A Conversation With Dustienne Miller, CYT, PT, MS, WCS
CMT teamed up with Dustienne Miller, Herman & Wallace instructor and creator of the DVD series, Your Pace Yoga to answer a common question we hear from our therapists. Read Dustienne’s response and her clinical strategies to guide you through this sometimes-confusing observation.
Q. “Some of my patients who have tender/tight pelvic floor muscles, may show almost no tension during rest when on biofeedback. This surprises me at times. I would expect patients with tender pelvic floor muscles to have higher resting muscle tensions, often above 2.0 microvolts. Others are way below the 2.0 line. That is where I get surprised and confused.
I remember reading somewhere, that if their muscles are in a shortened state, then they might show low tension during rest. However, they still may need some relaxation for optimal pelvic floor function. Can you shed some light on this subject?”
A. “Biofeedback is a useful tool we can utilize in the clinic for both uptraining and down-training of the pelvic floor muscles. The biofeedback unit gives our patients “eyes” to an area of our body where we usually don’t get the visual feedback. Surface EMG can be used with the sticky surface electrodes placed peri-anally or with internal vaginal and rectal sensors. This type of EMG is a way of measuring the action potential at the muscle. Cram & Kasman note that the measurements represent the electrical activity of the muscle, therefore this is not a way to measure strength or length.
If we reference 2.0 microvolts as a baseline resting tone, it makes sense that a resting tone of 10 microvolts would correlate with over activity of the pelvic floor. How confusing that another patient with an overactive pelvic floor would measure under 1 microvolt!
If someone has a shortened muscle, the motor unit action potential is diminished. A tight muscle is not sending the electrical activity that produces the higher microvolt reading on the biofeedback unit.
Therefore, we want to use all of our clinical findings to put the entire picture together. Putting together the subjective data along with our palpation evaluation will help solve the mystery of the “electrically silent muscle”.
Now that we have addressed the confusion of the electrically silent muscle, let’s talk about some treatment strategies.
Manual therapy: We can utilize our manual therapy skills in the clinic to treat over activity in the pelvic floor, and encourage our patients to try and
implement what they can at home.
Contract/relax: Some patients may not know if they are in an overactive holding pattern. Contracting and relaxing might help them realize they are holding and didn’t realize.
Imagery: Visualizing the pelvic floor softening with different verbal cues can be helpful for our patients. Inhale and imagine the pelvic floor releasing towards the feet like a jellyfish.
Dilators: Using mindfulness to increase pelvic floor muscle relaxation while using dilators is very helpful in decreasing muscle guarding and improving the locus of control for our patients. On my blog I have an article about mindfulness with dilator use which includes a guided meditation, which some patients might find helpful.
I hope this was helpful for those of you with questions about biofeedback and overactive pelvic floor muscles. Thank you for doing your part in the world to increase pelvic floor awareness and treating in this exciting specialty!
Dustienne’s mission as a physical therapist and Kripalu-certified yoga teacher is to increase awareness around all things pelvic health. Certified as a women’s health clinical specialist by the American Board of Physical Therapy Specialties, Dustienne established her clinical practice in sunny California in 2012. Now flourishing closer to her family in Boston, her practice in lively Copley Square holistically weaves yoga and breath postures into her traditional physical therapy.
Dustienne has had the honor of presenting her lecture “Yoga for Pelvic Pain” at CSM. Dustienne is on faculty at Herman and Wallace Pelvic Rehabilitation Institute teaching Pelvic Floor 1, and the course she wrote, Yoga for Pelvic Pain.
Dustienne is the creator of the pelvic health yoga videos series, Your Pace Yoga. Her video series, using yoga to relieve pelvic pain and increase bladder control, helps bring her techniques and practices to the homes of people everywhere. She is a contributing author in two books about the integration of pelvic health and yoga, Yoga Mama: The Practitioner’s Guide to Prenatal Yoga (Shambhala Publications, 2016) and Healing in Urology (World Scientific). Dustienne speaks at conferences and is looking forward to returning to the International Pelvic Pain Society’s Meeting this year to teach and talk about yoga for pelvic health.