It is important to note that when it comes to pelvic floor dysfunction it is important to stabilize the ‘house’ that the pelvic floor is the ‘floor’ of. Of course, if surgery is needed, then the ‘house’ stability has to be addressed as soon as the tissue is healed and can be rehabbed. It is therefore important to note that internal manual therapy in the form of digital assessment and therapy through the vagina and/or anus is not always a necessary part of treatment. To understand more about the comprehensive holistic approach to the treatment of pelvic floor dysfunction, please visit my blog.
Here is the grading system used to communicate the level of strength in the muscles of the pelvic floor. This is at a depth that can be reached by the index finger. Bear in mind that there are muscles of the pelvic floor that cannot be reached by the index finger. Of course, the length of the index finger varies as well so the access to those areas is not necessarily the same for every practitioner.
What is the Oxford Scale?
The grading system used to determine the strength of the pelvic floor muscles is called the Oxford Scale or Modified Oxford Scale. It is a subjective grading system used to assess the strength and quality of contraction of the pelvic floor muscles. The Modified Oxford Scale has 5 grades, which are as follows:
- Grade 0: No contraction felt
- Grade 1: Contraction felt but minimal lift
- Grade 2: Contraction felt with a moderate lift
- Grade 3: Contraction felt with a good lift
- Grade 4: Strong contraction felt with a very good lift
How Is The Modified Oxford Scale Used and Reported?
To determine the grade, the pelvic floor therapist will ask the patient to perform a pelvic floor muscle contraction. During the contraction they assess the quality and strength of the contraction by palpating the muscles internally. The grade is based on the degree of muscle contraction and the ability to keep the contraction for a certain period of time.
For example, when the patient is asked to contract the muscles of the floor and there is no contraction during the assessment, the grade is 0. If there is a contraction but only a minimal lift, the grade is 1. Contraction with a moderate lift is a grade 2 and if there is a contraction with a good lift, the grade is 3. Finally, a strong contraction with a very good lift is grade 4. With that said, the information will be reported as the following: “Pelvic floor muscle strength was assessed using the Modified Oxford Scale. The patient was able to contract their pelvic floor muscles with a good lift, consistent with a grade 3 contraction.”
Please note that while there is value in finding out the state of contraction or weakness of the pelvic floor, only attending to what is reached by the index finger of the pelvic floor is an absolute mistake. The pelvic floor is not a hammock that is suspending in the air and the integrity of the pelvis and what is attached to the pelvis plays a direct role as to how the muscles of the pelvic floor react.
If you have pelvic floor dysfunction, are not happy with the treatment you are receiving or suspect to have pelvic floor dysfunction and need help, please contact me.
Dr. Shakib