Rethinking Pelvic Floor Therapy and Rehabilitation: A Multimodal Approach with Shockwave + EMTT

Pelvic floor dysfunction rarely begins and ends with the pelvic floor.

Scar restrictions, persistent tissue tension, abdominal dysfunction, pelvic pain, urinary symptoms, pain with intercourse, and low back and hip symptoms can all overlap with pelvic floor concerns. This complexity is why an effective treatment can require looking well beyond the traditional pelvic floor playbook.

That was a central message from Dr. Allison Feldt, PT, DPT, during her recent CuraMedix webinar exploring the integration of Radial Pressure Wave (EPAT®), Focused Shockwave (ESWT), and EMTT® into comprehensive pelvic floor physical therapy.

Founder of Body Motion Physical Therapy in the Seattle area, Dr. Feldt works with women throughout pregnancy, postpartum recovery, perimenopause, menopause, and beyond. Her approach starts with an important clinical principle: treatment needs to be targeted to each patient’s quality of life challenges, tissue restrictions, and functional goals.

During the webinar, Dr. Feldt showed what that philosophy looks like in practice, sharing how she has successfully used Shockwave and EMTT alongside manual therapy, movement, breathing, and patient education to address scar restrictions, pelvic pain, urinary symptoms, postpartum rehabilitation, and related musculoskeletal concerns.

Watch Dr. Feldt’s full presentation here, or keep reading for the clinical insights, patient cases, and practical takeaways from the webinar.

How Shockwave Became Part of Dr. Feldt’s Pelvic Floor Care Practice

Dr. Feldt’s interest in Shockwave began with an orthopedic problem of her own. While working to rebuild strength after the birth of her youngest child, she developed persistent lateral epicondylitis. After experiencing relief following a Radial Pressure Wave treatment at a conference, she began considering how the technology might fit into her own clinical work.

The connection to pelvic floor care started with a familiar challenge: helping patients with persistent symptoms following a C-section. Dr. Feldt was already spending considerable time working on abdominal scars, and she wanted to explore whether the technology that had helped her elbow could also support the tissue mobility she was trying to restore in these patients.

Her initial pelvic floor treatment approaches were developed using Radial Pressure Wave alone, which remains central to her practice today. Focused Shockwave and EMTT expanded what she could offer as her experience grew.

Starting with C-Section Scar Care

For Dr. Feldt, C-section recovery was a practical starting point because it built directly on her continuum of care. According to Dr. Feldt, “Every single pelvic floor client is also an orthopedic client.” Some patients experienced scars that continued to feel tight or restricted despite extensive manual treatment, and some would return months later reporting renewed tightness or difficulty engaging their abdominal muscles. These experiences prompted her to look for additional ways to support recovery alongside hands-on care.

After incorporating Radial Pressure Wave, Dr. Feldt saw improvements in both scar mobility and tissue flexibility, encouraging signs that led her to explore Shockwave’s use more broadly. For a clinician accustomed to repeatedly working on the same restrictions by hand, the changes she felt in the tissue offered a compelling reason to keep exploring.

From there, the practice expanded Shockwave treatments to include other abdominal scars and postpartum perineal scars, always within a larger pelvic floor rehabilitation plan. As a core part of scar care, Dr. Feldt noted, “you want to restore the function and the integrity of that tissue.”

One patient example involved a woman recovering from an episiotomy and a third-degree tear after a difficult first birth. In this case, radial treatment and pelvic floor physical therapy helped address persistent scar restrictions and discomfort with intercourse. The patient had previously felt that her traumatic first birth would prevent her from having another child. As her comfort and function improved, she felt ready to pursue another pregnancy.

Looking at the Full Range of Pelvic Floor Function

Dr. Feldt focuses on targeting treatments based on the different demands placed on the pelvic floor throughout daily life. These muscles help support the pelvic organs and contribute to bowel, bladder, and sexual function. In her clinical approach, an assessment of their ability to relax, lengthen, and coordinate with breathing is a critical starting point for understanding a patient’s symptoms.

As she explained, “The strongest pelvic floor is the pelvic floor that can fully relax,” as well as fully contract. When patients arrive with substantial pelvic floor tension, sometimes alongside scar restrictions or compensations following childbirth, her assessment looks closely at the movement available to the tissues and how the pelvic floor works with the diaphragm and abdominal wall.

This functional understanding guides how she incorporates Shockwave and EMTT:

1. Identify the contributing factors. Consider where restricted mobility, discomfort, or tissue changes may be contributing to the patient’s symptoms.
2. Build a coordinated multimodal treatment plan. Integrate Shockwave and EMTT with manual treatment and movement, giving each element a clear role in supporting recovery.
3. Support progress with patient education. Help patients understand how breathing, movement, and daily habits relate to their symptoms and how to apply what they learn between appointments.

Training and ongoing education help medical professionals translate their clinical knowledge into effective use of these technologies. Understanding device selection, application techniques, and how to adapt treatment to different tissues and patient responses gives clinicians a stronger foundation for integrating EPAT/ESWT and EMTT into their existing work. As Dr. Feldt emphasized, “It is all about the skills and knowledge of the clinician.”

Integrating Shockwave into Comprehensive Pelvic Floor Care

Pelvic floor symptoms often bring patients into the clinic with concerns that extend beyond the pelvis itself. Abdominal scar restrictions, hip and back pain, and difficulty engaging the core can all be part of the same patient’s experience. For example:

• With urinary incontinence, leakage can occur alongside a tense, overactive pelvic floor, which makes the muscles’ ability to relax and move an important consideration when planning treatment. Simply asking the patient to perform more contractions may leave those limitations unaddressed. In Dr. Feldt’s approach, hands-on assessment helps identify restricted tissues and coordination problems, guiding how Shockwave and EMTT are incorporated alongside pelvic floor rehabilitation.
  
  
• Diastasis recti calls for a similarly connected approach. Patients often focus on closing the gap between their abdominal muscles, but rehabilitation also needs to address how the abdominal wall handles tension and supports movement. Pelvic floor mobility and pressure management are part of that work.
  
  
• Persistent pelvic pain can also interfere with work and everyday activity. One patient, a real estate agent with endometriosis and a history of disc herniation, struggled to stay on her feet to show houses despite seeing several physical therapists. Dr. Feldt incorporated radial treatment to the abdominal wall and Focused Shockwave for accompanying back symptoms, reporting improvements as part of the patient’s broader care.

Adding Focused Shockwave expanded Dr. Feldt’s options for treating those concerns within the overall care plan. As she explained, “You’re not treating the diagnosis, you’re following the patient.” Each technology serves a purpose within a treatment plan shaped by the patient’s symptoms, tissue restrictions, and functional goals.

Learn More About Integrating Shockwave and EMTT with Your Practice

Pelvic floor concerns can affect some of the most personal parts of a patient’s life, from intimacy and recovery after childbirth to the ability to exercise. The patient experiences Dr. Feldt shared brought those stakes into focus, showing why she continues to explore additional ways to help women whose symptoms have been difficult to resolve. Her work with Shockwave and EMTT offers an evolving example of how these technologies are finding a place in pelvic floor therapy and care.

We would like to thank Dr. Feldt for sharing her experience with the CuraMedix community. Watch the full webinar for a closer look at her patient cases, treatment approaches, and responses to questions from fellow medical professionals.

If you’re interested in learning more about Shockwave, EMTT, or how these technologies can fit into your practice, contact the CuraMedix team.