What can I expect at my first physiotherapy visit?
Your first physiotherapy appointment begins the unique process, Your Path to Improved Health. The first visit involves: “Clarifying your Injury/Complaint step”.
The initial assessment is an integral piece of your Path to Improved Health. This is your opportunity to discuss why you are visiting our facility with your professional, skilled physiotherapist.
At GWHA we offer extended first visit time appointments so that you can sit back and relax and share your story.
Our assessment includes:
- a detailed review of what brings you to the clinic and your relevant medical history
- a full physical examination that may include range of motion, strength, orthopaedic and other specialized tests (you may be required to wear shorts or a gown for better visibility)
- At GWHA if you are being seen for a pelvic health concern, you will likely be asked to participate in an internal pelvic assessment
What is the purpose of the internal pelvic floor assessment?
During the pelvic floor assessment, we give a detailed review on pelvic floor anatomy so that our clients understand key muscles and areas of concern.
- We observe and palpate the general state of the pelvic floor with gentle palpation
- Assessing for areas of thickening, tenderness or other symptom reproduction
- Ensuring that the vaginal tissue has normal mobility
- We assess through manual palpation the tone of the pelvic floor muscles
- Assessing for pelvic floor muscles that may be “tight” or have “trigger points”, which often are painful
- Assessing for pelvic floor muscles that are weak
- Assessing the coordination of the pelvic floor with breathing
- Assessing the ability to relax the pelvic floor
- Assessing the ability of the pelvic floor to counter downward forces that are created with activities like a cough or sneeze
- Observing and assessing the pelvic floor for areas of prolapse
- Other unique areas that are assessed at our Women’s Health focused area of practice include:
- Integrity of the abdominal muscles (looking for the presence of Rectus Diastasis) to close adequately and generate the necessary core stability force
- Symmetrical positions of the sacroiliac joints (SIJ)
- Following your assessment your physiotherapist will explain your treatment plan and clarify timelines involved for recovery, as well as discussing any outstanding concerns
- This is often an opportunity to highlight any other resources that may be useful to accelerate recovery.
FAQ: Should you do sports/aerobics with a tight pelvic floor?
Your pelvic floor muscles behave like most muscles in your body. The provide optimal strength when they start from their optimal resting position.
Just like your bicep muscle in your arm, if your muscle is tight or held in an extreme shortened or lengthened position, it loses its ability to generate force. Try it! Hold a 5-pound weight in 3 different positions and the repeatedly bend and straighten your elbow. You should have found it the easiest to do when your elbow was bent to 90 degrees – the bicep muscle’s optimal position.
Anytime you need to recruit your pelvic floor for support it will be easier and more effective if the muscle is starting at its optimal length. When you return to sport or aerobics you are challenging your pelvic floor to counter the natural increase in abdominal pressure that occurs. If your pelvic floor is tight and already short it may not be able to generate the necessary force and often attempting to generate this force overtime can lead to pain. The other consequence of using tight pelvic floor muscles is the fact that they will be weak. If the muscles can’t counter the force during sport the “downside” is that you are not supporting your bladder, uterus and vagina – this could lead to prolapse.
Generally, we would recommend that every woman that returns to sport has a normal pelvic floor length and can generate enough force in the pelvic floor to resist gravity and a downwards force that occurs with a basic cough…
FAQ: If you feel like you have to go to the bathroom often, should you restrict your fluid intake?
While this is commonly used as a strategy to minimize bathroom visits it is NOT recommended. The bladder can be thought of as a water balloon. It needs to receive fluids to a “regular volume” in order to turn on the receptors in the bladder wall that ultimately send the “I need to go pee” signal to your brain. If you are decreasing fluid intake the bladder responds by becoming hypersensitive or “overactive”. Now with small volumes the receptors still turn on sending the same signal to the brain that you need to go pee – even though the actual volume that you will pee will be small. The other important factor to realize is that poor hydration increases the concentration of urine. Concentrated urine acts as a “bladder irritant” and similarly will cause those signals to the brain to happen before we want them to.
There are MANY reasons to stay hydrated, especially before exercise. For the sake of normal bladder function hydration is equally as important. On average people should void 6-8 times a day with volumes slightly less than their first awakening void.
If you are using this strategy or know that you are voiding low volumes on a regular basis a pelvic floor assessment can offer resources to get you back to a normal routine.
How is Physiotherapy Funded?
Many extended health care policies do provide physiotherapy coverage. However, we always recommend that you contact your provider to determine whether or not you are covered and the amount which your provider will cover you for. Some insurance companies will allow us to bill them directly. However, we do have specific guidelines which must be followed in order to do so. Otherwise, you are billed directly and provided with a detailed statement for you to submit to your insurance provider for reimbursement. Most of our sites allow our clients 30 days to remit to their insurance company before our payment is expected.
Physiotherapy is not covered by OHIP at our sites.
If there are any concerns with funding, we encourage you to discuss this with your physiotherapist. Many conditions that we see are successfully treated in a timely cost-effective manner. In order to expedite a quick recovery, we always give home exercises with detailed instructions and pictures, in addition to resisted elastic band.
Pelvic physiotherapy provided exclusively by a Registered Physiotherapist and falls under the same as umbrella as physiotherapy.
How is Naturopathic Medicine Funded?
Like physiotherapy, many extended health care policies will provide coverage for Naturopathic Medicine. Please contact your provider for details. Payment for Naturopathic Services are due at the time of the service with your provider.
How is Osteopathy and other Robin’s Nest Family Care Services Funded?
In many cases osteopathy is covered by extended health care policies. Please contact your provider for details. Payment for Naturopathic Services are due at the time of the service with your provider.
Do you treat Workplace Safety and Insurance Board Injuries (WSIB)?
Yes, we do accept PHYSIOTHERAPY clients. Clients seen through WSIB have access to the same services as all of other clients. We will assist you in gathering the necessary information for a successful WSIB claim, reducing any chance of out-of-pocket expenses as a result of an unapproved claim. We will work closely with your employer and doctor so that you can have a successful and safe return to work. Please notify our administration upon booking that you are being funded through WSIB, and ensure that you have reported the work-related injury to your employer.
Unfortunately, at this time we are not able to provide services under ND or Osteopathic Medicine through the above providers.
Do I need a doctor’s referral for Physiotherapy?
No. Physiotherapists are considered Primary Health Care Providers, meaning Physiotherapist have the expertise to assess patients directly. However, if you have extended health insurance through your workplace it may require you to have a doctor’s referral for reimbursement of physiotherapy services. You may check by simply calling your extended health insurance or your employer. We always encourage our patients to involve as many as their providers in their treatment plans. With your permission, we will include your doctor and utilize them for any follow up procedures/tests when necessary.
I received a doctor’s referral for another Physiotherapy clinic. Can I still come to GWHA?
Yes, you can! As a client, you can choose your physiotherapy provider. We offer convenient locations, early morning and evening hours and a skilled group of Physiotherapists who are leaders in their profession. You can be assured that our focus is on you as a client. We have a very large group of physicians that refer to our clinics, but our biggest and most valuable referral source is our returning patients and word of mouth.
Unfortunately, there is a growing number of physiotherapy clinics owned by lawyers, physicians and other non-physiotherapists. If you are being sent to a new unfamiliar clinic, feel free to ask why. Ensure that there is not a conflict of interest with your referral and always ensure that your care is being provided by a Registered Physiotherapist.