23 Dec The Commitment to Pelvic Health
Just like any other form of physical therapy, pelvic health rehabilitation requires the client to be committed to their care for their symptoms to improve. On the other hand, pelvic health rehab also requires the clinician to be committed to helping the client improve. Rehab is a two-way road that requires a unique partnership and trust between the patient and the provider. While pelvic health rehab can be much like any other form of rehab (after all, the pelvis is full of muscles, tendons, nerves, and fascia!), there are some characteristics about it that make this type of physical therapy different from other forms of PT.
One thing that makes pelvic health PT unique is the obvious: the muscles and tissue of interest are located inside the pelvis, making them inconveniently difficult to access. The primary mistake that can often be made by a physical therapist is the assumption that the patient knows and understands exactly what these muscles do and how they behave after simple verbal education and instruction (especially with regards to performing a pelvic floor muscle contraction). Unfortunately, this is an unfair assumption. Research suggests that simple verbal instruction is not the best approach for a patient to engage in a pelvic floor muscle (PFM) training program 1. As pelvic health PTs, it is our role to assist patients along the curvy path to discovering the full function of the pelvic floor muscles. It is often work that requires attention to detail, imagination, precision, teamwork, and most of all…patience.
In recent years, pelvic floor dysfunction is gaining increasing awareness in the public eye. Furthermore, it is beginning to be more common knowledge that tight pelvic floor muscles can frequently cause pelvic pain and dysfunction (vs muscles that are too long and weak). As noted in prior blog posts, short and tight PFM can cause similar symptoms compared to long and weak PFM (example: urinary incontinence). If someone’s PFM are short and tight causing urinary incontinence, a rehab approach will promote lengthening and letting go of the tension in order to reduce pain and improve function. However, this process requires time and guidance. Patients are all too often told to simply relax and meditate in order to have less pain and less tight muscles. While relaxation and meditation are certainly helpful, patients are often left to their devices to navigate through the process of letting go without skilled guidance of HOW does a person simply let go of their PFM?
Accessing the PFM is one thing but attempting to relax and lengthen the deeper muscles is a whole different ball of wax. Successful pelvic health rehab requires consistent biofeedback and guidance from the pelvic health physical therapist. Therapist-assisted biofeedback facilitates improved brain-muscle connection for the patient because the therapist can use both tactile cues (palpation) and verbal cues to assist in pain relief and general muscular awareness. The patient and the therapist interact and work as a team in order to help the muscles gain range of motion and overall improved function. This process can last anywhere from 4-6 weeks to several months depending on the patient. Usually visits that occur consistently (1x/week) yield the best results. Ultimately, the goal is to help the patient get back to function and resume their normal life activities as soon as possible (walking, running, HITT classes, caring for children/grandchildren, house chores, and more!). With a little dedication and teamwork, consistent pelvic health PT sessions can yield lasting results.
Resources: Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction Richard C. Bump, W. Glenn Hurt, MD, J. Andrew Fantl, MD, Jean F. Wyman, PhD From the Department of Obstetrics and Gynecology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia. August 1991Volume 165, Issue 2, Pages 322–329.