Most people have never heard of women’s health PT or pelvic floor physical therapy and when they find out what we do and what we treat they are shocked! In many other countries it is standard of care to receive physical therapy during and after pregnancy to address any and all concerns that women may have as they navigate the changes in their bodies.
In France and Germany women receive physical therapy from women’s health physical therapists after they have a baby…even if they don’t have any issues! In France they get “Perineal Reeducation” to make sure their nether region is in tip top shape after having a baby. Why isn’t this standard of care in the US? And why are we not told about any of the conditions that could happen after childbirth and what options we have to address our concerns? Even if women go to their healthcare practitioner with these complaints after having a baby, many of them are never given any solution to fix their problem.
Unfortunately in the United States there is little awareness about women’s health physical therapy. We also seem to have blurred the lines between what is COMMON vs. NORMAL during pregnancy and after childbirth. Back pain is a very common complaint during pregnancy and pregnant women are told that it is just a part of being pregnant. But it doesn’t have to be this way! Back pain is very treatable during pregnancy and there are very important things to learn about, especially with regards to your posture and body mechanics while you’re pregnant to help you once the baby arrives. Many women are also told that it’s normal to pee your pants every time you laugh, cough, sneeze, or jump after you’ve had a baby but it is NOT normal…it’s a common complaint among women during the postpartum period, but there is something you can do to fix it! The same thing goes for painful intercourse. I hear from so many of my patients that sex was painful for months or even years after they had their first baby and they were always told that it was normal…but this is NOT normal and you can get your sex life back without just living with the pain.
What can we treat? A QUALIFIED women’s health physical therapist should be able to evaluate and treat all conditions related to pregnancy and childbirth. Here is a list of common complaints that you don’t have to live with during pregnancy or after having your baby:
Pubic bone pain
Urinary, gas, or fecal incontinence (leaking)
Urinary or bowel urgency
Abdominal separation (Diastasis Recti)
Scar pain or adhesions (Cesarean or perineal
Difficulty walking, standing, rolling in bed, or performing any other childcare activities or daily activities
In addition to treating current discomforts I also like to have at least one session with my pregnant patients for labor & delivery prep and I see quite a few pregnant women that aren’t having any issues during pregnancy and just want to have this session for childbirth prep and prevention of tearing. This isn’t typically provided by many women’s health physical therapists. In this session I teach women and their partners how to do perineal massage and go over labor positions with biofeedback to see which positions the pelvic floor muscles are the most relaxed (which is what you need during delivery).
Who should you see to treat these conditions? Just like most medical professions, physical therapy has various specialties. You wouldn’t want to go to a general orthopedic physical therapist to treat conditions related to pregnancy and postpartum as most people aren’t trained in the changes your body goes through during and after pregnancy. That would be like going to an orthopedic surgeon to deliver your baby…probably not the best idea! If you can, look for a women’s health physical therapist and ideally someone who is board certified as a Women’s Certified Specialist (WCS) (this document has a list of PTs with their WCS and is organized by state: http://www.womenshealthapta.org/wp-content/uploads/2015/01/WSC-Directory.pdf). For practitioners who have taken women’s health courses you can check out http://hermanwallace.com/practitioner-directory but this does not mean they have a WCS. Even if someone has a WCS do a little more research to see if they treat your condition and are very familiar with pregnancy and postnatal conditions.
You should also look at the length of your PT sessions. Ideally you will get at least 45 minutes or longer one-on-one with your physical therapist every session to get quality treatment…anything under that and the treatment techniques aren’t as effective or long lasting (read: you’ll probably have to go more frequently and it will take longer to recover).
So what exactly do women’s health physical therapists do? The first visit will typically consist of gathering your history and current complaints and then assessing a variety of things depending on what you’re being seen for. Ideally they will check your posture, alignment, and body mechanics and then assess your muscles and joints to assess strength, tone, length, range of motion, scar mobility, etc. For pelvic-related conditions this should include at least all the muscles from the rib cage to the knees including pelvic floor muscle assessment as appropriate. Palpation of these muscles is most direct and accessible if done via the vagina and/or anal/rectal canal (these muscles are just like any other muscle in the body but in order to get to them we have to go internally!).
From there your physical therapist will use treatment techniques to address whatever musculoskeletal dysfunctions they find. The specific techniques will vary based on your PT’s training and experience and techniques can include manual therapy techniques (such as myofascial release, trigger point release, strain-counterstrain, scar tissue mobilization), visceral/organ mobilization, muscle energy techniques, neuromuscular re-education, exercises (such as core stabilization and therapeutic exercises), postural education, and body mechanics training. You may even receive Biofeedback which is another tool that we can use to assess and treat your pelvic floor and transverse abdominus muscle. This is a tool that measures nerve activity in your pelvic floor muscles and then transmits it to a computer so you can see your pelvic floor muscle activity on the screen as your muscles contract and relax. I typically use it with my patients to monitor pelvic floor and/or transverse abdominus activation during functional activities like lifting, squatting, lunging, childcare activities, and exercise to determine if you are using your core muscles appropriately both during pregnancy and postnatally. Another great use of this technology is to assess labor positions while you are pregnant to see what positions allow you to relax your pelvic floor muscles the most so you can use that information while in labor.
If you have any questions or would like more information please check out the rest my website, restoredphysique.com, or contact me at firstname.lastname@example.org.