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Dec 05, 2014

This post was written by H&W instructor Martina Hauptmann. Martina will be presenting her new Pilates for the Pelvic Floor course in Denver in 2015!


Martina Hauptmann

It is commonly known that exercise while pregnant is important. In every city there are numerous pre-natal group exercise classes. These classes offer an excellent way to maintain fitness and also create a support group for these clients. Unfortunately, medical research studies conducted by physical therapists do not show that group exercise for pre-natal clients decreases the prevalence of low back pain in pregnancy (Eggen et al, Physical Therapy: June 2012.)


If the focus is on decreasing the prevalence of low back pain in pregnancy, the European Guideline for Physical Therapists recommend individualized exercise sessions. With individualized exercise sessions, the client’s posture, quality of movement and sequencing of muscle recruitment can be monitored and altered as necessary for the client.


Dec 03, 2014


A recent case report in the Journal of Physical Therapy Science describes the benefits of specific strengthening of the subdivisions of the gluteus medius in a patient with sacroiliac joint pain (SIJ). The intervention is based in prior research that demonstrated varied muscle firing patterns in the gluteus medius during different exercises. The author of the study suggests that the stabilizing role of the gluteus medius can influence sacroiliac joint pain.


The patient in the case report was a 32 year-old female who complained of pain in the left iliac crest area and sacroiliac joints for 6 months. Symptoms worsened with forward bending, standing for more than an hour or walking for more than thirty minutes. Before and after a 3 week intervention of specific strengthening exercises, objective tests included the Gaenslen, Patrick, and the resistive abduction (REAB) test. These tests were all positive for pain provocation. Exercises were instructed for gluteus medius strengthening and were performed over a period of three weeks. Following the 3 week exercise intervention focused on gluteus medius strengthening, the patient's Visual Analog Scale improved from a 7/10 to a 3/10, and repeated objective tests were negative. Exercises for the various portions of the gluteus medius (GM) were prescribed at 3 sets of 30 repetitions/day and are as below:

  • anterior GM: hip adduction in sidelying
  • middle GM: wall press exercise in standing
  • posterior GM: pelvic drop exercise from platform in standing

    Keeping in mind that this case represents only one clinician/patient interaction, we can ask ourselves several questions about the positive results of the intervention. Are we currently challenging the hip abductors enough with our patients who have pelvic girdle pain, and is there enough specificity in the exercises to challenge the appropriate muscle fibers? Can isolated strengthening of hip abductors in absence of other interventions have a positive effect on sacroiliac joint pain in our patients? Are there other plausible rehabilitation concepts inherent in performing these open and closed chain activities that contributed to improvement in this particular patient, rather than an isolated increase in muscle training for the gluteus medius? The sacroiliac joint can be a confounding source of pain, and at the same time, successes in treating patients who have SIJ dysfunction can be very rewarding. If you would like to learn more about evaluation and treatment of sacroiliac dysfunction, the next opportunity to take faculty member Peter Philip's course Sacroiliac Joint & Pelvic Ring Dysfunction, offered next in Seattle in January.

    Dec 01, 2014


    The Herman & Wallace Pelvic Rehabilitation Institute is thrilled to announce a new course about pelvic rehabilitation applications of Pilates exercises. Martina Hauptmann, physical therapist and STOTT-trained Pilates instructor, has customized a course for the Institute that will instruct both foundational principles and exercise techniques for Pilates as well as specific skills for the pelvic rehabilitation provider. Special populations will be discussed within this course titled "Pilates for the Pelvic Floor" including, but not limited to, patients who have urinary dysfunction, overactive pelvic floor muscles, and women in the peripartum period. If you would like to join Martina at her new Pilates continuing education course, the soonest opportunity to take Pilates for the Pelvic Floor is in Denver in March of next year.


    With the popularity of the Pilates method as a health and fitness approach, research has investigated use of Pilates-based exercises and topics such as specific muscle activation, low back pain, pelvic dysfunction, and other variables. A recent article published in the Journal of Aging and Physical Activity evaluated the effects of a 5-week Pilates exercise program on fall risk factors. Interestingly, the follow-up was completed twelve months after the initial training, with a hypothesis that those who continued to participate in the instructed exercises would have less fall risk than those who did not continue with exercises. To test this theory, forty older adults (mean age of 69 years) were instructed in Pilates exercises, with thirty completing follow-up testing. Outcomes tools included the get Up and Go and the Four Square Step Test. Leg strength was measured in the knee extensors and ankle dorsiflexors with a dynamometer, and variables of dynamic balance were measured with a force plate. The participants completed testing prior to and immediately after the 5 week exercise period, and again at twelve months after the exercise period.


    The classes included only up to six participants at a time, and standing, floor mat exercises, and circuit activities with Pilates Reformers and Chairs were completed. Sessions were held twice per week for one hour each session, with a significant portion of the class activities completed in standing to challenge balance. Each participant was also given a one hour home exercise program. Following the study, participants were invited to continue at 1-2 sessions/per week (with small fee paid to instructor). The results of the study included that all of the participants demonstrated improvements in static and dynamic balance, regardless of their continuation in Pilates classes after the initial 5-week instruction period. Strength improvements were more significant in those who continued to take Pilates classes throughout the 12 month period.


    Nov 25, 2014

    This post was written by H&W instructor Ginger Garner. Ginger will be presenting her Hip Labrum Injuries course in Houston in 2015!


    Ginger Garner

    There are two accepted forms of hip impingement currently documented in the literature. The two types are 1) CAM type FAI (femoracetabular impingement) and 2) Pincer type FAI. These two types are found inside the joint, meaning they are considered intra-articular bony anomalies.


    FAI is a common comorbidity found with hip labral injury (HLI); and in fact, FAI is a risk factor for HLI. Specifically, FAI is a bony impingement that arises in the femoral head-neck function and the rim of the acetabulum (see photo at right). The two types of FAI also generally occur together more than they do in isolation. However, it is possible that, combined with other issues like acetabular undercoverage or hip instability, CAM or Pincer-type FAI can be found a singular diagnosis.


    Nov 24, 2014

    In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Alyssa Rutchik Padial, PT, MS, OCS, PRPC


    Alyssa Padial

    Describe your clinical practice:

    For 18 years, I have been privileged to be a part of NYC’s #1 New York Presbyterian Hospital, working in the hospital-based out-patient arena. The patient population is diverse, and the great fortune of being at an academic institution means that I have had the opportunity to see and learn about effective treatments for all kinds of patients. We treat any orthopedic, neurological, vestibular, trauma, burn, hand, spine, and of course pelvic patient! Our pelvic health program was initiated in 2002 and we see male and female patients with all types of pelvic dysfunction – bladder, bowel, sexual, pain. We treat women throughout the peri-partum and post partum span. Our practice has 3 pelvic rehabilitation physical therapists and patients are typically seen 1x/week for 30-45 minute sessions. Additionally, I see patients in Westchester and Rockland Counties in NY on a fee-for service basis.


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

    Nov 24, 2014

    According to the World Health Organization (WHO) sexual health relies upon a "…positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence." This definition provides an excellent framework, yet how many of us were provided with the tools we needed growing up to understand the many domains that affect sexual health such as physical (how does sex work?), and social and psychological implications? Herman & Wallace Pelvic Rehabilitation Institute co-founder Holly Herman has been a long-time proponent of sexual health and function, and in courses, she might be heard asking participants to consider most individuals first sexual encounter: was it relaxed, were both parties informed, was the experience pleasurable? Regardless of a person's stance on when an individual should first engage in sexual activity and with whom, developing a life-long healthful approach to our own sexuality is clearly an integral part of optimizing quality of life.


    Ff we expand this concept to the pelvic rehabilitation caseload we often face, how can we best meet the needs of our patients if our own education in sexuality was limited? How can we best understand the varied approaches to sexual health and function if the approaches do not match our own? Our world has fortunately shifted to include the recommendation that healthy sexuality begins in childhood. The American Academy of Pediatrics states that a simple step in childhood sexual development is in using the correct anatomical names for genitalia. How can youth and adolescent sexual health education and support be improved to further promote lifelong healthy sexuality?


    An article published last year in the journal Public Health Reports addresses a paradigm shift from teenage pregnancy prevention to youth sexual health. The Oregon Youth Sexual Health Plan was developed in 2009 following a collaborative effort from state agencies and private partners, and focuses on "development of young people" and embracing "sexuality as a natural part of adolescent development." This article lends historical perspective to the advancement of the concept that adolescents have a right to sexual health knowledge, not simply in relation to reproduction and sexually transmitted disease, but also in relation to quality of life and interpersonal relations. The researchers also point out the failure of abstinence-only sex education to produce significant evidence of efficacy.


    Goals of the youth sexual health plan include having young people use "accurate information and well-developed skills to make thoughtful choices about relationships and sexual health." Additional goals include that sexual health inequities are removed, rates of teenage pregnancy and sexually transmitted diseases are reduced, and non-consensual sexual behaviors are reduced. The Oregon Youth Sexual Health Plan is public policy, and one that may pave the road for other states seeking to move from a negative stance that focuses on potentially harmful impacts of sexuality to a positive sharing of needed information, knowledge, skills, and support in developing a healthy view of sexuality. If you would like to learn more about sexual health and sexual medicine, join Holly Herman at her course titled Sexual Medicine for Men and Women. The next opportunity to take this course is in January in Houston!

    Nov 24, 2014

    This post was written by H&W instructor Susannah Haarmann, PT, WCS, CLT, who authored and instructs the course, Rehabilitation for the Breast Oncology Patient.


    Elizabeth Hampton

    According to Schmitz et al, 94% of people experience fatigue as a side effect during breast cancer treatment, and, unfortunately, this condition commonly persists after treatment ends. Fatigue is often described as an unrelenting sense of tiredness that interferes with daily functioning. The symptoms of fatigue, such as generalized weakness, inability to concentrate and impaired short-term memory are often disproportionate to activity levels and unresponsive to sleep (Mitchell, 2010).


    The causes of fatigue during cancer treatment are often multi-factorial and may be related to anemia, pain, deconditioning, hormonal and electrolyte imbalances or emotional distress, among other reasons. Physicians may attempt to alleviate the symptoms with pharmaceutical interventions such as pain and sleep medications or iron supplements, however, the only intervention that has been shown to have a significant effect in lowering fatigue levels is exercise. The NNCN states that exercise has been shown to lower fatigue levels by 40-50% (NCCN, 2008).


    Nov 20, 2014


    We are thrilled to announce that the results of the November 2014 administration of the Pelvic Rehabilitataion Practitioner Certification (PRPC) are in! Thirteen incredible therapists have joined the ranks of Certifed Pelvic Rehabilitation Practioners!


    Huge congratulations to the follwing dedicated experts who sat for and passed the exam this fall:


    Lauren Calabrese, PT, DPT

    Nancy Corvigno, MSPT

    Nov 20, 2014

    Can pelvic floor muscle training during the peripartum period prevent or cure urinary incontinence? A systematic review was completed by two pioneering pelvic rehabilitation researchers, Kari Bo, and Siv Morkved, physiotherapists who are experts in pelvic floor therapy. The authors included twenty-two randomized, controlled trials (RCTs) or quasi experimental design studies in the field of pelvic floor muscle training during the peripartum period. Interventions included in the eligible studies included exercise and biofeedback, vaginal cones, or electrical stimulation. As is reported among many systematic reviews, the variability among study populations, criteria, and outcomes measures was wide, however, the authors did conclude that pelvic floor muscle training (PFMT) during and after pregnancy can prevent and treat urinary incontinence (UI). This training should be supervised, the contractions instructed should be close to maximum effort, and at least eight weeks duration is recommended based on the review.


    Research issues cited as having potential effects on the research reporting include the lack of outcomes data measuring adherence to the instructed exercise programs. Also brought into question is the practice of treating patients with pelvic floor dysfunction once per week, which may effectively provide a suboptimal dose of care if the effect of treatment is to hypertrophy muscles and provide a plan of care based on strength measures. In many studies, the control group was also completing pelvic muscle exercises as part of "usual care" and creating difficulty in assessing differences among treatment and non-treatment groups. Another question posed by the authors is that if physiotherapists, nurses, and physicians are instructing in exercises, is the instruction equivalent based on training? To improve this potential factor, Bo & Morkved suggest that fitness instructors and coaches should be trained in effective PFMT approaches.


    The take home point of this study is that PFMT should be a routine part of women's exercise programs,especially during the peripartum period. Bo & Morkved also point out that UI is inhibitory to exercise participation, and should be considered when designing postpartum exercise guidelines. To learn more about postpartum challenges to recovery of pelvic health and function, join faculty member Jenni Gabelsberg in California this winter for the Care of the Postpartum Patient. The next opportunity to take this course is in January in Santa Barbara!

    Nov 20, 2014

    Researchers in Brazil assessed the effects of low-frequency and high-frequency TENS, or transcutaneous electrical stimulation on post-episiotomy pain. This randomized, controlled, double-blind trial included the two electrotherapy interventions as well as a control group. TENS was applied for 30 minutes to the three groups: the high-frequency TENS (HFT) (100 Hz, 100 ms) the low-frequency TENS (5 Hz, 100 ms), and the placebo group. Electrode placement was near the episiotomy in a parallel pattern, and pain evaluations were completed before and after TENS application in resting, sitting, and ambulating. (Electrode placement specifics can be found in the article that is available within the above link.) The interventions and pain evaluations were carried out between six and 24 hours after vaginal delivery.


    The intensity of the HFT and LFT was controlled by the participants, with instructions to allow the sensation to be both strong and tolerable. A total of 33 participants completed the study, with 11 in the HFT group, 13 in the LFT group, and 9 in the placebo therapy group. The researchers found that for HFT and LFT, pain improved following application of the electrotherapy, and the effects of the pain reduction lasted one hour after the intervention. Because TENS is a low-cost, low-risk modality, TENS use may be a welcome addition for postpartum care following an episiotomy. The women using high or low-frequency TENS in this study reported that TENS was comfortable and that they would opt to use it again.


    If you are interested in learning more about postpartum care and issues such as episiotomies which can interfere with return to function, join faculty member Jenni Gabelsberg in Santa Barbara in January. In addition to discussing a wide variety of common musculoskeletal conditions, she will discuss pelvic floor issues following childbirth that can impact a woman's postpartum recovery. Click here to view the learning objectives for Care of the Postpartum Patient as well as additional dates and locations for this course.

    Upcoming Continuing Education Courses

    Pelvic Floor Level 2B - Houston, TX
    Feb 27, 2015 - Mar 01, 2015
    Location: Texas Children’s Hospital

    Pelvic Floor Level 1 - Bayshore, NY (SOLD OUT!)
    Mar 01, 2015 - Mar 03, 2015
    Location: Touro College: Bayshore

    Care of the Pregnant Patient - Seattle, WA
    Mar 07, 2015 - Mar 08, 2015
    Location: Pacific Medical Center

    Pilates for the Pelvic Floor - Denver, CO
    Mar 07, 2015 - Mar 08, 2015
    Location: Cherry Creek Wellness Center

    Pelvic Floor Level 3 - Fairfield, CA
    Mar 13, 2015 - Mar 15, 2015
    Location: NorthBay HealthCare

    Male Pelvic Floor - Nashville, TN
    Mar 14, 2015 - Mar 15, 2015
    Location: Vanderbilt University Medical Center

    Pelvic Floor Level 1 - Denver, CO (SOLD OUT!)
    Mar 20, 2015 - Mar 22, 2015
    Location: University of Colorado Hospital

    Pelvic Floor Level 2A - Madison, WI (SOLD OUT!)
    Mar 20, 2015 - Mar 22, 2015
    Location: Meriter Hospital

    Coccyx Pain - Torrance, CA
    Mar 28, 2015 - Mar 29, 2015
    Location: HealthCare Partners - Torrance

    Hip Labrum Injuries - Houston, TX
    Mar 28, 2015 - Mar 29, 2015
    Location: Women's Hospital of Texas

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

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

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

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

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