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Pelvic Floor Physical Therapy Rehabilitation

About Pelvic Pain

For many people, dysfunction and pain in the pelvic region are uncomfortable to talk about, even with a doctor. For that reason, people often wait until mild discomfort and minor symptoms escalate into unbearable pain with embarrassing and unmanageable symptoms before seeking help.

Because of the complex anatomy of the pelvic region, many things can be at the root of pelvic pain and dysfunction, and until the cause is identified, the issue cannot be resolved. Treatment with internal manual therapy, drugs and steroid injections may dull the pain and mask the symptoms, but the condition often remains unresolved, relegating patients to a vicious cycle of pain and therapy.

Dr. Lev Kalika

Clinical director & DC RMSK

Dr. Escudero

Manual Physical Therapist

About NYDNRehab Pelvic Pain Specialists Dr. Kalika and Dr. Escudero

Dr. Lev Kalika has been an active member of the International Society of Medical Shockwave) (ISMST ) since 2007, and has performed over three thousand ESWT procedures. He is a world renowned expert in ultrasound guided dry needling and has published multiple peer-reviewed articles about ultrasound guided procedures.

Dr. Kalika applies his expertise in ultrasound guided procedures to perform dry needling and ESWT to treat pelvic pain and dysfunction. Dr. Kalika has developed his own unique approach to pelvic pain, with a track record of success that supersedes that of conventional pelvic pain physical therapy.

Dr. Daniela Escudero, DPT is a Certified Manual Physical Therapist who specializes in pelvic floor health, with an emphasis on functional movement and manual therapy. Dr. Escudero is dedicated to improving the quality of life of her patients, so they can pursue their full potential without pain or dysfunction.

The combined expertise of Dr. Kalika and Dr. Escudero makes NYDNRehab the clinic of choice for pelvic floor physical therapy in NYC.

How Treatment at NYDNRehab Differs from Conventional Pelvic Floor
Physical Therapy

Most traditional approaches to pelvic pain fail to get at the root cause of pelvic floor dysfunction and correct it. Instead, we see an excessive amount of internal, intravaginal, intrarectal myofascial work, which does not really address the underlying cause of pelvic problems. Those methods merely treat the symptoms without fixing the problem. While this type of treatment may be useful or even necessary at times, we do not overemphasize it at our clinic.

We believe that pelvic pain and dysfunction is caused by trigger points located deep within the pelvis, along with pudendal nerve compression. However, these trigger points in themselves are not causative, they are merely a reaction to the dysfunction in the hips, deficits in the mechanisms that generate intra abdominal pressure, and deep intrinsic instability of the spine and the entire locomotor system.

This is due to:

Dysregulation of the forces within the intra-abdominal and intrapelvic cavities
Inability of the motor system to cope and coordinate postural and spinal stabilization with breathing, and sexual and excretory functions.
Hip muscle dysfunction caused by excessive sitting and deficient walking gait mechanics
Poor postural and lifestyle habits
Stress, emotional issues and poor coping strategies

Watch this video to learn more about NYDNRehab’s unique approach to pelvic pain treatment.

Symptoms and Causes of Pelvic Pain and Dysfunction

Symptoms

Pain in the genital area
Pain in the perineum
Rectal pain
Pain in the pelvis
Pain during sexual intercourse
Urine leakage during intercourse
Urine leakage during exercise
Leakage when coughing, sneezing or laughing
Difficulty emptying your bladder or bowels
Prolapsed uterus or internal organs
Low back or hip pain

Causes

Postural issues affecting the pelvis and low back
Trauma
High-impact physical activities
Surgery
Obesity
Sedentary lifestyle
Pregnancy and childbirth

Risk Factors

Pregnancy and childbirth
Advanced age
Obesity
Chronic constipation
Chronic coughing
Pelvic muscle atrophy post-menopause
Radiation or pelvic surgery
Smoking
Enlarged prostate

Accurate Diagnosis of Pelvic Floor Dysfunction Means Successful Treatment

Diagnosis begins with a medical history and physical exam of the pelvic floor, low back, hips and pelvis. Gait analysis may be performed as well. Your clinician will ask for detailed information about pregnancies and childbirth, and any difficulties or abnormalities you experienced associated with childbearing.

At NYDNRehab, we use high resolution dynamic ultrasound to visualize the structures of the pelvic floor with the patient in motion. Since the pelvic region is closely related to the low back and hips, we perform diagnostic and functional sonography to rule out hip and low back issues.

During a diagnostic ultrasound session, both patient and clinician can view the muscles of the pelvis and abdominal wall in motion, to assess for muscular deficits, excessive force production (pressure) and trigger points.

With real-time ultrasound imaging, we are able to diagnose and treat a number of issues related to pelvic dysfunction, including:

Low back pain
Chronic pelvic pain
Hip and groin pain
Postpartum issues
Urinary and bowel incontinence
Post-surgical issues

Regenerative Technologies for Pelvic Floor
Physical Therapy

The human body has its own innate healing mechanisms, but it sometimes needs a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.

Focused Shockwave Therapy

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a fairly new technology that transmits high energy magnetic pulses to targeted tissues. The magnetic waves synchronize with the body’s own magnetic fields, causing a disturbance that triggers a regenerative response. EMTT waves can penetrate deep tissues up to 18 cm beneath the skin’s surface, to target difficult-to-reach tendons, muscles, bones and nerves.

Electromagnetic Transduction Therapy (EMTT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues. This speeds up the delivery of oxygen and nutrients to damaged tissues and stimulates cellular metabolism, to accelerate the healing process.

High Energy Inductive Therapy (HEIT)

HEIT uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes. HEIT generates a magnetic field 600 times stronger than the field of a normal magnet, to stimulate healing of nerves, muscles and blood vessels.

HIGH ENERGY INDUCTIVE THERAPY (HEIT)

Regenerative Indiba

INDIBA CT9 Radiofrequency Device

Our INDIBA Tecar therapy machine converts electrical current into a stable radio frequency current of 448 kHz, designed to increase and stabilize the exchange of ions in damaged cells, evoking a regenerative response that accelerates healing. INDIBA can be used to successfully treat joint and muscle disorders, low-back pain, sports injuries, surgical incisions and various pain syndromes. Another therapeutic effect of INDIBA is extreme and prolonged cellular hyperthermia. Due to this effect, INDIBA therapy combined with manual therapy and soft tissue tissue manipulation enables instantaneous release to occur, significantly shortening the number and duration of physical therapy sessions. What is normally accomplished in two months of physical therapy can be accomplished in 3-4 sessions with INDIBA.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to lower back pain. Dry needling is an outpatient procedure that inserts non-medicated needles into the trigger point to evoke a twitch response, releasing the trigger point and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing pain and discomfort for the patient.

Regenerative Ultrasound Guided Injection Therapies

Pelvic Conditions Successfully Treated with
Regenerative Therapy

Growing evidence indicates that regenerative therapies like ESWT are especially effective in treating the following pelvic conditions:

Pelvic pain of unknown origins
Pelvic floor muscle pain from myofascial trigger points and spasms
Pudendal neuralgia (damage to or irritation of the pudendal nerve)

Vulvodynia
Urinary incontinence
Dyspareunia (painful intercourse)

Ultrasound Guided Injection
Therapies

Injection therapies use natural/neutral solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.

Platelet Rich Plasma (PRP)

PRP therapy uses a sample of the patient’s own whole blood, which is spun in a centrifuge to extract a high concentration of platelets. When injected into damaged tissues, PRP initiates tissue repair by releasing biologically active factors such as growth factors, cytokines, lysosomes and adhesion proteins. The injected solution stimulates the synthesis of new connective tissues and blood vessels. PRP can help to jump-start healing in chronic injuries and accelerate repair in acute injuries.

Proliferation Therapy, aka Prolotherapy

Prolotherapy uses a biologically neutral solution, often containing dextrose, saline or lidocaine. The solution irritates the affected connective tissue, stimulating the body’s own natural healing mechanisms to encourage growth of new normal ligament or tendon fibers.

More treatment options

Acute Pelvic Pain

Sudden onset pelvic pain should not be ignored. It is essential to immediately rule out visceral pathology (organ dysfunction).

Treatments for acute pelvic pain include:

Pudendal or genitofemoral nerve blocks followed by tibial nerve neuromodulation

Chronic Pelvic Pain

Ongoing or intermittent pelvic pain that lingers for weeks or months can often be eliminated with non-invasive conservative treatment.

Treatment options for chronic pelvic pain include:

Extracorporeal shockwave therapy (ESWT)
Extracorporeal magnetic transduction therapy (EMTT)
Ultrasound guided dry needling
Comprehensive Pelvic floor physical therapy

Home treatment options for pain management and restoration include:

Sitz bath
Foam rolling on the painful region
Physical therapy exercises
Meditation with focus on your pelvic floor

Get Personalized Pelvic Pain Physical Therapy Designed Just for You

At NYDNRehab, we take a one-on-one approach to patient care. We understand that every patient has a unique anatomy, and that each condition has unique characteristics. We tailor our treatment plans to the individual, and never use cookie cutter approaches.

Our experience using innovative treatment methods and advanced technologies makes NYDNRehab the number one choice for pelvic floor physical therapy and rehabilitation in NYC.

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Benefit from Our Innovative Non-Invasive Therapies

The muscles and connective tissues that make up your pelvic floor form a hammock that spans from your tailbone to your pubic bone, creating a wall of separation between your perineal region and your pelvic bowl. The pelvic floor provides support for your intestines, bladder and uterus, and its muscles govern bladder, bowel and sexual function.

Signs that your pelvic floor may not be doing its job often begin with bladder and bowel leakage, urinary hesitancy or urgency, or constipation.

High-impact sports like gymnastics, basketball and running create downward pressure on the pelvic floor muscles, putting athletes in those sports at risk for dysfunction. Pregnancy and childbirth may also lead to pelvic pain and dysfunction.

Pain that persists for six months or longer is categorized as chronic pelvic pain (CPP) which can seriously interfere with normal daily activities. CPP is common in women, accounting for about 10% of all visits to the gynecologist. It is also a common urologic complaint among men under age 50.

We strongly believe that the pelvic floor muscles are not the underlying cause of pain. Experience tells us that pelvic pain originates in walking gait deficits and imbalances in the hips and low back, interfering with the body’s ability to balance intrapelvic and intra abdominal pressure. While ESWT, EMTT, and USGDN are effective in relieving pain, restorative pelvic floor physical therapy provides the ultimate solution to pelvic pain and dysfunction.

Preventing Pelvic Pain and Dysfunction

Lifestyle factors play a key role in pelvic dysfunction. Eating whole organic foods and drinking plenty of plain filtered water can help you avoid urinary and bowel issues that lead to pelvic pain. Regular exercise that targets muscles throughout the entire body helps to strengthen the pelvic and core muscles and promote healthy function. Managing your weight, avoiding smoking, and stress management are all important lifestyle factors that help to prevent pelvic issues. Staying fit and active throughout your pregnancy can reduce your risk of developing pelvic floor issues.

In addition, you should rule out visceral pathologies by consulting your healthcare provider. If you suffer from hip or back pain, you should seek treatment, as untreated pain in those areas can affect the pelvic region. A 3D gait analysis can help to identify and correct asymmetrical gait patterns. Try to remain aware of your pelvic floor, and do not clench your pelvic muscles when stressed. Be sure to void your bladder and bowels when you feel the urge – do not hold your urine. Eating an organic whole foods diet and drinking plenty of purified water will help you avoid constipation.

Preventing Pelvic Pain and Dysfunction Image

Get Pain-Free Pelvic Floor Treatment That Really Works!

Pelvic floor physical therapy helps your body heal itself, to eliminate pelvic floor dysfunction for good. However, not all physical therapy is effective. Conventional therapy uses manual intra vaginal or intrrectal release techniques to target the internal pelvic floor muscles. In our experience, this type of treatment only provides temporary relief with no significant progress, making patients dependent on ongoing therapy to relieve pain.

At NYDNRehab, we help our patients get long-term relief using a combination of extracorporeal shock wave therapy (ESWT), extracorporeal magnetic transduction therapy (EMTT) and ultrasound guided dry needling (UGDN). Our treatment approach goes beyond pain management, to actually regenerating damaged tissues and promoting healing. We are the top rated physical therapy clinic for pelvic pain in NYC.

Certificates and Postgraduate Education

Lev Kalika Clinical Director and DC, RMSK

Dr. Kalika is the first practitioner on the East Coast of the US to have the privilege of introducing the DNS method It has made a world of difference in how back pain and other locomotor issues are approached and treated.

Our Specialists

Dr. Mikhail Bernshteyn MD (Internist)

Dr. Michael Goynatsky DPT

Dr. Daniela Escudero DPT

HyunJu YOO, PT, MPT, DPT, CPI (Licensed Physical Therapist)

Dr. Christina Pekar DC

Dr. Michelle Agyakwah DC

All Staff »

Resources

https://www.degruyter.com/document/doi/10.1515/med-2020-0174/html?lang=en

Research at NYDNRehab

Conference: The 50th ICS Annual MeetingAt: Las Vegas, USA
Dry needling of trigger points under ultrasound guidance effective to treat chronic pelvic pain and pelvic prolapse

We are trying to get pregnant but my doctor says I have a prolapsed uterus. Is there anything I can do to fix it?

Uterine prolapse is often caused by weakened pelvic floor muscles and connective tissues that fail to hold the organs in place. Pelvic floor physical therapy with a pelvic pain specialist can help restore the integrity of the structures of your pelvic floor and reposition your reproductive organs.

Ever since my baby was born, I have had urine leakage when I sneeze, laugh or exercise. Is this something I will have to live with indefinitely?

Pelvic Floor Physical Therapy Rehabilitation

About Pelvic Pain

About NYDNRehab Pelvic Pain Specialists Dr. Kalika and Dr. Escudero

How Treatment at NYDNRehab Differs from Conventional Pelvic Floor
Physical Therapy