Diagnosis & Treatment

man-pelvis-xray

What are the most common diagnoses treated?

(In no particular order)

  • Pelvic pain (acute, chronic – CPP)
  • Vaginismus
  • Levator Ani Syndrome
  • Pudendal Neuralgia
  • Abdominal / Pelvic Adhesions (post-surgical, post-partum)
  • Coccygodynia
  • Interstitial Cystitis (IC) / Painful Bladder Syndrome (PBS)
  • Constipation / Outlet Obstruction
  • Male Pelvic Pain
  • Post-prostatectomy dysfunctions
  • Urinary incontinence – stress, urge, mixed
  • Dysfunctional voiding – hesitancy, frequency, retention
  • Fecal incontinence
  • Vulvodynia
  • OB pain / dysfunction
  • Diastasis Recti
  • Abdominal, Hip, Sacro-iliac (SIJ) or Low Back Pain
  • Pelvic Organ Prolapse (Cystocele, Rectocele, Prolapse)

What is a typical session like?

  • Sessions typically last from 45-60 minutes each – sometimes longer – depending on your condition.
  • All sessions are completed one-on-one with the original evaluating PT.
  • All sessions are completed in a warm and private treatment room.
  • After initial evaluation, session interventions will vary depending on the diagnosis, including a combination of treatments (described below).

What treatments are offered?

  • Evaluation: Much of the first session involves review of history and symptoms. Then a thorough physical evaluation is provided, including postural assessment, orthopedic screening, internal and external pelvic examination as indicated. Evaluation is ongoing – each session will include assessment of current conditions and how they relate to pre-treatment, initial evaluation and so forth. More formal evaluations and reports are completed at regular intervals as your therapy progresses.
  • Treatment for pelvic problems - massageManual Therapeutic Techniques: Gentle hands-on approach to reduce tension and pain, improve coordination and retrain muscle function. The most frequently used techniques include Myofascial Release (MFR), Visceral Mobilization (VM), Muscle Energy Techniques (MET), Integrated Manual Therapy (IMT), Trigger-Point Release (TrP), and Cranio-Sacral Therapy (CST). All manual techniques are supported with exercise, taping, re-education and functional training.
  • Neurological re-education: Pelvic retraining involves improved coordination with the surrounding structures for safe and pain-free movement. All tissues are involved, including muscles, connective tissue, nerves, bones, joints, and organs. The pelvis is also the connection point for the upper and lower body – coordinated movement and appropriate recruitment of muscles is essential for function.
  • Pelvic Exercises / Activities: Whether the exercises/activities are directed toward strengthening, tension reduction, or training optimal recruitment patterns, they are all vital to supporting other clinical treatments provided. (Note: I emphasize “activities” in addition to “exercises” because for many people with pain, traditional exercises can be difficult or even contraindicated and should not be part of the program. However, there are many activities these people can do to reduce the pain/tension that involve the pelvic floor.)
  • Home Treatment Program: Clinical visits are necessary, but much of the program rests in self-care and self-training. Independence from therapy is a primary goal and your confidence in being able to regain control is essential. Some forms of treatment you would complete at home include manual techniques, exercises /activities, behavioral training (bladder retraining, dietary and nutritional modification), vaginal/rectal dilators, vaginal weights, and sexual health training to progress personal/clinical goals.
  • Perineal Biofeedback (BFB): Biofeedback is basically EMG (electromyography). Simply put, the muscle activity is registered by sensors (either external or internal) and that activity shows on a graph. The feedback of visualizing how your muscles respond when you attempt various contractions / maneuvers guides body awareness. BFB can therefore be used to train strength, isolate certain muscle groups, train relaxation, and re-educate pelvic coordination. It is a wonderful tool for visual learners in particular.
  • Perineal Electrical Stimulation (e-stim): Electrical stimulation may sound intimidating, but applied appropriately it is not so scary. It is a low-level electrical current applied through either a rectal or vaginal sensor in an effort to retrain pelvic floor neuromuscular structures. Indications for using e-stim may include increasing strength, coordination or to reduce tension patterns. It has proved particularly useful in urgency reduction (both urinary and fecal).
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