Women’s Health Physical Therapy addresses the unique musculoskeletal problems of the pelvic region that can have a significant impact on a woman’s quality of life.Millions of women suffer from pelvic floor dysfunction which can lead to urinary and/or bowel incontinence and pelvic pain. Pregnancy, childbirth, chronic constipation, chronic coughing, surgery, trauma and aging can cause pelvic floor muscle tension, incoordination and weakness.From incontinence to prolapse, pelvic pain or constipation, there is growing evidence that physiotherapy can alleviate, and in many cases cure these symptoms. Most women don’t know that help is available and it can be an embarrassing topic.
At Progressive Care, we understand the intimacy of these issues. Our experienced healthcare professionals are devoted to treating a variety of musculoskeletal conditions by providing one-on-one care and customized treatment programs in a discreet and comfortable environment.Our goal is to provide you with excellent care in a comfortable atmosphere with plenty of patient education We offer Women’s Health services and specialized therapy for pelvic health and obstetrical care. Treatment can often address the cause of issues and improve your quality of life.
Common Conditions we treat
- Musculoskeletal pain related to pregnancy and post-partum
- General pelvic pain disorders
- Urinary incontinence
- Fecal incontinence
- Constipation related to pelvic floor muscle dysfunction
- Dyspaerunia or painful sexual intercourse
- Osteoporosis and fall prevention
- Vulvar pain syndromes
- Pelvic floor muscle dysfunction
- Orthopedic Injuries
- Low back pain
- Sacroiliac joint pain
- Symphysis pubis problems
- Mastectomy /Post Cancer rehabilitation
- Hysterectomy rehabilitation
- Cesarean and vaginal delivery rehabilitation
- Antenatal and Postnatal Classes
- Posture advice & Ergonomics and
- Advice on lifting and carrying baby
- General wellness and education
Anatomy of Pelvic Dysfunction
Women’s Health Physiotherapy during pregnancy
Pelvic girdle pain and stress urinary incontinence are common amongst pregnant women. These symptoms often occur due to hormonal changes and the ever increasing weight of your baby and uterus.
The mounting pressure of the uterus on your bladder ,giving less room to store urine just when it’s becoming more difficult to stop the flow. One may leak urine when sneezeing or find it harder to hold your urine when one needs to ‘go’. Urinary incontinence in pregnancy should not be ignored as research suggests that if stress urinary incontinence is developed during your pregnancy, or within 6 weeks following the birth of the baby, it is more likely to suffer from incontinence 5 years later.
An assessment with a Women’s Health Physiotherapist is often all you need to prevent this. Making sure that you are doing the right pelvic floor exercises; activating the correct muscles for a suitable length of time is important in maintaining a strong pelvic floor through your pregnancy and beyond.
Pelvic stability exercises are also valuable through pregnancy to strengthen the supporting muscles of the pelvis and ease the pressure on the pelvic floor. An internal assessment may not be appropriate whilst you are pregnant and therefore an assessment of the muscles of your abdomen and pelvis is often an efficient way of pelvic floor re-training in pregnancy.
1 in 3 women experience low back pain during pregnancy whilst 1 in 5 experience pelvic girdle pain. This is often a result of the hormones Relaxin and Oestrogen relaxing the ligaments which support the pelvis. The Pelvis bones and sacrum slot together like a loose puzzle relying on the ligaments and muscles to provide joint stability. In pregnancy the extra strain on these ligaments can cause pain and movement dysfunction. In such conditions the muscles supporting these ligaments become extra important in providing stability and control. There is much evidence to support physiotherapy for pelvic pain in pregnancy and the treatments you may be offered include
- Manual therapy techniques
- Connective tissue release of the abdomen, back, hips and pelvis
- Pelvic stability exercises
- Advice on sleeping positions, exercise and movement modification
- Electrotherapy modalities
- Heat/Ice therapies
Women’s Health Physiotherapy postnatally
Your body undergoes many changes during pregnancy and continues to change post-natally. It is important to address any issues that occur at this time so as to prevent problems later in life. Childbirth can lead to pelvic floor trauma, perineal tears and pudendal nerve injury (the nerve which supplies your bladder and pelvic floor). Consequently the pelvic floor can become dysfunctional and you may experience urinary or bowel urgency and/or incontinence, urinary frequency, incomplete emptying, pain on urination/defeacation and pain or discomfort with sexual intercourse.
- A pelvic floor assessment is important to establish the cause of these symptoms.
- A Physiotherapist can assess you from 6 weeks post-natally or after your 6-week check up.
Following your assessment appropriate treatment can be provided which may include
- Pelvic floor re-training and exercises
- Provision of pelvic floor educators/muscle stimulators to improve your activation and power of your pelvic floor contraction
- Internal manual therapy techniques to relax the pelvic floor muscles, including trigger point release, myo-fascial stretches, scar massage, neural mobilisations.
- Myo-fascial release of the connective tissue of the abdomen, hips and pelvis which support the pelvic floor
- Relaxation and breathing techniques
- Advice on toileting and positional modifications
- Provision of pelvic floor exercises and general exercise to assist in release and re-training of the pelvic muscles
- Provision of vaginal dilators, pelvic floor educators or muscle stimulators to assist in the release and relaxation of pelvic muscles
- Assessment and treatment of any unresolved low back, hip or pelvic pain
Osteoporosis is a skeletal disease characterized by compromised bone strength. Physical therapy can assist in improving bone mass, reducing your risk for fracture and reducing your risk for falls. This can be achieved through an individualized exercise program, balance training, and education on fall risk reduction, proper posture, and proper body mechanics. With physical therapy, you can work towards improved functional mobility and an improved quality of life.
A Physiotherapist can also help with advice on return to exercise and healing of separated abdominal muscles (Diastasis Recti). Diastasis Recti often occurs in the third trimester of pregnancy when the abdominal muscles are at their greatest stretch. The linea alba normally joins the left and right hand rectus abdominal muscles. When the linea alba is overstretched a separation can occur between the left and right sides. Diastasis recti may make it harder for you to regain your tummy tone and return to your normal exercise routine. It is important to have an assessment to determine if your muscles are stretched; “Divarification Recti” or separated “Diastasis Recti” as this will determine which exercises are suitable for you. An assessment can be carried out from 6 weeks if you had a vaginal delivery or 8 weeks if you have had a c-section
Screening Maneuvers for Musculoskeletal Problems in Pregnancy and Postpartum
Women who are pregnant or who have given birth and are experiencing one or more of the following symptoms are good candidates for rehabilitation.
- Low-back pain, groin pain or pelvic joint pain
- Pain upon getting out of bed; any sharp, stabbing pain
- Pain during transitional movements such as sitting to standing, climbing stairs, rolling in bed or getting into and out of the car
- Radiating pain to the groin or down the buttocks or back of the leg
- Feeling as though a leg is “giving way”
- Joints popping or clicking
- Pain that worsens with prolonged standing or sitting
- Pain that increases with normal daily activities
- Urinary urgency, frequency and/or incontinence during pregnancy or postpartum
- Fecal/bowel incontinence following delivery Painful intercourse postpartum
- Pelvic floor muscle exercise and training
- Manual therapy, joint mobilization and myofascial manipulation
- Electrical stimulation
- Pain management
- Therapeutic exercise, strengthening and core stabilization Sport-specific strengthening and training
Therapy after Breast Cancer Treatments
Cancer treatment can result in pain, loss of mobility and loss of function. Some women experience difficulty with job-related, recreational and other daily activities. With these challenges often comes an overall decreased sense of well-being.
A range of rehabilitation treatment options exist to address many possible needs at any point during and after cancer treatment.
- Therapeutic exercise
- Neck and shoulder movement
- Manual therapy
- Pain management And Activity Specific rehabilitation
Who May Benefit from Breast Cancer Rehabilitation?
- Pain in the neck, shoulder, upper back, shoulder blades, arm or trunk
- Difficulty performing any activities of daily living, such as reaching into cabinets, hooking one’s bra or lifting groceries
- Difficulty performing any desired recreational activities, including favorite sports or hobbies
- Soft tissue and scar restrictions caused by surgery, postural difficulty or radiation
- Muscular weakness or restricted range of motion Cancer-related fatigue
- Lymphedema—swelling in the arm or chest
Vulvodynia—sharp, burning pain limited to the vulvar vestibule—contributes to both dyspareunia and chronic pelvic pain. Therapists will assess posture, tension in the pelvic floor, pelvic girdle, associated pelvic structures, and bowel/bladder function; testing digitally the pelvic floor; assessing hip, sacroiliac joints, and spine mobility; and strength testing abdominal and lower extremity musculature. Common treatment modalities included exercise for the pelvic girdle and pelvic floor; soft tissue mobilization/myofascial release of the pelvic girdle, pelvic floor, and associated structures; and joint mobilization/manipulation. Many physical therapists also counsel patients regarding behavioral therapeutic interventions including bowel/bladder retraining, help with contact irritants, dietary changes, and sexual function.
In the pelvis, trigger points can develop from trauma, post-surgical healing, interstitial cystitis, and inflammation. Myofascial trigger points are taut bands or tender nodules that evoke twitch responses or reproduce the character and location of symptoms during palpation.Research has shown that these painful nodules improve with manual physical therapy in patients with painful bladder syndrome.
Polycystic Ovarian Syndrome (PCOS) is an endocrine disorder that causes enlarged ovaries and can be responsible for infertility. The condition affects between 8 and 20% of women worldwide.
In a 10-year study that examined nearly 1400 patients and 28 patients with PCOS, the authors found that physical therapy was effective in leading to pregnancy for 54% of patients. With only 20 hours of manual physical therapy, more than half of PCOS patients were able to get pregnant, significantly better than the results from surgery and similar to the best oral medications
PCOS is a serious disease with greater effects than infertility, so medical management of the condition is very important, but physical therapy can be a very important adjunct to treatment that improves the chances of pregnancy, without the risks of surgery.