In the COVID world, it feels like absolutely everything is digital. From grocery shopping to work meetings to urgent care appointments, you can now access almost all of your needs via your computer or phone. And as a company founded to provide virtual-first postpartum care, we are totally here for it!
Still, this new digital age comes with a lot of questions, especially about healthcare delivery. How can you be fully evaluated over Zoom or FaceTime? How do you connect with your provider if you never meet in person? This is particularly true of pregnancy and postpartum care, which we typically think of as being “high touch” (or, necessary to happen in person).
But the truth is, so much of the care we want and need can happen virtually. That includes important modalities like physical therapy, including that all-important pelvic floor therapy. Virtual pelvic physical therapy can actually be more accessible to new parents when it happens online—which is such a good thing! Many parents wonder how care for such an intimate area can happen over the internet, us included!
To learn more about virtual pelvic floor therapy, including what new parents can expect in an online appointment, we spoke with Kimberly McFerron, PPES, CES, and Head of Birthwork at Ruth Health. Ruth Health is a telehealth hub for pregnant and postpartum people—and pelvic care is one of their specialities. Here’s what you can expect from virtual pelvic physical therapy.
Major Care: How do pelvic PTs do an exam when working virtually?
Kimberly McFerron: In many ways, our virtual assessment works similarly to an in-person appointment. Our providers evaluate your posture and alignment (areas both related to your pelvic floor!) by observing your movement patterns. For example, you may be asked to stand upright for an assessment of your spinal mobility, or do a breathing exercise (hello, diaphragm/pelvic floor connection) and then verbally provide feedback. We use this external assessment of your body’s mechanical functions to inform us of deeper underlying issues and combine it with your health history, chief complaints, pain and discomfort, and other biological, physical, and environmental factors that are unique to you. All of this gives us incredible insight into structural dysfunctions and their root causes and allows us to create a true one-of-a-kind treatment strategy—no internal or hands-on exam needed!
How do virtual pelvic PTs know what types of care/advice to offer to virtual patients? How do they know how patients are progressing?
Because we get to know each patient’s complaints and needs so specifically, we can understand their progress very deeply. We also rely on you as the individual to take a collaborative approach to your care. By listening to your feedback (i.e. what feels good, what doesn’t) we can assess your progress and how your sessions are impacting your overall life. And since we focus so strongly on shared decision-making, you will never see a cut-and-paste treatment plan. If something isn’t working for you, we take notes and adjust in real-time. No two bodies are built the same and our entire methodology is built based on that fact.
Can you describe the usual flow of an online pelvic PT appointment and the flow of the overall patient relationship?
During your first session, you’ll meet your provider and have the opportunity to discuss, frankly, anything related to your health history that you want to! We spend about 20 minutes getting to know your body (i.e. pregnancies, postpartum experience), chief complaints, and goals. The approach is very similar to an in-person appointment in that you’ll get to ask questions, learn about our methodology, and walk away with an understanding of what’s to come next.
After the initial intake session, each Pelvic Training & Recovery session will consist of a combination of mobilization, physical therapy, strength training, and functional range exercises. Think of these sessions almost as if you’re meeting with a personal trainer. We’ll start the session by checking in with how you feel at the moment and discussing what the plan is for the next 30 minutes. In this way, each session is tailored to you (NOT a cookie-cutter approach that assumes everyone will benefit from the same exercises).
We focus largely on the diaphragm-pelvic floor relationship as a means to address the entire body. Your provider can see a remarkable amount of information based upon the way you move and the way that you feel. Our patients are only asked to do an internal vaginal self-assessment if they express interest and are already familiar with internal assessments. Research shows that many pelvic floor dysfunctions are successfully addressed based upon strategic movement patterns- and all of this can be done fully clothed!
Are there tools/apps/approaches that pelvic PTs use with patients that are different than those of in-person PT care?
This is a difficult question to answer as there are so many wonderful PF specialists out in the world and numerous treatment methods! Pelvic Training & Recovery sessions with Ruth Health were strategically designed to take a root-cause approach to treatment, which means full body treatment. We spend time each session educating our patients on what is happening in their bodies to empower them to be a part of the decision-making process.
We also intentionally conduct our sessions in 30-minute windows because we know that time is precious and we want to fit seamlessly into the patient’s life rather than becoming another obligation. Research has shown that 20-30 minutes of targeted work is an ideal range of time for muscle memory, mind-body connection, and overall effectiveness. So the Ruth Health approach means that each patient gets one-of-a-kind care from the comfort of their own home with maximized results.
What do you wish people knew about pelvic PT care in general, or online pelvic PT care?
A lot of things!
Number one is simply that pelvic floor care is so much more than Kegels. Kegels have a time and place in some treatment plans but if we are not looking at the entire pelvic floor complex as well as the muscles that are affected by it we are not truly caring for the pelvic floor (and the rest of the body as a result).
Number two is that pelvic PT is not just for birthing people. We see pelvic floor dysfunction in all ages, genders, and lifestyle types. So many movements and behaviors can contribute to pelvic floor dysfunction (anyone else visiting the bathroom “just in case” before leaving the house!?), so normalizing talking about pelvic PT is a benefit for everyone.
Number three is that pelvic PT care can be just as beneficial virtually as in-person. The science behind the treatment methodology will always lead to a more positive outcome, rather than simply the location of the session. Often a provider already has clear insight into your body’s needs based upon the initial Q & A, and the internal exams performed in an in-person session are simply to confirm their hypothesis. There are other ways to confirm our hypotheses without an internal exam, which means that treatment can happen wherever it is convenient for you without placing additional demands on your schedule and lifestyle. This is also a great option for someone who may not be comfortable with an in-person session.
Is there anything else you’d like to say about this topic?
It’s never too early or too late to start supportive pelvic floor exercises. Whether you want pelvic PT to prepare you for birth, to recover from postpartum, or just to be stronger in your body, doing pelvic PT is the best way to strengthen your foundation and start feeling better. We see so many patients that didn’t realize that their shoulder pain, back pain, or knee pain was rooted in pelvic floor dysfunction. Pelvic PT will give you a whole new window into your physical world!
Ruth Health is a wrap-around hub for care and support throughout pregnancy and beyond. With evidence-based expertise, Ruth Health partners with parents in their journey from pregnancy to postpartum to make them active participants in their health.