To P.T.:

Have you instructed her to contract when these events occur (i.e. just before the actual sneeze and a few seconds after)? Also, she could be having high tone issues, which could have given the sense of weakness previously. Are you in a position to check her tone level with biofeedback? I find with my patients that once the strength is there they need instruction for the functional application of the strength, and sometimes many cues for the follow through/ compliance with this. I have had some patients, including one referred this week, with stress UI and had I not performed biofeedback I would have taken it as solely muscle weakness and not found her hypertonicity. So, of course, I am now treating that hypertonicity with eventual progression/ blending with PFM strengthening. Best of luck, and please keep us posted!