Physiotherapy Assessment for Women's Health

A physiotherapy assessment is a comprehensive process in which a physiotherapist evaluates a patient’s health status, functional abilities, and identifies any physical, emotional, or psychological issues. The assessment helps the physiotherapist design a personalized treatment plan to address specific problems and goals.

For women’s health, the assessment process involves a holistic approach to assess physical function, pain, mobility, and mental well-being. It also considers gender-specific health issues such as pelvic floor dysfunction, pregnancy-related concerns, postpartum recovery, osteoporosis, and other musculoskeletal conditions.

 

1. Patient History (Subjective Assessment)

This initial stage involves gathering comprehensive information about the patient's health, lifestyle, and medical background. The physiotherapist needs to understand both the patient's symptoms and their personal health history to form a clear picture of their needs.

A. General Health History

• Demographics: Age, occupation, lifestyle, and daily activities.

• Medical History: Any relevant past or ongoing conditions such as diabetes, hypertension, cardiac issues, autoimmune diseases, or musculoskeletal disorders.

• Surgical History: Any past surgeries, particularly abdominal, pelvic, or spinal surgeries that could affect physical health (e.g., C-section, hysterectomy, joint replacements).

• Medications: Information on medications being taken, particularly those affecting muscle function, hormone levels, or mental health (e.g., antidepressants, hormonal therapy).

B. Specific Women’s Health Concerns

• Pregnancy History: Number of pregnancies, type of delivery (normal, cesarean), complications (e.g., gestational diabetes, preeclampsia), and recovery.

• Pelvic Health: Any history of incontinence, pelvic organ prolapse, or pain during intercourse.

• Menstrual Health: Any history of dysmenorrhea (painful periods), endometriosis, or irregular cycles.

• Musculoskeletal Issues: Chronic pain (back, neck, shoulders), osteoporosis, and arthritis (especially post-menopausal).

• Mental Health: History of depression, anxiety, or any other emotional issues.

C. Current Symptoms

• Pain: Location, intensity (using the Visual Analog Scale (VAS)), duration, and any patterns of occurrence.

• Functional Limitations: Difficulty with activities of daily living (e.g., lifting, carrying, sitting, standing, walking).

• Physical Changes: Any noticeable changes in physical appearance, such as weight gain, muscle weakness, postural deviations, or signs of pelvic floor dysfunction.

• Emotional Health: Feelings of fatigue, stress, anxiety, or emotional strain.

 

2. Physical Examination (Objective Assessment)

The physical examination includes several tests and techniques to assess the patient's musculoskeletal, neurological, and postural status. The examination will also look for any signs of pelvic floor dysfunction or posture-related issues.

A. Postural Assessment

• Static Posture: Assess the alignment of the head, neck, spine, and pelvis while standing. This helps identify any postural deviations such as forward head posture, kyphosis, scoliosis, anterior pelvic tilt, or rounded shoulders.

• Dynamic Posture: Observe the patient during functional movements (e.g., walking, bending, squatting) to assess posture during activity.

• Pelvic Alignment: Check for pelvic tilt or leg length discrepancies that could affect posture and lead to musculoskeletal pain.

B. Musculoskeletal Examination

• Range of Motion (ROM): Assess joint flexibility and muscle length in key areas like the spine, hips, knees, and shoulders. Decreased ROM can indicate muscle tightness, joint stiffness, or injury.

o Shoulder: Forward flexion, abduction, and internal/external rotation.

o Hip: Flexion, extension, abduction, and internal/external rotation.

o Spine: Flexion, extension, lateral bending, and rotation.

• Strength Testing: Manual muscle testing of key muscles in the lower limbs, upper limbs, and core.

o Assess specific muscle groups that may be weak due to pregnancy, postpartum recovery, pelvic floor dysfunction, or osteoporosis.

o Functional Strength: Assess how well the patient performs weight-bearing activities like squatting or standing up from a chair.

• Palpation: Palpate muscles, joints, and soft tissues to identify areas of tenderness, tightness, or trigger points. Special focus should be given to the lumbar spine, pelvic floor, and hip flexors (which can become tight after pregnancy).

• Special Tests: Certain orthopedic or neurological tests can help assess specific conditions:

o Straight Leg Raise (SLR) for lower back pain.

o Patrick’s Test (FABER) for hip pain or sacroiliac joint dysfunction.

o Muscle Length Testing to check for tightness (e.g., hamstring length test).

C. Pelvic Floor Assessment (if relevant)

• Internal Examination (done by a trained women’s health physiotherapist): Assess pelvic floor muscle tone, strength, and endurance.

• External Assessment: Assess pelvic floor function through muscle palpation and biofeedback techniques.

o Pelvic Floor Muscle Strength: Palpation or perineometer readings for muscle strength.

o Pelvic Floor Endurance: Tests that measure how long the pelvic muscles can maintain contraction (e.g., Kegel exercises).

o Pelvic Organ Prolapse: Check for signs of pelvic organ prolapse (e.g., vaginal bulging, incontinence).

• Urinary and Bowel Dysfunction: Evaluate for signs of incontinence (stress, urge) or constipation that may suggest pelvic floor weakness or dysfunction.

D. Neurological Assessment

• Reflexes: Check deep tendon reflexes (e.g., patellar, Achilles) to assess neurological integrity.

• Sensory Testing: Light touch, pinprick, and temperature testing to assess nerve function in the lower limbs, especially in cases of sciatica or pelvic nerve involvement.

• Motor Control: Assess core stability, gait, and balance.

E. Cardiovascular and Respiratory Examination

• Heart Rate and Blood Pressure: Monitor heart rate, blood pressure, and respiratory rate before and after exercise, especially for women with cardiac conditions or pregnancy.

• Breathing Patterns: Assess diaphragmatic breathing and any signs of poor posture or shallow breathing, which can exacerbate anxiety or stress.

 

3. Functional Assessment

A functional assessment evaluates how well the patient performs everyday tasks. This helps identify areas that need improvement and can provide a baseline for future progress.

A. Activities of Daily Living (ADLs)

• Assess the patient’s ability to perform basic functions like sitting, standing, walking, dressing, lifting, or carrying.

• Look for functional limitations such as difficulty with walking after pregnancy, pelvic floor dysfunction, or low back pain that affects daily life.

B. Specific Functional Tests

• Timed Up and Go Test (TUG): Assesses mobility and balance.

• Five Times Sit-to-Stand Test: Tests lower limb strength and endurance.

• Functional Movement Screen (FMS): Evaluates fundamental movement patterns (e.g., squat, lunge, hip hinge).

C. Pelvic Floor Function

• Assessment of incontinence (urinary, bowel) or pelvic organ prolapse through functional tests (e.g., cough test, Valsalva test).

 

4. Goal Setting and Treatment Plan

Based on the findings of the assessment, the physiotherapist and patient will collaboratively set realistic short-term and long-term goals. These may include:

• Pain Reduction: For example, reducing musculoskeletal pain or pelvic floor pain.

• Functional Goals: Restoring the ability to return to work or perform daily activities like lifting, walking, or playing with children.

• Strength and Mobility: Improving core strength, posture, flexibility, or pelvic floor strength.

• Mental Health and Wellness Goals: Incorporating stress management strategies such as relaxation techniques or mindfulness exercises.

Treatment Plan

• Based on the goals and findings, a treatment plan is developed, which may include:

o Exercise prescription: Strengthening exercises, flexibility training, pelvic floor rehabilitation, and aerobic exercises.

o Manual therapy: Soft tissue mobilization, myofascial release, joint mobilization.

o Posture correction: Postural training, ergonomic adjustments, body awareness exercises.

o Breathing and relaxation techniques: Breathing exercises, progressive muscle relaxation, mindfulness practices.

o Education: Providing information on self-care strategies, injury prevention, and lifestyle modifications.