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Behind the Scenes: A Patient's Guide to Receiving Treatment at Healthy Core

If you have received traditional physical therapy, you may have been interviewed about your condition in an open gym environment. In a sports medicine or orthopedic clinic, this is expected. However, when you have core and pelvic floor issues that may involve bowel, bladder or sexual function, privacy is essential. Here's what to expect when you receive treatment at Healthy Core:

You will be taken to a private room where your female physical therapist will discuss your medical history and the history of your condition and what treatment, if any, you have received. Your physical therapist will explain to you the deep core anatomy, including the pelvic floor, transversus abdominus, diaphragm and multifidus muscles, how the hip muscles (obturator internus) attach to the pelvic floor hammock as well as the piston function of the pelvic floor and diaphragm. She will explain how tightness in one hip or malalignment in the sacrum or pelvic bones creates abnormal tension or pulling on the pelvic floor. She will explain how adhesions in the abdominal wall create a strait jacket around muscles and organs that disrupt the core from functioning. You will be taught how to EXhale with any EXertion or lifting, including lifting yourself out of a chair, to augment the natural function of your pelvic core.

What to Expect at the Initial Examination:

  • Assessment of your spinal mobility. Your therapist is looking for motion at each segment and stability at other segments, including sacral mobility and how well the sacrum moves on the lumbar spine.

  • Leg length and pelvic alignment. Think of the hip bones as being wagon wheels and if one wagon wheel is rotated forwards or backwards, it creates a false appearance that one leg is longer than the other, causing abnormal tension inside the bowl of the pelvis.

  • Hip passive range of motion and the ability of your pelvis to move on your spine.

  • Core muscle assessment with particular emphasis on the timing and coordination of the multifidus and transversus abdominus.

  • Manual muscle testing of your hip strength, particularly the gluteal muscles, along with palpation of tension in your inner thighs and obturator internus musculature.

  • Assessment of your abdominal wall integrity and mobility of your organs (viscera) and scar tissue, including your diaphragm and key areas of tightness around peripheral nerves that exit your pelvis such as the sciatic nerve, pudendal nerve and obturator nerve.

  • Pelvic floor muscle assessment intravaginally, if appropriate for the condition you are seeking help for. Typically, this is performed at a later date once pain improves and is tolerable.

What Treatment You Might Receive the First Day:

  • Trigger point release and education in self treating hypertonic, dysfunctional muscles at home.

  • Visceral mobilization - a deeper form of myofascial release to the abdominal wall, peripheral nerves and pelvic floor.

  • Integrative dry needling therapy (optional) - using a fine, microfilament tool into areas of tightness and trigger points on both sides of the body, often including the low back, hips and legs.

  • Home exercise program instruction - diaphragm breathing (reverse Kegels), realignment exercises, self trigger point suggestions and/or gluteus maximus retraining.

  • Modification of your current exercise program. If you are doing sit-ups or crunches, using the inner thigh (adductor) machine at the gym or impact exercises, your therapist will suggest you discontinue these exercises. Return to impact exercise, including running or boot camp style exercise will depend on core muscle timing and strength and not be recommended until the pelvis is stable.

  • Goal setting - your therapist will explain how progress will initially involve realignment of the pelvis and restoring hip range of motion and will include fundamental core retraining followed by a gradual progression to advanced core exercises.

How You Might Feel After the First Appointment:

  • Improved mobility with walking, daily tasks and exercise.

  • A sense of empowerment and hope, with improved motivation to exercise.

  • Improved pain intensity and muscle function. You might feel weak or tired, although some people feel energized.

What to Expect at Follow-up Appointments:

  • Your therapist will listen to how you responded to the previous treatment and symptoms you are currently having, scheduled typically once per week for four weeks.

  • Your therapist will briefly check your hip range of motion and pelvic alignment for symmetry.

  • You will receive manual therapy including visceral mobilization, trigger point release, and/or dry needling therapy, depending on structures that continue to be tight or dysfunctional.

  • Progression of your home exercises with modifications and additional exercises to address remaining issues.

  • Discussion of your diet and health of your gut to maximize core muscle function. This may or may not include a referral to a functional medicine provider or allergist to address gut inflammation.

When Will You be Discharged From Therapy?

  • When initial established goals have been >90% met.

  • When you have the appropriate skills and exercises to manage your condition going forward.

What if You are Not Ready to be on Your Own?

1. You can set up a monthly Phase II appointment to check in with your therapist and receive manual therapy. This is considered "maintenance" and will not be a covered benefit under your insurance.

2. You can schedule a wellness dry needling session once a month or as needed.

3. Your therapist can keep your chart open for a short time and check in with you to see how you do over time on your own. You can return for treatment at a later date if you have a flare-up. This tune-up typically requires two to three visits.

We believe in getting to the source of the problem and empowerment at Healthy Core and want you to have the skills going forward to be pro-active in the health of your core. You don't have to live with pain and dysfunction and there is help! We are excited to partner with you in gaining a healthy core and living well!

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