What Makes a “Great” Pelvic Floor Physical Therapist? Look for These 10 Attributes.

The following list highlights the top 10 attributes of what you—the patient—should be looking for (regardless of your diagnosis) in finding the right pelvic floor physical therapist to help you along your healing path.

By Julie Sarton, PT, DPT, WCS

I have thought about this question a lot.

After practicing for 20 years in this field, teaching pelvic health courses (nationally and locally), and mentoring physical therapist after physical therapist, I often ask myself, “What wisdom can I share with patients who are looking to heal from complex pelvic floor issues? Likewise, what wisdom can I share with other physical therapists looking to specialize in this growing field of pelvic health?”

Like anything else in life, not all pelvic floor physical therapists are created equal. Some pelvic floor physical therapists are early on in their journey, while others have decades of experience. Some have fancy credentials behind their name, and others do not. Still, experience and extra letters after one’s name alone do not always guarantee that you are in the best hands to heal. So, how do you distinguish a “great” pelvic floor physical therapist from the average (or sometimes below average) physical therapists? This can get tricky since the nature of pelvic floor musculoskeletal dysfunction (PFMD) can be complicated, and there is no one-size-fits-all formal standard protocol out there for physical therapists to follow. Despite this, there are some essential key elements that I feel strongly identify what truly sets the great physical therapists apart.

The following list highlights the top 10 attributes of what you—the patient—should be looking for (regardless of your diagnosis) in finding the right pelvic floor physical therapist to help you along your healing path.

A Truly Great Pelvic Floor Physical Therapist…

1. is your true partner in crime.

This means that your physical therapist will listen—yes, actively listen to you. You as the patient need someone who will take the time to hear your story, as it is likely complex. Even still, detailed journeys offer clue after clue to your provider to help you with your recovery. If your physical therapist does not take at least 20-25 minutes (or often more, as we do in our practice) to just review your history in detail at the time of your evaluation, then they are likely missing key golden nuggets to help you heal. Your initial evaluation should always be 60 minutes long to allow for this. If you travel from out-of-town, request 2 hours for your initial evaluation to allow for appropriate time to get through everything. Follow up treatments also need to be close to an hour to allow for true listening to occur at every visit. Your physical therapist should always have his or her ears on and be listening to help put the pieces of the puzzle together every time you see her or him. At every visit, your physical therapist should ask about your progress, what is making you feel better, and what is making you feel worse. In addition, a great physical therapist should be able to connect with you on a personal level, be sensitive and empathetic to your situation. and be one of your best cheerleaders on your harder days.

2. absolutely should know how to internally treat your pelvic floor—both trans-vaginally and trans-rectally (even if you don’t have rectal pain).

Common internal treatment techniques consist of: trigger-point release, myofascial release, proprioceptive neuromuscular facilitation, strain/counter-strain, contract/relax and visceral mobilization. Ask your physical therapist to describe which techniques he or she is administering while treating internally so you can get a sense of what’s going on.

3. Should be looking outside of the box—literally.

Yes, your pelvic floor muscles may be dysfunctional, but, it is likely that your external tissues are, too. Your physical therapist needs to see “the big picture”. Your posture, gait, breathing techniques, entire spine and bony pelvic structure all influence the pelvic floor. Your physical therapist needs to look at all of these! Additionally, he or she needs to see what your connective tissue around the bony pelvis is doing, while also taking a look at key external muscles. Did you know that more than 30 muscles attach onto your pelvis? Many times, the external muscles can set the stage for the dysfunction internally, so make sure that this is being evaluated. Additionally, your physical therapist should check out any scars you may have from prior surgeries (such as episiotomies or C-sections if you are a woman, or hernia or prostate surgery scars if you are a male). In addition to all of the above, your pelvic floor physical therapist should have an appreciation for underlying systemic issues that may be driving your pain, such as thyroid problems, vitamin deficiencies or problems with methylation.

4. needs to know anatomy.

This includes anatomy from a musculoskeletal perspective as well as a visceral/organ perspective. Even a brain and nervous system perspective is important. For example, your pelvic floor physical therapist should have knowledge of not only peripheral nerves of the pelvis (like the pudendal nerve or genitofemoral nerve). but also the nervous system as a whole and even neuroanatomy (which leads us to the next point)!

5. should understand pain science.

Often, pelvic pain patients have neuropathic pain due to longevity of their symptoms and larger issues within the nervous system (or changes on the brain level) are present. So, your physical therapist needs to understand these principles, apply them into your treatment and then educate you on the biology of pain. He or she should also guide you to resources to learn everything you can about this! Research reveals that understanding pain science alone will impact and decrease your pain. Furthermore, your physical therapist should absolutely know how to integrate central nervous system calming techniques into your therapy and teach these to you as part of your home program.

6. will stress the importance of integrating appropriate exercise into your treatment regimen.

Specifically, he or she will highlight core strengthening and stretches. Both are important, but timing is critical. If exercises are done too soon or too aggressively, they can flare a patient. Furthermore, your pelvic physical therapist needs to be able to perform effective movement analysis to help decide which specific exercises you need–this will vary according to patient presentation. Your program should progress as you progress, not remain static. Lastly, your exercises should be functional and translate into better motion in life.

7. will teach you how to self-treat both internally and externally.

Self-treatment is another important piece of the recovery puzzle (see our healing heart to understand how all the pieces are interconnected). The patients that do best with physical therapy are the patients who don’t just show up for treatment, but also self-treat. Your physical therapist should educate you how to use some of the most effective self-treatment tools out there, such as dilators, crystal wands, body balls, bands, foam rollers and many more.

8. is plugged into a network or team of other key practitioners.

A good working relationship with knowledgeable physicians is absolutely necessary, and provides for more comprehensive care. In addition to having a relationship with a physician, a physical therapist should be able to give you the names of other practitioners such as acupuncturists, pain management specialists, pain psychologists, sex therapists and compounding pharmacists who can further complement your care. A multi-disciplinary approach is always a must as healing takes a village—a true healing team—especially when dealing with chronic pelvic pain diagnoses such as pudendal neuralgia, interstitial cystitis, vulvodynia or vestibulodynia.

9. is a good detective.

She or he is constantly on the case, trying to figure out what exactly is causing each layer of your pain. If a physical therapist, or any other practitioner for that matter, states that they have developed a one-size-fits-all treatment protocol, then they are likely not the best physical therapist for you. There is NO ONE standard protocol for treating pelvic floor muscle dysfunction; each patient presents with her own unique issues–each nervous system is unique. No two patients are completely alike. A great pelvic floor physical therapist should develop individualized treatment strategies for each of her patients that can be measured and tested for effectiveness. In order to effectively do this, a great pelvic physical therapist should be updated on all of the latest pelvic floor muscle dysfunction treatment options, research and even clinical trials.

10. is not afraid to refer you elsewhere if the treatment isn’t working.

We recently evaluated a patient who was seen at another local pelvic floor physical therapist clinic for two years without any changes or measurable progress. None! This patient paid cash for his treatment and was told to keep coming despite not getting better. Physical therapists: we, as a profession, need to do better than this. If you are a patient, do not let this happen to you. If you are not experiencing any type of progress within a reasonable amount of time, then it is time to look for a different path of healing. It doesn’t mean healing isn’t possible, it just means that your current provider may not be be the one to get you there and other treatment options may need to be investigated.

The Sarton Summary

A truly great pelvic floor physical therapist may not always be easy to find, but do not give up hope. The field is growing rapidly, with more and more resources becoming available to locate one hopefully near you! Below are links to be able to find providers, regardless of where you are across the country. Remember, you are the CEO of your body. You have choices. Do not settle for subpar treatment. Empower yourself with the knowledge above, and discover the right provider for you.

Unable to see us in California? Find a pelvic floor physical therapist near you:

https://pelvicrehab.com/
https://ptl.womenshealthapta.org/
https://join.pelvicguru.com/opt-in
- (launching January 2019 - until then, use https://pelvicguru.com/2016/02/13/find-a-pelvic-health-professional/)

We want to encourage you to get evaluated by one of our outstanding physical therapists, and regain control of your life. Pelvic pain, pelvic floor dysfunction, back pain, tailbone pain—you name it—these conditions do not have to control your life. There is hope. Call us today to book an appointment for 1 of our 3 Southern California locations, or inquire about a virtual, online treatment session.

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