Does everyone's pt do this I feel mine is lacking:(

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A typical therapy evaluation should focus on the abdominal and pelvic areas, but not ignore the rest of the body. The posture and alignment of the patient is first observed. The therapist may also test for any sacroiliac joint dysfunction. The therapist will also assess any limitations through range of motion of the upper and lower extremities and their strength. Neural (nerve) tension tests are tests of provocation that are performed passively in order to stress the area of neural (nerve) tissue and note for any irritation and discomfort along the neural tissue pathway.

For example, the Sciatic nerve can be tested with the patient lying on their back, test leg in a position perpendicular to the treatment table and then brought across the body (into adduction). A test is considered positive if there are signs of pain due to increased resistance of the tissues and reproduction of symptoms.7 The therapist will use a “hands-on†technique to palpate the tissues and musculature. This usually consists of both an external (abdominal, gluteal/buttock, back muscles, etc…) and internal pelvic examination (transvaginal or transrectal).

Most patients may feel uncomfortable about this type of therapy and want to know why this is necessary. The answer: this is the best way to palpate and evaluate the pelvic floor muscles and observe any restrictions in the tissues and structures such as the bladder, ovaries and uterus. Palpation is crucial in noting the location of trigger points and decreased connective tissue mobility. Finally, biofeedback can be used in order to evaluate the pelvic floor muscle strength and ability to relax. Biofeedback allows the patient to see the muscle activity in the pelvic floor through a sensor and is used to help teach the patient how to relax or activate these muscles on their own.

Physical therapy helps most or all of these symptoms previously described through techniques such as myofascial trigger point release, deep tissue, scar tissue and connective tissue manipulation of the internal and external pelvic, abdominal, hip and back structures. Women with endometriosis commonly have trigger points in the abdominal wall as well as the pelvic floor, back and gluteal (buttock) muscles. According to Travell and Simons, a Myofascial Trigger Point (MTrP) is defined as a “hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band.â€8 When pressure is applied onto a MTrP, referred pain and/or tenderness may occur. Trigger points found in the abdominal wall are probably a result of dysmenorrhea9, chronic pain and/or surgery.

Connective tissue manipulation is used for improving circulation to areas with decreased blood flow and pelvic congestion. This also allows for better mobility of the surrounding structures.10 Connective tissue is mobilized by techniques such as skin rolling. The therapist will note any changes to the skin texture, color, temperature and elasticity. Areas of restrictions will be noted to feel sharp or bruised as opposed to a “scratching sensation†in normal connective tissue.5

“I feel that connective tissue mobilization in the referral areas of the pelvis (Sir Henry Head) and intra-vaginal soft tissue mobilization work best for the patients I treat with endometriosis. I probably see a 75% success rate with these patients who are adherent to the treatment plan. Success defined as a significant decrease or elimination of the painful symptoms are measured by PPI (Present Pain Intensity)-VAS(Visual Analog Scale).†Leann M. Croft, MS PT (02/23/2006), Endometriosis Association member, Miami PT, Illinois

Other similar manual techniques are used to reduce pain, increase mobility of soft tissues and again, to ultimately reduce adhesions. These techniques can help decrease and release adhesions, which can later result in less pain and improved quality of life. Patients report such things as being able to sit for greater periods of time, participation in work and/or home activities and improved bladder, bowel symptoms and/or sexual function. During these processes, the muscles will be re-educated to return to their “normal†position.

Scar tissue release is another crucial aspect of treating patients with endometriosis. As stated above, most women with endometriosis have undergone some abdominal or pelvic surgery. Research has shown the importance of releasing the scar with each physical therapy treatment until the return of elasticity (normal flexibility) and lack of adherence to deeper tissues.11

Neural (nerve) Tension testing, as mentioned in the physical therapy evaluation, is used to identify the involvement of neural tissue. If he test is positive, then neural mobilization should be used as treatment. Neural mobilization is usually performed on the sciatic nerve (that extends through the thigh and leg) and/or pudendal nerves.5

Physical therapists will also work with their patient using neuromuscular re-education techniques such as contract relax or reciprocal inhibition. These techniques can be used along with or as a replacement for passive stretching. They are used as inhibition techniques to help relax the muscles. Through such techniques, the physical therapist is helping the patient re-train the muscles to return to normal position and function properly. All of the muscles in the body have a normal resting tone and function optimally at this level; however, with chronic pain such as seen with endometriosis, the muscles of the body may tighten as a guarding response.

Patients with endometriosis and PFD tend to present with tightened muscles, more specifically, the abdominal, pelvic floor, gluteal (buttock) and thigh muscles as a result of the pain and discomfort they are feeling. As a result, the muscles become hypertonic, or develop and increase in resting tone, and with time, the normal resting tone is lost. As a result, the muscles become hypertonic. This means that the muscles have increase muscle tone, which may be beyond conscious control. This muscular tension may result from guarding against pain or lead to pain. The physical therapist usually noted decreased movement and circulation to the area. The decrease in blood flow to the area will also increase the chance of MTrPs to develop. As previously stated, the trigger points may lead to localized or radiating pain. This can obviously star a vicious pain cycle.

The physical therapist helps the patient to identify the tightened/hypertonic muscles and re-educate them through proprioceptive neuromuscular facilitation (PNF), verbal cuing and biofeedback. The goal is for the patient to learn how to relax (or, down train) the muscles, which in turn helps break the pain cycle. This in conjunction with the manual therapy described previously will help the muscles to return to their normal resting tone. Transcutaneous Electrical Nerve Stimulation and electrical stimulation units can assist in pain reduction, including chronic pain.Get a sneak peek of the all-new AOL.com.