It’s the group of muscles that lines the bottom of the pelvis. They provide continence (for both pee and poop!), support for your pelvic organs and stability of the spine and pelvis. These muscles need to be healthy and functional for sexual activity as well.

Your improvements will be influenced by physiology, stress, childcare, time, energy, nutrition, sleep, age, general health, chronicity and your ability to follow the home program. We decide together what frequency of visits will best support you for sustainable lasting change. We don’t just want to resolve symptoms, we want to get to the root cause and prevent them from coming back. At the end of each session we will take 5 minutes to review what we found, what it means and what next steps will be, so you are never left wondering where you are in the healing process.

Plan for 75 minutes. We’ll review the information from the forms you filled out, I’ll ask follow up questions to help guide my assessment and then perform a physical exam. Depending on relevance that might include muscle strength testing, functional tasks like breathing or squatting, palpating muscles/fascia/joints for restrictions and (for pelvic floor conditions) an internal (vaginal or rectal exam). The internal exam, if performed, is to assess the strength, coordination, laxity and tension of the muscles in the pelvic floor. Depending how we’re doing on time I may treat any tension we find with manual therapy techniques or start training uncoordinated/weak muscles. I’ll teach you exercises, stretches, breath work or lifestyle/behavioral strategies to address our findings and make a plan for creating long lasting change. Please ask questions at any time. I’m happy/try to justify my thinking so that it all makes sense to you and you can participate/consent fully in your plan of care.

• One-on-one with Dr. Natalia Martinez, no aides or techs.

• 50-55 minute sessions

• We’ll check in on symptom progress, review the home program, adjust it if necessary and the rest varies. We might do further assessing and experimenting to confirm hypotheses about pain generators, we might treat tense structures with manual therapy or we might focus on coordination/strength/skill building. The process is collaborative and I want each session to prioritize your goals. 

The plan is to get you better long term, not just short term symptom relief. Please note, it may take several sessions of investigation to identify the root source of the issue. 

Yes! It’s not necessary for all conditions but it can be helpful for complex cases and available for patients who are driving longer distances.

Late cancellations within 48 hours of your appointment will be charged 50% of the visit cost and cancellations within 24 hours will be charged 75% of the visit cost. No shows will be charged the full price of the visit.

Depending on your condition and specific presentation, kegels may actually worsen your symptoms. I prescribe them when appropriate and determine whether speed, endurance, or coordination is the issue and assign exercises based on exam findings. You will not get a stock program and your home program will likely include exercises for muscle groups outside the pelvic floor to improve the way the system works as a whole. 

Pelvic floor physical therapy exams are very different from the ones at the gynecologist office. I use a gloved lubricated finger (no speculum or stirrups) to gently palpate the muscles and check for tension. I then assess your strength and function of the pelvic floor muscles. I am not assessing your organs like a gynecologist would. A PT internal exam is often longer than a gynecologist exam and will involve your participation. 

I will never pressure you to have one. You are 100% in charge of that decision and there are often alternatives that can be helpful. Depending on the condition it might be optimal to have internal work performed but I will work with you to find a solution such as teaching you how to perform the internal exam and treatment yourself or using slower paced modalities that can eventually get us almost as good results. However, I will be honest when I think your condition would get better faster/more significantly/more long term with internal work. You are entitled to that information and to give informed consent to your plan of care. 

You can say “Let’s stop”, “I need us to end the exam” or  “I’m no longer comfortable” and you don’t need to tell me why. It will help me provide better care if you can provide feedback but sometimes internal work just triggers memories/feelings you don’t want to share and that’s totally ok. 

Yes! We can still perform internal work while you are on your period but if you prefer to wait until your next visit, that’s fine too. There are always activities we can do without internal work.

Yes! There is still plenty to do, learn, and discuss. Maybe we need to redesign your program to make it easier or more likely for you to do. Maybe it’s already time for new ones. Come on in and we’ll find out!

Athletic or leisure wear is ideal so you can be comfortable for stretches and exercises. Please do not wear jeans or other thick materials as they limit both motion and palpation. Sneakers are helpful if our session might involve jumping/running. 

Yes! It can be really hard to access child care so please do whatever helps get you in. Children can be distracting during sessions and so it isn’t optimal sometimes but we strategize together to make it work for everyone and can still get so much done. Please plan for your child to stay in a stroller, car seat or chair for the duration of the session.

Yes! And anyone else for that matter. We oftentimes will be discussing very sensitive matters (bowel, bladder and sexual dysfunction) so keep that in mind. There’s also the option to have the person sit in the room with us for part of the session and sit in the waiting room for part of the session.

Yes! Please note that I wait until the 2nd trimester for internal exams. 

During pregnancy we can work on reducing general physical pain/discomfort, reducing tearing from vaginal delivery, reducing diastasis recti, pushing practice, labor positions, core strengthening, leakage and more! The goal is to keep you active and comfortable throughout your pregnancy and optimize delivery whether that’s vaginal or C-section.

Anytime! We won’t do an internal exam until you’re cleared by your MD (usually at 6-8 weeks) but there’s plenty we can do until then. 

Arrive early to allot sufficient time for parking and using the bathroom before the visit. My office is located on the ground floor. Handicap parking is available out front. Metered street parking is usually fairly accessible within a block of the office and there is a parking garage next door (called The Promenade). Street parking and the garage are the same price but the garage closes at 5pm sharp so please do not use for later appointments. If Addison is full, often there is parking available a block over on Center Street. Free parking can also sometimes be found west of MLK in the residential area. The lot in front of the building is for tenants only except for the accessible disability parking.

I do not. Insurance reimbursements do not allow for the one on one care that quality physical therapy requires and I am not willing to make the compromises necessary (such as shortened visits or using an aide to perform part of your treatment) to make that sustainable. Insurance also limits the number of visits we can see each other for and the body parts we can work on. I need the flexibility to adapt to the person in front of me in order to deliver lasting results. 

If cost is a barrier there is a sliding scale available or I can provide you with a superbill (an invoice) that you can submit to insurance/HSA/FSA for reimbursement. Not all insurances reimburse for out of network visits. Please note that if you have a high deductible plan it may be less expensive to be seen at Duende than at an in network provider (such as a hospital system) that charges more per visit. 

*If you have Medicare I am not legally permitted to accept cash payments or provide a superbill for reimbursement.

Depends! I will always try. Please let me know what you need e.g dimming the lights for a migraine, lightening the pressure during manual treatment, extra explanations, repeating information, repeated requests for consent, masking, etc. I want you to feel comfortable and safe so please let me know if there’s something I can change or offer. 

Nope! In California you can see a PT for 45 days/12 visits (whichever comes first) before needing a referral. Once we get started I’ll fax our plan of care to your provider to sign.

In addition to extensive training, experience and mentorship I have an investigative approach to search for the root of the issue rather than providing stock programs for a certain symptom profile. The same symptoms can come from different sources (e.g leakage can be caused by both overly tight and lax/weak muscles!) so it’s essential to determine which before creating a program customized to you. 

Many pelvic floor therapists zoom in on the pelvic floor but that’s oftentimes not the origin of the symptom and so I look at the body as a whole to see where else this problem could be stemming from. 

We start the first session with a thorough intake where you can share what worked before and what didn’t so that we don’t take you back down an ineffective path and can start with what we already know is beneficial.

I do not use a biofeedback machine, but provide more accurate feedback in real time through tactile, verbal and visual cueing. Biofeedback machines often detect the wrong muscular activity, give false information and confuse bearing down with contracting (opposite activities!). Also, when you are hooked up to the machine your mobility is significantly limited and my goal is to get you off the table and performing functional activities that mimic your daily life. 

I abandoned this technology several years ago and my patients have been much better served by alternative strategies.

Please help us maximize our time together by using the bathroom before our visit. The bathroom is conveniently located just outside the clinic door.