Pelvic PT Session

Part 2 of 2: What is a good pelvic PT session like?

In Pelvic Floor Physical Therapy by Emily Tran1 Comment

Last week, in Part 1 of What is a good pelvic PT session like,  we described what a pelvic floor physical  therapy evaluation consists of and how we go about developing an assessment and setting goals to help our patients get better. This week we dive deeper into pelvic floor physical therapy treatment plans, patient education, and ongoing treatment sessions.

Treatment Plan

A typical treatment plan includes physical therapy one to two times per week. Based on the severity and chronicity of the problem, the duration of each patient’s plan varies from one to several months. Each plan is designed and tailored to that person’s specific needs. The treatment plan almost always includes patient education (LOTS!), manual therapy, neuromuscular re-education, manual biofeedback, and a home exercise program.

It is important to us that we provide key education and exercises/homework to do after the initial evaluation. The patient’s role in this process is just as important, if not more important,  than the physical therapist’s role. Therefore, the patient is also a key member of the team.

Patient Education

Most people have little knowledge about “normal” pelvic floor function. Whether our patient is a new mom, a gentleman with stress incontinence and erectile dysfunction after prostatectomy, or someone with pelvic pain, everyone needs education and guidance. We are often able to neutralize fear, eliminate misconceptions and start to address patient concerns day one. The education process continues on a weekly basis. We aim to improve function on a weekly basis, this occurs through changing beliefs and thoughts and normalizing impairments.

It is important to us that we give a sound explanation and are able to justify all of our treatments in physical therapy. The patient deserves to understand what we are doing and why to progress towards healing. Oftentimes, patients are left confused and full of questions after doctor appointments. They may understand the treatment plan but, most of the time, they are not given the why. For our treatments to work, the patient has to understand why something is important to focus and work on. This will speed up the time of their recovery and overall produce better results.

If your physical therapist or doctor is not giving you the why explanation, do not be afraid to ask. You will be that much more committed to the treatment if you understand why it is important. Plus it allows the provider to confirm they fully understand your symptoms and are recommending the best possible treatment. If you do not understand an explanation, again, do not hesitate to ask for clarification. Otherwise, the provider may think that you understand and that a review in the future is not necessary.

A Typical Treatment Session

Each treatment session is typically one hour just like the evaluation. The first treatment after the evaluation often begins with answering any questions the patient may have after the initial encounter. Every treatment session begins discussing symptoms they have experienced over the last week, new exercises or habits they are working on, and changes they have noted (whether for better or for worse) since the initial evaluation.

The PT will often ask specific questions about their symptoms. For example, if the person has pain with urination, we will ask detailed questions about the nature of the pain, intensity, how long it lasted and if the treatment or exercise provided relief. The answers to these questions help us decide what to tackle during each session.

A typical treatment may include manual therapy techniques such as connective tissue manipulation, trigger point release externally, trigger point release internally, neural mobilizations, joint mobilizations, and neuromuscular re-education. We focus on the muscles of the pelvic girdle and pelvic floor; however, we incorporate daily postures, movements, breathing patterns, and behaviors. For instance, if a patient has constipation, we will spend time teaching them why bowel movements are difficult for them, how we will help address the impairments,  and what they can do to at home to help. Some people will need more help with neuromuscular control and some people may benefit more from manual therapy. Generally speaking, manual therapy is often part of a treatment session for people with pelvic pain whereas coordination and strengthening may be more involved in post-operative rehabilitation or for people with low-tone pelvic floor disorders. However, “hybrid” situations do exist and are treated accordingly.

The treatments we provide in each session are customized to the individual and their needs. Based on your response to the initial questioning, we focus on the areas that we believe are the biggest factors in your limitations. This means that one treatment may incorporate more manual therapy while the next treatment may be focused on re-training your habits, postures, and movements. Typically, each treatment session requires some internal manual therapy or manual biofeedback since these conditions almost always produce some form of pelvic floor dysfunction and this is the best way to understand how your pelvic floor muscles are working.

Near the end of each appointment, we review what the patient is working on at home, why these are the areas of focus, and we may add new exercises or changes to their home program. As previously mentioned, the patient is a key player in the road to recovery so the things they do at home are just as important as the time they spend in the clinic.
To learn more about our approach please visit our website: www.pelvicpainrehab.com
Liz and Stephanie’s book, Pelvic Pain Explained, covers all the topics in this blog in much more detail. If you have not read it you can pick up a copy from Amazon today!

So, now that we’ve given you a rundown of what we believe is a good pelvic PT session, we’d love if you’d share your experiences with us and our readers. Did we miss anything that you have found helpful or useful? We’d love to hear from you!

Please either leave any questions or comments you might have in the comment box or on our Facebook page.

If you’d like to leave an anonymous comment, just don’t fill in your name or email address and it will be posted as “anonymous”.

FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.

Comments

  1. Hi Katie, I was under the excellent care of Shannon from the Lexington office. I found the sessions to be very helpful in correcting a nerve impingement which resulted in incontinence and prostate and bladder problems. I was also seeing a urologist but I feel that Shannon’s work made profound advances in my recovery. The session atmosphere was relaxed, informative, and above all results orientated. I am very pleased that I decided to seek out pelvic floor Pt.

Leave a Comment