Pelvic Health
Pelvic floor dysfunction occurs when there are impairments of the trunk, pelvis, or hips, and difficulties with the bowel, bladder, and sexual health. These issues include urinary & bowel incontinence, constipation, pelvic pain, painful intercourse, pain related to pregnancy, lymphedema, and post-cancer treatment (radiation induced vaginal stenosis, pelvic pain, post-mastectomy). Women, men, and children experience incontinence and pelvic pain. It is estimated that 25% of females in the United States have some form of pelvic floor dysfunction.
Incontinence
Incontinence is defined as the involuntary leaking of urine or bowel, usually as a result of underactive pelvic floor muscles. There are many types of incontinence, but most fall under the categories of urge, stress, and mixed incontinence. Urge incontinence occurs when one has a sudden desire to pass urine, which is difficult to defer. People with urge incontinence generally report having a difficult time “making it to the bathroom”. Stress incontinence is leaking that occurs when one exerts an effort (such as moving, exercising, or jumping) or has a sudden increase in abdominal pressure, such as during laughing, sneezing, or coughing. Mixed incontinence has characteristics of both urge and stress incontinence.
Causes of incontinence include injury during childbirth (both vaginal and cesarean deliveries), obesity, chronic cough, asthma and smoking, repetitive lifting, chronic constipation, high impact exercise (52% of female athletes experience urine loss during sport or daily activities), joint malalignment of the low back and pelvic girdle, sexual abuse, bowel and bladder disorders, infection/disease, and age, and surgical history (hysterectomy, prostate, and colon surgical intervention. Although there is variability in studies, it is generally thought that the prevalence of incontinence is 30-50% in women and 3-10% in men. Men have a chance of developing urinary incontinence after radical prostatectomy or transurethral resection of the prostate.
Physical therapy treatment of incontinence involves bladder retraining techniques, education on bowel health (if you struggle with constipation), lifestyle changes, pelvic floor muscle re-education, and progressive core (abdominal and pelvic floor), electrical stimulation to facilitate muscle activity, and hip strengthening. Men who experience erectile dysfunction may also benefit from performing pelvic floor exercises. Your physical therapist may also suggest other treatment options, specific to your symptoms and lifestyle including the use of continence products, medications and surgical interventions.
Pelvic Pain
Pelvic pain is burning, aching, and/or pain in the abdominal, pelvis, trunk, or pelvic floor region that lasts longer than 3-6 months duration. Both men and women have pelvic pain, and it can make gynecological examinations and sexual intercourse painful.
Oftentimes pelvic pain is caused by problems in pelvic alignment, muscles and nerves. Asymmetries and dysfunction of the pelvis can cause changes in the length and tension in muscles, leading to overactive and underactive muscles. Overactive trunk, hip, and pelvic floor muscles can contribute or cause tender points and discomfort in the pelvic floor. In some cases, pelvic pain can be caused by entrapment or pressure on nerves within the pelvis. Scarring from birth, surgery, and prior trauma to the pelvic floor can also produce pain.
Physical therapy treatment of pelvic pain involves correcting pelvic asymmetries through muscle energy techniques, stretching and strengthening muscles, core muscle strengthening to decrease pressure on the pelvic floor, downtraining/uptraining pelvic floor muscles, and manual therapy to help corrective imbalances in muscle activity. Other treatment options include autonomic nervous system quieting, use of dilators, and education on lifestyle changes. Your physical therapist may also suggest other treatment options, specific to your pain.
Pregnancy-related pain
Many women experience low back and lower extremity pain during pregnancy. Posture changes, hormonal changes, and altered body mechanics may contribute to increased discomfort.
Physical therapy provides help in establishing specific exercises to reduce pain and prevent injury. There are several bracing options that may improve comfort as well. Manual therapy may also be used to relieve pain in muscles or gently correct trunk and pelvic muscle imbalances. Pelvic floor exercises started during pregnancy result in less incontinence and pain after delivery. Physical therapists can help in finding good birthing positions to reduce discomfort, support injury, and promote relaxation during labor. Physical therapy can also help with instruction on how to perform perineal massage, gentle stretching of the pelvic floor tissue, prior to delivery. Controlled studies show that perineal massage does seem to result in a greater likelihood that the perineum will be intact at the time of delivery.
After delivery, many women continue to experience low back pain and pain at incision sites. Manual therapy is used to decrease pain and promote incision mobility. Proper body mechanics are very important for reducing pain and injury after delivery. Physical therapists provide instructions for improving postures and reducing stresses placed on the body during repetitive infant care activities such holding, lifting/carrying, nursing/feeding, changing diapers, carrying car seats and pushing strollers. Pelvic Floor muscle exercises are important prior to and after delivery, especially if a new mother is experiencing incontinence. Exercises can usually starting within 1 week of an uncomplicated, vaginal delivery and after 6 weeks in cases of cesarean sections. Physical therapy can also be helpful in address diastasis recti (a separation of abdominal muscles) and screening for postpartum depression in new mothers. Resuming exercise and finding ways to exercise with a new baby is important in helping new mothers bond with their baby, return to their pre-pregnancy weight, improve cardiovascular fitness, decrease incontinence, and promote energy and feelings of well being.
Lymphedema
Lymphedema is a swelling caused by the abnormal collection of lymph under the skin. The lymph is fluid from the tissues in your body that travels in the lymphatic system. This system is part of the immune system that includes lymph nodes and vessels. The lymph vessels collect and carry the excess fluid, fats, proteins, and wastes from the tissues of the body to the bloodstream. This system also works to clean and remove bacteria and waste products from the body.
Lymphedema occurs when the lymphatic system is blocked. When the lymph vessels or lymph nodes are blocked or damaged, lymph does not drain properly. This causes abnormal build up of lymph. This leads to swelling. This swelling can occur in arms, legs, trunk, head, neck, or genitals. Lymphedema cannot be cured by medicines, but the swelling can be reduced by physical methods.
The gold standard treatment of lymphedema is Complete Decongestive Therapy (CDT). This includes manual lymphatic drainage (a special massage used to facilitate drainage of the lymphatic system), compression wrapping, specific exercise, and self-care training. Three Rivers Physical Therapy provides CDT.
Early diagnosis and treatment of lymphedema is always best. We are very passionate about the treatment of lymphedema and providing education. Maria became a CLT (Certified Lymphedema Therapist) through Klose Training in 2013. This training requires 135 hours of training. She is certified to treat the entire body: limbs, head/neck, trunk, and genital lymphedema.
Oncology Rehabilitation
Rehabilitation has not traditionally been associated with oncology patients, but research is changing that. There is a much needed push for patients to participate in oncology rehabilitation to address whole body wellness throughout diagnosis, treatment, and survivorship.
Maria Iles, our physical therapist, is passionate about treatment for oncology patients in our Missoula location. She has received advanced training through STAR Program Survivorship Training & Rehabilitation. We treat neuropathy, balance problems, pelvic problems/dysfunction post radiation, lymphedema, radiation fibrosis, post-mastectomy shoulder, chest wall, and back function, general deconditioning with knowledge of exercise recommendations for oncology patients
Functional Dry needling
Dry needling is the use of an acupuncture needle to stimulate and “re-set” a trigger point within a muscle. Trigger points are localized areas of tightness and tenderness that create both local pain as well as referred or projected pain that can be felt remotely from its source. As these trigger points release, pain decreases and mobility increases. Dry needling works on both chronic and acute conditions.
Functional Capacity evaluations & work hardening
Three Rivers Physical Therapy offers valuable services geared at assessing patients’ work-related abilities and getting them back to work. One of the services that we offer is the administration of Functional Capacity Evaluations. These services are not only offered for individuals suffering from injuries sustained while working, but also individuals and employers looking to gain insight on job recommendations and accommodations.
Functional Capacity Evaluations or FCE’s can be administered to patients who are currently utilizing Worker’s Compensation or who need a formal assessment of work capabilities. FCE’s can give detailed information about physical work capabilities based on a variety of physical tasks, as well as consistency of pain ratings and effort given over the course of a 3-4 hour evaluation. Our goal is to give physicians detailed and job-specific information regarding patient’s work related abilities as well as limitations. These findings can generate specific recommendations and accommodations for your clients. During an FCE, patients should expect to be assessed in a variety of tasks such as squatting, bending, kneeling, walking, reaching, carrying, pushing, pulling, and gripping. Throughout the test we will also be monitoring pain ratings and consistency of effort. Patients should expect the evaluation to take up to 4 hours and should wear comfortable clothing.
Three Rivers Physical Therapy also offers Work Hardening/Work Conditioning programs. These programs are patient specific and focus on preparing for the return to work. The program may include work simulated tasks, cardiovascular conditioning, improving musculoskeletal function, coordination, work behaviors, work safety, and general endurance. The goal is to safely return the patient to their vocation and reduce the risk of re-injury.
Temporomandibular joint
It is estimated that 1 in every 3 people suffer from one or more of these TMJ symptoms: Headaches (chronic or migraine), earaches, congestion, ringing ears, clicking, popping or grating sound in the jaw joints, limited jaw opening or locking, dizziness, pain when chewing, facial pain, neck and or throat pain, difficulty in closing teeth together, and tired jaw.
The two temporomandibular joints (TMJ's) are located on each side of the head in front of the ears. They attach the mandible (lower jaw) to the skull. Muscles and ligaments attach both the bones and joints to allow movement. Each joint has a small disc which enables smooth movement of the jaw when chewing, talking, shouting, singing or yawning. A malfunction of one or both of these jaw joints can be caused by trauma, whiplash, malocclusion (bad bite), poor posture, bruxism (teeth grinding), clenching or skeletal malformation.
Any malfunction prevents the complex system of muscles, bones and joints from working together in harmony. The result is TMJ disorder. The jaw joint is like any other joint in the body. In actuality, TMJ disorder is an orthopedic problem.
Sports physical therapy
We apply scientific knowledge to train athletes for the primary goal of improving athletic performance. We conduct sport-specific testing sessions, design and implement safe and effective strength training and conditioning programs and provide guidance regarding injury prevention.
We also use taping techniques to help stabilize joints if needed and can help with brace fitting and ordering.
We welcome athletes of any age from any athletic background and will personalize a plan for you. We incorporate: plyometrics, agility and speed training, strength training, flexibility, and balance depending on your weaknesses and sport specific needs!
Manual Therapy
Manual Therapy interventions focus on hands-on, direct contact therapy.
Manual therapy is a specialized form of physical therapy delivered with the hands as opposed to a device or machine. This involves joint mobilizations, joint manipulation, soft tissue mobilization, or mobilization of neural tissue.
Manual therapy is used to diagnose and treat soft tissues and joint structures for the purpose of modulating pain, increasing range of motion (ROM), reducing or eliminating soft tissue inflammation, inducing relaxation, improving contractile and non-contractile tissue repair, extensibility, and/or stability, facilitating movement, and improving function.