Choosing the right pelvic floor physical therapist is an important decision. They will become a part of your life in an intimate way and you deserve someone that is great! But what are some important things to look for when choosing one? I've outlined the top 6 things that you should be looking for when making this decision. Keep in mind, these are general guidelines, and there are exceptions to every rule, but this can be a good starting point for your search and let you know the right questions to ask.
1. Credentials and Years of Experience – Nowadays, most PTs will at least have their masters in physical therapy, if not their doctorate. I would highly recommend that your pelvic floor physical therapist also be an APTA board certified specialist (WCS). Read more about what becoming a WCS requires. While this is not absolutely necessary, and you may not be able to find one in your area (there are fewer than 350 of us in the country!), it shows that the therapist is fully dedicated to the practice of pelvic floor physical therapy. Ideally, you want to see a therapist that has more than 3 years of experience in the field. If you do see a new grad (we were all there once!), make sure they have a more experienced mentor that they work with regularly. If you're looking for a specialist in your area, you can use the APTA search tool and select Women's Health (even for you, men!) to find one near you.
2. Appointment length with your PT – With insurance companies cutting their reimbursement, some PT clinics are cutting the amount of time they spend with the patient in order to get more patients through the door. They can also foist you off on an "aide" or "assistant", while they see another patient. I feel strongly that at least 45 minutes should be spent directly with your pelvic floor physical therapist. Some clinics are very savvy about spending the minimum time possible with the patient. Technically you can see even see a patient for just 23 minutes and then bill the same amount as if you saw them for 30!
At PelvicSanity, we spend 55 minutes directly with all of our patients. This allows time for the proper external and internal treatment to be administered, but also gives us time to educate you about your condition, progression of your home program, answer your questions and help to map out the “big picture” of your care. Personally, I would find it difficult to recommend a clinic that doesn’t give at least 45 minutes with the physical therapist to each patient.
3. Both Internal and External Treatment – Your physical therapist should be performing both internal and external manual therapy every visit. To fully eradicate symptoms, your physical therapist MUST look beyond the pelvic floor. Most times, your pelvic floor is the victim and you have to have your physical therapist get to the root cause of your pelvic floor dysfunction. Other orthopedic areas that should be cleared of dysfunction are the lumbar and thoracic spine, SI Joint, hips, feet, and abdominal region. This is why it is so important for your physical therapist to also have an extensive general orthopedic background (see below) in order to fully treat the system. That’s a lot of other things to look at and treat – which is just another reason why the amount of time you have with your therapist is KEY.
4. Orthopedic background – Ideally, your pelvic floor physical therapist will also have experience in treating the areas listed above. There are many different types of continuing education courses in the practice of orthopedic physical therapy, so your pelvic floor physical therapist should have a combination of pelvic floor training and associated regions of the spine and pelvic girdle to round out their education and background.
5. A Specialty Clinic – Having your pelvic floor physical therapist in a clinic where pelvic floor physical therapy is the primary focus is important. Be aware of the clinic that has one pelvic floor PT in a non-pelvic floor practice. Many times that clinic is trying to get on the “pelvic floor bandwagon” and isn’t truly dedicated to women’s and men’s pelvic health. Sometimes this therapist may only have a single weekend of training in pelvic floor therapy, and are now treating incredibly difficult and complex patients. Of course, there are exceptions, but make sure you ask the right questions about your therapist and their experience in treating these complex conditions.
6. Continuing Education – Any pelvic floor physical therapist should have an extensive list of the continuing education classes that they have gone to in women’s and/or men’s pelvic floor and health. There are essentially two major groups that provide continuing education for pelvic floor physical therapy: Herman and Wallace Pelvic Rehabilitation Institute and the American Physical Therapy Association. Your pelvic floor physical therapist should have taken classes through one of these organizations. In addition, they should also have taken orthopedic courses in the region of the pelvis, SIJ, lumbar spine and/or the hip.
Bottom line – You have to ASK the questions! Do your research! This is a budding field of practice – which is great, but that also means that there are many new and inexperienced PTs in the field. Any therapist or clinic should be able to EASILY answer these questions, have them listed on their website, and should be happy that you are taking ownership of your healthcare. If they aren't glad you're asking questions, it's a great sign that they are not the right therapist for you.
Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.