Q&A WITH ARIEL WYNNE PT, DPT: “JUST BECAUSE IT’S COMMON, DOES NOT MEAN IT’S NORMAL”

Central Consideration of this Article: How is the work of a Pelvic Floor Physical Therapist (PT) integral to treating chronic pelvic pain?

Bio: Ariel Wynne is a pelvic floor physical therapist in Chicago. She is a passionate sex educator and advocate for her patients. Her interest in pelvic floor PT started with hearing about her friend’s struggles with vaginismus, a condition that makes vaginal penetration difficult due to pain and muscular restriction. Pelvic floor physical therapy helped her friend use tampons, go to doctors appointments, and have pain free sex. Ariel wanted to become a pelvic floor PT so that she could improve her patients quality of life the same way!

Website: GroundFloorPT.com Twitter: @ArielWynnePT

Background on Pelvic Floor Physical Therapy: A physical therapist is a muscle and bone specialist who helps patients get back to their previous daily activities and move about the world. A pelvic floor PT does the same thing but with a focus on the area in and around the pelvis. We work with a wide variety of patients from children, pregnant adults, cancer survivors, and people who are post-menopausal. The pelvic floor is tied in to our identity and independence from potty training onwards!

Treatment can include a pelvic examination to assess the pelvic floor muscles, scar tissue mobilization, strengthening, and trigger point release to name a few. Your PT will do an evaluation and come up with a personalized plan for your condition and goals.

Q&A:

JR: What did your training involve to become a pelvic floor PT?

AW: I graduated with my Doctorate of Physical Therapy (DPT) in 2018. I learned a lot about becoming a PT during graduate school but very little about the pelvic floor! We had a few specialist lectures and learned the basics but I was determined to learn more so I could treat these patients. I immediately started continuing education courses to learn more about pelvic floor rehabilitation. This included courses, readings, and tests outside of my regular full time schedule as a PT.

JR: What are some classic causes of pelvic pain?

AW: We work with the referring Doctor to rule out more serious causes of pain like infections or hormonal disorders. After that, most often I see patients with pelvic pain due to tight muscles. Those symptoms might be felt in the pelvis or they can refer to the hips, inner thighs, low abdominals, and back. These patients are often not aware of how tight these muscles are or how to relax them even if they tried. I always use the neck and upper shoulders as my example. We all know someone who gets a tight neck and high shoulders when they are stressed, sometimes they may even get headaches or jaw aches because of all that tightness. The same thing happens in the pelvis! Those muscles can be tight and restricted which causes problems elsewhere in the body.

JR: What does PT treatment for pelvic pain look like for you with your patients?

AW: I spend a lot of time educating my patients on the pelvic floor anatomy and functions. Once you understand what is going on, you are better able to manage it. We usually start with deep breathing and stretching to reduce tension. Many patients also benefit from hands on therapy like massage or trigger point release to help lengthen those muscles.

JR: What are some of the most frequent myths and misconceptions of your work as a Pelvic Floor PT that you hear from patients or the general public?

AW: I think the biggest misconception about pelvic floor PT is that it is something shameful or embarrassing. There are countless numbers of people who could benefit but don’t seek out care for that reason. I always tell my patients there are muscles and bones there just like other parts of the body and they can get better just the same way. I think another big misconception is that pelvic floor problems are “normal” as we age. People will talk to their friends or family about these issues first and often hear that pain with sex or severe menstrual cramps happen to everyone. This is where I always say “just because something is common, does not make it normal!” If you are having any issues of pain in and around the pelvis, talk to your Doctor and get the help you deserve.

JR: How do you approach discussing goals with your patients?

AW: Goals are wildly different for everyone! Some patients want to be able to sit long enough to focus on work, some want to get back to running marathons. Some want to get back to pain free sex with their partner, some want to use a tampon for the first time. It takes time to really see the effects of pelvic floor PT so it is so important to get a clear idea of what success means to your patient and use that as the motivating factor on days when progress feels slow. I ask my patients to really dream big and not let the present limit their vision of the future.

JR: What is the most meaningful part of your work to you? Why?

AW: I love surprising my skeptical patients! My patients often have seen multiple specialists and some have had issues for years before seeing me. They may not think things can change much, but once we start working they dream a little bigger. I got an email from a former patient just the other day to tell me she had sex for the first time in her life and she had mostly given up on that as a possibility because of her struggles with pain before. She thanked me for validating her experience and giving her hope things could change. It made my day!