Accessing Hard to Reach Places: Biofeedback for the Pelvic Floor Muscles

Accessing Hard to Reach Places: Biofeedback for the Pelvic Floor Muscles

One of the most common things I hear from clients as a pelvic health physical therapist is “I had no idea I had muscles down there!” If you have been keeping up with our blog, you will already know that the pelvis is full of muscles and other tissues that helps us with our daily functioning. And, better yet, you can control the muscles of the pelvic floor just like you can control any other muscle group. However, sometimes people need help in being able to establish awareness and control in the pelvic floor muscles. Because these muscles are located inside the pelvis, we call upon a special tool called ‘biofeedback’ to help bring awareness to these muscles.

In short, biofeedback is a tool that provides information on what’s going on inside the body in order to help someone facilitate a change in their behavior to positively affect the tissue or bodily function being measured. Biofeedback for muscles is specifically the measurement of how much muscle is firing either during a contraction or a resting period (ie, is the muscle on or off?). One thing Biofeedback is not: a measure of muscle strength. The pelvic floor muscles are a unique set of muscles because they are located inside the pelvis. Biofeedback is helpful in order to access these muscles, usually with the use of a biofeedback machine. This small handheld device is connected to wires that are connected to the patient either by external electrodes placed on the skin of perineum or by an internal sensor placed into the vaginal or rectal canal. These electrodes and sensors then pick up the activity (or lack thereof) within the pelvic floor muscles, both when the patient is at rest as well as when the patient is cued by the therapist to engage or relax their muscles. The information is read by the handheld unit so the patient can see the activity of the muscle and then be able to change their muscular activation as needed. Biofeedback units range from being small, handheld devices all the way to very expensive computer systems. No matter the size or cost of the unit, generally speaking, biofeedback can be used for both strengthening weak pelvic floor muscles (referred to as ‘up training’) as well as training painful, tight, and overactive pelvic floor muscles to relax (called ‘down training’).

While the use of technology is helpful for biofeedback, especially when it allows patients to use home units between PT sessions, there’s another type of biofeedback that is considered the gold standard approach: the therapist! The physical therapist is an excellent resource to help a patient gather information about her body to help facilitate a positive change in muscle behavior. Pelvic health PTs are specialized in using their own palpation and manual therapy techniques (ie, their hands) combined with their clinical expertise (ie, their verbal cues and patient education) during internal pelvic floor muscle assessments in order to guide patients into proper muscle contractions and/or muscular relaxation. As we all know, computers (this includes biofeedback units) are not fool proof. They, too, can sometimes facilitate altered muscle habits that are less than ideal. This is why seeing a pelvic health PT to specifically get to know your own pelvic floor muscles is important in order to access those hard to reach places. Getting in touch with your own pelvic floor muscles with the help of a pelvic health PT will eventually translate into reduced pelvic floor dysfunction during daily life, keeping you pain free and leak free when you need it the most.


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Covid-19 Notice

3/27/2020 Covid-19 Notice:

On March 19th, we made the difficult, yet important decision to close both clinics, in order to do our part to flatten the curve. We will reopen the clinics part time on Monday, April 6th, with an emphasis on telemedicine. This will allow us to comply as much as possible with the governor's Stay Home Stay Healthy order if it is extended, while also meeting our obligation as essential infrastructure workers. According to Dr. Matos, an expert in biological surety and the management of select agent programs at federal facilities: "Physical therapists are essential in flattening the curve of the Covid-19 pandemic. They play a key role in keeping people they can help out of doctors' offices and ER's. This will not only free up the medical teams to treat those impacted by Covid-19, but also limit the exposure of those seeking the care of the physical therapist." To that end, we will focus on telemedicine, but also allow for select, necessary in-office treatments for low risk, healthy individuals. This will be a joint determination between you and your PT. Many, if not all of our patients, have come to appreciate the effectiveness and efficiency of the hands-on manual therapy techniques our physical therapists use to help relieve pain and improve function. So, we recognize that a telemedicine visit may not seem as appealing. At this time, telemedicine is the appropriate and safe way to continue your care without further interruption and your physical therapists are prepared to alter their approach in order to still provide effective care.

During our temporary closure, your physical therapists have been on unemployment and not able to contribute to our communities financially as they normally would like to. Getting back to work, providing your care will allow us to resume caring for you and our community. For every telemedicine visit we provide in April, the clinic will donate $5 to the following organizations:

Kelsea Cannon, PT- Westside Baby
Lauren Esmailka, PT- Treehouse
Elizabeth Rogers, PT- Rainier Valley Food Bank

We remain passionate about helping you improve and maintain the function of your movement system so that you can do the activities you love. I remain available for urgent (i.e. post-op care, acute injury, treatment needed to decrease/avoid use of NSAIDs and Opiods) in-clinic treatment and telemedicine treatment from now until April 6th. We invite you to follow/Like our  Facebook page, where I am offering complimentary weekly Pilates mat class on Wednesdays at 7am and foam roller class on Fridays at 7am. All are welcome to participate in these classes or view them anytime on our Facebook page.

Please contact me directly with any questions or concerns. If you are a current patient, you should have received an email from me with scheduling/rescheduling info. Be in touch with your PT to schedule your telemedicine visit. I am available via clinic phone (206-535-7356) and email ( We will update you here and our Facebook page as things change.

We are counting the days until we get to resume our work together both virtually and in the clinic! Thank you for your support of this small, locally-owned physical therapy private practice!

Elizabeth Rogers, PT

Owner, Elizabeth Rogers Pilates & Physical Therapy, PLLC

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