What does a Pelvic Floor Physical Therapist Do? (and everything you've been to shy to ask!)

You're not alone

Pelvic floor therapy is relatively new specialty of physical and occupational therapy. While there is evidence of aspects of pelvic floor health being performed many centuries ago, the "Kegel" has only been in existence since the 1940's when it was invented by Dr. Kegel as a pelvic floor exercise. The 1960's and 1970's proved pivotal in bringing attention to women's unique health needs and biofeedback became a tool utilized for regaining control of women's pelvic floors. But this didn't solve all of our problems and it was clear that a more comprehensive approach was necessary to regain true control over our pelvic health concerns. We now have the ability to tackle complex issues such as chronic pelvic pain, sexual dysfunction and prolapse.

Due to this being a relatively new field, it stands to reason that most women don't know what a pelvic floor physical therapist does. Heck, there's a chance that a lot of physical therapists don't understand everything a pelvic floor physical therapist can and does on a daily basis. Social media has begun to shed light on this topic, but when you're about to give a clinic a call, those anxious thoughts about what you're getting in to begin to surface. That's perfectly fine! It's normal to wonder or have reservations about what's to come next and it's perfect that you're here to get those answers.

Let's begin with a definition:

What is pelvic floor therapy?

Pelvic floor therapy is a specialty of both physical and occupational therapy. Pelvic floor therapists take extra classes beyond their doctorate to learn and specialize in the nerves, muscles, and other tissues that support the pelvis. This includes the bladder, bowel and reproductive system. These abdominal and pelvic structures influence your whole body, which is why hip and low back pain, pregnancy and postpartum and also subspecialties in this field. In this world, most physical and occupational therapists treat relatively the same, especially at our clinic. Our training is similar and our goals the same: to get you relief from the symptoms that ail you.

Buyer BEWARE

Unfortunately because there is no standard school work and no "legal definition" that defines who can and can't do "pelvic floor therapy", ensure that when you are talking with a clinic or individual about what they do, that they are, in fact, a physical or occupational therapist and not just a personal trainer or other unrelated profession. Once that's established, ensure that they have also taken more than just a weekend course in pelvic health. These are complicated diagnosis that women have been, usually, dealing with for years. Someone who has only completed a 2-day course, is not yet equipped to handle the more complicated diagnosis or help those women who have been dealing with these issues for years. If your "therapy" has only ever consisted of being attached to or sitting on a machine or a kegel program, then you haven't experienced true pelvic floor physical therapy.

What to expect:

Pelvic Floor Physical Therapy is Healthcare

Pelvic Floor Therapy is performed by a licensed physical or occupational therapist and by and large, has many of the same attributes as a typical physical therapy appointment would have.

• Hands on Care: Pelvic Health Therapy consists of soft tissue mobilization of the pelvic floor muscles, the abdominal wall, hip, glute, and lumbar stabilizing muscles to improve mobility and length of the tissue. It can also consist of joint mobilization to improve the movement and alignment of the joints. Both of these improve your mobility and allow for improvement in function of the muscle itself.

• Exercise: Does it surprise you that exercises isn't listed first? It's on purpose! Because, while physical therapy has an exercise component, exercise does not equal physical therapy. Physical therapists should be handing you strategic exercises that are tailored to you, not just 30 exercises printed off the internet. The exercises should be watched and corrected to ensure accuracy and success in accomplishing the goal. You should have been told when and how often to do exercises and any compensations to be looking for. If you're finding the activity or the amount of exercise to be difficult to fit in, this conversation needs to be had with your therapist. While the exercise should be challenging, strategies should be in place to ensure that you have the time and ability to engage with them.

• Other modalities: Other tools in our toolbelt include dry needling, cupping, biofeedback, kineseotape, electric stimulation (i.e. tens unit), and others.

But is it invasive?

This is always the most asked question and rightfully so. Many women come to us in pain or following a trauma and are worried about the treatment. We're here to help you out of pain, not put you into more. Rest assured, you are in control of anything and everything that happens in the appointment. But what can you expect to be asked of you?

• History Taking: Your story is so important to your care. The how's, what's, when's, and why's of your history play into our decision making on our diagnosis and your treatment plan. It's important you tell us everything.

• Movement Exam: We will watch you move: walk, jump, run, bend, squat, stoop... Anything that causes you issue, we need to see.

• Breath and Posture Assessment: The pelvic floor is directly impacted by your posture and breath. Assessing these in real time or alongside activities is an important tool to discover why you have the symptoms you have.

• Orthopedic Hip and Back exam: Got hip and back issues too? They're likely related. Your pelvic floor is the initiator of core stability and when it's not working well, the whole core system starts to fall apart.

• Pelvic Exam: You need an assessment, not a guess as to what your pelvic floor is doing. The best way to do that is to both visualize the muscle working and to feel what the muscles are doing. Rest assured, it is far less invasive then a gynecological exam. There are no speculums, no stirrups, just one gloved finger that assesses the function and mobility of the musculature. In this exam we are also able to assess for prolapse, or falling of the organs. This should be explained and demonstrated in order to gain your consent prior to the exam.

With any of these, any information is enough information. At any point, you can stop the exam and it will have given us a baseline of information to start with.

"The pelvic floor doesn't work in isolation. It's role in the human body is vast and any physical or occupational therapist that treats you for pelvic floor conditions should be looking at you as an entire person: from the physical to the emotional."

Whole Body Approach

As our profession has evolved, the biggest change to physical therapy as a whole, but especially pelvic floor physical therapy, is the emphasis on whole body approach. The pelvic floor doesn't work in isolation. It's role in the human body is vast and any physical or occupational therapist that treats you for pelvic floor conditions should be looking at you as an entire person: from the physical to the emotional. It all plays a part in getting and KEEPING you better.

Are you looking for a pelvic floor therapist either in person in the Dallas-Fort Worth area or virtually in Texas? Click here to contact our clinic to get more information. Connect with us

Looking for more information on pelvic floor therapy? Click here or read more about pelvic floor issues on our other blog post: Untangling the Knots: What are the Symptoms of a Tight Pelvic Floor?