Hina Sheth MS, PT, OCS, MTC, IADN-cert is the owner and practitioner of Rebalance Physical Therapy, a one-on-one holistic manual physical therapy practice in Philadelphia, PA. She is a board-certified physical therapist, and orthopedic specialist, as well as a certified manual therapist with more than 22 years of specialization in the limbo-pelvic-hip complex. Sheth’s practice in functional health coaching helps clients adopt behavioral changes that nourish improved health.

A respected colleague and community leader, Sheth shares her expertise in public forums as well as the academy, offering lectures on a host of physical therapy topics including spinal dysfunction and pelvic pain. A writer for the American Physical Therapy Association (APTA) women’s specialist exam, Sheth has participated in National Institutes of Health (NIH) funded studies for pelvic health. Sheth’s articles appear in two urologic volumes, and her insights about physical therapy and wellness are frequently featured by local and national media outlets including NPR, Livestrong, IC today, mainline health, and Philly magazine.

Pelvic health has become more accepted in the healthcare field, especially with social media helping reach those in search of more pelvic health knowledge. But there needs to be more public awareness on the topic of pelvic pain and sexual pain - in all genders. When TEDx reached out to me to develop this talk, I was so excited. Finally, what years ago, used to be a “taboo” topic was now gaining attention as something that needed to be voiced and spread on a larger platform.

The TED community is a perfect platform for those seeking validity to their symptoms as well as a way for them to communicate their symptoms to their friends and family. I focused on making this often difficult topic approachable. I hope that this talk helps those dealing with these issues feel understood, supported, and empowered. I also hope that this talk can be used to help teach their loved ones and other healthcare professionals that this is something that can be helped by pelvic floor therapists around the world. I hope you all can help this message spread!

Herman & Wallace faculty member Dr. Heather Rader has created an all-inclusive pelvic rehabilitation course for physical and occupational therapists who treat patients in the home health setting Home Health and Pelvic Rehab - External Skills for the Home Environment.

61% of females and 38% of males over the age of 65 have some form of urinary and fecal incontinence, and nearly half of the patients receiving home health care have incontinence¹. Despite these statistics, bladder and bowel symptoms are relegated to being part of the medical history rather than treatable impairments.

Home health therapists are required to ask about the presence of urinary and fecal incontinence as part of the admittance form, known as the OASIS. That’s typically where the conversation ends. This course will teach therapists how to quickly screen for the type of urinary incontinence, constipation, and pelvic pain conditions with simple and unintimidating interview skills. This can open the door to meaningful treatment interventions.

One of the challenges that home health therapists have with conventional pelvic health education is the emphasis on internal pelvic floor examination. Home health therapists don’t have access to a hi-lo examination table or the necessary supplies for a typical pelvic floor muscle examination. This course teaches external examination skills that can be performed in a living room chair or on a couch. 

Teaching pelvic floor exercises (Kegels) can be difficult in any setting or population. Cognitive impairments bring additional challenges. Learn how to teach “Kegel-less” exercises to facilitate pelvic floor strength through hip and trunk movements. The pelvic floor has anatomical and physiological relationships with the hip joint, spine, and abdominal muscles. Incontinence clusters with falls, balance, and gait dysfunction. Learning what these conditions have in common with each other allows the informed therapist to treat them together as co-morbidities.

This course is also a great place to start for therapists who want to explore pelvic rehabilitation techniques but aren’t ready for internal examination coursework. While the clinical examples are home health based, the concepts can be applied to any rehab setting.

Home health therapists are uniquely positioned to help our older population reduce the burden of incontinence, constipation, and untreated pelvic pain conditions. This course teaches easy-to-follow treatment pathways customized to the home care experience, giving the participant confidence to ask about and treat pelvic floor dysfunctions. Join Heather Rader on February 25th for Home Health and Pelvic Rehab.

Reference

1. Prevalence of Incontinence Among Older Americans U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics. Prevalence of incontinence among older Americans. Hyattsville, Maryland, 2014. Print.

Home Health and Pelvic Rehab

Course Date:
February 25th

Price: $450
Experience Level: Beginner
Contact Hours: 15

Description: This remote continuing education course includes 8 hours of pre-recorded lectures and one day of live remote content covering external pelvic rehab skills for the rehabilitation professional who works with patients in Home Health, Adult Day Care, Assisted Living, Extended Care, or Memory Care. This course is intended for therapists treating patients with the goal of staying in their current home setting and toileting as independently as possible. Topics include functional pelvic anatomy, function and dysfunction, and geriatric comorbidities, as well as pelvic health documentation skills. Topics specific to the home health setting include gaining consent in the home setting, how to include caregivers and staff in the pelvic rehab process, and external examination options and techniques. The live remote lecture will cover rehab strategies for urinary and fecal incontinence, constipation, and pelvic pain.

This course will focus on real-world examples of home health experiences in rehabilitation External evaluation and treatment techniques adapted to the home and bedside environment, including the use of biofeedback for pelvic floor muscle dysfunction and treatment protocols for co-morbidities, such as UTIs, falls and balance, and gait disorders.

Obtaining patient and caregiver consent for pelvic floor examinations and treatment adaptations to accommodate variable treatment surfaces (bed, chair, couch, wheelchair) will be discussed. Participants will receive reproducible handouts for patient and caregiver education and have skills labs on documentation compliance. This course will prepare the home health therapist to be ready and able to meet the urological and colorectal therapeutic needs of the homebound population.

Equipment needed for Labs: Home Health Bag, TheraBand, small air-filled ball, gait belt

Darla Cathcart, PT, DPT, WCS, CLT  graduated from Louisiana State University (Shreveport, LA) with her physical therapy degree, performed residency training in Women’s Health PT at Duke University, and received her Ph.D. from the University of Arkansas Medical Sciences. Her dissertation research focus was on using non-invasive brain stimulation to augment behavioral interventions for women with lifelong vaginismus, and her ongoing line of research will continue to center around pain with intercourse. Darla is part of Herman & Wallace's core faculty and instructs Pelvic Floor Level 1, Level 2A, and Level 2B, the Pregnancy & Postpartum Series, and recently launched her own course Vaginismus and Vulvovaginal Dyspareunia.

How is this class different from the information in Pelvic Floor 2B?
The main difference is in the questions that these two courses answer: "what treatments can I use" versus "how can I use those treatments effectively?" In Pelvic Floor Level 2B, participants are told about various methods for addressing pain with intercourse (such as using vaginal trainers/dilators and manual therapy techniques), with brief descriptions of how to use some of these tools. In this Vaginismus and Vulvovaginal Dyspareunia course, we go into depth on how to use these treatments specifically based on a patient's examination findings and goals.

What are the top 5 takeaways a practitioner could hope to gain from this class?
1. Vaginal Trainers (dilators) can be more effective when going beyond "just sticking them in."Traditionally, patients have been taught to just insert "dilators" to a point of stretching and discomfort, and to hold that stretch, maybe even distract themselves from the activity by watching TV or reading a book. As with other areas of the body, using active methods to increase tissue flexibility, such as incorporating contract-relax and breathing techniques, can really enhance the treatment! During the labs in this 100% remote course (a combination of self-paced preview videos and live online instruction), participants will be guided through step-by-step instructions for using and progressing through vaginal trainers and other treatments (the same step-by-step instructions you can use with your patients on Monday morning!). Additionally, as in other areas of the body, focusing on the body part that is being worked on is beneficial for increasing motor control, which is also desirable for addressing pelvic floor muscles that have too much tone and tenderness or pain with attempts at insertion. Participants will also be walked through activities that increase the brain's connection with and control of the pelvic floor and genitals, thus tapping into contemporary pain science concepts as well. And speaking of pain science . . .

2. As a practitioner, you likely already know that our words, verbiage for questions and instruction, and analogies and stories matter! Throughout the course, we will talk about why some words or terms can be harmful or less helpful, and how to replace them with healing or more neutral terms. For instance, we will talk about how the traditional term "dilator" can be a bit scary and anxiety-provoking for someone who has had lifelong vaginismus; but the term "trainer" suggests that the muscles are being taught and retrained on how to function. We will also walk through examples of approaching and discussing sexual abuse and trauma, general sexual history and activity, and patient goals. We will review some basics about contemporary pain science, and analogies that we can share with our patients to help decrease their fear and anxiety surrounding treatment for and engaging in sexual function. Participants should leave the course feeling more confident in talking about sex with their patients!

3. How do we incorporate the female sexual cycle/response (arousal, desire, orgasm), sexual positioning, and sexual assist devices and props into helping our patients? These are topics that will be tackled and broken down in both the preview material, with key concepts being reviewed or covered during the live remote portion of the course. We will talk about using the timing of sexual responses to a patient's advantage with transitioning to sexual function.

4. When should a patient move from vaginal trainers to the bedroom? Should the patient's partner(s) be involved? How do I answer questions about specific sexual positions? How do I answer my patient's questions about libido concerns? These are all concepts that will be tackled, with both specific examples and cases and also with general guidelines for applying the information to your individual patients.

5. You will have the opportunity to practice or follow along with the very things you will teach your patients during the live remote lab portion of the course, from the privacy of your own home or private treatment room in your office. I believe a great advantage that rehabilitation professionals have in treating patients is that we have experienced many of the examination and treatment techniques while practicing them in a class, course, or another setting. Personally testing out these techniques gives you, as a practitioner, a strong advantage in knowing how to best describe the nuances of applying treatments to aid in your patient's understanding. It also gives you a good dose of empathy for being the person on the table!

What special interest do you have in this topic?
As a pelvic health therapist for over 20 years, working with patients who have lifelong vaginismus, acquired vaginismus, and dyspareunia has been one of my primary passions. In completing a Ph.D. in 2020, my line of research began with a clinical randomized controlled trial working with patients with lifelong vaginismus and vaginal trainers, using neuroscience and pain science concepts to incorporate contract-relax and breathing techniques to enhance treatment. I never tire of having a patient return to the clinic excited that they finally had pain-free intercourse! I am passionate about teaching other therapists, healthcare providers, patients, and their partners about the concepts I've learned in my many years of practice.

Who is the audience for this class?
This course is for any pelvic health rehabilitation or health care provider who is a novice or wants to enhance their skills for working with patients with vaginismus and vulvovaginal dyspareunia.

Why was it needed and developed?
This course, Vaginismus and Vulvovaginal Dyspareunia, is needed to move beyond the basic concepts about what we can do to help patients having pain with intercourse. This course takes a deep dive into the detail of how to make the rubber meet the road to not only get treatment started but to really help progress a patient into a satisfying sex life. This course was developed so that the participant could leave this course and understand how to really approach the examination, history taking, and step-by-step procedures in instructing and using vaginal trainers and other tools for patients having painful intercourse. Additionally, this course should increase the practitioner's confidence in incorporating instructions and education related to a patient's concerns about the female sexual cycle and response (arousal, desire, orgasm), sexual positioning, lubrication, and partner integration.

Vaginismus and Vulvovaginal Dyspareunia

Course Date:
February 4

Price: $375
Experience Level: Beginner
Contact Hours: 15

Description: This course is for the pelvic health practitioner who is new to treating patients with vaginismus/vulvovaginal dyspareunia or to vaginal trainer(dilator) use or pelvic health rehabilitation; or for the experienced practitioner who has found that patients with vaginismus/vulvovaginal dyspareunia plateau with vaginal trainers or other treatments. In this course, pelvic health rehabilitation providers will learn about the different types of vaginismus and dyspareunia. Definitions and history of terminology will be explained related to pain with sexual activity and intercourse, including Genito-Pelvic Pain/Penetration Disorder, Lifelong or Primary Vaginismus, Acquired or Secondary Vaginismus, Dyspareunia, Vulvodynia, and others.

From a pain-science viewpoint, verbiage and terminology to reduce patient fear and anxiety will be discussed and incorporated throughout the course. Evidence for focalized dystonia as a component of lifelong vaginismus and how that impacts treatment will be reviewed. Causes for acquired vaginismus (such as postpartum healing or hormonal changes) will be addressed. Treatment approaches for reducing patient fear and anxiety, addressing medical and/or sexual trauma/abuse history, and promoting patient empowerment will be covered. The remote live portion of the course will also focus on rehabilitation treatments, including walking the participant through the functional use of vaginal trainers (commonly known as dilators), and methods for progressing their use. Clinical cases will be provided to illustrate a variety of treatment approaches based on different patients’ treatment goals, history, examination findings, and sexual pain diagnosis.

Hello Practitioners!

This Monday I would like to share a very special invitation with you. Join us in Seattle, WA for HWConnect 2023 - the first-ever conference from Herman & Wallace, the leading provider of continuing education to pelvic rehabilitation professionals. HWConnect 2023 will run Friday, October 6 - Sunday, October 8 and comprises 10+ contact hours of continuing education.

The Saturday night Keynote Presentation will be given by Diane Lee, an internationally-recognized expert with 40 years of clinical experience in thoracic, lumbar, and pelvic disability and pain. Diane will be delivering our Saturday night keynote address and will be presenting her latest research on diastasis rectus abdominis.

Registration includes access to all scheduled lectures and receptions, as well as a Teachable (a digital learning platform) course which will contain additional resources and a conference manual. Cocktail receptions will follow the speakers on Friday and Saturday evenings, so attendees will have a chance to have fun and socialize with each other, HW faculty, and conference presenters.

We have secured a room block and special pricing for registrants of this conference. Staying at the host hotel will be the most convenient option, so we highly encourage everyone to make arrangements via this URL before the room block is full!

After years of pandemic quarantine and Zoom meetings, we feel the need to gather together and connect our community again. HW Connect is an opportunity to meet with colleagues and friends old and new, and a unique chance to learn new skills and information from some of the leading voices in our field. Speakers will cover a range of topics related to pelvic rehab.

We’re several years into our COVID pivot, and while the remote and satellite learning options work great for delivering education, what’s missing is the opportunity to connect face-to-face with our community. Participants miss the chance to gather in person, and so do we.

HWConnect is a chance for friends and colleagues old and new to connect with one another and with some of the founding pioneers in our industry. Putting on a big conference is something we’ve wanted to do for years. After two years of Zoom meetings, now is the time.

We can’t wait to connect with you in October!

HWConnect

Announcement Week Registration Price Until January 28th:
$525

Schedule:
Friday, October 6th
5:30 PM - 8:30 PM

Saturday, October 7th
9:00 AM - 8:30 PM

Sunday, October 8th
9:00 AM - 12:15 PM

Mora Pluchino, PT, DPT, PRPC (Faculty member, and Sr. TA) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). Mora authored and instructs Ethical Concerns for Pelvic Health Professionals and Ethical Considerations from a Legal Lens.

When I used to hear the word “ethics requirement,” I would wrinkle my nose and find the cheapest, quickest course to fulfill my New Jersey requirement. I would sit through it and count down the hours. It was not out of a lack of respect for the continuing educator or the importance of the material. I just felt, no matter how the material was presented it was just dry and did not feel like it applied to my more niched areas of practice.

As I dove deeper into pelvic floor treatment and the pelvic floor community, I realized there was such a need for us to have these conversations on the topic of ethics. A lot of questions posted on social media forums and groups have an underlying ethical component and practitioners are not necessarily aware. The more I researched, the more I realized these topics are so complex and can be very interesting when applied to the daily life of a pelvic health provider

Let’s talk about how you can know if something has an ethical component or concern. There are a variety of tests and measures to assess ethical situations and we review these in the class Ethical Concerns for the Pelvic Health Professional. If you are wondering if some of the clinical questions you have are actually founded in ethics you may find yourself asking questions like the following.

One of my favorite ways to assess an ethical question is by using the Kidder’s Ethical Decision Making Model. The fourth step of this model includes four checkpoints that can be helpful for quick clinical questions. These give us an idea of ways to recognize right versus wrong in scenarios and how we can correct or act accordingly. The four tests proposed by kidder are “The Legal Test,” “The Stench Test,” “The Front Page Test” and “The Mom Test” (Ferrier, 2021). If an ethical concern does not pass one of these tests, it does not have merit as an ethical course of action. If something doesn’t pass these tests, the right versus wrong aspect is a moral temptation and a person has to decide which option they would like to choose. We all have different moral compasses and backgrounds and so each person’s comfort level with these decisions may be different.

If a scenario arises, we start with “The Legal Test.” This is where we think about whether an action (or inaction) is legal or not. This may require some research or consultation if we do not know the answers. “The Stench Test” tests a person’s inner moral intuition. How does it feel with how you have been raised and when referenced against your moral foundation? “The Front Page Test” encourages a person to theorize how they would feel if the ethical situation they are thinking about were to be on the front page of a newspaper. It is a publicity test, do you want that to be how the world sees you, your clinic, your practice, your skills, etc? “The Mom Test” makes us reference all those who have been moral examples or might pass judgment on decisions we make (Ferrier, 2021).

Knowing these tests, look at the scenarios at the end of this blog. Imagine how you might run through the four Kidder Tests clinically. This can be great practice for clinical decision making. Like any skill, the more we practice, the more confident we are in the skill and the easier it is to do the task.

Ultimately with ethical decision making, there is a lot more “grey area” and “it depends” answers than there are clear cut scenarios. We can be much more comfortable with the decisions we make based on how we have examined the information and considered all options and outcomes. One of the positives of this class, Ethical Concerns for the Pelvic Health Professional - January 29, 2023, is having an audience of peers to talk through real clinical concerns and situations to problem solve and get input on things that may be weighing on a provider.

Scenario 1: Your patient comes in and tells you that their partner yells at them on a regular basis and controls how they can spend their money.

• The Legal Test: What are your legal abilities and obligations here?
• The Stench Test: How do you feel about this?
• The Front Page Test: If someone posted the story “Therapist told about XYZ and does ABC” how would you feel?
• The Mom Test: How would your parent/ caregiver feel about your decision on this scenario?

Scenario 2: A patient tells you that their practitioner forced them to have a pelvic examination without explaining the procedure and continued after the patient asked them to stop.

• The Legal Test: Is what this practitioner did legal?
• The Stench Test: What is your gut feeling in this scenario?
• The Front Page Test: If someone wrote a review about your practice and included this story, would it be a positive for your practice?
• The Mom Test: How would your favorite clinical instructor have felt about this situation?

Scenario 3: You have been invited to an affiliate program with a popular medical device company. You have the opportunity to make $15 for every patient care item you can sell in your clinic.

• The Legal Test: Are there any legal implications?
• The Stench Test: How do you feel with a quick “right versus wrong” decision here?
• The Front Page Test: How could you advertise this for your clinic in a way that is positive?
• The Mom Test: If someone posted this situation in a Facebook Pelvic Support Group, what would the response be?

Resource:

Ferrier, Patricia. Applying Kidder's ethical decision making model - in this article, the author uses a model of. Studocu. (2021). Retrieved December 26, 2022, from https://www.studocu.com/en-us/document/florida-institute-of-technology/introduction-to-behavior-analysis/applying-kidders-ethical-decision-making-model/20045486

Ethical Concerns for Pelvic Health Professionals

Course Dates:
January 29, September 16

Price: $175
Experience Level: Beginner
Contact Hours: 6

Description: The purpose of this class is to explore the ethical challenges Pelvic Health Practitioners may experience including consent, managing trauma and abuse, and preventing misconduct. This includes basic decisions for billing, patient care, safety, and compliance. Pelvic Rehabilitation comes with additional layers of vulnerability and ethical challenges due to the anatomical areas being treated, topics being discussed, and intimacy of sessions

Hello everyone…we hope your 2023 has been peaceful and productive. Dr. Meehan and I are very excited about the upcoming course on Menstruation and Pelvic Health. We’re excited because this is a chance to discuss the Menstrual Experience, an opportunity that is not common in society today. Menstrual Symptoms and anxiety about seeing blood on clothes or furniture can create obstacles to opportunities in education, career advancement, relationships, health care, family, sports, and enjoyment. Society has missed out for too many generations on the contributions of people who have had to miss opportunities to shine due to challenging aspects of their Menstrual Experience.

Many patients have Menstrual Concerns that they would like to discuss with someone but don’t feel confident or able to engage in these important conversations. Pelvic floor practitioners have a unique opportunity to evaluate their patients’ Menstrual Experience and create an individualized care plan that takes that experience into consideration. We discuss how to initiate conversations with patients on a topic that is surrounded by cultural taboo and stigma, and we discuss biological underpinnings of the normal Menstrual Cycle and of Menstrual Symptoms that so many people experience each month, often hundreds of times in a lifetime

There is a very exciting section of the live course dedicated to understanding the quickly evolving landscape of options to manage Menstrual Flow. We carry out live demonstrations on how much blood is lost on each day of a ‘typical’ period, and we have demonstrations of use, mode of action, and maintenance of wide variety of disposable and reusable products: Liners, Pads, Intra-Labial Pads, Tampons (we discuss absorbency, expansion, and applicators), Cups, Discs, and ever-expanding options in Period Underwear, Period Activewear, Period Sleepwear, Period Swimwear (bikini and 1- piece), and Menstrual Sponges (not recommended). We discuss pros and cons of these collection and absorption method on different days of flow, and we develop a Flow Management plan so each person can confidently engage in the things that are important to them on any day of the month.

This course was designed to promote open discussion of the Menstrual Experience among health care providers so we are confident and prepared to serve as advocates of productive Menstrual Dialogue to re-consider the Menstrual Experience in a more positive light. It is our hope that this course inspires participants to engage in Menstrual Conversations with patients, with people who are important to them, within professional circles, and in social communities to erode Menstrual Stigma and find solutions real practical that reduce barriers to opportunities in education, career advancement, relationships, health care, family, sports, and enjoyment.

We hope to see you soon in the class to take the next important step together on this exciting Menstrual Journey!

Nicholas Gaffga, MD, FAAFP, MPH and Amy Meehan, PT, DPT, MTC

Menstruation and Pelvic Health

Course Dates:
February 25-26

Price: $575
Experience Level: Beginner
Contact Hours: 19

Description: This course is designed for clinicians who want to obtain advanced knowledge and skills to educate patients on non-hormonal, non-surgical, and non-prescription interventions for improving the Menstrual Experience. Developed by Nicholas Gaffga, MD, MPH, FAAFP and presented together with Amy Meehan, PT, DPT, MTC, this course is geared towards the pelvic rehab provider looking to impart Menstrual Interventions that:

1. Put control in the hands of people who menstruate to identify and carry out the interventions that are appropriate to them.
2. Use a holistic approach and advanced knowledge and familiarity with body and mind.
3. Emphasize healthy practices that can positively impact the Menstrual Experience and beyond, in areas such as mental health and chronic diseases.
4. Discover root causes of issues, rather than quick fixes, to have benefits that are sustainable across the lifespan.

Megan Pribyl, PT, CMPT is a practicing physical therapist at the Olathe Medical Center in Olathe, KS treating a diverse outpatient population in orthopedics including pelvic rehabilitation. Megan’s longstanding passion for both nutritional sciences and manual therapy has culminated in the creation of her remote course, Nutrition Perspectives for the Pelvic Rehab Therapist, designed to propel understanding of human physiology as it relates to pelvic conditions, pain, healing, and therapeutic response. She harnesses her passion to continually update this course with cutting-edge discoveries creating a unique experience sure to elevate your level of appreciation for the complex and fascinating nature of clinical presentations in orthopedic manual therapy and pelvic rehabilitation.

It has been nearly 8 years since I taught my first in-person rendition of “Nutrition Perspectives for the Pelvic Rehab Therapist” in Seattle, WA through Herman & Wallace – and over a decade since I began writing the course in earnest.  Creating and teaching this course has been an honor for me and truly a full-circle opportunity to share my passion for nutrition with other clinicians.  The mission of the course is to create a ripple effect from one person to the next. But if there’s anything the last couple of years has taught me, it’s that we still have a long way to travel to reach the destination of fully integrated care centered on the whole person.  As a guide, I tap the growing body of literature on nutrition and health to help show us the way.

I recall having taught this course on 11 occasions in-person between June 2015 and October 2019 at gracious site host clinics nationwide.  I enjoyed each and every one of these experiences.  Since the 2020 pivot to remote format, I have taught Nutrition Perspectives via Zoom 18 times - after we were faced with restrictions on traveling and gathering.

Having taught Nutrition Perspectives in both formats, I’d like to share with you first why I love teaching this course, and second why I love teaching it in its remote format.  It truly is a class perfectly suited to this mode of delivery.

First, why I love teaching this course:

It is my passion to share nutrition information with peers in pelvic rehab.  Before becoming a PT, I studied nutrition as an undergrad.  After becoming a PT, and more specifically a pelvic PT, it became crystal clear that we needed to incorporate the essence of nutritional sciences into pelvic rehab– and even into general clinical practice.  Nutrition Perspectives became my answer to the burning and urgent questions I had about how we could blend the worlds of rehabilitation and nutrition.  I scoured the literature to find answers – and what I found was astonishing.  Paradigm shifting.  Compelling.

Early in my career, I would only sporadically encounter patients who would experience what I would now describe as “functional gastro-intestinal disorders with extra-intestinal manifestations”.  Fast-forwarding to today, it is rare to see a patient who does not experience any conditions such as GERD, constipation, gas/abdominal pain/bloating/discomfort, anxiety, depression, and complex or chronic pain conditions.  Because of this reality, it has become essential for healthcare providers to have a basic working knowledge of functional nutrition.  Especially providers in pelvic rehabilitation.  Having a working knowledge of these conditions and potential nutritional underpinnings can help us better understand and serve our clients.

Not only does nutrition have significant relevance to our patients – it is relevant to each of us as human beings!   But be aware – the realm of nutrition appears chock-full of confusing contradictions.  And our patients are now – more than ever – asking us for our thoughts on nutrition-related topics.  They’re listening to podcasts.  They’re reading social media posts and blogs.  They’re watching short video clips to find quick answers to complex questions.  And they want to run some of their questions by you – their trusted health professional ally.   You want to feel confident and competent in what you’re sharing.  My mission is to make evidence-informed information accessible and relevant to you, the practicing clinician so then you can, in turn, share with confidence and competence.

Now, on to why I love teaching this course remotely:

Don’t get me wrong – I love to travel.  But imagine traveling alone to new cities -not as a free-spirited adventure solo traveler – but instead as an idealistic instructor who doesn’t want to be without any supplies needed for teaching a course far from home!  This translates to a very heavy suitcase filled with visual aids and lab supplies. This humongous check-in bag contains items necessary to conduct the course descriptively – books, empty product containers, glass jars (yes, GLASS), carefully packaged kefir grains, a SCOBY, bowls, spoons, kitchen towels, and those hard-to-find food items that one can’t be certain to find in an unfamiliar city.  And a tablecloth.  Because when we’re talking about food with guests, presentation is important!

Now imagine navigating travel challenges with said heavy, giant suitcase; chucking it on and off a rental car bus during a cold rainstorm for example..  Imagine pushing it down a carpeted hotel hallway that is so plush, it prohibits the wheels from functioning properly.  Imagine repacking in 15 minutes what took 3 hours to initially pack in order to catch a return flight home. 

This was the reality of logistics I eagerly and enthusiastically took on to be able to teach this class.  But that giant suitcase couldn’t hold even close to everything I wanted to share, and it actually was a bit cumbersome to manage.  Maybe a lot cumbersome.  Always plastered with the bright orange “HEAVY” sticker warning – there was a limit to what I could bring along to live course events.

When we first transitioned this course to remote format, it was a quick response to begin offering CEUs when lockdown mode began.  The silver lining, we discovered, was that the remote format for this course was in fact – much better than the live event format. 

Now, all the necessary supplies are right where I need them to best instruct.  Plus, predictable kitchen and lecture spaces create a seamless experience for the participants.  Teaching from home has been life-changing as an instructor.  I can practice what I preach about nourishing the nervous system and mitigating stress with lifestyle choices.  It is nourishing to be able to sleep well at home the nights before I teach.  Adequate rest is a superpower that allows me to give my best well-rested self to the participants.

The remote format is not just nourishing to me, but also to the participants who can attend from the comfort of home or familiarity of a clinic.  Wherever you are, you can take the course.  No airports, no suitcases, nor carpeted hotel hallways.  That’s accessibility.  That’s getting this information into the hands and minds of providers in locations all around this country and beyond.  We need this accessibility if we ever hope to reach our destination of fully integrative care of the whole person – for all.

For these reasons, Nutrition Perspectives for the Pelvic Rehab Therapist will remain in this remote format – even as our lives begin to involve travel and in-person events again.  All good things.  But I do hope you enjoy taking Nutrition Perspectives as much as I enjoy teaching it.  I invite you to join me on the journey toward implementing more integrative care as standard practice.  It’s not always an easy road, nor the popular road.   And sometimes it feels as hard as dragging a giant, heavy suitcase behind you.  But it’s a path worth taking – one that will be fruitful for both you and the clients you serve.  Let’s travel it together.

Nutrition Perspectives for the Pelvic Rehab Therapist will be offered quarterly in 2023:  January 21-22, June 10-11, September 16-17, and December 2-3. 

Nutrition Perspectives for the Pelvic Rehab Therapist

Course Dates:
January 21-22, June 10-11, September 16-17, and December 2-3

Price: $525
Experience Level: Beginner
Contact Hours: 17.75

Description: Participants will be introduced to the latest research in nutrition through immersive lectures and hands-on labs.  The course will cover essential digestion concepts, nourishment strategies, and the interconnected nature of physical and emotional health across the lifespan. Further, clinicians will delve into nutritional relevancies in bowel and bladder dysfunction, pelvic health, pain, and healing.  Labs throughout include insightful demonstrations and breakout sessions. The course participant will acquire new, readily applicable tools for patient empowerment, engagement, and self-management utilizing presented principles.

Nicholas Gaffga, MD, MPH, FAAFP sat down with The Pelvic Rehab Report this week to discuss himself and how he came to TA (and teach) for Herman & Wallace. Niko is scheduled to TA next in Birmingham, AL for Pelvic Floor Level 1 scheduled March 4-5 2023, and will be instructing Menstruation and Pelvic Health on February 25-26 2023.

Who are you?
Describe your clinical practice. My name is Niko Gaffga, and I am a family medicine physician seeing patients in Atlanta, GA. Over the 20 years I have been practicing medicine, I have worked in a number of settings: pediatrics, gerontology, emergency room, ICU, HIV prevention in Africa for 4 years, occupational medicine, travel medicine, and obstetrics and gynecology. As I look back over these memories, the area of work where I most feel connected with my patients is women’s health and outpatient gynecology.

How did you get involved in the pelvic rehabilitation field?
My journey in pelvic health physical therapy has been one of the most exciting and rewarding of my career. One day in my clinic I saw a patient who had pelvic pain. When I walked into the room she was crying. Over the next few months, we were able to reduce her IC symptoms considerably with medications and diet modification. And one time when I went into the room to see her, she stood up and smiled and hugged me. This reminded me why I wanted to be a doctor. Along this journey, I realized there were aspects of her experience that I could not address using my training as a physician, so I began investigating other ways to provide more holistic care to my patients. That was when I discovered the world of pelvic floor physical therapy. To understand more, I signed up for PF1. During that 3-day weekend, I saw the power of powerful pelvic floor physical therapy to help patients feel better. Since that time, I have taken all the courses in the Pelvic Floor series, as well as Male Pelvic Floor and three other specialty courses offered at Herman & Wallace. I even overcame my fear and anxiety and signed up to be a teaching assistant. I thought I could never be a TA…but since that time I have been TA 13 times and each time I am grateful for the opportunity to make a difference in other people’s lives. My experience working with pelvic floor practitioners has shown me the power of collaborating among health care professionals with different skills and treatment modalities to offer our patients the most holistic and effective care they can get.

What patient population do you find most rewarding in treating and why?
The most interesting and rewarding aspect of my work is helping patients improve their Menstrual Experience. Menstrual Forums can be difficult to find, but they create opportunities to share knowledge and understanding of the Menstrual Experience to increase Menstrual Optimism, Menstrual Confidence, and ultimately, Menstrual Pride. I have been working for 7 years to create a course that empowers pelvic health practitioners to open a Menstrual Forum with patients to help them better understand and improve their Menstrual Experience. It is a humbling, fascinating, and rewarding experience to walk with someone on a Menstrual Journey.

If you could get a message out to physical therapists about pelvic rehab what would it be?
If there are issues that as a rehab practitioner you are having trouble helping your patients with, explore referring them to a pelvic floor therapist who can help the patient in a whole different way.

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?
There is a simple scenario that profoundly changed how I see my patients. Physicians carrying out gynecological procedures are trained to sit at the foot of the bed to get the best field of view and to be able to carry out procedures on the patient. However, pelvic floor physical therapists usually sit next to the patient for ergonomics and also to be able to detect pain or anxiety on the face of the patient with each procedure that is carried out. This simple change in perspective invited me to be more aware of the effect that the visit is having on the patient and be more mindful of how they experience the encounter.

What do you find is the most useful resource for your practice?
My most useful resource is the ability to communicate with a variety of health professionals who have

What is in store for you in the future as a clinician?
My dream is to work in outpatient gynecology in close collaboration with a pelvic floor physical therapist to provide holistic health care for our patients.

What books or articles have impacted you as a clinician?
The Female Pelvis (Bandine Calais-Germain) for its beautiful informative illustrations that make pelvic anatomy and physiology come to life; In the Flo (Alisa Vitti) and The Rumi Collection (Kabir Helminski) for their new perspective on life; Period Repair Manual (Lara Briden); and The Fifth Vital Sign (Lisa Hendrickson-Jack) for their informative and proactive approach to understanding and improving the Menstrual Experience.

What has been your favorite Herman & Wallace Course and why?
Pelvic Floor Level 1 was life-changing for me because it introduced me to a whole new field of care and a whole different way of seeing patients. Herman & Wallace has been welcoming to me, as a physician and as a male, into a world where I could have potentially felt like an outsider. Thank you.

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?
In the past 3 years, I have worked with 14 different Herman & Wallace instructors as a participant and as TA. I have learned many lessons, but the one that has helped me the most is the encouragement to follow my dreams and to be the best I can be, even if the road seems difficult or unorthodox. There is a world out there waiting to be created.

What do you love about assisting at courses?
Being a TA at Herman & Wallace courses is the highlight of my month. I literally look at my calendar each day to see how soon it will be until the class starts. I love being a part of other people’s journey to learn more about pelvic floor physical therapy, I love helping people find their way in their careers, I love sharing the things that I am passionate about, I love sharing a physician’s perspective, and most of all I love seeing the light bulb turn on in someone’s eyes when they have visualized something in a new and exciting way.

What is your message to course participants who are just starting their journey?
If pelvic floor therapy is a field that you are curious about or find interesting and you feel a calling for, I encourage you to invest time and energy to learn more about it. Your professional options and your ability to help people will only be limited by what you can imagine.

Ziya Altug, PT, DPT, MS, OCS is a board-certified doctor of physical therapy with 32 years of clinical experience treating musculoskeletal injuries. Z currently provides outpatient physical therapy in the home setting in Los Angeles, California, and serves as a continuing education instructor. He received his Bachelor of Science in Physical Therapy at the University of Pittsburgh in 1989, a Master of Science in Sport and Exercise Studies in 1985, a Bachelor of Science in Physical Education in 1983 from West Virginia University, and a Doctor of Physical Therapy from the College of St. Scholastica in 2015. Z is a long-standing member of the American Physical Therapy Association and a member of the American College of Lifestyle Medicine. He has attended workshops in yoga, tai chi, qigong, Pilates, Feldenkrais Method, and the Alexander Technique.

Dr. Altug is the author of the books Integrative Healing: Developing Wellness in the Mind and Body (2018), The Anti-Aging Fitness Prescription (2006), and Manual of Clinical Exercise Testing, Prescription, and Rehabilitation (1993). In 2020, he published the chapter Exercise, Dance, Tai Chi, Pilates, and Alexander Technique in The Handbook of Wellness Medicine. In 2021, he published the article Lifestyle Medicine for Chronic Lower Back Pain: An Evidence-Based Approach in the American Journal of Lifestyle Medicine. Z joins the H&W faculty and is presenting his personally curated course Integrative and Lifestyle Medicine Toolbox for Rehab and Pain Management. This week he sat down with The Pelvic Rehab Report to discuss his course.

What made you want to create this course?
My father was a physician specializing in internal medicine. He specialized in treating conditions such as tuberculosis, chronic obstructive pulmonary disease (COPD), and asthma. Starting in elementary school, I remember discussing with my Dad the importance of nutrition, sleep, stress control, and sustainable activity in healing. Of course, as a ten-year-old, I played with his stethoscope and reflex hammer for hours! My father used “lifestyle medicine” principles to help his patients recover. My Mom introduced me to the benefits of aromatherapy for relaxation. She used to wash our clothes with lavender-scented soaps, and there was lavender-scented potpourri throughout our house. My mother used to say the lavender was to “keep the wolves away so the sheep can sleep.” She also taught me how to prepare and cook healthful meals in high school. Now, I have a fascination with culinary medicine. I am very grateful for all of these childhood experiences.

Before entering PT school, I majored in physical education and exercise science. After I graduated from PT school, I wanted to use my interest in wellness, health, fitness, and self-care strategies to help patients heal and recover. Recently, I have followed the American College of Lifestyle Medicine research and webinars to gain additional knowledge. Currently, I treat patients in their homes and teach continuing education courses in integrative and lifestyle medicine.

What need does your course fill in the field of pelvic rehabilitation?
This course provides practical tools to help clinicians manage pain. For example, my course will cover research, resources, and labs to create clinically relevant pain, anxiety, depression, and stress management strategies using lifestyle medicine, integrative medicine, and expressive and art-based therapies. Participants will be able to practice Tai Chi/Qigong, expressive and art-based therapies including Music, Dance, and Drama Therapy, nature and aromatic therapies, self-hypnosis, and self-massage. All of these strategies may be helpful for clinicians specializing in pelvic rehabilitation.

Who, what demographic, would benefit from your course?
Rehabilitation providers of any experience level would benefit from taking this course.

What patient population do you find most rewarding in treating and why?
I currently focus on orthopedics and geriatrics. I especially enjoy working with older patients in their homes and designing creative home exercise programs they can use to stay healthy.

What do you find is the most useful resource for your practice?
I enjoy using resources from the following organizations:

• American College of Lifestyle Medicine
• American College of Sports Medicine
• International Association for the Study of Pain

What books or articles have impacted you as a clinician?
I enjoyed reading the following three books to expand my knowledge of lifestyle medicine and integrative medicine:

• Lifestyle Medicine by James Rippe
• Lifestyle Medicine Handbook by Beth Frates and colleagues
• Lifestyle Medicine by Garry Egger and colleagues

What is your message to course participants who are just starting their journey?
I recommend all clinicians collaborate with professionals outside their own profession. For example, I recommend physical therapists work with the following:

• Acupuncturists, massage therapists, registered dietitians
• Practitioners in yoga, Pilates, qigong, tai chi, Alexander Technique, Feldenkrais Method
• Specialists in expressive therapies such as dance, music, art, drama, poetry, and play.

Integrative and Lifestyle Medicine Toolbox for Rehab and Pain Management

Course Dates:
January 21, 2023

Price: $125
Experience Level: Beginner
Contact Hours: 4.5

Description: This course was written and developed by Ziya “Z” Altug, PT, DPT, MS, OCS, a board-certified doctor of physical therapy with 32 years of experience in treating musculoskeletal conditions, Brief lectures on the research and resources and labs will cover a toolbox approach for creating clinically relevant pain, anxiety, depression, and stress management strategies using lifestyle medicine, integrative medicine, expressive and art-based therapies, and the impact of nature on health. Participants will be able to practice Tai Chi/Qigong, expressive and art-based therapies including Music, Dance, and Drama Therapy, nature and aromatic therapies, self-hypnosis, and self-massage. 

Janet Drake Whalen, PT, DPT sat down with The Pelvic Rehab Report this week to discuss herself and how she came to TA for Herman & Wallace. Janet is scheduled to TA next at the Doylestown PA for Pelvic Floor Level 1 scheduled January 7-8 2023.

Hi Janet, can you tell us a little bit about yourself and your clinical practice?
I am a physical therapist with 36 years of experience who has spent 34 years of my career in women’s health physical therapy. Over my career, I have been an advocate and continue to promote abdominal and pelvic health for all.  My career led me to become a Lamaze-educated childbirth educator, certified neuroscience practitioner, women’s health coach, and professional yoga therapist. My clinical practice now is in a hospital setting where I am educating outpatient therapy staff, healthcare providers, and physicians on pelvic health.  I am heading the start of a 4th-trimester program and a sexual health program.

What has your educational journey as a pelvic rehab therapist looked like, and how did you get involved in the pelvic rehabilitation field?
My educational journey started after an unplanned cesarean birth of my first son 34 years ago. In 1988 resources for women after delivery was scarce. I started looking into education and found a course taught by a nurse, Jo Laycock, from England. I attended her course sitting with nurses to learn about incontinence. My first women's health physical therapy courses were through the OB/GYN section of the APTA taught by Elizabeth Noble, Holly Herman, Kathy Wallace, Jill Boissonnault, and Marla Bookout. When Holly Herman and Kathy Wallace started their own education company, I started to attend courses through Herman & Wallace. After my vaginal birth after the Cesarean of my second son in 1990, I studied and earned my Lamaze International Childbirth Educator certification. I taught Lamaze for 9 years and continue with my certification. I started as a teaching assistant with Herman & Wallace approximately 15 years ago.

What patient population do you find most rewarding in treating and why?
This is a difficult question for me, although I would have to say that pregnancy and postpartum was my initial passion. Sexual health and whole-body wellness have been my passion for the past 12 years. I enjoy the interdisciplinary approach to sexual dysfunctions and continuing to learn more every year from patients and fellow clinicians.

If you could get a message out to physical therapists about pelvic rehab what would it be?
Every patient has a pelvis with organs and muscles. If you are treating spine and hip patients, you are affecting the pelvic floor muscles and the pelvic floor muscles are affecting your patients’ symptoms. External treatment can be as effective as internal treatment - so take a pelvic health course, you and your patients will benefit!

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?
I've had so many amazing instructors and colleagues over the years. From my therapeutic pain specialty certification to Louis Gifford’s work on what patients really what to know: 4 questions...

• What is wrong with me?
• How long will it take?
• What can I (the patient) do for it?
• What can you (the healthcare provider) do for it?

Also, listen to your patient's story. Meet your patients where they are and ask them open-ended questions.

What do you find is the most useful resource for your practice?
Besides a hi-low table, my ears and my heart.

What is in store for you in the future as a clinician?
To educate as many clinicians and therapists as possible to be ready to hand over the baton in five to seven years. A successful 4th-trimester program and sexual health program at the hospital I am currently employed.

What books or articles have impacted you as a clinician?
This is another tough question for me I have a library of books. But I will say that a textbook that I always have on hand is Anatomy Trains by Tom Myers. Research articles that provide a consensus of terminology and classifications with algorithms that are great to discuss with other clinicians.

What has been your favorite Herman & Wallace Course and why?
Pelvic Floor 3 (now Pelvic Floor Capstone) with Holly Herman piqued my interest in sexual health. Since that time all the visceral and myofascial courses with Ramona Horton have shaped and deepened my practice.

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?
One lesson that has stayed from Nari Clemens is how important it is to take care of yourself. Another from Ramona Horton regarding hands-on treatment is that you are having a conversation with the brain/nervous system.

What do you love about assisting at courses?
What I love about assisting at courses is meeting all the physical therapists from different stages of their careers with an interest in pelvic health. Their energy excites me and reminds me how wonderful our profession is.

What is your message to course participants who are just starting their journey?
If you're just starting your journey, hold on! There is a lot to learn, to practice, to share, and to educate others. You are going to influence so many people’s lives.