The treatment of disease, injury, or deformity by physical methods such as massage, heat treatment, and exercise rather than by drugs or surgery.

A provider referral is not mandatory. However, most health plans require a referral to be eligible for insurance.

What is pelvic floor physical therapy?

Pelvic floor PTs specialize in treatment of orthopedic and pelvic pain, pregnancy/postpartum related aches and issues, and pelvic floor disorders impacting bowel, bladder and sexual function. 

How long are appointments?

At Piedmont HealthCare Physical Therapy we have 45 to 60 minute evaluations and private treatment sessions. We ask that you arrive 30 min early to your first appointment to complete registration paperwork.  

What should I wear to my appointment?

Please wear comfortable clothing to your appointment. We typically assess your movement, posture, strength and flexibility.  

Can I bring someone along with me to my appointment?

Yes, you are welcome to bring a supportive friend, loved one, or even a new baby to your appointment. 

What can I expect to happen at my initial visit?

We will review your medical history and concerns. There are no silly questions or embarrassing points to share. Your discussion is confidential and we want you to share as openly as comfortable on day one. We will ask questions regarding your symptoms, spend time reviewing pelvic anatomy and discuss our exam of the pelvic floor. Each part of the exam is optional and you provide consent prior to any assessment.  

Should I reschedule my exam if I am menstruating?

It is not necessary to reschedule if you are on your menstrual cycle. If you are not comfortable with a pelvic exam during menstruation we can always change the direction of our session to work outside the pelvic cavity while continuing to progress toward your goals.  

Will the therapist complete a pelvic exam at the first appointment?

It depends. Our team at Piedmont Healthcare Physical Therapy has extensive experience in orthopedics and this is important. Your pelvic floor does not float in space and it is important for us to look at the surrounding structures to gain perspective of the big picture.  We will often look at your posture, watch you move, test your strength and look at your abdomen. Depending on your symptoms and your comfort level we will examine your pelvic floor muscles.  

Remember that you are in control of the session the entire time and we will work with you, at your pace, to achieve your goals.

THE LYMPHATIC SYSTEM

The lymphatic system is part of our immune system, aiding our body to remove and destroy waste, debris, dead blood cells, pathogens (like bacteria and viruses), toxins and cancer cells. It also removes excess fluid from the spaces between the cells of the body’s’ tissue.

The lymphatic system absorbs fats and fat-soluble vitamins & large proteins from the digestive system and delivers these nutrients to the cells of the body where they are used by the cells.

Lymph fluid is a clear or whitish liquid that flows throughout the body through lymphatic vessels. The flow is unidirectional, always toward the neck. The fluid is filtered through lymph nodes where harmful materials are removed and appropriate cells are stimulated to attack foreign invaders. Excess fluid from the lymphatic system is then returned to the circulatory system.

Lymph nodes, mentioned above, are the filters and can be found throughout the body with large clusters located in the axillae (armpits), groin and head/neck. There are typically 600-700 lymph nodes present in the average human body.

WHAT IS LYMPHEDEMA?

Lymphedema is swelling of a body part that occurs when the lymph system doesn’t function properly. This swelling typically occurs in an arm or leg but can occur anywhere including the face, neck, trunk, chest wall & genitals.

There are two types of lymphedema. Primary lymphedema is typically the result of a malformation of the system. Often, this is congenital (from birth). In this case, the swelling may be immediately observed, but may not appear or be diagnosed until around the time of puberty. Secondary lymphedema is a result of any other type of damage to the lymphatic system including but not necessarily limited to: cancer and its related treatments, trauma, orthopedic surgeries, blood clots, longstanding circulatory insufficiency and obesity.

SYMPTOMS OF LYMPHEDEMA

TREATMENT

There is presently no cure for lymphedema as the lymphatic system is unable to repair itself or regenerate once removed or damaged. There are four primary “puzzle pieces” that MUST be utilized for effective long-term treatment.

**Once the swelling is deemed to be under the best control, recommendations will be made for long term daytime, and possibly night time compression garments to maintain the reduction achieved. This could include ready-made garments or may require fitting for custom made garments.

FREQUENTLY ASKED QUESTIONS

Is there a cure for lymphedema?

There is presently no cure for lymphedema and it is a progressive condition if not treated and maintained through the use of the above “puzzle pieces”. While lymphedema is not fatal, it does place sufferers at higher risk for recurrent infection and other related conditions. Early treatment is the key to health!

Is there any medication that will decrease swelling or make it go away?

This condition has no long-term benefits from medication. Initially, a water pill, or diuretic, will reduce the fluid but the protein that remains in the lymphatic system will always pull fluid back into the area and the swelling will return.

Will surgery decrease the swelling?

Surgery is not typically used for the treatment of lymphedema. There are specific instances when surgery is utilized by specialized practitioners to decrease the risk of lymphedema development, particularly in the setting of breast cancer.

Is there a certain diet that will help reduce the swelling?

If you are overweight, losing weight will certainly be of great benefit, however there is no specific diet that will target the reduction of swelling. (Further information found in the Nutrition handout.)

Do ACE bandages do the same thing as the lymphedema bandages?

No! ACE bandages are “long stretch” allowing increased stretch which can allow increased swelling. ACE bandages are utilized infrequently if the swelling is not a result of a problem with the lymphatic system.

Can I just get a compression garment and be done?

In some cases, a compression garment is all that needs to be done, however, compression garments are designed to contain swelling. They are not designed to reduce swelling. If there is swelling that could be reduced with comprehensive treatment (MCB, MLD, exercise), this is best practice.

Once the swelling is reduced do I still have to wear compression, exercise and perform MLD?

The primary long-term goal of lymphedema treatment is ALWAYS the development of a maintenance plan that you and your caregivers can follow DAILY! Your lymphedema therapist is the healthcare professional best equipped to help establish this plan so that your swelling will stay controlled. There is likely something that you will have to do on a daily basis to manage your lymphedema well. In this regard it is no different than managing any other chronic condition.

More questions??  Talk to your Certified Lymphedema Therapist!

Why did my provider send me for vestibular rehabilitation?

Vestibular Rehabilitation is utilized to treat a variety of disorders.  You will likely be referred for Vestibular Rehabilitation if you are dizzy, experiencing imbalance, disequilibrium, stroke, concussion or have had an illness related to your brain or inner ear.  

What should I expect during the initial evaluation?

Your evaluation will take about one hour and will vary greatly based in your symptoms and diagnosis.  The Physical Therapist will work one-on-one with you to discuss your symptoms and problems.  Throughout the interview process, your evaluation with be personalized to be able to determine a diagnosis and treatment plan.  The evaluation with consistent of some eye and visual testing, balance testing, coordination testing and observing gait and mobility.  Specialized positional testing may be utilized if positional vertigo (BPPV) is suspected.  Treatment will likely be initiated on your first visit and you may be expected to complete some home exercises.  You will work closely with your Physical Therapist to create a plan that will work for you and your schedule.

Should a family member or friend bring me to the appointment? Will I be dizzy afterward?

If you are dizzy all the time, it is certainly not recommended you drive. If one of your symptoms is room spinning dizziness, it is recommended to have someone drive you to and from your appointment for your comfort, but this is not completely necessary if you need to drive yourself. You will likely leave your appointment feeling better than when you arrived.  

How long will I have to come to vestibular rehabilitation?

We schedule one-on-one visits for one hour each session.  The duration of your care varies based on diagnosis, participation with home exercises, prognosis and progress while under our care.  Typically, Physical Therapy treatment cycles last from 3-6 weeks.  This plan will be discussed and agreed upon between you and your Physical Therapist.

Dry Needling: What is it?

Dry needling is a safe, effective treatment technique physical therapist (certified in the procedure) use to treat pain and movement impairments.  The physical therapist inserts a “dry” thin monofilament needle, one without medication or injection, into a trigger point within a tight muscle.  

Dry Needling vs. Acupuncture:

Dry needling is not acupuncture, it uses similar tools, but that is where the similarities end.  Dry needling is based on modern Western medicine and evaluation of pain patterns, posture, movement impairments, function and orthopedic testing, and is supported by research.  Acupuncture is based on traditional Chinese medicine, and restoring proper energy flow through the body.  Dry needling treats muscle tissue, and its goal is to reduce pain, inactivate trigger points and restore function.

What is a trigger point?

A trigger point is a local contracture of tight muscle fibers that disrupt function, restrict range of motion, refer pain, or cause local tenderness.  

What can Dry needling be used for?

Dry needling can be used for a wide range of musculoskeletal issues (shoulder, neck, back, hip pain), and research indicates that it is a safe and effective approach for treating and managing pain.  

Will my insurance cover Dry Needling?

Some insurances do cover dry needling, but some may not reimburse for the procedure.  You may want to contact your insurance company to determine if your individual plan covers the service, but you may elect to pay an out-of-pocket fee to receive dry needling.  

What are the benefits of dry needling?

What are the cons or complications of dry needling?

How long does the procedure take?

Research varies on the time frame of needle insertion; however, plan for it to take 15-30 minutes as part of your treatment session.  Dry needling will be used in conjunction with other physical therapy treatment techniques in order to help meet your individualized needs.  

What are the benefits of Dry Needling with E-stim?

Dry Needling is effective on its own, but the addition of E-stim helps to expand the needles effect on the muscle, by stimulating blood flow and increasing analgesic effects of the pain.

You will be evaluated for mandibular (jaw) movement, and strength.  We will look at your functional issues during your day and possibly night. Posture and habits will be assessed and discussed.

A cervical spine (neck) screen is done for any motion and dysfunction that may arise in this part of the body. The neck and facial muscles are interdependent.  Any problems with the upper quadrant (head, neck, shoulders) will be addressed with your evaluation.

Typically exercises are given along with written instruction for habits to avoid, and foods to at least temporarily avoid.

The goal with physical therapy is to help you to become more aware of poor postures and habits which could impact the TMJ’s, along with treating the imbalances and dysfunctions that you may have with the muscles and joints.  Typically, this will decrease pain and improve movement patterns.

Independence with the home exercises and self-care is imperative.