your first pelvic floor physical therapy session: what to expect
Dr. Allea Francis, PT, DPT
We highly recommend reading our Pelvic Floor Physical Therapy blog post before this one, as it explains the anatomy and functions we are assessing—and why each part of the evaluation matters.
Introduction
Whether this is your very first pelvic floor physical therapy appointment or you’re simply new to Tonic & Phasic Holistic Pelvic Health, this guide will help you understand what to expect. Our clinic operates differently than many standard physical therapy practices. We take a whole-person, trauma-informed, and nervous-system-aware approach that blends functional movement, hands-on care, and personalized strategies to support long-term healing.
Your first session is designed to gather meaningful information, build a safe and collaborative partnership, and create a plan of care that aligns with your goals.
Before Your Appointment
You’ll first connect with our Care Coordinator, who will help with:
Directions to our clinic
Scheduling logistics
Paperwork and intake forms
Answering any preliminary questions
This is your first introduction to who we are and how we support you from the moment you reach out to us.
Your First Appointment
When you arrive, you’ll be greeted by the therapist you’ve been matched with. Each of our Doctors of Physical Therapy has specific training and clinical strengths that allow us to coordinate the best possible fit for your needs.
Your therapist will walk you to a private treatment room, where you’ll begin reviewing your intake form and discussing your history, symptoms, goals, and concerns.
Step 1: History + Conversation
This portion of the session is one of the most important parts of the entire plan of care. For some individuals, this discussion may take the full hour, especially when the history is complex. It is crucial to us that we prioritize getting to know each patient, so we can craft a tailored plan of care – every person’s pelvic health history is different from the next.
Your therapist will ask about:
Your symptoms and what makes them better or worse
Medical and surgical history
Menstrual, pregnancy, or postpartum history (if applicable)
Bladder and bowel habits
Sexual function
Lifestyle, stress patterns, and nervous system habits
Exercise, daily movement, and occupational demands
This conversation gives your therapist a better understanding of the complexity of your case, helping answer the very common question: “How long will this take?”
Your therapist will begin estimating this based on your individual presentation, goals, and contributing factors.
Step 2: The Biomechanical Assessment
Now that the history is complete, you and your therapist move into the physical exam and begin your plan of care. Everything is explained clearly, step by step. Nothing is done without your consent.
Your biomechanical assessment may include:
Spinal range of motion
Hip mobility and strength
Core engagement and coordination
Glute strength
Functional movements: squatting, hinging, single-leg balance, forward folds
Reproduction of symptoms with movement
This helps us understand how your body loads, stabilizes, and compensates—often revealing contributing factors to pelvic symptoms.
Step 3: Breathing + Abdominal Wall Assessment
The abdominal wall gives us a tremendous amount of information about the pelvic floor without even evaluating it directly.
We will assess:
Breath mechanics
Ribcage position and movement
Abdominal tension or guarding
Coordination between the diaphragm and pelvic floor
Signs of overactivity or laxity
Organ positioning of the colon, bladder, reproductive system
These patterns guide how we approach treatment—because the abdomen and pelvic floor work together as a system.
Step 4: Pelvic Floor Assessment (If Appropriate)
We always explain what we are looking for and why, review the purpose of the pelvic floor assessment, and ask for your explicit consent before proceeding. This assessment can be done transvaginally or transrectally depending on your biology or symptoms.
A pelvic floor assessment typically evaluates:
Resting muscle tone
Ability to contract, relax, and lengthen
Endurance and coordination
Tenderness or trigger points
Reproduction of symptoms
Pelvic organ support
Nerve tension
You will be in a supported, comfortable position on the treatment table. If at any moment you change your mind or feel uncomfortable, you can simply say:
“I don’t feel comfortable continuing.”
We honor that immediately and shift to alternative evaluation strategies. After the assessment, your therapist will step out so you can change back into your clothes.
Step 5: Reviewing Findings + Building Your Plan of Care
Your therapist will then discuss:
What they found during the assessment
How these findings relate to your symptoms
The underlying contributors
The estimated length of your plan of care
Frequency of visits
What you can expect in the coming weeks
A typical musculoskeletal healing timeline is 8–12 weeks, similar to strength training—because the nervous system and soft tissues need consistent input over time. This varies from person to person and will be individualized to you.
You’ll then book your appointments according to your plan with our care coordinator. While we know life happens, illness, travel, or holidays, we aim to maintain consistency to support steady progress.
Follow-Up Sessions
The first month is often described as “peeling back the layers.”
We are discovering:
What your body responds to
What creates relief or change
Where your nervous system lands on the spectrum of tension vs. relaxation
Follow-ups may include:
Manual therapy
Nervous system regulation strategies
Vagus nerve stimulation
Breathwork and core retraining
Pelvic floor coordination practice
Strengthening and mobility work
Lifestyle and behavioral modifications
Guidance on cycle tracking, bladder diaries, nutrition, or further imaging if needed
Every session is designed to progress you, even if progress is not always linear. Healing often moves in waves, but consistency leads to meaningful improvement.
Your Role in the Healing Process
We will give you individualized home practices—this may include:
Stretches or strengthening exercises
Daily movement strategies
Breathwork or grounding
Modifications to habits or routines
Reading or educational resources
Symptom tracking
Menstrual cycle tracking
If you show up, practice the strategies we recommend, and allow your body and nervous system time to adapt, you will see progress.
Ready for Your First Appointment?
We are honored to support you. If you're preparing for your evaluation, or if you’d like to learn more, visit our Pelvic Floor Physical Therapy post or reach out to our care coordinator at (949) 612-7695 for any questions.
