Lynley Box of Niverville is a licensed physiotherapist who is bringing a unique service to the area.
Pelvic floor therapy is a specialized focus within physiotherapy that aims to improve the strength and function of pelvic floor muscles. The techniques are proven to alleviate pain, weakness, and dysfunction in the muscles—common conditions which can manifest as urinary incontinence and issues with sexual arousal and orgasm, among other things.
When Box finished her postsecondary training, she took a physiotherapy job in a hospital setting. After starting her family, she discovered a lot of the personal education she had received during her pregnancy and postpartum experience inspired her to make a change in vocation.
“I developed a passion for pelvic floor physio, which is likely part of the nature of someone like me having children and all that goes with that,” says Box. “It was a whole new area of healthcare to learn about.”
Box says that a physiotherapy clinic will typically offer treatment that focuses on the cardiorespiratory system, neurological system, and orthopaedics.
For the post-graduate certification required for pelvic floor therapy, Box needed to travel to an education provider based out of Toronto.
“It’s just that kind of a niche area of physio,” Box says. “Not everybody offers it, but so many people could benefit from it and it needs to be talked about more.”
Who Benefits from Pelvic Floor Therapy?
The struggles involving the pelvic floor are many and varied, but one of the most common is incontinence.
According to the Urology Care Foundation, one in three women suffer from stress urinary incontinence at some point in their lives, and that number increases with age.1
“You see people and they are struggling with incontinence, but the question I have is, let’s figure out what type of incontinence, because there’s different types,” says Box. “Men definitely do have pelvic floor issues, and I offer services to whomever needs, but they don’t have as many as women do.”
Box says that she often begins to see women experience a need for pelvic floor support during pregnancy.
“The pregnant population is a niche for this type of physiotherapy,” she explains. “Sometimes people just have that pelvic girdle pain and they need help, or there are muscles that have become quite lax, or they have diastasis. Postpartum care is important, too, because depending on how the birth went, sometimes there is trauma associated with the body. It’s not always a happy experience and then it triggers some things when you go back into an intimate relationship with your spouse.”
Box says that Niverville is an ideal place to start a business like this one, which caters to women’s needs.
“Niverville is growing,” she says. “It’s almost 6,000 people and pelvic floor physiotherapy is typically offered only within the perimeter. There’s nobody south of Winnipeg doing this. The population of Niverville is a whole lot of families. There’s a whole lot of moms, and that’s probably who I will be seeing most of. I offer services for those heading into menopause and there is a considerable retirement-aged population in town here as well.”
Attention, Ladies: No, It’s Not Normal
When we target areas of the body to improve our health, the pelvic floor is often overlooked, mainly because it involves body parts that are highly sensitive and private.
Box feels that how we deal with these subjects, which are hard to talk about, are rooted in the language and behaviour we were exposed to when growing up.
“We tend to minimize a lot,” says Box. “When you think back to how you grew up and the things you heard, how many times do moms go and jump on the trampoline with their kids? And the reason they’re not jumping on the trampoline is because they’re going to pee. They’re going to have incontinence because their core is not working properly to hold it in.”
Box says that another common phrase people have heard and continue to use is “I laughed so hard I peed my pants.” It’s not just children who use this phrase! It’s adults, too, but the real reason why isn’t quite so funny.
She says that it’s common for people to have incontinence. Besides pregnancy, the body changes throughout life for many reasons, for both men and women, and those reasons are wide-ranging, including aging, long-term health conditions, accidents, or injuries.
“For women, hormones can play a part depending on our cycle, or how close we are to perimenopause or menopause,” says Box. “It’s common that incontinence can happen and there’s reasons why it might happen, but there’s things that we can do to minimize it and to make it better.”
While Box says that it can be beneficial to normalize the human experience, it’s absolutely not normal to pee when you cough, laugh, sneeze, jump, go up and down the stairs, or go from sitting to standing.
“Anytime you have urine exiting the body, but are not sitting on a toilet to actually pee, this is incontinence and it can be helped, regardless of how old you are or how far you are postpartum,” says Box. “Talking about it is huge because it makes you feel you’re not alone. You always feel you’re the only one experiencing this and you’re not. That’s the biggest thing to take away here. It’s common, but it’s not normal.”
Appointments Are Safe and Inclusive
Box is accepting patients 18 years of age and up, male or female.
“And anywhere in between,” she adds. “I will see anyone who is LGBTQ, and sometimes there are specialties in those areas. Paediatrics is another specialty, but I haven’t done that as a focus.”
Niverville Family Chiropractic has agreed to provide dedicated and private space for Box’s practice. They offer online appointment booking, payment options, as well as virtual appointments which can be arranged to assist with getting a patient’s medical history before a physical assessment.
Privacy is important to Box and she is confident that her clinical space provides a safe and structured atmosphere to conduct her practice.
She also says even phone appointments can be very beneficial, since a lot of discussions can take place on the phone in your home where you’re comfortable.
“The space you’re in is very important, because yes, this is very personal,” Box acknowledges. “It is hard to open up and talk about what’s going on, especially if you need to be able to tell someone, ‘I can’t have sex with my husband because it really hurts.’ People don’t really want to talk about that, so let’s take the pressure off. We can sit, we can have a conversation, and you’re in your home and I’m in mine, in our comfortable spaces. We can just talk about what’s going on.”
But What if It’s Awkward?
Besides awkwardness surrounding the subjects of incontinence, pain, or sexual dysfunction, a person can feel anxious just by thinking about seeing this kind of specialist.
Box directly tackles the reason people don’t go for pelvic floor therapy: it feels invasive.
“My goal is, I don’t want you to feel icky about it,” says Box. “I don’t want you to feel like you’re being invaded. That’s not cool. I’m not okay with that.”
Box says that people may not know what pelvic floor therapy is or how it’s done, and one way of overcoming anxiety about the physical exam is to provide a lot of information.
“Information is power and knowledge, and when you know more about something, you feel less nervous about it,” she says. “If you’re nervous about it, we’re going to sit and talk about every single component of it, all your questions, until you’ve got them all answered, and then if you still need a week to think about it, great. And if you need a month? Great. If you’re like, ‘I really want you to take a look at me, but I’m still not ready for the internal exam,’ no problem.”
Box says that the physical exam is an important aspect of pelvic floor therapy, but there are still many techniques she can provide without having to do an exam.
She encourages people to think about the initial assessment in two parts: the discussion portion and then the physical examination. And they can be conducted separately.
“There are always ways we can help improve things, lots of lifestyle modifications, or little tweaks to routine we can recommend to help,” says Box of how she treats people who aren’t ready for a physical exam. “And if at any point that person would like to change their mind and eventually do an internal exam, like they are seeing results but just aren’t quite where they’d like to be, then we can do that. There’s no pressure.”
Passion for Health Education
While acknowledging the common perception that physical exams are awkward, Box emphasizes that the main benefit of contacting a pelvic floor specialist is the life-changing amount of information she can provide.
“Education is really the primary focus when discussing pelvic health, because there’s such a nervous system-mind connection with the pelvic floor. It’s part of the nervous system loop,” says Box. “So when there’s a lot of stress happening, it gets tight. When things get tight, they don’t function very well.”
Box says that the pelvic floor picks up tension in the same way that your neck and jaw becomes rigid when you’re under stress. And as you breathe in, your diaphragm should move down and relax your pelvic floor.
Aside from the diaphragm and pelvic floor, good core strength in one’s front and side abdominals is also important.
“We do a lot of focus on learning, sometimes about simple things like breathing patterns,” Box explains. “People breathe up high when they should be breathing down low, so there’s all sorts of desynchrony that just doesn’t work well—and when it doesn’t work well, they’re prone to have more problems.”
Aside from the physical aspect of her job, Box says that she also wants to make sure incontinence or pain issues are discussed in the context of the whole person.
“I follow the bio-psycho-social model, which is taking into account the entire person. It takes into account stress levels, emotions, experiences, education, and how their nervous system would function depending on their life situation as a whole picture. All of this is good information to have, which informs how I can best help someone.”
Box feels an immense sense of passion and purpose for what she does. Pelvic floor physiotherapy can be life-changing, even life-saving, because people who have stopped enjoying life can start enjoying life again.
People who stopped working because of pelvic issues may even be able to return to work.
“I’ve had people who have had to stop working because their pain was so bad,” she adds. “And then we do all sorts of education and we practice all this stuff and then they can go back to work. It feels so good to help, because you feel like you’re actually making a direct impact on somebody’s quality of life.”
