Pelvic rehabilitation is a relatively new concept in the world of physical therapy. For many years, women have been seeking physical therapy for pelvic floor concerns (weakness that results in issues such as incontinence or sexual dysfunction). Now, the medical community is beginning to realize that the idea of pelvic health encompasses much more than just the pelvic floor.
While the pelvic floor is a very important component, the low back, ASI joint, hip, and core are all crucial areas that work together. If you think about it, everything we do revolves around the pelvis. Walking up a set of stairs, picking up children, and standing up from a seated position all rely on movement of the pelvis. If you’ve ever been an athlete, you can probably already hear the voice of your coach telling you to drive through the hips, since your power originates in the hip area.
That is very true: our movement depends on the strength from our hips, so any kind of pain, instability, or weakness will result in not performing activities to the best of your ability. Pelvic rehabilitation takes a broad focus on the pelvis as a whole along with its surrounding structures to ensure that any kind of pain, weakness, or instability is properly addressed. That way, you can be restored to your normal function and ability.
People tend to think that pelvic physical therapy is mainly suited for pregnant women, women who recently had a baby, or the aging populace who is dealing with incontinence. In actuality, pelvic physical therapy can encompass just about anybody. If you think about it, many children wet the bed past a certain age, which indicates pelvic dysfunction. Athletes are also often in positions that cause discomfort in the hips and pelvis. Along with pregnant and post-pregnant women, men are also dealing with incontinence as well. There is not just one portion of the populace who can stand to benefit from pelvic therapy.
Once a patient comes to us, we will be able to take a look at the pelvis to see exactly where the problem originates. Is it actually a low back problem that involves the pelvis, or is it perhaps a hip dysfunction that is causing pain or discomfort? Is it a musculoskeletal issue causing imbalance or weakness, contributing to pelvic floor issues? Maybe it’s a timing issue (this is more of a neuromuscular issue, and not a musculoskeletal one). In that case, the pelvic floor is working fine, but improper timing is causing it to fire too early or too late.
About 85 percent of the population deals with low back pain. If this pain is caused by a disc issue, it can then refer down into the pelvis. The patient may think that they have pelvic pain, but it is actually a low back issue. If you’ve ever had a hip replacement or suffered from a hip labral tear, it can also result in major discomfort. Structural abnormalities (such as a leg length discrepancy) are actually very common in the population. They can throw the pelvis off balance just enough to cause pain. Instability in the ASI joint affects 85 percent of pregnant women. This pelvic instability can also result in significant pain.
After determining whether the issue is musculoskeletal, neuromuscular, or something else altogether, we can devise an effective treatment program. Pelvic floor exercises (you’ve probably heard of Kegel exercises) are just a very small subset of the different exercises we can do with the pelvic floor. Hip strengthening and core conditioning are also very effective—if your core is weak, then the low back and hips have to carry the load to compensate. By doing exercises that strengthen the hips and the core, everything will be back in balance and working together properly. We can retrain the muscles to work properly (and at the proper time), treating dysfunction through exercises and modalities such as biofeedback. This will reduce pain and ultimately restore function.
The key is to create a tailored treatment program that works best for the individual patient. The patient’s goals and needs are central to devising an effective plan of action. Treatment may last anywhere from a short time up to many months, depending on how significant the case is. While we will often see rapid pelvic floor progress, our goal is to give patients the encouragement and tools they need to focus on recovery.
If you would like to learn more about how we can help you with pelvic physical therapy, contact us today or give us a call at (918) 743-3737.
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