WHAT TO EXPECT DURING AN INTERNAL EXAM WITH A WOMEN'S HEALTH PT

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As a specialist in Women’s Health, I am competent in assessing the function of the pelvic floor both internally and externally.  At the time of initial consultation and after a thorough medical history and orthopedic assessment, it is determined if this type of evaluation is necessary to reach your treatment goals.  If so, and consent is given, an internal exam is done manually without the use of any instruments.   Since most of the women I treat are not familiar with this type of evaluation, I thought I would break down and simplify the steps that a Women’s Health physical therapist might go through with you.  

  • First, the examination is  explained verbally with visuals such as pictures and a pelvic floor model so you would know exactly what to expect.  The therapist will talk you through the entire exam, allowing you to connect to your pelvic floor and work as a team throughout the process.
  • Then in a lying down position, your external pelvic floor is assessed visually and tactilely.  Looking for discoloration, movement during active contraction and relaxation, and bearing down of the pelvic floor. 
  • The external pelvic floor is then assessed for sensation and pain.
  • The nervous system is then tested for normal reflexes with touch.
  • Then using a water based lubricant, the internal examination begins.  This is done with 1-2 fingers based on comfort.
  • Tissue is assessed for elasticity, pain and trigger points.  
  • Strength is tested with the patient doing active pelvic floor contractions and relaxations.
  • Prolapse is assessed.
  • Depending upon findings and patient’s tolerance, treatment will also begin at that time.  This could be education to correct a dysfunction, manual work such as applying pressure/scar tissue mobilizations to the painful or restricted areas of tension in the pelvic floor, and coordinating the pelvic floor work with breath and alignment.  
  • At the end of the assessment, a treatment plan is made with the patient for the goals moving forward. 

Personally, I have never done internal work (pelvic exams)  in isolation from other treatment modalities, and believe most therapists are the same.  The internal work is just one component to the overall treatment plan.  I treat the patient as a whole and internal pelvic exam is only a part of that. 

“Our goal as a physical therapist is to get your body to work as optimally and efficiently as possible to prevent injury and for some people that might include assessing and treating the pelvic floor.”

Having the knowledge that this work exists can be so helpful in recovery of symptoms.  Some clients might need internal work weekly for a few weeks, others only once and some will even continue doing parts of it on their own at home.  It is completely individual, there is no one size fits all approach.

So if you are struggling with pain, incontinence, anorgasmia, recovery from labor or simply want to connect with your pelvic floor, this assessment could be for you. I look forward to connecting with you during a session.

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WHY I OPENED PLUMB LINE PILATES & PHYSICAL THERAPY

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Seven years ago, I opened the doors to Plumb Line Pilates & Physical Therapy. Little did I know that my women’s health practice in Santa Monica, CA would be something that I cherish so dear to my heart. Today, I am so grateful to everyone that has walked through these doors and for my Pilates Instructors and therapists, who ensure that each client receives the best care at the studio. I’ve collected together a few questions I’ve received through Instagram, emails and inquiries about my work and the studio. If you are interested in coming in for Women’s Health Physical Therapy, Pilates, lymphatic massage or a combination of all, I look forward to connecting with you and being a support in your journey to more balance and good health! Xx

 

Why Plumb Line Pilates AND Physical Therapy? 

I wanted to create a space where I could see my patients for physical therapy and seamlessly progress them to a Pilates program if appropriate. Because Pilates is based on building a strong foundation and connection to the mind and body, I knew it would be a perfect fit for my patients. 

 

Do you teach just Pilates separate from Physical Therapy?

As a Doctor of Physical Therapy and Pilates Instructor, I utilize Pilates based exercises as part of my approach, as I believe it is the ideal adjunct to physical therapy. Therefore when I see patients there is always an underlying therapeutic angle or treatment during the Pilates portion. When my patients reach a point when we both feel they are ready to continue to further their strengthening with traditional Pilates, I transition them to one of my trained instructors. This can be while they are continuing to see me for treatment or after, it is a case by case basis. 

 

Do you offer Pilates classes? 

We do offer small classes, often referred to as semi privates since they are 3-4 people only. Community is important to us as Plumb Line, and these classes offer that sense of connection, as well as make it more accessible. We hope to continue to expand them as the need grows!

 

If I start a Pilates program, could I still see you for Physical Therapy say after my first Pilates session or vice versa? 

Absolutely! Some clients who want to start with Pilates but would like to make sure that they are cleared for this type of movement first or if they have questions/concerns regarding any previous injuries, they can have an Initial Consultation with me before or after their first Pilates session. This sometimes is a great option as it helps the Pilates Instructors at the studio ensure you get the most out of your Pilates program. But again, each case is individual, and we work together to create the best approach for you. 

 

How long would you expect to see patients?

As there is no one size that fits all, it really varies from patient to patient. My overall objective in my women’s health practice is to instill the education and confidence in my patients and teach them that they are their own healers. An ideal situation is they come in for a few sessions, I teach them tools in the studio and for home use, incorporate some Pilates and other healthy resources and send them on their way knowing I am always available for them. I am also launching videos this winter to make it even easier for my clients to get the tools in the convenience of their own home which I am so excited about.

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WHAT IS A WOMEN'S HEALTH PT?

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The practice of physical therapy has greatly evolved over the years.   Along with most other fields of medicine, physical therapy continues to become more and more specialized. More than ever before, physical therapy has also branched into areas of wellness and prevention that has allowed patients to continue their overall health long after recovery.  

Being exposed to a Women’s Health course in my Doctorate program, I immediately knew that was the speciality I wanted to achieve.  After passing my board certification and attending many continuing education courses, I became a Doctor of Physical Therapy and Board Certified as a Women’s Health Clinical Specialist. 

But exactly what does that mean?  What is a Women’s Health PT specialist and why should I see one? How could this possibly benefit me? 

As a Women’s Health Physical Therapist, our goal is to optimize function as it relates to the pelvic floor.  A Women’s Health Physical Therapist is competent in treating women who have had any pain, dysfunction, surgery or anything associated in their abdominal and/or pelvic region.  This might include, but not limited to, issues in and around pregnancy and delivery, pelvic floor pain, incontinence, anorgasmia and more.  And because the proper function of the pelvic floor is a key component to the core system, many other orthopedic concerns such as hip or back pain, can be treated by a Women’s Health PT as well. 

A Women’s Health physical therapist will take you through a thorough medical history,  assess your posture, strength, flexibility, movement, gait, viscera and pelvic floor function through an internal pelvic floor exam if appropriate.  Nutrition and lifestyle is also a key component to Women’s Health and wellness, so will therefore also be addressed and incorporated in the treatment plan. 

In today’s society many women’s health issues such as back pain during pregnancy, or incontinence after pregnancy are easily brushed off and considered “normal”.  When in fact, these symptoms might be very “common”, they are not “normal” at all.  I’m here to tell you that you can live pain free after giving birth. That you can continue to have mobility in your upper body post mastectomy. And you don’t need to leak urine every time you laugh.  Symptoms or no symptoms, a Women’s Health Physical Therapist can guide you to feeling like your best self and connect to your inner core.

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