How I work with pelvic floor physios

Thinking Girl

Who should I see about my problems?

FAQ: Who should you see if you have problems with your pelvic floor?

This is a great question. Ideally, you would see a physiotherapist who has had extensive Musculoskeletal (MSK) Physiotherapy training AND training in Women's Health (WH) Physiotherapy. Unfortunately, there aren't too many of these physios around. They are definitely out there but not all MSK physios know about the pelvic floor very well and not all WH Physios know about the rest of the MSK system.

Also, in my opinion, a thorough understanding of the thorax and pelvis is lacking among physiotherapists. I know for a fact that most Masters programs do not address these 2 areas very well. As an exercise (if you are a health professional), close your eyes and imagine the anatomy of the knee - most physios can picture this in good detail with bones, ligaments, cartilage and muscles all in the right place. Now do the same with the thorax...not so clear huh? Can you name all 13 joints that exist for the 4th Thoracic Ring (T3, T4, L+R 4th rib, Sternum)? I rest my case!

What I am good at...

I look at a person holistically - for a review of this, click here - and consider what regions are important to look at. For example, a patient might come in with difficulty controlling the bladder during exercise. Is it a joint, muscle, nerve, visceral or brain/beliefs problem? Is their pelvic floor strong enough? Does it relax enough? Is it on too long or too hard? Is it under pressure from other muscles or joints? Is the pelvic floor actually damaged?

All of these things are important to identify and investigate.

How I am Incomplete...

Now, the way that things work is this: If I want to be trained in Women's Health, I have to do courses. However, whilst they would let me do the theory, it has been suggested to me that it would be highly unlikely that the other participants would allow me to do the internal examination practicals that I would need to do to learn. In theory, there are male obstetricians so male WH physios shouldn't be a problem. In theory, it is sexist and discriminatory. In reality, I don't mind. There are plenty of good female therapists around who I can refer to. I don't need to be able to do internal examinations to be a good physio. I can live without the fear of being sued or charged with sexual assault!! There is enough work for everyone so let's just share the love!!

Sharing the Love - I refer patients to good WH physios!

So, when there is a patient who looks like their primary problem is a damaged pelvic floor, I refer them to a WH physio I can trust. I will always check all the MSK systems to make sure that I have taken care of everything I need to make the WH physio's job easier. I also write a letter explaining what I have found and what I think the potential problems may be and specific issues I would like an opinion on.

What I would like to see from WH physios...

Too often, patients get categorised into a WH physio problem or a MSK physio problem. This is an issue because it isn't a holistic approach.

The type of WH patients I can help are those that don't seem to be improving their bladder/bowel control, have an endurance problem, have pain...basically anyone who is not improving!

If you are a suffering from pelvic floor issues and your treatment doesn't seem to be working, then ask your WH physio for a MSK physio referral. If you need help finding one, just ask me!

A holistic approach - is your therapist using it?


Better understanding between MSK physios and WH physios needs to occur. Thankfully, the last 15 years has seen a great improvement in the communication between the 2 groups!

If you are a women's health physio, I invite you to comment below and make sure you add your website or FB/Twitter page to your comments. That way, patients can locate you!

If you are a patient who has issues with your pelvic floor, please feel free to ask questions below about who you should see. Any good physio would be ok with you asking if a referral to a MSK or WH physio would be helpful 🙂

Remember, 1 in2 to 1 in 3 women will have pelvic floor issues in their lifetime. Let's solve the problem, not just use panty liners!

14 Responses

  1. Great post Antony and I totally agree wholistic approach is essential. I am lucky enough to work with @equuspilates and we refer back and forth for these very issues to ensure our patients receive optimal Rx.
    We are Sports and Spinal Physiotherapy on the Sunshine Coast QLD and happy to provide an holistic approach to both Women’s AND Men’s health -l let’s not forget the boys here !

    1. Thanks Fiona. That’s excellent that you have such a good relationship. The physio I referred to us recently stopped working so I am on the lookout for another one. Any suggestions for the Sydney area, preferably Southern Suburbs. Thanks!

    1. Thanks Sandy. I really feel that Physios in general are too territorial instead of realizing that there is plenty of work for everyone and we should “share the love”. Admitting that you are incomplete is not a sign of weakness either! I felt so encouraged by Linda-Joy Lee when she told me that she refers all those who need an internal examination to another physio. She can probably do it just fine but she concentrates on what she is good at and lets others do what they are good at 🙂

  2. Hi Antony – we’re totally on the same page as I’ve been advising cross referral for years. I’m going to include a link to your post for physios attending my Pelvic floor & core workshops. When all systems are assessed we can develop “a clinical plan that will unravel the interconnected nature of the dysfunctions” (Hodges)

    1. Thanks Mary – definitely agree 🙂 I loved the workshop I attended with you last year. If you and Craig ever want to collaborate on something together, let me know…I think I have a slightly different perspective than Craig but Sports + WH + MSK is a good mix 🙂

  3. Hi Antony!

    Great post! Like you, I am passionate about helping people in a holistic way. Through my practice, I have come to realize that not everything is a matter of “if it’s stiff, mobilize it” or “if its loose, strengthen it”. The whole body is integrated, and an issue in the knee may have been set-up by a weakness in trunk, or core, stability. Over the past couple of years, I have added a Women’s Health perspective to my MSK practice, blending the two! My goal is to help active females achieve their goals of function and fitness, both pain free and leak-free! 🙂

    The pelvic floor as a part of our core stability is an integral part of my treatment plans. And on the MSK side of things, I am most recently finishing up my Manips accreditation as well as taking the Diane & LJ Lee Discovery Series. It all comes full circle.

    You sound like an awesome physio! I wish I were a little closer so that we could connect in person. Oz is like my second home, I did my PT degree there at UQ in Brisbane!

    Cheers mate, thanks for the props to the Women’s Health sector!
    twitter: @ellephysio
    Facebook: ellephysio

    1. Thanks Karen, Isn’t the DP series great??!! I am on their LinkedIn group so look for me there too 🙂 I think it is fantastic that you can do MSK and WH. Totally agree with your philosophy of physiotherapy – the pt’s needs are so important.

      Thanks for the compliment but don’t most people sound awesome until you meet them? I just try to be a nice physio who is good at what he does 🙂 I used to be more arrogant but I realized that everyone is trying their best…it is their attitude that counts. I believe in lifelong learning. I will never know it all and I can learn from everyone I meet. If you don’t have that attitude, you run the risk of being insecure about yourself as a person and as a physio.

      I plan to visit overseas one day so I will be sure to add your location…the problem is that I can’t find it anywhere on your website!!!

      See you around – don’t forget to follow this blog or subscribe 🙂

  4. Great post, Anthony! And I love hearing this from a male physio!! We cannot separate the pelvic floor from our MSK treatment, it is a part of every move that we make! Like all the other folks who have weighed in…I am pushing this agenda hard alongside all the rest! Trying to reach out to both sides of the fence (WH and MSK) to bring everyone to the middle thru courses, blogging, vlogging, and ranting on twitter and FB! Thanks for adding a great post to the cause!!

    Julie Wiebe, PT (@interiorfitness)

    1. Thanks Julie. Totally agree. I think part of the problem I have had in the past is that I have had patients who had been to WH physios and had been plugging away at their exercises diligently without much success and a simple back treatment suddenly allows proper activation of their pelvic floor. Or carefully teaching my clients the difference between an isolated contraction and a global “grip” with good results and sending onto a WH physio for internal examination to then have them teach a full on gripping strategy, undermine my treatment plan and not consider the whole MSK picture. I am sure WH physios have the same problems with MSK physios.

      I think if we can work together with mutual respect and consideration, life won’t be so frustrating for us and confusing for the patient!

  5. Hi Antony,

    Great post! I started with sports, moved to spines, women’s health and now am a pelvic floor physio (internal assessment). The more you learn, the more everything is integrated. I just opened a women’s health clinic to focus on diastasis recti abdominis and pelvic floor recovery in pre/post natal women. I have done the abdominal wall and the pelvis courses with Diane Lee and signed up with @ellephysio for the DP series. I am in Toronto, she’s in Oakville (Ontario, Canada).

    Being able to see the body from many perspectives but treating it as a whole is an incredibly powerful tool. If physios referred to each other more often, we would have a much stronger profession worldwide! Spread the love!

    Julia Di Paolo
    Toronto, Canada

    Twitter: @physioexellence

    1. Hi Julia, sounds great. You should do well. The Series is a great time – I have learned so much from the course – and I had taken lots of courses with LJ before (unfortunately only 1 with Diane). I obviously have developed my own opinion on what works for Diastasis Rectii and pelvic floor post-natally…would be interested to discuss this. Maybe a blog post is in order 🙂

  6. eleebognar

    Hello Anthony,
    Good stuff! I think all the comments are very accurate. I think we need to talk about grass root thinking and training. University courses are still compartmentalizing training in how medicos,physios,etc. develop their learning and assessment,I can’t recall one single referral for pelvic floor physio from a respiratory physician or respiratory physio when I started out with my work as a pelvic floor physio. There’s so much change that has to take place …….

    Eleanor Lee-Bognar

  7. Thanks for this article! I absolutely agree that some issues require a more local, pelvic floor approach, but for the most part, patients will benefit from a therapist or TEAM of therapists/healthcare providers who are looking at the WHOLE MSK system.
    Thank you!
    Tracy Sher, MPT, CSCS ( @pelvicguru1

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