A workshop for fitness professionals - approved by Fitness Australia for 5 CEC points.

Presented by
Mary O’Dwyer
MAPA, BPhty, Post Grad Cert Pelvic Floor Rehab & Contin.
Senior Teaching Fellow
School of Health Science & Medicine
Bond University, Australia
Author- ‘My Pelvic Flaw’ and ‘Hold It Sister’- The confident girl’s guide to a leak free life

Course Contents

• Introduction
• What is the pelvic floor?
• The relationship between pelvic floor and core muscles
• Function and dysfunction of the pelvic floor
• What causes pelvic floor damage?
• At risk populations of females with a higher risk of pelvic floor dysfunction
• The role of the pelvic floor during activity
• Case studies
• Why training women is different
• The trainers role
• Learn to identify ‘at risk’ women
• Training posture
• Postural control prac
• Breathing prac
• Exercise programmes for at risk women
• References
• Exam questions
• Feedback

To Book a One Day Seminar contact our co-ordinator -
Ina Koka: inaden@bigpond.com
Ina can organise a workshop in your gym, city or region with full CEC points from Fitness Australia.

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Introduction

Research shows a high rate of pelvic floor dysfunction in women. The rate of bladder incontinence is 40% although higher in certain populations eg. Pregnant women, post birth mums, women with neurological problems, overweight and diabetic women, those with collagen disease, chest disease, smokers and elite sporting women.

50% of women have vaginal pelvic organ prolapse (the bladder, cervix or bowel can protrude exernally). Rates of women with hypertonic pelvic floors vary (a pelvic floor which is too tight can cause muscle weakness, poor bladder control and pain through muscle trigger points)

For many well researched reasons women need to exercise, yet exercise which is too challenging for the women in the above populations, has the potential to aggravate their pelvic floor dysfunction.

Research is now identifying a difference in how continent and incontinent women activate their pelvic floor muscles. The pelvic floor in continent women contracts first and automatically with activity.   Many incontinent women contract Rectus Abdominis and External Obliques first, before their pelvic floor. This uncoordinated activation causes higher intra abdominal pressure down onto the pelvic floor, causing incontinence. Exercise which is too challenging will reinforce this altered muscle strategyin affected women.  Strong rises of intra-abdominal pressure downwards onto a pelvic floor already struggling to lift and control, will in turn aggravate incontinence and prolapse.

Research has identified the co-contraction of the pelvic floor with Transversus Abdominis and Multifidus in providing core stability with activity.

So how, as a Trainer, do you have any idea if your client has pelvic floor problems?

Until now, a ‘head in the sand’ approach has been used by both the client and the trainer usually due to personal embarrassment. Even if you are aware your client rushes to the toilet before every class or refuses to jog or do certain exercises, would you know how to modify her programme? Which exercises should be avoided and which ones should become a focus with training?

Do you have a working relationship with a Women’s Health Physiotherapist?

Fitness Professionals are at the front line of teaching exercise. Women’s pelvic floor health will be advanced through educating Fitness Professionals about pelvic floor dysfunction and the effect of exercise on the female pelvic floor. While it would be inappropriate for Fitness Professionals to teach pelvic floor exercises (due to the complex nature of the pelvic floor and the different types of dysfunctions), identifying women with pelvic floor dysfunction before they begin training and modifying their exercise program is essential.

At present there are no protocols in place for questionnaire assessment to alert the trainer to the presence of pelvic floor dysfunction in their clients.

Guidelines are required for suitable exercise programme for affected women so they continue to exercise safely.

Learning Outcomes
As a result of this workshop, participants will

• Understand the structure and roles of the pelvic floor in the female body
• Understand female pelvic floor dysfunction
• Understand how pelvic floor dysfunction is aggravated by inappropriate training
• Understand the ‘at risk’ populations of women with increased rates of pelvic floor dysfunction
• Understand the link between altered abdominal muscle actitivity, posture, breathing and pelvic floor dysfunction
• Use Case Studies in a group situation to understand why females must train the pelvic floor/core muscles coordinated action first before starting challenging exercise programmes
• Learn appropriate exercise strategies for training females with pelvic floor dysfunction
• Learn when to refer for specific rehabilitation of pelvic floor dysfunction
• Test knowledge through written exam questions

Learning Strategies

• Power point presentation
• Take home manuals
• Case studies
• Practical sessions on posture, breathing, and assessment of functional and non functional abdominal patterns of activation
• Practical session on pelvic control with exercise and suitable exercise protocols
• Examination questions

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