In-home concierge physical therapy services in Orange County CA

Pelvic & Abdominal Physical Therapy Services

Services During Pregnancy

Some common conditions that we can address during pregnancy include:

Back pain
Pubic bone pain (Symphysis Pubis Dysfunction)
Tailbone pain
Urinary leaking (Incontinence)
Pelvic pressure/heaviness (Prolapse)
Painful intercourse
Abdominal separation (Diastasis Recti)
Scar adhesions (Cesarean or perineal)

Treatment is focused on restoring optimal muscle tone, strength, coordination, and flexibility in the surrounding pelvic musculature of the back, abdomen, thighs, and pelvic floor using various manual therapy techniques and exercises.

We can work on the pelvic floor muscles and perineal scar tissue to prevent perineal tearing as well as address any previous cesarean scar tissue to improve your chances of a successful vaginal delivery (VBAC). We can also address appropriate posture, body mechanics, and core stability to prepare you for the increased demands of caring for a baby.

Biofeedback is another tool we can use to assess your pelvic floor and transverse abdominus muscles (see biofeedback info below). You will also be given a home exercise program to maintain your progress in between sessions.

Labor & Delivery Prep Session

I recommend having this session scheduled between weeks 34-36 of your pregnancy but it can also be done before or after these weeks as well. If your partner and any other birth professional would like to attend that would be ideal.

We will review:

Labor positions with biofeedback to determine in which positions your pelvic floor muscles are the most relaxed
Perineal massage techniques to prevent perineal tearing
Partner techniques for managing back discomfort during labor
Breathing techniques with pelvic floor muscle relaxation

Postnatal Services

Once you're postpartum, you're always postpartum, so these visits can be done even years or decades after having your baby to address any of the symptoms below. Ideally, all women would have a physical therapy screening at 6 weeks after birth, right after your 6 week follow up with your OB or midwife. At that visit we would do a full postnatal screening including assessment of posture, body mechanics, scar tissue mobility, alignment, diastasis recti, core stability, pelvic floor muscle tone, strength, and endurance and get you started on a treatment plan to address any dysfunction we find. If you have pain or discomfort before the 6 week follow up, we can address your needs earlier but will not perform any internal pelvic floor muscle work until you are cleared by your healthcare practitioner.

After you have your baby you may experience various discomforts or symptoms including:

Scar pain or restrictions (Cesarean or perineal)
Urinary leaking (Incontinence)
Urinary or bowel urge or frequency
Pelvic pressure/heaviness (Prolapse)
Painful intercourse
Abdominal separation (Diastasis Recti)
Poor posture
Difficulty walking or lifting
Back pain
Pubic bone pain
Tailbone pain

Although these symptoms may be common, they are NOT normal and in most cases can be easily treated with physical therapy.

Other services that can be provided in your home are real-time ultrasound to actually see your deep core abdominal and pelvic floor musculature to teach you the correct recruitment of these muscles for optimal core strength and stability. We can also measure your abdominal separation with this technology and visualize a prolapse.

We can also assess and set up your nursing/feeding station for optimal posture and alignment and body mechanics evaluation and training for childcare activities such as lifting your baby, transfers into and out of the crib, car seat, bath tub, stroller, and any other activities that you would like assessed.

Biofeedback is another helpful tool to use in the postnatal period to help you improve awareness of your pelvic floor muscles by getting visual feedback when you contract and relax the muscles. We can also use this as you perform functional activities to make sure you are activating your pelvic floor when needed.

Physical Therapy Treatments Provided:

Each treatment session typically includes a combination of manual techniques including myofascial release, trigger point release, strain-counterstrain, scar tissue mobilization, visceral mobilization, muscle energy techniques, proprioceptive neuromuscular facilitation, neuromuscular re-education and exercises including core stabilization, therapeutic exercise, postural education, and body mechanics training.

Biofeedback is another tool that we can use in your home to assess and treat your pelvic floor and transverse abdominus muscles. This is a tool that measures nerve activity in your pelvic floor muscles and then transmits it to a computer so you can see your pelvic floor muscle activity on the screen as your muscles contract and relax. It provides a great visual for you to see the strength, endurance, and relaxation of your pelvic floor muscles during kegels. We can also use it to monitor both your pelvic floor and transverse abdominus activation during functional activities like lifting, squating, lunging, childcare activities, and exercise to determine if you are using your core muscles appropriately both during pregnancy and postnatally. Another great use of this technology is to assess labor positions while you are pregnant to see what positions allow you to relax your pelvic floor muscles the most so you can use that information while in labor.

Real-time Ultrasound is an additional tool that we can use to assess the abdominal musculature to measure diastasis recti and view the layers of the abdominal muscles to train them for optimal recruitment. With this technology we can see how the transverse abdominus, internal obliques, and external obliques are recruiting and in what order to be able to properly rehab the abdomen to get the results you desire. This technology can also be used to visualize pelvic organ prolapse, bladder, and rectal capacities to address any other pelvic organ, bladder and bowel issues.

For more information on what to expect during a session, please take a look at my article, "You’re putting what, where? Women’s health physical therapy for pregnancy, labor & delivery, and the postnatal periods"