What in the world is pelvic physical therapy, and why have I never heard of it?
Even though it has been around for centuries, pelvic physical therapy is a largely unknown to the average person, preventing people from addressing common issues that are treatable.
I remember sitting in my penultimate semester of physical therapy school thinking (probably out loud if you know me), “wait, wait, wait, we can do what? Where? Why would anyone want to do that?”
Like many physical therapists, I started school with the goal of working with high-level athletes and the dream of working for a professional team. Oh, how dreams can change.
You’re probably wondering what possibly could have shocked me that far along into our physical therapy coursework. The moment in class I was referring to was, of course, the (very) short blurb that was the “intro to pelvic health” presentation that included a vague explanation of an internal coccyx (tailbone) mobilization technique.
This information rocked my world! It changed how I thought about my own body and it changed how I looked at physical therapy as a profession. That day, I realized we are so much more than just the rehabilitation of sports injuries, and I needed to know more.
So, what exactly is the pelvic floor?
Take a moment to consider your abdominal area as a soda can with the respiratory diaphragm as the top, your “core” muscles as the front and sides, and your back muscles as the back of the can. The can is still missing a very important component: the bottom!
Your pelvic floor supports the bottom of the can by providing a hammock, or bowl-like support, at the bottom of the pelvis. It has five very important functions:
- Supports the internal organs
- Sphincteric control of urethra and anus (urine and stool)
- Stabilization/core activation (completes the soda can!)
- “Sump pump” for circulation/lymphatic system
Origins of pelvic physical therapy
Now, since no one knows about pelvic physical therapy that must mean it's new, right? Nope!
Some of the techniques used by pelvic physical therapists have been described in the ancient texts of Chinese Taoism 6,000 years ago. Hippocrates and Galen of Ancient Greece and Rome also taught pelvic floor exercises. However, these techniques were long forgotten during the dark ages until modern medicine received its first dose of pelvic floor-specific exercises.
Margaret Morris stepped up to the plate when she connected the importance of pelvic health to the overall health and well-being of her dancers. She published a paper in 1936 that introduced British society to pelvic floor physical therapy. Unfortunately, she is often overlooked in history. Many erroneously think the world was introduced to pelvic floor exercises by Dr. Arnold Kegel in the 1940s. While Dr. Kegel helped spread knowledge of pelvic health and his “Kegel” exercises, his techniques had been used around the world for centuries.
What does pelvic physical therapy look like today?
Today, pelvic floor physical therapy is so much more than just “Kegel” exercises. As pelvic floor/pelvic health therapists, we are musculoskeletal experts that specialize in the area associated with and within the bony pelvis. This includes the innominate (ilium, ischium, pubis), sacrum, sacroiliac joints, and coccyx. The pelvis houses the pelvic floor which is a region (not just one muscle!). We seek to see and treat the body as a whole and treat our clients as a WHOLE person. We are interested in how the gastrointestinal tract, reproductive, orthopedic, urologic, neurologic, and dermatological systems function together and how that affects your overall function and health.
The muscles of the pelvic floor are skeletal muscles. They behave just like other muscles in the body: they can be too short/tight or too long, or they can be weak and ineffective at their “jobs,” or they can even lack coordination. And did you know that eight out of 10 patients who are performing “Kegels” on their own are doing them incorrectly? Often this is due to poor proprioception (awareness of the position/movement of the body and its parts). It is hard to master the coordination of these muscles when you can’t see them working!
It's not just you — and you can get help.
Unfortunately, many of these pelvic health issues go untreated and undiagnosed because of one simple fact. It’s a little weird to talk about, but it shouldn’t be!
New moms in France are referred to a pelvic physical therapist immediately after birth and are insured for a minimum of 10 visits, which is obviously not the case in the United States. But it’s not just recent moms who are in need — there are many reasons to see a pelvic physical therapist. Common diagnoses treated by pelvic therapists include (but certainly are not limited to):
- Incontinence (urinary and fecal)
- Vulvodynia and Vaginismus
- Dyspareunia (pain with intercourse)
- Coccyx pain
- Diastasis Recti
- Interstitial Cystitis
- Polycystic ovary syndrome
- Chronic pelvic pain
Although talking about issues in the pelvic region can seem a little strange, and maybe even a little taboo at first, it is important to see how important this little area is to overall health and quality of life.
Jessica Klecki, DPT, is a pelvic health specialist whose unique approach involves creating comprehensive treatment plans that incorporate various exercises, breathing techniques and stretching methods.
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