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Navigating Pelvic Floor Therapy with Dr. Melanie Carminati at EndoFound

Embarking on a journey towards better pelvic health is crucial in enhancing overall well-being. Today, we’re delving into the insightful world of pelvic health with Dr. Melanie Carminati, a distinguished Doctor of Physical Therapy and the founder of Inspira Physical Therapy in Brooklyn. This blog will detail the impact of endometriosis on exploring pelvic floor anatomy and receiving expert advice on treatments and exercises. 

Understanding Endometriosis and Its Effects on the Pelvic Floor

Dr. Carminati begins by shedding light on the intricate relationship between endometriosis and pelvic health. Drawing from extensive research, she emphasizes that a staggering 93.3% of women with endometriosis experience pain, with 75% exhibiting increased tone in their levator ani muscles—the deep pelvic floor musculature. Furthermore, more than half of these women showcase impaired pelvic floor ability to relax, highlighting the prevalence of hypertonic pelvic floor issues among those with endometriosis.

Research Findings and the Role of Pelvic Floor Physical Therapy

In her discussion, Dr. Carminati shares compelling findings from systematic reviews. These studies confirm that pelvic floor physical therapy not only reduces pain in individuals with endometriosis but also significantly improves their overall quality of life. This revelation underscores the transformative impact that targeted physical therapy interventions can have on managing pelvic pain associated with endometriosis.

Demystifying the Pelvic Floor

Before diving into therapeutic approaches, Dr. Carminati briefly explains the pelvic floor’s anatomy. Describing it as a three-layered muscle group resembling three hammocks, she illustrates how these muscles span from the pubic bone to the tailbone. This insightful glimpse into the pelvic floor lays the foundation for understanding the subsequent discussions on muscle tension, dysfunctions, and treatments.

Objective Assessments and Holistic Considerations

Dr. Carminati’s approach to pelvic health begins with objective assessments in her clinic. A common revelation is the prevalence of hypertonic pelvic floor muscles, indicating a spasm accompanied by weakness due to tension. This observation underscores the complexity of pelvic floor issues and the need for tailored interventions.

Beyond muscular concerns, Dr. Carminati delves into diaphragm breathing dysfunctions, fascial restrictions, and muscle tension in various areas. This holistic view ensures that her evaluations consider the body’s interconnectedness, providing a more comprehensive understanding of pelvic health considerations.

Connecting Through Subjective Experiences

Understanding pelvic health goes beyond clinical assessments; Dr. Carminati actively connects with her audience by acknowledging their subjective experiences. Drawing from individuals dealing with endometriosis, she identifies common reports such as painful intercourse (dyspareunia), pain with urination, urinary frequency, bloating, painful periods, back pain, and hip pain.

Dr. Carminati establishes a rapport with her audience by aligning her insights with relatable symptoms. This empathetic approach emphasizes the importance of addressing these issues and encourages individuals to seek personalized solutions for their unique challenges.

The Pelvic Floor’s Role in the Deep Functional Core

Dr. Carminati shifts gears to demystify the pelvic floor’s connection to the deep functional core. Stressing its harmonious relationship with other muscles, she introduces the diaphragm as a key player. The rhythmic interplay between the diaphragm and pelvic floor, disrupted by adhesions or tension, is a contributing factor to dysfunctional pelvic health.

Exploring the Pelvic Wall

Beyond the pelvic floor, Dr. Carminati introduces the pelvic wall, encompassing muscles like the obturator, internist, and piriformis. This revelation holds particular significance for individuals with endometriosis experiencing hip and back pain. Appreciating the interconnection between the lumbar spine, hips, and pelvic wall muscles becomes crucial in evaluating and assessing patients with endometriosis.

Practical Insights into Pelvic Floor Physical Therapy

Dr. Carminati outlines what to expect during a pelvic floor physical therapy assessment. Emphasizing the importance of open communication, she covers various aspects, including sexual function, urinary and bowel issues, exercise habits, sleep, fatigue, and past surgeries. The physical assessment involves a holistic examination, evaluating posture, walking patterns, and specific checks for the pelvic floor.

Layered Approach to Pelvic Floor Physical Therapy

Dr. Carminati unveils a layered approach to pelvic floor physical therapy, seamlessly combining external observations, palpation for muscle tension, and internal assessments with the patient’s consent. This multi-layered examination facilitates a comprehensive understanding of the pelvic floor’s condition, strength, and function. It also enables the creation of tailored treatment plans to address specific concerns.

Manual Therapy and Osteopathic Techniques

Delving into treatment modalities, Dr. Carminati discusses various manual therapy techniques employed at Inspira Physical Therapy. From external and internal pelvic floor manual therapy to osteopathic approaches like visceral manipulation, she emphasizes the importance of addressing myofascial restrictions and promoting normal motility in visceral organs.

A specific focus is given to Winback radio frequency therapy, highlighting its role in relaxing hypertonic pelvic floor muscles. These therapeutic interventions contribute to the overall restoration of pelvic health.

Osteopathic Techniques for Central Nervous System Regulation

Recognizing the impact of chronic pain on the central nervous system, Dr. Carminati introduces osteopathic techniques such as craniosacral therapy, vagus nerve manual therapy, and visceral manipulation. These approaches aim to down-regulate the nervous system, creating a foundation for subsequent manual therapy interventions. Dr. Carminati underscores the importance of addressing the central nervous system as a crucial aspect of pain management.

Pelvic Floor PT Treatments and Exercise Considerations

We take a deeper dive into the practical aspects of pelvic floor physical therapy treatments. Dr. Carminati discusses neuromuscular reeducation with dilators or wands, addressing hypertonic pelvic floor through down training and subsequent up training. These nuanced approaches provide a comprehensive understanding of the therapeutic process.

Exercise considerations play a vital role in improving pelvic floor function and stability. Dr. Carminati explores diaphragm breathing, relaxation meditation, pelvic floor stretching, and Pilates-based core reeducation as integral components of a holistic approach to pelvic health.

Building a Collaborative Support Team

Dr. Carminati advocates for a collaborative approach to pelvic health, underscoring the importance of a multidisciplinary team. In conditions as complex as endometriosis, assembling a team of healthcare providers, movement practitioners, and pelvic floor specialists ensures a comprehensive and supportive treatment plan. Dr. Carminati actively collaborates with her patients’ healthcare providers, fostering a team-oriented approach to rehabilitation.

Validation and Encouragement

Before concluding, Dr. Carminati takes a moment to validate the experiences of individuals dealing with pelvic health issues. She encourages them to find providers who truly listen and establish trust. This affirmation reinforces the notion that seeking supportive healthcare contributes significantly to overall well-being and progress.

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