If you are in the United States – The American Physical Therapy Association’s “Find a PT” and Herman & Wallace Pelvic Rehabilitation Institute’s Practitioner Directory.
If you are located in Canada – check this page out.
Pelvic Floor Therapist Credentials
According to an article I read at Jessica Reale PT, you should look for the following credentials in a Pelvic Floor Physiotherapist.
Entry-level degree – BS, MSPT, or DPT
WCS (Women’s Health), OCS (Orthopedic), SCS (Sports), etc.
BCIA-PMDB: This is a certification for using EMG biofeedback for pelvic floor muscle disorders through the biofeedback certification international alliance.
PRPC: This refers to the Pelvic Rehabilitation Practitioner Certification through Herman & Wallace.
What an Pelvic Floor PT Will Do During an APPT
After obtaining your informed permission, the internal exam follows. The physical therapist inserts her gloved, lubricated index finger intravaginally, up to the level of the pelvic floor muscles, approximately one inch from the vaginal opening. She will feel for tissue excursion (whether one side is more flexible than the other side, checking for tension and resistance), again noting pain, adhesions, trigger points, and whether her palpation over specific muscles reproduces your symptoms. For an example, when the therapist presses on a trigger point on one of my pelvic floor muscles I can feel a burn in my uretha. It is such an AHA moment!
Muscle-strength testing of the pelvic floor follows, with the therapist’s index finger remaining internally to feel for quality of your pelvic muscle contraction. She will measure how strong your pelvic floor muscles are, whether your muscle can maintain that strong contraction up to 10 seconds, and typically whether all this be done up to 10 times.
Biofeedback testing may be next. Biofeedback measures the electrical activity of the muscle and transmits that information to either a range of numbers and/or sounds. The patient sees the numbers and learns how to retrain her pelvic-floor muscles with the guidance of the physical therapist. It really is amazing. As I can make my numbers go from a 4 to a 1.8 or less just by mentally telling myself to relax. You don’t think you’re clenching your floor, but typically we do!
The therapist may measure pelvic floor contractions with a perineometer, a small, tampon-like device with sensors, placed into the vagina or rectum(the width and length of a female index finger) slowly and with your conscious use of breath. These sensors pick up the electrical activity of your pelvic floor muscles.
Your therapist will measure the electric voltage (microvolts) that your pelvic-floor muscles elicit during rest, during slight contraction, and then during full contraction. She will measure if your muscle returns to complete baseline rest following contractions, whether your muscles have good endurance etc. She may use the information obtained through Biofeedback to help you learn how to properly recruit your pelvic muscles and regain normal function.
I love this from Pelvic Pain Rehab – the following is what they do in a typical appointment and more like what my amazing therapist does! (My comments are in brackets) Please check them out, they have wonderful information for pelvic floor pain sufferers on their site.
The first thing we’ll do during treatment is to treat the patient’s connective tissue. The reason we do the connective tissue manipulation first is that it makes it easier to treat underlying trigger points, it calms the nervous system down some; it increases blood flow to the area; and it relaxes the pelvic floor a bit. (Consider a person may have connective tissue dysfunction – my PT does this first)
For the most part, there are four rungs to the ladder of pelvic pain treatment. They are: working out external trigger points, working out internal trigger points and lengthening tight muscles, connective tissue manipulation, and treating at structural abnormalities. However, the last, treating structural abnormalities, is only incorporated when it applies. So during a typical appointment, we are focused on these strategies.
Typically we spend about half the appointment on connective tissue manipulation and external trigger point release (external work), and half the appointment on internal trigger point release and muscle lengthening (internal work). An appointment lasts for one hour – And patients either see us once or twice a week.
So that’s what we do during a typical PT appointment. What we don’t do during an appointment is: We don’t ever leave our patients alone in the room hooked up to a tens unit or to a biofeedback machine or performing exercises with an aide. When it comes to the successful treatment of pelvic pain, what works is manual, hands-on treatment, so that’s what we do.
Also, we don’t use a cookie cutter, one-size-fits-all approach to pelvic pain PT. Not only will every patient’s treatment be different, but a specific patient’s treatment will change and evolve from appointment to appointment!
My therapist also focuses on my abdominals. Many trigger points in the stomach can mimic pelvic floor pain.
I can’t stress enough that NOT all physical therapists are the same! Read more about the therapies on this page.
Pelvic Floor on Social Media
Consider following these groups/people on Twitter and Facebook for more information on pelvic floor pain. Consider asking around social media for a recommendation for a qualified pelvic pain physiotherapist. Send me an email if you know of anyone else that should be added to this live document.
Check out #pelvicmafia on Twitter! When you use this hashtag you can ask questions that will be followed by a host of pelvic floor therapist or people interested in pelvic floor issues.