ROBYN ALLEN, PHYSIOTHERAPY
General Definition of a Physiotherapist
As primary health care professionals, physiotherapists combine in-depth knowledge of how the body works with specialized hands-on clinical skills to assess, diagnose and treat symptoms of illness, injury or disability.
With your independence in mind, a physiotherapist’s goal is to restore, maintain and maximize your strength, function, movement and overall well-being.
Physiotherapists prescribe personalized therapeutic exercises, and provide essential education about the body, what keeps it from moving well, how to restore mobility and independence, and how to avoid or prevent bodily harm.
(definition from the Canadian Physiotherapy Association’s website)
Physiotherapy at Two The Core
At Two The Core we encourage preventative health care. You do not require an injury, disease or surgery to be helped by a physiotherapist. The following are types of services provided:
- Sports specific training and injury rehabilitaion
- Pre and post surgical therapy
- Neuromuscular disease
- Musculoskeletal injuries
- Pelvic health
- Fitness based therapy
- Hipppotherapy (therapy using horses)
Pelvic Health is the assessment and treatment of a wide variety of issues pertaining to the pelvic girdle area for both females and males. These may include incontinence of bladder and bowel, frequency and urgency, pre and post partum pain, organ prolapse, lumbo-sacral and sarcroiliac joint pain, mobility problems, as well as sexual pain and dysfunctions. Physiotherapists trained in pelvic health are able to not only consider the dysfunctions of the external musculoskeletal system but are also specially trained to internally evaluate the pelvic floor system in order to provide a specifically guided treatment plan.
What Is Your Pelvic Floor
The Pelvic Floor is a group of muscles attaching from your pubic bone to your sacrum and coccyx. It is what keeps your bladder, bowel, and uterus (for females) held in place and functioning properly.
Weakness, poor co-ordination, or abnormal tone in these muscles can cause incontinence of urine and stool, difficulty voiding, pain, organ prolapse, and sexual dysfunction.
The pelvic floor is also a major component of “core” stabilization as it directly influences the sacroiliac, symphysis pubis and lumbo-sacral joints.
What Is a Kegel?
A contraction of the pelvic floor system is termed a “Kegel”. This is often what women are told to practice after childbirth or men following a prostatectomy however it has been found that approximately 1/3 of women are unable to contract their pelvic floor on demand and 1/4 actually promote incontinence by straining. It has been recommended by the Society of Obstetricians and Gynaecologists of Canada that the proper performance of a Kegel exercise should be confirmed by digital vaginal examination or biofeedback.
It is important to note that not all individuals are appropriate for Kegel exercises as they may do more harm than good. Some individuals may need to have their pelvic floor ‘released’ and be trained on how to relax the muscle system versus focusing on the contraction phase of the Kegel. Physiotherapists are more specifically trained on muscle testing than any other professional therefore, we are able to assess how your muscle system is performing and prescribe appropriate excersises for your condition.
What To Expect At My Initial Visit
A detailed health history will be taken as well as your diet and bowel and bladder habits in order to obtain a full understanding of your concerns. The physical examination may include internal palpation and strength testing of your pelvic floor muscle system, as well as postural alignment and general testing of any other involved muscle groups.
Once a thorough exam has been completed, together we will develop individual goals and determine the treatment plan to obtain those goals.
The Canadian Continence Foundation simply defines incontinence as losing urine when you don’t want to. Definitions in the literature can vary anywhere from experiencing leakage once per month to frequently every day. The quantity of leakage is very individualized, as one drop from coughing may be significant enough for one person but insignificant to another.
Prevalence of Incontinence
An estimated 10% of Canadians are incontinent which translates into 3.3 million people in our country alone. Depending on the research study and how it defined incontinence, estimates can range from 2% to 50% of the Canadian population.
Urinary incontinence is a difficult condition to accurately diagnose as it has a significant stigma and embarrassment associated with it. A lot of people assume it is part of the normal aging process but it is not. The emotional, psychological and social consequences of incontinence can include:
- Decreased physical activity
- Decreased self confidence
- Decreased sexual function
- Depression and isolation
- High financial cost
How Can Physiotherapy Help With Incontinence?
The physiotherapy approach to treating urinary incontinence combines behavioural therapy (bladder retraining, education, dietary modifications) with more physiotherapy specific treatments. Specially trained physiotherapists can assess and treat the pelvic floor muscles by use of manual therapy techniques, exercises, biofeedback, electrical muscle stimulation and functional applications.
Conservative treatments combining these parameters have been strongly recommended by the Society of Obstetricians and Gynaecologists of Canada, as they are considered highly effective.
If You Answer “yes” to any of the following, a physiotherapist can help!
- Do you leak small amounts of urine when running, jumping, coughing, sneezing, or lifting?
- Do you rush to the bathroom as soon as you enter your home, workplace, or mall?
- Do you loose urine while trying to undress to get on the toilet?
- Do you frequent the bathroom more than 8 times per day or multiple times per night?
The following women may be more at risk and may choose to see a physiotherapist for prevention of incontinence if they are not already experiencing signs or symptoms:
- Pre and post partum
- Having had more than 1 child
- Peri and post menopausal
- Pre and post gynecological or urinary surgery
The following men may choose to see a physiotherapist for help with bladder control:
- Pre and post surgical for prostatectomy and TURP
- Post radiotherapy
- Prostatodynia (chronic pelvic pain syndrome with associated urinary changes)
- Over active bladder
- Post-voiding dribble
**You don’t need to be “leaking” to be appropriate for pelvic floor therapy. Prevention is the key.
A Joint Policy Statement done in May 2005 between the Society of Obstetricians and Gynaecologists of Canada and the Canadian Physiotherapy Association recommend the following (Britnell S.J. et al, JOGC, May 2005):
- pelvic floor muscle training with a physiotherapist is recommended to preventurinary incontinence during pregnancy and after delivery
- core stability training with a physiotherapist is recommended to prevent and treat back and pelvic pain during and following pregnancy
- pelvic floor muscle training with a physiotherapist is recommended for women with stress urinary incontinence
The Society of Obstetricians and Gynaecologists of Canada also released guidelines in 2006 for conservative management of urinary incontinence that include (Robert et al, JOGC, December 2006):
- behavioural management protocols using lifestyle changes in combination with bladder training and pelvic muscle exercises are highly effective and should be used to treat urinary incontinence
- proper performance of Kegel exercises should be confirmed by digital vaginal examination or biofeedback
Pelvic Health for MEN
Most men are referred to pelvic health physiotherapy for urinary dysfunctions or pelvic pain assoiciated with conditions of the prostate. The prostate is a small walnut-shaped gland that is situated between the bladder and the pelvic floor muscle layer.
Men having undergone a Radical Prostatectomy or Radical Resection of Prostate (RRP) (prostate removal) may have residual incontinence symptoms as the internal sphincter of the bladder has been significantly disrupted. Post surgery these men will need to learn how to use their pelvic floor muscles appropriately to prevent leakage whenever their intra-abdominal pressure rises (eg. cough, sneeze, lift, bend over, sit to stand). It would be very beneficial for men that are awaiting this surgery to see a physiotherapist that will educate them regarding what to expect post surgery, maintaining proper bladder and bowel habits, and most importantly teach them a proper pelvic floor contraction and how to use it post surgery to prevent long term leakage.
The other treatment for prostate cancer that can affect incontinence is Radiotherapy or Radiation. Again with this type of treatment it is the effect on the internal urinary sphincter that can cause leakage if the pelvic floor muscles are not responding appropriately. Men may also experience stool incontinence secondary to the tissue damage and scar tissue formation on surrounding areas.
Benign Prostatic Hyperplasia (BPH)
BPH is the proliferation of normal prostatic tissue and has a link with increased testosterone levels. Symptoms of BPH include difficulty initiating micturition, weak or slow flow, increased frequency of urination, post-mictruition dribble, frequency during the night (nocturia), as well as urinary urgency. Some of these symptoms can be confused for over active bladder however both will eventually lead to similar consequences such as poor bladder habits, increased bladder spams, frequency and possible hypertonicity of pelvic floor muscles. All of these can be helped by seeing a pelvic health physiotherapist as we can educate on improving bladder habits, urge suppression techniques, teach proper use of the pelvic floor muscles as well as use manual techniques to release excess muscle tone.
Physiotherapy may also be indicated following surgical treatment of BPH with the TURP procedure (trans urethral resection) as there may be some urinary stress incontincence that follows.
Prostatodynia / Chronic Pelvic Pain Syndrome
This is a chronic pain condition that has symptoms very similar to a prostatis (inflammation of the prostate with or a without a bacterial cause) however there is no evidence of either bacteria or inflammation present. Men complain of perineal pain, burning, itchiness, muscle tension into testicles, scrotum, and anus. Bladder symptoms such as urgency, difficulty inititiating flow, and post mictruition dribble may also be present. Over time these men develop hypertonicity (excess resting tone) into their pelvic floor muscle system linked to their hightened level of pain in this region.
Pelvic health physiotherapists are able to help these men get their pain levels under control by helping to break the differenct components of the pain cycle. Manual techniques are used to release the pelvic floor muscle system and other local joints that are becoming involved (hips, low back), relaxation strategies and exercises are taught to maintain these techniques as well as progressively strengthen the pelvic floor to be used more appropriately.
Fitness Based Physiotherapy
Who Is Appropriate?
Individuals who are looking to receive appropriate guidance to reach their health and fitness goals may also be helped by a physiotherapist. For example, if you have an old injury that tends to re-appear when attempting to increase your activity level or a current injury where you still want to maintain your fitness level during your rehabilitation phase, a physiotherapist is the professional to establish and oversee an appropriate workout for your needs. You may also be recovering from or going through treatment for disease or illness and wish to have appropriate direction and supervision for your program. Those who have a clean bill of health are also appropriate and simply wish to increase their fitness level or work specifically towards a sporting competition.
What Is Involved?
An initial assessment will be completed to go over your past and current medical history followed by a full body assessment looking at posture, core strength and control, as well as upper and lower extremity strength and stability. It is important to determine any at risk areas as well as specifically assess already problematic ones. Goals will be set between you and the physiotherapist and a treatment program will be developed.
The treatment goals may be tailored towards you entering safely into personal training or into group fitness sessions. Treatments may also include manual therapy techniques in order to stretch, release or mobilize problematic soft tissue (muscular) areas or joints.
Hippotherapy (HPOT) refers to how physiotherapy, occupational therapy, and speech-language pathology professionals purposefully manipulate an equine’s unique movements to engage neuromotor, sensory and cognitive systems to achieve functional outcomes in their clients. HPOT is just one intervention within an overall therapy treatment plan.
Through Hope Haven Therapeutic Riding Stables in Markdale, Robyn Allen will be providing physiotherapy services with the use of HPOT in combination with other intervention strategies such as manual therapy and home programs. Robyn will start with an initial assessment off the horse to gather the information needed to create an overall picture of the client. Then together with the client and family, short and long term functional goals will be developed as well as a therapeutic plan to achieve these. As long as the client is appropriate for hippotherapy, this will be incorporated as the primary treatment strategy.
Who Is Appropriate for Hippotherapy?
Anyone of any age who has goals that a physiotherapist can help with may be appropriate for hippotherapy, as this is just one tool in the physio’s toolbox. Using the horse to achieve these goals is a more exciting, motivating approach than a clinic setting and affects so many systems simultaneously that gains are multi-fold.
An idea of impairments that are appropriate referrals are listed below:
Ø Sensorimotor regulation
Ø Muscle tone
Ø Postural control, asymmetry, spinal dysfunction
Ø Motor control
Ø Communication, speech, language
Diagnoses and medical conditions that may be appropriate for hippotherapy:
Ø Developmental delays
Ø Neurological conditions (cerebral palsy, spina bifida, Parkinsons, MS)
Ø Neuromuscular dysfunction
Ø Brain injury, CVA/Stroke
Ø Autism Spectrum Disorder
Ø Sensory Processing Disorder
Ø Chromosomal abnormalities or deletion
Ø Impaired sensory processing (hyper and hypo)
Ø Functional spinal curvature
Benefits of Physiotherapy at Two The Core
There are obvious benefits of having physiotherapy on site at our fitness studio, in particular if you are a fitness member. The physiotherapist is able to make very specific recommendations towards certian classes and at any point is able to modify your workouts knowing your medical history. She is able to have discussions and provide recommendations to any of our fitness instructors or personal trainers as to how to make your workouts safe with respect to your current or previous conditions.
To Book An Appointment – Contact Robyn Allen
Email [email protected], or call 519-375-6868.
Most people with private health insurance are able to claim physiotherapy services either fully or partially. Inquire with your insurance company as to your specific details. Unfortunately we do not bill OHIP for this service. Payment by credit card, cash, cheque and email interac transfers are accepted.
Do I Need A Doctor’s Referral?
A doctor’s referral is not required. Your insurance company may however require a referral letter from your doctor in order to get your claim reimbursed.