Wellness begins in the Pelvis

Heal and hope again

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Pelvic Health Physical Therapy, sometimes shortened to Pelvic PT, has been an established specialty field in the profession of physical therapy since 1977.

 

Advanced certifications in pelvic rehabilitation, such as the PRPC, BCB-PMD,  and WCS, became available in the early 2000s. 

 

If you would like to learn more about the history of Pelvic PT,  click here to see an interactive timeline from the American Physical Therapy Association (APTA).

Pelvic Rehabilitation is a physical therapy approach that focuses on the pelvic girdle and pelvic floor regions and their related dysfunctions.

Pelvic Girdle Dysfunction

Tailbone, Pubic, and Sacroiliac Pain

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Pelvic Girdle Dysfunction refers to pelvic joint issues. 

The pelvic girdle consists of three joints:

  • Sacroiliac joints (right and left)

  • Pubic symphysis (pubic bone)

  • Sacrococcygeal joint (tailbone)

 

While these joints are quite small and have very little movement compared to your shoulder or knee, they are crucial to the body's ability to stabilize itself. 

Common movement issues include pain and difficulty with sitting, prolonged standing, standing on one leg, extreme flexion of the trunk and hips, and wide squat type movements.

Conditions include

  • Coccydynia - Tailbone pain and fracture

  • Sacroiliac joint dysfunctions and alignment issues

  • Pelvic fracture recovery

  • Pubic Symphysis pain

Pelvic Girdle Pain can impact your ability to stay fit.  Pain with walking, running, and cycling is common. 

 

Pelvic Floor Dysfunction

Bladder, Bowel, and Sexual Dysfunctions

 
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Pelvic Floor Dysfunction refers to pelvic muscle issues. 

 

  • The pelvic floor muscles are part of the "core" you hear so much about. 

  • It teams up with the deep back muscles (multifidus), deep abdominal muscles (transverse abdominis), and the breathing diaphragm. 

  • Just like any other team, it's only as strong as its weakest link.  This means dysfunction in one area can contribute to dysfunction in another.

  • The pelvic floor muscles are at the base of the pelvis. They form a sling or hammock shape from the tailbone to the pubic bone and are situated between your sit bones in the underwear area.

  • The pelvic floor muscles support the bladder, bowels and genitals inside the pelvis. They give you bladder and bowel control. 

  • A normal pelvic floor can contract and relax. Your pelvic floor may be weak, tight, or even uncoordinated, just like any other muscle.

  • While strength is important for control and preventing incontinence, the pelvic floor muscles have to relax, too.  If they can’t, you might have trouble emptying your bladder (Urinary Retention) or feel like your bowel movements are obstructed (Obstipation).

  • Dr. Rader will evaluate the function of your pelvic floor muscles by determining their strength and power, endurance, and coordination, as well as the ability to relax. She has decades of experience helping men and women with these difficult and sensitive problems.

  • Pelvic floor muscle therapy under the guidance of a pelvic health specialist, such as Dr. Rader, has been a recognized and highly recommended treatment approach by the American Urological Association since 2014.

Underactive  Pelvic  Floor Muscles

Symptoms of a weak and unsupportive pelvic floor muscle group include urinary and/or fecal leakage, urgent and frequently need to visit the toilet, and getting up often at night. Orgasm strength can also be compromised.

Conditions include

  • Urinary and fecal incontinence

  • Urinary and fecal urgency and frequency
  • Chronic UTIS's

  • Voiding dysfunction (strain to empty, weak stream)

  • Pelvic Organ Prolapse (bladder, rectal, uterine)

  • Post-surgical leakage (prostate cancer, prolapse or incontinence surgeries, hysterectomy, cesarean birth)

Overactive  Pelvic  Floor Muscles

The urethra, vagina, and anus pass through the pelvic floor muscles. If they are tight, tense, or in a spasm, pelvic floor muscles can impede the flow of urine, obstruct bowel movements, and make sex painful.  Sitting pain is also a common issue with a tight pelvic floor.  Pelvic floor muscles are very "protective" and will guard against nearby pain.  That's why overactive pelvic floor muscles are so common with pelvic and abdominal organ pain conditions. 

​Bladder and Urinary Conditions:

  • Interstitial Cystitis

  • Bladder Pain Syndromes

  • Chronic bladder infections

  • Urinary and urethral pain

  • Urinary Retention issues

Bowel and Anorectal Conditions:

  • Constipation

  • Anal pain and fissures

  • Painful Bowel Movements

  • Incomplete stool evacuation

  • Tailbone pain

Genital and Sexual Dysfunctions:

  • Painful sex

  • Vaginismus

  • Dyspareunia

  • Penile and scrotal pain

  • Clitoral pain

  • Vulvodynia and vulvar pain

  • Prostate pain and prostatitis

  • Gender confirmation management

Check out Dr. Rader's bog on overactive pelvic floor dysfunction, "When Pelvic Floor Muscles Attack!"

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Spinal and Hip Pain

How it's related to your pelvis

 

Pelvic Dysfunctions and the Spine and Hip

  • Do you have stubborn low back, buttocks, or hip pain?  Do you have trouble sitting? Researchers estimate up to 30% of “low back pain” is really pelvic pain.

  • The pelvis is the base from which your spine and hips move.  So it makes sense that pelvic dysfunction could impact how your back and leg function. 

  • Very often, Dr. Rader can help you rule out the pelvis as a contributing factor to your hip or back problem.

The Hip and the Pelvic Floor

  • Many traditional gynecological conditions, like vulvodynia, have a higher association with hip conditions. 

  • Many "groin" strains are really pelvic floor muscle and genital pain issues. 

  • Focusing solely on the hip joint and the rest of the leg, and excluding how the hip and the pelvis function together, can lead to the real problem being missed. 

 

Conditions

  • Hip arthritis pain

  • Hip labrum tear

  • Hip impingement syndromes

  • Snapping hip syndromes

 

The Low Back and the Pelvic Floor

  • Low back pain has a very high association with incontinence and breathing disorders. 

  • Dr. Rader will screen your entire core function (deep back muscles, deep abdominal muscles, the breathing diaphragm, and pelvic floor) to determine how well they all work together.

​Conditions

  • Low Back Pain

  • Spondylolisthesis

  • Stenosis

  • Sciatica

  • Herniated discs

  • Degenerative disc disease

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Pelvic Nerve Conditions

Sciatica, Pudendal Neuralgia, and Cauda Equina Syndrome

 

When someone experiences nerve pain in the pelvis, there are 3 areas to consider before an accurate diagnosis can be made. All three can cause pelvic and genital pain.

Nerves from the T12-L2 Region (Thoracolumbar plexus) are often called the "border nerves" because they innervate the area between your abdomen, thigh, and upper pubic region. 

 

  • They can become compressed in the belly or leg crease due to poor posture, repetitive motions, or because of surgical scarring. 

  • Because these nerves come from the mid back and the pain is in the underwear area, misdiagnosis is common. 

  • Dr. Rader can help you find relief due to:

    • Meralgia paresthetica

    • Iliohypogastric neuralgia

    • Genitofemoral neuralgia

    • Ilioinguinal neuralgia

Nerves from the S2-S4 Region (Sacral Plexus) provide sensory and muscle functions to the pelvic floor and pelvic organs.  

  • The primary nerve, the pudendal nerve, is responsible for bowel and bladder control, as well as sexual arousal and orgasm. 

  • The 3 branches span from the anus, to the perineum, and to the penis or clitoris.  They are very superficial, which means when you sit, you are sitting on them.

  • People who sit a lot (desk job, cycling, horseback or motorcycle riding) are at risk. So are weight lifters.  Any pelvic surgery can lead to pudendal nerve irritation.

  • Pudendal neuralgia is also known as Cyclist's Syndrome. Symptoms include tingling pain in the genital region, extreme difficulty with sitting, and disruption of normal bladder, bowel, and sexual functions.

  • Other lesser known nerves also contribute to these functions, and also give control over the gluteal muscles and hip rotators.

  • You can get expert treatment at Rader Pelvic PT for these sacral plexus nerve issues:

    • Pudendal Neuralgia

    • Pudendal Nerve Entrapment (PNE)

    • Post-surgical or post-injection rehab

    • Posterior Femoral Cutaneous Neuralgia (can mimic sciatica)

    • Superior and Inferior Gluteal Neuralgia

    • Obturator Internus and Piriformis nerve dysfunctions

Nerves from L3-S4 (Lumbosacral Plexus) are primarily responsible for lower extremity function.

The Sciatic Nerve

  • Every nerve that innervates your thigh, knee, leg, ankle, and foot passes through the pelvis, and the vast majority of leg nerves branch from the sciatic nerve.

  • If you are experiencing nerve symptoms like tingling in the leg and shooting, electric pain down the back of the thigh and into the foot, you may have sciatica.

  • Dr. Rader does not consider sciatica to be a true low back issue - she evaluates the nerve's function from a pelvic perspective, not as a spinal condition.

The Cauda Equina

  • Did you know your spinal cord ends high in the back at the L1-L2 vertebral level? 

  • Remaining spinal nerves that reach your leg branch off and travel down to the pelvis.  This is called the Cauda Equina because it looks just like a horse's tail.

  • Cauda Equina Syndrome (CES) is a collection of neurological symptoms due to damage to the cauda equina due to compression (usually a herniated disk), infection, trauma, epidurals, childbirth, cancer, autoimmune or connective tissue disorders.

  • Dr. Rader sits on the Cauda Equina Foundation's medical board and is passionate about this poorly understood condition.

  • If you are reading this and you have any of the CES Red Flag Symptoms after sustaining a recent trauma to the butt or back, go to the the emergency room now and DEMAND an MRI

  • Cauda Equina Syndrome is a medical emergency that typically needs immediate surgical correction to spare your bladder and bowel control.  Click here to learn more. 

  • If you have been diagnosed with CES and have residual bladder, bowel, sexual, and pelvic pain issues, know that pelvic rehabilitation can still improve your symptoms. 

Abdominal and Pelvic Pain

Low Front Pain Syndromes

 
Do you have “Low Front Pain?"
Dr. Rader coined the phrase "low front pain" after recognizing the pain and movement dysfunctions in the belly and bottom are very similar to low back pain syndromes. 

 

Many digestive, urological, and gynecological conditions can be painful.  Your organs are surrounded by protective muscles which can spasm and tense up, making your pain even worse.  Dr. Rader applies rehab principles used for back pain to successfully treat the pain and dysfunction caused by these abdominal and pelvic pain conditions.

 

  • Irritable Bowel Syndrome

  • Interstitial Cystitis

  • Chronic Pelvic Pain Syndrome (CPPS)

  • Chronic Abdominal and Pelvic Pain Syndrome (CAPPS)

  • Endometriosis or Adenomyosis

  • Recurrent Prostatitis

  • Painful Abdominal Pelvic Scars or Adhesions

  • Unresolved pain from abdominal, urological, and gynecological surgery

Woman in Pain