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Who Can PFPT?

April 21, 2023

Erin MS Warner

That’s a weird sentence, but it’s a common question, not just for patients but for therapists alike. Why?

Pelvic floor physical therapy (or PFPT) is a specialty among physical therapy. However, due to the variety of symptoms and indirect

approaches that can be taken to address those symptoms – and their causes – most any physical therapist (PT) and/or physical therapist assistant (PTA) can treat most patients.

Our education and training teaches us to find a root problem and address it with manual techniques (think massage, myofascial release, joint mobilizations), body movement education (A.K.A. exercise), and proper breathing techniques with movement. All of these techniques are used for pelvic floor patients as well as your “typical” orthopedic patient.

But aren’t symptoms more directly related to pelvic floor muscles? The answer: It depends. 

Pelvic floor muscles can be influenced by how someone moves, in particular their gait, how they lift something, their posture, how they breathe. These are all fairly indirect reasons for a pelvic floor problem. Not everyone likes or wants a direct approach with PFPT (internal assessment). Though it can take longer to heal, the outcome is the same: a change in bad habit to a better habit, meaning more efficient body function. 

Now there are cases where a pelvic floor patient does need internal assessments and work. For some, symptoms are so chronic or so debilitating that the best treatment method is internal work (more often a release of a muscle knot, or trigger point). It’s like if someone has arthritis: no matter how often you exercise or how much you stretch, there is only one way to remove arthritis and that is surgery. But again, even if direct treatment is the best option, you as a patient have the right to choose whether you’re comfortable with the direct or the indirect approach.

Ok, so why would therapists not know if they can treat a PFPT patient? 

Overall, PFPT is a speciality. It’s a matter of understanding that the indirect approach to PFPT treatments are the same as dealing with an orthopedic patient. It can be very intimidating for a PT or PTA who is used to working on knees or shoulders to”work on” pelvic floor issues. Sessions are also more geared toward one-on-one time that many outpatient clinics do not have due to the structure of that particular business. It’s not a bad thing, but it is a reason. 

PFPT is a subtle treatment method, a quiet and nuanced work. It takes a slightly different approach to seeing the symptoms and addressing them versus the “in-your-face” problems of an orthopedic outpatient clinic. It’s the difference between, “his shoulder hurts because he just had a replacement surgery,” or, “her knee hurts because she blew out her ACL during a soccer match,” versus, “I’ve had tailbone pain for twenty years and I don’t know why.” There’s a lot more detective work to do.

My goal for this post is to reduce the intimidation factor for both patients and therapists alike. If you are or working with a therapist who is new at treating pelvic floor issues, they already know how musculoskeletal structures work (which are pelvic floor muscles), how to teach you how to breathe, what is good posture/alignment. Once all the pieces align, it’s just like any other typical PT session.

Thanks for reading.

Erin MS Warner is a Physical Therapist Assistant and a Pilates Instructor trying to help people feel more like themselves since 2016.

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