
pelvic floor. So that's the bottom of
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what we call the container. Oftentimes
you might hear this terminology of these four
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muscles as the piston, but you
have the pelvic floor on the bottom.
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On the top of that you have
the diaphragm. The diaphragm is a muscle
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that really does play well with the
pelvic floor if the diaphragm is working in
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its full capacity, and so when
you breathe in, so the diaphragm is
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the major muscle for inspiration. So
when you take a breath in, that
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diaphragm is going to contract. When
the diaphragm contracts, it is going to
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push down upon the container space and
the pelvic floor is going to naturally expand
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and open. So this is one
thing that you can work with your patients
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if you're suspecting a little bit of
high tone or hypertinicity and the pelvic floor
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is just generally breathing or maybe looking
at the way they are breathing and making
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sure they're getting that really good diaformatic
breathing. We call it breathing three sixty
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eight, so good ribcage breathing all
the way around, and they're not taking
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shorts, shallow breaths or breathing up
into their shoulders this way because if that's
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the case, that's going to create
more tone into the pelvic floor. So
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the diaphragm and the pelvic floor work
hand in hand. Another muscle that works
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hand in hand with the pelvic floor
is the transverse subdominous muscle. We have
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done so many AMG studies that indicate
that in order to properly recruit and activate
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the pelvic floor musculature, transverse subdominous
activation needs to happen as well, that
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transverse subdominous activation has a better capacity
to build strength within the pelvic floor than
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just an isolation of keygels only.
So we have research that indicates that transverse
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subdominous helps to strengthen pelvic floor better
than just isolation of keegels alone. And
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then you can look at the backside
of this diagram and then you have the
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multipitous and that is going to round
out our container space. And so we
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know the transverse abdominus comes back,
goes into reps around posterially through the thrackle
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lumber fashion can increase stability or content
in the area. And then we know
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that has an effect great effect on
the transverse abdominus and the multipitous coactivation together.
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So you can see here these four
muscles work hand in hand with the
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pelvic floor. Those are more of
the global system. Some of the other
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00:28:44.319 --> 00:28:48.759
associated muscles that can also have an
effect of the pelvic floor are going to
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be the gluten Maximus because of its
direct attachment into the coxics into the sacral
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area. That's can play in big
time with the external anal sphincter as well.
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And then also that optuator in turnus
or your hip external rotators can affect
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the pelvic floor as well. That's
it for today's episode. Be sure to
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00:29:23.480 --> 00:29:27.559
tune in for part two in episode
sixty three, where we will continue this
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00:29:27.640 --> 00:29:33.079
discussion and dive deeper into the important
role of proper breathing mechanics in correcting pelvic
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00:29:33.119 --> 00:29:37.599
floor dysfunction. We will also touch
on the impact these conditions can have on
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00:29:37.640 --> 00:29:42.079
the mental health of your patients,
as well as best practices for collaborating with
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00:29:42.160 --> 00:29:48.319
other healthcare providers. You won't want
to miss it. Episode sixty three drops
350
00:29:48.359 --> 00:29:52.599
in two weeks, and be sure
to visit our show notes, where you'll
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00:29:52.599 --> 00:29:56.240
find a link to a free Yes
I Said, free online course, the
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