At Donna Sarna Physiotherapy & Rehabilitation, the post-partum assessment is a two-part process with a global approach taken both with assessment and with treatment. During the assessment process, a detailed history as well as an internal and external evaluation will occur incorporating not just the pelvic floor, but also assessment of posture, as well as range of motion and strength of the torso, back, hips, pelvis and extremities. An examination of the associated musculature and fascia as well as the nerves and joints will also be included. Diastasis recti (abdominal separation) will also be assessed for as well as trigger points within the abdominal wall. The pelvic floor component will include an external evaluation of the skin and connective tissue in the perineal and genital area as well as an internal examination of the vagina and possibly the anal canal if indicated. The pelvic floor muscles and sphincters are tested for muscle tone and tightness, strength, endurance, trigger points, and tissue integrity. The pelvic floor is also assessed in conjunction with the rest of the core to ensure that timing of activation and sequencing of the muscles is optimal. Position of the pelvic organs and integrity of their supporting ligaments and fasciae are also evaluated. You are always welcome to have a trusted individual present during assessment or treatment.
An individualized treatment plan is developed based on the assessment findings and may include education regarding posture, breathing, proper toileting techniques, bladder training/urge delay techniques, prolapse reduction techniques, bladder irritants, perineum care, perineum support and evacuation techniques and abdominal massage. Manual techniques to address adhesions and scar tissue that may occur with episiotomies, tears, or C-section scars are a key component of treatment. Techniques that are utilized include myofascial release, mobilizations, visceral manipulation and biofeedback. An individualized home exercise program will also be provided to release and/or strengthen with a whole body approach to include the pelvic floor, but not specific to. Other modalities such as electrical muscle stimulation (EMS), transcutaneous electrical nerve stimulation (TENS), mechanical biofeedback, ultrasound and acupuncture may also be included as components of the treatment plan.