1. What is an internal pelvic floor muscle exam and do I have to have one? 

• A pelvic floor muscle examination through hands-on internal palpation using one or two digits is used to determine the state of the pelvic floor muscles and may be an important part of your assessment. Without this, it is an estimate/guess of what is going on in these tissues. An internal exam allows us to pinpoint exactly what may be happening in the muscles and target/tailor your treatment appropriately. An internal examination is safe for most people and  is important for anyone presenting with bladder, bowel, pelvic floor symptoms, pelvic pain, prolapse, low back pain, hip pain, groin pain, sexual pain/dysfunction, menstrual pain, gynecological conditions/diagnosis and pregnancy/post-partum issues. With all parts of an exam, consent is required, and if you are uncomfortable with this, please discuss this with your therapist and alternative options will be provided. Your therapist will discuss the risks/benefits/alternatives to you during your assessment if a pelvic floor muscle exam is indicated in your case before proceeding to ensure your comfort and informed consent.

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2. Do I need a referral from my physician and/or midwife? 

• No, physiotherapy services are direct access in Ontario meaning you can see us without a referral from a physician or other healthcare provider. However, some insurance companies require a physician's note for coverage. Please check with your company directly. 

• We are not covered by OHIP

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3. Is your work covered by Physiotherapy Benefits on an insurance plan?

• All services provided by Physio Works Muskoka are  physiotherapy services and are covered by most insurance plans (contact your plan directly to identify your specific coverage amount)

• We are not covered by OHIP

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4. Do you bill insurance companies directly?

• No, unfortunately, we do not billy insurance companies directly at this time. Payment is given after each appointment followed by a receipt which you can then submit to your insurance company for reimbursement. 

• We are not covered by OHIP

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5. Do you treat men?

• Yes! Men have pelvic floors too, we treat men for all conditions 

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6. Do you treat children? 

• Yes! We treat children from birth to 18 years for any pediatric concern including infant/early years development, neuromotor, congenital and acquired disorders, sports injuries and training, pediatric pelvic health, and orthopedics. More information for paeditric physiotherapy is located here for orthopaedic and developmental concerns and here for paediatric pelvic health concerns. We also have a Registered Massage Therapist who provides infant and paediatric massage with more information here. 

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7. Do you treat general orthopedic, muscular, post-operative, or sports injuries? 

• Yes! We treat orthopedic injuries, overuse injuries, sports injuries, post-operative or post-fracture care across all ages - from birth to geriatrics!

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8. Do you have Massage Therapy?

• Yes! Miranda Carley, RMT, provides massage therapy services out of our clinic. More information here

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9. I have chronic pain and have tried many different treatment techniques, can physiotherapy help?

• Physiotherapy is highly effective for chronic and persistent pain problems of all kinds - check out our webpage for more information here

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10. Do you offer Virtual treatment sessions?

• Yes, there are a variety of different ways we can perform physiotherapy assessment and treatment sessions including over phone or Zoom. We use secure, healthcare-compliant connections. Virtual Physiotherapy can be very effective and is a great option for many people when they are driving from far away locations, have poor winter driving conditions, have health concerns, need to isolate,  cannot find childcare, or simply enjoy doing their sessions from the comfort of their own home. 

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11. I am travelling from far away, how often do I need to see you?

• This is different for every person and every condition, but if distance or time is an issue for you, we will do our best to accommodate this through a variety of different ways including phone or Zoom check-ins. 

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12. How long are your visits? 

• An assessment is one hour with the physiotherapist, however, plan on being in the clinic for 1.5 hours as exercises prescribed by your physiotherapist are reviewed by the physiotherapy assistant after your appointment.

• Follow-up visits are 30 minutes long with the physiotherapist, however, plan on being in the clinic for 45 minutes as exercises prescribed by your physiotherapist are reviewed with the physiotherapy assistant after each visit. 

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13. Is an internal exam safe while pregnant?

• An internal exam is safe during pregnancy if the patient is still allowed to have intercourse, and a health care provider has not restricted the patient from doing an internal exam.  This might happen in the case of an incompetent cervix. Please discuss with your midwife or physician if you have any concerns. 

 

14. Will the internal exam be painful?

• The internal exam should not be painful. This exam will be very different from the internal exam at a doctor's office. The therapists use a finger, not an instrument, and are looking at the function of the muscles. Mild pain may be experienced if the therapist finds a trigger point to release, but you are encouraged to communicate your pain levels to the therapist. You can ask the therapist to decrease the pressure level if you find it uncomfortable. You are in control and can tell the therapist to stop at any time.

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15. Who will be performing the treatment?

• These treatments are provided by a registered physiotherapist who is highly trained. If you are coming for internal pelvic floor physiotherapy,  then by law, they must be registered with the College of Physiotherapists in order to perform this type of examination.

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16. How should I prepare for my appointment?

• Please complete the questionnaires that the clinic sends you prior to your appointment. You can also arrive 30-45 minutes prior to your appointment time to fill them out in the clinic.  However, doing them ahead of time will make your appointment day less long and stressful.

 

17. Do Kegel exercises help?

• Kegel exercises can be helpful if they are performed properly and at the appropriate time. The pelvic floor muscles can be difficult to find and exercise correctly.  Men and women often need help in figuring out how to properly perform Kegels to see optimal results.  Alternately, these muscles may also become tight and develop trigger points.  This is often the case when pain is one of the symptoms experienced, or with urinary and fecal urgency and/or frequency.  In this case, Kegels may have no effect, or could even make symptoms worse.  When the pelvic floor muscles have trigger points, treatment may include trigger point release, pelvic floor relaxation and stretching exercises, as well as acupuncture.  Pelvic floor strengthening (Kegels) will often aggravate trigger points, so this must be addressed before pelvic floor strengthening can be initiated if appropriate.

 

18. Is incontinence a normal part of aging?

• No! Incontinence is usually due to pelvic floor muscle problems; physiotherapy is effective 80-90% of the time

 

19. What happens if my appointment falls during my cycle?

• You can still come for treatment during your cycle. It is something that happens quite often and the therapists have no problem treating patients during that particular time. Extra protection can be used during the internal exam to make the patient more comfortable. If you are uncomfortable having an internal exam during this time, there are usually other treatment techniques that can be used during that session.

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20. or phone us with any other question - we are happy to help!