FAQs

It will not be painful. I do not believe we need to increase your pain to decrease your pain. That makes no sense to me. On your first visit, we will do a thorough medical history review, including all areas of pelvic functioning (urinary, bowel, and bladder). Good care takes time. I ask for your intake paperwork in advance, and I thoroughly review it before the first visit. Every aspect of your history will be considered to obtain a thorough understanding of which of our treatments are warranted. A gentle physical therapy exam will then be performed, which may include internal muscle evaluation, external joint and muscle evaluation, and gait analysis. Together we will discuss how your condition has disrupted your life, set wellness goals, and conceive a structured therapy plan to meet those goals. Frequently, patients report having a better understanding of their condition after the first visit than they have had, even after years of PT or multiple PT’s and other health care providers. Exams are as pain free as possible: even patients with pelvic pain are surprised that the process does not hurt. It is best to have a physician who is overseeing your care and whom we can send a care plan to. A referral is not required. Plan on 2 hours of one-on-one time for your first visit.

We believe good care takes time and attention. . Your follow ups are 50-55 minutes of one on one care with Nari, not being rushed through a system or passed to assistants and aids for your care. Your care will consist of both evidence-based practices and holistic approaches. No two sessions will be the same. Though the primary modality is very specific manual therapy and education for self care, we also may utilize biofeedback, internal electrical stimulation, dilation therapy, exercise prescription, patient education, home programs, and lifestyle modifications. We will start where you are comfortable, and you are in charge of each session.

NO. Patients are frequently surprised that techniques which are so gentle are able bring about so much change in the body. Our goal is to minimize all discomfort as we work with you. Even if you have had painful pelvic PT or exams in the past, it is my belief that we can not resolve pain by inflicting more pain. The clinic is a very comforting environment, and the treatments are relaxing and pain free. Many patients fall asleep while I work on them! Please do not use past pelvic physical therapy or painful experiences to form a preconceived notion of what will happen here.

This is difficult to answer without having an evaluation. You should see a significant difference in your pain and function by the 6th visit. Because of this, we do offer a 6 visit package. Most patients schedule once a week for the first month, then two additional visits two weeks apart. Most patients find the severity of the pain has greatly reduced and they have had a significant return to function by the 6th visit. However, many patients find that visceral work once a month helps their entire body and emotions to work more smoothly and that they just feel better with a monthly "tune up". So, most patients stay on for monthly or quarterly self care and relaxation. Some patients are better in 2 visits, some take 12. It just depends on the individual and the pattern of dysfunction, how many compensations have occurred over time, and how the patient's whole picture of health and self care is.

I offer varying appointments each day, with some visits as early as 7am and some as late as 6pm start time. But the majority of appointments are between 7 and 5.

Absolutely, see the “Male Care” section on the Treatment Options page.

Yes!!. I have many patients who fly in for intensives. However, if you are wanting to come from across the country, I recommend you see someone closer first. I can try to recommend someone closer to your region. If you are coming from out of this region, we recommend 2 hours each day for 3 consecutive days. This may require scheduling a month out. If you come from just a few hours away, I am quite used to this, and we can try to work out your appointments at a time that works for you. We can book out two hours at a time to make it worth your drive.

Current rates: Initial appointment and treatment (120 minutes in person, 30 minutes reviewing your intake paperwork before your visit): $300*** Follow up treatment (50-55 minutes) $190 Venmo, cash, or check. 6 visit package: $950 No-show or last minute cancellation: full visit cost if not within cancellation window (48 hours for evals, 24 hours for follow ups) Please note, this is the amount of time that is reserved for you, lateness will take away from that time. We require completed paperwork prior to scheduling the first visit/evaluation.

For evaluation (first) visits, we do not make exceptions, since we block out a full 2 hours. For Evaluations, we will require a deposit, refundable only with 2 business days (M-F) notice, which is half the cost of an evaluation visit. For ongoing patients: 1. After the first no show or less than 24 hour cancel, we give you a friendly reminder of our policy. 2. Once the patient has had a second <24 hour cancel, you will be required to pay for the missed visit in order to continue care. 3. If there is severe winter weather and Portland or Beaverton schools are cancelled or delayed, we will likely be. Please check your phone and email before driving in on severe weather days. Please do not put yourself in harm's way to get here, etc.

For the optimal care of my patients, I have made the decision to be an out of network provider starting 2014. I collect payment at the time of service, and I will provide you with a superbill receipt to self submit to your insurance, who will reimburse you directly (except for Medicare, see below). We do not fill out insurance paperwork. My patients are generally patients who have seen many providers and not responded to conventional therapies. I offer longer sessions, treatments not available at most clinics, and treat in the way that is best for the patients. When calling your insurance regarding benefit, ask about out of network coverage for physical therapy, if they cover PT for your specific diagnosis, and if they will cover chronic conditions. Even if your insurance does not cover out of network care, you can apply the cost to your annual deductible. Medicare patients, please scroll to the next session down. Please find out if you need a pre-authorization. I can fill that out for my normal hourly rate, if you are purchasing a package.

In this state, we do not need a script from a doctor to start. However, we do prefer to send the care plan to someone who has seen you in the prior year or two for your condition. Keep in mind, there can be many reasons for pelvic or abdominal pain or dysfunction, so a medical screening from your primary care is helpful for ruling out other disease processes. You can download a referral form to take to your doctor from our forms section on the website.

As of 2014, I do not have a relationship with Medicare, which means I can not treat patients who wish to submit to Medicare or for conditions normally covered by Medicare. Please let us know if you would like a recommendation to a different provider.

The coccyx is wonderous structure. All of the pelvic floor muscles connect with it, it is the attachment site for the two most stabilizing ligaments in the pelvis, and it should have 30 degrees of motion and move with pelvic floor motion. The problem is when someone has a fall onto their behind (particularly on steps), or perhaps with birth, the tailbone can heal. Or, sometimes after surgical fixation to one of those ligaments after a hysterectomy, it can get pulled over to the side. If the pelvic floor muscles are firing unequally, it can get out of alignment. And then, the small coccygeal nerves, anococcygeal ligament, or the coccygeus muscle can get very tender. We can adjust this and treat all the attaching structures, so it does not have to hurt you.

Dyspareuniais the medical term for painful sex. I like to think of it as painful intimacy, because people can have many kinds of sex lives, and it can limit any of those, including self-pleasure.  It usually does not go away by ignoring it, and it can be very isolating and hard to talk about. There can be many components to dyspareunia. Sometimes it is acutaneous/superficial irritation (see vulvadynia and vulvar vestibulitis above). When it is due to spasm at the opening of the vagina causing a small opening (which is actually a SMALL percentage of dyspareunia), it is referred to as vaginismus. When the deeper muscles in the vagina or the pelvic floor are tight and painful, it may be referred to as levator anisyndrome.  Men can also have dyspareunia, see male pain section. Patients may report they have had pain since a vaginal birth injury or an episiotomy. Many patients also report pain after a pelvic floor repair or hysterectomy. Similarly, patients who are cancer survivors also have vaginal pain after radiation or hormone therapy. Common patient descriptors are as follows: “It feels like a too tight fit with my partner." “It feels like my partner is hitting something." “I have cramping when I have sex." "I have a tearing sensation when I try to have sex." “I have burning with sex." "it feels likeperiod cramps during and after sex." Among many others. Regardless of the cause, it is not your fault or something you did wrong. There are many reasons for dyspareunia, and there are now many therapy options to heal it. Often very specific manual therapy that goes far more specific than stretching internal pelvic floor muscles can be helpful, as can working small fascial restrictions all around the vulvar (orpenile) region.

Fascia is a web of connective tissue in the body that holds integrity, both in small units and to transmit forces across the body. The fascia can hold tensions that cause pain or restriction of a nerve or organ, or a tightness that stretching does not seem to resolve. The fascia can be worked with to restore integrity and more helpful tension dynamics to optimize movement and structural integrity, while reducing pain.

Yes, men have pelvises, so yes, men can have pelvic pain. Whether it is testes pain from the spermatic cord and ilioinguinal nerve, or penile base pain from fascial restriction, or deep pelvic pain from levator tightness, we treat men’s pelvises with the same level of attention and specificity as women (not just rectal work or avoiding treating the pelvis). We treat post hernia repair pain, post vasectomy pain.

Using lymphatic techniques in the neurovascular bundle and decompression techniques to take pressure off a nerve. Working proximal to distal, along the pathway of the nerve or the nervous system to take pressure of a nerve and decrease pain signaling or increase nerve function. Based and modified from osteopathic traditions from Europe.

The pelvic floor is a wondrous structure: 4 superficial muscles, 4 mid-layer muscles, 4 pelvic floor muscles, and 2 pelvic wall muscles. Each can be reached and treated a bit differently. One can be tight and another weak, depending on the person. Each muscle has its own function, and after a baby comes through, they may be quite different side to side. When they are working well they control the appropriate flow and discharge of urine or feces, help us orgasm, support our pelvis, help with blood flow out of the pelvis after intercourse, and are generally pretty amazing. But when the nerve to them is overactive, they stay a bit tight, and sometimes after an incident, such as birth, they may need a bit of help learning to work again.

Growing a baby is a lot of work. Getting it out is one of the most difficult things your body will have to do. With vaginal birth, muscles can get stretched or torn. In almost 30 percent of births, women can have an avulsion (disconnection from bone) of the pubococcygeus muscle, and most may never know. Babies do not come through symmetrically, left and right sides may need to be retrained and rehabbed differently. It’s rare for every muscle to be tight or every muscle to be weak. Starting with a thorough evaluation will allow us to make a plan and to understand how to care for your pelvis the rest of your life. The pelvis is meant to birth, but the US is one of the few developed countries that neglects the need for post vaginal birth care. C-sections are necessary to preserve the health of the baby in many cases. It makes me sad when women feel like they somehow failed or were less than for this.  The truth is, c-sections leave a more intact pelvic floor, and the safest birth for all parties is the best outcome. Usually, the scar will benefit from care and manual therapy to help mobilize it and decrease adhesive or restricted motion issues around the bladder and the small intestine. Sometimes people come to me 3 or 9 years after a c-section with pain in the area or bladder leakage, and working the fascia, viscera, and scar almost always helps the issue we can begin care as soon as 6 weeks after birth or as far out as a couple of decades. There is no expiration for care.

The pudendal nerve is amazing in function. It helps us feel sensations of pleasure, helps pelvic floor muscles to contract, and helps us to have control of our bladder and bowels. But this special structure has a somewhat tortured pathway: out the greater sciatic foramen, under the piriforms, wrapping around the sacrospinous ligament, back in through a hole called the lesser sciatic foramen, traveling in a tunnel between a pelvic floor and wall muscle (alcock’s canal), while under an incredibly dense ligament (the sacrotuberous ligament), then exiting the internal pelvis just inside the sitting bone (ischial tuberosity), where it is easily irritated by a bike seat, to travel in 3 branches (one to genitals, one to perineum, and one to anus).  It can be entrapped anywhere along that pathway or pinched between the sacrospinous and sacrotuberous ligament. As if that is not enough, the plexus it comes from (sacralplexus) shares so many fibers with the sciatic nerve, that if there is a history of sciatica, it can keep that pain alive. We treat every one of those structures, to give the nerve more room, less compression.  In fact, I teach a class I wrote with Herman Wallace that specifically teaches how to treat the pudendal and sacral plexus nerves. I have never seen a pudendal nerve calm down with pelvic floor stretching alone... it’s too non-specific for the problem. And the nerve will get irritated if you stretch and glide it without decompressing it. I’d love to help you get over this pain!

The rectum is the end of the colon, before it exits the body at the anal canal. Patients may report pain with bowel movements that can last for hours. Sometimes it is before, sometimes after. It may or may not be related to when one has their menses, or perhaps when attempting to enjoy anal intercourse. When fleeting and intense, it can be called procticalgia fugax. At times it can cause a patient to awaken in the night or can come on with no rhyme or reason. Patients sometimes report a pain so severe that it stops them from leaving the house or working. At times it is more than a minor annoyance. Some people have a persistent ache or a pain that grows with sitting. The patient may state they have a pain deep in the buttock that is difficult to define. We can help stop the suffering! A muscle spasm by any other name is still a muscle spasm. It often responds well to direct stretching. Additionally, by releasing other structures in the region with visceral manipulation, neural manipulation, or learning muscle retraining with biofeedback, patients can learn to break this cycle of pain. We do offer intrarectal as well as intravaginal manual therapies at our clinic, so we can get to the source of the problem.

The Sacroilliac joint connects the bottom of the spine with the base of the spine. It has very few degrees of motion. But it can get inflamed. Often, this pain is kept alive with the uterosacral ligaments that are attaching to the front side, so doing visceral (organ) work, can often help resolve those cases that keep needing “realignment” that have not responded to other types of PT. Also, the coccyx should always be treated with the sacrum as well as dural tension throughout the nervous system. We can address all of that for you.

An osteopathic technique of working with organs to restore mobility and motility of structures. This treatment is very helpful for reducing pain syndromes with adhesions or endometriosis, and restoring bladder and bowel function.

Vulvadynia is just the medical way of stating the vulva has pain. It’s a bit of a nonspecific diagnosis. Vulvar pain in the absence of other known pathology. Common complaints are: a burning sensation in the vaginal region, simple touch feeling like burning or scraping, or poking. Patients may have an inability to wear tight or fitted slacks or tolerate the feel of underwear or sensation of tampons. Sometimes patients report an unrelenting itching that does not have adermatologic or infection origin.  The reason? That is not well understood. There are literally dozens of possible reasons: In some cases, there is a link with autoimmunity or other inflammatory conditions in the body. Sometimes there are abnormal c-fibers in the tissue, sometimes itis a pudendal nerve issue. Often tight pelvic floor muscles are involved (either a precursor or a result of the pain). The honest truth is that we often don't know the exact cause, but we have treatments which often help. Part of the reason for our 2-hour initial visit is to assess several possible factors: entrapped genitofemoral or dorsal or perineal branches of the pudendal nerve. carefully assessing the integrity of the skin evaluating the pelvic floor muscle and wall tension assessing the deep fascia in the abdominopelvic cavity and getting a clear treatment plan The truth is that the pain is often multifactorial, and it takes a bit of detective work to assess the system as a whole. We often find that treating the pathway of the genitofemoral, ilioinguinal and pudendal nerves and doing very specific fascial work in the areas of the labia, mons, and peri clitoral tissues free up enough small and large nerve endings to help the pain reduce. Vulvar vestibulitisis a specific form of vulvodynia, in which the tissues at the entry to the opening of the vaginal canal are hypersensitive. Vulvar vestibulitis patients often have increased c-fibers or pain sensitive fibers in the tissues in this small area. Sometimes the area just at the opening of the vagina is red and inflamed. Please know that whether you are vulvodynia or vestibulitis sufferer, you are not alone, and you are definitely NOT crazy. Many therapies are available to help reduce or eliminate this pain. Often many manual techniques internally and externally, including visceral mobilization, myofascial techniques and direct muscle release techniques (internal and external) are helpful. We may contact your referring physician regarding topical agents we may suggest as prescriptions to assist the treatment. We may refer you to a vulvar pain specialist to help us. Additionally, extensive lifestyle modification tips, from self-care to diet to meditation or yoga technique may be utilized.