what should i look for in a pelvic floor physical therapist?
There are SO many things to take into consideration when shopping around for a provider. And this is even more important when looking for a pelvic floor physical therapist to work with.
You not only want a provider who is skilled, but you also want someone that you connect with and feel comfortable and safe with. Pelvic floor physical therapy is a pretty intense type of therapy, so to speak, and we are usually talking about topics that can be pretty sensitive in nature and bring up different emotions and memories depending on your history.
When it comes to selecting a pelvic floor clinician, I definitely always recommend working with someone who helps to calm your nervous system down. Someone that is good at self-regulating themself and prioritizes their own self-care which, in my opinion, is usually super obvious depending on how they make you feel when you are around them during your appointments. How is their bedside manner? Do they have a calming personality where you leave the appointment feeling more calm than when you arrived? Or do you leave feeling stressed and you even feel rushed and hurried during your treatment sessions?
These soft skills are incredibly important to look for because if you’re unable to actually relax to some capacity during your appointments with your provider (and say you’re coming in for some form of pelvic pain) it’s going to be incredibly hard to improve your pain when your nervous system is unable to calm down when you’re in a stressful or hostile environment.
Outside of soft skills, there are definitely a few things that I recommend folks look for when deciding who to work with for pelvic floor physical therapy treatment:
Credentials and experience are actually kind of important. Things to be looking for when selecting a pelvic floor physical therapist should include someone that has extensive education and experience. Usually I educate the general community that if a physical therapist has the letters WCS (Board-Certified Women’s Health Physical Therapist) or PRPC (Certified Pelvic Rehabilitation Provider) at the end of their name that they likely know what they’re talking about and have the clinical expertise and training to back it up. You aren’t even eligible to sit to take these specialty examinations until you have completed a certain number of hours of training which takes at least 2 years to complete. I also highly recommend working with a clinician that has been practicing as a pelvic floor physical therapist for a few years. Usually seasoned clinicians have been practicing for at least five years and are able to give informed, effective, and evidence-based treatment to their clients. Another added bonus is if you are able to find a pelvic floor physical therapist who has specifically completed a residency in Pelvic Floor Physical Therapy treatment. This is extremely uncommon and less than 1 in 10 physical therapists have actually gone on to receive residency training.
Someone who is actually qualified and comfortable with providing an internal pelvic floor muscle assessment (and treatment). Since pelvic floor physical therapy treatment is becoming more mainstream and kind of a “hot topic,” many medical providers and physical therapy clinics are starting to jump on the bandwagon and say that they provide pelvic floor physical therapy treatment. Even if they haven’t actually received formal training on how to complete a thorough internal and external pelvic floor muscle assessment. I frequently have clients that make their way to me after working at an orthopedic-based physical therapy clinic where they were told they would be receiving “pelvic floor physical therapy treatment” only to find out that they worked in a public gym for months on end without ever actually having an internal pelvic floor assessment for their pain that they were experiencing during sex. Which literally doesn’t make any sense.
Obviously I never ever force clients to complete an internal pelvic floor muscle assessment while we are working together if this is something they aren’t comfortable with or don’t consent to. But this is something that is critical to have as an option while working with clients if consent is given and it is deemed medically necessary based on what a person is struggling with and their goals are for physical therapy treatment.
Some of the main governing bodies for physical therapists to receive formal training on completing external and internal pelvic floor muscle assessments are through the “American Physical Therapy Association (APTA)” and Herman and Wallace. These courses usually are a large time (and financial) commitment where clinicians attend weekend long courses that are provided over a series of time to help train physical therapists in the treatment of pelvic floor issues in addition to learning how to safely and effectively perform a pelvic floor assessment.
So all of this to say is if you are working with someone who claims that they are a “pelvic floor physical therapist,” yet they aren’t comfortable with completing both a thorough external and internal assessment of your pelvic floor muscles to help you resolve your pelvic floor issues, then it may be time to shop around and find another provider.
Choose someone who actually specializes in the pelvic floor. Again going back to #2, pelvic floor physical therapy treatment is a hot topic right now in mainstream media and everyone and their mother is claiming to be a pelvic floor specialist. Especially larger hospital-based physical therapy clinics and larger physical therapy mills because there is money to be made if you claim to be a pelvic floor specialist. But y’all, not all pelvic floor providers are created equally. I strongly encourage folks to look for a clinic that specifically focuses on the treatment of pelvic floor dysfunction and pelvic floor issues. Some clinics and clinicians who claim to focus on the pelvic floor may only work with pelvic floor clients a few days out of the week and focus on a different client population for the remainder of the week. This really limits how much clinical experience a pelvic floor physical therapist actually has when it comes to working with pelvic floor dysfunction, which depending on the client can be very medically complex. This can also severely limit continuity of care for folks struggling with pelvic floor diagnoses when they may require regular appointment options depending what they are struggling with.
Find someone who doesn’t get stuck inside of your pelvis. What the heck do I mean by this? I’ve been specializing in the treatment of pelvic floor diagnoses for seven years now and I recently had a client come to see me for penile pain that has been ongoing for a few years now after working with a pelvic floor occupational therapist for over six months without any results. When I asked my client what they had worked on together, he shared that they mainly did some hip stretches, some external pelvic floor muscle release techniques, and two internal pelvic floor muscle exams. And that was pretty much it. For every appointment once a week for the past six months. My mind was blown. I started thinking of literally ALL of the things that could be potentially causing this clients pelvic pain both inside and outside of his pelvic floor that hadn't been explored yet. And also felt horrible that he was wondering if pelvic floor therapy was even effective because of the experience he had had with his previous therapist. We have only had three appointments working together and he is already noticing pain relief from not only interventions we are providing to his pelvic floor muscles, but also to the surrounding areas like his hips and low back.
So please please make sure that the pelvic floor physical therapist that you are working with isn’t just looking at your pelvic floor muscles. Because depending what you have going on there is so much to explore that can impact how the pelvic floor works. Especially if you are finding that your symptoms aren’t changing or improving.
A pelvic floor physical therapist who prioritizes and knows your goals for therapy. I literally cannot stress this enough. Just because you have leaking of urine may not actually mean that the leaking of urine is a problem to you. So if I am working with you and focusing on the physical therapy treatment of leaking of urine even though your goal is to be able to have sex pain-free with your partner, then what is the point? If it’s not a priority to you, then it shouldn’t be a focus of your treatment (unless it potentially is a stepping stone to reaching your specific therapy goals).
You want to be working with a pelvic floor provider who has specifically asked you what your goals are for treatment and then works with you to create tangible steps to reach those goals. Again, just because something is happening may not necessarily mean that you want it addressed or focused on during pelvic floor physical therapy treatment. So make sure that you find a provider who actually listens to you and is able to work together with you to help you prioritize what means the most to you…so that you get the most out of your appointments.
Have questions or feeling on the fence about whether or not pelvic floor physical therapy is for you? If you’re struggling with pelvic floor issues and looking for a pelvic floor physical therapist and you’re located in Durham, North Carolina I would love to work with you! Reach out to me here to tell me a little more about what is going on so we can chat more and get the process started. Live outside of the state of North Carolina? I also offer virtual appointment options to provide more accessible care to those seeking out pelvic floor treatment.
Dr. Brook Orvis is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people, men, women, kids, and the LGBTQIA+ community so that they can take better care of themselves and receive equitable care. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of being a human.
Thinking that you may benefit from pelvic floor physical therapy treatment? Or know someone else struggling with a pelvic floor issue and looking for care? Reach out here to schedule a pelvic floor physical therapy appointment with me today. At Flora Physical Therapy I am passionate about providing 1:1 accessible treatment options including in-home, in-clinic, and virtual appointment options to help meet you where you are.
