A woman's body goes through many physical changes before, during and after childbirth, with many of these changes being accompanied by pain. With all the other emotions and physical changes during this time (lack of sleep, excitement over the new baby, spending time with visitors, learning how to be a new parent, etc.), having to deal with pain is the last thing a new mother wants to add to the mix. Pain can be felt in various parts of the body. A combined study (Vleeming 2000) reports the prevalence of low back pain and pelvic girdle pain during pregnancy to be 20%, with 30-50% reporting pain severe enough to lose time from work and social activities (Kristiannson 1996, Noren 1997). Survey of women who delivered within the past 3 months indicates complaints of headaches, low back pain, dyspareunia, legs pain, urinary incontinence, and carpal tunnel syndrome. 37% of women reporting back pain in pregnancy still report back pain at 18 months postpartum (Larsen 1999) while and 8.6% suffered pelvic joint pain 2 years postpartum (Albert 2001).
Anatomical, physiological and hormonal changes during pregnancy and postpartum may become the source of pain and musculoskeletal dysfunction. Physical therapists, as experts in the musculoskeletal system and function, are essential in providing pain relief, optimizing function and promoting a healthy recovery. Physical therapists specialized in pregnancy and postpartum play a key role in education, pain management, positioning strategies, and exercises prescription. While temporary pelvic pain during pregnancy is common and usually not cause for concern, it’s one more thing for an expectant mother to deal with. When pain is due to soft tissue changes, physiotherapy often proves effective for relief. Effective treatment can prevent an increase in pain intensity and may even prevent new pain from occurring.
At PhysioNetics we have achieved the highest level of training in obstetrics physical therapy through the American Physical Therapy Association Section on Women’s Health and are one of two clinics in the State of Florida to hold CAPP-OB certification. We are your local experts when it comes to musculoskeletal disorders caused during pregnancy and postpartum.
Physical therapists are experts in treating the musculoskeletal system (the muscles, joints and the surrounding soft tissues of the body). Physical therapists who are specially trained in women’s health can safely and effectively help women overcome musculoskeletal dysfunctions during pregnancy and the postpartum stages. Many conditions arising from childbirth respond well to treatment. Incontinence may develop during pregnancy and continue afterward with several possible causes. Body changes may cause stress or urge incontinence, or a combination of both. While hormonal changes play a part, weakened muscles and strained connective tissues place physical strain on the bladder. Some problems can arise when a dropped—or prolapsed—pelvic floor no longer supports organs in the same way. Abdominal muscle separation—a condition called diastasis rectus—frequently occurs during pregnancy and birth. This alone can cause many of the complications of pregnancy, including incontinence, lower back pain, pelvic, and hip pain. Treatment under care of the professionals at PhysioNetics can improve the patient’s core strength and pelvic floor muscle group.
Pregnancy Related Conditions We Treat: Sacroiliac Joint Dysfunction Pubic Symphysis Diastasis Diastasis Rectus Abdominis Pelvic Floor Dysfunction Low Back pain Pelvic Girdle pain (excluding pelvic floor internal release) Sciatica Soft Tissue Sprain/Strain Scar Tissue Adhesions Myofascial Pain Muscle Weakness Pain with intercourse Carpal tunnel syndrome Tendinitis Incontinence and urgency of urination Shoulder/arm pain and tingling Postural deviations and concerns Prolapse Coccydynia
Pain and dysfunction in the pelvis may have many underlying causes and can result from a combination of factors. The pelvic organs (uterus, vagina, bladder and bowel), soft tissue and the pelvic joints may produce a specific pattern of pain or pelvic discomfort. Your pelvic pain and symptoms must be discussed thoroughly with your physician to rule out systemic causes or possible problems with the organs. However, the bones, muscles and soft tissues of the pelvis can also contribute to pelvic pain. These symptoms must be addressed properly to ensure effective treatment and optimum outcomes. This is where a physical therapist trained in women’s health can help.
Improper alignment or impaired mobility of the pelvic bones and joints, overactive pelvic muscles, underactive pelvic muscles, and restricted or impaired mobility of ligaments and tendons may cause pelvic pain. Physical therapists are experts in treating the musculoskeletal system. Physical therapists utilize their specialized medical training to thoroughly evaluate each patient and design treatment programs that address the individual needs.Physical therapists that are specially trained in women’s health can safely and effectively help women who suffer from pelvic pain. It is the goal of the therapist to empower the patient and make her a partner in her care. Treatment under care of the professionals at PhysioNetics can improve the patient’s core strength and pelvic floor muscle group.
Pelvic Pain Related Conditions We Treat:
Pain with intercourse Pain with tampon use Pain with internal examination Difficulty with recreational activities Difficulty with normal daily activities Pain the buttocks Pain in the coccyx area with prolonged sitting Urinary incontinence Chronic low back pain Sciatica Abdominal pain
Women with urinary incontinence tend to suffer in silence because they are too afraid or embarrassed to talk to their doctor. Many women, in fact, with this problem assume that the loss of bladder control is a normal part of aging or childbirth. Studies have shown that 50% of first-time mothers and one in three women who have already had a baby experience some urinary leakage. If urinary incontinence is affecting your daily life, you are encouraged to talk to a medical professional. Your family doctor, nurse practitioner, urologist or gynecologist can do a number of tests to determine what type of incontinence you have and what might be causing it. This may include keeping a bladder diary for several days and having a urinalysis and/or blood tests. Further specialized testing may be needed to provide more detailed information.
Physical therapy can help increase awareness of your pelvic floor and teach you to use your muscles properly and incorporate exercises into your daily living in order to achieve optimal pelvic health. At PhysioNetics in Naples, Florida our physical therapists are trained in the evaluation and treatment of pelvic conditions. PhysioNetics can work with you to design a customized program that will help address weakness and spasm, regular bowel and bladder emptying as well as exercises to prevent further injury. Three common techniques that PhysioNetics uses to help improve bladder control are:
Exercises – Many people simply need to strengthen and re-educate their pelvic floor muscles to dramatically improve their symptoms. Gaining greater control over the muscles deep in your lower abdominals can also help improve pelvic floor muscle function. Rigid contractions of both the abdominal and pelvic floor muscles can actually make leaking or pain worse.
Biofeedback – Although many people have heard of Kegel exercises, more than half are not able to contract the right muscles based on verbal or written instructions. Biofeedback can be used in combination with an exercise program to help make sure you are targeting the proper muscle groups. Biofeedback provides you information by a computer screen or a sound that tells you when you are contracting the correct muscles. This enables you to learn how to control the muscles during functional activities in sitting, standing and lying down. It also lets you know if you are fully allowing the muscles to relax. This is a crucial function especially with clients with pelvic pain.
Muscle Stimulation – Sometimes pelvic floor muscles are so weak that doing exercises (even with biofeedback) isn't enough. The muscles need to be physically reminded how to work properly. To do this your Physical Therapist will teach you how pelvic floor muscle electrical stimulation can assist your muscles to remember how to contract. As the muscles start to remember how to work properly, your Physical Therapist will add strengthening exercises into your treatment program.
Behavioral modifications are lifestyle and dietary changes that can significantly reduce your symptoms and improve your overall health. Combining behavioral modifications with pelvic floor strengthening techniques improves the effectiveness of your program. Your Physical Therapist at PhysioNetics may include one or all of the following to help improve your control over your bladder:
Bladder Training – People with incontinence often get into the habit of going to the bathroom too often. There are a number of techniques you can use to gradually increase the amount of time between bathroom trips, including learning how to control the urge to urinate and learning how to empty your bladder more completely. A licensed Physical Therapist can also give you advice on how to modify your daily habits to help you regain control of your bladder. Monitoring what and how much you drink, losing weight and doing regular exercise may also help reduce or eliminate your symptoms.
Relaxation Techniques – Stress, anxiety and tension only make bladder problems worse. Physical Therapists at PhysioNetics can instruct you in breathing, postural and relaxation techniques that can help put you back in control.
If these options are unsuccessful, your Physical Therapist may ask you to visit your healthcare provider or specialist again to discuss other treatment options. These may include medication, acupuncture, pessaries, interventional therapies or surgery.
Urinary Incontinence Conditions We Treat:
Stress Incontinence Urge Incontinence Mixed Incontinence
Dr. Varveris, DPT, with advanced knowledge and training in women’s health, specializes in treatments specific to a woman’s pelvis, particularly conditions surrounding pelvic floor dysfunction, incontinence, pain, pregnancy and postpartum health. Dr. Varveris, DPT, is one of only two physical therapists in Florida awarded the Certificate of Achievement in Pregnancy and Postpartum Physical Therapy (CAPP) from the American Physical Therapy Association Section on Women’s Health. Dr. Varveris, DPT, is also a member of the National Association for Continence. A mother of two, Dr. Varveris understands the demands of pregnancy as well as the benefits of treatment. Contact PhysioNetics whenever you need physiotherapy advice and treatment before, during or after pregnancy. For more information visit: www.womenshealthapta.org or www.nafc.org
Although PhysioNetics Physical Therapy is an in-network provider with some health insurance companies, we are out of network with many others. Many insurance companies require providers to accept 30-40% less than the Physician Fee Schedule rates for their services if they become in network providers. Other physical therapy clinics decide to accept these reduced payments and see more patients with less one-on-one treatment time to make up for the decrease in income. We at PhysioNetics do not consider these viable options. Each of our patients is scheduled for an exclusive appointment time with a licensed physical therapist during which time they receive one-on-one physical therapy care tailored exclusively for them. Unlike other clinics, we utilize the latest technologies in rehabilitation services to facilitate faster recovery, which in the long run will cost you less out of pocket expenses. Since we will not compromise on our level of care, we are unable to accept most insurance contracts. Often times our cash fee is less than your in-patient co-pay requirements. We will be happy to provide you with the proper forms and paperwork for you to submit your claims if you wish to do so. Typically, for patients with high deductibles and copays, it is more cost-effective to pay our cash-pay rates. PhysioNetics sets itself apart from other clinics on the basis of quality of care and we are confident that after your first visit you will realize that you made the right decision to choose us over perhaps an in-network provider. We are sure you will not be disappointed! What is your health, wellness and quality of life worth?