Connecting Pelvic Floor and Postural Exercises, Veronika Wiethaler. 2015. $24.95. Available Through OPTP. Soft cover, 127 pages with DVD.

This patient exercise program is written by Veronika Wiethaler who is a graduate of the School for Body-Mind Centering in the United States and an approved naturopath in Germany. She lives in Italy and has 2 other books on pelvic floor muscle exercises. It is clear that this book was translated into English.

The back of the book states that this technique is "for a healthy pelvic floor." In the introduction Ms Wiethaler mentions that she has used the technique with postpartum women, postprostatectomy men, and the elderly. I would agree with the use of the techniques for wellness and prevention. Although pelvic floor muscle (PFM) facilitation exercises have been researched, the level of evidence is low in patient populations and most research favors isolated exercises first with coordination of PFM during daily activities after patients have mastered the isolated contraction. The author suggests physiotherapists, gymnastic teachers, yoga teachers, midwives, and others have used the techniques. I would be concerned some patients may find the text difficult to understand with abstract concepts and vague instructions. Adults in a yoga class may be more familiar with the concepts and methods. The DVD makes the book's instructions easier to follow.

PFM exercises are described as follows: "Imagine a walnut between the ischiopubic rami, or a sponge ... Inhale doing nothing and then exhale, imagine crushing the walnut between the ischiopubic rami ...." Another explanation for PFM exercises is to "pull a cloth up inside." This may not be enough explanation or clarity for some to be able to do the exercises correctly. The main focus of the book and DVD is overflow exercises of the PFM (pelvic tilt, adduction) and exercises for the trunk, hips, and pelvis to restore posture. In this way it is more of an orthopedic book. Exercises are demonstrated in supine, quadruped, standing, prone, and sitting. Exercises use small balls, medium balls, and bands. The starting point of the exercise is stressed, starting from the nose or starting from the tail. I like the description of abdominal PFM coordination as starting from the base of the pelvis and secondarily noticing a light gently abdominal contraction avoiding downward pressure (increased intra-abdominal pressure). Breathing and movement, flexibility, and strength are discussed throughout. PFM anatomy is reviewed with simple clear pictures for both males and females.

There are no references and the concepts do not appear to be based on completed research. I believe the book may be helpful for prevention, general health, and in patients with a good understanding of movement and good body awareness.

Beth Shelly, PT, DPT, WCS, BCB-PMD

Moline, Illinois