Pelvic Floor Dysfunction

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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.

Dysfunction Of The Pelvic Floor

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.

Prevalent Symptoms Include:

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

Chronic Pelvic Pain (CPP)

Pain that persists for six months or longer is categorized as chronic, and CPP 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 relatively common urologic complaint among men under age 50.

Causes Of Pelvic Floor Dysfunction

A number of anatomical changes can lead to pelvic floor dysfunction. Tight or weakened muscles, joint impairment in the low back or pelvis, or sensitive painful tissues may be contributing factors.
Other causes include:
  • Postural issues affecting the pelvis and low back
  • Trauma
  • High-impact physical activities
  • Surgery
  • Obesity
  • Sedentary lifestyle
  • Pregnancy and childbirth
Subcategories of pelvic floor dysfunction

Diagnosis Of Pelvic Floor Dysfunction

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 real-time ultrasound to visualize the structures of the pelvic floor during activity. Since pelvic floor pain and dysfunction is closely related to the low back and hips, we perform diagnostic and functional sonography to rule in or 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 conditions, including:
  • Low back pain
  • Chronic pelvic pain
  • Hip and groin pain
  • Postpartum issues
  • Urinary incontinence
  • Post-surgical issues


Most traditional approaches fail to get at the root cause of dysfunction and correct it. Instead what we see is an excessive amount of internal, intravaginal, intrarectal myofascial work, which we believe is not really addressing the root cause of these problems, but merely providing temporary symptomatic relief. Although this work may be necessary in some cases, unlike most pelvic pain physical therapy clinics we do not place great emphasis on it.
We believe that the cause of these trigger points within the pelvis, as well as the cause of pudendal nerve compression is due to:
  1. Dysregulation of the forces within the intra-abdominal and intrapelvic cavities, and the inability of the motor system to cope and coordinate postural and spinal stabilization, breathing, sexual and excretory functions.
  2. Hip muscle dysfunction caused by excessive sitting and deficient gait (walking) mechanics
  3. Poor postural and lifestyle habits
  4. Stress, emotional issues and poor coping strategies

NYDNRehab Diagnostic and Rehabilitation Equipment

EMTT (magnetotransduction)

EMTT (magnetotransduction)

Focused ESWT treatment for pelvic pain

ESWT (extracorporeal shock wave therapy) is a noninvasive and absolutely safe treatment for the myofascial component of multiple pelvic pain conditions. ESWT can significantly improve the symptoms of pelvic pain and urination disorders in chronic pelvic pain patients. Its therapeutic effect is attributed to the improvement of angiogenesis and non-invasive pain nerve blocks. ESWT has been used extensively in Europe for over a decade to treat pelvic pain. Evidence indicates that ESWT provides significant pain relief and regenerative effects to pelvic floor musculature and significantly decreases pelvic pain. At NYDNREHAB we use highly effective combination of ESWT and EMTT (magnetotransduction) therapy!

ESWT shockwave



We are experts in diagnostic and functional ultrasonography. These two methods enable us to examine the structure and function of the:
  • Pelvic floor
  • Low back
  • Abdominal wall and hips
  • Pudendal nerve
We have the only available system in NYC to perform state-of-the-art 3D gait analysis.
Our physical therapy is based on a meticulous clinical exam and diagnostic and functional ultrasonography, not on symptoms alone. We use Dynamic Neuromuscular Stabilization (DNS) therapy and restoration of postural breathing mechanics to restore pelvic balance and stability.
Pelvic floor problems often stem from abnormal walking gait. Ours is one of the few clinics providing gait-specific physical therapy for pelvic floor dysfunction.
We use highly effective ultrasound-guided dry needling on muscles of the pelvic floor, abdomen and hips.
We perform ultrasound guided pudendal nerve blocks when necessary.
We provide pelvic floor visceral manipulation.
Numerous studies and our personal experience shows that extracorporeal shockwave therapy (ESWT) for intrapelvic trigger points,is by far more effective than manual intrapelvic trigger point release.

The following publications enumerate the numerous positive effects of ESWT:


Effect of radial shock wave on chronic pelvic pain syndrome/chronic prostatitis:

ESWT has been used extensively in Europe for over a decade to treat pelvic pain. Evidence indicates that ESWT provides significant pain relief and regenerative effects to pelvic floor musculature and significantly decreases pelvic pain. At NYDNREHAB we use highly effective combination of ESWT and EMTT (magnetotransduction) therapy!
We also use a highly effective combination of guided imaging and intrapelvic device biofeedback to release and strengthen the pelvic floor muscles.
Treatment options for pelvic floor dysfunction
Our goal is to restore optimal pelvic floor function, so you can enjoy an improved quality of life.

Guo, Qi, Mei Hong, and Zhi-Ping Wang. “Extracorporeal shock wave therapy for chronic pelvic pain syndrome: an update.” Zhonghua nan ke xue= National journal of andrology 20.8 (2014): 747-750.

Range of Available Unique Physical Therapy Treatments at Nydnrehab

Advantages of Ultrasound Guided Dry Needling (UGDN) at NYDNRehab


Ultrasound guided procedures at NYDNR use the most advanced ultrasonography equipment, enhanced with sonoelastography, rarely available in private clinics.


High resolution ultrasonography is the method of choice for UGDN procedures, able to detect deep trigger points that cannot be manually palpated.


UGDN is highly effective, requiring only 1-3 applications, versus blind dry needling that requires multiple repetitions.


Blind dry needling cannot access deep trigger points, and lacks precision and specificity.


We are able to combine UGDN with focused and radial shockwaves, for optimal results.


UGDN can eliminate the symptomatic phase of physical therapy, moving the patient directly from symptoms to correction, and reducing care by 4-8 weeks.


UGDN is an evidence based treatment approach with a high degree of efficacy.


Dr.Kalika is an internationally recognized expert in UGDN, with multiple scientific publications to his credit.

Pelvic Floor Specialist

Dr. Kalika has been treating pelvic floor disorders using focused shockwave therapy for over 10 years. You can read about his research on pelvic pain disorders here: Bubnov, L and Kalika, L (2019). Dry needling of trigger points under ultrasound guidance effective to treat chronic pelvic pain and pelvic prolapse. ICS 2020 Online, Abstract 494. Dr. Lev Kalika has revolutionalized the methodology of treating knee pain and other motor disorders of the lower kinetic chain by introducing unique integrative approaches and combining Dynamic Neuromuscular Stabilization (DNS), C.A.R.E.N (computer assisted rehabilitation environment), biofeedback force plate retraining and the most solid conventional approaches in his New York City’s Midtown practice. The results of these new methods are quicker, deeper and longer lasting when compared with basic physical therapy being used today.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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