



For Referring Practitioners
REFERRAL PAD in Adobe PDF Format
Physician's Prescription for Physical
Therapy.
- Pelvic Physical Therapy and Lymphedema Services at Beth Shelly PT:
- Pelvic floor dysfunction
- Underactive pelvic floor muscle – weakness,
incontinence, prolapse, male and female
- Specific PFM strengthening with and without biofeedback (EMG,
pressure)
- Proper abdominal muscle contraction, lifting
- Bladder, bowel training
- Electrical stimulation
- Overactive pelvic floor muscle – spasm & pain
(levator ani, vaginismus, vulvodynia, dyspareunia)
- Complete evaluation of primary & secondary musculoskeletal
pelvic dysfunction
- Treatment of joint dysfunction – lumbar, SI, pubic, coccyx, hip
- Exercise for pelvic muscles to stretch and strengthen
- Manual techniques to scars and tight tissues – pelvis, vagina,
rectum – internal and external
- Vaginal dilators
- Pain reducing modalities – TENS, HP, CP, US
- Education on self management
- Incoordination – Obstructed defecation, urinary
retention
- Similar to supportive dysfunction
- Biofeedback – EMG
- Visceral dysfunction – Endometriosis, interstitial cystitis,
abdominal adhesions
- Pain reducing modalities
- Exercise to increase functional activity level
- Swelling management and lymphedema
- Manual lymphatic drainage
- Multilayer compression bandages
- Pneumatic, gradient, sequential pump
- Measurement and fitting of compression garments
- Patient education on self care
- Orthopedic, peripheral vascular, wounds and lymphedema
- Obstetrical physical therapy
- Prenatal and postpartum musculoskeletal pain (sciatica,
low back, pubic symphysis, neck, wrist – carpal tunnel syndrome)
- Therapeutic exercise to stretch tight muscles
- Manual stretching of specific muscle spasms
- Joint mobilization
- Heat packs
- Education on body mechanics, posture and self care
- Support binders and straps
- High risk OB
- Pain treatment as above
- Establish maintenance exercise program