Jen Torborg, PT, DPT, CMTPT is a physical therapist specializing in pelvic health. She serves the Chequamegon Bay area in Northern Wisconsin, treating people of all ages and genders for pain, bowel & bladder dysfunction, and rehabilitation post birth, injury, and surgery. Jen earned her doctorate in Physical Therapy at UW-LaCrosse and is also a Certified Myofascial Trigger Point Therapist. Jen’s primary passion lies within treating women for a variety of pelvic health concerns including bladder problems, pelvic organ prolapse, pregnancy-related issues, postnatal concerns including stubborn clogged milk ducts, bowel problems, and pelvic pain.
Originally from Sheboygan Falls, Wisconsin, Jen came to Northern Wisconsin for the first time in 2015. Her and her husband fell in love with the area while visiting the ice caves in Cornucopia. They thought, “if we like in the winter, we’re gonna love it year round.” Soon after falling for the South Shore, Jen started commuting to work in the Ashland office of the company she had been with, Orthopedic & Spine Therapy. When the couple settled in Washburn, Jen simultaneously opened a Bayfield office. She divides her time between both offices, so you can schedule with her at either location.
Nena: How did you get into this line of work?
Jen Torborg: I always knew I wanted to do something healthcare-related, and I was drawn to physical therapy. It wasn’t until I actually got into physical therapy school, that I learned there was such a thing as pelvic health/women’s health physical therapy. I was inspired to pursue that specialty which has become a huge passion of mine.
When I asked Jen how far clients travel to see her, she let me know that some of her male pelvic PT clients drive from up to three hours away to work with her. At this point, I was definitely mind blown…and had to ask:
I don’t know if I had ever thought about male pelvic [PT] until you said that. Could you say a little bit about what’s similar and different for men and women [in your care]?
Most men I see for pelvic PT come because of urinary leakage, especially post-prostatectomy, and pelvic pain. Ideally, it would be great to see men pre-op for post-prostatectomy.
What we’re learning now is that we shouldn’t treat men the same way we’re treating women. It’s one of those few cases where we’ve actually got more research on urinary leakage in women than in men. I recently went to a male-specific course in Chicago. We learned under real time ultrasound imaging that different anatomy cues can really effect the way men are able to stay continent.
Why do you think this work is so important? What do you love most about it?
I love that sometimes very little tips and tricks can completely change what someone’s experiencing. Not to minimize what I do, but the reason some of the pelvic dysfunctions come on in the first place is just because we don’t talk about it enough. We often don’t know what’s normal. So for example, women who are going to the bathroom a lot (sooner than every two hours) or who are holding it all day (more than 4 hours) and maybe restricting fluid – that’s a conversation on healthy versus unhealthy habits. You should go to the bathroom every two to four hours. You should drink roughly six to eight cups of water.
Let’s talk and learn and be aware of how our body works. And all of a sudden, changes happen, we feel empowered and we better understand what is in our control. So that’s what I’m really drawn to – helping people understand.
It’s kind of funny because when I was a kid I did not like to talk about that stuff. I was pretty embarrassed about some of those things and had my own struggles with bathroom issues. I want to help normalize talking about how our bodies function.
Do the women who come to see you tend to come in a certain life phase or if a certain thing is happening? Or do you get a pretty big range?
Pretty big range. I’ve treated kids, usually around middle school and high school, girls who are leaking during the school day or sports. Then I’ve treated 90 year olds who have had success with physical therapy and keeping continent. Pelvic pain anywhere throughout the lifespan. I do see a lot of pregnancy and postpartum, too.
How is pelvic floor work, awareness, and health helpful to women during pregnancy and after birth? Do you think that it’s helpful preconception as well?
That’s a really good question. I think the more we can know about that part of our body, can be empowering. I think understanding how the pelvic floor, the transverse abdominis, and the diaphragm change during pregnancy. There are normal changes from carrying a baby and increase in laxity, but there are things you can do preventatively – like learning how to contract and relax those muscles, how to breathe, how to hold your posture as you’re experiencing those changes — that can be helpful in having a better labor and delivery, and postpartum recovery. So those would be great things to learn early on in pregnancy or maybe even preconception.
Definitely postpartum, too. If things don’t feel quite right yet, especially if you’re having pain or leakage or feelings of falling out, those are things we want to address right away and make you feel more comfortable in understanding why they’re happening and what you can do. I think it’s so important to have a musculoskeletal check postpartum at some point. There are plenty of women who will come in and they’re doing fantastic. Our bodies are strong and meant to do this, and so it doesn’t mean that everyone is going to have all this dysfunction because they were pregnant or had a baby. But just having that assurance and having someone to talk to to know what to watch for and what’s normal, how to return to exercise and how to return to sex. That doesn’t always just happen at six weeks.
Do you see a lot of clients who have experienced trauma either sexually or through birth and how does your work help someone who has experienced trauma?
Yes, I’ve treated many clients who’ve experienced trauma – some who are willing to share with me and some who may not. I approach each person’s evaluation and treatment program individually. Some who’ve experienced trauma may take more time to be comfortable working in the area of direct trauma whether that is near the pelvic floor externally, internally or over a cesarean section scar. My goal is to guide them to healing in a way and at a pace that feels comfortable to them.
Do you ever have people who want to be able to do the inner work, but it might take a while [to get there]? Have you worked through that process with anybody?
Yes, internal work is not for everyone. Often times doing an internal exam can be extremely helpful in understanding what’s going on with a person’s symptoms but if they are uncomfortable with this it can be avoided or delayed. So the fear of internal work should not scare potential clients off from coming to pelvic PT. Sometimes internal work is a part of a treatment plan. This is sometimes done by myself in the clinic and sometimes I will teach clients on a model and they can work through it independently at home. It’s really about finding out what works for each person.
I’ve worked with women with vulvodynia/vestibulodynia and other pelvic pain dysfunctions. It’s important to not force internal work on anyone who’s not ready. That might mean starting above clothes. It might be deciding if it’s easier for a client to touch herself, for her partner to do the work or for me to as the clinician. Sometimes we bring partners into the equation and into the clinic to teach them home programs. It just depends on each person and what they want.
How can this work impact a woman’s experience of sex?
If there was any sort of trauma physically to that area during childbirth, such as tearing or episiotomy, sometimes the scar tissue – even if they really want [to be intimate] and they are ready psychologically – the physical aspect can kinda slow it down or become painful. So teaching scar tissue mobilization. I can do it for them here or teach them or their partner to do it. Once you’ve had one pain experience, sometimes the whole body wants to tense up a bit. So as soon as we can, begin breaking down the pain cycle and creating positive experiences of touch. There are many other reasons a woman may have pain with intercourse and lots of options for treatment within pelvic PT.
After disclosing my admiration for the holistic sex and relationship coach Kim Anami, the gorgeous tan woman you may have seen with a chandelier dangling from her vagina, and proposing the quandary of doing kegels without resistance (which Anami likens to doing bicep curls without a weight), I asked:
So what is your opinion about kegels?
So a kegel is activating your pelvic floor muscles, but Pelvic PT is much more than simply strengthening one muscle group. Kegels aren’t appropriate for everyone and I want to restore function for optimal body movement. So I often include a discussion about breathing patterns, posture and then add in what’s happening with your pelvic floor –can you activate AND relax it in a variety of positions and with a variety of movements. I want not only the pelvic floor functioning well but also all the muscles and joints around that area. And I want to quickly take clients from doing kegels in isolation to adding them (with posture and breath) to functional activities. Vaginal weights are an option in pelvic floor rehab, but they’re not necessarily for everyone. And I would recommend being checked out by a pelvic PT before starting an internal weight exercise program. There’s also internal biofeedback devices that can hook up to your smartphone to give you feedback on your pelvic floor strengthening – devices called k-goal and Elvie.
Some people need reverse kegels which is essentially just the let-go phase of it. I don’t want people squeezing all day long; I want them to also honor the relaxation phase. An easy way to start “kegels” is to follow it with your breath cycle (inhale = relax, exhale = gentle squeeze) but again these are broad concepts and anyone experiencing pelvic floor dysfunction may benefit from being checked out individually.
So you’ve kind of been talking about this, but could you walk me through what working with you looks like? What happens in the first session? How do you design longer-term working together?
So everyone’s experience may be different based on what they’re seeing me for. Typically, for incontinence, prolapse, and postpartum rehab, sessions may be once a week for six weeks. For pelvic pain or pain during pregnancy, sessions might be twice a week for six to eight weeks. But it really varies per person, and I’m all about finding out what works best for you. Taking into consideration availability, travel time, finance, goals, the amount of feedback needed, etc.
And do they come right away, right after birth?
Usually around four to six weeks after. I’ve had clients come a week later if they’re in a lot of pain afterwards and want to [address] it. But if it’s more for pelvic floor or diastasis recti rehab afterwards then most clients ask for a referral at their six week checkup with their care provider.
Is there anything that women should avoid doing that could hinder their pelvic health?
Breath holding. That’s a big one. It’s important we breathe! I don’t think there are inherently bad exercises out there. It’s how they’re performed and is your body ready for that. So if you’re feeling pain, leakage or pelvic heaviness during movements – that’s when you should listen to your body and seek out help for modifications and learn how to fix what’s going on.
I would say ones that are commonly performed incorrectly would be crunches and sit-ups, but it doesn’t mean they’re bad. They can be very functional activities. They just might not be your first one to choose postpartum. You might want to wait a little bit. The more we can get full body motions – squats, lunges, going to pick things up, reaching – I think those are going to be really beneficial.
I’m glad you said that “it’s never too late,” though you don’t want people to wait [to come see you]. I feel that in my work with birthwork and studying things and also just for myself personally – there are so many things that I read and learn about that say, “You have to do this before you get pregnant or during pregnancy or the first 40 days, the first 40 days.” And I’m just like, Well, it’s three to six months later, I never did those things, but I’m still having these experiences. And I’ve had to just tell that to myself. I missed that window; all these other things were going on, it’s three, six, eight months later and I need that intensive resting and recovery now. And I’m really glad that I have a supportive family and [decided] I’m just going to do this now. But I FEEL for women – there’s no way I’m the only one who thinks, Oh I missed that, I learned such important things way after the fact, IS there hope for me?
YES there is, there’s so much hope. And you’re saying it in a matter of a few months. I have people who come in like ‘”Okay, now it’s 10+ years postpartum and finally my kids are off doing their own thing and I can take the time to treat my leakage.” “Now it’s three years later, I want to get pregnant again, and yeah, that pain from intercourse never stopped.” I hear the stories all the time and it’s never too late. If something doesn’t feel right, even if you kind of knew it all along but you didn’t either have the courage to ask for help or the time or finance or things like that – it’s not too late. I think there have been and there are a lot of people that don’t know that pelvic PT exists. Even within the healthcare and fitness world.
We’re also continuously learning new things in pelvic PT. So people might have tried pelvic PT 10 plus years ago, and it wasn’t that successful for them. They may benefit from trying again now if their symptoms still haven’t resolved.
What are the improvements you’ve seen in clients such as issues resolved in their lives on any level – physical, emotional, mental? Because – it’s not just physical.
It’s pretty high success rate, really. Almost everyone I see improves in some way, shape, or form. Even if their improvement is just being listened to and coming up with a team/game plan for their treatment that improves their confidence and hopefulness.
That’s one of the parts I love about physical therapy – we get a lot of one on one time, we’re not rushed. You get at least 40 minutes with me each time to sit down and talk through this and practice these things (and more time if we need it). And there’s people who leave completely cured. I have people come in who are using eight pads a day and they’re down to ZERO by the end of their treatment. Or women who haven’t had sex in a long time or it was painful, and now they’re actually enjoying it again.
I’ve been amazed and kind of shocked about how little people know about vulvodynia and vaginismus…I think it’s really fascinating to be in a time where people are starting to have names for these things and talking about it, and even if the research is minimal – it’s happening. Or people are noticing, Hey there’s not a lot of research on this. What’s going on? So I really appreciate that.
Yeah, I didn’t know about most of these diagnoses myself prior to my education and training. I also had very little idea of what’s normal versus not normal. Even going back to those very simple things like how often should I have a bowel movement and what should it feel like? The amount of times I tell people, you shouldn’t have to push or strain…their mind is just blown! Like no way, I’ve done that my entire life. You’re saying it’s possible to sit down on a toilet and just let it go?
That’s part of what’s so great about squatting!
Exactly. I had no idea prior to being a pelvic PT that good bowel movement posture was to mimic a squat.
Can we talk about internal trigger point therapy a bit? I’ve heard it can be painful.
This is something maybe all PT’s don’t agree on, but almost all the stuff I follow on pain science [says] our therapy should not hurt people. Very rarely should we have to experience pain to make gains. So trigger points may be one of those few exceptions. Sometimes we’re finding that the release of the trigger point, which may be a little painful, is successful in breaking a pain cycle and changing the tissue or nervous system input. And that the brief pain is worth the awesome relief some clients experience. But the whole session should not hurt!
So only will I continue doing trigger point therapy if by the next treatment or two, they’re like, wow I felt such a release, I can stretch more now, I can do my job, I’m not getting these radiating pains…I’ll only continue if whatever they’re seeing me for is getting better. The rest of the therapy sessions should ideally focus on things you can follow through with yourself outside of the clinic, whether that be teaching you how to do manual work, posture, breathing or getting you moving.
Thank you for that clarification!
I noticed that you teach HIIT. I’m curious about how these worlds connect for you – the PT work and the fitness.
The fitness thing is something I started to do recently as a way to have more options in the community. HIIT stands for high intensity interval training. I definitely keep it we’re just there to move and show up and we can make it whatever you want. So I have some people who are bustin’ through and sweatin’ and getting a really good workout in. And then somebody else is taking their time, going through the steps, listening to their body, maybe really working on form or breath or whatever it might be. So I offer tons of modifications.
It’s different every single week. It’s fun! Men and women can come. And as long as you’re not doing anything that’s going to cause you pain or leakage or feelings of falling out – those are my little disclaimers. Please tell me! I’d want to find an alternate for you.
That’s good. I don’t think you’d normally have a fitness person say, “Are you leaking? We need to change this.”
Are there any other modalities of healing or bodywork or anything that you feel are really complementary to the work that you do?
There’s a lot of complimentary healing work out there and I’m very open to finding out and supporting what works for each one of my clients.
Is there anything else that you want to share?
Just knowing that I’m here. For a lot of women (and men), these are embarrassing conditions. They’re not sure who can actually help. People can always talk to me on the phone ahead of time. They can come in for free screens where we just sit down and chat. I love being able to answer those questions.
Also, there’s a website from the American Physical Therapy Association, where you can type in your zip code and see who the pelvic PT closest to you is. So if you’re not in this area, you can use this tool to find a provider.
And are you able to take insurance?
Yes. Orthopedic and Spine Therapy takes most insurances and we also have cash rates available. Please call if you have questions: 715-685-9656.
Connect with Jen at her office’s upcoming Open House in Bayfield!
Orthopedic & Spine Therapy of Bayfield will be offering an Open House on Thursday, May 3rd, from 1-5 p.m. Our physical therapists, Jen Torborg and Kennan Archer, will be available to address any of your current health concerns. They can answer questions such as; is physical therapy right for me, how can I avoid surgery, what is aquatic therapy and dry needling, and how can I stay fit and healthy? Our patient care coordinators will also be available to help with any insurance coverage questions.
Come and join us for an afternoon of refreshments, educational opportunities, and drawings to win local goodies! Let us show you what we have to offer this wonderful community, and come and share your personal journey with us!
More info available at: