Pelvic Floor Physical Therapy

I often get asked the question “what made you become a pelvic physical therapist?” aka “why do you want to stick your finger in holes as part of your job?” I get it. Even my parents give me a look when I describe my typical day at work. But that’s not how I look at what I do. Being a physical therapist, I am considered an expert of the musculoskeletal system. That includes the muscles, bones and ligaments of the human body. The pelvic floor, being a series of muscles, is part of the musculoskeletal system. Therefore, I think the question that should be asked is “why isn’t internal pelvic floor assessment and treatment part of the standard education of a physical therapist?”

I noticed this gap in my education in early 2017. I had many patients that were peri-menopausal with chronic low back, hip, and/or sacroiliac pain. All of them were mothers. Their pain had decreased since I started seeing them but at since reached a plateau and I didn’t have the tools to get them over it. I started to think about what I was missing. It’s common knowledge that proper core function is essential to low back, hip and sacroiliac joint health. Whats not commonly acknowledged is that the pelvic floor is the bottom of the core. I had been focusing on abdominal strength for these women but what if that wasn’t the epicenter of their core dysfunction? I started asking them questions to screen for pelvic floor dysfunction…do you leak a little pee when you cough or sneeze? do you have pain with penetration? do you feel pelvic heaviness or pressure? do you wake up at night to pee? to you feel like you have to pee all the time?…100% of them answered yes to at least one (if not all) of these questions. It was my ah-ha moment. I feel bad I didn’t have it sooner.

Coincidence or not, I became pregnant around that the same time so knowledge of the pelvic floor was also in my best interest. Just as I became amazed that pelvic PT is not part of PT school, I became acutely aware of how perinatal care surrounding our pelvic health is practically non-existent. When I returned to work after my maternity leave, I came back not only as a pelvic physical therapist, but also as an educator and an advocate for pelvic floor health. I am happy to say I am not alone in this and that the topic of the pelvic floor is starting to be talked about more but we have a long way to go before pelvic floor health is part of standard quality care.

Because the need for pelvic physical therapy is so high, it is really common for an orthopedic physical therapist to end up only treating the holes once they are trained to do so. I have promised myself, and my clients, that I will not fall into this trap. Just as its a form of neglect to not treat the pelvic floor, its also negligent to treat only the pelvic floor. As I mentioned before, the pelvic floor is the bottom of the core and its proper function depends on its coordination with the abdominals and diaphragm to stabilize the spine in addition to maintaining continence, sexual functions and pressure management. While I separate orthopedic and pelvic physical therapy for marketing purposes, I do not treat this way. I treat the human body, the entire musculoskeletal system, holes included. I believe this approach is absolutely essential to being effective at eliminating pain and improving function of all parts permanently.

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