Ultrasound Imaging in Pelvic Physical Therapy

Have you wondered how ultrasound imaging in pelvic physical therapy or OT can actually help you if you are not just having pelvic pain? I think there’s a misconception that if you’re doing pelvic physical therapy then you just have pelvic problems and that’s not accurate. 

The Respiratory Diaphragm

The respiratory diaphragm is the universal diaphragm that sits between your eight thoracic vertebrae and your second lumbar vertebrae. It’s a pretty big muscle that is connected to the vocal diaphragm and the pelvic diaphragm through multiple outlets and variables. The fascia and neural connections are two examples.

Imaging The Respiratory Diaphragm

Why is imaging the respiratory diaphragm important? Your diaphragm attaches at multiple points to the spine, ribcage, tendons, and hip flexors. It is integrated with the same nerve that integrates with vocal folds. It influences intra abdominal pressure, spinal stiffness, and it is like a sump pump for the pelvic bowl. If it has not shaped properly, then you can have a problem because all those things I just listed: the abdominal wall, the spine, the rib cage, the hip flexors, the vocal folds, everything becomes affected. Because of this, I love imaging the respiratory diaphragm. 

What Does the Respiratory Diaphragm Look Like? 

On imaging, the respiratory diaphragm is kind of an upside down bowl shape, like a deep bowl that’s narrow. If you don’t have a good position, it looks flat. When it’s flat, it can’t move enough through range because it’s lost its range. Proper position should be when you inhale it goes down and then when you exhale, it comes back up again. When your diaphragm goes down, the pelvic floor goes down with it. It’s a piston effect and as you exhale, it all comes back together. 

Flat Diaphragm and Breathing

If I image the diaphragm and it looks pretty flat you’re not going to have much of an excursion. That means your breath is going to be really short and your exhale is not going to be great. Your inhale is also not going to be very great. You don’t get that nice lymphatic pump, that kind of sump pump action. What else happens? You don’t get much stretch on the pelvic floor, because it’s already kind of flat. 

What Happens When the Pelvic Floor Doesn’t Move?

When you breathe the pelvic floor may not move at all, and what happens to the pelvic floor when it doesn’t move? What happens when a muscle doesn’t move? What happens when you don’t move and you just sit around? You get stiff, things get tight, and it might even start hurting even though there’s not necessarily a pathology there. The tissues get tight and they get out of shape. Your pelvic floor and your vocal diaphragm can get out of shape, just like your respiratory tract can get literally out of shape. 

Imaging Can Help So Much

This is why I like to image the respiratory diaphragm in the clinic. There are all kinds of tips and tricks but if it was very simple to fix, then you could just watch a YouTube video and fix your own respiratory diaphragm. Be encouraged because if you have long COVID, pelvic pain, vocal issues, back pain, sacroiliac joint pain, pubic symphysis pain, endometriosis, painful bladder syndrome, prolapse, or polybrene prolapse, all of these things can be helped by just doing respiratory diaphragm imaging. 

Where Can I Get Respiratory Diaphragm Imaging?

Respiratory diaphragm imaging is used for biofeedback in real time. I then train you how to breathe correctly, which sounds easy, but it’s a stepwise process because it involves all three diagrams. If you can find someone who’s doing imaging nearby that is helpful, but if not you can reach out if you are in the state of North Carolina. Take a trip to come and see us and I can image for you. I do have people traveling from out of state and out of country. I certainly can’t see everyone, so I will try to point you in the direction of someone who does imaging your area. However, this is an emerging expertise and there aren’t a lot of people that are doing it because the technologies are so expensive. 

Imaging Can Help Many Conditions

There aren’t many clinics doing imaging yet in the United States,  but there’s a good number of them so I will try to help point you in the right direction. If you would like to come see me, I can see a limited number of people as well. If you have any of the above listed conditions, it can be very transformative and you can improve very quickly just from simply having respiratory diaphragm imaging and biofeedback in real time.

What Happens During Imaging?

What happens during imaging? Rehab ultrasound imaging for the lumbar pelvic region is an emerging technology that is not yet widely accessible or readily affordable. There’s a maintenance cost to it as well. Without diving into the cost of what it takes to do imaging as a pelvic ortho PT, I just want to talk to you about what I do with the information from imaging. If you are struggling with any problems between the voice, the respiratory diaphragm, and the pelvic diaphragm (which actually extends all the way down to the plantar fascia via the fascia), then you can benefit from ultrasonic imaging. 

What Imaging Looks Like

I believe it is absolutely essential to find a therapist who can do ultrasound imaging. Here’s why: we do something called trans perennial (TP for short), which allows you to see things in real time. Your bladder should kind of look like a golf club head, the uterus will look like an avocado, you’re not going to see the vaginal canal because it’s just a space unless something’s in it. The anal rectal canal looks almost stacked. When I’m measuring the imaging, I draw a line literally between the two broni. The context between the pubic bone and coccyx, are measurements that are relatively standard. 

If You Have Pelvic Floor Issues

There are people out there that are doing caterers on themselves or getting themselves colonics and enemas in order to try and go pee or poop. That’s tough, and it shouldn’t have to happen that way. But if your floor is too tight or has too much tension in it, nothing’s going in and nothing’s going out without pain or dysfunction. 

Ultrasound Can Help Diagnose Issues

The first thing we measure is the standard between two lines on the ultrasound. It shouldn’t be too big. The bladder can get too low, floppy, or too mobile, then that can impact how the cervix also drops. That’s called pelvic organ prolapse when these things start to drop, but it also can create leakage. It can also create pain, painful intercourse and pain when just sitting around doing nothing. 

Fixing Pelvic Floor Issues

The last thing that we measure here is the anal rectal canal, which should be about 120 degrees. If you have a prolapse, it could be that the canal kind of bumps into the structures over here, like the bladder. That’s called a posterior wall prolapse. The 120 degree angle right here should get straighter as we poop. If it doesn’t, I can see that and we work on fixing it. If you struggle with constipation, going to the bathroom too often, or not being able to empty the bladder fully, we can work on that. If you’re having painful intercourse, imaging can help. It can also help if you have pelvic pain or a core that doesn’t seem to be quite aligned.

Imaging Helps with Treatment Plans

If things don’t really work as well as they used to, we can also measure your TPUS area. I take all these measurements into consideration before I prescribe any kind of physical therapy, which could include integrative medicine, functional medicine, and lifestyle medicine as approaches to the way that I use PT. All of what I do is very much informed by these objective measurements and imaging. 

The Pelvic Floor Can Be Too Tight

Sometimes the pelvic floor is too tight and it’s hard to get things in and out of the vaginal canal. It’s hard to get pee out of the bladder if the pelvic floor isn’t acting correctly. You can end up having an angle that looks like you’re pushing uphill and it feels like you’re trying to push a hill and around the corner to get poop out. That’s not sustainable, and you end up having constipation and bladder issues, painful bladder syndrome, and things like that. 

Reach Out For Help 

Don’t let anyone tell you that your bowel/bladder function and your gastrointestinal function have nothing to do with your urological and gynecological issues. This is how I address transcranial ultrasound in low pelvic rehabilitation as a pelvic and ortho physical therapist. If you need help, don’t hesitate to reach out. I do a limited number of free consults. If you’re having significant issues anywhere between the voice and the pelvic floor, it’s connected, and we can measure it, you can see it and we can help.