Professional Documents
Culture Documents
Margaret Bronson
Margaret Bronson
Bony pelvis
Pubic arch (pubic symphysis, inferior pubic rami, ischial
rami)
Ischial tuberosity
Ischial spine
Coccyx
Anatomy of the Pelvic Floor
Pelvic floor muscles
Pelvic Diaphragm (levator ani)
Pubococcygeus
Iliococcygeus
Coccygeus
Puborectalis
Associated muscles
Piriformis
Obturator Internus
Anatomy of the Pelvic Floor
Anatomy of the Pelvic Floor
Function of Pelvic floor muscles
Pelvic diaphragm
Supportsbladder, bowel and uterus in a functional position and assists the
closure of the bladder and bowel outlet. It moves the sacrum/coccyx on the
pelvis.
Stabilizes
pelvic ring together with the diaphragm and transversus abdominus to
provide trunk and pelvic stability
Obturator internus
Laterally
rotates the hip and lifts the bladder, bowel and uterus into a
functional position while assisting in closure of the urethra and anus
Interactswith pelvic floor via arcuate tendon to stabilize hip (“rotator cuff of
pelvis”) while larger hip muscles move (eg. Squat)
Piriformis
Laterally rotates the hip. It moves the sacrum on the pelvis in standing .
Anatomy of the Pelvic Floor
Pelvic ligaments
Sacrotuberous ligaments attach the ischial
tuberosity to sacrum
Sacrospinous ligaments attach spine to sacrum
Anatomy of the Pelvic Floor
Anatomy of the Pelvic Floor
Anatomy of the Pelvic Floor
Anatomy of the Pelvic Floor
Anatomy of the Pelvic Floor
Facilitatory
muscles
Adductors
Gluteals
Tranversus abdominus
Obturator internus
Synergistic
muscles
Transversus abdominus
Deep lumbar multifidus
Respiratory diaphragm
Anatomy of the Diaphragm
Anatomy of the Diaphragm
http://well.blogs.nytimes.com/2013/09/05/think-like-a-doctor-the-gymnasts-
big-belly
/
http://well.blogs.nytimes.com/2013/09/06/think-like-a-doctor-the-gymnasts-
big-belly-solved/
Physical Therapy for Pelvic Floor
Dysfunction
Comprehensive history taking and evaluation of pelvic
floor musculature and associated musculature
Review of bladder diary/ fluid intake/ voiding
Assessment of strength, endurance and coordination of
PFM
Development of individualized plan of care
Physical Therapy for Pelvic Floor
Dysfunction
PFM strengthening for endurance and coordination
Education regarding behavioral strategies to improve
continence
Urge suppression techniques
Timed voiding
Toileting strategies
Bladder irritants discussed
Flexibility and strengthening of associated musculature
Postural and functional retraining for activities causing
dysfunction (sport, sitting, intercourse)
Modalities as needed: biofeedback, electrical stimulation
Integrating Pelvic Floor, Diaphragm and
Core in Your Athletes/Patients
DISCLAIMER: The following exercises are suggestions
based on the common muscle imbalances found in active
female patients with pelvic floor dysfunction. These are
not meant to substitute for a comprehensive and
individualized evaluation by a pelvic physical therapist.
Integrating Pelvic Floor, Diaphragm and
Core in Your Athletes/Patients
Integrating Pelvic Floor, Diaphragm and
Core in Your Athletes/Patients
Integrating Pelvic Floor, Diaphragm and
Core in Your Athletes/Patients