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  • Writer's pictureRachel Richers

An area of physical therapy that I have become specialized in is Pelvic Floor Physical Therapy. Pelvic health has been historically under treated for reasons such as shame, feelings of being "broken" or embarrassment. Additionally, our culture has often held discussion of "private parts" to be taboo.


Within this post I will discuss what this is and whom it can help.


What is the pelvic floor?

The pelvic floor is a collection of muscles that comprise the inside of our pelvis. It has many responsibilities including:

  • Support: The pelvic floor acts as a hammock to support organs such as your bladder, uterus, rectum, and abdominal organs. Without adequate activation, strength, and control, pelvic organ prolapse can occur.

  • Stability: The pelvic floor muscles help to support your hips, pelvic and low back as an important contributor to our core. Stability in our pelvic floor ensures appropriate force transmission from our back to our legs and vise versa.

  • Sphincter Function: The pelvic floor allows the control of the urethra and anus opening and closing (contraction and relaxation). Without appropriate control of sphincter function, a person may experience incontinence.

  • Sump Pump: The pelvic floor muscles help with circulation and moving lymph and blood through your pelvis back up to your trunk

  • Sexual Function: The pelvic floor muscles assist in sexual arousal


What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction can refer to any deviation from a pain free presentation of pelvic structures with appropriate continence, organ stability, sexual arousal and function. There can be an array of symptoms consistent with pelvic floor dysfunction including:


• Incontinence (leaking urine, gas or stool)

• Urgency with urination and defecation

• Pressure/heaviness/bulging sensation

• Organ prolapse

• Pain with intercourse or penetration

• Constipation

• Difficulty or lack of orgasm


********If you experience the above mentioned dysfunctions of the pelvic floor********* you are NOT alone!

  • Urinary Incontinence affects 40% of women under the age of 65 and 60-70% of women over the age of 65 years old - Katarzyna et al 2016.

  • Most women have some degree of Pelvic Organ Prolapse in their lifetime - Katarzyna et al 2016.

  • 1 in 4 women report moderate-severe symptoms of Urinary Incontinence, pelvic organ Prolapse, or fecal incontinence - Nygaard et al 2016

  • 65% of female athletes have stress urinary incontinence and/or urgency Schettino et al 2014

  • 52% of women have pelvic pain - Schelttino et al 2014

  • 18% of community dwelling men will experience urinary incontinence - Assad 2000

  • 11% of Male visits to their primary care provider is for pelvic pain


Frequently Asked Question: If I do Kegels, isn’t that enough?


Although "Kegels" have been the tried and true way to activate your pelvic floor in the past, pelvic floor therapists want you to know two things.


First: Studies have found that women who complete kegels are often found to be performing them incorrectly. Between 24-70% of kegel activations assessed via internal vaginal examination have been found to be either wrong, insufficient, or counter productive in the maintenance of continence.


Second: Kegels have often been the ability to contract the pelvic floor as hard as you can. While it is important to achieve muscle contraction, simple contract and relax is not enough. We want our pelvic floor muscles to be able to actively contract in a graded and controlled manor. We want our pelvic floor muscles to relax on command. And, we want our pelvic muscles to be able to bulge in order to complete a full range of motion.


Pelvic floor muscle examination may assist in providing instruction and feedback for correct activation of pelvic floor muscle activation. This may help improve quality and effectiveness of muscle contractions to assist in controlling symptoms of pelvic floor dysfunction and disorders




One way to answer the question of "What conditions do Physical Therapists treat?" is to say that Physical Therapists treat most any condition involving the musculoskeletal system. The term musculoskeletal refers to joints (where two bones meet) and the muscles, tendons, ligaments, and capsule at and around that joint that create or resist movement. Physical therapists often treat these injures directly. These injuries are known to be:

  • Bone - Fracture or break

  • Muscle - Strain or Tear

  • Joint

    • Ligament - Sprain or Tear

      • Ligament = structure that connects one bone to another bone.

    • Tendon - Strain or Tear

      • Tendon = structure that connects a muscle to a bone.

    • Capsule - Capsular injuries occurring within the synovial joint structures


But also, physical therapists must be able to assess whether injury to these tissues occurred directly, or, as the result of poor movement patterning (compensations). Compensations often occurs when we have a goal to accomplish but our bodies are not strong enough to do so correctly, forcing other muscles and structures to do the work. Examples of this include:

  • Pain and tightness in the back of the neck in a person who works on the computer all day.

    • Compensation = neck and shoulder muscles have to support a forward jutting head.

  • Pain in the shoulder when lifting the arm because their shoulder blade isn't stable.

    • Compensation = bigger, stronger muscles force the movement to occur rather than the appropriate smaller coordination muscles working together for smooth movement.

  • Pain in the hip or back because of a developed limp.

    • Compensation = more force is being pushed through one side, generally to offload an acute injury (possible example: rolled my ankle and it hurts so I'll walk a little differently for a few days). If their "different walk" becomes their "new normal walk" even after the initial cause goes away, the asymmetrical forces will accumulate over time to cause injury and damage elsewhere.

(To learn more about compensations, go to compensation blog post - not yet releases as of 9.11.2023; will link in the comments when published.)

To treat a person coming to therapy with acute (new) or chronic (I've had this pain for a while) pain, physical therapists spend our first meeting asking about things such as:

- Where do you hurt?

- Did something happen that started the pain? Or did it develop for no known reason?

- What makes your pain better? What makes it worse?

Answers to these questions will assist in directing treatment sessions. The goal is to identify the interventions needed to get better in the fewest possible sessions.


To learn more about what types of treatments you may receive in physical therapy, go to blog post "Treatment Techniques in General".


Please leave a comment or question, or reach out to me directly via the contact form for further clarification.

  • Writer's pictureRachel Richers

Balance is a person’s ability to remain in an upright, and stable position. A person with good balance will demonstrate good postural control of their center of gravity within their base of support - whether, sitting, standing, or walking. In every position, our bodies are actively using muscles to, subconsciously, keep us balanced. Even when we are standing or sitting as still as possible, we use small postural muscles every second to stay in the desired position. If the body has to work to maintain balance while remaining still, imagine how hard the body works to maintain balance during more complex activities such as walking, running, turning a corner, sitting down, or navigating stairs! What systems actively coordinate balance? An individual is able to maintain balance through the integration of sensory information collected by our eyes, ears, muscles, and joints.

  • The visual system provides information regarding what a person can see in their surrounding environment. The brain is constantly receiving information from the eyes regarding where the horizon is and where the body is in relation to external objects. When the body is moving, the brain is able to calculate the speed, direction, and even the body’s safety as it navigates environmental features.


  • The vestibular system is a very intricate system of sense organs located deep in our inner ear. ​ These organs are connected to semicircular canals which, as a system, provide information about the orientation of the head in space. The vestibular system is constantly tracking the head’s position relative to gravity, in addition to the head’s acceleration (either forward or backward, left or right, up or down), and any angular combination of motion around these planes of movement.


  • Proprioception is the final piece of our balance system and comes from our muscles and joints. Within every muscle, ligament, and tendon exist sensory cells that relay information to the brain regarding body position. Proprioception is a more difficult sensory system to understand because it doesn’t represent what we have all learned to be our “primary senses” - see, smell, hear, taste, and touch. However, just like those senses, our brains require little to no conscious attention to process it - proprioception is our body’s “sixth sense”.


What causes balance changes?

  • Damage to inner ear structures

  • Loss of inner ear nerve conduction

  • Changes in vision

  • Changes in sensation in feet.

  • Age related changes (may include the above or further worsen them)

​​ Why is balance so important?

Poor balance can cause falls that result in a traumatic injury.

When a person loses their balance they will either catch themselves and remain upright, or fall. By definition, a fall is an event which results in a person coming to rest on the ground, floor, or other lower level. Falls are the leading cause of fatal and nonfatal injuries among adults over the age of 65, and statistically, 1 in 3 adults over 65 will fall this year, 1 in 2 adults over the age of 80 will fall this year. Of those falls, 20-30% will result in decreased mobility and functional independence. 800,000 patients are hospitalized every year following a fall. Each fall with resultant hospital stay has an average cost of $30,000, and as a nation, falls cost over $24 Billion in hospital cost per year. Postural deficits, over time, can lead to progressive wear and tear of a person’s body.

  1. The body is built very specifically and every person is able to activate their body’s musculature appropriately and maintain good joint alignment when actively accepting, resisting, or generating a force.

  2. While ideal body mechanics are often discussed, encouraged, taught, and reinforced, the body’s natural tendency is to find “the path of least resistance”. In other words, the body is always on the lookout for energy saving strategies to maximize efficiency. In the short term, this is not a problem, however, when repeatedly changing how the body should move into how the body wants to move, the person will develop movement patterns that, over time, progress into overuse injury, muscle overactivation or underactivation, muscle length being too short or too long, or joint structure wearing away. All of these changes in movement patterns occur so slowly, it is often unfelt by the person, and unnoticed by family and friends. That is, until pain occurs.

How can Physical Therapy help balance?

Physical therapy can identify the risk factors that are related to your balance deficits, can identify the cause, which system deficiency is causing balance difficulties, and work to reduce or compensate for these deficits. Testing to determine the source of imbalance:

  • Range of motion - does one side move differently than the other? The more asymmetric the body is, the more risk of muscle and joint imbalance upon load.

  • Strength - is one side stronger than the other? Is there a muscle group that is too strong and overpowering another group? Is there a muscle group that is too weak, or is undertrained? Is there lacking or inhibited nerve conduction affecting how the muscles are working?

  • Walking pattern - is there noticeable deviations that may need to be retrained?

  • Balance - is it easy to stand with the feet together? What about on a soft or compliant surface? Is it easy to stand with feet in line or even standing on one foot? What about these positions with eyes closed or head turns?

  • Vestibular system - is there any dizziness that contributes to balance difficulties? Do the eyes behave appropriately as the head moves side to side? Up and down?

​Physical Therapists are exercise and movement specialists and are specially trained to assess all areas that contribute to balance. Additionally, Physical Therapists know how to restore each person to their greatest potential through movement training, strengthening, coordination training, potential vestibular rehabilitation, fall risk education and fall risk reduction training, and how to use an assistive device, if needed, to provide that extra stability.

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