What Is Pelvic Floor Physical Therapy?

October is Physical Therapy Awareness Month, dedicated to highlighting the contributions of physical therapists and recognizing the value that physical therapy can provide in a treatment plan to improve overall musculoskeletal health. At Pelvic Rehabilitation Medicine, using every tool available to us is a central part of our approach to treatment, and we have often worked with pelvic floor physical therapists to help treat a wide range of pelvic pain symptoms, including painful intercourse, persistent genital arousal disorder, and other issues caused by pelvic floor dysfunction. In honor of physical therapy awareness, here are some things you should know about pelvic floor physical therapy.

What is pelvic floor physical therapy?

Pelvic Floor Physical Therapy is physical therapy for the treatment of pelvic pain and pelvic floor muscle dysfunction. Pelvic floor physical therapists have undergone specific training in pelvic health, pelvic floor dysfunction, and pelvic pain.

As a physiatrist, why would you want to team up with a pelvic floor PT when treating a patient?

As pelvic physiatrists, we traditionally work closely with pelvic floor physical therapists. Our goals align in that we are both working to treat underlying myofascial pain and dysfunction, joint pain and dysfunction, and nerve dysfunction through non-invasive means. We each have different “tools” to obtain this goal but our areas of expertise are highly complementary. Working together is often highly useful in wielding the most effective treatment and finding the optimal outcome for the patient.

What is the goal of pelvic floor PT for your patients?

For our patients who have hypertonic pelvic floors and pelvic pain syndromes, the first phase of treatment is called “down training.” Pelvic pain symptoms are often caused by tightness and spasticity in the pelvic floor muscles, and this first portion of treatment aims to address this issue. Down training includes internal and external myofascial release of the fascial restrictions and spastic muscle, as well as calming of the central and peripheral nervous systems.

Once the immediate problem is addressed, the second phase of pelvic floor physical therapy is an individualized neuro-muscular re-education program to help support a patient's pelvic structures. This involves manual techniques and exercises which improve balance, strengthen the pelvic floor, and reinforce normal, healthy movement patterns to help facilitate long-term neuromuscular health.

How does pelvic floor PT help treat pelvic floor dysfunction?

Pelvic floor physical therapy can help with both hypertonic (muscle tightness or tension) and hypotonic (muscle weakness) pelvic floor dysfunction. For hypertonic pelvic floor dysfunction, the focus is first on release of the spasm and then on strengthening the muscles. For hypotonic pelvic floor dysfunction, the focus is on neuromuscular re-education to help improve the nerve and muscle connection and increase responsiveness of the muscles and nerves.

Can pelvic floor physical therapy help treat painful sex?

Yes, pelvic floor physical therapy can help release tight fascial restriction and muscles that may be contriuting to painful sex. Pelvic floor PT can also assist with desensitization of peripheral nerves and help to increase space for the nerves to flow freely and with less restriction.