1. Use e-stim or biofeedback – E-stim and biofeedback should NEVER be your primary treatment plan for your pelvic floor. It will NEVER have the same results as appropriate stretches, exercises, and manual therapy. It can be an adjunct but should NOT be the primary treatment. I’ve seen women who have been put on machines for months with minimal results. Occasionally, a patient may benefit from using this as a part of a home program for either activation or down training, but I find a PT’s brain, words, and hands to be the best treatment for any pelvic floor.
2. See patients for months on end – if you haven’t improved in a few visits, it’s time for a new plan or PT. It is negligent to see patients for months with no improvement and no change in treatment plan. This is a waste of your money – please don’t get talked into it!
3. See patients more than every 3-4 weeks – while this is not common practice, this has become my treatment model, and after using it for the past 5 years, I’m going to say that it works SO well – I’ll never go back. My patients get ~3 weeks of progressive exercise (a new set of exercises each week) and return for follow-up after that point. They have direct access to me in between visits if something’s not going well, but this way, THEY are in charge of getting the work done and in charge of their healing process. By putting patients in charge and having them less dependent on me, they get results MUCH faster and need very few appointments.
4. Do a lot of internal work—Again, I know this is unusual for pelvic PT, but because I don’t see my patients very often, I don’t do a lot of internal work. I teach them how to do manual treatment on their own as needed. Most tightness and pain get resolved with a variety of treatments, not just internal work. My patients get better with less intervention and reliance on me to “fix them.”
5. Think everyone needs an internal exam – Only 25-30% of my patients get an internal exam, and it’s always on THEIR terms with their FULL consent. It’s not that I’m against internal exams; I just find that they’re often unnecessary, and most patients can get better without them, especially if they are anxious about an internal exam.
6. Do internal work during pregnancy or early postpartum – I’m going to always err on the side of caution with this one in avoiding introducing anything into the vaginal canal during pregnancy and early postpartum. If someone really needs something, this can often be addressed with an external exam, but that’s rare.
7. Give endless amounts of kegels – kegels are NOT my primary form of treatment. They are a foundational piece for the connection from the brain to the muscle (we should all know where our pelvic floor is, how to contract it, and how to relax it), but they’re actually not a great way to improve strength b/c they don’t mimic the true function of the pelvic floor in real life. If this has been a big part of your treatment plan and you’re not getting results, I’d urge you to try a new PT.
Do you have questions about any of these? What has been your pelvic PT experience?
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