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.
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.
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!
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