3.Physio-congress, 17th – 19th May, D - Aachen

Being a fanatic about the topic pelvic base, the opening day of the 3rd Physio congress has been the highlight of this event for me.
Having the possibility to listen to five, in this topic specialised lecturers and their newest findings has been very enriching for me.
Mrs. Ulla Henscher, showed in her presentation “Support of continence when being aged” the up-to-dateness and problematic situation of continence and numerically supported this point. The tendency of an increase of the problem with incontinency is to be expected due to a higher life expectancy. There are various kinds and forms of incontinency. Urine- and anal incontinence as well as obstipation tend to be wider spread among women than among men. Therefore a successful training of the pelvic base shall not only focus on the training itself and its integration into daily life. It should also contain the information and guidance about behaviour in daily life, eating- and drinking habits and stress reduction.
With anal incontinence, the sphincter makes only 20% of the anal closing mechanism. The remaining 80% are taken over by M. puborectalis. This again supports the tendency towards a holistic training of the pelvic base in physiotherapy.
Frau Henscher also emphasised the positive effect on the process of giving birth, if there is a regular training of the pelvic base. She also recommended the vertical Giving-birth-position. Unfortunately, she didn’t discuss this topic any further, as this had overstretched the scope. Also interesting was the detailed explanation about the ideal posture when defecting. It could be described with the posture a coachmen sitting on his coach, with his feet slightly lifted up. This enables an opening and slight pre-strain of the pelvic base. Mrs. Henscher made it pretty clear, that pressing, while emptying your intestine is not recommended and she also mentioned, that the normal process of emptying your intestine generally takes about 11 seconds. Eventually it all comes down to the consistency of the stool. Already talking about such a delicate topic, Mrs. Henscher also spoke about sexuality and its importance and presence among elder people. Also in the future, sex remains to be the most pleasurable way to train your pelvic base. Over all, it was a very well done and comprehensive presentation about the topic continence.
The next lecturer Mrs. Barbara Gödl-Purrer talked about clinical reasoning for patients with dysfunction of their pelvic base. She presented a clinical case, which was also used to show her working method. At the beginning, she also mentioned the importance of including clinical reasoning and ICF. We always see a person within its social environment, not only the pelvic base.
When it comes to pelvic base, several systems are connected to it. These are musculoskeletal and neural functions, motor maturity, cognitive, sexual, social, hygienic and hormonal situation. Mrs. Gödl-Purrer spoke about a 43-years old patient, who is, after two aborts mother of two children and recently, she had a Hysterectomy. The patient had basic weakness of connective tissue and she suffered from a slight incontinence. Mrs. Gödl-Purrer mentioned the problematic of an increased motility of the bladder caused by hysterectomy. With the uterus missing, the bladder has more space to move and a support for organs is missing. Motor control, CPG (central patter generator) is also an important factor. Again, this is strongly connected with the ventromedial system of pelvic base and its function as stabiliser of the lower region.
What caught my attention was the emphasis on the importance of a dynamic training of pelvic base. This also enables the pelvic base training to be integrated in daily life. Definitely this also includes subsystems of musculature, structures of joints, faszes and ligament structures. Additionally, our thoughts and emotions are very important for a successful integration of pelvic base function into daily life. This leads us again to the integration of ICF.
To diagnose a weakness of pelvic base it needs a thorough examination. Therefore a diagnostic by sight and touch is absolute necessary. At the same time you can also check the cough-reflex. You will also diagnose if arbitrary pelvic base function is apparent and you can develop an adequate therapy. Electro stimulation is used in rare occasions. If arbitrary contraction of pelvic base is existent and well practiced, you can begin with dynamic pelvic base training and with its integration in daily life.
This presentation was well done. Unfortunately, the practical part was not mentioned. After the break, the congress continued with an interactive presentation by Mrs. Bärbel Junginger and Dr. med. Kaven Bässler. Topics are: Dysfunctions of muscles, respectably progressions of illness of and around pelvic base.
In this presentation, participants were overloaded with very much interesting information and illustrative images. Here you will only find an extract of it. In Germany, there are statistic records about the effectiveness of pelvic base training. However, there are studies from other countries, which show a success of 70% based on pelvic base training. Pelvic base is a form of segmental muscles. 70 - 90% of it are slow twitch fibres. Breathing strongly influences its function, also. Therefore it makes more sense to train the pelvic base in daily life and to condition it for a long-term performance instead of creating a training that focuses on strength. When urinating, the normal procedure sees the whole pelvic base (M. levator ani) being relaxed and so will be the sphincter, afterwards.

The lecturers also made it very clear, that the bladder is lifted by a contraction of pelvic base. Interesting was also the vagina’s form and its ligament connection with M. levator ani. Memorable was the finding, that M. puborectalis is stretched 3,3 times during the birth process which leads to a rupture of the anal sphincter with 6-33% of the patients. Causes for a weakness of pelvic base can be:

  • Pregnancy
  • Weakness of connecting tissue
  • Genetic initial position
  • Deficit of hormones
  • Obstipation with excessive pressing
  • Smoking
  • Chron. bronchitis, asthma
  • Adiposity
  • Heavy corporal work

Three factors are decisive for rectozele:

  • Smoking
  • Adiposity
  • Hormone replacement therapy

When it comes to an overactive bladder, hyperactivity of M. detrusor, a lowering and a weakness of the pelvic base are decisive.

For me, the most interesting in this presentation was a study. With the support of ultra sound (Vaginalsonde, M. transversus abdominis, tiefe Teile des Multifidii), it was discovered, that with every movement we make, the deep areas of Multifidii, transversus abdominis and pelvic base are the first muscles to be active and only thereafter movement executing muscles do. Those muscles are most effective at 20% of the maximum of possible strength of contraction. This shows, that in order to achieve a segmental stability less than 100% of contraction strain is necessary.
This proofs that I’m following the right path in my daily work as a physiotherapist and movement pedagogue.
Also in this presentation, I did miss the practical execution. Inside me, the question came up, to what extent M. transversus abdominis and pelvic base work as synergists or antagonists and if it is also possible to examine via an ultra sound diagnosis, whether a muscle operates concentric or eccentric.
This study encourages to pursue further studies in this area, also incorporating M. psoas, that may not be left out in this field of research.
The last lecturer Mrs. Judith Krucker spoke about BeBo® Training - the concept for success from Switzerland. She found herself in a difficult situation, because the heads of participants were already overloaded. By using some practical exercise Mrs. Krucker brought a neat ending to this topic.
After all, this afternoon with a focus on pelvic base was very informative. Personally, I had liked to see practical exercises and discussions resulting from them.
I do work with this topic very much, I use many images, I aspire female patients to incorporate anatomy and I integrate this in daily life. The topic of pelvic base not only is an important factor for continence, it also has an influence on problems of the back-, knee-, feet-, and up to the jaw. To proof this and to bring the topic of pelvic base out of a life in shadow to its rightful place within physiotherapy is a major ambition of mine, as I perceive pelvic base as a central topic of Physiotherapy.
With all my heart I want to thank those lecturers who have clearly recognized the importance of this topic and who have demonstrated an intensive exchange among those various fields of expertise.

With many thanks

Helene Moser
Physiotherapist, Franklin-Method ® Therapist and Movement Pedagogue