Far too often I see people writing to others on online forums telling them to go to pelvic floor physical therapy (PT) when it actually has been tried many times before and hasn’t been helpful for the original poster. While there are many benefits to going to pelvic floor PT for internal examination (rectally or vaginally), trigger point release, manual therapy and stimulation, bio-feedback, learning mind-body connections, there are times when PT should be put on hold or another specialist should be sought. I am not against pelvic physical therapy in any means and I think that it is EXTREMELY important for combating dysfunction or pain issues. Here are just a few reasons to why you should seek another specialist or stop attending pelvic floor PT.
You have the wrong diagnoses and you don’t know the root cause of your symptoms. There might be other contributory factors that your doctor has not discovered yet such as a hidden autoimmune disease, orthopedic abnormalities, nerve issues, and hormones. Far too often I have seen women complain that physical therapy is not working. It is usually due to the fact that they have received a diagnosis of vulvodynia or vaginismus which can be called “bucket diagnoses” if the root cause of the problem has not been discovered. Could it be a tissue component? A orthopedic component from the spine or the hips? Or are nerves entrapped? Physical therapists cannot diagnose they can only feel and go based off what your muscles feel like, and it can be more harmful than helpful.
Your therapist relies on too many passive techniques in the office. If you are only doing heat therapy, ice, dry needling, manual therapy and then you go home and your body spasms up immediately, your body is not learning how to actively correct itself and it will become reliant on the physical therapist. While these techniques are beneficial, pelvic floor therapy should include both active and passive treatments. Heat and ice can be also done at home and shouldn’t take up more than five to ten minutes during your session. You should at least receive at least two exercises during a session as a bare minimum and be shown how to correctly do them.
Your therapist is not an active communicator and does not adjust to your body’s issues. Every person is different and thus should not be treated with standard textbook techniques all of the time. A good therapist actively asks when such treatments are painful, and wants to know what feels good and what doesn’t feel good for you at all times. There are MANY modifications for any exercise. If your PT is not able to think critically, then it may be time to find someone else. If something feels painful, they should be receptive to it. They should also be available through email. Your therapist makes you feel uncomfortable. A good therapist should also never ask you to strip down right away or discuss treatment options with you while you are bottomless and they should provide a sheet to keep you covered. They should always ask for your consent at any moment. If you feel comfortable with doing internal work on the first session, then by all means go for it. You should always feel in control of the session, so you never feel pressured to do internal on the first few sessions.
Your therapist is negative about your medical history. A good therapist will never insult you, criticize your previous treatments or doctors, or roll their eyes at anything you have done previously or are currently doing. Your previous treatments and medical history are not your fault. This is supposed to be a safe space and you are paying them. If this ever happens, then get out.
Your therapist makes it a requirement that you buy a lot of tools for your recovery and says you won't improve with it. While it is normal to invest in some therapy tools, you shouldn't have to buy everything. I've spent over 10k on dilators, lidocaines, sacroilliac belts, creams, suppositories, bands, back seats etc, and nothing ended up working for me even though I was told it would help. This is a financial barrier to health care for many, and some stop attending physical therapy because they don't feel as if they can financially afford it.
A therapist that says they “are the best” are generally not the best and may actually be insecure about knowledge they may lacking. It should be a huge red flag when a therapist says that they are the best, as they shouldn’t have to justify themselves to you and you are already seeking out their expertise by attending at least one session.
You are not seeing any improvement after six to ten sessions, or you are getting worse after two – three sessions. While healing and therapy is slow, you should never be told that it will take years and you should never be getting drastically worse after a few sessions. It means that this person is not skilled enough to handle your conditions and you should seek help elsewhere. There were two sessions of pelvic floor PT that I went to with someone and I was simply crawling around on the floor because my hips weren’t being considered during treatment. When I started going to hip physical therapy after 34 sessions of pelvic floor PT with no improvement at all and got drastically worse, I saw improvement after my first session of just focusing on hip strengthening. After five sessions of only hip PT, I am back to walking, doing some light cardio, and gaining my life back.
The therapist focuses too much on a patient’s anxiety, when the root cause of the pain symptoms have not been discovered yet or the pain symptoms are 100% real and have been discovered by diagnostic tests. There are a lot of discussions surrounding this. Vulvar pain, endometriosis pain, and other physical abnormalities are 100% real. Sometimes, when patients are told that they are anxious, it makes them feel more anxious, and it becomes an endless cycle of feeling anxious about being anxious. Anxiety can definitely worsen pain however if a person is already anxious about their issues it has to be dealt with in a more professional way especially if cognitive therapy has not been useful in the past. Additionally, it may be worth considering that if the patient was not actually experiencing pain than their anxiety levels could be lower.
Your PT has certain conditions listed on their website but tries to avoid discussion of these certain issues when attending a new consultation appointment. It is a major red flag especially if the PT doesn’t want to try to delve into issues that are listed on their website. If the word “hip pain” or “back pain” are listed, and can't speak to it, then choose another provider. Most PTs are not familiar with hip abnormalities yet and there are lots of regimens or exercises that put strain on the hips. Hip dysplasia needs a very specific protocol. That being said, do not go to pelvic floor PT for periacetabular osteotomy rehabilitation. Only go to your doctor’s recommended PTs.
When doctors tell their patients to go to PT, physical therapists recommend their patients get involved in cognitive therapy, doing lots of meditation, breathing and awareness exercises. While there is proof that such a relationship exists between stress and pain, it is too big of a jump to decide that it is the case for some people who doesn’t have a clear diagnoses yet and it can be actually psychologically traumatizing for people who are in a lot of pain to think that their pain isn’t real.
Therefore, there are times when you may have to take a pause or discontinue working with a certain provider, and these are just a few reasons for red flags or issues. Overall, pelvic floor PT is a great tool for dysfunction, incontinence, bowel issues, organ issues, tightness and weakness, and if any of these criteria do not apply to you then by all means continue with your plan. Give yourself a pat on the back for finding something that works for you!
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