What is Pelvic Health Physiotherapy?
Pelvic floor or pelvic health physiotherapy is an orthopedic “specialization” a licensed Physiotherapist can pursue after extensive post-graduate training. Its focus is on the proper functioning of the structures within and of the pelvic basin, including bladder, bowel, sexual and reproductive systems from a structural, biomechanical and pain perspective for both men and women.
Dysfunctions of these systems can include but are not limited to urinary or fecal frequency, urgency, and or incontinence, pelvic organ prolapse, pelvic pain including coccyx, symphysis pubic, or SIJ pain, pain with sexual arousal, intercourse or climax, abdomino-pelvic surgical scarring and pain, painful periods, chronic constipation and more. Newer to this realm of care is the ability to successfully treat mechanical fertility challenges in women.
While these dysfunctions are related to the pelvis and its local structures, contributions to and root causes of can come from any part of the body, often from a few contributing places. It takes a well trained therapist to be able to determine when, where and how to intervene to ensure successful rehabilitation for the individual in front of them. For this reason, a myriad of treatment techniques are used in a protocol-free, individualized approach and treatments are typically not the same from one session to the next.
Why see a Women’s & Pelvic Health Physiotherapist?
- Able to treat more directly and specifically: As a Pelvic Health Physiotherapist (PH PT) we not only have extensive training in musculoskeletal and abdominal/ pelvic conditions, but we also have special designation and training to perform treatment internally (both vaginally and rectally); whereas many other professions do not. In this way, we are able to more directly and specifically treat influencing structures allowing for faster recovery and success of care.
- Pelvic structures can contribute to persistent complaints: More and more health practitioners are finding that the pelvis and its structures can be a major contributing factor to common chronic musculoskeletal conditions (especially when recovery does not progress as expected or plateaus). Through its many direct and indirect connections, the pelvic floor and its surrounding structures can contribute to lumbopelvic pain, lumbosacral or lower limb neural tension/ irritation, headaches/ migraines, upper quadrant dysfunction and more; even if asymptomatic of bladder, bowel or sexual dysfunction.
- Integration of movement to enhance and empower: Not just manual therapists, PH PT’s are trained in assessing the complexity of movements throughout the body, as well as how all these moving parts are influencing one another. Through this biomechanical lens coupled with knowledge of disease and rehabilitative movements, we are able to provide guidance and instruction on how you can help yourself to retrain your system toward improved health, empowering you in your recovery.
- True core function and rehabilitation is our keystone: As part of our focused training in women’s and pelvic health, we integrate true core function and rehabilitation into all aspects of our care. More than just kegels and planks, many factors need to be assessed, triaged and optimized including: alignment, biomechanics, control, breath, reflexive patterns, pressure dynamics, mobility, and more; and then related to whole body tasks, movements and daily functions. Whether it’s for prevention, preparation for pregnancy, recovering from injury or body changes (including pregnancy), or years of poor body habits a Pelvic Health Physiotherapist can help.
What to Expect
Your first visit will be an hour in length and gives us the time to discuss your unique health picture (history, current complaints and goals), clinically assess your current movement, functional and structural restrictions, determine a working diagnosis, discuss findings and treatment options, as well as provide some hands on treatment and get you set up with a home program. An internal assessment of the pelvis will be completed at this time to determine more specifically how these structures may be contributing to your concerns.
Follow-up visits are typically 30 or 45 minutes depending on the complexity of your care and recommended treatment plan (all of which will be discussed at your first appointment based on findings). These treatments will focus on providing you with hands on therapy, education, ideas on integrating new concepts into daily life, instruction on movement and exercise, as well as reviewing and progressing your home program.
If at any point (during your assessment or any time during a pelvic health treatment) you no longer consent to treatment, that is fine. Please just let our Physiotherapist Andrea know and you can discuss alternative options. It is also your right to bring someone in to any assessment or treatment, should you so desire.
Our Physiotherapist Andrea follows the most current infection control and hygiene protocols outlined by The College of Physiotherapist of Ontario for all aspects of your care, especially with respect to internal pelvic assessment/treatment. Non-latex gloves are used, as well as organic water-based and oil-based lubricants. If you have any allergies please let her know.
Treatment Techniques Used
As each person is unique in their movement and health profile, a cohesive blend of treatment techniques are utilized in a protocol-free, functional and individualized approach.
Education: Empowering you with the knowledge of what is going on in your body is the first step towards making positive change. Andrea believes in helping you to become an expert in your own body, identifying more easily its cues and providing you with the information and tools you need to achieve your goals. She explains the anatomy and physiology of what she is finding, what she is doing and why, and how it will assist in your recovery. If ever you have questions please do not hesitate to ask.
Gentle Joint Mobilization: Working gently with the articular (joint) system of the skeleton assists in restoring optimal alignment, movement, and control to the body, helping to reduce muscular imbalances, nerve irritations, and pain. No fast or aggressive force is ever used and the technique is very specific.
Myofascial Release: The myofascia (“myo-fa-sha”) is the three dimensional muscular and fascial/ connective tissue system of the body that surrounds, infiltrates, and connects every tissue, organ, and cell of your body from head to toe and skin to spine. It’s function is to provide support and structure to the body as well as work as a bracing mechanism from injuries. Release of these tissues will facilitate increased flow of blood, lymph, neural and hormonal messages, as well as freer movement of the tissues themselves and the bones and joints they connect to. Pressure can range from gentle to deep depending on the restriction and structures being targeted.
Cranio-Sacral Therapy: Cranio-sacral therapy (CST) works with the skull, spine and sacrum, as well as the neural and endocrine systems within in a very gentle and subtle way. Through identifying and releasing restrictions in these systems (composed of neural, fascial, articular, and vascular tissues) the body’s physiology can rebalance, freeing the very important central and autonomic nervous systems to function unencumbered. CST is integral for cases of infertility caused by hormone dysregulation.
Visceral Manipulation: Just like muscles, joints and nerves, our internal organs and their surrounding structures can get stiff or stuck, reducing mobility, function and affecting their neighbours and other systems. Applying this gentle manual therapy directly to the affected organs optimizes not only their mobility, but also their biochemistry and function through optimizing their environment.
Breath, Mindfulness, and Movement: Breath is our life force, connecting body and mind, providing oxygen to our cells, and altering our perceptions and stress response. Using breath with awareness (or mindfulness) alone has been shown to improve mental-emotional health, as well as physical health and longevity. Add with that tailored movement to enhance treatment, empowering you in your health and you have an amazing self care toolbox with which to make big positive change.
Pelvic Health Physiotherapy For Fertility: How It Can Help You
As women, we have the amazing and divine ability to create, grow and birth human life. As you know many factors contribute to this including hormones, reproductive cells, systemic health, environmental factors, medical history, lifestyle, and stress. Becoming a little more well known are how structural or mechanical factors of and around the reproductive organs and neuroendocrine system can also influence a woman’s innate gift – this is where Pelvic Health Physiotherapy can help!
The Reproductive System: Structural issues such as uterine or ovarian cysts or fibroids, endometriosis, abdomino-pelvic visceral &/or myofascial adhesions from traumatic, inflammatory or surgical sources, and fallopian tube occlusion can all challenge a woman’s fertility. By reducing these structures’ movement, circulation and waste removal capacity the local environment can become non-optimal for conception or carrying to term.
The Nervous System & Hormone Balancing: The main driver of our body’s fertility hormones and part of our stress response is the hypothalamic-pituitary gonadotropic (HPG) axis. The hypothalamus is part of our primitive brain that connects our nervous system to our endocrine (hormone) system via the pituitary and then to the adrenal glands and ovaries. Additionally, the thyroid gland is intricately connected to the pituitary and thus also plays a role in fertility. Any dysfunction in alignment, mobility, blood flow, and lymphatic drainage of these glands and their encapsulating structures (i.e. cranium, spine, neural/ dural tube, and abdominal musculature and fascia) can negatively influence the neuroendocrine system, possibly resulting in hormone imbalances and fertility challenges.
Treatment & Hope: Traditionally focusing on bladder, bowel and sexual health, Pelvic Health Physiotherapy has more recently started to assist in the successful care and treatment of reproductive health, including mechanical infertility in women.
Through specific manual therapy performed directly on the reproductive organs (uterus, ovaries, and surrounding/ connecting structures), female infertility has shown to be reversed by 39-61% in cases such as occluded fallopian tubes (1, 2), endometriosis, hormone dysregulation, premature ovarian failure and polycystic ovarian syndrome (1). Studies have yet to be done looking at how similar manual therapies performed on structures of the neuroendocrine system may further assist in these successes. However, it is theorized that they too can only optimize the body’s innate ability to reestablish balance and flow, especially in the case of infertility.
A cohesive blend of treatment techniques including gentle joint mobilization, craniosacral therapy, myofascial release, visceral manipulation, and mindfulness including Yoga and other therapeutic exercises, are utilized in a protocol-free, functional and individualized approach to optimize the function and mobility of these structures – ideally assisting to reverse female infertility.
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