Orthopaedic Physiotherapy Overview

What Does the Initial Assessment Involve?

The initial assessment takes approximately 1 hr to complete. It involves a thorough history taking and physical exam. The physical assessment will look at global and local contributors by considering the whole body. The assessment begins with observation of posture and functional movements.  It then progresses to external assessment of connective tissue, trigger points, respiratory function, and neural involvement.  If deemed necessary, additional orthopaedic manual tests will be carried out at this time.  If the patient consents, an internal exam will be conducted and will assess connective tissue, trigger points, prolapse and pelvic floor muscle strength/endurance and coordination.  Please note that the internal exam is not mandatory, but does provide extremely valuable information which guides appropriate and effective treatment.

 
It does/can involve internal and external examination and treatment, which is carried out by specially trained and regulated physiotherapists.

What Does Treatment Involve?

Treatment will be guided by the findings from the initial assessment.

Treatment May Include:

  • Education
  • Internal/External manual therapy (facilitation, stretch, release)
  • Stretching and strengthening exercises
  • Trigger point release
  • Connective tissue and scar tissue mobilizations
  • Acupuncture
  • Electrical stimulation/TENS
  • Core strengthening exercises
  • Graded motor imagery exercises
  • Correction of pelvic asymmetry and SIJ dysfunction
  • Correction of Rectus Diastasis

Patients are typically seen for 30-45 min and initially  1x/weekly. Treatments will be tapered as appropriate.

Why Do We Perform Internal Palpation?

One of the most important reasons why internal palpation is performed is to help distinguish if the muscles are hypertonic (high tone, tightness) or if they are hypotonic (low tone).  Hypertonicity is typically associated with pelvic pain, urgency, and frequency, whereas hypotonicity is typically associated with stress incontinence.  It is important for treatment that we know what state these muscles are in, as we do not want to make a tight muscle tighter by doing contractions/kegels.  We could actually make your symptoms worse by doing so.

Another reason why internal palpation is needed is to do with the physiological make up of the pelvic floor muscles. Proprioception is the sense of position and movement in one’s body. We need this to determine body position and limb movement. There are special receptors that send messages to the brain to say where a joint is in space.  For example, close your eyes and bend your elbow to 90 degrees.  You are probably pretty close to the right position.  Unfortunately, the pelvic floor muscles are lacking in these receptors and hence can make it hard for you to know if you are properly contracting the muscles.  Internal palpation allows us to provide feedback or a stimulus so that your brain is better able to sense the position and contraction of the muscles. This ultimately leads to better outcomes.