Elvie has made me fall in love - for the first time ever with a pelvic floor device

Most people can agree that having a pelvic floor that does its job is desirable, many people struggle with knowing how to optimize their pelvic floor muscle function.

The opinions about how to do a pelvic floor contraction, how many you should do, and why you should do them vary dramatically.

So what is a lady to do?  There are an abundance of items that offer to help improve pelvic floor strength, cure incontinence, and give you better orgasms!  Sounds like a win-win-win !  So why aren’t we all continent and having fantastic orgasms?  This post will address the various products that are out there for ‘pelvic floor strengthening’.  These products range from vaginal weights, Ben Wa Balls, vaginal barbells, electrical stimulation machines, to biofeedback machines.

While some of these products work wonders, some women discover that the device they’ve chosen don’t work for them.  Why might this be?  I propose 3 simple possibilities:

1)   The device is not addressing the issue that needs to be addressed.

2)   The device is being used improperly.

3)   The device is not being used.

The pelvic floor muscles are just that:  muscles.  To function properly, the muscles need to be properly innervated, have good coordination ( the ability to contract and relax), and adequate strength. 

I’m skeptical by nature about ‘new’ products, and the idea that they can really help a woman improve her pelvic floor function. (Notice I said ‘function’, NOT strength).  I’m skeptical, but I have my reasons - I've been a pelvic floor Physiotherapist for over 10 years now. I've watched products come and go.  I've also helped clients sort through the products online, trying to find the one that would make working on their pelvic floor fun and effective.  I've also chatted with those people later, and even if their pelvic floor issues have resolved, they admit that they've not used the product that they had invested so much time and money in purchasing.

Any of the devices I mentioned, both the weights and the biofeedback, can be used improperly.  Weights don’t work well if you don’t know how to contract your pelvic floor properly.  Biofeedback typically works one of two ways – via EMG (electromyography ) or using pressure.  Both of these devices typically involve inserting a sensor (hard plastic or a air-filled balloon), which is then connected to a handheld monitor via a cord or tube.  If the set up already sounds a bit complicated, it can be.  Getting the sensor positioned properly, making sure all of the wires are connected, and get the monitor into a position where you can see it, and then start to actually do your pelvic floor contractions can be time and effort intensive for some people. 

Once everything is situated and you’re ready to work, you need to consider what information you’re actually seeing about your performance.  EMG biofeedback units will show you the relative change in the electrical activity in your pelvic floor muscles.  This sounds high tech, but unfortunately it’s not as scientific as it may sound.  These units utilize surface electrodes that are inserted into the vagina (or rectum).  This means that the information is general – it’s not necessarily the muscle activity of the pelvic floor, but a general report of the activity in the area.  There are several ways to get inaccurate readings, which may lead women to believe they are performing better (or worse!!) than they actually are. 

Pressure Biofeedback has challenges as well.  There are many variables that can skew the readings of a vaginal pressure biofeedback – holding one’s breath or pushing down (instead of contracting the muscles) can all give the appearance of a pelvic floor contraction.

Even if these devices were highly accurate in giving feedback regarding pelvic floor muscle function, the cumbersomeness of set up and multiple components to keep clean would challenge even the highly motivated consumer. 

So is there a product out there that I would recommend to my friends and clients?  There is now!  I’d like to introduce you to Elvie!

Again, I tend to be a skeptic.  I was given an Elvie to try from the brilliant ladies at the Women’s Health Foundation.

I opened the box, and I’ll be honest – it’s adorable.  Simple packaging, and the device itself is sleek and elegant.  Elvie comes in a little storage container, which is also the way you charge the device.  I was impressed so far…. 

But how does it work?

I charged it up, and downloaded the app to my iPhone.  There were just a few steps to set up the app, and I was ready to give this a go. 

I settled into a treatment room, and started to follow the instructions on my phone.  Once the Elvic is inserted, it sets about connecting to my phone via Bluetooth.  NO WIRES!!  I can move around comfortably without worrying about yanking anything out or breaking expensive equipment.  I can even stand up and move around a bit! 

I’d like to speak for a moment about the comfort of Elvie.  It’s covered with a medical grade silicone (so no latex!), and was so comfortable.  The size for me was comfortable, and many women would be able to accommodate the device as is.  However they also include a silicone ‘custom sizing’ sleeve in every unit.  More on that later.

Comfort and convenience?  Check

Not scary or hard to use?     Check

But does it actually work??  In my opinion – yes.  Very well, in fact.

I was taken through a set up phase, and then my first work out.  I appreciated the fact it was assessing both endurance holds, as well as ‘quick flicks’.  We were off to a good start, but it got better….

During the long holds, I tried to cheat.  When a contraction is done properly, there is a red gem that is lifted.  It sets your ‘goal’ during the set up, so you have a target to hit.  I wanted a good grade, so I did my best on the first few reps. Now to see if I could fool Elvie….  I squeezed my knees together.  I pulled in my ads.  I held my breath.  I pushed down.  The only way I could make that gem move was by doing a proper contraction.

I was further impressed when I moved onto the agility portion of the training.  Reminiscent of Space Quarks (a video game of my youth),  red gems streamed across the screen, and it was my job to contract at the right times to hit those gems.  It was a really good challenge, but the feedback I got was amazing….  Guess who wasn’t relaxing all the way between contractions?  This girl.  Guess who encouraged me to relax more?  Elvie. 

My most consistent complaint about pelvic floor contraction (or Kegels) is that the emphasis tends to be on the contraction.  The other units don’t really give accurate feedback on relaxation, and there are no norms.  I love that Elvie takes into consideration that the relaxation is just as important as the contraction in a healthy pelvic floor!

At this point, I was very impressed with Elvie.   So impressed that Sandy and I agreed to meet with a representative, Hannah, from Elvie.  What I learned about the product and the company only increased how excited I am about this product. My 2 favorite points? 1)   Elvie comes with a ‘custom sizing’ sleeve, for women who may need a slightly larger device to stay in place.  The sleeve is included with each unit.  The thoughtfulness of this almost brought me to tears.  Hannah explained that there were 2 women in the testing groups who were more comfortable with a slightly larger device.  They developed the sleeve, and decided to include it with every unit, rather than creating a situation where a woman would have to request a larger size.  Pelvic health can be awkward for some women, so I’m grateful they’ve removed one barrier for women to get a device that fits appropriately.

2)   During my attempts to cheat the results on Elvie, I did not know that if I cheated enough, Elvie would recommend consulting a pelvic health physiotherapist for some assistance before continuing the program.  How amazing that a device has been developed that not only figured out a different way to measure pelvic floor strength and coordination, but to also to recommend whom to seek help from.  You’re not sick if your pelvic floor doesn’t work well.  You just need a person who is an expert in pelvic floor function to help guide you, and that person should be a pelvic floor physiotherapist.

Has the Elvie been extensively studied in pelvic health?  Do we know long-term outcomes?  Not yet.  But they are gathering data, and working with health organizations in the UK to improve pelvic health on a larger scale.  The design is elegant, clean (literally and figuratively), the set up and use is intuitive, and the method by which the pelvic floor performance is assessed is advanced far beyond what  other pelvic floor biofeedback units have to offer.  I can say happily that is this is the first device for pelvic health that I’m truly excited about on every level!

You can learn more about Elvie on your own at their website.  If you'd like to see one in person, they were nice enough to give us a demo unit to have at Entropy!  Shoot me an email, and I'm happy to show you how it works!  We've even been given a code to give you $20, if you decide to try one out yourself!  A pelvic floor therapist can help you learn what you need to do to address any of your pelvic floor concerns, and if you need any other interventions before using Elvie.  We're happy to offer guidance, if you feel like you need some!  Good luck! 

Thanks for reading,

Sarah

Medically Induced Healthcare Issues

Healthcare can do better....

This weekend I had the good fortune to attend a wonderful course, Comprehensive Management of Bowel Dysfunction. As a pelvic health physio, patients with gastrointestinal, digestive, and bowel issues are always challenging. And the fact of the matter is, if you ask your patients (even the ones coming to see you for their knees), they’d tell you about their bowels.

As much as I love talking about bowel issues, one of the most profound things that I experienced in this class was a completely comfortable, completely pain-free vaginal and rectal exam. That’s right, even the rectal exam.

It got me thinking about what my patients go through on their quest for health. The exams they experience, the things that they are told about their condition, and the testing they must endure are unfortunately unhelpful. Many patients will come into the clinic ‘worse’ after visiting their physician for a recheck, or after undergoing ‘further testing’. Why are the examinations and tests people are put through making them worse?

In our clinic, we’ve started referring to these as ‘medically induced conditions’.

We unfortunately see this often. Patients traumatized following their medical interventions or hospitalizations or physical therapy treatments. Why does this continue to happen?? Is it necessary to ‘get worse before you get better’? Is it necessary to endure further testing? Here are some thoughts and questions for patients and clinicians to ponder. I hope it makes clinicians (physios, physicians, anyone touching a patient ever) reflect and reconsider their actions/suggestions/prescriptions. I hope it makes patients speak up if they’re being hurt.

1. If you poke anything hard enough, it’ll probably hurt. This goes double for poking into any orifice.
2. Poking something hard enough to make it hurt won’t necessarily tell you what to do to help that person. Especially if the person has already told you, ‘it hurts if this bit gets poked’.
3. Testing should be done to help rule out red flags, or to help direct the plan of care.
4. Patients should understand why they’re having a test, and understand how the results will impact their plan of care.
5. Clinicians should take the time to make the healthcare experience better. Make the patient comfortable. Take the time to explain what you’re doing. Take the time to answer the questions. Pay attention to verbal and non-verbal indications that what you’re doing to them is causing pain.
6. If a patient says ‘ouch, that hurts’, or they’re squirming on the table, stop hurting them. Take a minute and reflect on what might be happening, and why in spite of your perfect technique this patient is not feeling better.
7. If a patient isn’t getting better, doing whatever you’re doing harder, deeper or more often isn’t likely the answer.

I have a hopeful heart, that even when patients have negative healthcare experiences, the healthcare practitioners are basically good people with good intentions. There are a lot of us who also fancy ourselves to be wonderfully qualified: specializations, advanced degrees, conference and course attendance trying to acquire new knowledge, new skills, and new evidence to educate those patients. Professional development (heck, learning in general) should be life-long. However that knowledge should not replace common sense and good manners.

Your Vagina is Awesome….

Even after 3 kids. Even after menopause. Even if you didn’t know how awesome it is.  

As a pelvic health therapist, it amazes and saddens me that in 2014, women are still ashamed, self-conscious, and confused by their lady bits.

I’d like to address a few of the myths and inaccuracies that I’ve heard, in and out of the clinic…

1) It can be a challenge to see your vagina. – The vagina is essentially a hallway from your uterus to the outside world. It’s a hallway that can stretch. A lot. If you can see your vagina without trying, you might want to see a physician… Vaginal prolapse can happen, and it would need to be addressed.

2) The parts you can see vary much from person to person. And I’ve never seen an ugly one. - The first thing most of us run into if we’re to take a peek at our genitals is the labia majora. If we separate those, we’ll be able to see the labia minora, clitoris, as well as the vaginal opening. These bits do change with arousal, childbearing, and age. If you’re curious about what ‘normal’ is, I recommend the documentary The Perfect Vagina.

3) The vagina is not the same as your pelvic floor. – The pelvic floor muscles are a group of muscles that are located in the bottom of your pelvis, spanning from your pubic bone, to your tailbone, and out to each ‘sits bones’. The pelvic floor has 3 openings for us ladies: (starting from the front) An opening for our urethra to urinate, an opening for our vagina (for sex and childbirth), and finally our anus for defecation. The pelvic floor also plays a role in respiration and core stability. Bladder, bowel, and sexual function can all be impacted by pelvic floor muscles that are not functioning up to par, which brings us to my next point.

4) Having a baby can greatly impact the function of your pelvic floor muscles. There’s much to say about this…

1. If you give birth vaginally, you’re pelvic floor muscles stretch more than any other muscle at any time in your life. It is one of the wonders of the world that a woman can pass a child through her pelvic floor, and more often than not, regain fairly good bowel and bladder control quickly, and resume sexual activity in as little as 6 weeks.
2. If you give birth via C-Section, you did not get the ‘easy way out’. Studies show that pelvic floor dysfunction (bowel, bladder and/or sexual dysfunction) are just as high in women 12 months after a C-section as they are in women who have a vaginal delivery.
3. Some women recover more quickly than others. Some women just think they’ve recovered. There are several common things that women experience after childbirth, such as incontinence or painful intercourse. These are certainly common, but should not be considered ‘normal’, and therefore ignored. There is much to be done to improve these symptoms, and I’d seek out a qualified pelvic health therapist to get an assessment as soon as possible.

5) Even if you haven’t had a baby, it’s ok to get help for pieces that don’t seem to be working as well as you’d like. - Sometimes things aren’t as good as you’d like. Yep. I’m talking about sex. Lack of enjoyment, lack of desire, lacking the ability to have orgasms… These can be more complicated, but not impossible to address. Identifying the different pieces that may be contributing to the situation is key. There are physical, medical, mental and emotional issues that can contribute in various ways to sexual dysfunction. Understanding what your bits are, and what they’re supposed to be doing can go a long way in decreasing fear and anxiety relating to sexual dysfunction/lack of enjoyment.

If you find yourself in a situation where you don’t love your vagina, get help. Don’t assume nothing can be done, and don’t suffer in silence. If you’ve not had a physical lately, I’d recommend you check in with your gynecologist. If you feel like you can’t talk to them, or feel like you’re not being heard, don’t give up. We’re happy to offer some suggestions on a starting point for you to start your journey to better sex.

Men Have Pelvic Floors, Too…

I’ve considered myself a ‘pelvic floor therapist’ for about the last decade. That’s a long time, but it’s amazing how little the public and the medical community knows about this area of physiotherapy. Many people have heard about “Kegel exercises’, usually in relationship to preventing urinary incontinence after childbirth. In fact, I’m usually called a ‘Women’s Health Therapist’. Not very fair to all of the gentlemen who’ve been sent to me over the years for various pelvic issues…  

In an article currently ‘in press’, Andrew Siegel, discusses the benefits of Pelvic Floor Muscle Training (PFMT)(what Kegels really are) for male pelvic issues. The pelvic floor is a group of muscles that run from the pubic bone in the front, all the way back to the coccyx and sits bones, and are instrumental in bowel, bladder, and sexual function. The pelvic floor muscles are skeletal muscles, just like our biceps and quadriceps. And like all skeletal muscles, exercises can be done to improve the strength, tone and coordination of the pelvic floor muscles.

So what might happen if these muscles get stronger or more coordinated? It’s been found that pelvic floor muscle exercises can improve symptoms of Stress Urinary Incontinence, Overactive Bladder, Postvoid Dribbling, Erectile Dysfunction and Ejaculatory Dysfunction.

PFMT can help decrease or eliminate stress urinary incontinence (SUI) by increasing the tone, strength and endurance of the pelvic floor muscles. As a result, the external urinary sphincter (which lives in the pelvic floor and helps maintain continence as the bladder fills) becomes stronger, and the reflexes that help all of us maintain continence become more robust. Improving the tone of the pelvic floor (and indirectly impacting the strength of the guarding and cough reflexes) can assist not only in SUI, but also with post-prostatectomy UI.

Overactive Bladder (OAB) is the presence of urinary frequency, urgency, and nocturia with our without urge incontinence. There are many factors which can contribute to that ‘gotta go’ feeling. Once infection and prostate issues have been ruled out, there’s a good chance that learning how to manage your bladder with PFMT will be an effective choice of treatment. There is a muscle surrounding the bladder called the detrusor. This is a smooth muscle that should be relaxed while the bladder fills, while the sphincters and pelvic floor contract gently to maintain continence. (Imagine holding a water balloon closed with your fingers). Then, when the time is right, you go to the bathroom to urinate. You would relax your pelvic floor, and the detrusor would contract to squeeze the urine out. (Now imagine letting go of the balloon, and squeezing all of the water out).

Sometimes, for various reasons, that bladder will start to contract inappropriately, giving an urge to void. Sometimes it’s because we’ve ingested bladder irritants, sometimes it’s because the pelvic floor doesn’t know how to let go, or sometimes the detrusor has just been trained to contract too often. You can use your pelvic floor to retrain the detrusor by reinstating the natural rhythm of ‘pelvic floor relax/detrusor contract-pelvic floor contract/detrusor relax’.

Post-void dribbling is an issue that arises from time to time for men, which is the loss of urine immediately or shortly after completing urination. The male urethra is much longer than the female urethra, and sometimes urine will become ‘stuck’ in the urethra. Using the pelvic floor, one can learn to successfully expel urine completely to avoid post-void dribble.

Now, let’s talk about sex. The penis (to quote the article) ‘is a marvel of engineering’. It has the ability to increase its blood flow by a factor of 40-50x over baseline. Without going into too much detail, there are many factors that contribute to erectile difficulties. Blood flow is one of these factors. For a successful erection, followed by a successful ejaculation, having a healthy pelvic floor is very helpful.

Wow! Then why aren’t Pelvic Floor Muscle Exercises recommended more often?? Part of the reason may be the medical culture in our country. Lifestyle improvement measures and exercise programs may be recommended, but as with any other area of our lives, not always easy to follow through. Medial professionals tend to recommend a surgical or pharmacological intervention, which may at first appear to be the ‘quick fix’ patient are looking for. Another obstacle is that these exercises are frequently done incorrectly, as physicians don’t have the time to properly instruct patients and pamphlets have been found to be ineffective in teaching proper technique. This article was a lovely summary of how pelvic floor muscle training is beneficial for some male pelvic issues.

There are some situations when pelvic floor exercises may or may not be able to help. How might one decide if pelvic floor muscle training will be helpful? First, see your physician for an assessment if you have any sudden changes in bowel, bladder, sexual function, or begin to experience unrelenting pelvic pain. Your physician can assess your general health, and run necessary tests to rule out any ‘red flags’. If the physician cannot find anything that needs to be addressed, like an infection, then physical therapy is a great option.

A trained pelvic floor physical therapist will be able to assess a person’s complaints (incontinence, decreased ability to empty bladder, fecal incontinence, pelvic pain, prostatitis), as well as assess the function of the pelvic floor: ability to contract, ability to relax, strength, sensation and coordination. It’s important to asses the person as a whole, not just how the pelvic floor works, but how does it work in conjunction with breathing, posture, as well how these things impact a patient’s symptoms and communicate these findings back to the physician. Doing PFMT correctly is the first step in determining if PFMT will be beneficial for you. Learn to do them properly by finding a pelvic floor physiotherapist .

Part of an Interdisciplinary Team

When Should Health Professionals Refer a Patient to Women’s (and Men’s) Physical Therapy? Thanks to the great job by the LA Times there is renewed interest and increased visibility around the too-often taboo subjects of peeing, pooping and sex. It’s not necessary to suffer these problems in silence or shame, and there are qualified professionals who can help you find the care, support and courage you need. You can recover your health!

What is this special kind of Physical Therapist?

Physical Therapists who specialize in pelvic health are a key component of an interdisciplinary team. We do a musculoskeletal screen of the spine, pelvis, legs, check on breathing and coordination, PLUS we know how (and when) to do an internal pelvic examination to determine how the internal pelvic muscles are doing. It’s not all about Kegel’s - a healthy muscle can contract AND relax. If the problem is an unrecognized/unaware pelvic contraction then there is a need to learn to lengthen/relax and recover the nuance and bounce of the pelvic muscles. Specialized Pelvic Health therapists also understand how complex pain is, and respect that pain in the pelvic area comes with additional complexity. We can do our evaluations and treatments with pain science underpinning our treatments and help to calm a sensitive nervous system. (No Pain and Plenty of Gain).

How would you know WHEN to refer a person to a Women’s (and Men’s) Physical Therapist?

Part of a routine examination gives the clues:

• Urinary Incontinence (Stress or Urgency/Frequency)
• Pain in the genitals
• Pain with intercourse
• Unresolved Hip/SI pain in the absence of pathology
• Fecal Incontinence
• Back/hip pain in pregnancy
• Heaviness or pressure in the perineum (Pelvic Organ Prolapse)

Any of these problems should be evaluated by a specialized physician, typically a Urogynecologist, Urologist or Gynecologist. Once pathology is ruled out, the next step should be a Physical Therapist that specializes in pelvic health. That’s a bold statement – read on!

Sex should never hurt – there are a variety of reasons why it might, and pain neuroscience education combined with careful graded exposure to tissue stretch and fitness, manual therapy and consultation with a qualified sex therapist if needed will help restore not only tolerance to sex, but the enjoyment and glorious benefits associated with orgasm.

It is not normal to leak urine, although it is common and 1 in 3 women report this problem. Stress incontinence and Urgency/Frequency respond to education and training. Physical therapists can design a program to regain control and restore function. Some more information is here and here.

It is not normal to leak stool either, or to be constipated. Bowel health can be a bit complicated and we typically work closely with a physician to ensure bowel health and interdisciplinary treatments. We’ve addressed this previously here.

Pain in the perineum is to be taken seriously and treated (labia, testicles, penis, vaginal or rectal pain). After a good evaluation by an MD to rule out pathology, you should come to see a pelvic health therapist. We know that pain is 100% a protective response that may not have as much to do with the tissue health as we think. There’s a patient education book underway that will address pelvic pain from a biosphyscosocial perspective – which is what the pain science literature is pointing to as the most effective way to treat pain. In the mean time, we love this video.

Low back, hip or SI pain that isn’t responding to treatment may involve a coordination issue that includes the internal pelvic muscles. Normal movement is a combination of multiple systems and sensory awareness, the pelvic muscles are important in this symphony of motion. If things aren’t getting better, consider an internal pelvic evaluation to see if the pelvic musculature is coordinated, supple and able to both contract AND relax.

There may be a strong sense of hesitation to talk about these things – by the health professional and by the person experiencing it… but since we can make a difference in a persons most basic necessity of life – don’t hesitate to refer!

Where would you find a qualified therapist?

The American Physical Therapy Association and the Section on Women’s Health have locators to find qualified therapists in your area. There are growing lists in Canada, the UK and Australia as well. If there isn’t a qualified provider in your area it may be worth a phone call or consultation with the closest you can find. We can help, often we will see measurable change in 2 or 3 weeks.

What can we do to help?

How would an orthopedic Physical Therapist know when to refer a patient to a Women’s (and Men’s) Physical Therapist? This question came up on Twitter today and we think it is a great one.

Part of a routine orthopedic physical therapy examination should include checking for common Red Flags:

• Incontinence of bowel or bladder (Stress or Urgency/Frequency)
• Pain in the genitals
• Sexual dysfunction including pain with intercourse
• Unresolving Hip/SI pain in the absence of pathology
• Back/hip pain in pregnancy
• Heaviness or pressure in the perineum (Pelvic Organ Prolapse)

If a Medical Doctor has already seen the patient and pathology is ruled out, the next step should be referring this patient for a consultation or treatment with a Physical Therapist that specializes in pelvic health.

What is the difference?

A physical therapist who specializes in women’s and men’s health will be able to do an internal pelvic assessment that may include:

• Coordination of the pelvic muscles and the ability to contract and relax.
• Tissue mobility, the pelvic muscles should be non-painful.
• A detailed history of bowel and bladder function and habits.
• Assessing the ability to integrate the pelvic muscles in normal activities.
• Reassuring the patient that it is never normal to have pain during sex, incontinence can be helped by a well-designed program, and it is never normal to leak.

Where would you find a qualified therapist?

The American Physical Therapy Association and the Section on Women’s Health have locators to find qualified therapists in your area. There are growing lists in Canada, the UK and Australia as well. If there isn’t a qualified provider in your area it may be worth a phone call or consultation with the closest you can find.

Sexual Dysfunction…. There is help!!

Defining sexual dysfunction: Sexual dysfunction or sexual malfunction is difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including physical pleasure, desire, preference, arousal or orgasm. … http://en.wikipedia.org/wiki/Sexual_dysfunction

Our sexuality is an intimate and private part of our lives. Messages from media, friends, and partners combined with complicated cultural and societal norms come together to form our assumptions about sex. It is something we don’t often freely discuss. This is especially true when bits and pieces aren’t working how they should.

Sexual dysfunction can be a difficult topic to broach with health providers. Understandably, the sterile lights, thin walls, and chaos of a doctor’s office can discourage an already sensitive topic.

That is why we created Entropy Physiotherapy. We have created a warm, welcoming space that invites dialogue about sexuality. The truth is many men AND women suffer from sexual dysfunction. We recognize this and it is something we address daily here at Entropy!

So how can physical therapy help you to regain your sex life?

The definition of sexual dysfunction is broad, and there are many different factors that may be impacting your sexual function. Emotional, hormonal, physical and psychological influences can all impact your sexual function.

We understand you may be surprised to know that physical therapy works with people just like you who for one reason or another aren’t experiencing sex in the way that they should. A physical therapy treatment with Sarah or Sandy will include an assessment of the pelvic muscles. We are confident that we can help you to restore normal muscle function by identifying, relaxing, and retraining any muscles or groups of muscles that are short, tight, in spasm or otherwise not behaving nicely.

By Anne Shea, SPT