Pelvic Therapy Specialists: What They Do and When To See One
Dr. Maryssa Steffen, Board-Certified Pelvic Health Clinical Specialist, training a client in abdominal pressure activation and breathing.
Authored by Dr. Maryssa Steffen, PT, DPT, Board-Certified Women’s Health Clinical Specialist
Are you looking for a pelvic therapy specialist?
Have you seen multiple providers for your symptoms, including chiropractors, physical or occupational therapists, medical doctors, urogynecologists, colorectal surgeons, nurse practitioners, acupuncturists, but you still experience pelvic symptoms and you do not fully understand why?
Do you have multiple symptoms in your body, not just one symptom?
Do you have a history of a complicated intervention, like a surgery, injury, or birth trauma?
Do you have many other medical conditions that need to be managed along with your physical therapy related symptoms?
Has your medical doctor specifically directed you to a particular expert clinician?
You can be confident you are working with a pelvic therapy specialist if they are an American Board of Physical Therapy Specialities (ABPTS) Certified Clinical Specialist in Women’s/Pelvic Health (WCS). Meeting the standards of certification indicates that a physical therapist (PT) has proven that they have the specialized knowledge, skill, experience, and advanced clinical proficiency exceeding that of an entry-level physical therapist, unique to the area of women’s and pelvic health PT practice.
The ABPTS WCS certification recognizes “advanced clinical knowledge, experience, and skills in treating conditions affecting people throughout their lifespan, including pregnancy, postpartum, menopause, and other gender-specific health issues.”
What makes a licensed physical therapist different from other body-based and medical professionals?
First of all, the physical therapy profession has evolved and changed significantly in the last 10-20 years. If you heard from someone that PT did not do much for them when they saw a PT 25 years ago, you must understand that physical therapy was greatly different at that time. Our practice has evolved, from education, training, and research, so much that the California Physical Therapy Association is currently working to modernize the CA PT Practice Act.
In January 2016, the Commission on Accreditation in Physical Therapy Education (CAPTE) made the doctorate in physical therapy the required degree for all of its accredited entry-level physical therapist education programs, thus recognizing the complexity of patient needs and the required greater understanding of how to treat an individual.
“Initial education is broad, as a physical therapist must know a lot about a wide range of medical conditions and injuries. That includes mental health, exercise techniques and, especially, the location, function and structure of bones and muscles.”
After earning a doctorate in physical therapy at an accredited university, and passing the PT national licensure exam, the new physical therapist is entry-level and can competently work with multiple client populations. After years of practice and maintaining their PT license with continuing education and additional training, they may decide to focus on a specific population (children, athletes, oncology, neurological rehabilitation, cardiovascular/pulmonary, pelvic health) and become an expert in that population.
To become a pelvic floor specialist, therapists are required to complete at least 2,000 hours of direct patient care in the area of pelvic health and have successfully completed a rigorous seven-hour written examination.
Board certification is a guarantee of quality recognized by physical therapists around the country.
To maintain the speciality certification, a commitment to learning and advanced levels of education is required and confirmed by the The Maintenance of Specialty Certification (MOSC) process. Certified clinical specialists demonstrate continuing clinical competence and commitment to lifelong learning by retesting every 10 years in order to renew the specialist certification.
What is the role of a pelvic floor specialist?
They attend to the “dysfunction” in the pelvic floor muscles and help you investigate the cause of the symptoms so you are more empowered.
Examples include:
Bladder urgency, frequency, or leaking urine.
Constipation, hemorrhoids, fissures, rectal pain, and abdominal bloating
Persistent pelvic, low back, and hip pain, lasting more than 6 months. Pelvic pain may be centered in the pelvis, your belly, it may travel to your thighs and genitals, and is severe enough to interfere with your life.
Myofascial pelvic pain is caused by a sensitive restricted area in your muscles, that is tender to touch and unable to relax voluntarily. It may be referred to as a “trigger point.”
Tailbone pain may limit your ability to sit comfortably and it may be experienced as a deep ache and cramping sensation. It can be more painful associated with a bowel movement or bowel urge, it may cause symptoms when you transfer from sitting to standing, and you may also experience headaches, pain with coughing, low back pain or sciatica, and pain during penetrative sex.
“Sexual dysfunction” may be caused by issues in the pelvic floor muscles because these muscles support arousal, orgasm, erection, penetration, and ejaculation. “Female” or vulva bodied anorgasmia can be treated by a pelvic health specialist. A pelvic physical therapist will ask you questions to ascertain if “impairments” in your movement system are likely causing your report of sexual dysfunction.
Pain with penetrative sex, including vaginismus and dyspareunia, likely occurs when the pelvic floor muscles are too tense, tight, and unable to relax and stretch. Fear is a common and understandable response to discomfort and can lead to continuing pelvic floor muscles tension and tightness.
Low back, abdominal, and pelvic nerve injuries may be caused by birth trauma, surgical or injury history, and is treatable when working with a pelvic physical therapy specialist.
What to expect when working with a pelvic health specialist?
Manual therapy (myofascial mobilizations, joint mobilizations, nerve glides, visceral fascial mobilization, and internal pelvic floor therapy). This just means skilled hands-on care with a physical therapist.
If you have received chiropractic care, massage therapy, craniosacral therapy, Rolfing, myofascial release, abdominal massages, then you will likely benefit from specific “treatments” from a pelvic health specialist to empower your understanding of how to care for your symptoms and what is causing them, by experiencing a tailored plan of care developed by you and your physical therapist.
Movement training, biofeedback, breathing and posture work
Diaphragmatic breathing is often taught by pelvic health specialists. It involves the gentle expansion of your rib bones, particularly the lower ones that connect to your respiratory diaphragm muscle, and the simultaneous yielding of your abdominal wall and pelvic floor muscles. You may know it as “belly breathing.” The exhalation is a passive recoil and hopefully improves relaxation. Breathing animation here.
Intra-abdominal pressure management is an important basis for any core strengthening and posture training practice. Your core muscles are ready for strengthening when stiffness in your chest, shoulders, and low back is minimized, and your respiratory diaphragm muscle can flatten fully, and your lower ribs can expand like a 360 degree circle. Your abdominal pressure, from your flattening diaphragm, can freely travel to your tailbone and groin, without pushing with your abdominal muscles. Your exhalation is also a quiet recoil, without pushing or forcing the air out.
Optimal intra-abdominal pressure management and appropriate intra-abdominal pressure activation improves the support of the urogenital hiatus (“female”/vulva body) which is the space that allows the vagina and urethra to pass through the pelvic floor muscles. If the pressures above this opening are straining the pelvic floor soft tissues, then you may be vulnerable to pelvic organ prolapse.
Muscle, joint and nerve treatments may be indicated if your pelvic floor muscles are habitually tense, tight, sensitive to touch or stretch and thereby contributing to your pain experience, and bladder/bowel/sexual “dysfunctions.” Pelvic floor specialists are skilled in external and internal manual therapies that are consensual, safe and effective for pelvic floor muscles and surrounding muscles and joints. Sometimes biofeedback, with internal or external sensors, is also used for muscle training and/or regulating and supporting your nervous system.
Client education may include individualized bladder training to decrease urinary frequency and urgency, toileting positioning, more sustainable lifting movement patterns, home practices, dilator training and lubrication recommendations. These options are great to explore in-person or during a Telehealth visit with your pelvic floor specialist.
How does a pelvic therapy specialist compare to another pelvic care professional?
There are many roads to pelvic health, and you are in good hands with any trusted professional who embodies integrity, compassion, accountability, and care as they listen to you and guide the parts of you that may need support and integration.
These roads may include chiropractors, physical or occupational therapists, medical doctors, urogynecologists, colorectal surgeons, nurse practitioners, acupuncturists, psychotherapists, healers, and hopefully you have had positive experiences with these practitioners.
A pelvic therapy specialist can collaborate with any of your current providers to help to integrate your care and support you more fully.
If you have any lingering pelvic floor symptoms listed above, then a pelvic health specialist can specifically question and investigate pelvic health factors that may be contributing to your symptoms. By the first visit, you will understand what this means for you and how to start to care for it.
How to find a pelvic health specialist?
You may verify qualifications by reading the PT’s bio or by asking them.
If you are looking for cash based pelvic PT and you have out-of-network health insurance benefits, a pelvic floor specialist may be a good option for you.
