If that’s part of your treatment protocol as determined by your therapist, she may use one finger to stretch and mobilize the pelvic floor muscles, explains Tadros. While it may seem like some patients would balk at this, “I find that patients are so desperate for help, they’re more than okay with having it done. We don’t use a speculum or stirrups. This isn’t invasive, it’s designed to keep someone as comfortable as possible,” she adds.
If you’re dealing with pelvic pain, Kotarinos recommends researching the International Pelvic Pain Society or the American Physical Therapy Association to find a qualified pelvic floor physical therapist. (You can also see your PCP for a referral.) Dr. Huang also suggests focusing on your health holistically, with things like stress management, regular exercise, and a well-balanced diet. “We want to educate and empower women to be in control,” she says.
Strengthening weak pelvic floor muscles often helps a person gain better bowel and bladder control. A physical therapist can help you be sure you are doing a Kegel correctly and prescribe a home program to meet your individual needs. Diet modifications can also reduce urinary and fecal incontinence. Bladder re-training can decrease urinary frequency and help you regain control of your bladder.
Some pelvic floor physical therapists may have the opportunity of getting a lot of time to speak one-on-one with a patient to determine possible causes of his or her symptoms, educate the patient and to guide them to other practitioners who may optimize their physical therapy results if necessary. We truly can find out so much by just listening to what our patients have to say. A fall, or infection can be significant as well as a patient’s feelings and knowledge about their current condition.
Joint mobilization is a common and favorite tool of most orthopedic physical therapists. We love it so much because it can have so many different benefits depending on the type of technique used. Maitland describes types of joint mobilization on a scale between 1 and 5. Grade 1 and 2 mobilizations are applied to a joint to help to lessen pain and spasm. These types of mobilizations are typically used when a patient is in a lot of pain and to help break the pain cycle. On a non-painful joint, grade 3, 4, and 5 (grade 5 requires post graduate training) mobilizations can be used to help restore full range of motion. By restoring full range of motion within a restricted joint, it is possible to lessen the burden on that and surrounding joints, thereby alleviating pain and improving function.
During the internal exam, your physical therapist will place a gloved finger into your vagina or rectum to assess the tone, strength, and irritability of your pelvic floor muscles and tissues. Internal exams and internal treatment are invaluable tools that are taught to pelvic floor physical therapists. It can tell us if there are trigger points (painful spots, with a referral pattern or local); muscle/tissue shortening; nerve irritation and/or bony malalignment that could be causing your pain directly or inhibiting the full function of your pelvic floor muscles. We can also determine if your pelvic floor has good coordination during the exam. A pelvic floor without good coordination, may not open and close appropriately for activities such as going to the bathroom, supporting our pelvis and trunk, sexual activity, and keeping us continent.
Myofascial release was developed by John Barnes to evaluate and treat the myo-fascia throughout the body. The myofascial system is the connective tissue that coats our muscles, nerves, blood vessels, and bones, and runs throughout our bodies. Any tightness or dysfunction in the myofascial system can affect the aforementioned structures and result in pain and or movement dysfunction. By treating the fascia directly, therapists can improve their patient’s range of motion, reduce pain, and improve a patient’s structure and movement patterns.
Tabletop splits: Tabletop splits engage your core, hips, inner thigh muscles, and pelvic floor. To do a tabletop split, lie down on your back in a comfortable position on the floor, and bring your knees up in the air, so your thighs are perpendicular to the ground. Slowly spread your knees until your legs are as far apart as they can comfortably go, then slowly bring your knees back together. Repeat 10–15 times, up to three times per day.