When you come to Four Corners, the first thing we ask you is, What are your goals for physical therapy? 

Once we establish your goals, we examine you from head to toe so that we can find and treat the root of your pain. Our whole-body approach helps us to determine if your pelvic floor dysfunction may be related to a structural problem in your back, or hips, or even the way you exercise. After a thorough evaluation, we work with you to set a path toward attaining your goals, including hands-on manipulation, stretching, and strengthening.

Why did you name your practice Four Corners Physical Therapy?

The intersection outside Debra’s first office was called “Four Corners,” a name she learned was associated with the Native American medicine wheel. The medicine wheel is a symbol of many things, including the four directions of the Earth and the four elements. This concept of four resonated with Debra, because she sees physical therapy as having four essential components as well: mind, body, spirit, and motion.

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FEMALE PELVIC PAIN

Vulvodynia • Vestibulitis • Vaginismus Endometriosis • Abdominal & Pelvic Adhesions Pudendal Nerve & Other Abdominal and Pelvic Neuralgias Painful Bladder Syndrome • Interstitial Cystitis Pelvic Organ Prolapse • Bladder & Bowel Stress & Urgency Incontinence Pregnancy Related Pubic Symphasis • Back • Sciatica • Hip • Pain & Weakness Post-Partum Diastasis Recti • Coccydynia • Pelvic Floor • Back & Hip Corrective Strengthening Post-Partum Scar Pain & Adhesions Pre & Post-Surgical Hip Labral Tears

MALE PELVIC PAIN

Scrotal • Penile • Perineal Pain with Sitting & Exercise & Sex Chronic Non-Bacterial Prostatitis Pudendal Nerve and other Abdominal/Pelvic Neuralgias Painful Bladder Syndrome & Interstitial Cystitis Post-Prostatectomy Incontinence Proctalgia Fugax • Coccygdynia • Levator Ani Spasm Pseudo-Hernia & Groin Pain • Hip and Back Pain Post-Surgical Vasectomy • Oncology/Colo-Rectal/Abdominal Recovery

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What makes your practice unique?

At the first visit, patients often comment that they have never before been examined so extensively and with such care. We do a thorough examination of your spine, hips, and pelvis to assess joint and soft tissue tightness and identify specific weaknesses and faulty movement patterns that may be contributing to your pain. We do this every visit in order to check your progress and modify treatment accordingly. The hands-on work we do is to provide tissue-specific localized treatment to nerves, muscles, joints, and viscera to allow pain-free movement. It’s gentle, subtle work that is highly effective and does not hurt.

“I want to be able to laugh hard at funny movies without peeing all over myself.”

“I want to be able to take care of my newborn without crying because I’m in so much pain.”

I just had a baby and I am having a lot of pelvic pain, but it is nearly impossible to leave my house. Can you help me?

Yes! Four Corners is proud to offer a new service for new moms. We will come to your home and help you to get the critical muscles of the deep abdominals, hips, and perineum to start returning to normal. Any internal pelvic floor work will wait until you have your 6-week check-up with your provider. Getting your muscles and joints back to work early can do so much to prevent the problems that can persist years after childbearing.

What kinds of problems are you referring to?

Millions of women experience pelvic organ prolapse, bladder and bowel incontinence, and sexual dysfunction after childbirth. In addition to muscle weakness that may have occurred during pregnancy, musculoskeletal injuries may occur during delivery that if left untreated will remain unresolved for years to come. This may occur from an unhealed episiotomy, a 4th degree tear into the anal opening, a nerve stretch during the baby’s descent, scarring, or restriction in the vagina or vulvar area.

“I want to be able to eat normal food that doesn’t make my bladder go crazy.”

I am newly pregnant with my second child and am terrified that the lower back pain and leakage I had with my first pregnancy will return. The advice I received with my last pregnancy—a heating pad, Tylenol, and staying near a bathroom—just didn’t cut it. How can you help me?

Have a conversation with your provider, OB, or midwife. Express your concerns and inform them that you will be attending physical therapy with a specialist in prenatal care. It’s good to have everyone on board. I always send my evaluation to the referring or soon-to-be-referring physician. We will work on correcting joint dysfunction of the spine, hips, and pelvis with gentle, safe hands-on work and specific exercises to help you get through your entire pregnancy in much better shape. We’ll also create a postpartum plan to help you in those early weeks of recovery.

Debra Goldman physiotherapist stretching patient

Can I get treatment without seeing a physician?

Absolutely. Direct Access in NJ allows patients to see a physical therapist without a prescription. The exception is for Medicare patients. That being said, we are all about collaborative care. If you are not under the care of a physician, we will refer you to our list of providers who will help you on your path to recovery. You need to make sure there are no other medical issues impacting your care.

“I want to be able to swing a golf club without wearing a man diaper.”

What kinds of problems do men with pelvic pain and pelvic floor dysfunction have?

Men with pelvic dysfunctions include penile pain with ejaculation; testicular pain with sitting or walking or exercise; severe shooting pain into the rectum; unresolved groin pain; coccyx pain with sitting; lower back pain; constipation; bladder and bowel dysfunction.

“I want my episiotomy stitches to heal normally so I can have sex without it hurting.”

I have had burning and itching in my vulvar area for months and my pelvic muscles feel as if they are in spasm. How does therapy help?

It is important to see your provider and rule out medical issues such as chronic yeast infections, urinary tract infections, bacterial infections, and sexually transmitted diseases. Pelvic floor muscle spasm can be a response to nerve irritation. We use gentle hands-on therapy that treats the nerves, the connective tissue, and the muscles of the pelvic floor, and restores any other imbalances that we find in your comprehensive evaluation.

Why is it so hard to find the right treatment for these problems?

Typically patients with pelvic pain see 5-7 physicians before they are treated by a pelvic floor physical therapist. Unfortunately, even in the tri-state area, not enough physicians understand or appreciate the role of pelvic floor physical therapy for these issues.

I’m 48 years old and I have been told by my doctor that I have a prolapsed bladder. I am noticing that I have to run to get to the bathroom when I arrive home, otherwise I leak urine. How can you help me? I’m not ready for surgery!

Millions of women experience pelvic pressure, tissue at the vaginal opening, and bladder urgency and leakage. It is very common but it is not normal. Physical therapy should be the first line of intervention for a prolapsed bladder. Prolapse is caused by laxity in the vaginal walls but could also be affected by weakness or spasm and restrictions of the abdominal wall, spine, hips,  and the pelvic floor. We will provide you with a comprehensive exercise program and hands on work as needed to address these problems and avoid surgery.

“I want to get back on the spin bike without scrotal pain.”

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