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. 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, 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: Here’s a great 3D video by 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? If you would like access to the Pelvic Guru anatomy images, look into becoming a Global Pelvic Health Alliance Member!

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

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? 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 is a great article about how physical therapy can help with urinary leakage during workouts: 

•  ‘Curing a Case of the Workout Pees’

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 Licensed 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 Global Academy! We offer live courses and online courses coming soon! American Physical Therapy Association: Academy of Pelvic Physical Therapy 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. **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 someday. Connect with Tracy on Linkedin. Check out Pelvic Guru on Facebook or Twitter @pelvicguru1 If you are interested in more pelvic health education, please see our online platform, Pelvic Guru Academy for some amazing courses.