Active Perineal Rehabilitation (APR)
Treatments are made with NON-invasive techniques, based on the Active Perineal Rehabilitation protocol that was developed by physiotherapist Laira Ramos due to her need to offer a more appropriate treatment for women and men with perineal dysfunctions and to care of women during pregnancy and in the postpartum period.
It is the first, and still now the unique, protocol with scientific validation to promote a global pelvic floor muscle rehabilitation, and not to treat any isolated pathologies.
All treatment is done in individual sessions using modern equipment and an intracavitary probe that perform electrostimulation and biofeedback by electromyography, making the results more effective. In it we use kinesiotherapy with biofeedback, electrostimulation and home exercises; women are taught how to use vaginal cones to continue treatment at home.
Perineal rehabilitation is quick, safe and effective, the sooner you look for treatment, the better the results.
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Only those who are authorized by me can use the APR protocol.
The Active Perineal Rehabilitation& Series concept arose from the need to develop a series of programs with other techniques that can also be used in treatments:
Passive Perineal Rehabilitation, where equipment is used to make treatments more effective (stretching, TENS, inhibitory current detrusor, vaginal dilators, pessaries, vacuum pump, etc).
Sexual Perineal Rehabilitation, for specific and detailed care addressing all aspects of sexuality.
Myofascial Perineal Rehabilitation, where manual techniques are used to free the myofascial and visceral tissues.
Hypopressive Perineal Rehabilitation, where hypopressive exercises work the abdominal muscles and protect the muscles of the PERINEUM.
Dermato-functional Perineal Rehabilitation, where techniques are used to treat scars and cutaneous lesions.
Perineal Rehabilitation via Imaging, where ultrasound is used for assessment and treatment.
Obstetric Perineal Rehabilitation, for full care during pregnancy and postpartum.
None Of These Techniques Cause Pain Or Discomfort.
In order to choose the most appropriate and individualized treatment and obtain the quickest and most satisfactory results in the first appointment, all patients undergo a specific assessment of the PERINEUM muscles.
The evaluation is done by vaginal or rectal touch. In some cases, a probe can be used to obtain more objective values.
Only through this evaluation is it possible to know if the patient contracts and relaxes these muscles in the correct way, to check the strength, the reflexes, and if there are pain points or scars in this region.
Postural assessment and specific abdominal assessment may be necessary to check for abdominal diastasis.
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Kinesiotherapy | Kegel exercises
First, we start with the isolated movement of the PERINEUM, to teach contraction and relaxation, increasing your body and perineal perception.
Then we evolved to the contraction associated with hip and trunk movements, and after the patients do the contraction while standing, to train muscle agility.
Finally, we finish with the functional training, making the PERINEUM contraction associated with the movements of daily activities, promoting an individualized training for the needs of each patient.
This is an instrument used so that the patient can follow the movement he is performing.
Biofeedback by electromyography allows us to teach muscle contraction and relaxation because, through a computer graphic, the patient can visualize the intensity and duration of the contraction.
This leads to more effective muscle work, promoting neuromuscular and metabolic changes responsible for muscle performance.
All sessions are performed with biofeedback so the results are faster.
Electrotherapy is a technique widely used in physiotherapy and essential in perineal rehabilitation, but it is contraindicated in pregnancy.
Electrostimulation leads to metabolic changes that can increase muscle performance, but it is not enough to promote muscle hypertrophy. It promotes perineal perception, proprioception, sensitivity normalization, improving the function of the PERINEUM muscles.
Through electrical stimulation, it is possible to make an involuntary contraction of the muscles, so that the patient can identify which muscle should be contracted, which helps a lot in teaching contraction and relaxation.
Vaginal cones are complements that women can use in perineal rehabilitation, as part of the Active Perineal Rehabilitation protocol. Advanced patients can use these accessories to increase muscle strength and continue treatment at home.
They can have different weights and shapes, so it is very important that, before starting to use the ball or the cone, the woman makes an evaluation to be able to decide, together with the physiotherapist, the best treatment option.
These accessories are not suitable for women who do not know how to contract the PERINEAL muscles properly.
For the stretching and relaxation of the PERINEUM muscles, we can perform a perineal massage and use the stretching balloon.
The term massage is not the most appropriate because in this technique it is necessary to really stretch these muscles so that they gain more flexibility.
The balloon is an instrument used for more global stretching and a great resource for training at home.
Stretching is very important for pregnant women who want vaginal birth and in some cases of pelvic pain and sexual dysfunction.
Scar massage is a technique used in the prevention and treatment of scar adhesions from an episiotomy, laceration, cesarean section, and other pelvic surgeries.
These scars can be the cause of pelvic pain and pain during sexual intercourse, greatly reducing the quality of life of these patients.
Vaginal dilators are a kit with usually 6 dilators of different sizes and diameters, they are widely used in cases of vaginismus, neo-vagina, and vaginal atresia.
The use of dilators should not be the only form of treatment for these pathologies, they should be used as part of the perineal rehabilitation treatment, together with relaxation and stretching techniques for the PERINEAL muscles.
Pessaries are orthoses used in the conservative treatment of pelvic organ prolapse and stress urinary incontinence, which can delay or replace the surgical procedure.
There are several different sizes and models, each suitable for a specific case. It is necessary that an evaluation be carried out by the health professional in order to choose the most suitable pessary.
These exercises are part of the ancient practice of yoga under the name of NALI, but they have been widely publicized as hypopressive exercises in modern times. They are performed in order to make an intense work of the abdominal muscles, especially the transverse, in order to increase the abdominal girdle.
The great advantage of these exercises is that they do not increase intra-abdominal pressure, therefore they do not increase pressure on the PERINEUM, being highly recommended for the correction of abdominal diastasis, in the treatment of prolapses, and in the postpartum period.