WORKSHOP

BRIDGING THE GAP: THE ROLE OF THE PELVIC FLOOR IN MUSCULOSKELETAL AND UROGYNECOLOGICAL FUNCTION. Lee D¹, Lee L^2,3; ¹Diane Lee & Associates – Consultants in Physiotherapy, White Rock, BC, Canada. ²Synergy Physiotherapy & LJPT Consulting, North Vancouver, BC, Canada. ³University of Queensland, Brisbane, Queensland, Australia

LEARNING OBJECTIVES: 1) Review the evidence for clinical tests for pelvic girdle musculoskeletal function and relationships between the pelvic floor and other muscles linking low back/pelvic girdle pain and urogynecological dysfunction. 2) Combine evidence with clinical reasoning to assess and treat lumbopelvic and pelvic organ impairments with multi-modal programs, including using real-time ultrasound imaging; highlight areas needing further research to create clinical trials. 3) Integrate knowledge from different physical therapy specialization subgroups to facilitate optimal care for patients by exposing therapists to new techniques and treatment approaches and emphasizing the importance of communication and efficient cross-referral between therapists of different subgroups. SUMMARY: In recent years, there has been an explosion of scientific and clinical knowledge pertaining to musculoskeletal and urogynecological function relevant to physical therapists. Consequently, specialization within physical therapy has evolved to meet the challenge of evidence-based clinical practice. While focusing on one area of evidence facilitates expertise in an area (back/pelvic girdle pain, incontinence/pelvic floor dysfunction), it can limit the holistic view of the patient and the presenting problem. Recent studies highlight epidemiological links between low back/pelvic girdle pain, incontinence and respiratory disorders. Neurophysiological studies identify biomechanical and neurological connections between the musculoskeletal system and the internal organs. It is increasingly apparent that patients with low back and pelvic ‘girdle’ pain share common neuromuscular impairments with patients presenting with stress urinary incontinence and pelvic ‘floor’ pain syndromes. It is time to bridge the gap that has evolved with specialization and revisit an integrated approach to these two common problems for men and women. To effectively treat people with the above impairments, a multi-modal evidence-based rehabilitation program is required. This workshop will discuss scientific and clinical evidence that led to an integrated approach for assessment and treatment of the lumbopelvic-hip region for low back/pelvic girdle pain and urinary incontinence/pelvic floor syndromes. Case studies will be presented to reflect variances in clinical presentation and illustrate how education, manual therapy, real-time ultrasound imaging, and exercise are integrated. Validated tests for load transfer through the joints and organs of the pelvis as well as for deciding which muscles to target for rehabilitation will be demonstrated through video clips. The goal of this workshop is to demonstrate that optimal musculoskeletal function and urogynecological function share common components; therapists in previously separate fields need to bridge a gap in order to build an integrated and effective approach to rehabilitation. The mergence of this information will facilitate networking within the profession with the ultimate goal of providing optimal rehabilitative care. IMPLICATIONS/CONCLUSIONS: The multi-modal, evidence-based rehabilitation program presented draws on clinical experience of the presenters to bridge the narrowing, yet still present, gap between what we know (the evidence) and what we still need to know (clinical tools to be validated) to effectively restore optimal function for the lumbopelvic region, both in the musculoskeletal and internal urogenital/gynecological systems. This workshop will facilitate information sharing for further development of multi-modal programs and stimulate research to validate and improve treatment for people with impairments of the musculoskeletal and urogynecological systems. KEYWORDS: Low back pain, pelvic girdle pain, incontinence. FUNDING ACKNOWLEDGEMENTS: This work is funded privately by Diane G. Lee Physiotherapist Corporation and LJPT Consulting