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Jul 24, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Deanne Wade, PT, PRPC, BCB-PMD


Deanne Wade


I am very honored to finally have the opportunity to have earned a designation that sets what I do as a pelvic therapy practitioner apart from other specialties. As with many in this area, I was known as the local “women’s health” practitioner for quite some time. In reality, I work with men, women and children. This certification provides validation of my 17 years of experience in this specialty area.


As a student 24 years ago, I would have told anyone who asked that I would never want to treat patients with chronic pain. I had planned to be an acute care practitioner. Through a series of employment changes and opportunities, I began working with women with “chronic pelvic pain”. What motivated me to continue to pursue treating not only chronic pelvic pain, but any type of pelvic diagnosis was the impact I could make so quickly on quality of life. It is one thing to help a patient recover from an injury and return to everyday activity, but it was incredibly rewarding to hear a patient tell me that this treatment “changed my life.” I was provided with story after story of patients who had restored intimacy in their marriages or who were no longer embarrassed to leave the house for fear of urinary or fecal incontinence. Pelvic rehabilitation changes lives and I love being a part of that.

Jul 21, 2014

This post was written by H&W instructor Ginger Garner, MPT, ATC, PYT. Ginger will be instructing the course that she wrote on "Yoga as Medicine for Pregnancy" in New York this November.



Research has long confirmed the effects of maternal health on fetal development and outcomes. But scientific inquiry into the genesis of disease processes in an adult with no apparent risk factors has been uncharted territory until the last few decades.


The interrelationship between maternal stress and fetal “programming” was considered as early as the mid-1980’s, beginning with the suggested connection between poor nutrition in early life and adult disease. But the developmental origins of adult health and disease were not studied until the mid-1990’s, with little understanding of the etiology until the last two decades.


Jul 18, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Eve Baron, PT, PRPC


What advice would you give to physical therapists interested in earning PRPC?

At the time I took the PRPC exam, I was working in a private practice, which specialized in pelvic floor physical therapy. My coworkers and another pelvic floor PT had a study group which met 4-5 times, and we went through all the H & W manuals for PF1-3. We shared anecdotes about patients that enabled me to remember certain diagnoses and clinical findings. In addition, reviewing anatomy in a group setting is always beneficial because often someone has an acronym that you weren’t aware of that can be very helpful.


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

Many years ago while working in an acute care setting, I was working with an older woman, who had given birth to many children. I cannot remember the exact number, but I remember thinking, “Wow, that’s a lot of kids.” I was assisting her in using a bedpan and was horrified to see what I know in retrospect was a rectovaginal fistula. She said “That’s been happening for ages. I tore real bad when I had my last baby.” I remember thinking how pitiful it was that a woman had to go through the rest of her life with that condition and how underserved women were that had traumatic births. At that time pelvic floor physical therapy was in its infancy, but I knew I wanted to be a part of it. It took me 10 years to take my first course, but it was, and is, the path for me.

Jul 18, 2014

This post was written by H&W instructor Ginger Garner, MPT, ATC, PYT. Ginger will be instructing the course that she wrote on "Yoga as Medicine for Labor and Delivery and Postpartum" in Washington this August.



You may or may not realize that the United States has a very poor track record for postpartum care. In fact, the US has the worst track record for not only postpartum care, but for maternal and infant mortality and first-day infant death rate in the developed world (Save the Children 2013). Between 1999-2008, global mortality rates decreased by 34% while the US’s rates doubled for mothers (Coeytaux et al 2011).


In After the Baby’s Birth, maternal health advocate Robin Lim writes,

"All too often, the only postpartum care an American woman can count on is one fifteen minute appointment with her doctor, six weeks after she has given birth. This six week marker ends an arbitrary period within which she is supposed to have worked out most postpartum questions for herself. This neglect of postpartum women is not just poor healthcare, it is abusive, particularly to women suffering from painful physical and/or psychological disorders following childbirth."

Jul 16, 2014

This guest post was written by H&W instructor Debora Chassé Hickman DPT, WCS, CLT-LANA. Debbie will be instructing the course that she wrote on "Lymphatic Drainage for Pelvic Pain" in California this October.


PRR: How did you come up with the idea to perform manual lymph drainage on patients with pelvic pain?

Debora Chassé

Physical therapist colleagues approached me 3 years ago asking if I could come up with a solution using lymphatic decongestive therapy for pelvic congestion. Pelvic congestion is a diagnosis involving varicose veins in the lower abdomen and pelvis causing chronic pelvic pain. After conducting research on pelvic congestion I found there were only medical treatments to reduce the symptoms. The cause of pelvic congestion is due to blood in the veins that drain the ovaries by backing up causing an abnormal dilation of the vessel. As I began looking at the symptoms related to pelvic congestion with other pelvic pain diagnosis, I saw a correlation between those symptoms and lymphedema.


Patients with pelvic congestion have increased swelling, increased inflammation in a dependent position and uterine wall thickening. Lymphedema symptoms consist of chronic swelling, increased swelling of limb in a dependent position and increased thickening of connective tissue. Crisostomo et al. (2013) conducted research shows manual lymph drainage increase venous blood flow in the lower extremities. I conducted a case study to determine if manual lymph drainage would decrease symptoms of pain in patients with pelvic congestion. Following 5 days of consecutive manual lymph drainage, her symptoms decreased 50%.

Jul 13, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Deborah Benson PT, MEd, COMT, PRPC


Deborah Benson PT, MEd, COMT, PRPC

Describe your clinical practice:

I work in an outpatient orthopedically based manual therapy practice, but work largely with chronic pain patients.

How did you get involved in the pelvic rehabilitation field?

I initially became interested when I started having chronic pelvic pain and urinary leakage myself. I had treated everything I knew how to treat, but continued to have problems. I took the Herman and Wallace Pelvic Floor I class and found that pelvic floor muscle over-activity was part of the “missing piece” for treatment of my problems and some my orthopedic patients who had plateaued. Once I started incorporating assessment and treatment of pelvic floor muscle dysfunction, some of my patients became even more functional.

Jul 11, 2014

This post was written by H&W instructor Steve Dischiavi, MPT, DPT, ATC, COMT, CSCS. Dr. Dischiavi will be instructing the course that he wrote on "Biomechanical Assessment of the Hip and Pelvis" in Virginia this August.



In an outpatient sports medicine clinic the traditional model of physical therapy evaluation typically includes the therapist reviewing a patients chart and subjective symptom questionnaire of some sort. Then the therapist will bring the patient to an area to begin a subjective history and then onto a physical exam. After these procedures have been completed the therapist will typically assign a working clinical diagnosis and then begin treatment. In short, I would like to suggest a paradigm shift to this traditional model of thinking. Instead of starting the exam on a table with a static assessment of the structures involved and identifying the pain generator, I suggest the therapist begin with a specific set of movements used as an evaluative tool to identify movement dysfunction within the anatomical system as a whole.


All human interactions on earth occur between ground reaction force and gravity, our bodies are mostly just stuck in the middle of this constant battle and typically we succumb to whichever power exposes the weakest link in our biomechanical chains. One of the reasons the biomechanical chains in our bodies are so pliable and vulnerable to constant ground reaction force and gravity acting on them is because we are basically bones or struts suspended in a bag of skin all connected by soft tissue. Suggesting that without skin, fascia, and connective tissue supporting us, we would collapse to the ground in a pile of bones! Ingber (1997), suggested this concept, known as tensegrity, was the “architecture of life.” So in summary, the tensegrity structures are mechanically stable not because of the strength of the individual bones, but because of the way the entire human body distributes and balances mechanical stresses through the use of polyarticular muscle chains called slings. There will be more on slings in the upcoming blogs.


Jul 10, 2014


The term "sports hernia" has been used over time to describe a variety of issues, and the medical and rehabilitation community has recently been provided with more clear definitions and descriptions of the condition. Sports hernia has referred to groin and pubic injuries and dysfunctions, as well as abdominal wall disruptions. Clinical diagnosis and treatment has often been challenging because of the inconsistency in definitions, recognition of signs, symptoms, and optimal treatment approaches. A clinical article update published last year states that the term "sports hernia" is a misnomer as there is no classical herniation of soft tissue. The article further describes how the term has become synonymous with sportsman's hernia, athletic pubalgia, and Gilmore's groin.


Improved terminology to describe a sports hernia may be an "inguinal disruption" as referenced in this website of Dr. William Brown. (His site, www.sportshernia.com also includes anatomy images and descriptions of a sports hernia.)The anatomy most often involved is the oblique muscles and accompanying aponeurotic fascia, the adductor attachments to the pubic bone, and occasionally the pubic bone itself. Sports medicine literature, and research involving hockey players in particular, has been rich with reports of players who have had a repair of the aponeurotic fascia and/or oblique muscles, followed by a short period of rehabilitation and a full return to sport. Other commonly involved athletes are those who participate in football, soccer, and tennis. Any sport that may include explosive stops and starts with twisting, turning, and lower extremity rotations can result in a sports hernia.


Institute faculty member Steve Dischiavi has been on the front line of treating athletes with abdominopelvic injuries, and he has prepared an outstanding continuing education course complete with many videos, assessment techniques and intervention strategies. To learn more about differential diagnosis and treatment of the lumbo-pelvic-hip complex, join Dr. Dischiavi this August in Arlington, VA for Biomechanical Assessment of the Hip & Pelvis.

Jul 10, 2014


More than ever, patients are recognizing the value of training themselves to breath, pause, rest, relax. With the explosion in availability of free resources available on smart phones, computers, magazines and handouts, the public has increased access to tools with which they can apply concepts in relaxation training, mindfulness, and meditation techniques. Which is the best strategy for our patients? That answer depends on many factors, and the truth is, with the variety of patient presentations, goals, and strategies, the patient may need to simply trial a few different approaches.


A recent radio interview I heard mentioned calm.com as a resource for relaxation training, so I decided to check it out prior to recommending the site to patients. The site is simple, with the ability to listen to 2, 5, 10, 15, or 20 minutes of guided relaxation, set a timer for the same time intervals, and download an application for the iPhone. The site is visually calming, with a very clean and intuitive interface. My sense is that users would find the site very simple to access and utilize. A simple search on the iPhone application store using the terms "free relaxation" brings up nearly 900 apps. As most of our patients (and selves, friends, families) may benefit from focused, practiced breathing and calming practices, these resources are great to know about.


There is a science behind finding balance, and one resource that has integrated much of the science behind techniques in relaxation and balance is the Institute of HeartMath. The website describes physiological coherence as a state characterized by heart rhythm coherence, increased parasympathetic activity, increased entrainment and synchronization between physiological systems, and efficient functioning of the cardiovascular, nervous, hormonal, and immune systems. In pelvic rehabilitation, we know that increased parasympathetic activity is important for patients who present with pain, with bowel, bladder, or sexual dysfunction. An imbalance in the autonomic nervous system can affect all of the physiologic functions taking place to aid pelvic health.


Jul 08, 2014

This post was written by H&W instructor Ginger Garner, MPT, ATC, PYT. Ginger will be instructing the course that she wrote on "Yoga as Medicine for Labor and Delivery and Postpartum" in Washington this August.


Note: This post is for colleagues, patients, and friends whose greatest desire is to have a healthy baby via natural childbirth. In this article, natural childbirth refers to an unmedicated delivery of your baby, assisted with natural, non-pharmaceutical means. While not all women have the luxury of natural childbirth, and some choose other means, please know that Ginger’s course supports all women and their personal decisions about birth.



My first natural birth was December 27, 2005. After a long, hard labor that started on Christmas, my son Michael arrived safe and healthy into my arms.


Upcoming Continuing Education Courses

Pelvic Floor Level 2B - Durham, NC
Oct 03, 2014 - Oct 05, 2014
Location: Duke University Medical Center

Male Pelvic Floor - Tampa, FL
Oct 04, 2014 - Oct 05, 2014
Location: Florida Hospital - Wesley Chapel

Pelvic Floor Level 2A - St. Louis, MO (SOLD OUT!)
Oct 10, 2014 - Oct 12, 2014
Location: Washington University School of Medicine

Chronic Pelvic Pain - New Canaan, CT
Oct 10, 2014 - Oct 12, 2014
Location: Philip Physical Therapy

Pelvic Floor Level 3 - Maywood, IL
Oct 17, 2014 - Oct 19, 2014
Location: Loyola University Stritch School of Medicine

Lymphatic Drainage for Pelvic Pain - San Diego, CA
Oct 18, 2014 - Oct 19, 2014
Location: FunctionSmart Physical Therapy

Pelvic Floor Level 1 - Boston, MA (SOLD OUT!)
Oct 24, 2014 - Oct 26, 2014
Location: Marathon Physical Therapy

Bowel Pathology and Function - Torrance, CA
Nov 08, 2014 - Nov 09, 2014
Location: HealthCare Partners - Torrance

Pelvic Floor Level 1 - San Diego, CA (SOLD OUT)
Nov 14, 2014 - Nov 16, 2014
Location: FunctionSmart Physical Therapy

Mindfulness- Based Biopsychosocial Approach to Chronic Pain - Seattle, WA
Nov 15, 2014 - Nov 16, 2014
Location: Swedish Hospital - Cherry Hill Campus

Yoga as Medicine for Pregnancy - New York, NY
Nov 16, 2014 - Nov 17, 2014
Location: Touro College

Pelvic Floor Level 2B - St. Louis, MO
Dec 05, 2014 - Dec 07, 2014
Location: Washington University School of Medicine

Pelvic Floor Level 1 - Omaha, NE (SOLD OUT!)
Dec 05, 2014 - Dec 07, 2014
Location: Methodist Physicians Clinic

Pelvic Floor Level 3 - Derby, CT
Dec 12, 2014 - Dec 14, 2014
Location: Griffin Hospital

Pelvic Floor Level 1 - Oakland, CA
Jan 09, 2015 - Jan 11, 2015
Location: Samuel Merritt University