Do you find it difficult to examine a pregnant woman past her fith or sixth month when she may have difficulty lying supine? How do you alter or perform some of the special tests at that stage?
Answer
It definitely is difficult to examine a pregnant woman at this point when she cannot get onto her back. I would right away thinking of what tests I can do that are not in the supine position. I look at what I can do in standing. How does she look when she stands on one leg? Does she have the Trendelenberg? Does she have a positive Stork test? Does she have pain across the SI joint? In that one test, having her stand on a leg, you could get all three positive tests and make your diagnosis of pelvic girdle pain. You can get her into side-lying to do the SI Joint Compression and Distraction tests, or the Gaenslen’s test. The first part of our approach is to make the diagnosis. Once we make the diagnosis, we do not have to feel compelled to continue examination. I think that is one of the interesting things about us physical therapists. We think we have to do all the muscle testing and all the palpation. If we think about it, if we have made the diagnosis of this pelvic girdle pain, and you have someone who is in so much pain that she cannot lie on her back, we could begin treatment right away, right then and there. What I want to encourage you to do is move past the idea that you need to do every examination that you were taught. Make your diagnosis and start your intervention as soon as you possibly can with these patients. I think that will be very helpful for you. You might not be able to get her onto her back even after a couple of visits.
Cynthia Neville, PT, DPT, WCS, BCB-PMD
Dr. Cynthia (Cindy) Neville, PT, DPT, WCS is Assistant Professor of Physical Therapy, Mayo Clinic Alix College of Medicine, in Jacksonville, Florida. She is a Women’s Health Certified Specialist (WCS), board certified by the American Board of Physical Therapy Specialties. She serves on the faculty of the Mayo Clinic Florida Orthopedic Physical Therapy Residency Program, and advises multiple medical specialty programs at Mayo Clinic Florida. Her outpatient clinical practice at Mayo Clinic Florida serves women and men with pelvic floor disorders. Dr. Neville has authored and co-authored several research articles and book chapters on the topics of pelvic health rehabilitation, pelvic pain, and urinary incontinence. She has presented her research and provided rehabilitation and medical education nationally and internationally. She has developed successful Pelvic and Women’s Health Rehabilitation Programs at premier healthcare organizations including the Rehabilitation Institute of Chicago (now the Shirley Ryan Ability Lab) and Mayo Clinic Florida. At Brooks Rehabilitation in Jacksonville, Dr. Neville developed the first institutional pelvic health rehabilitation program across all levels of care, and the first credentialed physical therapy women’s health residency program in the state of Florida. She has trained more than a thousand physical therapists, occupational therapists, physical therapist assistants, and physicians in pelvic floor examination and pelvic health rehabilitation.
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