Pelvic Physical Therapy

Physical therapy is a treatment strategy that focuses on improving physical function. Many people do physical therapy to help recover from an injury, manage a chronic pain condition, or improve function that has been limited by a health condition. The physical therapist (PT) works with each patient to develop an individualized treatment program, set specific goals, and determine which techniques will be most effective for improving ability to move and function with limitations. Physical therapists treat patients across the age span and often specialize in a specific condition or area of the body.

Individualized treatment plans often include education about the specific condition, and how it relates to daily function. A treatment plan typically includes specific exercises within each therapy session and exercise to perform at home. Hands-on techniques, referred to as Manual Therapy, may also be included during treatment sessions to accelerate the success of the exercise programs. In some cases, adding complementary therapies such as ultrasound, electrical stimulation, hot or cold packs, may add additional benefit or help manage symptom exacerbations.

Pelvic physical therapy is performed by PTs who have specialized training in conditions that affect the pelvis and surrounding structures. Pelvic PT is often used to help manage conditions like pelvic myofascial pain, vulvodynia, sexual pain, interstitial cystitis/bladder pain syndrome, urinary urgency and incontinence, constipation and irritable bowel syndrome, chronic low back pain and SI joint pain.

Pelvic PT often involves:

• Addressing orthopedic issues

  • Posture

  • Correcting your spine and/or pelvic alignment

• Improve spine/hip mobility and flexibility

• Gentle manual releases to improve mobility of fascia and organs where you are restricted and normalize pelvic floor muscle tone

• Modalities such as ultrasound, cupping, low level laser therapy may be used to break up adhesions, provide myofascial traction/stretch and reduce pain, inflammation

• Individualized home program

Your PT will ask about your specific symptoms, pain triggers and current management strategies. They may perform as assessment of your musculoskeletal system (e.g., joints, bones, muscles), neurological system (e.g., reflexes, coordination, balance), and your cardiopulmonary function (e.g., heart, lungs, circulation). Testing for these areas can be as simple as answering a question, walking on a treadmill, or touching your toes. Gentle manipulation of a muscle or joint to better assess the primary limitation may also be necessary.

Treatment sessions last between 30–60 minutes depending on the location and the issues being addressed. Generally, PTs will recommend treatment sessions at least once per week, but the frequency of sessions may change as you make progress. A course of pelvic PT usually takes at least 8-12 weeks.

Physical therapy sessions should occur in a comfortable, private location. The best way to assess the tone and function of pelvic floor muscles is typically through the vagina. Your pelvic PT will ask if you are comfortable with an internal pelvic exam, during which they will place a finger in the vagina in order to access the pelvic floor muscles. While this is typically considered to be the optimal approach to perform manual release of the pelvic floor muscles, you should be open with your PT if you feel uncomfortable with an internal exam. Some people opt to focus initially on external areas, such as back, hips, and SI joints, and move to internal or vaginal areas as they become more comfortable with the process. Your PT may be able to suggest some tools, such as curved vaginal wands, that can allow you to perform manual release yourself, typically after a brief introduction on the specific location or muscle group to target, amount of pressure, and massage technique. Some people initially feel a little hesitant or uncomfortable with the idea of internal or vaginal therapy. However, most people report that this was much more comfortable than they initially anticipated. A large proportion of patients report that pelvic PT was the single most helpful treatment they have used for pelvic pain symptoms, so try to stick with it!

Your PT will provide an individualized home program based on their examination findings. It is so important to play an active role in your PT by performing your home program and provide feedback to your PT on how it is or is not working so it can be adjusted. Your home program is key to your success! Progress in physical therapy takes time (usually 8-12 weeks). You might feel general muscle soreness like you started a new exercise program initially but symptoms should not be more than mild. If you are experiencing more intense pain, talk to your PT so they can adjust your treatment.

Some people benefit from use of medications such as muscle relaxants in addition to physical therapy. This can be particularly helpful during the early weeks of a PT course when the initial increase in muscle soreness often occurs. You should talk to your health care provider to discuss whether these may a good option for you. See Muscle Relaxants for more.

Some people only need to do a single 8-12 week course of physical therapy, whereas other people may need an extended course. Some people need to do a refresher course or another full course of PT at some point, as it is common to have recurrent symptoms with chronic conditions such as pelvic myofascial pain, vulvodynia, interstitial cystitis/bladder pain syndrome, or irritable bowel syndrome.

If you do not have an adequate improvement with a course of physical therapy, you may want to discuss whether additional treatments, such as trigger point injections or botox injections into the muscles, may help you make more progress with physical therapy. See Trigger Point Injections for more.

Pelvic Health and Rehabilitation Center

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Beyond Basics Physical Therapy

The following national websites can be used to locate a pelvic floor PT near you.

• www.aptapelvichealth.org
• www.hermanwallace.com
• www.pelvicguru.com