What is Pelvic Floor Physiotherapy?

Pelvic floor Physiotherapy involves assessment and treatment of conditions that affect muscles, ligaments, connective tissue, nerves etc in and around the pelvis. Most commonly treated pelvic floor conditions include:

  • Incontinence- stress, urge, mixed
  • Urgency, Frequency
  • Pelvic Organ Prolapse
  • Nocturia
  • Painful sex
  • Chronic Constipation
  • Pelvic pain: dyspareunia, vagisnismus, endometriosis pain
  • Pudendal Neuralgia
  • Pregnancy related low back and pelvic pain
  • Coccydynia
  • Pelvic related SI joint and hip pain

Who are Pelvic Physiotherapists?

Pelvic Health Physiotherapists are specially trained to assess the muscles, joints, soft tissue and nerves in your pelvic floor both internally and externally. These Physiotherapists recieve special training through post grad courses and workshops.Pelvic Physiotherapy is a controlled act and the Physiotherapists performing it have to be rostered by the College of Physiotherapists of Ontario. You can find the list of rostered Physiotherapists in Ontario on


Why is an internal pelvic exam important?

Internal pelvic exam is considered the gold standard to examine the muscle tone, function, integrity of your Pelvic Floor. It gives us valuable information on effectively treating your pelvic floor pain or dysfunction. Just like how your physiotherapist needs to touch and feel your biceps muscle to effectively treat it, your pelvic health Physio needs to touch and feel your pelvic muscles to manage your condition efficiently.

At our clinic, pelvic exam is done in a clean and comfortable private room. It is conducted with informed consent and will be done only as per your tolerance and comfort level. You will be appropriately draped with sheets.It is done with clean gloved technique with one or two finger palpation as per your tolerance. It will only be conducted after a thorough history taking and subjective exam. We will examine your pelvic floor through external techniques first and may proceed with internal exam afterwards as per your tolerance. You will be given education and information on feeling and contracting the pelvic muscles on your own to carry on a home program along with your therapy sessions.

I can do Kegels myself at home. Why do I need to see a pelvic Physio?

Kegels exercises involve contracting, holding the contraction followed by relaxing your pelvic floor muscles. Kegels exercises are shown to be first line of treatment to manage stress, urge incontinence and mild/ moderate pelvic organ prolapse. Kegels exercises help to strengthen the pelvic floor and hence play an important role in maintaining continence. Pelvic floor muscles are arranged in three different layers and directions. They are shaped  like a hammock supporting our bladder and other organs. You can feel some contraction externally but most of it is felt internally as a squeeze and lift when you have a strong pelvic floor.

Just like you cannot strengthen a tight biceps without effectively lengthening it first, it is not very effective to strengthen your pelvic floor if it is tight. A pelvic health Physio can help you learn techniques to stretch your pelvic floor, can perform manual therapy to release tight soft tissue and then teach you proper techniques to perform Kegels exercises. Most people with pelvic, hip or low back dysfunction will have some tension in their pelvic floor and would benefit from seeing a pelvic Physio to release it. It’s also very important to learn techniques to properly relax your pelvic floor muscles and to coordinate pelvic floor muscle training with diaphragmatic breathing. Proper pelvic floor training with allow you to activate the pelvic and core muscles together while you are doing a functional task such as lifting, running etc and will improve and maintain continence during those functional tasks.

At our clinic we will perform a thorough assessment and prescribe you with a tailored exercise regime best suited for your need. If you suffer from incontinence, pelvic pain, pelvic organ prolapse, painful sex, pregnancy or post partum pelvic or low back pain; please give us a call today.

We can help you!

Physiotherapy after Rotator cuff surgery. What to expect?

Surgical repair of Rotator cuff injury is often chosen after failed conservative management of a rotator cuff tear. It is usually done arthroscopically. Healing time after the surgery varies and is dependent on the extent of tear/ repair, quality of tissue etc. Physiotherapy plays a crucial role to get your shoulder better after the rotator cuff repair.

Physiotherapy treatment can begin early after the surgery. You will be provided with a written Physiotherapy protocol from your surgeon which entails different phases of Physio exercise recommendations. During the initial phases, your physiotherapist will focus on a lot of education; on posture, positioning, proper use of sling, strategies to manage pain and swelling. You will be educated on precautions and warning signs. Often times, in the first phase of rehab(0-6 weeks) it is recommended that you keep your shoulder immobile. After some time, as per your surgeon’s protocol, your Physiotherapist will start passive range of motion exercises. You may be given some pendulum exercises and passive range of motion exercises for home in the later part of the first phase. Your physiotherapist’s advice and feedback on how to conduct your daily activities with your arm being totally immobile is very valuable in this phase. There are Physiotherapy modalities that can help relieve pain and swelling along with the hands on manual therapy care you receive.

Phase 2 (6-12) weeks is very important in improving your range of motion, initiating Active Range of motion and often time beginning of strengthening exercises. Active ROM can begin somewhere between 6-10 depending on your surgeon’s recommendations. Your physiotherapist will teach you how to safely do these exercises at home. Manual/ hands on therapy will help regain normal shoulder joint mobility. Often times, inflammation tends to settle in this phase and your tolerance to activities of daily living improves progressively. Isometric strengthening exercises followed by isotonic exercises( with therabands/ tubes) could begin in the later part of this phase. You may not require as much pain relieving modalities in this phase.

Phase 3( 12 -16 weeks) focusses on normalizing your joint mobility, achieving full range of motion, maintaining and improving strength of Rotator cuff muscles, improving propriocetion. Your physiotherapist will aim towards cutting down on frequency of visits and giving you tools and strategies to continue to progress with a good home program. Your Physio may continue to monitor your progress infrequently to make sure you are able to achieve your goals and are able to follow through on your rehab program. You may need to see your physiotherapist longer if you develop stiffness, which is common in diabetics or in people who have had stiff/ frozen shoulder before surgery.

You may not return to contact spirts for 6-12 months post surgery. Return to work and activities will be determined by the nature of your job, availability of modified duties/ hours and the extent of the surgery and your healing process.

You May have heard from many people who had Rotator cuff surgery, that it takes good year or so for your shoulder to feel normal. But for many of you l, your shoulder will feel better a lot faster.

I am registered Physiotherapist with passion and over 15 years of experience in treating shoulders and orthopaedic conditions. I have gained valuable knowledge and skills working closely with many prestigious shoulder surgeons. I will be delighted to help you in your rehab journey. Please give me a call today!