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Case Study: The Use of Winback Tecar Therapy for the Treatment of Superficial Primary Dyspareunia

Carminati, M., Lahonda, L. June 2023. Inspira Physical Therapy & Pilates. Brooklyn, NY. 

Introduction: 

Winback Tecar Therapy has emerged with innovative technology via the bracelet which allows Pelvic Floor Physical Therapists to administer high-frequency electromagnetic waves (0.3 to 1.2 MHz) into soft tissue structures of the pelvic floor region for male and female patients. This technology allows for greater patient comfort during treatments, increased effectiveness of manual therapy, and longer-lasting results for pain relief and soft tissue tightness. This case study will focus on a 37-year-old patient assigned female at birth with primary diagnosis of superficial primary dyspareunia (3) and the use of 7 pelvic floor physical therapy sessions with the use of the Winback Tecar therapy bracelet during the internal manual therapy portion. 

Background: 

Both treating Physical Therapists are licensed Physical Therapists in NY State and received pelvic floor Physical Therapy training through Herman & Wallace. The Physical Therapy office where the patient received care, is a private office where all treatment sessions are 1 hour in length and the patient spends the entire treatment with the same licensed Physical Therapist. Patient was referred to pelvic floor physical therapy by a pelvic Physiatrist. 

Case Description: 

Patient is 37 y.o. AFAB, with history of septum removal surgery d/t uterine didelphys. Patient received Physical Therapy in our office with primary symptoms of superficial primary dyspareunia. Patient’s main complaint is pain with sexual intercourse upon initial penetration which significantly affects her quality of life. No symptoms of urinary incontinence were reported. Patient reported normal bowel movements. Patient does have a history of IBS and food allergies. Patient does not have any active urinary tract infections, yeast infections or other similar diagnoses. Psychosocial factors influencing pain were discussed and addressed with the patient. The patient receives regular psychotherapy as well and has addressed potential psychosomatic influence with their provider.

Patient’s physical activity includes Barre classes regularly and walking. Objective findings include: Static Postural Analysis= Forward head rounded shoulder posturing, downward rotated shoulders (B), hip thrust forward posture with PPT, (B) knee valgus, and decrease in (B) arches. Manual Muscle testing (MMT) revealed patient had difficulties connecting to deep core muscles, Hip Abduction weakness of 3/5 (B), ER 3+/5 (B).Hip Active Range Of Motion: Flexion/IR/ER: 105/15/80 (B). Hamstring flexibility at 90/90: (35) deg (B) Pelvic Floor Assessment: External observation revealed no tissue irregularity in perineal region and labial tissues. Internal palpation revealed no palpable scar tissue from uterine didelphys septum removal, increased Tone in 1st and 2nd PFM layer (B) TTP 2nd PFM layer (B), Trigger Points along Isciocavernosus muscles and superficial perineal membranes (B). Pelvic floor MMT (PERF Score): 3/5 (B), endurance 2-3 sec, able to complete 3 quick contractions at ⅗ strength, able to complete 4 1 second quick contractions. Patient unable to bear down (reverse kegel). 

Interventions: 

Patient (pt) was asked to stop participating in Barre classes for the initial period of physical therapy treatment. This helped to reduce a large amount of the hypertonicity present in the patient’s pelvic floor musculature. After the initial course of pelvic floor physical therapy. The patient was then seen for 7 visits with the use of the Winback Tecar Therapy bracelet and she reported significant improvements in her symptoms. Before incorporating Winback Tecar therapy, patient’s treatment included internal manual releases, education of pelvic floor muscle elongation (“reverse Kegels”), diaphragmatic breathing with use of visual imagery of “elevator” to guide the breath to the pelvic floor with the goal to release tension. Pt was responding well to treatments and reported significant improvement after introducing Winback Tecar Therapy into the treatment. This was also noted by both treating Physical Therapists Initially, Winback Tecar therapy was used with the bracelet placed on the treating physical therapists forearm muscle belly of the treating hand. Disposable medical exam gloves were worn on both hands of the treating physical therapists. Pt was treated in hook lying position and when improvement of symptoms were noticed, the patient’s treatment position was progressed to modified prone position as well (with pt on her elbows and pillows under the belly). In a hook lying position the ground plate was placed under the buttock and the physical therapist utilized a bracelet on

the forearm muscle belly of the same side of patient PFM that was to be treated. Then it was repeated on the opposite side of the patient after glove changes and replacement of the Winback Tecar Therapy bracelet on the opposite forearm muscle belly of the treating hand. In the modified prone position 2 pillows were placed under the belly and the ground plate was placed under the belly. In this position the internal manual therapy treatment was provided rectally with focus on release of deep transverse perineal musculature. The settings of the Winback Tecar Therapy treatment were RES at 30% of intensity. Each side of PFM was treated for about 10-15 min, with the entire Winback Tecar Therapy treatment to be at least 30 min. The focus of internal treatment was on deep transverse perineal muscle, ischiocavernosus and levator ani muscle on both sides. The home exercise program included diaphragmatic breathing with focus on lengthening of PFM on inhalation 2×8, and use of pelvic wand to stretch 2nd layer of PFM and address tender points in 3rd layer of PFM. 

Follow-Up & Outcomes: 

During the initial course of Pelvic Floor Physical Therapy treatment, the pt reported a decrease in pain and decreased sensation of tension in PFM during the session. However, her symptoms would return and it was challenging to maintain results gained from session to session. Pt would continue to have sexual intercourse with her partner but would still have pain with initial penetration. Significant improvements were found after initiation of the use of Winback Tecar Therapy during the internal manual therapy portion of the pelvic floor Physical Therapy treatment. Pt responded very well to the Winback Tecar Therapy and demonstrated carryover and gained results from session to session. After the third session pt reported that the intercourse with her partner felt much more comfortable but still with noticed discomfort. During the following sessions with the use of Winback Tecar therapy, the patient demonstrated improved resting tone of 1st and 2nd layer of PFM, decreased TTP in Levator Ani muscles, improved connection and lengthening of PFM during diaphragmatic breathing. After 6th visit with the use of Tecar pt reported that had minimal discomfort during sexual intrcourse and was very happy with the results. Pt was advised to schedule an appointment once every two weeks for the next month and to continue with her HEP and the use of pelvic wand as needed.

Conclusions: 

Treating dyspareunia can be very challenging at times. Patients might have difficulty relaxing their PFM in anticipation of pain/discomfort. They may also experience difficulty controlling pelvic floor function 

(contraction/relaxation/bearing down) due to increased tone. The use of Winback Tecar Therapy in treating dyspareunia offers patients a sensation of relaxing warmth/heat that alone offers an analgesic benefit. Winback Tecar Therapy provides a diathermic effect on the tissue resulting in increased vascularization of the target area. According to Ron Clijsen, et al. there is a significant change in intramuscular blood flow with the use of Winback Tecar Therapy treatment in RES mode. Winback Tecar treatments use high-frequency electromagnetic waves that contribute to reduction of muscle spasms and contractions, improves blood flow and muscles oxygenation resulting in decrease in pain (2). 

Using Tecar modality for treatment of dyspareunia offers patients opportunities to respond to internal treatment with less fear, improved relaxation, ability to connect to pelvic floor muscles better, longer lasting results in between treatments, decreased muscles spasms, and reduced pain with fewer visits compared to treatments of the same condition without use of Winback Tecar Therapy modality. This case study strongly supports the use of Winback Tecar Therapy treatment for superficial primary dyspareunia. 

References: 

  1. Chevalier F, Fernandez-Lao C, Cuesta-Vargas AI. Normal reference values of strength in pelvic floor muscle of women: a descriptive and inferential study. BMC Womens Health. 2014 Nov 25;14:143. doi: 10.1186/s12905-014-0143-4. PMID: 25420756; PMCID: PMC4251926.
  2. Ron Clijsen, Diego Leoni, Alessandro Schneebeli, Corrado Cescon, Emiliano Soldini, Lihui Li, and Marco Barbero Does the Application of Tecar Therapy Affect Temperature and Perfusion of Skin and Muscle Microcirculation? A Pilot Feasibility Study on Healthy Subjects The Journal of Alternative and Complementary Medicine 2020 26:2, 147-153 
  1. Tayyeb M, Gupta V. Dyspareunia. [Updated 2022 Jun 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562159/

4. Vahdatpour B, Haghighat S, Sadri L, Taghian M, Sadri S. Effects of Transfer Energy Capacitive and Resistive On Musculoskeletal Pain: A Systematic Review and Meta-Analysis: Galen Med J. 2022 Nov 17;11:e2407. doi: 10.31661/gmj.v11i.2407. PMID: 36698689; PMCID: PMC9838110. 

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