Telerehabilitation for Pelvic Floor Physiotherapy. Really?
As we attempt to provide care in a unique and safe way, in the form of Telerehabilitation, there can be a sense of loss or comparison against what we are used to. This makes sense as we are creatures of habit and Physiotherapy is traditionally quite physically and hands on based.
However, there are many more ways to assess, influence and make effective change in the body than putting hands on.
But don’t I need a physical exam?
Our assessments are more than hands on. While manual and in person clinical tests do help to confirm diagnoses and inform our treatment plan, they may not be necessary to get a good understanding of your current health situation, to make an informed diagnosis, nor to provide appropriate and effective treatment options.
This is because a multitude of other factors are taken into account which informs our assessment, diagnosis, and treatment plan.
Your intake form, health history, story of current situation and complaints, as well as goals provide us with a lot of information on where, what and how we will assess. By the end of your subjective evaluation, whether in person or not, your Physio has a pretty good idea already on where they need to look more closely, and a few possible diagnoses.
The Power of Observation
Seeing how you position, move, and support yourself informs us on what structures, mechanics or control of those pieces is non-optimal. We can then, in combination with our many other assessment tools, hypothesize how this is relating to your symptoms and what may need to be treated.
The pelvic bone is connected to the… entire body.
Because the pelvis sits at the bottom of our trunk, connects us through limbs to our ground, and houses numerous important organs it can often be the victim of multiple influencing factors. It just presents as pelvic dysfunction such as pain, altered sensation, incontinence, heaviness or pressure, etc. as the pelvic floor may just be reacting to other influencing factors.
We always assess the entire body to determine where and what we need to treat in order to restore proper functioning the fastest. Our experience in holistic and applied abdominal pelvic health allows for this insight for more targeted care.
Posture & Pressures
The pelvic floor (& its proper function) is very easily influenced by what sits on top, the breath, and the coordination of our center. These aspects provide subtle but important information on how your pelvic floor and its contents are being challenged on a daily basis.
Alignment and posture are all typically assessed via observation, often times with manual confirmation. However, when it comes to pelvic health there are certain postures which we know result in common abdominal-pelvic complaints (see Diane Lee’s blog on Butt-grippers, back-grippers, and chest-grippers.)
Pressure, too, can be observed but also felt and/or reported by the patient. Your guided awareness and reporting now inform our assessment. See here for more info on how pressure impacts pelvic health.
We can’t talk about posture, pressure and pelvic floor without talking about the breath. How we breathe, use our breath, or hold our breath can seriously impact the reflexive activation and pressure exerted on the pelvic floor. Again, we can use observation or patient report to assess. For more information on how pelvic floor is related to breath, check out our blogs.
We screen for any other influencing factors that may be contributing to patient complaints such as diet & nutrition, sleep, energy levels, daily routine, activity levels & participation, mental health, and social support. We may ask you to track some of these domains to identify ways you can adjust to better support where you are now and where you want to be in the future.
How can you treat without being in the same room as me?
While Physio treatment often includes manual therapy, we always integrate mindfulness, connection, breath, control/ stability, strength, function, movement, and any other lifestyle medicine aspects as appropriate.
Pelvic Floor is Part of the Core
We know that pelvic floor strength is not a direct determinate of function (i.e. someone may have great pelvic floor strength but still be leaking or having symptoms). More often than not, we treat the pelvic floor within the system of the core; getting these 4 muscles, which includes the pelvic floor, to work synergistically and dynamically in a way that supports your function and goals. More info on core basics from Julie Weibe, PT.
Release with Awareness, Align, Connect & Move
There are many different ways to effect change in the body, including how we connect with certain areas, support, stretch, load, and move. We always take into account which areas need to be released (i.e. tight, stiff, limited), aligned (statically or dynamically), supported (through connection to stability mechanisms), and moved to achieve goals (this could be anything from mobilizing, strengthening, or repatterning).
We do this through bespoke rehab movement and exercise that are provided based on individuals needs, not on diagnosis. Every person is different, so what may work for one person may not be the best option for another.
It is in this domain that research shows Telerehabilitation Physio services to be comparable to in person visits; and better for increased compliance with home exercises, ease to access appointments and overall satisfaction with care. See our blog post here.
Knowledge Transfer + Life hacks
Education is one of the most important aspects of our treatment, whether in person or not. We help you understand your condition and symptoms, explain anatomy, physiology, and basic biomechanics, as well as educate on how to modify other influencing life factors to ensure proper recovery and empowerment in your health.
To us, success means you can integrate what we ask you to do in your daily life. We brainstorm with you to find options on how you can take our treatment even more into your home and do it consistently to create positive change.
Connection. Motivation. Success.
We have recently started integrating a free App (Embodia) for patients to access personalized home exercise programs as prescribed by your practitioner, receive exercise reminders, make notes &/or track adherence and progress. All of which can be seen by your practitioner, helping you to succeed in your health goals. This is used for both in person and Telerehabilitation patients alike.
What do you recommend for follow up visits?
Typical in person follow ups occur once every 1-3 weeks depending on the severity and requirements of care. This will be the same for Telerehabilitation Physiotherapy.
Follow up treatments can range from 15 minute check ins to 45 minutes depending on findings and recommended treatment plan as discussed and agreed upon by you and your therapist.
Of course, as conditions permit us to return to in person care, we can see you in the clinic to complete any relevant physical evaluations and treatment, including manual therapy. At that time, we will continue to progress your already well established home program.
Telerehabilitation, while limited in the manual, hands-on care Physiotherapy is well known for, there are many other tools and ways in which we can assess and treat with good effect and patient outcome; and are already using during in person visits.
In future, Telerehabilitation can also be a great primary or adjunct form of care for:
Any individuals with transportation or mobility difficulties (acute or chronic)
New mom’s who find it difficult to come in person either before or after their 6 week postnatal in-person check up
Individuals whose care no longer requires manual therapy, but is focused more on exercise progression, education, lifestyle medicine and integration, among other non-manual therapies or treatment requiring close supervision
Professionals whom are stuck at the office and can’t get away for care
Someone living in a remote community with no local clinic to attend
Weather makes it so you can’t get out to the clinic
Practitioners whom wish to consult with an advanced practice provider
Those who live in a community that does not have the specific services you need
We thank you for your curiosity and trust in our care and we hope to “see” you either online or in person (once we are back to the clinic).
Interested in learning more about Telemedicine & Telerehabilitation? Click here.
Disclaimer – Everything shared is for informative purposes only. It is not intended for assessment, diagnosis or treatment purposes. If you feel there needs to be further investigation, please seek out a qualified health care professional for a proper assessment.