Every patient receives Lizanne’s personal attention with hands-on therapy, expert advice, and education. Treatment programs include continual reassessment, resulting in a unique session that is perfect for you alone. This summary of services is just a guide to some of the more common techniques employed at Sonoma Pelvic. As of March 2019, we have been offering Telehealth services too; you'd be amazed at how creative we can get over a Telehealth platform!
Passive joint mobilization is an integral part of manual therapy. It is used when there is stiffness, pain, or lack of function in a joint. Frequently, after a joint is passively moved by a therapist, the individual experiences less pain, more active movement, and increased function. When joints are free, it helps the surrounding muscles relax and it helps align that region of the body, thus allowing one to heal more quickly. For example, after an auto accident, the injured person might have a very stiff neck. After a thorough assessment, it might be appropriate to gently traction or move the neck bones to allow more range of motion and decrease the neck stiffness and pain. Any joint in the body may be mobilized.
Nerve mobilization is a fancy way of saying moving or stretching a nerve. Nerves can experience tension, just like muscles. But unlike muscles, nerves are more fragile and need to be mobilized very carefully, and only after a sound assessment. People with certain kinds of repetitive stress injuries or sciatica often benefit from good nerve mobilization in addition to other kinds of manual therapy.
Myofascial release, deep tissue work, cross friction massage, scar tissue massage are just a few types of soft tissue mobilization. Almost everyone benefits from some form of soft tissue work. Muscles often spasm and contract during trauma or in response to insidious injury or poor posture. It is important to get them worked out and to follow through with good stretching.
There are good and not-so-good ways to work with tendons and ligaments. They require certain types of therapy. Tendon injuries, if severe, can take up to 12 months to heal! Tendons also need certain progressive exercises to build themselves up after injury. It is important that clients understand the nature of their injuries so that they don’t re-injure a weakened structure.
At some point, everyone has either stretched or done some kind of physical strengthening exercise. After one’s pain is under control, an individualized home program becomes a way to self-manage one’s own injury. Frequently, stretches and strength exercises are provided. A word on "stretching." Technically, stretching is a type of "inhibition," ie: neural inhibition. When we stretch or "lengthen" a muscle, we are "inhibiting" or slowing down the neural input into that muscle. There are many ways to inhibit an overactive muscle, but we like our patients to understand what they are accomplishing when doing something, stretching is not just a "biomechanical" process. "Stretching" a tight structure takes a long time, but there are tricks to inhibit an overactive muscle or even an overactive system that can be instantaneous! It's all about understanding the nervous system.
Functional skill training encompasses many things. It might mean working with an individual’s gait, one’s posture at work, or one’s ability to bend and lift correctly. Frequently there is a need to return to work or sports, and a regular strength program isn’t enough. It becomes important to retrain an individual very specifically for certain tasks.
Not only is it vital to regain strength, flexibility and movement after injury or illness. It is equally important to regain the subtleties of movement. Neuromuscular re-education implies a way of teaching an individual to fire the right number of neurons at the right time for the correct duration of time. It’s tricky business getting the timing, balance, and strength all coordinated. We use balance exercises, like on a ball or roller. We can also perform special exercises that train us to re-think the way we move. Sensory awareness and movement awareness techniques help with this too.
Cranio-sacral therapy is a way of working with the fluid system, which surrounds our nervous system. It is an extremely gentle and calming hands-on technique. It is often beneficial for those who can’t tolerate much touch, for example immediately after a trauma, or for those in severe pain. It is also great for clearing areas of swelling. It has a somewhat mobilizing effect on the nerves and connective tissue.
"The Arvigo Techniques of Maya Abdominal Therapy TM (ATMAT) for the reproductive and digestive systems is an external, noninvasive, manipulation using only the hands to reposition reproductive organs and improve blood flow to digestive organs." (from The Arvigo Techniques of Maya Abdominal Therapy Professional Care, level 2 Manual Sixth ed. p. 19)
This gentle, yet powerful modality is used to enhance other techniques used for a variety of issues, including pelvic organ prolapse, constipation, reflux, pelvic pain and other colorectal and urogenital problems. Patients learn how to perform their own self-care using these techniques. For more information see https://arvigotherapy.com
Awareness training is just what it sounds like. It is a way of helping a person become more in tune with his/her physical and/or emotional sensations. Sometimes, after trauma or after being in pain for a long time, we learn to block out certain sensations or feelings. Sometimes, there are “negative” feelings like anger or resentment that are held in the body and we experience these “feelings” as bodily pain. Or, we can lose awareness of our actual bodily postures. For example, a woman who works on a computer all day may have no idea that she is sitting in a dangerous posture, which is a major factor of her neck and arm pain. There are myriad exercises and ways of working with people to increase their body awareness.
Frequently when we understand the etiology and physiology of our pain, we experience less of it. So PNE (pain neuroscience education) simply means explaining pain. There is excellent research proving that decreasing our fear around pain, understanding how our beliefs alter our pain, and just basically having a better awareness of how pain works, all help reduce pain! For those individuals with severe, chronic pain, it is important to live as normally as possible. Usually, for these people, it is unlikely that actual damage occurs in the old painful areas with normal activity. Yet, often we modify our behavior and develop patterns of movement, postures, and belief systems that only feed into the pain. In some instances, it is possible to re-train the brain to decrease one’s experience of pain. This becomes the core feature in creating functional goals to manage pain and loss of function resulting in improved quality of life.
A more appropriate term for this therapeutic approach would be “visceral fascial mobilization.” This hands-on technique is a form of myofascial release, but instead of working on muscle we target the fascia, ligaments, and connective tissue that surround our ‘viscera,’ or organs. For example, in people with chronic psoas tightness I might check the kidneys, sigmoid, and cecum—their fascia lies along or near the psoas muscles.
Fascia is rich in nerves and often responds to a type of touch that engages with those nerves or the broader nervous system. We do this by accurately assessing the direction of the restriction and working with it, rarely against it. By engaging with the person’s own restrictions (as opposed to fighting against them, say with deep tissue massage or cross friction massage) the practitioner encourages the patient’s inherent self-correcting systems to assist in the release work, and the effects can be quite long-lasting. Visceral mobilization is usually performed as an external technique, although there are internal techniques for the urogenital region. Patients may experience a range of palpation from very light to quite deep, but the techniques themselves are usually subtle and comfortable.
Biofeedback is a process of gaining improved awareness over a body part or bodily function. Often equipment is used to help us achieve this improved sensation—think about electrodes attached to the head monitoring muscle tension in the treatment of migraines for example. But biofeedback can be as simple as touching the body part we want to stimulate to bring more attention to it.
For my patients with pelvic floor issues I use biofeedback both for up-training—to improve motor control, and down-training—to calm & reduce muscle tone and ease pain. There is a great deal of evidence supporting its use with pelvic floor dysfunction. I use a Pathway dual channel MR-20 biofeedback unit that connects to my computer so that we have a large, colorful visual of what your pelvic muscles are doing in real time. I enhance this with guided imagery and visualization techniques as well as manual therapy.
Electrical stimulation, or E. Stim, or NMES (neuromuscular electrical stimulation,) is the process of using electrical currents to affect/stimulate different types of nerve endings to treat a variety of neuromuscular problems. In my practice, I use E. Stim for Stress Incontinence, Urge Incontinence, and Mixed Incontinence. It can also be used to treat pelvic pain. We use internally placed vaginal and rectal electrodes. The sensation ranges from subtle to more strong pulsations that the patient controls herself.
After pelvic pain, bowel and bladder "dysfunction" (gosh, I hate that word) is probably the most typical thing a patient seeks help from a pelvic floor PT. We see all kinds of urinary and fecal incontinence, urinary urgency & frequency, overactive bladder, bladder retention and difficulty evacuating the bladder, and serious bladder pathology from disease or cancer, and much more. Bowel "dysfunction" also has many forms from loss of stool to severe constipation and retention. Bladder and bowel retraining simply implies teaching strategies to improve your urinary and bowel habits, and might include beneficial toilet postures, (yup, sitting properly to evacuate can really help,) diet/nutrition counseling, education on laxatives and bladder irritants, bowel and bladder urge suppression techniques if urge is too strong-or-techniques to help you increase your ability to feel urge if urge is too weak. We have tricks. Lots of tricks to help you pee and poop more normally.
A word about Home Exercise Programs. If you’ve been to PT before, you’ve no doubt been given a home exercise program (HEP). Often it’s a cornerstone of therapy—a way to encourage a patient’s active participation. Often I’ll hear my patients say, “I saw a PT and all she did was give me a HEP. She never even touched my back!”
First, I always work manually, except in rare situations when it isn’t indicated. Research overwhelmingly supports the use of manual therapy for almost every musculo-skeletal condition there is!
Second, my HEP’s are extremely individualized and are often an extension of what the treatment has been. They are an active and dynamic thing—not a once-given and forgotten-about thing. I often make things up on the spot to try to replicate what I’ve just done with a patient. My HEP includes do’s and dont’s. It might include “rescue poses” for my pain patients—positions or postures you can try if you have a painful flare. It might include breathing exercises for calming the nervous system. It includes multiple ways of doing a particular stretch, so you can do it at home or at your desk at work. I modify things often, change things that don’t work, simplify things if you just don’t do it, advance things if you are motivated and work hard.
My goal for your participation is for you to be well as soon as possible and for you to realize how much control you have over your own healing journey. As much as I LOVE to see you each week, I want you to find your own way as soon as possible!