FAQ

General | Conditions treated | COVID | Telehealth | Payment

General

I’ve been to PT before and it didn’t help. How is your practice different?

• I listen and observe to discover how best—for you and your condition—to facilitate healing and improve function; and to free you from symptoms that limit or impair your ability to enjoy and participate in life.

• I’m a three-dimensional thinker, making use of 25 years of practice with hundreds of patients just like you to pinpoint what’s causing your symptoms, and then how best to treat them.

• This process is about teamwork: enabling and empowering you to function better, enjoy life more, and feel more connected with your body and more at home in your body.

• I specialize in treating complex conditions. Healing from pelvic conditions can be a journey with many steps, and my goal is to help you feel better and do the things you value.

• Through my commitment to keeping up with the latest research about pelvic conditions and attending national and international continuing education and conferences, I’m able to offer you the treatment and education that have the highest probability of helping you.

• Although fancy equipment and trendy techniques may be appealing, I rely on my knowledge, skills, and hands to help you get better. The exercise program I design will be tailored to you. The manual therapy I perform will be specific to the areas of your body which it will benefit. I’ll describe to you the “why” of treatment I do as well as the “why” of homework I give you to do.

• My goal is for you to be independent in managing your condition—to get you well enough that you know what to do to keep feeling good/better. That said, you are always welcome to come back for a tune up! Over the years, many of my patients have found that a couple of follow up sessions—6 months, a year, or several years later—really help them to continue to make progress.

Healing is a process, not an event. My goal is to find what works to help you get better, knowing that each step along the way is important, and that it will move you in the direction of feeling better.

What should I expect on my first visit? 

• We’ll spend a fair bit of your first visit talking. This will give me the information I need to understand your body, your pain, and your issue(s). Then I’ll do a physical assessment.

• This is a hands-on evaluation based on your symptoms.  Although your symptoms may be in your pelvis, I’ll look at your whole body, since symptoms often arise from more than one source or area.  The goal is to trace your issue to its source (s) so that we get the best results possible. I’ll check your pelvic and postural alignment, your pelvic girdle and hip muscles, and your external/internal pelvic floor muscles to assess strength, tone, and function.

• An internal vaginal and/or rectal muscle assessment will only be performed with your permission.  Before performing it, I’ll describe the how and why so that you understand the process.  While many of my patients over the years have been uncomfortable initially with this process, it gives a huge amount of useful information for how we can best work together to help you get better.  That being said, you can make the decision not to have an internal exam on the first or any visit. As the patient, you decide the care you are comfortable with, and I’ll structure your visits to your comfort level.

• If possible, bring your phone or tablet so that we can record your home exercise program. This will make it much easier for you to do it correctly. 

•  By the end of your first appointment, we’ll talk about my findings from the assessment, the treatment I think will help you the most, and discuss what you need to do and why.  We’ll be working together as a team; both of us will move this process along.

• If you’d like to have a support person or chaperone present during any part of your evaluation and/or treatment, please let me know that you’ll be bringing someone. They’ll need to follow the same COVID precautions that we do, including wearing a mask.

Are pelvic floor problems normal?

It’s important to know that while pelvic floor problems like urine leakage and pain are very common, they are not normal. They are not something that you have to suffer with, or for which there is no treatment. To the contrary, that’s what pelvic floor therapists specialize in helping you with.

What is pelvic floor dysfunction and why does it happen?

Pelvic floor dysfunction is very common for both men and women. It can happen when the muscles, soft tissue, or nerves of the pelvic floor are weakened, tightened, or injured by trauma, chronic strain, or overuse. Pelvic floor disorders can be a consequence from traumatic injury such as a fall, from sporting activity, surgery, or childbirth. They can also be the result of chronic issues, like infection, chronic inflammation, or endometriosis. Poor alignment or posture, overuse, or suboptimal movement can cause pelvic issues. The pelvic floor muscles (also known as “Kegel” muscles) surround the urethra, rectum, vagina and prostate; when these muscles aren’t working correctly, the result can be urinary, bowel, or sexual dysfunction in people of all ages.

What is pelvic physical therapy?

Pelvic Physical Therapy refers to the assessment and treatment of some very common problems. These problems can affect bladder, bowel, and sexual function and can cause pain. As a pelvic floor therapist, I evaluate your muscles for weakness, tension (tightness), and incoordination. I check for scar tissue and trapped nerves. Then I create an individualized plan to help restore optimal function, using manual therapy, exercise, muscle re-education, and a home program. I treat women, men and transgender people.

How do you treat pelvic conditions?

Treatment of pelvic floor dysfunction in Physical Therapy may include an external and/or an internal pelvic floor muscle—aka “Kegel” muscles—assessment, which will help me determine if the muscles are weak, uncoordinated, shortened (tight), or hypertonic (overactive). It will also include a whole body scan, with special attention to your spine, pelvis, and hips. Pelvic problems are often a result of muscle or structural imbalances which must be identified and treated to help you heal more fully. This assessment is how I’ll understand what’s going on with you, and make a plan to help you get better. Our work together will include plenty of education, so that you understand what’s going on with you and how you can get better. Manual therapy—hands on treatment focused on improving the mobility of your soft tissue and joints—is a powerful tool. I’ll design an exercise program especially for you aimed at stretching and strengthening, and teaching your muscles how to work properly. We may use biofeedback to help you learn how to use your muscles more effectively.

Chronic pain conditions are complicated. What can PT do for me?

Chronic pain is tricky. There is good reason to believe that you can change your ability to move and return to those things in life that are important to you. You might need to modify how and what you do in your daily life. I’ll work with you to understand the biology and science of pain and the complex changes that happen when a body has been in pain for a while. All treatment is not the same, and your history and lifestyle matter in what your program will involve. In general treatment will follow some basic principles:

• I’ll do a careful evaluation of your motion, movement patterns, strength, sensitivity (where do you hurt and what makes it better or worse).

• I’ll work with you to devise an exercise and lifestyle plan that works for your life and priorities.

• I’ll use a variety of manual therapy techniques to address soft tissue restrictions and improve function.

Why do some physical therapists have a master's degree and others have a doctoral degree?

Little did I know when I graduated PT school that if only I had waited a couple of years, my degree would’ve been a doctoral degree, not a master’s. The PT profession has evolved since it began in the 1920s in response to the poliomyelitis epidemic, to help soldiers returning from the battlefields of World War I. It evolved from certificate, to associate to bachelor’s to master’s and doctoral degree. I seriously considered doing a transitional DPT back in the late 1990s/early 2000s. Eventually I decided instead to pursue other continuing education opportunities, balanced with the challenges of launching both an outpatient PT program, then a Women’s Health PT program; and serving in state and national roles of the American Physical Therapy Association (APTA). These are recorded in my CV.

What’s your thinking about “Kegel” muscles and “Kegel” exercises?

Decades ago Dr. Arnold Kegel realized that the pelvic floor muscles could be strengthened, just like other muscles in the body. While it’s true that Kegel exercises have helped many women—and men!—it’s also true that many people do them incorrectly, often worsening the initial problem they’re trying to remedy. Normally it just takes a few physical therapy sessions and focused practice to remedy your problem.

Do you see transgender patients?

Yes I do. Transgender people often go through life with little to no help while making changes in their daily lives such as binding, tucking, having hormonal treatment, and having surgery. Physical therapy can help.

Do you see men?  

Yes, I work with men for pelvic issues such as pelvic pain syndromes, painful orgasm, chronic non-bacterial prostatitis, Peyronie’s disease, bladder and bowel problems, and erectile dysfunction.

I see that you treat patients with erectile dysfunction and pelvic pain. Is this a sexual therapy?  

Pelvic rehabilitation may include sexual health concerns such as erectile dysfunction. Treatment is designed to improve the health and function of muscles and nerves that control erections, and help you better understand how you can optimize your sexual health. Treatment is physical therapy that is directed towards the pelvic area. The therapy is not sexual in nature.

I’m worried that I might get an erection during the treatment, what can I do?  

It’s not unusual for someone to be concerned about having increased blood flow in the penis, or an erection, during treatment. This is uncommon but does occasionally occur. If this happens, the therapist can simply take a break from working on or near the genital area until the increase in blood flow passes. You and your therapist can check in to make sure you each feel safe and comfortable, and continue as appropriate.

My partner is worried that a therapist will be touching me in a sexual way.  

Any touch in the clinical or rehabilitation environment will be provided only in a professional, non-sexual manner. Relevant anatomy, physiology, and reasoning for working on or near the genitals will be described and any questions answered prior to therapy for such a sensitive part of the body. If you and your partner prefer, your partner is very welcome to attend rehabilitation sessions with you, and with your consent, your partner may be able to learn to help with some of the rehab activities to complete at home with you.

Do you massage the penis to see if there is improved blood flow after treatment?  

No massage-type treatment to the penis will be applied, and the goal of treatment is non-sexual in nature. If a patient is requesting inappropriate treatment or making any suggestive comments, treatment may be discontinued immediately with no further option to reschedule.

How will I know if PT is helping?

Your symptoms should start to improve within 2-4 weeks if not sooner. Keep in mind that muscles can feel sore at the onset of a new exercise routine, or after manual therapy. If you feel new or different discomfort after the first few sessions, that’s normal—and actually a good sign for future recovery. I’m always ready to communicate and explain, and can talk you through what to expect!

Do I need to reschedule my appointment if I get my period?

There’s no need to reschedule if you get/have your period. Our sessions together will be multifaceted, including education, exercise, manual therapy, and movement retraining. We will adapt each session to you and to what we can do to help you get better.

What should I wear and bring?

• Please wear whatever you’re comfortable in!

• We want to make the most of our time together, so plan on filling out forms before your first visit. I’ll let you know which forms to fill out. This will help me start to get to know you before your visit, and will allow us to focus on understanding your condition and creating a plan to help you. If you will be starting with a telehealth visit, I will send you instructions for that visit.

• Referral forms, from your physician, or other provider, if you have any.

• Recent x-rays or other medical records relevant to your visit.

Can I bring my baby/my child?

Absolutely! We can use this time to check your body mechanics while you’re holding/picking up/caring for your child; and do some training. If we need to take a break so that you can give your child some attention, we will.