Login / Create an Account

Phone646.355.8777

Tags >> Clinical Practice
May 21, 2015

Earlier this week a blog post asked the question "Do male therapists belong in pelvic rehab?" With increased frequency, male therapists are participating in pelvic rehab coursework and practices. Some of the male therapists are even attending coursework as students. I asked Justin Stambaugh, a student from Duke University (who very much impressed me with his command of the material, and his calm, curious, and competent demeanor), a few questions about his path into pelvic rehab. Below are his responses.

 

Holly: How did your path lead towards pelvic rehab in general?

Justin: Pelvic rehab really necessitates an openness and sense of comfort regarding issues that can be seen as very personal, private, and even taboo. I was drawn to pelvic rehab because I am the type of person who doesn’t believe that individuals should have to suffer in silence because of fear or embarrassment of addressing their issues. I want people to know that they can and should seek treatment for their pelvic health issues, and that physical therapy can be a valuable resource in this regard.

I also value the complexity of pelvic rehab. In addition to the clinical aspect of care there is also the psychosocial element that adds to the scope and depth of treatment. I appreciate that pelvic rehab requires the clinician to continuously evaluate and adapt their approach in order to be proficient.

Additionally I find that often times many physicians, patients, and other physical therapists don’t realize the extent of what we are capable of treating, and how great of an impact we can have on someone’s life. I get excited about educating and promoting this side of the profession.


May 20, 2015

Today's post on the Pelvic Rehab Report comes from faculty member Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC. Allison instructs the ultrasound imaging courses, the next of which will be Rehabilitative Ultra Sound Imaging: Women's Health and Orthopedic Topics in Baltimore, MD on Jun 12, 2015 - Jun 14, 2015.

 

In the past several decades there has been quite a bit of research regarding stabilization of the low back and pelvic ring. We as therapists have changed our focus from working more of the global stabilization muscles to the local stabilizing muscles; the transverse abdominis, the lumbar multifidus, and the pelvic floor. Both research studies and clinical experience has shown us what a positive difference working on these muscles can makes for back pain and pelvic ring pain, as well as for the risk of injury in the back and pelvic ring. However, what does it do for risk of injury for the lower limb? In 2014, Hides and Stanton published a study looking at the effects of motor control training on lower extremity injury in Australian professional football players. A pre- and post-intervention trial was used during the playing season of the Australian football league as a panel design. Assessment included magnetic resonance imaging and measurements of the cross-sectional area of the multifidus, psoas, and quadratus lumborum, as well as the change in trunk cross-sectional area due to voluntary contraction of the transverse abdominis muscle. A motor control program included training of the multifidus, transversus abdominis, and the pelvic floor muscles using ultrasound imaging for feedback that then progressed into a functional rehabilitation program was used with some of the players. Injury data was collected throughout the study. Results showed that a smaller multifidus or quadratus lumborum was predictive of lower limb injury during the playing season. Additionally, the risk of sustaining a severe injury was lower for players who received the motor control intervention.

 

This is interesting and intriguing information. Yes, there are many factors that are involved in sustaining an injury during a sport. However, it would be a good idea to do a quick screen of the local stabilizing muscles before a playing season, whether it is a professional player or an adolescent player. Do adolescents really have issues with weakness in their local stabilizing muscles? Yes! Clinically I have seen adolescent players who display back pain and other issues related to weakness in their core muscles. Usually this occurs after they have gone through a growth spurt, but some of these adolescent athletes did not recover, even several years after the large growth spurt.

 


May 19, 2015

This question is one that, a decade ago, may have made more sense to ask, as very few male therapists were engaged in the world of pelvic rehabilitation. Most pelvic rehabilitation practices still stem from programs developed in "Women's Health" so it's logical to see more female patients being treated, usually by female therapists. We are at an exciting time in the healing professions, and particularly in pelvic rehabilitation, when choice of provider may come to be based more on experience, personality and qualifications of the treating therapist than on the provider's or patient's gender. At the Institute's most recent entry-level Pelvic Floor 1 (PF1) courses, 2 male therapists were in attendance at 2 different PF1 courses on opposite sides of the nation. This shift (we tend to have an occasional male therapist within the pelvic floor series courses) has been noticed, and at the Institute, we have committed efforts at exploring if and how this shift affects our coursework. For example, are the instructors comfortable, are the female participants cool with it, and do the men feel welcomed? To find out a little more about the subject, I bring your attention to a few of the men who are currently representing the field of pelvic health.

 

Herman & Wallace Institute faculty member, Peter Philip, has treated both men and women in his practice for years. This treatment involves internal assessment and intervention when needed, and Peter approaches all of his patients with the same matter-of-fact, clearly defined consent. As a private practice owner, it makes sense that Peter is able to retain his patients regardless of the condition for which they are seeking care. Having to refer a patient to another therapist or clinic would negate the ability for a therapist to provide comprehensive care. On his website you will find a listing of women's health issues described next to sports, work, and other lifestyle injuries.

 

I posed the following question to Jake Bartholomy , physical therapist in Seattle, Washington: "Why is it so important for a male therapist to be involved in pelvic rehab, regardless if the goal is to focus on working with male or female or other gendered patients?" Jake's response reflects the value of offering choices to the patients he serves: "I believe it's important for people to have a choice in their therapist. Many people are shy and nervous to discuss their pelvic issues and if male or transgendered patients are more comfortable working with a male therapist, I'm proud to offer that service in the Seattle area."

 

I recall meeting Daniel Kirages, physical therapist and clinical instructor at the University of Southern California, at a male pelvic floor course years ago. When he introduced himself to the group, he joked that he was there as the token male "to break up the girl party." While this joke has stuck with me, it also drives home the point that it takes courage to show up at coursework which has previously been dominated by female therapists. Daniel has been involved in research, teaching in the classroom and online, and lecturing nationally about pelvic rehab.


May 18, 2015

If you area clinic owner, are in a management or leadership position, one of your jobs is making sure your therapists are using best practices. This can be a challenge when best practices are continually being researched and discussed, and when systematic reviews continue to tell us that pelvic rehabilitation research lacks homogeneity and enough high-level evidence to make convincing arguments about interventions. In the absence of this, we can still integrate recommendations from clinical practice guidelines and from best practice statements. The American Physical Therapy Association's (APTA) Section on Women's Health (SOWH) is participating in the APTA's initiative to develop clinical practice guidelines. For current guidelines, check out their page here. To see which guidelines are in development at the APTA, click here.

 

The American Urological Association (AUA) has also developed practice guidelines, including the Guideline on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (IC/PBS). Within this guideline, the first line treatments are listed as general relaxation/stress management, pain management, patient education, and self-care/behavioral modification. Second-line treatments include "appropriate manual physical therapy techniques", oral medications, bladder medications (administered inside the bladder), and pain management. What is very interesting about this guideline is that the authors define what types of manual therapy approaches are appropriate, and these include techniques that resolve muscle tenderness, lengthen shortened muscles, release painful scars or other connective tissue restrictions. The guidelines also define who should be working with patients who have IC/PBS and pelvic muscle tenderness: "appropriately trained clinicians". Very importantly, the authors state that pelvic floor strengthening exercises should be avoided.

 

How can these guidelines be used to assess best practices? Find out if your therapists who work with patients who have IC/PBS are indeed instructing in relaxation strategies, using pain education and pain management techniques (for pain-brain education specific to pelvic pain, check out the book "Why Pelvic Pain Hurts". Find out if your therapist is instructing in pelvic muscle strengthening as a first-line of treatment, since this would not be in line with the AUA guidelines. (Having said this, teaching pelvic muscle strengthening can be very appropriate when done with consideration of pelvic muscle pain.) Lastly, ask your therapist if she feels that her skill set and training is sufficient to treat the condition. Even in our comprehensive pelvic floor series, there is so much to learn at the initial course that IC/PBS is not discussed in great detail until PF2B. Maybe a little more knowledge and training would help your therapist feel that she is providing the "appropriate manual physical therapy techniques" recommended in the guidelines.

 


May 11, 2015

Even after teaching for a couple of decades, both in graduate level courses and in continuing education settings (live and online), I am humbled by all there is to learn and relearn about how to teach well. We all teach every day, regardless of what setting or roles we work in, and are required to share our thoughts and knowledge with respect, equanimity, and non-judgement. After teaching a course last month, I received feedback about an important topic that was not clearly addressed from an instructional or clinical standpoint, and the participant who brought it to my attention agreed to share her experience so that we as pelvic rehab providers can do a better job of addressing the issue when needed. The following post was written by Erin B. after I encouraged her to share her own thoughts about the issue.

 

"Having recently participated in the PF1 class after several years out of the classroom-style of continuing education, I made a few observations I felt compelled to share. (I do want to preface this with the fact that I am fully aware that my own insecurities play a role in my experiences and I recognize that they may alter my judgment of the situation.)

 

I am 5' 4" and currently 240 pounds. Although that is 50 pounds lighter than I was 6 months prior to attending this class, it is still significantly larger than 90% of the class participants, lab assistants and instructors. I am not someone who feels that fat is healthy. I do not feel that you need to act like I am in as good of shape as anyone else in the room. However, I do feel that there are certain assumptions made about me that are based on my physical appearance alone. Take a minute and think about your first reaction to seeing a person who is obviously overweight. (I do realize that I have made my own assumptions about some of you as well!) Just because you are much thinner and more fit looking I assume you exercise regularly, you always eat healthy and you judge me negatively for my appearance. I do know that my assumptions about you may be just as wrong as what I believe you assumed about me. However, when I see that the larger people in class have placed themselves more to the back of the room, when I have a hard time finding a lab partner and when the lab instructor struggles with how to say to the partner that got stuck with me "things may be different on her", I begin to feel like I am taking something away from the class experience for everyone else. I do not want to hinder another clinician's learning process so I don't push anyone to be my partner, but then I am actually denying myself the learning opportunities I came for. Not to mention that I may be denying the other participants the opportunity to learn how to handle a client that may look and feel like me.

 


Mar 25, 2015

Professionals

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.


Jan 14, 2015

Female Superior Obturator

As a physical therapist I am continually amazed at the myriad of ways the parts of our bodies are connected (and even more so by our brain/body connections, but that is another blog post.) Take one of my favorite muscles for example, the obturator internus. This amazing muscle is known for its relationship to the hip as one of the external rotators, and it’s anatomy is impressive! What other muscle sharply turns ninety degrees from its attachment to its origin? The obturator internus traverses the inside of the pelvis and attaches mid-belly to an important tendon, the Arcuate Tendon Levator Ani (ATLA) , which becomes the means by which the obturator connects to the pelvic floor. (I love to show patients how their hip literally connects to their pelvis!) The ATLA connects with the Arcuate Tendon Fascia Pelvis which connects to the fascia supporting the bladder and urethra.

We know that in our patient who have pelvic pain too much tension or trigger points in the obturator internus can create symptoms of urinary urgency or frequency, pain in the bladder, vagina, rectum, abdomen, pelvic floor and hip. But what happens when the obturator internus is uptrained to treat women with stress urinary incontinence (SUI)? An article in the May/August 2014 Journal of Women’s Health looked at the role of strengthening the obturator internus and the adductors and compared the effects to working the pelvic floor for the treatment of women with SUI. The results were quite interesting.

 

This research was a pilot study comparing two randomly assigned groups of community dwelling women with SUI. A group of 12 completed resisted hip rotation (RHR) and a group of 15 completed pelvic floor muscle training (PFMT). Each group exercised at home for six weeks with a weekly recheck. Outcome measures included subjective reports of improvement, leak frequency, and scores from the Incontinence Impact Questionnaire (IIQ) and the Urogenital Distress Inventory (UDI). The exercise routines were supposed to take about 5 minutes and be performed twice a day. Subjects were instructed to sit with good posture and with their feet on the floor. The pelvic floor muscle group performed 5-second holds for 20 reps followed by 20 quick contractions. The RHR group exercised by 1) rotating internally and externally with diaphragmatic breathing for 10 breaths , 2) 10 repetitions of resisted hip external rotation with a green band and 5 second work/rest cycle and 3) 10 repetitions of hip internal rotation/adduction against a 9 inch ball with the same 5 second squeeze and rest cycles.

 

The results of the study showed that BOTH groups had significant and equal improvement in outcome measures by the end of the six weeks, but that the RHR group showed improvements sooner than the PFMT group. The authors discuss the limitations of their study: small sample size, large ranges of participant ages, patients were not medically examined, outcome measures were subjective, and the pelvic floor group only received verbal instruction. This study was thought provoking to me for several reasons. First, it gives me a great platform to talk with my non-pelvic health colleagues about treating pelvic floor weakness dysfunctions with indirect pelvic floor treatment. Virtually any patient could sit and roll their legs in and out against resistance! This exercise could be easily incorporated into a routine for people with bladder leakage or at risk for bladder leakage. Secondly, we often see patients with non-functioning pelvic floor muscles. My typical protocol before discussing the treatment option of electrical stimulation is to uptrain (increase muscle activity) with hip rotation, adduction and transverse abdominus muscle exercises. I have often found that I don’t need to address the pelvic floor directly when the accessory muscles are appropriately engaged. This study points out the importance of muscles outside of the pelvic floor in providing support for continence.


Sep 18, 2014

A recent on-line survey queried fourty-four Obstetrician-Gynecologists (OB-GYNs) in British Columbia to learn more about the needs of physicians who treat women who have endometriosis and chronic pelvic pain (CPP). Physicians reported that women who present with endometroisis or chronic pelvic pain usually require more visits than other patients, for reasons including medical and pain management, lack of a clear diagnosis, and lack of improvement in condition. Evaluation techniques utilized by the physicians often included laparoscopy and ultrasound, and despite these practices, the OB-GYNS reported challenges in making a diagnosis or successfully treating their patients with CPP. In fact, survey results indicated that 5% of the respondents were able to diagnose a patient for a cause of pelvic pain in > 70% of patients. Most of the physicians reported that less than half of the women treated had a good response to interventions. Although the highest rate of referral for these providers was to another OB-GYN specializing in pelvic pain, nearly 60% of the time a referral to physical therapy was reported. 

 

 

Although some of the narrative comments encountered in this survey were positive, including one physician's report of having "…good success with physiotherapy…", more often the providers expressed frustration and annoyance when faced with not only the challenges of diagnosis and treatment, but also the poor compensation and the longer visits required for counseling and teaching of patients. In addition to wanting more clear guidelines on diagnosis and management of female CPP, physicians expressed interest in having group educational sessions for patients, and more resources such as educational brochures on self-management for patients.

 

 

How can pelvic rehabilitation providers fill in this knowledge gap? I recall asking a referring provider if he was pleased with his patients' rehabilitation outcomes, and he expressed such a relief that I was taking the "dregs of the practice." He meant nothing disparaging about the patients themselves, he explained, just that when these patients walked in the door he felt a sinking feeling because he did not know what to do for them. Now, he reported, these same patients were returning from a pelvic rehabilitation referral and excitedly reporting on progress they had made. So many physicians and other referring providers still do not understand the scope of the patient populations that we can treat in pelvic rehabilitation. We can provide a necessary bridge between the challenge of diagnosing and medically treating chronic pelvic pain and the rehabilitation approach that addresses the chronic pain issues. Differential diagnosis of chronic pelvic pain from a rehabilitation standpoint is a skill set  that every therapist must continually improve upon. If you are interested in learning more about these skills, sign up for faculty member Peter Philip's continuing education course Differential Diagnostics of Chronic Pelvic Pain next month in Connecticut. 


Sep 15, 2014

This is a guest blog-post by Herman & Wallace faculty member Jennafer Vande Vegte, MSPT, BCIA-PMB, PRPC

Erica Vitek MOT, OTR, BCB-PMD, PRPC

Stress. We all have it. We all deal with it in one way or another. Sometimes stress comes and goes quickly while at other times it lasts and lasts. Research shows that at times, short bouts of stress can be good, even helpful. The surge of adrenalin and cortisol we get staying up past midnight to finish that assignment before it is due the next morning can power our brains to accomplish a task about which we procrastinated because it seemed burdensome or boring. We are very grateful for the extra burst of speed we feel in our legs as we run to catch our naughty three year old as they run off into a busy street. After these stressful events are over, our bodies recover but chronic stress can affect our bodies in negative ways and our bodies may need help finding a way to cope.

Research shows one main pathway that stress takes in the body is the Hypothalamus Pituitary Adrenal Axis or HPA axis for short. In the HPA axis there is a systematic release of chemical messengers that create a cascade of effects in our bodies. The HPA axis governs our response to stress and also affects our energy levels, digestion, sexual functioning, immune system and other body processes. We don't even need the research to tell us this because we have all experienced it firsthand.

Unfortunately when stress in any form does not go away, our bodies may not find the way back to homeostasis and chronic issues can develop. Research also points out that the function of our HPA axis could have been impaired during our development. Maternal stress can affect a developing baby in utero, and trauma or stress in infancy or early childhood can influence the function of our stress response into adulthood.

Interestingly, there are also gender differences in how stress influences behavior. In their article on the female response to stress, authors Taylor et al. describe the effects of oxytocin on the HPA axis. Oxytocin is released during nurturing behaviors and helps to decrease the activity in the HPA axis. The authors postulate that estrogen may be one reason women cope and respond to stress differently than men. Mothers comfort their babies when they cry and help sooth them. This action is beneficial to both mom and baby. Friends offer comfort with a listening ear, a hug, and emotional support. John Gray in his book Venus on Fire Mars on Ice also notes that oxytocin is released when we feel loved, appreciated and heard. As physical therapists working one-on-one with our patients we are also in a position to listen to and validate our patients which may aid in combating their stress response. Joining a support group may also be of benefit.

How do you respond to stress in your life? Dartmouth researchers found their students drink more caffeine, sleep less, and consume more alcohol. Exactly the WRONG responses when you look at the physiological effects on the HPA axis.. According to the article, "Leproult et al. found that plasma cortisol levels were elevated by up to 45 percent after sleep deprivation, an increase that has implications including immune compromise, cognitive impairment, and metabolic disruption." Caffeine and alcohol also increase cortisol release.


Aug 28, 2014

One of the questions we frequently receive at the Institute is "Do you have any research about ___________?" At times, therapists are looking for information that can help with patient care, or they might be looking for support in a claims denial letter, or foundational material for a presentation. If you have been taught how to find articles, this may seem like a simple task. Many of us therapists went to school when the only use of a computer was for word processing, if we were lucky enough to have progressed from the typewriter or even the electronic typewriter. (Imagine no Google, no Wikipedia, and no Amazon to purchase textbooks!) There are basic search skills that can be shared so that every person interested in a particular topic can find recent articles in free search engines. While the full article may not be available, many times you will have access to full articles that synthesize recent works. (One website that you can use that offers full text article access is PubMed Central.) If you are not interested in reading articles, but prefer to read a scholarly summary of a health topic, check out www.uptodate.com, where you can subscribe to have full access to excellent evidence-based summaries. You can read through the reference lists on the site as well to see if there is a resource that you want to track down.

 

One method of finding articles is to go to www.googlescholar.com. In the search bar, type in the topic you are interested in, such as "urinary incontinence." You will then be provided with a list of all articles that have urinary and/or incontinence in the title or in the key words of the research. An even more refined way to conduct your search is by using Boolean terms, in which you connect your search words by "AND" or other key terms. To see this in action, let's say you want to know if there is any research about urinary incontinence and prostatectomy surgery. Try completing a google scholar search by typing in the following: "urinary incontinence" AND "prostatectomy". (Be sure to use the quotation marks and type the word "AND" in capital letters.) You will see that you come up with some very nice articles about the specific topic you searched. To make sure you are looking at recent articles, go to the left side of the search page and under the words "Any time" choose an option such as "Since 2010" so that you are seeing articles from within the last 5 years. Next, maybe you want to know if there is evidence for rehabilitation. Add the word rehabilitation, like this: "urinary incontinence" AND "prostatectomy" AND "rehabilitation". You will see that you now have even more results specific to rehabilitation of the condition. On the right side of the page you might see a link that starts with [PDF] where, if you click on it, you will usually be brought to the full article rather than just the abstract. If you see an article that you think fits your search, you can also click on "Related articles" located under the brief description of the article.

 

Being able to look up articles serves many purposes, including staying updated on patient care, and discussing evidence with peers, providers, and patients. Another valuable reason to find your own research is when studying for certification exams such as the Pelvic Rehabilitation Practitioner Certification (PRPC). On the PRPC certification page on our website, you can find a list of some articles for which we have added links. (Remember that there is no need to print out articles anymore! Save a tree and simply save the articles as a PDF file. You can name the article by the author's last name, year and main topic, and store in a folder on your computer so it is easy to access- no file drawer required!) If you are thinking about taking the PRPC exam, there is no time like the present to get your application put together! The deadline for applying is October 1 of this year, with the test taking place in the first couple weeks of November. Personally, I have enjoyed reading the blog posts introducing therapists who have earned their PRPC title- the reasons for seeking the distinction are very interesting and meaningful. We would love to see your name on the list of certified therapists, so check out the details on the website and contact us if you have any questions about the PRPC application process!


  • «
  •  Start 
  •  Prev 
  •  1 
  •  2 
  •  3 
  •  4 
  •  5 
  •  6 
  •  Next 
  •  End 
  • »

Upcoming Continuing Education Courses

Special Topics in Women's Health - Maywood, IL
May 30, 2015 - May 31, 2015
Location: Loyola University Stritch School of Medicine

Sacroiliac Joint Evaluation and Treatment - Middletown, CT
May 30, 2015 - May 31, 2015
Location: Middlesex Hospital

Pelvic Floor Level 2B - Seattle, WA (Sold Out!)
Jun 05, 2015 - Jun 07, 2015
Location: Swedish Medical Center Seattle - Ballard Campus

Pelvic Floor Level 3 - Atlanta, GA
Jun 05, 2015 - Jun 07, 2015
Location: One on One Physical Therapy

Visceral Mobilization of the Urologic System - Madison, WI
Jun 05, 2015 - Jun 07, 2015
Location: Meriter Hospital

Nutritional Perspectives for the Pelvic Rehab Therapist - Seattle, WA
Jun 06, 2015 - Jun 07, 2015
Location: Pacific Medical Center

Rehabilitative Ultra Sound Imaging: Orthopedic Topics - Baltimore, MD
Jun 12, 2015 - Jun 13, 2015
Location: Johns Hopkins Bayview Medical Center

Rehabilitative Ultra Sound Imaging: Women's Health and Orthopedic Topics - Baltimore, MD
Jun 12, 2015 - Jun 14, 2015
Location: Johns Hopkins Bayview Medical Center

Pelvic Floor Level 1 - Boston, MA (SOLD OUT!)
Jun 12, 2015 - Jun 14, 2015
Location: Marathon Physical Therapy

Pelvic Floor Level 2B - Derby, CT (SOLD OUT)
Jun 26, 2015 - Jun 28, 2015
Location: Griffin Hospital

Breast Oncology - Maywood, IL
Jun 27, 2015 - Jun 28, 2015
Location: Loyola University Stritch School of Medicine

Chronic Pelvic Pain - Arlington, VA
Jul 10, 2015 - Jul 12, 2015
Location: Virginia Hospital Center

Myofascial Release for Pelvic Dysfunction - Winfield, IL
Jul 17, 2015 - Jul 19, 2015
Location: Central DuPage Hospital Conference Room

Pediatric Incontinence - Houston, TX
Jul 18, 2015 - Jul 19, 2015
Location: Texas Children’s Hospital

Yoga for Pelvic Pain - Cleveland, OH
Jul 18, 2015 - Jul 19, 2015
Location: UH Case Medical Center - University Hospitals