Clinical Pelvic Floor Therapy

It's worthwhile to get an opinion from a provider experienced with soft tissue assessment and treatment. My work involves coordinating with other practitioners to resolve a patients’ condition making sure needed tests and procedures have been done to get to the root of the problem. My entire focus is hands-on manual therapy to restore normal function. My goal is, ideally, to resolve conditions by the use of hands-on manual therapy and other modalities, such as, therapeutic ultrasound, muscle stimulation, and home exercise techniques. Most patients self pay for care and this allows me to provide care that is needed versus treatment bound by insurance.

Yes, it's important to make sure that all the work needed is performed simultaneously or in close sequence to keep the healing window as short as possible. Coordinating care with practitioners who understand acute and chronic care needs is important to handle prescriptions, non-surgical, surgical and other treatments. Passive treatment is the care provided to you that you cannot do for yourself such as manual therapy, acupuncture, medication, and surgery. Active care is what you do for yourself such as home/gym exercise and sports after some form of technical instruction. Both are essential to ensure a positive outcome.

No. Oregon Chiropractors are primary care physicians and do not require a medical referral to initiate care. If the care requested by a patient is not covered by insurance, self-pay is always an option to get desired results. Referrals from another practitioner requesting specific bodywork are helpful to quickly focus treatments to help you meet your goal.

The need for surgery is best determined by a conservitave surgeon after all non-surgical options have failed. Endometriosis is a very common condition requiring surgery sooner than later. Many musculoskeletal conditions including urinary stress incontinence often respond well to non-surgical treatment. An aggressive surgeon may encourage surgical interventions first as opposed to referring for non-surgical physiotherapy first.

Our hope is to gain 50%-80% improvement with initial evaluation and 6 follow-up treatments for straight forward conditions. In some cases, 6 to 8 treatments will resolve an uncomplicated acute condition completely. This is clearly optimistic, but over many years we’ve seen both acute and chronic conditions resolve quickly when the correct treatment is provided. When a complex condition requires more extensive work and maintenance care, the number of treatments to resolve is difficult to determine, especially when the condition has been present for many years. To stay on track and measure progress, after the first 6 treatments, patients determine the percent of progress made and the future care needed to resolve can be estimated. Improvement is inspiring and our intention is to provide care regardless of how long your healing journey requires. Fully rehabilitating pelvic floor damage and dysfunction is important for future pregnancies, physical activities, preventing hip and knee problems later in life and just living fully.

No, mental health therapists are not required to treat all physical conditions but are helpful to balance mind body connections. Therapy is optional with uncomplicated physical injuries resolving in a timely fashion without lingering psychosomatic triggers. Both acute and chronic conditions that create recurring mental stress with pain and dysfunction greatly benefit, if not require, mental health therapy to fully heal. Working with the right mental health therapist helps create space between sensing and reacting to pain.

Chronic pain lasting over six months is complex. The source of organic physical triggers may not have been fully identified/resolved even when a practitioner has stated that they’ve done all they can. If the pain source has not been identified, the pain can still be physical or organic. On the mental, non-organic side, after six months, as a form of protection, the brain automatically begins to map pain generators, events, processes that could produce the pain. Central sensitization is the term for this process. It is unique to each person how they memorize actual painful events as well as anything that may lead them toward the pain triggering. After six months, even if the event is fun, the brain connects this event with pain. Anticipation of the pain can create the pain days/weeks before the event itself.

For example, over the last four years, a runner has consistent pelvic pain when running over 18+ miles. Runs under 15 miles never produce pelvic pain. As they begin to plan a fun 20 mile run with friends that is well over a month away, they begin to feel the exact pain produced on the 18+ mile runs. This is an example of central sensitization and brain mapping of pain. If a physical pain generator exists within the body, it must be found and treated to break the cycle.

It is common to have soreness from treatment for a few days if a condition is chronic from deactivated muscle tissue having the opportunity to contract and move more freely. Most often, new motion requires muscle control that the body has not been used to providing due to pain and restriction. To avoid pain from overuse with new movement, we recommend going easy until new muscle control is familiar and balanced.

Yes, if the condition was resolved in the past and has now resurfaced, look back to helpful treatments and lifestyle changes to implement again and hopefully resolve again. If the condition has never been resolved, have a current evaluation with new methods and new tools to see if treatments can fully address and resolve the condition now.

Yes. Clinically, I find leg length differences of greater than 5 millimeters are beneficial to correct with a heel lift worn in the shoe. Leg length correction is very helpful for people who are on their feet standing for long periods and endurance athletes who walk and run long distances. A bone length study is required for accurate measurements, rather than a standing pelvis x-ray.

A congested pelvis is a condition where circulation is abnormally reduced within the pelvic region. Venous stasis is one way this happens, when veins returning blood to the heart are expanded, losing ability to keep normal pressures and their ability to maintain normal blood flow. Another cause is lymphatic congestion, when lymph channels become pressurized and do not drain fluids effectively away from the pelvis. Venous stasis and lymphatic congestion can both cause local and regional swelling.

Yes, first it's important to determine the cause. If it is genetic, connective tissues can often be mobilized allowing the uterus to maintain a normal, comfortable position. If the cause is due to scar tissue restriction or a condition like endometriosis, hands on treatment is usually an option after an evaluation to make sure manual therapies can be performed safely. When scar tissue can be effectively mobilized the uterus can maintain a normalized position.

Yes. The pelvic floor is at the base of the GI tract. A mixture of peripheral nerves and autonomic nerves run through both areas. Many times, pelvic floor nerve pain signals can generate the feeling of GI symptoms within the abdominal region. Often, GI upset can affect the functioning of pelvic floor muscles in the same confusing manner.

Although common, it is not normal. An estimated 1 in 4 women have urinary incontinence regardless of pregnancy status. There are three forms: stress, urge, and mixed. Stress urinary incontinence is leakage without feeling the need to urinate. It occurs when abdominal pressures increase with physical activity. Urge urinary incontinence is leakage with a clear need to urinate. Mixed urinary incontinence is a combination of both. It is common to resolve incontinence with hands-on treatment if the condition was not present prior to giving birth and permanent tissue damage has not occurred during delivery.

Generally, 6-8 weeks with no significant complications during delivery. If tearing occurs and stitches are needed, additional time to heal is beneficial.

Yes. The Portland area has female pelvic floor providers. Working with a provider that you feel comfortable with is important for any care. Both IPPS and Herman & Wallace have pelvic floor providers listed.

Yes. Internal pelvic floor work is not always the starting point for chronic pelvic pain conditions. Whether internal work is performed or not, a detailed orthopedic evaluation should be performed for connective tissue, muscle, and joint function. An anatomic leg length difference often contributes to chronic pelvic pain, corrected with a heel lift. Adequate muscle tone and strength is important for normalized, painless function. Trainers, PT’s, and exercise classes are very helpful to provide technical instruction.

Most often, yes. Over the years patients continue to report marked reduction in duration of PMS before menstruating. Historically, with treatment, PMS symptoms of 7-14 days reduce to 0-3 days. Intensity of symptoms also reduces significantly during the PMS phase.