Pelvic physical therapy is something that is unfamiliar to many people. I would say for about every 10 new patients that come to see us here Legacy Physical Therapy, about 7 or 8 of them start out their evaluation by saying that they have never heard of Pelvic Physical Therapy and they are not sure how we can help them.
We are passionate about helping women & men of all ages enjoy active, healthy lifestyles, by restoring confidence and dignity in pelvic, bladder, bowel, and sexual function, without relying on medications or surgery. We provide conservative treatment options for many conditions that people may be unaware that they even can do anything about.
Conditions Pelvic Physical Therapy Can Help
- Bladder Issues:
- Leakage, Urgency, Frequency, Painful Urination, Urinary Retention
- Bowel Issues:
- Constipation, Fecal Leakage
- Pain Conditions:
- Back Pain, Pelvic Pain, Tailbone Pain, Sacroiliac Joint Pain, Vaginal Pain, Rectal Pain, Vulvar Pain, Abdominal Pain, Penile Pain, Painful Sex
- Pelvic Prolapse Issue:
- Cystocele, Rectocele, Uterine Prolapse, Vaginal Vault Prolapse
- Pregnancy/Postpartum Related Issues:
- Low Back Pain, Sciatica, Diastasis Recti, Clogged Milk Duct, Episiotomy or C-section Scar Tissue Adhesions
Many people are surprised to learn that all of the above conditions can be helped by pelvic physical therapy. One of the things that we commonly see happen is that a patient will be referred to us by their urologist for bladder issues. Then once we get talking with them, we find out that they also have some back pain or hip pain issues that despite treatment aren’t going away. We teach the patient how all everything can be related.
Aren’t You Just Going to Teach Me to Kegel?
One of the things that we get asked all the time is, “I’m already doing Kegel exercises. It doesn’t help, why would coming to pelvic physical therapy help?” For those of you who don’t know a Kegel exercise is simply a contraction of the pelvic floor muscles like you are trying to hold back gas or pee. Muscle function is not simply about contraction. We need to make sure that we have a variety of different movements with the muscles. Muscles need to be able to contract, relax, stretch, and coordinate with other muscles.
As pelvic physical therapists, our job is to figure out how your pelvic floor muscles are working and coordinating with other muscles. We really take the whole body approach to looking at how things are coordinating together. It is never simply just about Kegel exercises. Those may be a part of your treatment plan, but it may not be. For some people, the problem is that they are doing pelvic floor muscle contractions or Kegel exercises incorrectly and that is actually causing more of the problem. For other people their pelvic floor muscles may be too tense or tight and trying to squeeze them more isn’t going to improve their symptoms. Instead, we need to actually teach them to relax and let go.
Pelvic PT Can Help Before or After Surgery
Another thing we hear commonly when we talk with patients on the phone is that I’m planning them to having the surgery so why would I need to see pelvic physical therapy. Our simple answer to that is if you’re planning on having shoulder surgery, neck surgery, back surgery, or knee surgery; 9 times out of 10, you’re going see a physical therapist either before or after the surgery to help make sure that you rehabilitate the muscles and that everything is working well together. Similarly, working with the pelvic physical therapist after you’ve had surgery for a bladder sling, prolapse repair, hysterectomy, or giving birth can promote return to optimal muscle function allowing you to have better, longer lasting surgical outcomes.
Pelvic PT Helps During Pregnancy & Postpartum
Females who have given birth are at a greater risk for pelvic dysfunction. Here at Legacy Physical Therapy, we feel strongly that every women should see a pelvic physical therapist for at least for 1 visit postpartum to identify any musculoskeletal issues that may be preventing her from improving her core and pelvic function postpartum. This should happened before she starts out with any type of exercise regimen, especially a high level one, to make sure that the pelvic and abdominal muscles are functioning the way that they should be. The therapist will also review movement patterns to make so she doesn’t develop any bad habits that will potentially lead to problems down the road such as bladder leakage or pelvic prolapse.
Pelvic physical therapists also work with women during their pregnancy. We help make sure that the pregnancy progresses as comfortably as possible and that you are able to be as active as you want to be. Pregnancy is a time that can be very stressful on the abdominals and pelvic floor because of the changes in your body. Working with the pelvic physical therapist to help you maximize pelvic and abdominal support and control can really make a big difference for a comfortable pregnancy.
You May Need Need to Advocate for Yourself
So now that you have learn a little more about what pelvic physical therapy is, you may be wondering why you haven’t heard of it before or why your doctor has not told you about it despite you mentioning some of the symptoms. Unfortunately, many doctors are unaware that pelvic physical therapy is an option out there to help their patients. Even the ones who do refer to pelvic physical therapy already may not be aware of all of the different thing that we can be doing to help patients. Because of this, you may have to be an advocate for yourself if you feel like you need to see a pelvic physical therapist. Don’t be afraid to ask your doctor for a referral to pelvic physical therapy.
If you feel like you’re dealing with any of these issues that we’ve been talking about, you may have to be the one to advocate for pelvic PT. You as a consumer, have the right to go wherever you want to go for your treatment. You do not have to necessary to go only to a place that is in your doctor’s office. You can seek healthcare from a pelvic physical therapist with whom you feel comfortable.
So, that is the brief introduction to pelvic physical therapy. If anything you have read about seems like something you are dealing with, give us a call at 636-225-3649. We are happy to chat with you about what you are experiencing to see if pelvic physical therapy would be a good option for you.
Fibromyalgia is a clinical condition of unknown etiology characterized by chronic generalized body pain associated with fatigue and psychological distress. It typically presents in young to middle aged women and can result in sleep disturbance and significant impairment in activities of daily living.
While medical therapy for fibromyalgia exists and may to a limited extent be beneficial in managing pain, physical therapy plays a major role in treatment and rehabilitation. The aim of physical therapy is aimed at deconditioning and muscle weakness. There are different modalities of physical therapy aimed at treating different aspects of fibromyalgia.
1. Cadiovascular Fitness Training
Patients suffering from fibromyalgia are generally inactive and often become physically inactive over time. Exercise has shown benefits in long term management of fibromyalgia, with studies even showing an improvement in pain. In recent years, exercise remains one of the most commonly recommended treatments.
Exercises are ideally low impact and could include Tai Chi, water exercise, and Qi Gong. Water based exercises seem to offer a small degree of advantage over exercises performed on land, but sometimes are not as convenient to perform. Based on patient function prior to initiating therapy, exercise programs can be tailored to the patient specifically.
2. Physical Therapy
Treatment is aimed at increasing overall muscle strength, and is aimed at reducing muscle weakness. Common advice and treatment may include:
- Avoid muscle overloading- ie lifting heavy weights
- Correcting body alignment
- Muscle conditioning and stretching
- Encouraging general activity
3. Muscle Massage
While this provides both psychological and physical relief to some extent, there is no strong evidence that it is useful as an individual treatment modality; rather it is better used in combination with other therapies.
Randomized controlled trials have shown that acupuncture can provide significant improvement in pain reduction and a reduced perception of pain. However its long term benefits have not been adequately studied, and there is no clear guidance on how often treatment should be administered. It may be more beneficial as an adjunct therapy.
5. Transcutaneous Electrical Nerve Stimulation (TENS)
TENS is an electrical based pain reliever. It is more useful for localized pain, and hence its use for fibromyalgia may be limited. However it is an easy therapy that the patient can self administer at home.
Exercise and physical therapy are mainstay treatment options for fibromyalgia. Treatment options need to be tailored to the individual. With optimal therapy, patients can experience a significant improvement in symptoms.
BONE HEALTH FOR ALL AGES:
Why does bone health matter?
Healthy bones can help you stay strong and active throughout your life. If good bone health is achieved during childhood and maintained, it can help to avoid bone loss and fracture later in life. For bones to be healthy, it is important to maintain physical activity with a healthy, balanced diet full of calcium, vitamin D, and other supplements as needed.
So what is a physical therapist’s role in bone health?
Physical Therapists are experts in the movement system. They can help patients achieve peak mobility and strength, all while keeping your individualized care in mind. The advanced knowledge of PTs is especially important for patients who already have compromised bone health or risk for fracture like: osteoporosis, female athlete triad, fad dieters, obesity, post-menopause age, long-term steroid therapy, cigarette smoking, high alcohol intake. This is not a complete list! Based on information HERE: Fracture Risk Factors!
What is osteoporosis and what does it have to do with physical therapy?
Osteoporosis is a common bone disease that affects both men and women (mostly women), usually as they age. It is associated with low bone mass and increased fragility of bones, making them more susceptible to breakage. This is typically diagnosed by a physician with a bone mineral density scan, taking into account blood levels of vitamin D, calcium, and history of prior fracture. For more information about osteoporosis in general look at: National Osteoporosis Foundation!
Physical therapists are the ideal providers to create an exercise program for those individuals who have osteoporosis, osteopenia (low bone density, but not quite osteoporosis), or those who have risk factors for fracture or falling. PTs are trained, as part of their 3 year doctoral program, to understand postural alignment, movement, gait analysis, balance, and the importance of weight bearing exercise to increase bone density and prevent injury.
So what are weight-bearing exercises and how can I do them?
First off, noone who is at risk for falls, fracture, or who has a known medical condition should start an exercise program without the consultation of a physical therapist or physician first!
Second, weight-bearing exercise includes anything the stresses the bones through their long axis. This includes:
- Walking (best results for strengthening the femoral neck, thereby decreasing risk for hip fracture)
- Yoga (Controversial: may provide whole body weight-bearing, however, can increase risk of lumbar bending which can increase compression fractures; Additionally, fall risk should be assessed before performing higher level balance exercises.) Read more here: Yoga, vertebral fractures, etc.
- Dancing (Those dancing with the stars celebrities are protecting their bone density!)
- Tai Chi (TONS of benefits, see effects on bone density HERE)
So, isn’t this just for “older” people?
NO! Starting healthy habits sooner ensures more compliance later. It is much more difficult to start an exercise program after diseases or injuries have already occurred, so better sooner than later! Additionally, your peak bone mass is about 18 in women and 20 in men…. so START NOW!
For fun activities for your loved ones who are younger check out: Best Bones FOREVER!
What does posture have to do with it?
Obviously, as a physical therapist, I am biased about good posture. However, I know how hard it is to make this a habit. The reason it is so important is that proper posture can prevent injury, pain, falls, and FRACTURE. This is critical for those high risk people! Here are some tips:
- Remember the plumb line: Keep ears in line with shoulders in line with hips in line with ankles. See PLUMB LINE!
- Use pillows when sitting or lying to support yourself in a good position.
- Bend your knees and keep your back relatively straight while you lift things. Always keep loads close to your body.
- Maintain regular fitness as staying active can prevent injuries.
Remember: By 2020, over 50% of Americans are expected to have osteoporosis. Let’s try to keep that number lower and reduce fracture risk in the future!
If you feel you are at risk or you already have osteoporosis, call us today at Legacy Physical Therapy to set up an appointment to see how physical therapy can help. 636-225-3649
Karla Wente, PT, DPT, CLT
Legacy Physical Therapy
Clinical Resident in Women’s Health Physical Therapy at Washington University in St. Louis
Did you know that there are physical therapists who focus especially on female issues? In fact, there are physical therapists here in St. Louis who are Board Certified in Women’s Health Physical Therapy (WCS).
There are multiple times in a woman’s life in which physical therapy may be appropriate. We will talk about 2 important time periods in this article: 1) during pregnancy, and 2) postpartum
Physical therapy can be a wonderful adjunct care provider during pregnancy to help with common pain complaints such as:
- Low back pain
- Sacroiliac joint dysfunction
- Carpal tunnel syndrome
- Pelvic and pubic pain
- Foot pain
- Incontinence (bladder leakage)
- Round ligament pain
Physical therapy treatment during pregnancy may include:
- Posture education to avoid injury and decrease pain
- Manual therapy to restore alignment and improve soft tissue guarding
- Therapeutic exercises for improving muscle performance and posture
- Abdominal and pelvic floor training
- Fitting for various support belts to help with stability and pain
If you are like many pregnant women, you may have concern about what exercises are appropriate during pregnancy. A physical therapist is a great resource for instruction on the do’s and don’ts of exercise during pregnancy.
The stresses of pregnancy, vaginal deliveries, and C-sections may lead to myofascial complications following the birth of the baby. Many women suffer in silence because they feel their symptoms are “Normal” after they have a baby. Fortunately, many of these symptoms can be easily treated by a physical therapist specializing in postpartum care.
Common Postpartum Complaints include:
- Low back and lower extremity pain
- Upper back and neck pain associated with breastfeeding
- Upper extremity pain or numbness associated with child care
- Diastasis recti: Separation of the abdominal muscles which commonly occurs during healthy pregnancies.
- Pain with intercourse or orgasm
- Clitoral, vaginal, rectal, pubic, or tailbone pain
- Pain and decreased mobility at scar of C-Section, episiotomy, or perineal tear
- Pelvic floor weakness
- Urinary or fecal incontinence
- Urgency and frequency
- Pelvic pain
How Physical Therapy Can Help:
- Soft tissue mobilization, myofascial release, deep tissue massage
- Therapeutic exercise for improving abdominal and pelvic floor muscle performance
- Posture, lifting techniques and biomechanics
- Home exercise program
- Abdominal binder/brace fitting
- Scar massage
- Therapeutic ultrasound to breakup clogged milk ducts
- Modalities for pain control
- Instruction in return to exercise safely
- Instruction in proper lifting/carrying of baby, stroller walking, and other activities of daily living to avoid injury
Pregnancy, childbirth and childcare are all events that result in significant physical changes and new stresses on a woman’s body. Women’s Health Physical Therapists are specifically trained to meet the special needs of women during this time of their lives and beyond.
Call us today at 636-225-3649 to set up your FREE SCREENING to see if physical therapy is right for you.
The American Physical Therapy Association (APTA) and fellow members of the Therapy Cap Coalition, a group of almost 50 associations, organizations, patient and consumer groups, are working together to make sure Congress addresses the Medicare therapy cap before December 31, 2013.
APTA representatives have been a constant presence on Capitol Hill all year long, advocating for a permanent repeal of the Medicare therapy cap, but it’s crucial that legislators hear from their constituents. Thus, the Therapy Cap Coalition has created several coordinated grassroots opportunities to maximize impact.
Already, the coalition raised awareness with a 24-hour social media and e-mail effort on November 3, 60 days ahead of the expiration of the therapy cap exceptions process. But your help is still needed!
Take Action TODAY!!!
Use e-mail and social media to flood Congress with messages on December 2, 30 days ahead of the expiration of the therapy cap exceptions process.
Ask your legislators to permanently fix the therapy cap or at the very least extend the exceptions process by December 31, 2013.
Download the APTA Action app (members and nonmembers). Search “APTA Action” in the Apple or Google Play app stores to download the app, then select the “Action Center” button to e-mail your legislators.
Urge at least one friend or family member to use the Patient Action Center to send a prewritten e-mail to their legislators.
We at Legacy Physical Therapy know how beneficial physical therapy can be for our patients. We do not want the therapy cap to limit patient’s ability to receive quality care here. Please take a minute to contact your legislator today!!
Legacy Physical Therapy is excited to once again be partnering with Washington University Program in Physical Therapy for their Women’s Health Physical Therapy Residency. Karla Wente PT, DPT, CLT is the new Women’s Health Physical Therapy resident. She will be at Legacy Physical Therapy treating patients on Tuesdays and Fridays. We are very happy to have her with us this next year.
Karla is a physical therapist with a strong desire to treating men and women with pelvic and abdominal dysfunction, as well as lymphedema, fibromyalgia, and osteoporosis. She received her Doctor of Physical Therapy from Washington University in St. Louis in 2013, and is currently the Clinical Resident in Women’s Health at Washington University in St. Louis for the 2013-2014 year. Karla received the prestigious Beatrice Schulz award for outstanding performance in clinical education in May 2013.
Karla is an active member in the APTA and the Section on Women’s Health. She has pursued coursework in treating pelvic floor dysfunction through Herman and Wallace Rehabilitation Institute, in treating the pregnant patient via coursework through the Section on Women’s Health, as well as in evaluating and treating patients with lymphedema through the Klose Training and Consulting Lymphedema Therapy Certification Courses.
At the end of her clinical residency, Karla will sit for the APTA specialist certified board exam to become a women’s clinical specialist (WCS). She hopes to serve women and men with these special conditions throughout the lifespan. Additionally, she hopes to pursue teaching to promote the specialty profession to future therapists.
Bladder control issues are not a normal part of aging and they are definitely not something that you just have to live with!!!! Take this short quiz courtesy of the American Urogynecologic Society to find out if it is time for you to do something to take back control of your bladder.
YES NO Are you using the bathroom so often it disrupts your day?
YES NO Do you find yourself making a mental note of where all the bathrooms are when you enter a building?
YES NO Do you find it hard to make it to the bathroom, maybe even having accidents sometimes?
YES NO Are you using pads or other forms of protection to absorb bladder leakage?
YES NO Are you worried that you will leak with sneezing, coughing, lifting heavy objects, laughing, exercising?
YES NO Have tampons become too uncomfortable to use or do they fall out?
YES NO Are you experiencing pressure or bulging in your vagina, especially after you stand for long periods of time?
YES NO Has your urine stream become weak or turned into spray?
If you answered YES to one or more of these questions, consider talking to your physician about your symptoms and available treatment options. To learn more about physical therapy as a treatment option for bladder control issues visit the Legacy Physical Therapy website or call us at 636-225-3649 to set up your free screening appointment.
What can Physical Therapy do for you?
Do you know who your physical therapist is? When asked, people can usually name their doctor, dentist, podiatrist, or OBGYN, but they may be hard-pressed to name their physical therapist. We want to take this opportunity to educate you on how physical therapy can be an important part of your healthcare team and why you should get to know your physical therapist!
- Recovery from a sports injury
- Balance problems
- Pregnancy- related pains
- Common aches and pains of muscles and joints
- Urinary/fecal incontinence
- Spine problems
- Recovery from a stroke, brain injury, or spinal cord injury
- Pediatric developmental issues
- Running and overuse injuries
- Cardiopulmonary problems
- Work related injuries/ Work station ergonomics
- Post surgical recovery
- Pre & Post Mastectomy Issues
You are the most important member of your own health care team, and you are entitled to choose the most appropriate health care professional to meet your goals. The role of a physical therapists is to improve and restore motion to your life. As you make the important decisions about health care for you or your family, it is important to remember that physical therapists:
- Significantly improve mobility to perform daily activities;
- Provide an alternative to painful and expensive surgery, in many cases;
- Manage or eliminate pain without medication and its side effects, in many cases.
When it comes to health care, one size does not fit all. A physical therapist’s extensive education, clinical expertise, and “hands on” approach brings you a unique, individualized approach. When you are in the hands of a physical therapist, you have a plan of care that is safe and appropriate and addresses your individual needs and pre-existing conditions.
Freedom of Choice
You have the freedom to choose your own physical therapist. Most states allow you to go directly to a physical therapist without getting a physician’s referral first. In Missouri a physical therapist can evaluate you without a physician referral, but a referral is necessary for treatment. Keep in mind that your insurance policy may require a visit to the primary care physician first or may limit your access to preferred providers only so it is best to check with your insurance plan ahead of time.
You physician may make recommendations of where to go for physical therapy, but you as the consumer HAVE THE RIGHT TO CHOOSE WHERE YOU GO. You are not obligated to receive physical therapy in any specific facility and you want to find one that best fits your needs.
How to Choose a Physical Therapist
Make sure that you receive physical therapy from a licensed physical therapist. Physical therapists are professional health care providers who are licensed by the state in which they practice. When choosing a physical therapist you want to ask if the clinicians specialize in working with your specific condition. Not all physical therapists work with all types of conditions For example, if you were seeking treatment for your urinary incontinence it would be important to ask if the facility had therapists that specialize in pelvic rehabilitation or bladder problems.
Ask the physical therapist’s clinic if it participates with your insurance company. Receiving care from a participating physical therapist should minimize your financial responsibility. There may be good reasons, however, to see a physical therapist who does not participate with your insurance plan. If you need a physical therapist who has special skills related to your particular condition-or if the location or other aspects of the care or the facility meet your needs-this may be a good choice for you.
Ask whether the physical therapist’s clinic will submit claims on your behalf to your insurance company. Some policies require copayments for services, and the amount of the copayment will depend on whether the physical therapist is part of the insurer’s provider network. You also will have to meet your deductible. Your physical therapist’s clinic should be able to help you calculate an estimate of your financial responsibilities.
Your first visit should include an evaluation by the physical therapist. Your physical therapist will perform an examination to identify current and potential problems. Based on the results of the examination, and considering your specific goals, your physical therapist will design a plan of care to include specific interventions and will propose a timetable to achieve these goals and optimize your movement and function. Your physical therapist will likely provide you with instructions to perform exercises at home to facilitate your recovery.
You should feel comfortable asking your physical therapist any questions regarding your course of care, including specifics regarding interventions and expectations. You physical therapist should be a partner in your healthcare goals!
We at Legacy Physical Therapy look forward to a chance to partner with you in your healthcare. Call us any time to schedule your FREE screening/consultation to see if physical therapy is right for you! 636-225-3649
Back in May, I posted about my own personal fitness challenge for National Women’s Health week. It is now almost 2 months later and I realized that I have not updated anyone on my status. If you remember I signed up for the Rock ‘n Roll St. Louis half marathon on October 23rd.
These past 5 weeks I have been trying to keep up with a training schedule for a 5K race, so that when it comes time to start the training for the half marathon at the beginning of August, I am in decent enough shape to do so. In this training program I am supposed to be running at least 3 days a week. I have to say that I am not succeeding at this too well. I am lucky if I get in 2 times per week.
It took me until now to make the connection, but now it is pretty obvious to me that my poor running and update frequency are linked! From now on I am going to use this link to help hold me accountable. Starting today, I will post weekly what I did in my training program, as well as give updates on how the running and attempt at weight loss are going. What better way to be held accountable than to openly post about your progress and get your friends and supporters involved. SO HERE GOES…
WEEK 5 Training
2 2.5 mile runs completed, both on the treadmill, which is not my favorite at all. I still have to do a run/walk combination, but that is getting better.
WEEK 5 Body Stats
Weight: 230 lbs Height 6’2″
Biceps 15″ Bust 44″ Waist 41″ Hip 48″ Thigh 29″
I am not going to post body stats every week, but I wanted to get these measurements down and out there so that I knew there was no turning back.
I hope you will join me in your own personal fitness challenge and we can motivate each other together!!