The Athlete and the Pelvic Floor

This post was written by guest-blogger, H&W faculty member Michelle Lyons, PT, MISCP, who will be teaching her brand-new course, The Athlete and the Pelvic Floor, in Columbus,OH in August..

‘I approached my advisor and told him that for my PhD thesis I wanted to study the pelvis." He replied ‘That will be the shortest thesis ever…there are three bones and some ligaments. You will be done by next week.’ I told him ‘I think there is more to it’. (Andry Vleeming Phd 2002)

In sports medicine, the primary source of specialist consultation is the orthopaedic surgeon, who may perform a wide ranging assessment of the musculo-skeletal system with no real evaluation of the pelvic girdle or pelvic floor musculature. The patient is unlikely to be asked about urinary, bowel or sexual dysfunction and often does not volunteer this information unless prompted (Jones et al 2013)

The patient will more than likely then be referred to physical therapy but again, unless we as therapists have the knowledge to combine our orthopaedic, sports medicine and pelvic rehab skillsets, we may not be meeting the needs of our athletic patients.

In my new course for Herman & Wallace, The Athlete and the Pelvic Floor, I will be looking at how specific hip and groin injuries can impact the pelvic girdle and pelvic floor. We know that the most common site of strain is the musculo-tendinous junction of the adductor longus or gracilis muscle, and this is also the most common cause of groin pain in the athlete (Reid 1992). In cases where the athlete recalls a specific traumatic event, the diagnosis is more straightforward, but care must be taken to differentiate between muscle strains and tendonoses/ tendonitis from osteitis pubis, sports hernias and nerve entrapment, which can present with similar symptoms, especially if the athlete presents with insidious onset.

We will investigate differential diagnoses including acetabular tears, a recently recognised source of anterior hip, groin and pelvic pain (Lewis and Sahrmann 2006). Studies have indicated that 22% of athletes with groin pain (Narvani et al 2003) and 55% of patients with mechanical hip pain of unknown aetiology (McCarthy et al 2001) have a labral tear. Athletic pubalgias or sports hernias, are another controversial diagnosis. Although more commonly seen in men, but the female proportion, age, number of sports and soft tissue structures involved have all increased recently (Meyers et al 2008) We will also take into account nerve compressions and look specifically at cycling and genito-urinary symptoms in men and women, the potential mechanisms involved and how we as pelvic therapists can intervene.

It will be an intense two days in Ohio this August as we look at integrating the best of current practices in sports medicine with pelvic assessment and rehabilitation – I hope to see you there!

References:

Reid, D.C. (1992) Sports Injury Assessment and Rehabilitation. Churchill Livingstone, Edinburgh

Lewis, C.L. & Sahrmann (2006) Acetabular labral tears. Physical Therapy 86 (1), 110-121 Narvani et al (2003) Prevalence of acetabular labral tears in sports patients with groin pain Knee surgery, Sports Traumatology & Arthroscopy 11 (6) 403-408

Meyers et al (2008) Experience with sports hernias spanning two decades Annals of Surgery 248 (4)