Frequently Asked Questions - Physio

What should I expect on my first visit to the clinic?

We appreciate you arriving at the clinic 10-15 minutes before your initial visit to allow sufficient time to fill out the required health information forms. Your initial visit will be an hour in length and will include your assessment and first treatment.

 

For all clients it is recommended to bring shorts and a loose fitting top to allow for ease of assessment and movement during treatment. For pelvic floor conditions, an internal vaginal and ano-rectal exam will be completed (see below).

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How long are treatments?

Treatments for physiotherapy can range from 30, 45, or 60 minutes depending on the complexity of the condition(s) and treatment required in order to allow sufficient time to provide the highest quality of care. However, treatment time may be adapted based on findings to provide more intensive care as decided by you and your therapist.

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How many treatments will I need?

No set number of treatments can be determined as every patient is unique in their presentation of dysfunction, pre-existing health condition, and response to treatment. Your treatment plan including an estimated number of treatments will be discussed at your first visit and will be based on assessment findings and the judgement of your therapist.

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What if I need to cancel my appointment?

It is understandable that some appointments may need to be rescheduled or cancelled. However, I ask that you provide 1 business day (24 hours) notice by phone to cancel or reschedule any appointments as I set aside significant time for your treatment and care, and without prior notice any missed appointment time cannot be filled by other patients. Patients who do not provide 24 hours notice will be charged their full treatment fee.

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What is pelvic floor physiotherapy?

Pelvic floor physiotherapy is an orthopedic specialization in physiotherapy which requires post-graduate training. It is the urogenital, urogynecological, obstetrical/gynecological equivalent in physiotherapy as it treats conditions of the pelvic basin, for both men and women, including urinary or fecal frequency, urgency, and or incontinence, pelvic organ prolapse, pelvic pain including coccyx pain, pubic bone separation and pain, pain with intercourse, Cesarean section or episiotomy scarring and pain, ano-rectal dysfunction like chronic constipation, pain with elimination, and chronic non-bacterial prostatitis. The pelvic floor can also be very interrelated to other conditions including low back pain, sacroiliac joint pain, hip and lower limb issues, as well as head, neck, and jaw dysfunction.

 

Treatment employs a combination of education, positioning, strength, coordination, and functional exercises (many different types beyond typical Kegels), stretching, myofascial release, manual therapy, pelvic alignment, and visualization via biofeedback. Pelvic floor physiotherapists will use a combination of these techniques and will treat both internally (vaginal, ano-rectal) and externally.

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What should I expect on my first pelvic floor physiotherapy visit?

We ask that you please arrive 15-20 minutes before your appointment time to allow us to welcome you to the clinic, fill out the appropriate paperwork, and have a nice cup of tea or water. Your initial visit will be an hour in length and will include your assessment and treatment. All treatment is provided in private rooms and will be one-on-one with Andrea for its duration.At the beginning of your assessment you and your therapist will discuss your health history, reasons for seeking treatment, and how your current issues arose. Andrea will then go over the anatomy and physiology of the pelvic floor, what the physical exam will include (both external and internal), and answer any and all questions you may have.

 

After the external assessment is complete, Andrea will allow you to change for the internal (vaginal and/or ano-rectal) portion of the assessment. She will inform you of what she is doing at all times. If at any point (during your assessment or any time during a pelvic floor treatment) you no longer consent to treatment, that is fine. Please just let her know and you can discuss alternative options. It is also your right to bring someone into any assessment or treatment, should you so desire.

 

At the end of the assessment Andrea will inform you of her findings, outline possible treatment options, and prescribe a treatment frequency that works with your needs and schedule. She will also provide you with home exercises as needed.

Andrea follows the most current infection control and hygiene protocols outlined by The College of Physiotherapist of Ontario for all aspects of your care, especially with respect to internal pelvic assessment/treatment. Non-latex gloves are used, as well as organic water-based and oil-based lubricants. If you have any allergies please let her know.

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My doctor already did a pelvic exam. Why do I need to have another one?

While doctors complete pelvic exams regularly, they are not the same as the ones carried out by Pelvic Floor Physiotherapists. While some medical doctors may prescribe pelvic floor physiotherapy, they only assess for life threatening issues (e.g. infection, malignancy, etc. ) and identify areas where medicine or surgery may be the best course of action. Alternatively, pelvic floor physiotherapists assess for visible infection/irritation, bony alignment and mobility, muscle tension, strength, and coordination, pelvic organ positioning and mobility, and scar tissue adhesions.

 

This will allow your therapist to observe how your body is functioning in all aspects which provides the basis of your diagnosis, treatment plan, and overall care. Without it we would be missing crucial information which would only give you very limited results.

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What does the physiotherapy pelvic exam entail?

A physiotherapy pelvic exam is more detailed (and gentle) than a medical one. It will include an observation of the external anatomy to identify any imbalances, irritation, scarring or connective tissue dysfunction. Sensation and reflexes will be tested to ensure proper neurological function. 

 

A manual internal (vaginal and/or ano-rectal) assessment will identify imbalances, scarring or connective tissue issues, and muscle tension, strength, and coordination. Lastly, internal organs will be manually assessed to determine proper positioning and mobility. Andrea will guide you through the process instructing you to perform certain movements and will let you know what she is doing at all times.

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What if I don't want to have an internal exam or continue with internal treatment?

Your health is always in your hands. If after discussing your reasons for seeking treatment, understanding the anatomy and function of the pelvic floor, and possible treatment options you are still not comfortable undergoing a pelvic exam or continuing with internal treatment that is fine. Just let Andrea know and you can discuss other treatment options.

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I'm on my cycle. Can I still come in for a pelvic floor assessment or treatment?

Yes, you can still receive an internal pelvic assessment or treatment while menstruating. Proper hygienic protocols are used and being on your cycle does not interfere with assessment or treatment.

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Can I receive pelvic floor physio while I am pregnant?

Yes. Pelvic floor physiotherapy has been shown to be very helpful during pregnancy to help limit and remove pelvic girdle, pubic bone, groin, coccyx and low back pain, as well as aiding to open the pelvic floor and prepare it for labour and delivery, limiting the possibility of tearing or the need for an episiotomy.

 

There are no risks to the mother or baby with an internal pelvic assessment or treatment with a healthy and normal pregnancy. If however you are a high risk pregnancy and have been placed under medical precautions such as abstaining from intercourse, bed rest, etc. then an internal pelvic floor assessment or treatment would not be advisable. However, you would be at no risk of receiving general physiotherapy externally.

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How soon can I receive pelvic floor physio postpartum?

As soon as possible is best, but depending on your concerns as well as the type of birth (vaginal vs Caesarian) a few weeks wait after birth may be necessary to allow for healing in areas needing treatment. If a Caesarian was performed, you may want to wait until the incision has healed (approx 4-6 weeks) before having abdominal or scar work done. If you had an episiotomy, again you may want to wait a few weeks to allow for incision healing before having internal pelvic floor work done. But, if pain is significant, it is wiser to be treated immediately as there are numerous things that can be helped without disturbing incision sites to ease pain and rturn to function. 

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How can physiotherapy help fertility issues?

While hormone imbalances, reproductive cell (sperm, ovum) dysfunction, or other medical conditions are outside the scope of physiotherapy, structural issues such as abnormal inflammatory responses, adhesions, cysts, and poor cervial/ uterine alignment and circulation can all be treated manually.

 

The reproductive organs, as with all tissue in the body, are supported, enveloped, and infiltrated by connective tissue (aka fascia).  Working directly on this tissue can help to improve conception and carrying to term. Learn more in the published scientific article by Wurn and colleagues (2008): "Treating Fallopian Tube Occlusion with Manual Pelvic Physical Therapy."

Do I need a physicians referral?

No physician’s referral is needed to access physiotherapy care.

However, some private insurance companies require a physician’s referral to be compensated for treatment. Please check with your private insurer for their requirements.

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Is my treatment covered by OHIP?

Unfortunately private physiotherapy is not covered by OHIP. However, most private insurers cover up to or more than 75% of the cost. We do not deal directly with your insurance companies and so you are expected to pay at each of your visits and will be provided a valid receipt which you can submit to your insurance company for reimbursement. Health costs like physiotherapy may be deductible under your Income Tax. Please contact CRA for more information. 

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I am making a motor vehicle accident claim. What do I need to do?

It is important to come in as soon after a car accident as possible, even if you are not feeling any symptoms. It is very common for symptoms to show up a few days to weeks after an accident and research shows improved outcomes and less chance for long term issues with those who received early intervention and treatment. 

 

Once you have called and reported the accident to your insurance company, you can call the clinic to book your assessment. Make sure to let the reception staff know it will be for a car insurance claim so they can make sure you bring the appropriate paperwork from your insurance provider. We no longer deal directly with your insurance, so you are expected to pay at each visit. Our insurance coordinator will help you with any questions you may have.

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I am making a workplace injury (WSIB) claim. What do I need to do?

Unfortunately, we do not provide services for WSIB insurance claims. There are, however, many reputable physiotherapy, massage therapy, and alternative healthcare practitioners who do. 

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© 2019 Andrea Plitz, PT & RYT