Do I Need Pelvic Floor Physical Therapy?

Did You Know…

  • About 60% of women with bladder pain syndrome (Insterstitial Cystitis) also have chronic pelvic pain, while almost 
  • 50% percent of women with endometriosis suffer from chronic pelvic pain.
  • 70% of women with a previous diagnosis of endometriosis are diagnosed with chronic pelvic pain.
  • Women with a past medical history significant for pelvic trauma or surgery are at a much higher risk of developing chronic pelvic pain compared to the general population. 
  • 28% of women develop persistent pelvic pain following an elective cesarean delivery, three months postoperatively, while 20% of women continue to have persistent pain six months postoperatively.
  • Myofascial pelvic pain in women may be the underlying cause of chronic pelvic pain in 14% to 23% of cases and up to 78% of cases of interstitial cystitis.
  • Pain scores significantly improved proportional to the number of physical therapy visits completed, with 63% of patients reporting significant pain improvement, concluding that transvaginal physical therapy is an effective treatment for chronic pelvic pain resulting from myofascial pelvic pain. 

Pelvic Floor Dysfunction and Female Pelvic Pain

 Female pelvic pain generally refers to burning, itching, aching, or other types of pain in the vulva, vagina, perineum and/or anal area. These pain symptoms may be constant or intermittent. Symptoms can be provoked, such as with intercourse or tampon insertion, or unprovoked and spontaneous. Pain can be mild, moderate, or severe. 

Women with pelvic pain can also experience other symptoms such as:

  • Pain with intercourse
  • Hypersensitivity to underwear or other tight-fitting clothing
  • Pain with sitting
  • An exacerbation of pain with exercise
  • Urinary urgency, frequency, hesitancy, and leakage
  • Abdominal bloating and/or abdominal pain
  • Constipation
  • Low Back pain or Hip pain

Diagnoses associated with pelvic pain include:

  • Vestibulodynia
  • Vulvodynia
  • Vaginismus
  • Endometriosis
  • Interstitial Cystitis/Painful Bladder Syndrome
  • Pudendal Neuralgia
  • Irritable Bowel Syndrome
  • Lichens Sclerosis 

Women can develop pelvic pain for a number of reasons. Causes of pelvic pain include:

  • Pelvic floor muscle dysfunction
  • High stress and anxiety
  • Recurrent or chronic vaginal or urologic infections such as yeast infections or urinary tract infections 
  • Chronic gastrointestinal or dermatologic conditions 
  • Chronic Constipation
  • Prescription medications such as oral contraceptive medications, acne medications, or hormonal suppressive therapies commonly used for conditions such as Endometriosis or Polycystic Ovarian Syndrome
  • Surgical trauma such as a Cesarean section or hysterectomy
  • Orthopedic injuries or trauma
  • Biomechanical or structural dysfunction such as sacroiliac joint dysfunction, hip dysfunction, scoliosis, poor posture, abnormal foot mechanics
  • Vaginal childbirth
  • Menopause

Challenges to diagnosis and treatment 

Women face many challenges when it comes to diagnosing pelvic pain as well as receiving proper treatment. One of the reasons women are often misdiagnosed is that many of these symptoms mimic other pathologies such as a yeast infection, urinary tract infection, or sexually transmitted infections. Other times the symptoms may be mistaken for primary dysmenorrhea or menstrual pain. Many  medical providers are unaware that pelvic floor dysfunction can be the culprit for many symptoms of pelvic pain leading to misdiagnosis and delay of effective treatment.  

What is Pelvic Floor Physical Therapy and how it can help Pelvic Pain

Pelvic floor physical therapists specialize in the treatment of pelvic pain and other pelvic floor disorders. Pelvic floor physical therapy is often a vitally important component of the treatment plan for anyone experiencing pelvic pain. Women experiencing pelvic pain will almost certainly benefit from a pelvic floor physical therapy referral and evaluation. During the evaluation the physical therapist takes a comprehensive history to understand exactly how and when the symptoms began, the nature of the symptoms, the woman’s complete medical history, including previous diagnoses and treatments and the effectiveness of those treatments. During the physical examination the physical therapist evaluates the muscles, tissues, joints, nerves, and movement patterns. The pelvis should not be the only body part examined. A “whole body” approach should be taken; this includes an evaluation of spinal posture all the way down to foot ROM and strength. After the examination, the physical therapist reviews and explains their findings and develops a comprehensive treatment with collaboration by the patient. The treatment plan may last 6-12 weeks, potentially longer.  Additionally, the physical therapist gives the patient an evolving home exercise program to facilitate the in-person treatment. Importantly, the physical therapist coordinates their care with the other members of the treatment team to optimize quality of care. 

Do you think you need Pelvic Floor Physical Therapy and you are in the Birmingham, AL, area? Contact us to get more information!

How to Decrease Swollen Feet and Ankles During Pregnancy

Swollen feet are a common side effect during pregnancy and more than just an inconvenience when it comes to sizing up in a pair of shoes. Many women notice that their feet grow in length and width over the course of their pregnancy due to hormonal changes and excess fluid accumulation. The changes to your feet can cause your arches to flatten, putting increased strain on the muscles of your pelvic floor. 

During pregnancy, your growing belly causes shifts in your weight distribution and posture, which can flatten the feet and cause your pelvis to tilt differently. If your pelvis rotates too far forward or backward, it can cause decreased lumbar spine support, creating a cascade of other issues which can include pelvic floor dysfunction and core weakness. 

Fortunately,  just by giving your feet some regular attention you can decrease the severity of any swelling you may experience and ensure your feet are helping to balance your pelvis, rather than contribute to dysfunction.

Edema is another word for swelling. One reason you may experience swollen feet is due to water retention during pregnancy. Excess water helps ensure the efficient transfer of oxygen and nutrition to your baby. Why does swelling occur mostly in the feet and lower legs? Because we spend so much time with our feet on the ground, gravity tends to cause fluid to pool around the feet and ankles.

Perhaps opposite to what you might think, one of the easiest and most important ways to avoid fluid retention is to actually to stay hydrated. Drinking plenty of water helps improve lymphatic circulation, which flushes your body of toxins and keeps fluid from pooling. Caffeine and salt both cause dehydration and subsequently water retention, so limiting your intake of both is helpful when it comes to overall health.

Exercise is a powerful force when it comes to getting blood, oxygen, and lymphatic fluids moving. Walking is a great way to get exercise during pregnancy. As a general rule of thumb, you can perform most any exercise during pregnancy that you were performing prior to pregnancy. In general, try to avoid standing or sitting in one position for too long. If you have a desk job, try to get up at least every hour, stretch, and walk around a bit. 

Some other tips for avoiding swollen feet are: 

  • Put your feet up! Using a footstool at your desk, propping your feet up while you watch Netflix (or go down a scroll hole – no judgement!) and even using a little foot pillow for sleep can help with circulation. 
  • Wear knee high compression socks. Ankle compression socks will only push the fluid up to the lower leg. As a Certified Lymphedema Therapist, I recommend 20-30 mm hg compression socks for those with mild edema that recedes overnight. Be sure to measure your ankles and calves when they are at their smallest size and use the Brand’s sizing chart to pick which size will work best for you. Be sure to avoid folding over the top and smooth out any wrinkles when wearing them. Quality compression sock brands include Juzo, Jobst, Sigvaris, and Medi. 

Hydrating, exercising, and elevating your feet will not only reduce edema but also flush toxins, but it will also ensure lots of oxygen and nutrients are getting to your baby.

Do you need help managing your pregnancy symptoms? Contact us!

Magic City Physical Therapy
3075 John Hawkins Parkway, suite J
Hoover, AL 35244
Phone (205) 202-0874
Fax (205) 293-3895
www.magiccitypt.com
@magiccitypt (Instagram and Facebook)

The Pelvic Floor and the Foot Connection

Did you know that there is a strong relationship between your feet and the muscles of the pelvic floor? When addressing  pelvic floor dysfunction, including diagnoses like Pelvic Organ Prolapse or Incontinence, your Pelvic Floor Physical Therapist should be looking at other areas that could be contributing to the issue.

Healthy feet are the true foundation to a strong and healthy Pelvic Floor and Core and can contribute to improved body alignment and functional movement.

The truth is that everything in your body is connected, and dysfunction anywhere along the chain can create strain elsewhere in the body, impacting muscles, joints, and ligaments. For example, a hunched or slouched upper back posture can create abdominal and pelvic floor muscle shortening and dysfunction.

Whether you’re experiencing a mild, annoying pain in your pelvic floor or a major traumatic injury, the whole body needs to be evaluated to find the root of the problem. If you want a healthy, balanced, and stronger pelvic floor, follow these tips and give your feet and pelvic floor the attention they deserve. Just paying a bit more attention to the part of your body that connects you to the ground and carries you around on a daily basis can make a world of difference. 

Simply following these foot health tips can work wonders for your feet and body alignment. 

  • Walk barefoot as much as possible. This helps to strengthen the small intrinsic muscles of your feet.
  • Choose smart footwear (this is vital for your littles too). For example, wearing high heels or wedges on a regular basis can contribute to decreased Dorsiflexion range of motion at your ankle. The plantarflexed position of your ankle that high wedges and high heels cause will contribute to abnormal gait mechanics and can cause knee, hip, and low back pain.
  • Roll out the bottom of your feet regularly a tennis ball or frozen water bottle.
  • Regularly work on ankle/ foot/ toe mobility. See pictures below.
  • Stretch out your toes and help prevent bunions by wearing toe spacers on a regular basis. 
  • Work on strength and coordination of your toes by practicing toe curls and toe spreading.

All of these exercises will improve your sense of the connection between your feet and the ground, and your feet and different parts of your body, including your pelvic floor . A stronger connection may help you avoid falling back into old movement habits that aren’t helping you, and ultimately prevent collapsing into your inner foot arches, causing inflammation and possible damage to your tendons and dysfunction further up the chain.

All of these little tweaks to your posture and body awareness add up to fewer aches and pains during and  greater ease of movement. By making these adjustments and becoming more aware of your body alignment and movement functionality, you can repair the relationship between your feet and the rest of your body, and in doing so resolve any pelvic floor issues you may be experiencing. 

Give your feet some extra love today!

Do you need help improving your Pelvic Health and overall functional mobility? Contact us!

Magic City Physical Therapy
3075 John Hawkins Parkway, suite J
Hoover, AL 35244
Phone (205) 202-0874
Fax (205) 293-3895
www.magiccitypt.com
@magiccitypt (Instagram and Facebook)

What is a Pelvic Floor PT session like (follow up session)?

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 a few weeks to several months. Each plan is individualized to that person’s specific needs. The treatment plan almost always includes patient education (LOTS!), manual therapy, neuromuscular re-education, exercise and/or stretching, functional activities, manual biofeedback, and a home exercise program. You will be seen one-on-one by a Physical Therapist in our clinic. We will not use techs or students to substitute for a qualified PT. We will not juggle multiple patients at once and leave you to perform parts of your program on your own. 

It is important to us that we provide quality 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 young athlete, or someone with chronic pelvic pain, everyone needs education and guidance. We are often able to subdue fear and eradicate misconceptions to start to address patient concerns on the first day. The education process should be ongoing through every treatment session and home exercises, as well as clinic exercises, should be progressed. We aim to decrease symptoms and improve function on a weekly basis. 

It is important to us that we give a good 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. For our treatments to work, we want the patient to understand why something is important to focus and work on. This will speed up the time of their recovery and overall give 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 this may delay progress. 

A Typical Treatment Session

Each treatment session is typically one hour just like the evaluation. You should be with the same PT you saw at the initial visit (at any clinic you are attending!). 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 patient has pain with urination, the PT 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 how to proceed with that session.

A typical treatment may include manual therapy techniques such as connective tissue manipulation, trigger point release externally or internally, dry needling,  nerve glides or mobilizations, joint mobilizations or manipulations, and visceral mobilization. Generally speaking, greater 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 patient  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, most treatment sessions require 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 for the PT and the patient to understand how the pelvic floor muscles are working.

At the end of each appointment, we review what the patient is working on at home, why these are important, and we may add new exercises or make changes to their home program. As previously mentioned, the patient is an important player in the road to recovery so the things they do at home are equally as important as the time they spend in the clinic.

Are you ready to get started with Pelvic Floor Physical Therapy? Contact us!

Magic City Physical Therapy
3075 John Hawkins Parkway, suite J
Hoover, AL 35244
Phone (205) 202-0874
Fax (205) 293-3895
www.magiccitypt.com
@magiccitypt (Instagram and Facebook)