A client with a 9-second pelvic floor hold, stronger Grade 4
contraction, still slow to recruit fully, can build to more dynamic
movement and more challenging positions, as illustrated below
(taking care to ensure no issues occur due to fatigue onset):
Pelvic floor muscles, when assessed by
a pelvic health physio, can be graded for
strength, endurance, hold times, reps and
coordination.
What compensatory mechanisms do clients use?
Dynamic core control in 4 point
With the onset of fatigue, or the attempt to perform an exercise that is
too high a load, some clients will switch to a bearing down pattern in
their abdominal wall, including breath holding, switching to the use of
excessive amounts of upper rectus and external oblique activity. This,
in turn, can result in downward pressure on the pelvic floor, despite
an initial correct pattern of recruitment. These changes in recruitment
patterns can also occur towards the end of training if fatigue onset
occurs and the client compensates with incorrect patterns.
If a client is unable to sustain a plank position without any of the
above, consider modifying the exercise to include:
• shorter hold time
• positioning knee closer to hands and then moving further away
• use of a ball under trunk to assist building scapular stability
• moving back to other core control steps until they are ready to
retest the plank position.
When to refer
Core with resistance
The Continence Foundation of Australia’s 1-page Pelvic Floor
Screening Tool can be used to help determine the need to refer clients
to a doctor or continence professional, with anyone who answers
‘yes’ to any question in the second section requiring referral.
At the 4th International Consultation on Incontinence, Abrams et al
(2009) recommended ‘If an existing pelvic floor condition is revealed
by your client, then referring for appropriate treatment is the best
practice’; and ‘Pelvic floor muscle training should be offered as first line
therapy to all women with stress, urge or mixed urinary incontinence.’
Pelvic floor muscle training has been shown to be effective in the
treatment of stages 1 and 2 of pelvic organ prolapse (Braekken 2010, Hagen
2009), in that it can re duce the stage and bothersome nature of prolapse.
To help your client find a women’s, men’s or pelvic health
physiotherapist near to them, go to Find a Physio
MORE?
Progressing to full plank
To develop your expertise in building clients’ core fitness, CLICK HERE
to find out more about Network’s 5-CEC course, 100 Steps to Plank.
CLICK HERE TO SEE REFERENCES
Dianne Edmonds is a physiotherapist working in an Obstetric GP clinic, course
creator and Women’s Health Ambassador at Australian Fitness Network and
the Director of The Pregnancy Centre. She has worked in women’s health and
fitness for 25 years and was integral in the development of the Pelvic Floor
First resources.
Full side plank
66 | NETWORK SUMMER 2017
Acknowledgements
Acknowledgement is made to the Continence Foundation of Australia for
the permitted use of their diagrams developed through the Pelvic Floor First
campaign, and to Simone Kay from Train for Life, Cairns, and Stuart Frost,
photographer for the other images used.