Radial Pressure Wave Technology and Pelvic Floor Physical Therapy: A Combined Approach for Treating Pelvic Floor Dysfunction and Pain

Although pelvic floor strengthening and pelvic floor dysfunction have been topics for discussion for nearly a century, it wasn’t until recently that medical professionals started looking at regenerative therapies to address the root causes of pelvic floor pathologies.

Physician Background: Reinventing The Process of Postpartum Treatment

Dr. Allison Feldt, Pelvic Floor Physical Therapist and owner of Body Motion Physical Therapy, has dedicated her life to helping women before, during, and after pregnancy. She approaches pelvic floor physical therapy holistically - improving core function and the health of pelvic floor organs with the use of Radial Pressure Wave technology (also known as Extracorporeal Pulse Activation Technology, or EPAT^®), pressure management, and therapeutic activities. 

In doing so, Dr. Feldt works to help all of her patients achieve a healthy pelvic floor while preventing future pathologies like hip, knee, and back issues, in addition to incontinence, constipation, painful intercourse, or heavy and uncomfortable menstrual cycles. Her patients range from the aspiring mom-to-be to the mother of five, whose children have long since flown the nest.

Challenges: An Onset of Postpartum Pathologies Following Natural Childbirth

Thirty-six year old Cynthia M. is moderately active. She exercises several times a week, works full time, and now, with a toddler to look after, she is constantly on the run. After the natural delivery of her first child, Cynthia experienced a grade three perineal tear, among other maladies, which set her recovery back tenfold. Her primary complaints following delivery were right glute pain, stress urinary incontinence, painful intercourse, and diastasis recti.

Desperate for relief, Cynthia visited a local pelvic floor clinic, where physical therapy was recommended and initiated. However, Cynthia’s discomfort persisted. At the recommendation of a friend who is also a current patient of Dr. Feldt, Cynthia made an appointment at Body Motion Physical Therapy. 

Solution: A Combined Approach Using Radial Pressure Wave (EPAT) and Physical Therapy

After their initial consultation, Dr. Feldt confirmed Cynthia’s original diagnoses: a grade three perineal tear with a fibrotic scar, stress incontinence, diastasis recti, sacroiliac joint dysfunction, and dyspareunia. Dr. Feldt then set to work creating a custom physical therapy treatment plan for Cynthia. 

Here is Dr. Feldt’s approach to treating Cynthia M.:

Treatment Part 1: Internal and External Assessment & Physical Therapy

Dr. Feldt performed an internal and external assessment of all of Cynthia’s pelvic floor muscles. She also evaluated her scar tissue, checked for pelvic organ prolapse and diastasis, and studied Cynthia’s core coordination.

She then used visceral manipulation and manual release of Cynthia’s obliques and rectus abdominis to help allow core closure. Pressure management and therapeutic activities included observation of bowel mechanics, stool consistency, and pelvic floor coordination, followed by manual internal pelvic floor releases and scar tissue work. Dr. Feldt’s main focus here was to rebuild Cynthia’s core and continue downtraining her pelvic floor, thus helping Cynthia regain hip extension, and strengthen her glutes, transverse abdominal muscles, and pelvic floor. 

Treatment Part 2: Radial Pressure Wave Technology (EPAT)

Cynthia’s perineal tear scarring was so fibrotic, it was impossible to dissolve using traditional physical therapy methods. In addition, Cynthia’s pelvic floor was extremely hypertonic, making therapy difficult for both Dr. Feldt and Cynthia. Dr. Feldt then turned to Radial Pressure Wave Technology (EPAT) to help address Cynthia’s scar and remaining pelvic floor pathologies:

1. Meeting with Cynthia twice per week, Dr. Feldt performed 2,000 pulses per session for 20-30 sessions. She focused the treatments on Cynthia’s external pelvic region and perineal body, where the scarring was most dense.
2. She began with the V-ACTOR handpiece to warm up the tissue, then moved to the D-ACTOR handpiece.
3. When using the D-ACTOR handpiece, she used several different tips, starting with the F15 plastic tip, and setting the pressure for 0.3 bar and the energy level for 21 Hz.
4. She then increased the pressure to 4 bar, and swapped to the DI15 gold depth deep impact tip. 
5. From there, Dr. Feldt progressed to the D20-S standard oscillator tip, then finally the C15 ceramic head tip, adjusting the frequency to 15 Hz along the way.

Clinical Outcome and Benefits Achieved

Cynthia is pregnant and expecting her second child, so she and Dr. Feldt had to pause their shockwave sessions. They are, however, continuing with pelvic floor physical therapy. Based on Cynthia’s outcomes from her first delivery, it was recommended that she skip vaginal delivery entirely, and opt for a cesarean. However, Dr. Feldt’s treatment sessions with EPAT were so successful that Cynthia was given the all-clear to attempt a natural delivery for her next child. Her story continued weeks later, when Cynthia went on to have a successful, unplanned, home birth with zero tearing, thanks to Dr. Feldt’s treatment plan and the power of shockwave technology. Her pathologies and scarring are much less of a hindrance than they previously were, and Cynthia is feeling much more confident in herself and in the stability of her pelvic floor.

Following the birth of her second child, Cynthia and Dr. Feldt plan to continue using shockwave therapy to strengthen, tighten, and recoil the vaginal wall. Cynthia is looking forward to it, telling Dr. Feldt, “I can’t wait to have this baby, so I can shockwave my belly after!” 

Harness the Power of Shockwave and EMTT in Your Practice

Cynthia M. is one of hundreds, if not thousands, of patients seeking a regenerative, non-invasive treatment for pelvic floor dysfunction and pain. As the leading US distributor of STORZ Medical devices, including Radial Pressure Wave (EPAT), Extracorporeal Shockwave (ESWT), and Magnetotransduction (EMTT), CuraMedix is known for unrivaled service, support, education, and training. With the right tools in your armamentarium, and training and guidance from CuraMedix, you can not only increase your caseload, but increase the number of positive outcomes achieved on a weekly basis. 

As regenerative technologies evolve, more practitioners like Dr. Feldt are using EPAT, ESWT, and/or EMTT technologies to non-invasively treat dozens of pathologies. Ready to join them, and provide next-level patient care for your patients? Contact us and we can connect you with one of our shockwave or EMTT experts today.