#PTonICE Daily Show – Monday, September 18th, 2023 – Virtual pelvic floor PT: the objective exam

In today’s episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan emphasizes emphasizes the significance of comprehending your own body and the process involved in utilizing the pelvic floor. Without this understanding, it can be challenging to educate and support others in this area.

To better understand and utilize your pelvic floor, Alexis suggests a five-step process. The first step is to “tell” the actions of the pelvic floor, which involves becoming familiar with its location and functions. Alexis uses the analogy of an A-frame house to explain the contraction and relaxation of the pelvic floor.

The second step is to “demo” the actions of the pelvic floor. This can be done through videos or using a pelvic model to visually demonstrate the movements. The purpose of this step is to help individuals visualize and better comprehend what was explained in the first step.

The third step is to “practice” contracting and relaxing the pelvic floor. Alexis encourages listeners to pay attention to any sensations they feel when they contract their pelvic floor. During virtual sessions, she advises being mindful of any additional body movements that may occur during the contraction.

The fourth step is to “ensure” that the individual is correctly performing the pelvic floor movements. This step involves confirming if the person felt the intended movements and if they understood the instructions. If there is any uncertainty or confusion, Alexis emphasizes the importance of not progressing to the next phases until both the individual and the instructor are confident in their understanding.

Lastly, the fifth step is to “progress” in using the pelvic floor. Alexis mentions that this five-step process may not occur in one session and that it may take time before individuals can confidently progress. However, by understanding their own body and going through these steps, individuals can develop the knowledge and skills necessary to effectively assist others in utilizing their pelvic floor.

Overall, the episode highlights the significance of understanding one’s own body and the steps involved in using the pelvic floor in order to effectively educate and assist others in this area, as well as provide meaningful care virtually.

Take a listen to learn how to better serve this population of patients & athletes.

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00:00 INTRO

Hey everyone, Alan here. Before we get into today’s episode, I’d like to take a moment to introduce our show sponsor, Jane. If you don’t know about Jane, Jane is an all in one practice management software with features like online booking, scheduling, documentation, and a PCI compliant payment solution. The time that you spend with your patients and clients is very valuable and filling out forms during their appointment time can quickly take away from the time that you all have together. That’s why the team at Jane has designed online intake forms, that your patients can complete from the comfort of their own homes. And to help them remember to fill out their forms, Jane has your back with a friendly email reminder sent 24 hours before their appointment. This means they arrive ready to start their appointment and you can arrive ready to help. Jane’s online intake forms are fully customizable to ensure you’re collecting everything you need ahead of time, whether that’s getting a credit card on file, insurance billing details, or a signed consent form. You can build out your intake forms from scratch or use templates from Jane’s template library and customize it further to meet your practice needs. If you’re interested in learning more, head on over to jane.app slash guide. Use the code IcePT1MO at sign up to receive a one month grace period on your new account. Thanks, everyone. Enjoy today’s episode of the PT on Ice daily show.


Good morning, PT on Ice daily show. My name is Dr. Alexis Morgan, and I am here today representing the pelvic division. Happy Monday. I hope you all had a wonderful weekend. Let’s discuss a huge topic that is virtual care this morning. Virtual care is something that really grew a lot during COVID. and we all kind of had to pivot, right, and try to figure out, okay, how exactly is this done? One of the areas that I feel like is potentially the most surprising about doing virtual care in is pelvic floor health, pelvic floor assessment, pelvic floor physical therapy. A few weeks ago, I did a PT on ice, about the virtual care and the subjective exam. And did a whole entire podcast on that, did not have time to discuss the objective assessment. So today I’m hopping back on to discuss how we do the virtual objective assessment. If you missed last time’s podcast, go ahead and rewind back about a month and look for that. that virtual subjective care, because that’s gonna be important and of course it’s gonna lay the foundation for this pelvic floor assessment in the objective category. So, let’s go ahead and just dive right in to exactly what we teach and what we do for that objective exam. We talked last time, and we talk all the time in pelvic health, that we are educators, that we really teach people how their body works and we teach them the truth about their bodies when in fact they’ve read unfortunately online and in magazines and on YouTube and in various forms they’ve heard lies. They’ve heard myths and they’ve heard misconceptions. It’s very confusing. It’s a confusing area of our body. And we get the opportunity to be educators. Part of this objective exam, when we are virtual, is education. So here’s how it goes. It’s really a five-step process. Number one, tell. Number two, demo. Three, practice, four, ensure, and five is progress. So let’s dive into each of those categories.


So with tell, number one, first you’re gonna tell them the actions of the pelvic floor. You’re gonna essentially get them oriented with where the pelvic floor is and what it does. You’re teaching, you’re telling. So you’re gonna tell them the actions of the pelvic floor, right? So when it contracts, it goes up. We use the analogy attic, first floor, and basement of the A-frame house here at ICE. So tell them that. So when it squeezes, it goes up into the attic. When you’re just chilling, you’re hanging out at first floor. We’re just at rest at that first floor. That’s where life is. happens when we’re just chilling. Then we go into the basement. And that basement is the downward movement towards the feet. The holes expand, they enlarge. That analogy is helpful for someone to understand, helpful for them to kind of visualize that. But generally, that analogy isn’t quite enough. And because in this objective exam, you know you’re not gonna get to give them direct feedback, direct visual or tactile feedback, you’ve gotta go that extra step. So step number two, so step one was tell. Step two is demo. So you’re gonna demo with maybe a video or your pelvic model that you have. Help them visualize what it is that you just said with that analogy. So looking at the pelvic floor, when it squeezes, it goes up towards your head. When it relaxes or an effortful relaxation, it opens up and goes away from your body. That’s demo. So they can actually see. So tell and demo these two work hand in hand together. Step number three is practice. So you’re gonna ask the client, okay, I want you to practice that. Go ahead and contract your pelvic floor. Do you feel anything? When they are contracting, you’re looking for on this virtual call, you’re looking for any kind of extra little body movements that they may have. If they’re holding their breath, if their entire musculoskeletal system rises, they’re doing too much. They’re putting way too much into that. And so you can cue them and have them, okay, can you, can you do a similar thing? Can you still raise your pelvic floor? But can you do it with your entire body? relaxed. Just move your pelvic floor, even if it’s a little bit less of a muscular engagement practice. You also want to have them do the opposite. So you had them go into that attic. Now you want to have them go into that basement. If they had trouble going into the attic, we definitely want to just move on and go to the basement because maybe they’ll feel that a little bit better. So we go into the basement and we say, okay, I want you to bear down. I want you to push towards your feet. I want you to open up those holes, whatever language they need, and you wait for them to feel that. So we’re talking them through this practice, but that’s not really all. We’ve got to go on to step number four, which is ensure. So, you’ve got to ensure that they’re doing what you both think that they are doing, what you both want them to be doing. You’ve got to ensure. So you’re gonna ask them some questions, like, okay, so we talked about how it contracts, it closes up, and it goes, your pelvic floor, when you squeeze, raises up, like towards your head. Did you feel any of that movement? Are you sure that you felt it go up? Can you feel the difference between up and down, between that attic and that basement? Can you feel a distinct difference? If they can, I’m still reading their answers, and if they’re saying, yeah, yeah, I think I felt that, I’m not convinced with that. I’m not convinced with a little question mark sounding. Yeah, I think I felt that. What we want to hear is, yes. Yes, I felt it. It wasn’t strong. I didn’t feel much, but I definitely felt a difference in that direction. We want to hear that. Because from that, we can then progress them. Number five. progress them to teaching what the pelvic floor should be doing in their problematic movements. Whether that is double unders, squatting heavy, catching a clean, whatever that might be. We want to teach them what their pelvic floor should be doing. That’s again beyond the scope of this of this podcast this morning and please come on to our courses where we can really dive into that. But realize that that five-step process does not always occur in one session. So tell, demo, practice, and ensure absolutely will go hand-in-hand together. But it might be a while before you can progress. because if that person who’s like, I think so, I think I felt that, or maybe they’re saying like, I didn’t feel it at all. I really don’t know what you’re talking about, Alexis. I didn’t feel that. If neither one of you are sure that they felt those movements, you can’t go on. You can’t go on to the next phases because they have no idea. This little area of their pelvis is like a black box. They can’t feel it. They can’t move it. How are we supposed to rehab it? We’ve got to give them homework. We’ve got to give them projects to work on to be able to feel that. Some examples that I use is I’ll send them with a mirror. to look at their pelvic floor to see if they see that movement. Or they can use their finger. They can use a finger and insert it vaginally and feel those differences. They can feel that pelvic floor move. Just getting to the point where they can feel that mobility is a really big improvement and can get them to where they can feel that elevation and that depression of the pelvic floor. So a visual tool for them or maybe a tactile tool for them with their finger. That’s kind of a double tactile cue, right? They can feel it with their finger. They can also feel it in their pelvic floor. You might go with just a third option, a single tactile cue. So rolling up a washcloth and sitting on top of that. or straddling over the top of a bouncy ball to be able to feel a little bit of the difference. One of my most commonly used ones for the single tactile is actually tell them to sit in a bathtub where it’s super, super still and work on feeling those movements.


Because of the pressure of the water, and the stillness of the water, they can actually feel any slight movement, particularly if it’s still and if it’s quiet in there. So that’s one of my favorite ways to send them home with Homework, to try to get to where they can feel that movement, they can actually engage their pelvic floor, and they can discern the difference between a contraction and that effortful relaxation, or the attic and the basement. You send them home, you repeat all of this on the next visit in about a week or 10 days. Give them that practice to do and follow up with them soon on this, and you’re gonna go through that same thing. tell, demo, practice, ensure, see how their confidence is, and then potentially at that point, then we progress. Then we move on to their positions that challenge them or their movements that challenge them, and we educate accordingly. I hope that was helpful for you all to utilize in your own practice and realize that It is challenging to do this if you don’t understand your own body and if you don’t understand all of these steps. So if you’re listening to me today and you’re like, I don’t really understand how to use my pelvic floor, then you go through these steps. And I guarantee you that when you flip to the other side and you’re talking others through this, you being able to relate to them is really going to be able to help. and you can understand that client so much better. Thank you all so much for joining today. I hope this was helpful. I hope you all have a wonderful week. This weekend, I’m gonna be in Scottsdale, Arizona with a whole lot of you all. We are so excited to join you all for the two-day live course. We’re gonna have a blast down in Arizona. We’ve got several upcoming courses. So be sure to take a look on ptonice.com and be sure to register for our newsletter. Everyone always asks us, how do I find out more information? How do I stay up to date on the research? How, how, how in this fitness forward pelvic health world that is ice pelvic, The way to do it is to register for the newsletter. It comes out every other week, every other Thursday, and we give you all the goods there. So be sure to sign up for that, it’s absolutely free. And of course, come on over to our courses, our live courses, and we’re rolling out our last online course of the year right now, and we’re gonna start fresh in the new year. So we are really looking forward to seeing you all out on the road or online. Thanks for being here.

16:42 OUTRO

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