What IS Pelvic Physical Therapy and Why Doesn’t EVERYONE Know About It?

True story –

During graduate school (Northwestern shout out) for physical therapy over 15 years ago, I distinctly remember turning to a friend in class and stating emphatically,

“Mark my words, I will NEVER EVER do what the therapist is doing in that video. NEVER. Why are we even seeing this in class?”.

You may wonder what happened in that video that lead to my bold statement. Why was I so shocked at the time? Well, that was essentially my first exposure to learning about pelvic physical therapy. 

[The video demonstrated an internal rectal coccyx (tailbone) technique]. I had no idea there were highly skilled specialists who performed internal vaginal and rectal musculoskeletal evaluations and treatments for women and men.  I didn’t know at that time that the scope was even larger than that. And I certainly didn’t know I would end up spending my career focusing in this area and embracing it with such enthusiasm. After a wonderful clinical internship in women’s health and the professional influence of great mentors (thank you!), it was clear that this was the right path for me; and the need for this type of therapy was very evident. I tell my patients about the video story sometimes and we laugh about ‘never say never’, right!?

TERMS FOR THIS FIELD THAT ARE ALL RELATED:

PELVIC PHYSICAL THERAPY

PELVIC  OR WOMEN’S PHYSIOTHERAPY

WOMEN’S HEALTH PHYSICAL THERAPY  OR WOMEN’S HEALTH PT

PELVIC FLOOR PHYSICAL THERAPY

PELVIC PT

PELVIC REHAB

UROGYNECOLOGIC PHYSICAL THERAPY

PEDIATRIC PELVIC PT, WOMEN’S PELVIC PT, MEN’S PELVIC PT

PELVIC FLOOR BIOFEEDBACK THERAPY (but oh, so much more than that)

Here I stand today (because sitting for too long can be bad), stating without hesitation, that this type of specialized work, is very rewarding, challenging, and vitally important to people all over the world.  Pelvic physical therapists are musculoskeletal experts in the areas associated with the pelvis (sacrum, sacroiliac joints, coccyx), including vulvar and vaginal, penile and scrotum, colorectal regions. Most importantly, as physical therapists, we are trained to assess the musculoskeletal system and body as a whole as well (not just small bits and parts). We can still treat necks, shoulders, knees, etc., but some of us have such a high volume of patients needing pelvic health care that we focus in this area exclusively (and still treat the person as a WHOLE).  It is also common for pelvic physical therapists to take post-graduate advanced classes to study GI, reproductive/sexual, orthopedic, neurologic and dermatologic “systems” (and more) to understand the complexity of how this all impacts an individual’s function and movement. We are interested in how systems operate together. Many of us are lucky to work with a network of specialized physicians, midwives, sex therapists and educators, fitness professionals and others in associated fields.

A patient once told me (and we hear this type of thing often):

“Having endometriosis, painful intercourse, and constipation at the same time is tough. I feel crazy having to go to so many doctors for each thing  – GYN, GI, and Colorectal.  This is the first time I’ve been to someone who’s looked at all of these issues in a bigger picture at the same time, connecting the dots, and coordinating care with these doctors”

Depending on the type of physical therapy practice, the assessments styles and environments can vary. There are some fantastic therapists who focus on orthopedics and sports and do assessments without touching the pelvic floor internally; or some who focus on chronic pain conditions;  while others focus heavily on assessing the pelvic floor muscles and associated areas in private treatment rooms first and then transition to daily functional activities or athletic moves later. There are lots of options. The exciting part is that we can offer hope with conservative treatment! You may see us in private clinics, outpatient hospital facilities, nursing homes, gyms, and other settings.

Here’s a sampling of the types of conditions we treat (from my clinical website) The list shows some conditions for women and men and we also treat pediatric bowel and bladder issues:

pelvic PT conditions

Sample of some of the conditions treated by Pelvic PT. From http://www.sherpelvic.com

Here’s a great 3D video by biodigitalhuman.com and anatomyzone.com about the pelvic floor anatomy and bony landmarks. We love this stuff! “The BioDigital Human Platform simplifies complex health concepts through the power of visualization. Our platform reveals anatomy, health conditions, and treatments in interactive 3D, demystifying what goes on below the skin through friendly visuals” Anatomyzone.com has a fantastic female reproductive tutorial (and male) on their website.

Want to see more about pelvic anatomy?

Best Articles on Pelvic Physical Therapy. All in One Place!Thanks to My Wonderful Colleagues for These Contributions!

Great article by my colleagues, Sarah Talley and Emily Wegmann at Carolina Pelvic Health Center, Inc.: You Do WHAT? 

Elle Magazine explains treatment for pelvic pain:  Let WHO Put WHAT WHERE? Finding a cure for pelvic pain

Pelvic Guru blog post by Jessica Powley Reale:  Misconceptions of Pelvic Physical Therapy

Excellent Article by colleagues, Stephanie Prendergast and Liz Rummer, at Pelvic Health and Rehabilitation Center What’s the Patient’s Role During Pelvic PT?

Beyond Kegels: When Do Gynecologic Problems Call for Physical Therapy?

The French Government Wants to Tone My Vagina

Even Oprah’s talking about it: Physical Therapy for Your Lady Parts.

Pelvic Physical Therapy for Men with Pelvic Pain – 2 Case Studies, APTA

Another great one by Pelvic Health and Rehabilitation Center: The Role of the PT in Treating PN (Pudendal Neuralgia)

Here are some great articles about how physical therapy can help with urinary leakage during workouts: 

Side note: If a doctor’s office has an employee doing pelvic floor biofeedback (and/or electrical stimulation) as the ONLY treatment to every patient, regardless of the condition  (painful intercourse, urinary leakage, bladder pain), you may not be getting the full spectrum of care.
 

Where Does a Licensced Physical Therapist (Masters/Doctorate level) Go For Specialized Pelvic PT Training?

When physical therapy graduate students ask me how to get into this specialized area of work, I direct them to two main educational tracks of postgraduate study (and there are other organizations and groups to discover):

Pelvic Guru! We offer live courses and online courses coming soon!

American Physical Therapy Association – Section on Women’s Health

Herman and Wallace Pelvic Rehabilitation Institute

Find a Pelvic Health Professional – Physicians, PTs, Nurses, Sexuality Experts

Why Doesn’t Everyone Know What Pelvic Physical Therapy is and How Can We Change This!?

To Physicians, PAs, Nurses, Fitness Professionals – please consider referring your patients and clients to a licensed physical therapist who understands this specialty field and can complement your care.

To Physical Therapists and patients, please share this with friends, family, and your healthcare providers so that there’s awareness of this conservative type of care.

Here’s a directory of pelvic health professionals.

You can also follow the #pelvicmafia hashtag on Twitter- many great pelvic health specialists sharing information and research.

primal image

primal image

**If I missed anything, please let me know! 

  Tracy Sher, MPT, CSCS  Private Practice Owner in Orlando, FL; International Speaker/Faculty. Passionate about treating pelvic pain and all pelvic floor disorders – bowel, bladder, sexual function. Secretly hoping to be a circus clown or rock, paper, scissors champion some day. Connect with Tracy on LinkedinCheck out Pelvic Guru on Facebook or Twitter @pelvicguru1

24 Comments

  1. Debra Goldman December 28, 2013 at 12:43 pm - Reply

    Tracey, what a wonderful gift! Putting this all together, so succinctly and fun to read. It’s as if you read my mind, thinking about new marketing ideas for the new year.
    I would like to add and recommend the coursework taught by the Barral Institute. I have just completed Level 3 of Peripheral Nerve Manipulation and it has added so much to my manual therapy skills and the outcomes of my patients. It is especially amazing for all of the nerves of the pelvis. Plus, they keep their underwear on!!
    Happy New Year to my favorite Pelvic Guru and all the wonderful therapists I have been meeting at conferences in the past few years.

    • Pelvic Guru December 28, 2013 at 12:49 pm - Reply

      Debra! Thanks so much for your feedback and recommendation! The next step with this article is to add a PDF handout that we can fax or take to physicians’ offices…right?

      Do you have to take Levels 1 and 2 through Barral to take the Peripheral Nerve Course?

      • Debra Goldman December 29, 2013 at 10:11 am - Reply

        You do have to start with Level 1 but then I went to 3 because it was in my area, NYC. I plan on completing 2 another time. The Barral Institute has West Palm, Fl as their US base- so easy for you! Lol
        To be able to palpate the pudendal, obturator, inguinal, femoral nerves ( among others!) in such a gentle and effective manner is among the best work I have ever learned. I am getting really good results with my pain patients, even a very stubborn post-op pudendal surgery . I also am learning the Visceral work which I started with Ramona and Gail.

      • Debra Goldman December 29, 2013 at 10:14 am - Reply

        Also-yes to a PDF. That would be awesome!
        Tracy? Why does the reply face icon look sad and confused??

      • Pelvic Guru December 29, 2013 at 1:07 pm - Reply

        Thanks for the info, Debra. We actually some gentle “dermoneurmodulation” (a Diane Jacob’s term) and indirect mfr strategies in the Pudendal Neuralgia course Loretta and I teach. It would be interesting to see how these relate. http://hermanwallace.com/continuing-education-courses/pudendal-neuralgia-assessment-and-treatment

        Want to join us in Boston in March? 😉

        I’m not sure why the faces sometimes look grumpy or silly – it’s random. 🙂

  2. Evelyn Hecht, PT, ATC December 29, 2013 at 12:29 pm - Reply

    Tracey,
    Thank you for your enthusiasm in promoting our amazing speciality of pelvic physical therapy! To underliine the importance of our detailed assessment and “not one treatment fits all”, my practice, EMH Physical Therapy in NYC, recently had three patients present with the same complaint of urinary stress incontinence.
    The first patients’ symptom was due to traditional pelvic muscle weakness, the second was due to muscle/fascial adhesions of the hip adductor and levator ani and the third was due to the uterus literally sitting on top of the bladder.
    The first patient received strengthening of pelvic/core, bladder retraining and manual and biofeedback for up-training; the second patient received down training and manual therapy to release and lengthen her tight myofascia and the third patient required visceral mobilization techniques to reposition the uterus off the bladder and to release abdominal adhesions.
    As a Pelvic PT since18 years, I see a huge boom in in the last 3 years, as more patients spread the word and research is proving our efficiency in healing pelvic floor dysfunction.
    I applaud you and all of our colleagues for their passion and committment!
    Evelyn

    • Pelvic Guru December 29, 2013 at 1:10 pm - Reply

      Evelyn – thank you very much for sharing the point that we are doing extensive evaluations and this is not cookie-cutter treatment. We use evidence-based medicine to guide our treatment plans (which is very different than a Cosmo article on Kegels, right!?). I’m sure you’ve made a difference to so many lives in the past 18 years.
      I appreciate your support and valuable input.
      Regards,
      Tracy

  3. tahawur khan December 30, 2013 at 3:56 am - Reply

    hello Tracy. congrats…best article &efforts elaborated by you, ever never,i come across. thanks Dr. Tahawur Khan(Physiatrist)

  4. michellespicka January 2, 2014 at 12:48 pm - Reply

    I said the EXACT same thing in PT school and here I am, 13 years later, seeing only “pelvic” patients! Excellent work and keep up the awesome blog posts. I have referred so many patients to your site for the best information! Thanks again and Happy New Year!

    • Pelvic Guru January 2, 2014 at 5:54 pm - Reply

      Michelle! I bet many of us said the same thing! Thanks for all YOU do…and thanks for sending your patients this way. More good stuff to come in the future. Tracy

  5. Excellent Bodywork January 2, 2014 at 9:13 pm - Reply

    This is an awesome collection of information. Thank you

    • Pelvic Guru January 2, 2014 at 9:22 pm - Reply

      Thanks so much for your feedback. That was the goal and I’m glad it worked! Stay tuned for more…

  6. […] Good first stop:  The Pelvic Guru Explains What PPT Is […]

  7. […] you should see a pelvic floor physiotherapist asap! This is a bit more about what they are and do: https://pelvicguru.com/2013/12/28/what-is-pelvic-physical-therapy-and-why-doesnt-everyone-know-about-…  If you have any pain in your pelvic floor (vulva, vagina, perineum, anus) you should see a pelvic […]

  8. Carl February 11, 2014 at 2:34 pm - Reply

    Fascinating information. Thank you from a happy patient of Her Health Physical Therapy in Columbia, MD. They helped me to regain normal voiding patterns and continance following extensive back surgery recuperation.

    • Carla February 11, 2014 at 2:35 pm - Reply

      Carla that is

    • Pelvic Guru April 25, 2014 at 1:01 am - Reply

      Thanks so much for your comment! So glad you had a great response!

  9. […]  https://pelvicguru.com/2013/12/28/what-is-pelvic-physical-therapy-and-why-doesnt-everyone-know-abou… […]

  10. […] example: A 59 year-old male, traveling from out of state, presented to pelvic PT with the chief complaint of  “penis pain” he’s had for 14 years. He also said he […]

  11. […] In order to better understand how physical therapy can help someone with IC, we need to look a little deeper into why the muscles around the pelvis become tender in the first place. At my presentation last night, we spent some time discussing the muscles of the hips and abdomen as well as the pelvic floor muscles. If you aren’t familiar with these muscles already, you can take a quick course by reading Tracy Sher’s article here. […]

  12. […] do you know if you need pelvic floor physical therapy? Read this article about what pelvic floor physical therapy is and what it can do for […]

  13. […] What is pelvic physical therapy and why doesn’t everyone know about it? Tracy Sher, MPT, CSCS […]

  14. mlrkbd March 13, 2016 at 11:44 am - Reply

    1982 grad from Columbia University NY
    ‘you wont need to know anything about THAT area. flash card of pelvic floor. Thats all!

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