Interest and expertise in pelvic floor function and rehabilitation has expanded markedly over recent years. While the field of Women’s Health physiotherapy is not yet deemed mainstream, it is a growing specialty and is increasingly included as a first line of investigation and management in conditions ranging from nonresolving lower back pain (LBP) to urinary urgency/frequency. It is now accepted as standard treatment for female urinary incontinence and pelvic floor reeducation is included as routine care in many obstetric services.
This popularization within physiotherapy can be partially attributed to an improved understanding of the pressures in the pelvis and lumbar spine, and how these relate to pelvic floor loading and the associations with movement and visceral function.
Work on muscle rehabilitation was profoundly impacted by Andre Vleeming’s description of forces around the sacroiliac joint (SIJ). The concept of form closure and force closure as they apply to the body (skeletal vs. muscular and fascial systems) resulted in a rethink of the transmission of pressure between the central core of the lower spine and the abdomen (intra-abdominal pressure (IAP)), the thorax (breathing) and limbs (activity). Evidence based research describes the types of muscle function under varying degrees of load, looking at the different muscles that stabilize and mobilize the body. Muscle function is further divided into local and global systems, each having partner muscles working within functional slings. Control and quality of movement are now central treatment objectives, whereas the older benchmarks of strength and range of motion (ROM) are simple progressions.
This chapter aims to examine the diverse roles and functions of the pelvic floor. We will address the need for specificity in assessment and rehab selection and outline treatment options and techniques used to quantify and qualify PF function.