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Mar 30, 2015

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with Herman & Wallace instructor Michelle Lyons, PT, MISCP


Michelle Lyons

How did you get started in pelvic rehab?

Like a lot of therapists whom I talk to when I travel and teach, it was after the birth of my daughter, when I realized what an under-served population postpartum women are! After childbirth, the focus almost entirely shifts to the baby, and poor old Mum is left, by and large, to fend for herself. Now, more than ever, when we are looking at shorter hospital stays and the lack of maternity leave, we as pelvic therapists need to grow awareness of the needs of women throughout the life cycle and what we have to offer. Pelvic rehab is a high touch, low risk, cost effective and highly effective (yet under used) treatment option. I am passionate about spreading the Pelvic Rehab Gospel!


Who or what inspired you?

Mar 27, 2015

abdominal pain

A research article published last year i BioMed Research international aims to identify premenopausal and postmenopausal factors influencing endometriosis. The authors cite medical literature in stating that 10-15% of all women of reproductive age have endometriosis, with common symptoms of abdominopelvic pain, activity limitations, and decreased sexual function. Thirty-five postmenopausal women (in whom endometriosis was diagnosed premenopausally) completed questionnaires containing 147 questions. The questions referred to the patient’s general medical history, premenopausal symptoms and complaints, and postmenopausal complaints.


The good news is that endometriosis symptoms overall improved in the postmenopausal period. General physical activity limitations were less attributed to endometriosis in the postmenopausal period. Following are some of the reported changes in dysfunction and pain intensity reported on 0-10 pain scale.


Abdominal pain 94% (pain average: 8) 63% (pain average: 3)
Dyspareunia 71% (pain: 5) 54% (pain: 2)
Sexual dysfunction 80% (pain: 5) 54% (pain: 1)
Psychological dysfunction 51% 20%
Restriction of social activity 63% 17%
Work activity limitations 80% 20%


While the authors found that postmenopausal variables in large part were improved, the rather high incidence of dysfunction should still alert pelvic rehabilitation providers to the importance of working with women in the postmenopausal period. The analyses did not demonstrate a significant relationship between medications, pregnancy and parity, family history, comorbid diseases, and the postmenopausal variables studied. Surgical history also did not appear to have a negative impact on the postmenopausal symptoms, except for hysterectomy with the adnexa or bilateral adnexectomy.

Mar 26, 2015

This post was written by Debora Chassé DPT, WCS, CLT-LANA, who teaches the course Lymphatic Drainage for Pelvic Pain. You can catch Debbie teaching this course in April in Arizona.


Deborah Hickman

Lymphedema Management in Women’s Health Physical Therapy is a home study module developed for the physical therapist who would like to learn more about lymphedema as well as prepare for the lymphedema portion of Women’s Health Clinical Specialist exam. Complete Decongestive Therapy (CDT) has been used universally to treat lymphedema since the 1800’s. The well-known Foldi Clinic is located in Germany and in the 1990’s CDT was brought to America to train practitioners. You will learn about the anatomy and physiology of the lymphatic system, lymphedema diagnoses, differential diagnoses and the phases and steps involved in CDT. The course manual takes you through the physical therapy initial evaluation for lymphedema following the guidelines for specialty practice. It also contains many case studies designed to enhance your application of CDT. CDT has many concepts and procedures that will additionally help patients with inflammation, autoimmune disorders and pain. It is a must for all physical therapist.


Do you need another tool for treating pelvic pain and pelvic congestion? Manual lymph drainage for Pelvic Pain is a two-day intermediate course that covers the lymphatic system, lymphedema, pelvic pain, manual lymphatic drainage (MLD), and how this procedure is used to reduce inflammation and pelvic pain. The course will reveal the relationship between lymph flow and pelvic pain. Research shows that manual lymph drainage increases venous flow. In one case study, researchers found that using MLD on a patient with pelvic congestion decreased the patient’s symptoms, impairments and pain by 50% following 5 consecutive days of MLD. Another case study reported that a chronic pelvic pain patient had both an increase in energy level and a 50% decrease in abdominal inflammation and pelvic pain. Manual Lymphatic Drainage for Pelvic Pain is a procedure developed by Debora Chassé using MLD techniques on the vulva and in the vaginal vault to stimulate the lymphatics in the vagina to return lymph fluid to the circulatory system. This is a low risk treatment with outstanding outcomes for all pelvic pain diagnoses. This course is an excellent adjunct for clinicians interested in learning how to evaluate the lymphatic function, design an MLD treatment plan and master MLD treatment strokes for pelvic pain patients.


Mar 25, 2015


In order to refer patients to needed care, it is vital that health care providers understand the roles that each provider plays. Within pelvic rehabilitation, this issue presents barriers and opportunities, as many providers do not know about pelvic rehabilitation, and about the wide scope of care that we can provide towards bowel, bladder, sexual dysfunction, and pelvic pain in men, women, and children. An article written by a physiotherapist and published in the British Journal of Midwifery highlights the issues such barriers can cause. Utilizing a focus group of seven 3rd year midwifery students, a researchers asked questions about student midwives' perceptions of the physiotherapist's role in obstetrics. Five distinct themes were proposed as a result of the focus group interviews:


1. Role recognition: in order to enable services for patients, understanding other professional roles is valuable.
2. Lack of knowledge: participants expressed a lack of knowledge about the physiotherapy role, and the students wondered if they should be seeking out that knowledge, or if the physiotherapists should be educating the midwives about their role. Prior inter professional education opportunities, which provides the students with potential for understanding other professions, were not viewed as positive by the students.
3. Perceived views existed: Although participants did not have a clear view of what a physiotherapist's role is in obstetrics, they had developed ideas (accurate or not) about the role.
4. Utilization of physiotherapy: Numerous barriers to utilization of physiotherapy in obstetrics rehabilitation were identified, and variations in referrals and utilization of PT were noted.
5. Benefits of physiotherapy: Participants' lack of knowledge, lack of feedback from patients, and issues such as waiting periods prior to getting care limited the stated benefits of physiotherapy care in obstetrics.


In order to avoid working independently of each other, physical therapists and midwives, along with other care providers for women, must understand the complementary roles we play. One of the best ways that we can create a shared understanding is through spending time in each other's educational or clinical environments. Each of us can take responsibility for providing some level of education towards teaching other providers what we do, what we know, and how we can collaborate. One of the ways that the Institute attempts to make this task easier is to provide you with presentations that are already created for this purpose. Our "What is Pelvic Rehab?" powerpoint presentation allows you to edit the slides created for referring providers. Within the presentation, basic information about pelvic therapy and specific research about pelvic rehabilitation for various conditions is combined. To check out the "What is Pelvic Rehab?" presentation and other patient and provider education materials, head to the Products and Resources page and see what information may help you (and your patients) share information about the role of the pelvic rehabilitation provider in collaboration with other health professionals.

Mar 24, 2015

Researchers using a community-based sample in the upper Midwest cities of Minneapolis/St. Paul surveyed 138 women between the ages of 18-49 with diagnosed vulvodynia. Vulvodynia was classified as primary (pain started with first tampon use or sexual penetration) or secondary pain started following a period of intercourse that was not painful. The authors aimed to determine the rates of remission of vulvar pain versus pain-free time periods. Remission was defined in this study as having at least one period of time that was pain-free for at least 3 months. Generalized vulvodynia categorization was made after clinical exam and was determined by the subject having pain at each point on the perineal “clock” with cotton swab provocation.


The authors reported that women diagnosed with primary vulvodynia were 43% less likely to report vulvar pain remission that women with a diagnosis of secondary vulvodynia. They also found that obesity and having generalized versus localized vestibulodynia was associated with reduced rates of remission. The theory was discussed that women who have different types of vulvodynia may have varied underlying mechanisms of pain that lead to differences in symptoms. Specifically, the paper reports on recent brain imaging work that suggests women who have primary vulvodynia demonstrate more characteristics of central pain processing.


In relation to health behaviors (such as seeking pain therapy), the authors state that the data may not be sufficiently powered to determine the influence of therapy on remission. They do agree that “…understanding of both spontaneous remission and improvement owing to therapy will ultimately provide guidance in developing more effective interventions.” Because a significant portion of women do not seek care for vulvar pain (for unknown reasons), a bias is created in the research through the lack of representation of those women who are not being studied through healthcare access.


The research concludes with a few familiar themes including the need for more research studying the clinical courses of primary versus secondary vulvodynia. We are also left with questions about which women seek care and why, how their clinical outcomes and remission history may differ based on intervention and other intrinsic variables such as body mass index, and how central pain processing affects pain duration and remission. If you are interested in learning more about vulvodynia, come to one of our newer courses offered by faculty member Dee Hartmann, Assessing and Treating Women with Vulvodynia. Two entire days are spent discussing vulvodynia theory and clinical skills for helping women optimize their health and function. You still have a few weeks to sign up for this course that takes place next in April in Minneapolis!

Mar 23, 2015

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with Herman & Wallace instructor Jennafer Vande Vegte, MSPT, BCB-PMD, PRPC


Jennafer Vande Vegte

How did you get started in pelvic rehab?

A supervisor of mine suggested that I go to a course and develop a pelvic floor program. I thought she was nuts. As a late twenty-something, I wanted to work with athletes. Finally she convinced me to go. Imagine my surprise when I felt like a duck in the water in the Pelvic Floor Level 1 class.


Who or what inspired you?

Mar 20, 2015


A report in The Canadian Journal of Human Sexuality describes the level of emphasis placed on particular sexual health topics in Canadian medical schools. Both the level of emphasis and the utilized teaching methods among 51 residency programs for obstetrics and gynecology (OBG), family medicine (FM), and undergraduate medicine (UGM) were evaluated. Program Directors and Associate Deans of the respective programs were electronically surveyed about the following topics: contraception, disease prevention, sexual violence/assault, childhood sexual abuse, sexual dysfunction, childhood and adolescent sexuality, role of sexuality in relationships, aging and sexuality, sexual orientation, gender identity, disability, and social and cultural differences.


The topic that received the most emphasis among the 3 program types was “information and skills for contraception.” Disease prevention for sexually-transmitted diseases was also a high-ranking topic.

The authors point out that while it seems understandable that OBG residencies may not include a significant amount of training in male sexual health, there was an absence of evidence on training in child sexual abuse and adolescent female sexuality in the OBG programs. The article notes other omissions of emphasis such as the lack of training among family practice residencies in transgender and gender identity issues, disability and sexuality, and cultural differences.


This article gives some insight into potential topics of training in human sexual health, and the lack of education in physicians regarding topics of sexual function and dysfunction. In addition to lacking knowledge of some topics in childhood, adolescent, and men’s and women’s health, we can be certain that most providers are not instructed in the role of pelvic rehabilitation providers for sexual dysfunction. How can we contribute to a provider’s knowledge of rehabilitation of sexual dysfunction?

Mar 19, 2015

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with Herman & Wallace instructor Holly Tanner PT, DPT, MA, OCS, WCS, PRPC, LMP, BCB-PMB, CCI


Holly Tanner

How did you get started in pelvic rehab?

I joined Apple Physical Therapy as an orthopedic outpatient clinic manager back in 2000. The previous manager had begun treating women who had urinary incontinence and we had this (huge) old biofeedback unit. I told the company owners that I would be willing to take a course in treating urinary incontinence, which I quickly did. I also quickly learned that to do a great job in pelvic rehab, and to serve the patients well, you need to keep taking classes to learn about all the other issues that make pelvic rehab so potentially complex and engaging.


What have you found most rewarding in treating this patient population?

Mar 18, 2015



This post was written by Steven Dischiavi, MPT, DPT, ATC, COMT, CSCS, who teaches the course Biomechanical Assessment of the Hip and Pelvis. You can catch Steve teaching this course in May at Duke University in Durham, NC.

One thing that jumps out at me when treating a professional athlete, is that they have “a guy or gal” for everything! Most high profile athletes have a physical therapist, athletic trainer, acupuncturist, nutritionist, massage therapist, personal trainers for speed, power, cross fit, and pretty much “a guy or gal” for anything that has something to do with athletic performance or injury prevention. In most recent years I have been hearing more and more that athletes use someone that can analyze their movement and develop corrective exercises for them. These professionals are not just physical therapists, but some are personal trainers, exercise physiologists, chiropractors, and so on…


This has clearly been leading to a paradigm shift in not only evaluation of the athlete, but more specifically how we treat our athletes and clients. The Functional Movement Assessment is a tool that is gaining more and more popularity. It identifies “movement dysfunction” and then sets out to manage these movement patterns. I am a firm believer in functional movement assessment, and I believe it does need a larger role in our profession…I believe this so strongly I have recently changed gears professionally and have accepted an assistant professor position on the Physical Therapy faculty at High Point University. I want to affect change from within!

Mar 16, 2015

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Katarzyna Niebrzydowska PT, DPT, MTC, CFC, CKTP, PRPC.


Katarzyna Niebrzydowska

Describe your clinical practice.

I own KTS Physical Therapy - pelvic health practice on Staten Island, NY. My practice is dedicated to treating males and females with a wide variety of pelvic floor dysfunctions.


What/who inspired you to become involved in pelvic rehabilitation?

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Upcoming Continuing Education Courses

Pelvic Floor Level 1 - Seattle, WA (SOLD OUT!)
Apr 03, 2015 - Apr 05, 2015
Location: Swedish Medical Center Seattle - Ballard Campus

Myofascial Release for Pelvic Dysfunction - Tampa, FL
Apr 10, 2015 - Apr 12, 2015
Location: Florida Hospital - Wesley Chapel

Lymphatic Drainage for Pelvic Pain - Scottsdale, AZ
Apr 11, 2015 - Apr 12, 2015
Location: Evolution Physical Therapy

Assessing and Treating Vulvodynia - Minneapolis, MN
Apr 11, 2015 - Apr 12, 2015
Location: Park Nicollet Clinic--St. Louis Park

Pelvic Floor Level 2B - Columbus, OH (SOLD OUT)
Apr 17, 2015 - Apr 19, 2015
Location: Ohio Health

Athlete and the Pelvic Floor - New York City, NY
Apr 18, 2015 - Apr 19, 2015
Location: Kima - Center for Physiotherapy & Wellness

Pudendal Neuralgia Assessment and Treatment - Salt Lake City, UT
Apr 18, 2015 - Apr 19, 2015
Location: University of Utah Orthopedic Center

Finding the Driver in Pelvic Pain - Milwaukee, WI
Apr 23, 2015 - Apr 25, 2015
Location: Marquette University

Pelvic Floor Level 1 - Durham, NC (SOLD OUT!)
Apr 24, 2015 - Apr 26, 2015
Location: Duke University Medical Center

Sexual Medicine for Men and Women - Fairlawn, NJ
Apr 24, 2015 - Apr 26, 2015
Location: Bella Physical Therapy

Bowel Pathology and Function - Kansas City, MO
Apr 25, 2015 - Apr 26, 2015
Location: Saint Luke\'s Health System

Pelvic Floor Level 1 - Los Angeles, CA (SOLD OUT)
May 01, 2015 - May 03, 2015
Location: Mount Saint Mary’s University

Pelvic Floor Level 2A - Seattle, WA (Sold Out!)
May 01, 2015 - May 03, 2015
Location: Swedish Medical Center Seattle - Ballard Campus

Oncology and the Female Pelvic Floor - Torrance, CA
May 02, 2015 - May 03, 2015
Location: HealthCare Partners - Torrance

Care of the Postpartum Patient - Boston, MA
May 02, 2015 - May 03, 2015
Location: Marathon Physical Therapy