Pelvic Floor Dysfunction and Physical Therapy

June 12, 2008 by Jane O'Brien  
Filed under Physical Therapy, Women's Health

North Tahoe Physical Therapy June 11, 2008

The term pelvic floor refers to the sling of muscles, ligaments, and fascia which spans from the front of the pelvis at the pubic bone to the posterior pelvis at the tail bone. The purpose of the musculature is to support the pelvic organs (uterus, colon, and bladder), allow for control of the outlets (urethra and rectum) and provide tone for sensation for the sexual functions. It is important for this area to have proper muscle tone. Excess tone of the muscles can cause difficulty sitting, pain during intercourse, hip and low back pain or retention. Diminished tone may lead to incontinence, organ prolapse and possibly decreased sexual response.
Commonly, people associate pelvic floor dysfunction with incontinence. However, there are a myriad of diagnoses that fall under this category such as overactive bladder, pelvic pain, prolapsed uterus, painful periods (dysmenorrhea), interstitial cystitis, coccyx pain, painful intercourse, and many others. Symptoms may limit a man or woman’s ability to perform daily activities, cause a change in exercise habits and create embarrassment. Problems in this area are often not discussed with medical professionals and therefore, go untreated.

Many physical therapists have specialized training that can benefit men and women with issues of the pelvic floor. These therapists utilize every aspect of their physical therapy training to evaluate patients and to provide intervention to overcome these dysfunctions. Treatments may consist of a combination of many techniques. Exercises such as “Kegels,” which are geared for this area, greatly enhance muscle function when performed properly. Relaxation techniques may be utilized to assist with decreasing tone and pain. Manual techniques, such as Myofascial Release and soft tissue massage are often used to relieve tension. Biofeedback is used to increase awareness of proper muscle recruitment or to quiet overactive muscles. Electrical stimulation may be used to recruit and train pelvic floor musculature or to relieve pain. Joint mobilizations are often utilized to restore pelvic alignment and motion. In addition, patient education can assist with prevention of dysfunction.

Physical therapy for the pelvic floor dysfunction is relatively new and not widely known by many medical professionals in the USA. There are only a handful of Physical Therapists who are trained in Pelvic Floor therapy in Northern Nevada. But, Pelvic Floor Dysfunction is common. Just consider the number of commercials from the pharmaceutical industry promoting drugs aimed at treatment of these issues. Numerous surgeries are advocated as an answer for many pelvic floor issues. Many are unsuccessful. Physical Therapy can provide tremendous relief for Healthcare consumers who want to take control of their symptoms and overcome them without the use of longterm drugs or surgeries.

When choosing a physical therapist for treatment of a pelvic floor dysfunction, it is important to inquire of their training, experience and outcomes with this area to ascertain if they are qualified to treat this area. The Section on Women’s Health of the American Physical Therapy Association offers training and mentoring leading to a certificate program called the Certificate of Achievement in Pelvic Physical Therapy (CAPP). Approximately 150 PT’s have received the CAPP to date. To find a Physical Therapist who is trained to work with Pelvic Floor Dysfunction, one can contact the Section on Women’s Health of the American Physical Therapy Association. The web site is http://www.womenshealthapta.org/. The website provides articles and resources for consumers to learn more. One can also log onto www.northtahoept.com for further information and treatment options.
Jane O’Brien, MSPT is a physical therapist at North Tahoe Physical Therapy who provides services for the pelvic floor, orthopedics and pain. She is a candidate for the CAPP expecting to complete her certificate in summer 2008.

-Jane O’Brien, MSPT

Stay Physical, With Therapy

May 23, 2008 by admin  
Filed under Physical Therapy

Ask five people what physical therapy is and I’ll bet you a Spring Pass you get five different answers. The beauty is that physical therapy is very different depending on what the individual requires to optimize health and quality of life. A good therapist customizes treatment to reach a patient’s goals and improve quality of life. This means that the process should be very different for a competitive skier and a deconditioned elder, even if both have knee injuries. Physical therapists are trained to identify limitations or dysfunction on many levels and problem solve in a way that best serves the patient.

Many don’t realize that for those entering the field today, a Master’s of Science or Clinical Doctorate (DPT) is necessary to qualify for the licensing exam. In addition, the American Physical Therapy Association is advocating for all educational programs to be DPT accreditated by 2020, generally 6-7 years of college education. All this training is geared toward evaluation and treatment sensitive to each individual’s needs. This includes integration of a variety of body systems affecting one’s health. Musculoskeletal, neurological, cardiovascular, respiratory, integumentary, digestive/urinary, and emotional health are all part of this assessment process.

The advantage to this background is that a physical therapist can gear treatment toward the larger picture of health. An injured shoulder is not a separate entity, but a piece of the puzzle affecting daily activity, mental health, recreation, occupation, and social life. It is most therapists’ intention to see this spectrum and work toward improvement through treatment, lifestyle changes, patient education, and home exercise. For the patient with pain, the treatment approach should include identifying the problem, working toward relief, and then preventing future pain. The injured athlete may need guidance in pacing his/her progression for optimal recovery. The client with neurological dysfunction and balance deficits should be instructed on home environment modifications to prevent falls. These are very different situations with different needs. Also, taken into account are individual characteristics. Factors including fear, attitude, motivation and bodily awareness must be recognized. Responsibility also lies on the therapist to educate the patient so they understand their body and can help prevent future impairments. To work with the patient and understand this broad approach will create the best outcomes.

What many don’t realize is that one doesn’t have to be suffering to benefit from therapy. Wellness promotion can be the sole purpose with prevention of future ailments being the primary goal. For someone that has had a heart attack and isn’t quite sure just how to improve their fitness, physical therapy can be a great place to start. For the office worker with slight aches and pains, education in ergonomics and stretching to prevent carpul tunnel or thoracic outlet syndrome may be indicated. Unfortunately, our society has valued reaction instead of prevention in healthcare for much too long. Most problems are more successfully treated early in their course than later when dysfunction has escalated and negatively impacted physical activity or movement patterns.
Furthermore, every patient has the right to choose the physical therapist they utilize. As with any profession, some people work well together and some don’t.

Communication is the key to successful treatment to ensure that both understand the plan of care and how the patient is reacting physically and emotionally. Specialists in physical therapy may also better serve you. Training and expertise in many fields are part of physical therapy and can be overlooked. Physical therapists who are specialists in Women’s Health, pediatrics and geriatrics, wheelchair evaluation, orthotics and brace fitting, Myofascial Release, and other manual therapies can help manage specific problems or pain. This can supplement or prevent a need for medication or more invasive medical options. If it’s important to you, a bit of research may give you other alternatives.

To those young people looking for direction and wondering what occupation to pursue, I encourage an investigation of the field of physical therapy. Options are numerous with this degree. Sports physical therapy or rehabilitation from athletic injury is often the only mental picture people get when they think of this field. In actuality, one can work in hospitals, schools, with animals, in education, in research, or as specialist, among other options. It’s an exciting time in our history to be involved with healthcare as technology changes, research diversifies, and health trends evolve. If working with a broad range of people and studying the human body and its condition interest you, physical therapy may be a good fit. With permission, shadowing a physical therapist for a day can be a good opportunity to learn more.

For more information, visit the APTA website, www.apta.org, or, contact a clinic with your questions. Be well and enjoy the day.

-Andrew Emery, PT at North Tahoe Physical Therapy

Pelvic Floor Dysfunction

May 20, 2008 by Jane O'Brien  
Filed under Women's Health

Commonly, people associate pelvic floor dysfunction (PFD) with incontinence. However, there are a myriad of diagnoses that fall under this category such as overactive bladder, pelvic pain, prolapsed uterus, interstitial cystitis, coccyx pain, painful intercourse, and many others. Symptoms may limit a woman’s ability to perform her daily activities, change or limit her exercise habits, and create embarrassment. Problems in this area are often not discussed with medical professionals, and therefore, go untreated.

Physical therapy can greatly benefit the pelvic floor. Exercises geared for this area greatly enhance muscle function. Relaxation techniques may be utilized to assist with decreasing tone and pain. Manual techniques, such as Myofascial Release and soft tissue massage are often used to relieve tension. Biofeedback is used to increase awareness of proper muscle recruitment or to quiet overactive muscles. Electrical simulation may be used to recruit and train pelvic floor musculature. In addition, patient education can assist with prevention of dysfunction.

When choosing a physical therapist for treatment of a pelvic floor dysfunction, it is important to ascertain if she is qualified to treat this area. Be sure she has taken coursework specifically for PFD. Ask her how many clients she has treated for your issue. Ask outcomes of treatments. Ask if she can help you gain relief of your symptoms and improve your lifestyle.

PFD is common, but not normal. You do not need to simply accept your symptoms as a process of growing old or due to childbirth. You can take control of your symptoms and often relieve them completely.

Jane O’Brien, MSPT works with clients ( male and female) who have Pelvic Floor Dysfunction at North Tahoe Physical Therapy.