Question 1

What is pelvic floor physical therapy?

Accepted Answer

Pelvic floor physical therapy is a subspecialty of the physical therapy field that addresses problems primarily located in or around the pelvis, including urinary and fecal incontinence (leaking), pain with intercourse or activity, constipation, urinary retention, etc. While focus tends to shift towards the muscles and ligaments surrounding the pelvis and pelvic floor musculature, good pelvic floor physical therapy tries to address the entire body and the root cause of dysfunction. This can include looking at core stability and back pain, foot/ankle stability, how you move with certain tasks, etc. We humans with a pelvis, and should not be seen as "just a pelvis" through the lens of a practitioner.

Question 2

Why don't you take insurance?

Accepted Answer

Insurance in the United States.... leaves a few things to be desired. I, like many healthcare professionals, have found that insurance-based practice can be very restricting on time spent with people, treatments allowed, and is very limiting for patient-centered care. For instance, one private visit with me through Great Lakes Pelvic Rehab can cover about the same amount of information and treatment that I cover in THREE typical visits in the clinic under the insurance-based system.

Additionally, for many people, when their deductible has not been met, clinic care can cost up to $400-500 per 45 minute visit! In this case, going to a cash-based clinic can be more affordable. Working out of network allows me to spend as much time with you 1:1 as needed, allowing me to hear your whole story, spend a thorough amount of time with the evaluation, and creating a plan of care that is specific to YOU, and not think about which codes an insurance plan may or may not pay for.  You will never be passed off to a tech or left alone on exercise equipment. 
 
If you have an HSA, or an insurance plan with out-of-network benefits, you may be able to be reimbursed for cash-based physical therapy services.  If you would like, I can provide a list of services rendered that could be reimbursed depending on your insurance plan. Just remind me when we have our appointments =)

Question 3

Do I need a referral?

Accepted Answer

Because this will be out of an insurance network, a referral is not required. However, it is in a patient's best interest to see a medical professional prior to therapy, as many pelvic conditions can be medical in nature, and more serious conditions would need to be ruled out prior to seeing a physical therapist. It is also beneficial to have a managing primary care provider with whom I may coordinate care with to manage your health as a team. Per the state of Michigan, I need to have an MD, DO, DNP sign off on my plan of care, and I will ask you to whom you would like me to send my notes.

Question 4

What does the first visit look like?

Accepted Answer

If able, I prefer to have our first appointment be a virtual teletherapy visit, on the computer or smartphone. This provides a flexible, relatively low-stress option to talk through your history, what symptoms you are having, and possible solutions to your problems. I believe we heal best and improve more quickly when we understand what is going on with our bodies, so I also like to use this time to talk through the anatomy and why there is dysfunction, as well as how physical therapy can improve this dysfunction.

Following the initial consultation, I prefer to do an in-person physical assessment. Physical examination may include general movement patterns like bending forward and backwards, observing how you move your body, and particular tests for muscles, joints, and nerves. If you are being seen for a pelvic-specific condition. an internal examination of the pelvic floor muscles may be performed (through the vaginal canal, or rectal canal if indicated), which would include me inserting a gloved, lubricated finger into a canal to feel for what the muscles are doing (are they too tight, too weak, lacking coordination, etc.). There is no speculum or aggressive manual palpation. You have the option to opt out of ANY part of examination or treatment with which you do not feel comfortable, internal or otherwise. The most important thing to understand is that you are always in control of the treatment session, and there is no one part of treatment that is vital to your progress, so I encourage open dialogue to let me know your comfort and your boundaries.

Question 5

Do you take Medicare?

Accepted Answer

Unfortunately, Medicare limits their beneficiaries from receiving services with providers that are not enrolled with them, even with the cash-based model.  At this time, I am not enrolled as a Medicare provider, and unable to see clients who have Medicare. I would be happy to refer you to local providers who take insurance.

Question 6

What about pregnancy and postpartum?

Accepted Answer

YES! If you have a question about if pelvic floor therapy would be helpful during your pregnancy or postpartum journey, the answer is probably yes.

Pregnancy: Pelvic floor therapy can be helpful for a number of issues during pregnancy, including but not limited to: pelvic girdle pain, lightning crotch, low back pain, hip pain, urinary leakage, constipation; prepping for labor/delivery.

Postpartum: This is my bread and butter! I love working on return to activities postpartum, so that you can parent at full strength =) Regardless of how you birthed your child, pelvic floor PT can help to address painful scar tissue (from perineal tearing or C-section), pain with intercourse, core weakness, abdominal separation (diastasis rectus abdomens), urinary leakage, constipation, stool leakage, anal fissures, etc.

Question 7

I am not sure if physical therapy will help my problem, what do I do?

Accepted Answer

If you have a pelvic problem, but are not sure where to start, I would be happy to have a complimentary talk with you to see if pelvic floor physical therapy is right for you. If it sounds like you may not benefit from physical therapy, I will gladly talk through some other resources that can help you to address your problem. Email me at alainavincedpt@gmail.com.

Question 8

If I am on my period, do I need to reschedule?

Accepted Answer

It is typically not necessary to reschedule your appointment, and we can adjust the treatment program for the day to meet your comfort needs.

Question 9

Do you work with men/people with penises?

Accepted Answer

At this time, I only work with people with penises on a case-by-case basis.  If you are someone with a penis who needs pelvic health, I am happy to make referrals as able!

Question 10

Do you do dry needling?

Accepted Answer

Yes! I am excited to have this skillset in my toolbox. I am able to dry needle abdominals, low back, pelvis, pelvic floor, and upper thigh. This can be very advantageous if you are having pain in any of these areas, or need a muscle to "wake up" to activate better. It can also be very beneficial for those with irritable bowel issues, urinary incontinence, or chronic pain. I would be happy to talk about how this may be a beneficial part of your care.

If dry needling is going to be a part of your typical treatment session, there is no added cost to you. If we find that dry needling is particularly helpful to you, or you just need a quick dry needling session in between regularly scheduled appointments, I can do dry needling only appointments, which will be $50 per session.

Question 11

Isn't pelvic floor therapy just Kegels?

Accepted Answer

Oh, heck no. In fact, a majority of people that I see would WORSEN their conditions with doing "just Kegels." When it comes to the pelvic floor muscles, we want to have full muscle length, as well as strength. Many problems, including leaking, can be caused from muscles being over active, or overly tight. In that case, we need to improve the pelvic floor range of motion before strength. And when it comes to strengthening, I like to work with my people on full body strengthening, so that you have improved pelvic floor and core strength, as well as sufficient support to your hips, low back, postural muscles, and so forth, so that your pelvic floor can function with the rest of your body. Exercises are full body, and meet you where you are at with strength and conditioning, so that you can improve function with all of the activities you need to do in a day.

Not to mention, just doing Kegels is pretty boring.

Question 12

Can I just see you at the hospital and use insurance?

Accepted Answer

You absolutely can, just keep in mind that it will be different. It usually takes 2-4 months to get in to see me at the hospital, compared to Great Lakes Pelvic, where I can typically schedule you in 2-3 weeks or less. My treatments are more limited at the hospital, as they are restricted by insurance policies, i.e. I do not do dry needling there, which can be an immensely helpful tool, especially for painful joints and muscles. My appointments there are 53-55 minutes, vs at Great Lakes they are 60-90 minutes long. I can genuinely say that my clients at Great Lakes Pelvic get better significantly faster than my patients at the hospital.

Question 13

Do you still do home visits?

Accepted Answer

Yes, I can still do home visits on a case-by-case basis, so reach out if this would benefit you more than an in-clinic or Telehealth visit. I do not allow online booking of home visits to account for my evolving schedule and drive time, so email or text to set up an appointment.

Alaina K. Vince, PT, DPT, PCES
Doctor of Physical Therapy, Pelvic Floor Specialist

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