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Mar 20, 2015

Professionals

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.

 

Steve Dischiavi

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?


Mar 13, 2015

Blog by Holly Tanner

Research in the field of sexual dysfunction has taught us several things about patients and healthcare visits. Most medical providers don’t ask about sexual function, most patients don’t bring it up, and women’s sexual health has a history of being undervalued and under-evaluated. Authors Maciel and Lagana describe the common myth that as women age, sexual interest decreases, and review literature to propose improved strategies. The study highlights the fact that there are positive physical health effects for older adults, and that by approaching sexual desire through a biopsychosocial method, further understanding of the issues can be gained.

 

Several factors have been found to be linked to healthy sex in older females. Having a positive attitude towards sex, an interesting an interested partner, good health, and a willingness to experiment sexually can all contribute to an active sex life. Women who are dealing with high stress, anxiety, and depression are known to be less sexually active. In this paper, the authors describe the work of Sobecki and colleagues, who found that older women have just as much interest in talking about sexual health as younger women, but that doctors aren’t usually asking about it. Sobecki et al. found that a patient reported feeling less embarrassed about bringing up sexual dysfunction if the medical provider demonstrated a professional demeanor, comfort with the topic, and a disposition that is kind and empathetic.

 

This last point seems worthy of pause and reflection in relation to the role of the pelvic rehabilitation provider. I would submit that most pelvic rehab therapists are highly capable of presenting a professional, kind, and empathetic demeanor. I wonder how many of us, however, had enough education regarding sexual health to demonstrate to patients a level of “comfort with the topic” that inspires a patient to bring up sexual concerns. The more comfortable we are with our own sexuality and the more knowledgeable we are about sexual health practices that are outside of our own experiences, the more we have to offer to our patients.

 


Mar 12, 2015

This post was written by H&W instructor Elizabeth Hampton. Elizabeth will be presenting her Finding the Driver course in Milwaukee in April!

 

ms or pfm exam

One of the most consistent questions that we hear at the Pelvic Floor 2B course is, “How do you choose between a pelvic floor and a musculoskeletal exam during your first visit with a pelvic pain client?” The answer depends on a number of factors, which include your clinical reasoning, toolbox, the client’s presentation, the clinical specialty, and expectations of the referring provider as well as the expectations of the client. It can be stressful to imagine gathering a detailed history, testing, client education and a home program within the first visit! Now that we have less time and total visits to evaluate and treat these complex issues, it can be overwhelming to know where to start.

 

Chronic pelvic pain has multifactorial etiology, which may include urogynecologic, colorectal, gastrointestinal, sexual, neuropsychiatric, neurological and musculoskeletal disorders. (Biasi et al 2014) Herman and Wallace faculty member, Elizabeth Hampton PT, WCS, BCB-PMD has developed an evidence based systematic screen for pelvic pain that she presents in her course “Finding the Driver in Pelvic Pain”. “There are a number of extraordinary models that exist for treatment of pelvic pain including Diane Lee’s Integrated System of Function, Postural Restoration Institute, Institute of Physical Art and more,” states Hampton. “However, regardless of the treatment style and expertise of the clinician, each clinician should be able to perform fundamental tissue specific screening. If a client has L45 discogenic LBP with segmental hypermobility into extension, femoral acetabular impingement, urinary frequency > 12/day as well as constipation contributed to by puborectalis functional and structural shortness, all clinicians should be able to arrive at the same fundamental findings during their screening exam. The driver of the PFM overactivity(3) needs to be explored further as local treatment alone (biofeedback and downtraining) will not resolve until the condition causing the hypertonus is found and treated.” Finding the Driver in Pelvic Pain is a course that models a comprehensive intrapelvic and extrapelvic screening exam with evidence based validated testing to rule out red flags, understand key factors in the client’s case as well as develop clinical reasoning for prioritizing treatment and plan of care. The screening exam complements any treatment model as it identifies tissue specific pain generators and structural condition, which will lead the clinician to follow their clinical reasoning and treatment model. Once the fundamentals are established, the clinician can move beyond screening and drill down into treatment of key factors which may include specific muscle gripping patterns, arthokinematic assessment and respiratory evaluation and retraining, among others.

 


Mar 11, 2015

Pudendal Nerve

Human anatomy is a challenging, yet fascinating study that truly is a lifelong endeavor. Even if a health care provider has a photographic memory for what she learns in her professional training, the reality is that we are still working to understand all of the intricacies of how our bodies are put together to have all of the amazing capacities that our bodies can offer. Textbooks like Netter's anatomy helps us to memorize anatomy by using bright colors to highlight structures and by separating fascia from muscles and nerves, and yet this is a superficial representation of what is really going on in the body. Even once we memorize many of the structures in the body, we are still tasked with understand the functional interplay among our fascial-musculo-skeletal-attached-to-an-amazing-nervous-system bodies.

 

What does this have to do with pelvic rehabilitation? Most of us did not have an adequate study of pelvic rehabilitation in our initial training, and have benefited from learning pelvic anatomy and function at post-professional coursework. And for most of us, this is an ongoing process. Even when we have learned a lot about anatomy, there's this issue: anomalies and variations. We are not all created the same. Some of our patients have extra structures, some lack. Some people have tissues that grow in areas where we least expect it, others have joints that fuse where others have movement. Within pelvic rehabilitation, we learn some very interesting things by reading case reports or surgical histories, and by listening to our patients' stories.

 

One of the structures in the body that can be faced with some fairly challenging anatomical variations is the pudendal nerve. Many of us are familiar with some of the areas in the pelvis that the pudendal nerve can face challenges, or areas where the nerve can become more daily compressed or irritated such as between the sacrotuberous and sacrospinous ligament. Consider this cadaver study that demonstrates variations in inferior rectal nerve development, with differences in truncation and location, including nerves that travel through the sacrotuberous ligament, making it potentially more susceptible to compression. Or what about this cadaver dissection that revealed a double gluteus maximus with variations in nerve pathway between sides? What are the implications for the patient who has a complete ossification of the sacrotuberous ligament?

 


Mar 10, 2015

femoroacetabular impingement

An article appearing this year in Arthroscopy details a systematic review completed to determine if asymptomatic individuals show evidence on imaging of femoroacetabular impingement, or FAI. Cam, pincer, and combined lesions were included in the results. To read some basics about femoroacetabular injury, click here. Over 2100 hips (57% men, 43% women) with a mean age of 25 were studied. (Only seven of the 26 studies reported on labral tears.) The researchers found the following prevalence in this asymptomatic population:

 

Cam lesion: 37% (55% in athletes versus 23% in general population)

Pincer lesion: 67%

Labral tears: 68%

Mean lateral and anterior center edge angles: 30-31 degrees


Mar 09, 2015

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with Herman & Wallace instructor Elizabeth Hampton PT, WCS, BCIA-PMB

 

Elizabeth Hampton

Who or what inspired you?

I have been inspired by Kathe Wallace, Holly Herman and my clients who have been so grateful to be heard and helped by pelvic health PT. My first course with Kathe and Holly changed my enthusiasm about being a PT and caused a spark that has inspired me to continue to learn and work with this population for 19 years and counting!

 

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


Mar 06, 2015

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Reeba Varghese, DPT. PRPC.

 

Reeba Varghese

How did you get involved in the pelvic rehabilitation field?

I was asked to attend a course by my director back in 2008 because they wanted to expand pelvic rehabilitation services to a few of our company's locations. I told my director I did not think this specialty was for me but I would be willing to attend one course and see how I felt. When I attended PF1 I was immediately drawn in by the wealth of knowledge I gained. Learning the intricacies of the human anatomy, specifically the female anatomy just completely opened my eyes to one of Gods most amazing creations. Also, the passion in the instructors was contagious. When I returned to work and started to see patients with incontinence and listened to their stories my passion for supporting these individuals in their rehabilitation journey began to grow. As I continued to expand my knowledge base by attending more courses through Herman and Wallace I realized I had found my niche in the world of physical therapy.

 

What patient population do you find most rewarding in treating and why?


Upcoming Continuing Education Courses

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

Pediatric Incontinence - Minneapolis, MN
May 16, 2015 - May 17, 2015
Location: Mercy Hospital

Biomechanical Assessment of The Hip & Pelvis - Durham, NC
May 16, 2015 - May 17, 2015
Location: Duke University Medical Center

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