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Click below to read about these specific conditions:
Anismus, also known as pelvic floor hypertonicity, anal sphincter dysserynergia, dyssynergic defecation, and paradoxal puborectalis dysfunction, is a disorder of the external anal sphincter and puborectalis muscles (one of the pelvic floor muscles) upon attempted bowel movement. It is a form of pelvic floor muscle dysfunction. Upon defecation, the pelvic floor muscles should normally relax to allow for evacuation of stool. With anismus, the puborectalis muscle and anal sphincter contract causing the stool to not be able to pass through the anal opening to properly evacuate. This can be painful and can lead to obstructive constipation. Other complications can be fecal impaction and an enlargement of the diameter of the rectum called megarectum. Those with anismus chronically bear down or strain in attempt to have a bowel movement and further irritate the pelvic floor muscles. Medical evaluation may include a rectal digital exam, evacuation proctography, balloon expulsion test, and dynamic imaging studies. Medical treatment may include Botox injections into the puborectalis muscles and surgical resection.
How can Pamela Morrison Physical Therapy, PC help anismus?
One of the expert pelvic therapists at Pamela Morrison Physical Therapy will perform a complete history and physical exam. Close inspection of your pelvic alignment and pelvic floor muscles and sphincter will occur. Pelvic nerve tests will also occur. It would be determined if the puborectalis and other pelvic floor muscles and anal sphincter were in spasm and unable to relax also known as pelvic floor muscle hypertonicity. Surface EMG biofeedback of the pelvic floor muscles would assist the therapist in determining the severity of the spasm or hypertonicity and if normal relaxation of the pelvic floor muscles is possible. This is essential for resolving anismus. Physical therapy treatment at our practice for anismus would consist of realignment of the pelvic girdle via manual techniques, soft tissue mobilization of the pelvic girdle and pelvic floor muscles, stretching exercises, visceral manipulation, neuromuscular re-education of the pelvic floor muscles, surface EMG biofeedback training, therapeutic exercises, and a home exercise program. Surface EMG biofeedback for hypertonicity focuses on down-training the pelvic floor muscles. Down-training helps to lower the resting tone of the pelvic floor muscles and teaches you how to relax the pelvic floor muscles and anal sphincter for effective bowel evacuation. The manual therapies and modalities such as electrical stimulation help to eliminate the muscle pain and spasm. The use of rectal dilator therapy may also prove beneficial. Proper toilet posture and bowel evacuation techniques will be taught. Our practice has very successful outcomes treating anismus.
Women may experience breast pain and swelling due to injury or trauma, infections, breastfeeding complications, cancer, or surgery. Overuse or injury of the pectoralis muscle can result in a strain and cause breast pain and swelling. Many times there is pain along the sternum (breastbone) and anterior chest wall. Another source of breast pain may be costochondritis which is an inflammation of the junctions where the upper ribs join with the cartilage that holds them to the sternum. Trauma can include vigorous coughing or vomiting. The resulting strong, sustained contractions of the intercostal (rib) muscles can lead to chest wall tenderness that may be
perceived as breast pain. Some women experience mastitis, infection of the breast glands/ducts, which can lead to obstruction, pain, and result in inability to breastfeed your newborn. Blocked ducts, stress, fatigue, cracked nipples, and previous mastitis are risk factors. Women faced with breast cancer may develop musculoskeletal impairments following mastectomy and breast reconstruction. Lymphedema and weakness are complications that can affect the entire arm. Women who have undergone breast augmentation may experience swelling, scar tissue tightness and myofascial pain.
How can Pamela Morrison Physical Therapy help with breast issues?
These are all serious breast issues and Pamela Morrison Physical Therapy, PC can provide you with an expert evaluation and sensitive care of your specific complaint. Whether the breast issue is from trauma, disease, surgery, or breastfeeding complications, we evaluate the entire upper quadrant. This can include assessing the cause of pain and swelling, neck and arm range of motion, strength, scar tissue mobility, joint mobility, and flexibility. Treatment may consist of pain relieving modalities, manual therapy, prescriptive exercises, and stretching. Other more specific treatment can include manual lymphedema drainage to reduce accumulation of lymph fluid post-mastectomy. Our therapists are trained in a specific protocol to quickly resolve obstructed breast ducts and help resolve or prevent mastitis.
Coccygodynia or Coccydynia
Coccygodynia is a term that refers to the pain in or around the coccyx, also known as the tailbone. In most cases, patients feel the pain while in the sitting position yet it can also be apparent in various positions, even while walking. The pain can also be described as rectal and/or vulvar burning. Numbness of the buttock or posterior thighs can also be experienced. The coccyx pain can be aggravated by prolonged sitting, bowel movements, sexual intercourse, or during menstruation. Almost one third of all cases of coccygodynia are idiopathic in nature, which means that the real cause is unknown. Known causes include trauma from a fall backwards, fracture or injury from childbirth, repeated poor posture, straining upon bowel movements, spasms or trigger points of the surrounding pelvic floor muscles, referred pain from the sacrum or spine, inflammation or irritation of the surrounding nerves, and misalignment of the sacrum or sacrococcygeal joint.
How can Pamela Morrison Physical Therapy help with Coccygodynia?
At Pamela Morrison Physical Therapy, PC our therapists are experts in the evaluation and treatment of coccyx dysfunction and pain. We provide successful treatments including modalities for pain relief, correction of misaligned joints, release of spasm and trigger points in the surrounding muscles; perform nerve mobilizations to relieve nerve compression, instruct in proper posture, and recommend sitting cushions that are appropriate for each individuals needs.
Diastasis recti is a separation between the left and right side of the abdominal muscle which covers the front surface of the belly area called the rectus abdominis muscle. Diastasis recti is a common condition during pregnancy. As the fetus and uterus grows it may cause increase tension and pulling apart of the linea alba causing the abdominal muscles to separate. The linea alba is the connective tissue that attaches one side of the rectus abdominus muscle to the other. The diastasis may resemble a ridge down the center of the belly area and you may be able to feel the two separate edges of the rectus abdominus muscles. Diastasis recti is more commonly seen after multiple births but can be also be seen in a first time pregnancy. A diastasis recti that is not addressed can result in having significant core weakness, lack of pelvic organ support, incontinence, and eventual low back pain. A diastasis can be identified at your 6 week post partum exam at the obstetrician’s office or by your skilled therapist at Pamela Morrison Physical Therapy.
How can Pamela Morrison Physical Therapy help Diastasis Recti?
Your pelvic rehab expert at Pamela Morrison Physical Therapy will identify the diastasis recti at your 6 week post partum physical therapy evaluation or at anytime after labor and delivery. Specific testing occurs through manual palpation and using Rehabilitative Real-time ultrasound. Using an abdominal binder may be a crucial component of the rehab process and your therapist would measure and fit you for the proper binder. Specific diastais recti rehabilitative exercises are instructed. Pelvic alignment is assessed and corrected to achieve optimal results. Correction of the diastasis recti is critical prior to more pregnancies and may enhance having future successful painfree pregnancies and successful labor and delivery. Diastasis recti can even be improved many years after labor and delivery.
Endometriosis is a condition in which the endometrial tissue (the cells lining the uterus) grows in other areas of the body. The tissue growth typically occurs outside of the uterus, such as on the ovaries, fallopian tubes, bowel, rectum, bladder, and on the delicate lining or fascia of the pelvis. However, the implants can occur in other areas of the body, too. Every month to prepare for egg implantation, the uterine wall lining thickens and swells. The endometrial tissues that have grown in, on, or around other pelvic structures also thicken and swell and may even bleed but these cells stay in place and do not shed as does the normal endometrium. This tissue growth can cause adhesions, fibrous bands, and scarring in and around the pelvic organs and structures. Common symptoms of endometriosis include abdominal, hip, and pelvic pain, cramping, irregular bleeding, painful menstruation, low back pain, sacroiliac joint pain, bladder pain or painful urination, digestive problems, abdominal bloating, painful bowel movements, painful intercourse (dyspareunia), and can lead to infertility. Endometriosis can also be a cause of or related to pelvic floor muscle dysfunction. Endometriosis can lead to trigger points in the abdominal muscles and pelvic floor muscles causing even more pelvic pain. There are several theories as to why endometriosis occurs yet there is no known cause. One theory is called retrograde menstruation whereby endometrial cells loosen during menstruation and move upwards traveling through the fallopian tubes and then throughout the pelvis. Endometriosis is usually diagnosed between the ages of 25-35 years old. Testing that occurs by the gynecologist to diagnose endometriosis includes transvaginal pelvic ultrasound, pelvic exam, and pelvic laparoscopy.
How can Pamela Morrison Physical Therapy help with Endometriosis?
The best way to approach endometriosis is through a multidisciplinary approach which includes a skilled and experienced physical therapist that specializes in pelvic pain and myofascial release techniques, including visceral mobilization. At Pamela Morrison Physical Therapy, your expert pelvic rehab specialist will perform an extensive medical history and a physical exam which would include specific testing of your pelvic structures. Joint alignment and mobility, connective tissue mobility, pelvic nerve function and mobility testing, pelvic organ mobility/motility are assessed as well as pelvic and abdominal muscle palpation to identify tender points, trigger points, and tightness. Areas of painful pelvic adhesions and scar tissue are easily identified via our skilled therapist’s connective tissue mobility and palpation tests. Rehabilitative real-time ultrasound and palpation can help identify pelvic floor muscle dysfunction. Based on the evaluative findings, a comprehensive treatment program will be initiated. Treatment techniques may include modalities for pain such as moist heat, TENS, ultrasound, or cold laser. Manual therapies such as myofascial release, scar release techniques, visceral (organ) manipulation, trigger point releases techniques, neural tension release techniques, and joint mobilization would be utilized. Other treatment approaches may include stretching exercises, therapeutic exercises, dilator therapy, and pelvic floor muscle rehab. Patients find significant or full relief after being treated at our practice.
An imperforate anus (IA) is when there is defect in the opening of the anus from birth. The opening of the anus is either missing or it is blocked. Stools need to pass from the rectum through the anus in order to leave the body via the rectal sphincter. An imperforate anus may present with the rectum ending abruptly and not connecting with the colon or the rectum may have abnormal openings to the urethra, bladder, penis, or vagina. There may also be a narrowing or stenosis of the anus. This problem is caused by abnormal development of the fetus. Symptoms include: the infant not passing stool in the first 24-48 hours after birth, a very small anal opening, a distended abdomen, or stool passing out of the penis, vagina, or urethra. Your pediatrician can diagnosis this in the office or hospital during an exam and an further diagnostic imaging such as an ultrasound, MRI, or CT scan may be necessary. The medical treatment for this is surgical correction of the defect. Unfortunately, severe constipation can result in the post-operative phase. Stool softeners and a high-fiber diet are usually recommended.
How can Pamela Morrison Physical Therapy help after an Imperforate Anus Repair?
At Pamela Morrison Physical Therapy our expert pelvic therapists can assess your infant’s pelvic floor muscle function, neurological status of the area, coccyx mobility, and visceral (organ) mobility/motility to determine the cause of the constipation. The surgery may have resulted in scar tissue adhesions, anal sphincter and/or pelvic floor muscle spasm or overactivity, impaired visceral mobility/motility, change in anorectal angle, and impaired coccyx mobility. A successful treatment plan might include myofascial release, scar mobilization, soft tissue mobilization, visceral manipulation, joint mobilization of the spine, pelvic girdle, coccyx, and hips; Craniosacral Therapy, Integrative Manual Therapy, dietary advice, and positioning. We have had very good success reinstating normal bowel habits within a few treatment sessions.
There are different types of incontinence. Urinary incontinence is the inability to control the flow of urine and results in involuntary urination. Stress incontinence is when you leak urine during activities that increase pressure on the bladder such as sneezing, coughing, laughing, jumping, jogging, or lifting. There may be insufficient strength in the muscles supporting the bladder, urethra, and pelvis. The muscles that help support the bladder and resist urination include the pelvic floor muscles and the transversus abdominus, as an accessory. Urge incontinence is when you feel a terrible urge or pressure to urinate and leak on your way to the bathroom and you may leak urine before you reach the bathroom. Some also may experience urge and leak when they put their keys in the front door, when hearing water running, or when outside in the cold weather. Mixed incontinence is when someone has both stress and urge incontinence combined. Fecal incontinence is when you are unable to hold or control stool in the rectum and leak feces. Incontinence can also result from childbirth trauma, pelvic surgeries, consumption of bladder or intestinal irritants, food allergies or sensitivities, prostate issues, hormonal imbalances or deficiencies, a sedentary lifestyle, and neurological diagnoses such as multiple sclerosis, cerebral vascular accident, or spinal cord injury.
How can Pamela Morrison Physical Therapy help with incontinence?
Physical therapy can help all types of incontinence. After a comprehensive physical therapy evaluation with our pelvic expert, it may be determined that weak or incoordinated pelvic floor muscles or trunk (core) muscles are contributing to the problem. Other musculoskeletal issues such as pelvic floor muscle and abdominal trigger points, myofascial tightness, malalignment of pelvic, sacroiliac, spine, and/or hip joints may be a causative or perpetuating factor. Pelvic floor muscle hypertonicity (spasm, pain, shortened, high-tone) can be a causative factor in urge incontinence whereas pelvic floor muscle hypotonicity (weakness, low-tone) can be a causative factor in stress incontinence. Pelvic organ prolapse can also cause incontinence. Thus, your comprehensive evaluation includes close inspection of pelvic floor and core muscle function and tone. Studies have shown that pelvic floor muscle strengthening exercises help with urinary/fecal incontinence. Using our state-of-the art Rehabilitative Real-time ultrasound and surface EMG biofeedback enables the patient to understand the function of pelvic, core and low back muscles in bladder health. Anther modality that may be helpful is neuromuscular electrical stimulation (NMES) to help increase pelvic floor muscle recruitment and hypertrophy or strengthen the muscles. Transvaginal or transrectal NMES is useful in inhibiting the sensation of urge and helps strengthen the pelvic floor muscles rapidly. Trancutaneous electrical nerve stimulation (TENS) has been studied and its use for urinary incontinence proves effective when used over the bladder/suprapubic region and on sacral or tibial nerves. Diet and behavior can also affect incontinence. Food diaries and bladder/bowel voiding diaries are reviewed and changes are implemented to best improve your bladder or rectal function. Behavioral modification techniques are instructed. Core re-training exercises, lower quarter stretching, and pelvic floor muscle overflow exercises are also instructed. Your expert physical therapist at Pamela Morrison Physical Therapy would implement an individualized treatment program to address any issues found during the evaluation.
Myofascial restrictions or adhesions (abnormal connective tissue cross linking) can bind pelvic organs or structures together. Adhesions involving the female reproductive organs (ovaries, uterus, Fallopian tubes) can and do cause infertility. Pelvic, sacrum, coccyx, and/or spinal joint malalignment may compromise normal physiological processes necessary to facilitate pregnancy.
How can Pamela Morrison Physical Therapy help with infertility?
Your comprehensive evaluation at Pamela Morrison Physical Therapy can determine if there are any myofascial adhesions or joint dysfunctions. A study has shown that myofascial assessment and release of pelvic and abdominal structures can improve fertility and successful IVF outcomes. Deep abdominal massage, also called Mayan massage, performed by our expert physical therapists may help with achieving successful pregnancy. Specific visceral (organ) and urogenital manipulation techniques require advanced trained physical therapists to perform. Our therapists have undergone extensive training to provide expert care.
Interstitial Cystitis (IC) or Painful Bladder Syndrome
Interstitial cystitis is a chronic pain problem involving the pelvis, bladder, and urethra that occurs in men and women. Chronic inflammation in the lining of the bladder wall occurs. There is a defect in the bladder epithelium lining called the GAG (glycosaminoglycan) layer which makes the lining more permeable, sensitive, and easily irritated by the urine or other substances in the urine. Most patients have non-ulcerative IC involving glomerulations or pinpoint hemorrhages in the bladder wall seen on cystoscopy yet some suffer from more intense pain from Hunner's Ulcers in the bladder wall which are large red patches and are sometimes bleeding. Symptoms of IC may include urination frequency, urgency, pain, pressure, and burning. Other common symptoms include painful intercourse and diffuse pelvic pain. Symptoms can felt be in the suprapubic region of the pelvis and /or surrounding areas. Patients may also experience thigh, groin, low back, and hip pain. Some experience pain or pressure before, during and/or after urination. Upon urinating, symptoms are often alleviated. The cause of IC is unknown yet some theories or possible triggers include bladder trauma, sexual trauma, chronic infections or cystitis, pelvic floor muscle dysfunction, chronic holding or prolonging urination, autoimmune disorders, primary neurogenic inflammation, or spinal cord trauma.
How can Pamela Morrison Physical Therapy help with IC?
A comprehensive physical therapy evaluation can determine if there is a musculoskeletal or neurological problem potentially causing or perpetuating the bladder and pelvic pain. Your musculoskeletal evaluation at Pamela Morrison Physical Therapy would determine if there are related joint problems, muscular problems such as pelvic floor muscle dysfunction, or nerve involvement in the pelvis, around the bladder area, and in surrounding structures. Your physical therapist may perform myofascial and trigger point release techniques to abdominal, hip, low back, and buttock muscles; nerve tension release techniques, and realign pelvic, sacroiliac, spine, and hip joints which may improve your symptoms or resolve them. Skillful visceral manipulation to the bladder and surrounding organs has truly proven to be an effective treatment approach in our clinic providing long term relief of symptoms. There are also other modalities such as electrical stimulation that may help calm the bladder and/or relieve pain. Use of physical therapy modalities such as interferential electrical simulation and TENS (transcutaneous electrical nerve stimulation) have been proven effective via research studies in treating patients with IC. Using real-time ultrasound and biofeedback enables the patient to understand the function of the pelvic floor muscles and low back muscles in bladder health. Specific exercises such as stretching, core stabilization, and pelvic floor muscle exercises aimed at down-training may be prescribed. Helping you to gain control of bladder habits and dietary/behavioral triggers is a crucial component of therapy. Sexual positions for improved comfort are also addressed.
Osteitis pubis is a disorder of the pubic symphysis joint characterized by pain and inflammation of the joint and surrounding muscles such as the adductor group. Symptoms can include pain in the groin, lower abdomen, hip, perineum, bladder, clitoris, vagina, scrotum or testicles, and painful intercourse. It is most often caused by repetitive trauma or abnormal shearing forces to the pubic symphysis joint. Abnormal shearing forces can be caused by muscle imbalances, impaired flexibility, sacroiliac joint dysfunction, or a malalignment at the joint. When aggravating motions occur at the joint, microtrauma causes inflammation and muscle spasms can result. Other causes of osteitis pubis can be trauma from urogynecologic surgery, a motor vehicle accident or fall, sudden increase in exercise intensity, a leg length discrepancy, poor foot biomechanics, or poorly fitting shoes. This disorder is commonly seen in athletes. The pain increases upon kicking, changing directions or pivoting on one leg, jumping, and running. Sneezing or coughing, transferring from sitting to standing positions, and lying on one side can also exacerbate the pain. Clicking or popping may also occur at the joint upon walking or strenuous movements. Osteitis pubis can occur during pregnancy due to excessive pressure on the joint and release of the hormone called relaxin. Relaxin softens the ligaments at the pubic symphysis in preparation for childbirth perhaps leaving the joint susceptible to injury. Trauma from childbirth can worsen or bring on symptoms of osteitis pubis. Osteitis pubis can be a cause of pelvic floor muscle dysfunction if left untreated. An X-ray or CT scan can help with a proper diagnosis.
How can Pamela Morrison Physical therapy help Osteitis Pubis?
Your expert therapist at Pamela Morrison Physical Therapy performs a complete evaluation including history and a full physical exam. Your therapist will examine spinal, pelvic, and lower extremity biomechanics and muscle function thoroughly to identify any malalignments and muscle impairments. The most important aspect of evaluating and treating this disorder is differentiating it from other disorders of the pubic symphysis such as a pubic symphysis separation, hernia, or groin strain. Treatment will consist of joint mobilization to realign the pubic symphysis and sacroiliac joints; modalities to decrease pain and inflammation such as therapeutic ultrasound, TENS, cryotherapy, iontophoresis, interferential electrical stimulation, cold laser; soft tissue mobilization or massage, cross-friction massage to the pubic ligaments, muscle rebalancing around the pubic symphysis joint, stability exercises, core and pelvic floor muscle re-education, correction of any faulty movement patterns or biomechanics, and pelvic support belts. Prescriptive therapeutic stretching and strengthening exercises will be instructed as part of a comprehensive program to prevent future injury. Pregnancy support garments may also be recommended. It may be recommended that you discontinue any exacerbating activity until symptoms improve. A home exercise program is given to all patients to facilitate a faster recovery.
Pediatric Urinary Incontinence
Childhood urinary incontinence can be caused by an underlying disease process (organic incontinence), or can have no associated abnormality (functional incontinence). Incontinence is uncontrollable leakage of urine or ”accidents” or “leaks”. Nighttime bedwetting or sleep wetting is called enuresis. Nighttime bedwetting is more common than day wetting. Children with nighttime incontinence issues should see their doctor to assess them for bladder capacity, an immature nervous system, anxiety disorders, genetic predisposition, sleep apnea, or structural problems. Daytime incontinence can be related to or caused by an overactive bladder, infrequent voiding, small bladder capacity, structural problems, pressure from hard stools from constipation, consumption of bladder irritants, and the inability to control their pelvic floor muscles or weak pelvic floor muscles. Overstrenuous toilet training can result in children being unable to relax their pelvic floor and sphincter muscles to properly empty their bladder. This may result in being unable to fully empty their bladder when they do have the proper urge and use the toilet. Voiding frequency in children is relevant from age 5 or attainment of bladder control. Physical therapy treatment for pediatric incontinence therefore begins at age 5 and up.
How can Pamela Morrison Physical Therapy, PC help children with incontinence?
Physical therapy for pediatric incontinence might include scheduled bladder retraining, behavioral modification, pelvic floor muscle re-education, surface electromyography biofeedback (external electrodes or “stickers”), and prescriptive therapeutic exercises. Medical research has shown that proper pelvic floor muscle training and biofeedback drastically improves voiding dysfunctions in children. Treatment at Pamela Morrison Physical Therapy, PC is geared towards being educational and fun. Parents’ participation is crucial to the success of treatment.
Pelvic Floor Muscle Dysfunction (PFMD)
Pelvic floor muscles, also called the levator ani complex, form the muscular base of the pelvis running from front to back and in from the sides like a hammock. These muscles support the bladder, uterus, vagina, and rectum. They also provide function in maintaining continence, elimination, breathing, intercourse, and low back/pelvic stability. Pelvic floor muscle dysfunction (PFMD) refers to having pain, tension, trigger points, weakness, disuse, or discoordination in the muscles comprising the pelvic floor. There are two categories of pelvic floor muscle dysfunction seen in the literature: hypertonicity, known as high-tone pelvic floor and hypotonicity, known as low-tone pelvic floor. Pelvic floor muscles that have a hypertonicity presentation are shortened, painful, have trigger points or tender points, taut bands, higher tension at rest, and may be in spasm. Pelvic floor hypertonicity was also previously known as levator ani syndrome. Pelvic floor muscle hypertonicity is related to pelvic pain syndromes such as interstitial cystitis, vulvodynia, fissures, lichens schlerosus, endometriosis, irritable bowel syndrome, chronic pelvic pain, prostatitis, pudendal neuralgia or entrapment, and coccygodynia. It can also be related to hip derangement and sexual or physical trauma. Pelvic floor muscle trigger points can cause referral of pain to other areas of the pelvis including the suprapubic region, groin, inner thighs, buttock, sacrum, coccyx, rectum/anus, bladder, and vagina. Pelvic floor muscles that have a hypotonicity presentation are weak, lengthened, have low tone or tension at rest, and exhibit poor contractile properties. Pelvic floor muscle hypotonicity is related to urinary or fecal incontinence issues, pelvic organ prolapses, impaired nerve function, disuse, anorgasmia, erectile dysfunction, sedentary lifestyle, low back pain, pelvic instability, generalized hypermobility syndrome, and trauma. Pelvic floor muscle hypertonicity and hypotonicity dysfunction can result in discoordination and weakness of the pelvic floor muscles because in either scenario the muscles are not properly recruited or contracted due to pain or inhibition and not at normal resting length.
How can Pamela Morrison Physical Therapy help with Pelvic floor Muscle Dysfunction?
Your pelvic expert at Pamela Morrison Physical Therapy must first correctly diagnose your Pelvic Floor Muscle Dysfunction by taking a thorough history and completing a comprehensive pelvic exam. A prescriptive program is implemented which is personalized for your specific dysfunction since every patient has different issues and histories. For those patients with hypertonicity PFMD, a program may be comprised of pelvic joint mobilization techniques for realignment, modalities for pain such as electrical stimulation including interferential, TENS, cold laser, moist heat, cryotherapy, ultrasound; prescriptive pelvic floor muscle exercises, stretching and strengthening exercises, trigger point release techniques, surface EMG biofeedback, urogenital/visceral mobilization, relaxation training, soft tissue massage/mobilization, neural tension releases, skin rolling, and muscle re-education training. Down-training techniques to lower baseline pelvic floor muscle tone and tension are implemented. Other interventions may include dilator therapy and sexual education. For those patients with hypotonicity PFMD, your program may be comprised of pelvic joint mobilization techniques for realignment, neuromuscular re-education, electrical stimulation, surface EMG biofeedback, stability training, urogenital manipulation, neural tension releases, and prescriptive pelvic floor muscle exercises. Other interventions may include bowel/bladder retraining, dietary changes, instruction on proper body mechanics, pelvic support belts or garments, sexual education, and low back rehab. Use of our state-of-the-art Rehabilitative Real-time Ultrasound can help facilitate improved pelvic floor muscle function quickly. Up-training and overflow techniques to improve pelvic floor muscle recruitment and tone will be implemented. We are experts in the treatment of all types of pelvic floor muscle dysfunction and have successfully treated over 1500 patients since 2001.
Pelvic Organ Prolapse (POP)
Pelvic organ prolapse (POP) occurs when there is a weakness or laxity in the supporting structures of the bladder, urethra, rectum, or uterus. When there is a lack of support, one or more of these organs can drop down, bulge, or prolapse into the vagina. The organ may also begin to exit out of the vagina. The support structures for these organs include the pelvic floor muscles, pelvic ligaments, and connective tissue or fascia. There are several types of prolapses. A prolapse of the bladder is called a cystocele and the urethra prolapse is referred to as a urethrocele. A rectocele occurs when the rectum prolapses into the vagina. Lastly, when the uterus descends into the vagina due to loss of support, it is referred to as a uterine prolapse. Causes of POP include childbirth with excessive pushing during delivery, multiple vaginal births, trauma or defect of the pelvic floor muscles, connective tissue disorders, menopause, obesity, hysterectomy, muscle tone loss with aging, excessive coughing, frequent bearing down due to constipation, and genetics. Symptoms may include pressure sensation or fullness in the vagina, sensation of a bulge in the vagina, pelvic discomfort, urinary or fecal incontinence, urinary urgency, painful intercourse, pulling or pain in the groin region, or constipation.
How can Pamela Morrison Physical Therapy help with Pelvic Organ Prolapse?
Your expert pelvic physical therapist takes an extensive medical and pelvic history and then performs a thorough orthopedic and pelvic floor muscle exam. The pelvic floor muscle exam includes close inspection of the function and strength of the pelvic floor muscles. The prolapse(s) are graded (1 to 3) for severity. Grade 1 indicates a minor prolapse; Grade 2 indicates a moderate prolapse whereby the organ has descended close to the vagina opening; Grade 3 defines a severe prolapse: the organ has prolapsed outside of the vagina. Grade 3 requires surgical intervention, however, physical therapy is recommended post-surgically to restore normal function of the pelvic floor muscles. This prevents other pelvic organ prolapses from occurring and protects the surgical repair. Pelvic alignment is carefully assessed as well as pelvic connective tissue integrity. Your rehabilitation program can consist of pelvic realignment mobilization techniques, pelvic floor muscle rehab, postural re-education, neuromuscular re-education, pelvic support belts or garments, surface EMG pelvic floor muscle biofeedback, bowel/bladder retraining, prescriptive therapeutic exercises, and internal pelvic floor muscle electrical stimulation. Use of a temporary pessary (small removable device that supports a prolapse within the vagina) may be employed. We have a huge success rate with all types and grades of prolapses at Pamela Morrison Physical Therapy.
Pelvic pain may be acute, chronic, or recurring. Chronic pelvic pain is pain that has been present for more than 3 months. Both men and women can experience chronic pelvic pain. Pelvic pain is pain in the groin, lower abdomen, sacrum, coccyx (tailbone), vaginal, testicles, or rectal regions that can spread to the thighs, lower back or buttocks. Issues and diseases that contribute to or cause chronic pelvic pain include gynecological, urologic, gastrointestinal, musculoskeletal, neurological, trauma, sexual dysfunction, and depression. These issues can be related to myofascial trigger points in the abdomen, low back, and pelvic floor muscles.
How can Pamela Morrison Physical Therapy help men and women with pelvic pain?
Our comprehensive pelvic evaluation will help to identify the cause or perpetuating factors of your pelvic pain. An extensive medical history and physical exam will help determine whether poor posture, tight painful muscles, trigger points, weakness, or nerve disorders are a contributing factor. Other factors we evaluate include tight scar tissue or adhesions, misaligned joints, and faulty movement patterns. Treatment techniques that we find extremely effective with patients with pelvic pain include advanced manual techniques such as myofascial release, joint mobilization, nerve tissue tension release, and stretching. Correcting abnormal movement patterns and posture via neuromuscular re-education, therapeutic exercises and core strengthening is another goal for our patients. Incorporating pain reducing strategies using modalities such as moist heat, cold packs, therapeutic ultrasound, electrical stimulation and TENS is another component of our care.
At Pamela Morrison Physical Therapy, our therapists understand the birthing process, common medical interventions, and aftercare. After labor and delivery, women often have incontinence complaints, low back and pelvic pain, scar pain from c-section or episiotomy site, pain with intercourse, weak abdominals including diastasis recti, and pelvic floor dysfunction. At times, the cause of the problem is from the birthing experience including positioning, length of time pushing, trauma, pre-existing conditions, and other medical interventions. Some women may sustain a pubic symphysis separation or coccyx injury during childbirth. Obtaining clearance from your physician or midwife to begin exercise is advised. Postpartum women often are dealing with changes in their bodies, fatigue, and post partum depression.
How can Pamela Morrison Physical Therapy help postpartum patients?
A comprehensive women's health evaluation is provided by one of our expert physical therapists. Body mechanics instruction for bending, lifting, carrying, and other activities of daily living are crucial. Diastasis recti and pelvic floor dysfunction are assessed and severity is determined. Diastasis recti is when the linea alba (connective tissue) between the rectus abdominus muscles stretch during pregnancy and the recti muscles separate creating a gap. Weakness of these muscles results in decreased support of the spine and organs. The use of abdominal binders and prescriptive strengthening exercises for the core and rectus is our effective approach. Prolapse of the uterus, bladder, and rectum are assessed and addressed immediately. Strengthening pelvic floor and trunk muscles is very helpful. Hemorrhoids are other concerns that can be evaluated and treated by our trained women's health practitioners. Scar tissue mobilization, correcting pelvic and hip joint alignment and mechanics, and pelvic floor rehabilitation are also incorporated into your program.
At Pamela Morrison Physical Therapy our therapists are experts in working with pregnant patients. We understand the demands placed on the body during the different phases of pregnancy. There are tremendous increases in blood volume and hormonal changes that can impact soft tissue structures. Many pregnant women experience low back pain and "sciatica", which are usually caused by postural changes and sacroiliac dysfunction. Edema or swelling of the arms and legs, carpal tunnel symptoms, neck pain, headaches, incontinence, pelvic pain, and lower extremity pain are other common ailments. Stretching of the round ligaments that support the uterus may cause groin discomfort. Increased laxity in the ligaments may be a contributing factor to low back and pelvic pain during pregnancy.
How can Pamela Morrison Physical Therapy help pregnant patients?
Our special luxury treatment table has a removable belly piece for maximum comfort during treatment. This enables the expectant mother to assume a prone position (face down) more comfortably if necessary. Treating with expert manual therapy to ease painful muscles, decrease edema or swelling, and increase joint motion and flexibility is another key to our successful outcomes. Spinal strengthening, core stabilization, upper back strengthening, pelvic floor exercises (kegels), posture and body mechanics education, stretching exercises, and positioning education are addressed. Therapy balls and foam roller exercises are incorporated and quite useful in facilitating core stabilization. To prepare you for labor, your physical therapist will be sure to correctly align your pelvis and enhance mobility of the pelvis and coccyx (tailbone) to optimize your birthing experience. Prenatal exercises are prescribed to suit your individual needs. Using biofeedback, we can also assess which birthing position may be optimal in relaxation of your pelvic floor muscles. We also make recommendations for supportive garments such as sacroiliac belts to provide external support.
Pubic Symphysis Separation
A pubic symphysis separation or diastasis symphysis pubis is the separation of the pubic bones. The pubic symphysis joint is comprised of the 2 pubic bones and a cartilage disc that sits in between the two pubic bones. With a separation or diastasis, the pubic joint dislocates without a fracture. The causes of this separation can be due to the pressure and hormonal changes of pregnancy, trauma from childbirth, falls, motor vehicle accidents, sports injuries, or horseback riding incidents. During pregnancy, a hormone called relaxin causes the ligaments joining the pubic symphysis to soften. The body is preparing the joint to have increased range of motion and flexibility for ease of labor and delivery. However, this may cause the pregnant woman to feel sensitivity or pain in the pubic joint. The pubic symphysis separates to a certain degree normally during delivery however, in some women this separation becomes excessive causing trauma and pain at the joint. Also, sometimes during delivery forceps use and/or a rapid birth can be a cause of the pubic separation. A gap greater than 4-5 mm is considered normal during pregnancy and can increase up to 9 mm. An X-ray can confirm a pubic symphysis separation. A pubic symphysis separation can cause difficulty ambulating or taking care of your newborn. Daily chores, lifting, separating the legs, and rolling over in bed can be challenging. The bones of the pubic symphysis can remain malaligned and painful unless treated by a skilled physical therapist.
How can Pamela Morrison Physical Therapy help with pubic symphysis separation?
After a comprehensive pelvic evaluation, a pubic symphysis separation and malalignment can be identified. Our physical therapists perform gentle, effective joint mobilization and realalignment techniques to the pelvic joints including the pubic symphysis and sacroiliac joints. Modalities for pain are provided such as ice, electrical stimulation, ultrasound, cold laser, and TENS (transcutaneous electrical nerve stimulation). Soft tissue mobilization to the surrounding musculature, ligaments, and tendons is provided. Support belts and ambulation assistive devices are provided as indicated. We also prescribe progressive strengthening exercises to create stability around the pubic joint. Proper body mechanics for activities of daily living and improved postural awareness instructions to prevent further injury are provided. Whether this problem is acute or occurred many years ago we have had excellent results treating this disorder and our patients have been able to return to a painfree functional status. Our post partum patients have gone on to have future successful vaginal deliveries without reoccurrence.
Pudendal Nerve Entrapment (PNE)
The pudendal nerve is a somatic nerve within the pelvis comprised of branches of the sacral plexus levels S2-4. The pudendal nerve innervates the external genitalia in men and women including the labia, scrotum, penis, clitoris, and anus and provides motor function for bowel, bladder, and orgasm function. The pudendal nerve has three branches: perineal nerve, inferior rectal, and dorsal penile/clitoral. The pudendal nerve of the pelvis can become compressed (or entrapped) as it passes through the inside portion of the ischium or "sits bones" portion of the pelvis. The nerve path exits from the greater sciatic foramen, travels around the ischial spine, and passes through the lesser sciatic foramen. The pudendal nerve transverses through many other pelvic structures. It passes between the sacrotuberous and sacrospinous ligaments, between the piriformis and coccygeus muscles, and accompanies the pudendal artery and vein through the obturator fascia or Alcock’s (pudendal) canal. Compression or entrapment can occur at any of these sites along its path. A common cause of pudendal nerve entrapment is prolonged cycling on an incorrectly positioned or improperly shaped bicycle seat. This results in tension or thickening of the sacrotuberous and sacrospinous ligaments causing pudendal nerve entrapment between the ligaments. Other causes of pudendal nerve entrapment include pregnancy, pelvic floor muscle dysfunction, scarring due to pelvic surgeries, falls, sports injuries, horseback riding, and motor vehicle accidents. Chronic pain from pudendal entrapment can be felt in the abdomen, perineum, ischial tuberosities, buttock, vulva, clitoris, penis, scrotum, testicles, bladder/urethra, and anus. Most patients have increased pain upon sitting and have relief of pain upon standing, lying down, or sitting on a toilet seat. Symptoms can be pain, burning, numbness, and/or tingling in the pelvis and can radiate elsewhere. The pain is usually one-sided but there have also been cases where both sides are involved. Other symptoms may include urinary or fecal incontinence. An MRN can help with medical diagnosis.
How can Pamela Morrison Physical Therapy help with PNE?
After a comprehensive evaluation with your pelvic expert, your diagnosis can be confirmed. Our physical therapists perform specific connective tissue techniques, such as skin rolling and myofascial release, around the nerve to release the compression or entrapment. Soft tissue mobilization and deep tissue massage may prove beneficial in relieving compression off of the pudendal nerve as it transverses through pelvic soft tissue structures such as the piriformis and coccygeus muscles. Cross friction massage, integrative ligamentous releases, and therapeutic ultrasound of the sacrospinous and sacrotuberous ligaments is very effective in alleviating compression at this site. Specific techniques called nerve tissue tension releases and neural mobilization/gliding techniques may improve the mobility and function of the pudendal nerve alleviating symptoms within a few sessions. Malalignment of the pelvis, sacroiliac joints, spine, or coccyx can be a causative or perpetuating factor and are readily addressed by specific manual corrective mobilization or manipulation techniques. Proper bicycle seats, sitting habits and/or postural education will be addressed. Pelvic floor muscle dysfunction rehabilitation with a focus on lengthening, releasing trigger points, relaxing and down-training may be components of your program as this may be another source of your pudendal nerve entrapment symptoms. Prescriptive stretching and strengthening exercises such as hip, lower extremity, and spinal and core stabilization training are instructed. Because of our level of expertise in treating pelvic pain, we have successfully helped hundreds of patients with pudendal nerve entrapment overcome their pain and symptoms.
Please click here to read "Pelvic Trust", an article featured in TodayinPT.com about Pudendal Neuralgia Physical Therapy.
Pudendal Neuralgia (PN)
Pudendal neuralgia is a painful condition caused by inflammation or irritation of the pudendal nerve. The pudendal nerve is a somatic nerve within the pelvis comprised of branches of the sacral plexus levels S2-4. The pudendal nerve innervates the external genitalia in men and women including the labia, scrotum, penis, clitoris, and anus and provides motor function for bowel, bladder, and orgasm function. The pudendal nerve has three branches: perineal nerve, inferior rectal, and dorsal penile/clitoral. The pudendal nerve transverses through many other pelvic structures. It passes between the sacrotuberous and sacrospinous ligaments, between the piriformis and coccygeus muscles, adjacent to the ischial spine, and accompanies the pudendal artery and vein through the obturator fascia or Alcock’s (pudendal) canal. Damage or trauma to the pudendal nerve can result from falls onto the coccyx or ischial tuberosities (‘sits” bones), childbirth, abdominal or pelvic surgery, bicycling, horseback riding, sports injuries, squatting or lifting injuries, motor vehicle accidents, faulty biomechanics of the sacroiliac, sacrococcygeal, and hip joints; adverse tension of the pelvic ligaments (sacrotuberous, sacrospinous), pelvic floor muscle dysfunction, pelvic radiation therapy, chronic constipation with habitual straining, and chronic pudendal nerve entrapment. Common symptoms of pudendal neuralgia include pain or impaired sensation in the vulva, vagina, clitoris, penis, scrotum, testicles, rectum, or ischial tuberosities, pain upon sitting, sexual pain/dysfunction such as arousal, erectile, ejaculation, or orgasm; difficulty with urination or bowel movements, constipation, urinary or fecal incontinence, and the sensation of having a foreign object or “fullness” in the vagina, rectum or perineum. Symptoms usually worsen by the end of the day and improve upon lying down or sitting on a toilet seat. Common conditions that could mimic pudendal neuralgia include coccygodynia, sacroiliac joint dysfunction, piriformis syndrome, ischial bursitis, interstitial cystitis, chronic or non-bacterial prostatitis, prostatodynia, vulvodynia, vulvar vestibulitis, chronic pelvic pain syndrome (CPPS), pelvic floor muscle dysfunction (hypertonicity), and proctalgia fugax. Medical testing for proper diagnosis may include an image guided pudendal nerve block, pudendal nerve motor latency test (PNMLT), electromyography (EMG), and an MRI, MRN, or CT scan.
How can Pamela Morrison Physical Therapy help Pudendal Neuralgia?
Physical therapy is a proven effective treatment approach for pudendal neuralgia. Your expert pelvic therapist completes a comprehensive history and physical exam. Your physical exam would include evaluation of the spine, pelvic (sacroiliac, sacrococcygeal, pubic symphysis) and hip joints; lower extremity and pelvic soft tissue, muscle, and nerve function; pelvic floor muscle function, adverse neural tissue tension/mobility testing, and visceral mobility testing. Evaluation may also include surface EMG biofeedback of the lower abdominals and pelvic floor muscles. Your evaluation occurs over an hour and half time span to allow adequate time for thoroughness. Once a proper diagnosis and your evaluation findings are established, a prescriptive treatment program will be implemented to meet your individual needs. Treatment may consist of joint mobilization and manipulation to restore proper alignment and joint mobility, soft tissue mobilization (massage, deep tissue, and myofascial release), cross friction massage to pelvic ligaments, scar tissue release/mobilization, specific nerve mobilization/gliding techniques, connective tissue and skin rolling techniques, pain relieving modalities such as TENS, ultrasound, interferential electrical stimulation, cryotherapy, cold laser; stretching exercises, neuromuscular re-education of core muscles and lower extremities, visceral mobilization, and prescriptive strengthening exercises. Pelvic floor muscle rehabilitation occurs including manual therapies and surface EMG biofeedback to focus on down-training or relaxing the pelvic floor muscles. Restoring normal pelvic floor muscle length and resting tone, and releasing painful tender/ trigger points are main treatment objectives. Relieving pain, restoring pudendal nerve mobility and function, and restoring normal bowel, bladder, and sexual function will be primary goals of therapy. This will be achieved through advanced specific manual therapies mentioned above, therapeutic modalities, bowel and bladder re-training as needed, education of proper postural habits and body mechanics, sexual education, and behavioral modification training. Because we are pelvic experts at Pamela Morrison Physical Therapy, we have had tremendous success identifying and treating hundreds of patients with pudendal neuralgia.
Please click here to read "Pelvic Trust", an article featured in TodayinPT.com about Pudendal Neuralgia Physical Therapy.
Sports and Orthopedic Injuries
At Pamela Morrison Physical Therapy our therapists are experts in dealing with all orthopedic and sports injuries. Exercising improves health and is strongly promoted by health care professionals but sometimes injuries occur unexpectedly or overtime. Accidents, insufficient training, or using improper equipment can cause these injuries. Not warming up, poor hydration, fatigue, or lack of stretching can also lead to injuries. Some of the most common sports injuries are sprains and strains, knee injuries, Achilles tendon injuries, plantar fasciitis, shin splints, fractures, dislocations, tennis/golfer’s elbow, iliotibial friction syndrome, patellofemoral syndrome, low back pain, and rotator cuff tears. One of the best treatments for an injury that has just occurred is to rest, ice, apply compression, and elevate the injured area. This method helps to reduce swelling and pain and expedite healing. Seeing a physician is highly recommended to make sure the injury is not more severe than initially expected.
How can Pamela Morrison Physical Therapy help with sports orthopedic injuries?
A comprehensive musculoskeletal and biomechanical evaluation is performed to determine the cause of pain and a diagnosis is determined. Strength, flexibility, balance, and stability are evaluated. Gait and shoe wear analysis occurs for all leg and low back injuries. Pain is managed through use of modalities such as electrical stimulation, TENS, therapeutic heat ultrasound, ice, moist heat, and laser therapy. Manual therapy such as soft tissue massage, myofascial release, cross friction massage, trigger point release, stretching, neuro-reeducation, and joint mobilization are some of the techniques utilized by our manual therapists to facilitate faster healing. A prescriptive exercise program is designed for each patient. Sports specific activities are incorporated into the exercise rehab program. Principles of core strengthening are applied to athletes of all age groups.
We have extensive experience working with marathon runners in helping prepare for a race or with any post race injuries. Running shoes should meet certain criteria to be considered “high standard”. Ask us how to better evaluate running shoes for a smarter purchase.
Congenital Muscular Torticollis, also referred to as Wryneck, is a stiff neck and presents with the baby’s head tilted to one side and rotated to the opposite side. The infant or child will demonstrate limited neck range of motion turning to one side usually. The muscles on either side of the neck called the sternocleidomastoid will spasm and shorten. Many times one or both of the baby’s occipito-atlantal joints (the joint between the head and the neck) are restricted or stuck making moving the head very difficult. Torticollis occurs in newborns due to positioning in utero, after a complicated vaginal delivery, a breech presentation, or use of forceps or vacuum devices. You may notice that your baby or child favors looking to one side only, has limited rotation of the neck, may sleep with the head turned to one side only, or has a small bump on the side of the neck which is the muscle spasm. The infant may also prefer to nurse on only one breast and have difficulty or “reject” the other breast just because the infant can not maintain the correct head, jaw, and neck position to effectively suck. This can lead to decreased breast milk production on that side, clogged ducts, mastitis, or nursing pain. Torticollis limits an infant’s or child’s ability to turn the head to see, hear and interact appropriately with his/her environment. Because of this, torticollis may lead to delayed cognitive development, delayed whole body awareness, weakness, and impaired balance. Although this disorder is not usually painful in infants it should be addressed as soon as possible by your pediatrician and treated by a skilled physical therapist. Left untreated can result in the baby’s head misshaping called positional plagiocephaly or asymmetrical molding of the head/face and may progress to scoliosis as the child grows.
How can Pamela Morrison Physical Therapy help your baby with torticollis?
The expert therapists at Pamela Morrison Physical Therapy, PC will assess the severity of your infant’s or child’s torticollis by taking a birth and medical history and by performing a physical exam. Head molding will also be assessed. Gentle assessment of neck range of motion, neck muscle palpation for increased tone and spasm, mobility assessment of the occipito-atlantal joints, and developmental milestones observation will occur. Cranial bone alignment and cranial suture mobility will also be evaluated and corrected. Manual therapies such as joint mobilization, myofascial release, craniosacral therapy, integrative manual therapy, strain-counterstrain, and gentle stretching will be utilized to correct the torticollis. Guided and facilitated therapeutic exercises will help the infant/child increase their strength, achieve developmental milestones, improve their body awareness, improve their ability to see and interact with others and their environment, and help improve their balance. Positioning and stretching home exercises will be taught to the parents or guardian. A torticollis collar brace may be prescribed by your pediatrician.
Vaginismus is described as an involuntary contraction or tightening of the pelvic floor or vaginal muscles in response to attempted penetration. There are many possible causes such as anxiety, prior physical experiences that may have been traumatic, childbirth, hormonal changes, surgery, or a medical problem. If penetration is painful or there is a history of pain with intercourse, a cycle of pelvic muscle spasm can occur.
How can Pamela Morrison Physical Therapy help Vaginismus?
Following a comprehensive musculoskeletal evaluation, treatment may include correction of any misaligned joints of the spine, pelvis, sacrum, and coccyx. The pelvic floor muscle activity can be influenced by the supporting joints and/or the nerve pathways. Relaxation training, biofeedback, manual therapy, stretching exercises, prescriptive therapeutic exercise, electrical stimulation, heat modalities, and vaginal dilators may be incorporated into your therapy program. A physical therapy approach to vaginismus has been very effective for our patients.
Vulvodynia is defined as pain in the vulva lasting more than 3 months. The pain can be described as burning, rawness, itching, achy, stinging, throbbing, irritation, or discomfort. Vulvar pain can be generalized meaning that the general area of the vulva hurts or localized meaning that a specific area of the vulva hurts. Vulvar pain can occur at rest and/or be provoked by touch/pressure. Localized vulvar pain can be local to the vestibule (vaginal opening) called vulvar vestibulitis, or localized provoked vestibulodynia (LPV), or local to the clitoris called clitoridynia. Many patients complain of pain with intercourse, sitting, tight clothing, and/or sensitivity to topical agents such as creams and soaps. Others report that their pain fluctuates with their menstrual cycle. Vulvar pain can be related to an infection, inflammation, skin conditions, diseases, neurologic or musculoskeletal disorders.
How can Pamela Morrison Physical Therapy help vulvodynia?
Through a comprehensive evaluation of your musculoskeletal system it can be determined whether there is a muscle, joint, or nerve problem contributing to or causing the pain. Those who have vulvodynia may have associated hip, sacroiliac, coccyx, or low back pain. Pelvic floor muscle dysfunction is also a common finding. Nerves that may be involved include the sciatic, posterior femoral cutaneous, sciatic, ilioinguinal, obturator, genitofemoral, and pudendal. Treatment may include pain relieving modalities, biofeedback, manual therapy, pelvic floor muscle dysfunction rehab, therapeutic exercises, core stabilization training, use of vaginal dilators, and a home program. There have been several studies and articles showing that physical therapy can help patients overcome vulvar pain.