What should I expect?
- We’ll start by talking a bit about YOU – your medical history and any other background info, but also your goals, your true desires of what you’d like to get back to doing! Your first visit lasts about one and a half hours.
- Basically, we’ll look at how you move (or don’t), how you stand/sit and then run a few tests. The physical part is a thorough orthopedic / neuro screening and functional movement evaluation combined with an abdominal and pelvic-specific examination. That will possibly include an internal assessment (vaginal and/or rectal as appropriate).
- We’ll immediately go over your findings and develop a realistic plan of care based on your physical presentation, goals, schedule and needs. You’ll receive treatment during that very first session! You can expect to leave with homework and/or resources to review.
- Follow-up visits are either scheduled ahead of time or set up at the first visit. The frequency of visits depends on your particular situation (severity of symptoms, distance from clinic, need for in-person follow-up, etc).
- All sessions are 1-on-1 with the original evaluating PT – completed in a warm and private treatment space.
What are the most common diagnoses treated?
- Pelvic pain (acute, chronic)
- Pain with Penetration – Vaginismus/Dyspareunia
- Levator Ani Syndrome
- Pudendal Neuralgia
- Interstitial Cystitis (IC) / Painful Bladder Syndrome (PBS)
- Male Pelvic Pain
- Chronic Prostatitis
- Vulvodynia / Vestibulodynia
- Abdominal, Hip, Sacro-iliac (SIJ) or Low Back Pain
- Pubic Symphysis dysfunction
- Pain with Defecation or Urination
- Coccyx Pain / Coccygodynia (Tailbone Pain)
Pelvic / Supportive Dysfunction
- Pelvic Organ Prolapse (Cystocele, Rectocele, Prolapse)
- Constipation (Slow Transit / Outlet Obstruction)
- Urinary Incontinence (Stress, Urge, Mixed)
- Dysfunctional Urination (Hesitancy, Frequency, Retention)
- Fecal Incontinence
- Prenatal, Pregnancy and Postpartum Issues
- Diastasis Recti
Surgically related Issues
- Abdominal / Pelvic Adhesions
- Prostatectomy Issues (Urinary, Erectile)
- Pelvic Reconstruction
- Endometriosis Excision
- Laparoscopy (for varying reasons)
What treatments are offered?
Evaluation: We spend a good amount of time during your first session talking. It’s so critical to thoroughly review as many of the factors that may have brought you to this point – your history and symptoms. Just as important though is progressing into the physical evaluation, including postural assessment, functional movement evaluation, orthopedic/neuro screening and, as appropriate, internal and external pelvic examination.
In truth, 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.
Manual Therapeutic Techniques: Gentle hands-on approach to reduce tension and pain, improve coordination and retrain muscle function. Our 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). A key to manual work is recognizing its limitations – primarily that it’s a passive treatment. True recovery empowers you to address issues as well. That’s why ALL manual techniques must also be supported with instruction in self-care – exercise, taping, re-education and functional training – to allow your body to adapt and to ensure your progression toward independence.
Neurological Re-education: Retraining of pelvic function involves improved coordination with all of the surrounding structures for safe and pain-free movement. All regions and tissues are involved, including muscles, connective tissue, nerves, bones, joints, and organs. The pelvis is the connection point for the upper and lower body – coordinated movement and appropriate recruitment of muscles is essential for function. One of the powerful tools for retraining the appropriate neuromuscular activation (Neurac) patterns is Redcord.
Exercise / Activity Training: Whether exercises or activities are directed toward strengthening, tension reduction, or optimal recruitment patterns, they are 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. They may not be appropriate parts of the program yet. However, there are many activities people can do to reduce pain or tension.)
Home Treatment Program: Clinical visits are necessary, but much of the program rests in self-care and independent training. Self-efficacy 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 educational reading and review, manual techniques, exercises /activities, mindfulness activities, behavioral training (bladder retraining, dietary and nutritional modification), vaginal/rectal dilators, vaginal weights, and sexual health training to progress toward your goals.
Perineal Electrical Stimulation or “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) and fecal incontinence.