Two disciplines, occupational and physical therapy (OT / PT), offer unique treatment experiences for patients who may be interested in pelvic health services. For patients who have had therapy in the past for other ailments, they might have an idea of what and how PT and OT disciplines differ. Despite these differences, there are also many ways in which the disciplines complement one another.

Many people are familiar with physical therapy. Fewer are familiar with occupational therapy. Occupational Therapy was founded post-WWI when soldiers came back from war and resumed normalcy, but also had difficulty re-entering society due to trauma, either physical or mental. Since then, the OT discipline has grown to identify meaningful occupations in a patient’s life. The role of an OT can vary greatly depending on the setting. In the hospital, this might be instructing in bathing, showering and dressing techniques to simplify life. In an outpatient setting, this may be regaining arm movements and strength to dress, shower, perform toileting or carrying a baby. In pediatrics, this might be preparing handwriting for school or play. In an out-patient pelvic health setting, this might look like a return to intimacy (whatever that means to the patient), being able to void and have regular bowel movements on a toilet, or managing pelvic pain that is affecting the ability to exercise or go to work or school.

In the outpatient pelvic health setting, occupational therapists can focus on the relaxation phase, or what we call ‘down-regulation’ of the nervous system to allow the body to feel comfortable and relaxed to enhance further learning. Once we establish this rapport with a patient and build an environment of relaxation, we can progress to the next and somewhat more invasive techniques which may include internal and external manual therapy, similar to a pelvic floor physical therapist’s treatment.

Physical therapists are trained a bit differently, as they tend to focus more on the physical aspect of the body rather than the emotional, mental or spiritual. This is not to say that physical therapists do not focus on these other areas, but their training does not require this specialization like OT training does. Therefore, an appointment with a physical therapist may look a little differently and be more focused on
the physical aspect of the visit.

Together, occupational and physical therapists work to address the biological and psychosocial components of what makes the patient a person. Co-treatment can be utilized to allow for maximal healing. This means that a patient could be seen by two therapists in the practice, both addressing separate areas of the body, but with the same goal in mind; to improve a patient’s symptoms. The end result is a minimization of symptoms with a return to participation in the daily activities that give a patient’s life meaning.

Phoenix Physical Therapy strives to be a welcoming, safe, respectful place for all, our patients and staff.  Pelvic health is an important component of overall well-being and can be especially challenging for individuals in the transgender and gender diverse community. Gender affirming practices and surgeries can have significant impact on the pelvic floor muscles, the muscles that assist in pelvic stability, sexual activity, and control of bowel and bladder function. In addition to the conditions outlined on our website, transgender and gender diverse individuals may experience unique pelvic health concerns such as:

• Dilation for neo-vaginoplasties
• Wound and scar tissue management
• Changes in toileting practices
• Tissue changes secondary to hormone treatment
• Side effects related to tucking or binding including pelvic pain, back pain, chest pain, poor posture, shoulder pain, numbness, and scarring
• Development of UTIs related to changes in urinary patterns or positions

Phoenix Physical Therapy can assist with addressing these complications because we understand the complex ways in which the many systems of the body work together to provide optimal pelvic function.  We specialize in treatment aimed at improving pelvic floor muscle control, awareness of optimal pelvic function, and pain commonly associated with pelvic floor dysfunction.  

What should you expect from your first visit?

We will first discuss your history and concerns, review your intake forms, and answer any questions you may have regarding your symptoms. Next, we will educate you on the function of the pelvic floor muscles and how/why they are related to your symptoms. Every portion of the exam will be thoroughly explained to you, and you will have an opportunity to ask questions.  Most importantly, you have the option to choose or refuse any part of the process with which you do not feel comfortable.

Plan of care:

With your therapist, you will determine a plan of care that supports your goals and moves forward at a pace that is comfortable and practical for you. Progress will be reviewed at every visit to answer questions and promote a relationship based on trust and mutual understanding, as well as to collect feedback on what is working best for you and your body. Treatment throughout your plan of care may include strengthening, stretching, techniques for increasing pelvic floor muscle control and awareness, as well as manual therapies. As with the initial examination, we will proceed only with patient understanding, comfort, and consent.

We recognize that transgender and gender diverse individuals have limited access to quality and inclusive care, and we at Phoenix are here to support you. Contact us with any questions and a skilled physical therapist will be happy to assist you!

Precautions to take if you are receiving physical therapy at Phoenix PT

In an abundance of caution and with the desire to keep patients, families and staff safe during the pandemic, Phoenix Physical Therapy has the following recommendations/requirements in place in keeping with current Vermont state mandates:

1. Thanksgiving has always been an important time for families to come together in celebration. This year, gatherings will look slightly different. Please avoid gathering with others outside your immediate household, opting to experience a virtual dinner with others instead.
2. If you have children returning home for the holidays or family/friends who otherwise reside elsewhere (such as college), they must quarantine per state regulations (see details below) prior to you having an in-person appointment at Phoenix PT. 
3. Both during and after the holiday season, we require that any patient that has been exposed to individuals that may fall under travel restrictions (family or otherwise) utilize telehealth appointments for 2 weeks following initial exposure to these individuals. This includes exposure to anyone who was in your home who does not live there daily and who had not previously quarantined according to Vermont guidelines. Telehealth visits allow us to provide ongoing care and support for your health needs while lowering risks to other patients and clinicians.
4. If a family member is tested a few days before returning home, it does not mean they are risk free from covid once they arrive home.  A quarantine still needs to occur at home per state health regulations until new test results are received, in order to ensure safety to all involved.
5. Getting tested for Covid after seven days being symptom free and receiving a negative test result would allow patients to return to this office prior to the 14 day requirement. However you must remain in quarantine until you receive your test result.
6. Telehealth visits at Phoenix PT are highly recommended the week of Thanksgiving and the week after as well as throughout the holidays and beyond.    If you have ‘self quarantined’ at home for a minimum of 7 days after your guests or family have left and you have a negative COVID test, you are able to attend treatment in person.  Please remember, this is in place to protect you, other patients and all staff at Phoenix PT.

Vermont State Department Covid-19 Guidelines:

Vermonters are pleased and proud to welcome visitors, but during the pandemic there is guidance you must follow if you decide to come to Vermont. Do not travel to Vermont if you are sick. 

What to Know About Quarantine:

People who are coming to Vermont from many out-of-state locations will need to quarantine for fourteen (14) days. Quarantine helps prevent the spread of disease before a person knows they are sick or if they are infected with the virus and don’t have symptoms.

Quarantine means staying at a home or dwelling before doing any activities outside of the home, like grocery shopping or getting together with friends or family. People in quarantine should separate themselves from others and check themselves for symptoms. Learn more about quarantine and see tips about quarantining when you share a home. We strongly encourage anyone in quarantine to sign up for daily symptom check reminders. If you are a college student coming home to Vermont for a break or holiday, you must quarantine for 14 days, once you arrive. If you have not had any symptoms of COVID-19, the quarantine period may be shortened by having a test on or after day 7 of quarantine, though you must continue to quarantine until you receive a negative test result.

Phoenix Physical Therapy, PLC is pleased to welcome our newest staff member, Catherine Bergeron-Radoux. Catherine received her Doctor of Physical Therapy (DPT) degree from UVM and her undergraduate degree in Business Administration also from UVM. She is thrilled to join our staff finding fulfillment in helping patients with pelvic muscle dysfunction.

Catherine began her journey in health and wellness as a personal trainer and yoga instructor using strengthening and relaxation methods that were accessible, and empowering to her clients and students. She believes that wellness is a right, and that bodies of all shapes and sizes can achieve lifelong health with the right support and tools. Pelvic health was a natural fit for her as she understood the important connection between mindfulness and body function, mental health and physical wellbeing. She hopes to empower all her patients to be their own strongest advocate and to gain a better knowledge and understanding of their bodies for optimal function.

In addition to her love of healthcare and well being, Catherine enjoys cooking, baking, and gardening. She enjoys making beautiful flower arrangements from her blossoms. Additionally her favorite pass time of all is rock climbing throughout New England and the Adirondacks. She and her fiancé have two dogs. Catherine is fluent in French and has a great sense of humor.

Phoenix Physical Therapy, PLC would like to share a blog post with you that is not only well written, but gets to the point that all pelvic floor conditions and treatments should not be categorized as the same!  The author, Angela Law, has interviewed numerous medical physicians who are experts in the field of pelvic floor muscle dysfunction.  She offers great information that will prove useful to those of you who suspect or have been told you have a tense/high tone muscle. 

I urge you to take a few minutes and read this article from POPSUGAR. The information is well represented and concise.   You can view the article here: https://www.popsugar.com/fitness/symptoms-tight-overactive-pelvic-floor-muscles-47577094

POPSUGAR, the source for this blog post from June 28, 2020 is an American media and technology company that is parent to the media property POPSUGAR. Phoenix Physical Therapy, PLC is a pelvic floor physical therapy practice well known for treating all pelvic floor issues in all genders and ages.  

With Governor Phil Scott’s ‘continual and gradual turning of the spigot’, he is now allowing healthcare providers in private practices to resume treatments!  This is great news for the staff at Phoenix Physical Therapy as we are anxious to return to the work we love and to helping people like you over come the symptoms which led you to our practice in the first place. 

So what does this re-opening mean to you? 

• Employees, patients and necessary companions (no more than one person accompanying patient please and only if absolutely necessary) are required to wear a face mask.  Bring your own mask.  We only have enough Personal Protective Equipment to protect our staff and we will send patients away if not wearing required masks.

• We ask that all employees and patients that exhibit a fever, cough, or shortness of breath to not come to the office.  A sign on the outside door reflects this:  DO NOT ENTER If you suspect you have a fever .  You  will be refused entry and sent home with a plan for follow up to a physician for testing and a plan to reschedule an appointment with Phoenix PT.  If you have encountered someone you know that has traveled out of state or knows to have been exposed to someone else with COVID-19, you will be asked to reschedule your appointment after self-quarantining for two weeks.  All of these measures are to help keep everyone safe and protected against this virus!  Our staff does their temperature checks daily upon arrival to the office. 

• We are sanitizing our treatment rooms before and after each patient.  You will not be allowed to wait in the waiting room but will go to your treatment room as soon as your temperature is taken.  This will only occur after you have sanitized your hands with the sanitizer located within the hallway entering the office. 

• We have one waiting room chair, designed for those who cannot stand for more than a minute or two.  Please save that chair for someone in need.  You  will be taken quickly to your treatment rooms after your temperatures is taken.  We designed this plan to ensure social distancing.

• Hand sanitizer is essential to anyone entering the office.  Please look for the station just inside our entry door. 

• Your therapist will have hand sanitizer available for your use during your treatment, if requested, in addition to what is available outside the treatment areas.

• We have clearly displayed signage emphasizing social restrictions on distancing, coughing/sneezing etiquette, wearing masks and hand hygiene in all common areas, treatment rooms and bathrooms. 

• We disinfect all treatment rooms and common areas three times a day as well as after every treatment.  We are using FDA approved hydrogen peroxide wipes for cleaning and have the option to supplement with alcohol wipes or Chlorox wipes.  We disinfect the bathrooms frequently and as you will note there are signs in the restrooms indicating proper hygiene to flush the toilet.  Sink faucets, towel dispensers and trash cans are automatic.  Kick the base of the trash can to open the lid and wave your hand in front of the paper towel dispenser to activate. 

We understand your hesitancy while being able to resume important medical care and we are happy to answer any questions you may have.  We are here to be of assistance to you to achieve your goals and eliminate your symptoms.  REST ASSURED WE ARE TAKING EVERY MEASURE WE CAN TO KEEP STAFF AND PATIENTS SAFE AND HEALTHY.   YOU MAY ALSO CHOOSE TO MEET YOUR THERAPIST OVER TELEMEDICINE.  PLEASE LET THE KNOW THAT IS OF INTEREST TO YOU.

Let’s all work together to get through this pandemic – working as one makes us stronger!

On March 18, 2019, Phoenix Physical Therapy welcomed Shanna Duffy to their staff of therapists specializing in pelvic floor therapy.

Born and raised in Vermont, Shanna attended UVM’s College of Agriculture and Life Sciences, receiving her undergraduate degree from the Department of Nutrition and Food Sciences. She then received her Doctorate in Physical Therapy from the College of Nursing and Health Sciences in 2016. While earning her Doctoral degree, Shanna worked at clinics on opposite sides of the USA, Boston MA and San Diego, CA. After becoming a licensed PT, Shanna provided physical therapy in a home care environment in NH and VT and more recently worked in an outpatient hospital setting in New Hampshire.

Shanna has been fortunate to treat patients with a wide range of conditions such as acute and chronic pain, joint pain, post-surgical repairs, musculoskeletal disorders, balance impairments, gait impairments, and work and sports-related injuries.

She became fascinated with treating pelvic floor dysfunction in 2014 when Phoenix owner Jane Kaufman was a guest lecturer at UVM during Shanna’s graduate school program. With two years of clinical experience behind her, Shanna was prepared and excited to pursue her passion for pelvic floor PT.  “As a native Vermonter I wanted to try working and living in other areas before making any job decisions when I graduated from Physical Therapy school at UVM. I chose to have my student internships in California, Massachusetts, New Hampshire and Vermont. I had plans to move to those bigger states, but what I found was my favorite clinical experience was actually in Milton, Vermont and the reason was I loved connecting with my Vermont patients the most. It was extra special for me to help fellow Vermonters get back to what they loved doing, whether that was running a marathon or going back to doing farm work. Working for Jane was on my dream job list, since hearing her speak during one of my classes in graduate school at UVM. I can say working at Phoenix PT is everything and more than I imagined. It feels like home for me and most importantly our patients.”

Shanna enjoys getting to know patients and creating individualized treatment plans to ensure the most successful outcomes, using a combination of a holistic approach and evidence-based practice.

When not at the clinic, Shanna enjoys being physically active in the outdoors, eating out, spending time with friends, family and her tabby cat Xena, the “Warrior Princess”.

Everyone experiences constipation, sometime! Maybe it was on vacation and you felt bloated and miserable; or when you were busy at work and had to rush to complete a task. In any event, you felt ‘awful’. Maybe you couldn’t zip your favorite jeans due to abdominal bloating, maybe you experienced lower abdominal discomfort or experienced a painful ‘movement’ once you went. There are many people who experience these symptoms and more on a daily basis. When someone finally gets the courage to see a specialist about this problem, they might be diagnosed with ‘pelvic floor dyssynergia’ or ‘muscle incoordination’.

Pelvic muscle dyssysnergia (incoordination) refers to the action that occurs in the pelvic floor musculature at the time of defecation. It can become a withholding pattern and in the case of vacation or a change in your work schedule, it can simply be tensing the muscle to avoid the bowel movement (due to inconvenience) rather than heeding the ‘call’. Over time, if this behavior is repeated, it becomes muscle memory; instead of relaxing the pelvic muscle to defecate, the patient tenses the muscle; thus the term dyssynergia or incoordination.

The function of the pelvic floor for bowel function is to provide closure of the anal canal to maintain continence. The muscle should signal the rectum and the colon when to defecate and should provide opening of the anal canal by total relaxation to allow for complete and effortless elimination. A dyssynergic pattern shuts the opening of the canal by tensing the muscle to prevent elimination. Thus an incoordination.

The research by Heymen, Scarlett, Ringman, Drossman et al entitled “Randomized, Controlled Trial Shows Biofeedback to Be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-Type Constipation” supports the value of biofeedback in the treatment of this withholding pattern associated with stool elimination. This study supports the benefit of biofeedback treatments using sensors to provide the feedback displayed on a computer screen for visualization. This study goes on to say, “We also have shown that the machines are necessary—instrumented biofeedback is an essential element of successful training; however, there is a shortage of practitioners who are trained to provide this form of biofeedback, and there are few clinics where biofeedback instruments are available and where this form of biofeedback can be obtained”.

Biofeedback provides visual and auditory feedback of muscle tension, It is a non-invasive technique that allows patients to adjust muscle function, strength, and behaviors to improve pelvic floor function. The small electrical signal (EMG) provides information about an unconscious process and is presented visually on a computer screen, giving the patient immediate knowledge of muscle function, enabling the patient to learn how to alter the physiological process through verbal and visual cues. This mechanism allows the patient to assess muscle resting tone, creating an environment that teaches how to downtrain a tense pelvic floor while providing the means to teach coordination of muscle function.

In short, biofeedback treatment/training using the proper instrumentation provides the precise information necessary to change behaviors associated with tensing the pelvic floor for defecation instead of the proper relaxation of the pelvic floor for release of stool from the anal canal.

Re-training the pelvic floor muscle is what Phoenix Physical Therapy is all about; treating patients with pelvic floor muscle dysfunction is the sole focus of our staff of highly skilled pelvic floor therapists. Whether treating patients for constipation, or bowel or urinary incontinence or pelvic pain, Phoenix is recognized and acclaimed locally, regionally, and even nationally for our compassionate and successful treatment of pelvic floor challenges for patients from young children to the elderly.