Transcript of VPS Podcast 4 - Physiotherapy treatment for vulval pain: a presentation given by Helen Forth

Slide 15 (20:28)    Biofeedback (continued)

An EMG sensor or probe would be placed into the vagina. This detects the level of activity in the pelvic floor muscle, and as I was saying, with vulval pain, that pelvic floor will tend to be overactive at rest. These sensors are then attached to the computer, which gives a visual display of the intensity of the contraction when you’re either contracting or relaxing the pelvic floor muscle, and that instant feedback which is shown on either the display screen or this little handheld unit will obviously help to encourage and motivate you to continue with that method of therapy. So, that’s the theory behind it.

Slide 16 (21:06)    Biofeedback (continued)

Biofeedback, as I’ve touched on, can be used in either the clinic or home setting. Clinic use is often for initial assessment and detailed readings of pelvic floor muscle resting tone, muscle strength and endurance; home use is often really effective for ongoing treatment, and as I’ve said, that’s often via a smaller hand-held unit. People sometimes wonder about what the probes look like, and I’ve actually brought some with me that I’m going to show you, and you can perhaps pass around at the end if you want to. There has been development of a really good EMG anal probe that can be used vaginally really effectively for this, and the anal probes are much smaller than the vaginal probes, so if people have had previous attempts at biofeedback and have found they’ve not been able to insert vaginal probes, and there weren’t anal probes available to you at that point, this might be something that’s worth trying. There’s a particular probe that I’ll show you, that’s actually been CE-marked as being effective and suitable for vaginal use, and that’s really been helpful in terms of being able to use biofeedback for more patients.

Slide 17 (22:16)    Biofeedback (graphs)

I’ve just included a couple of graphs to give you an idea of the sort of things that you might see if you’re doing biofeedback, and the kind of readings and things that your physio might be interested in. The one at the top, here [she indicates on the slide] is a measurement of somebody’s pelvic floor muscle resting tone, and this is just very slightly increased, and what you can see is that this line is quite spiky, and some people might use the word ‘unstable’ to describe that. It means that when the muscle is resting, or you think your muscle is resting, there is some ongoing activity there. There is always going to be some activity within the pelvic floor when you think it’s relaxed, but we have measures of normal limits of resting tone, so this graph is just showing a slightly above normal level of resting tone there. The one underneath is just showing somebody trying to do a 10 second hold of a pelvic floor squeeze, and they’re trying to do this at 50% of their maximum contraction. You may remember that I was saying that I often don’t get people to work fully, to work maximally, because it can then be quite difficult if you’ve got abnormal muscle function to be able to let go well, so this is an example of somebody trying to do a slow squeeze that they’re trying to sustain for 10 seconds. You can see she was struggling a little bit. You should be trying to follow the Yellow Brick Road, basically, when you’re using these sorts of templates, and you can see that this lady was just struggling a little bit to maintain her pelvic floor activity at that level. So, I hope that’s helpful, just to see what it might look like. You might find that your physio prints off these sort of graphs, gives them to you to take away and pin to your fridge to act as motivation, or might put copies of them in your notes, and they can be a really useful comparison for when you come back for more sessions, to see how your muscle activity has changed.