The first visit will involve a lot of chatting at first. In my initial evaluations, I’m spending quality time asking pertinent questions and letting my patients tell me their story.
Things I’m asking about:
- Current symptoms, when they started, any relevant injuries, what your goals are with therapy, relevant past medical history, current bladder/bowel/sexual function
- I review what I plan to look at, explain how I’ll do that, and I always provide a lot of education and explanation regarding the pelvic floor component
- I always welcome questions!
The objective exam should be very thorough assessing your body from head to toe. The pelvis does not work in isolation and therefore the entire body needs to be evaluated to find the root cause!
Here’s what I include in my exams:
- Postural analysis
- Spinal mobility, Rib mobility and position
- Hip mobility
- Breathing analysis and how they manage pressure within the core system
- Functional assessment (may include single leg balance, squat, lifting, running, exercise)
- Strength testing— big hitters for me are hips, core, inner thighs, pelvic floor, foot/ankle
- Examine any scars around the abdomen, hips, back, pelvis, sometimes lower extremities
- Pelvic floor exam— internal and external
The Pelvic floor exam is always optional, but is a very important piece of the exam especially if the person is experiencing pelvic floor symptoms and/or chronic low back/hip/tailbone pain.
What is included in a Pelvic Floor Exam:
- External exam — assessing perineal scars, observing the perineum, looking for any obvious pelvic organ prolapse, examine vulvar tissue health, reproduction of symptoms with external tissue palpation, testing nerve function
- Internal exam (vaginal and/or rectal) — palpating for pelvic floor muscle tension and/or reproduction of pain or symptoms, assessing strength and function of the pelvic floor, more in-depth testing for prolapse, assessing the tailbone internally
Putting it all together! Once we chat and complete the exam, then we will chat about the results and what’s going on and determine a plan moving forward. Sometimes, finding the root cause can take more than 1 session, especially for complex or chronic conditions. So each session is treated as a re-exam in some way.
We will sit and discuss what we found, why it matters, ask questions, and determine how we are going to resolve the issues. We will discuss what the plan of care will look like and initiate part of your homework! All of my patients get some form of homework. This is important in moving forward with the plan of care and looks different for everyone. Then we plug away with addressing all the things we need to get you feeling better!