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Oct 30, 2014

 

Last week, Evidence in Motion, a large continuing education company that offers both live and online courses, announced that they are offering a new certificate program on pelvic rehab.  

The Pelvic Health Certificate (PHC) includes a number of courses on male and female pelvic health.

 

At Herman & Wallace, we think it's wonderful to see yet another example of pelvic rehab being offered and promoted as part of "mainstream" physical therapy practice, particularly by an organization that has previously focused on orthopedics, manual therapy and sports medicine. The increased number of continuing education offerings on the topics of pelvic floor dysfuntion in men and women means that all the hard work our amazing faculty, course participants and certifed therapists have done over the years has finally brought pelvic rehab into the limelight!

 

Just like H&W, Evidence in Motion's program shys away from using "women's health" to stress that these courses cover pelvic dysfunction in men and women throughout the life cycle. While we are taking some issue with their contention "Sadly, once you are finished with school, you’ll be hard pressed to find a continuing education course that mentions the pelvic floor unless you find a course with “women’s health” in the title" (AHEM! Over here! Check out our incredible course offerings and our amazing and inspiring Certified Pelvic Rehabilitaton Practitioners!) we think it's wonderful to see yet another organization trying to get the word out to therapists, patients and referral sources about the incredible work our therapists do!


Oct 30, 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

One year ago I received a phone call from my father on behalf of a friend, named Lynne,* from Oregon who was navigating her way through cancer treatment and jumping many medical and personal hurdles. “Susannah,” my father said, “Lynne is having terrible pain in her breast and arm and is unable to move it above her head. It started a couple of weeks after her surgery and months later it is still bothering her. She is a very active lady and this is really getting her down. Nobody can tell her what it is. Do you know what could be causing this?”

 

“Yes, dad, it sounds like lymphatic cording,” I said. I contacted Lynne and was able to speak with her physical therapist. Within a few weeks of treatment Lynne’s pain was gone, she had regained full range of motion in her shoulder and was back to paddling.


Oct 29, 2014

Consider the significant numbers of patients who suffer from post traumatic stress disorder, or PTSD. In the pelvic rehabilitation setting, we can think of the patients who may have experienced abuse, a loss of a child, witnessing violence, or other potential precursor. We know from the literature that there is a correlation between traumatic events such as abuse and women who have pelvic pain, within the military population, and among women who experience birth trauma. How then, can we provide patients with self-management tools to address common challenges that accompany PTSD?

 

Research published online this month in the journal "Mindfulness" states that in patients exposed to trauma, "…those with relatively high levels of mindfulness skills tend to have lower levels of symptoms. The article highlights previous research that has described benefits of mindfulness skills as including decreased anxiety and depression. Mindfulness-based interventions, according to the article, focuses on the development of the skills of awareness (the ability to focus on the here and now, aware of both inner and outer experiences) and acceptance (having a curious, nonjudgmental and open attitude.)

 

In this study, 101 patients diagnosed by a psychiatrist or psychologist with PTSD completed questionnaires including the Mini-International Neuropsychiatric Interview. The authors found skills in mindfulness correlated negatively with severity of symptoms and with "reactivity" or a tendency to respond with anxiety or depressive thoughts in response to stress. These positive relationships between mindfulness skills and symptoms of PTSD may have a significant impact on many of our patients who suffer from a variety of dysfunctions impacting health.

 

There is still time to sign up for Carolyn McManus's practical course on mindfulness training. Keep in mind that all therapists (not just pelvic rehab providers) will find this course immediately applicable to their caseload. Join us this November in Seattle for our new offering: Mindfulness-Based Biopsychosocial Approach to Chronic Pain.


Oct 28, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Angela Treadway, DPT, BCB-PMD, PRPC

 

Angela Treadway

Describe your clinical practice:

I work within a busy Urology practice with 2 physicians, 2 mid levels, and a psychologist specializing in sexual medicine. As the pelvic floor physical therapist member of this team, I serve the urological, colorectal and sexual medicine needs of the men and women referred from within the practice and from outside specialist and primary care physicians. We have recently added a second office and will be recruiting a second pelvic floor physical therapist to join our team.

 

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?


Oct 27, 2014

This post was written by H&W instructor Elizabeth Hampton. Elizabeth will be presenting her Finding the Driver course at Marquette University in 2015!

 

Elizabeth Hampton

In the United States, estimated direct medical costs for outpatient visits for chronic pelvic pain (women aged 18-50 y) is approximately $881.5 million per year. (Singh et al). Most physical therapists start their pelvic health practice focusing on incontinence only to find their practice filling with pelvic pain clients who need our help. One of the most common questions we hear in Herman & Wallace’s Urogynecologic Pain course (PF2B) is, “What do we focus on first during a pelvic pain evaluation? A direct pelvic floor assessment or a musculoskeletal exam?” The answer depends upon many factors, including client presentation and goals, client history, functional assessment, clinical toolbox in addition to sound clinical reasoning. In addition to the direct pelvic floor assessment, there are additional key musculoskeletal screening tests that are an essential part of a pelvic pain assessment.

 

Peery et al (2012) noted that abdominal pain was one of the most common presenting reasons for an outpatient physician visit in the United States. Abdominal pain is one of the many complaints that our clients may report requiring differential diagnosis including urogynecologic, colorectal, musculoskeletal, visceral or neurogenic causes. Lower abdominal quadrant pain may denote serious emergent pathology. Clinical findings, physical exam and client symptoms in addition to smart differential diagnosis must be used to determine if the abdominal pain is musculoskeletal in nature. Direct access requires clinicians to be able to perform a skilled initial screening for abdominal pain in order to determine if it is abdominal wall versus a visceral origin. Assessment of bowel and bladder function and habits are essential to perform. This blog specifically addresses two physical exam tests that can be performed as part of the physical therapy screening of abdominal wall pain. According to Cartwright et al, the location of the abdominal pain should drive the evaluation. The screening of abdominal pain may include two common tests that are used to determine if pain is due to abdominal wall versus a visceral origin.

 


Oct 23, 2014

PelvicHip

What are the roles of hip labrum innervation in both nociception and proprioception? Canadian researchers tackled this question by studying hip joints that were harvested during total hip replacement or hip resurfacing surgery. Twenty labrums were harvested and the structures in the labrum were divided into four quadrants including antero-superior (AS), postero-superior (PS), antero-inferior (AI), and postero-inferior (PI). The mean age of the subjects was near 60. The authors reported the following:

 

•Labral innervation is from a branch of the nerve to the quadratus femoris and the obturator nerve.

•All labrum samples had abundant free nerve endings according to the authors. These nerve endings are responsible for nociception transmission.

•Three different types of nerve end organs were noted: Vater-Pacini, Golgi-Mazonian, and Ruffini corpuscles. These nerve end organs operate to provide proprioception through their roles in pressure, deep sensation, and temperature.

•The free nerve endings and nerve end organs were observed more often in the AS and PS zones.


Oct 22, 2014

How long do hot flashes last in a woman's life? One recent study asked this question by following 255 women from premenopause to natural menopause. The authors found that moderate to severe symptoms of hot flashes continued on average 5 years after the date of the woman's last period. Unfortunately, up to 1/3 of the women continued to report hot flashes 10 or more years after menopause. Results also found that risks for hot flashes were higher in women who were African-American or in obese, white women. Higher education level was found to be protective against hot flashes.

 

The Mayo clinic states that while the exact cause of hot flashes is not known, there are several factors that may influence their occurrence. Changes in reproductive hormones in addition to hypothalamic shifts create a sensitivity to even slight changes in temperature. Women can experience a wide range of menopausal symptoms, with hot flashes ranging from sudden feelings of warmth that occur a couple times per day to profuse sweating that can occur up to one time per hour.

 

Menopause.org is a helpful resource for our patients, and lifestyle changes are offered such as avoiding stress, breathing techniques, and creating strategies to maintain body temperature within a limited range. Hormonal treatment and non-hormonal options are also described on this site, and while certain hormonal options may be contraindicated for some patients, there are therapies such as sleeping medications that may improve quality of life for a woman who is suffering significant sleep disruption. Decisions to utilize hormonal drug therapy may depend on many factors, such as benefits to risk ratios, if the patient has her uterus, and age of the patient. Many nonprescription options are also available, with conflicting or little evidence to support many of the claims. Regardless of the remedy that a patient may take for her menopausal symptoms, keep in mind that all medications or supplements should be reported to the physician and/or pharmacist so that drug interactions can be screened. Even herbal supplements can have a negative impact on other drugs that a woman is taking, so she should always fully disclose her medications, supplements (including teas!), creams, and other natural remedies.

 

If you are working with more women in the perimenopausal period, you may have questions about the hormonal changes and effects on rehabilitation. Faculty member Michelle Lyons will offer her new continuing education course called Menopause: A Rehabilitation Approach. At this course she will systemic changes in menopause, bone health, perimenopausal pelvic floor issues, sexual health, weight management, and procedures such as hysterectomy. The next opportunity to take this course is in February in Orlando - what a great time to head to the sunshine!


Oct 21, 2014

This post was written by H&W instructor Jennafer Vande Vegte.

 

Jennafer Vande Vegte

Biofeedback is a truly wonderful tool for a pelvic floor physical therapist. Using surface EMG can really help a patient learn how to control a muscle (typically the pelvic floor) that has been under improper voluntary or involuntary control, sometimes for many years. A recent article on biofeedback in medicine looked at the effectiveness of using biofeedback to treat a number of medical conditions (not just for pelvic floor function) and reviewed pertinent research. Using biofeedback for the treatment of urinary incontinence got the best rating (Level 5) as efficacious and specific. Treatment for constipation met Level 4 criteria for effectiveness while treating urinary incontinence in men, vulvar vestibulitis and fecal incontinence received a Level 3 rating as probably efficacious. (Frank et al., 2010)

 

It is wonderful when we have evidence that what we do as therapist works. But another question we might have is "HOW does it work?" Emmanuel and Kamm (2001) saw that biofeedback for constipation was effective in retraining faulty pelvic floor function but also noted that many patients undergoing treatment for elimination disorders also saw their transit time and bowel movement frequency improve. They theorized that this may be a response of the extrinsic autonomic nerves sending signals from the brain to the gut. They used mucosal laser Doppler flowmetry to show whether treatment changed extrinsic innervations, if autonomic changes were gut specific (or if there were cardiovascular changes as well) and whether gut transit was affected.

 


Oct 20, 2014

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Debra Goldman P.T., M.A. PRPC

 

Debra Goldman

Describe your clinical practice:

My clinical practice includes men and women with pelvic pain, nerve entrapments, incontinence, sexual dysfunction and much more. It’s dedicated to helping men and women holistically restore their bodies’ ability to move and function without pain. My motto is, recover, restore, move forward. In other words, don’t be a lifelong patient. The whole body approach I use helps me to determine if their pelvic floor dysfunction is related to a structural problem in the back, hips or the way they exercise, just to name a few. I do a thorough examination of the spine, hips and pelvis and pelvic floor to assess joint and soft tissue restrictions, specific weaknesses and faulty movement patterns. My treatments integrate manual therapy, specific exercise and mind-body retraining.

 

How did you get involved in the pelvic rehabilitation field?


Oct 20, 2014

This November, Herman & Wallace is thrilled to be offering a brand-new course instructed by Carolyn McManus, PT, MS, MA, called Mindfulness-Based Biopsychosocial Approach to Chronic Pain. This course will be offered November 15-16, 2014 in Seattle, WA. We sat down with Carolyn to learn more about her course.

 

Carolyn McManus

The constant flood of information in today’s interconnected, wired world trains the mind in distraction and away from the immediate experience of life. Many people spend hours gazing down at quickly changing images on the small frame of an electronic device and only notice the body when it has its aches and pains! Mindful awareness offers us a skillful way to pay attention, build body awareness, touch life fully and provides a healing antidote to information overload.

 

Mindful awareness invites us to rest the mind in the present moment with openness, friendliness and curiosity. This is not our natural tendency and requires training. Often we are caught in a struggle with the present moment, perceive it as flawed, find fault with ourselves and constantly drive ourselves to run, do and achieve. When mindful, we still have our plans, goals and to-do list, but this is not an obstacle to resting the mind here and now. We can stop the struggle with the present moment, touch life fully and open to the potential for ease and insight in the midst of things just as they are. New perceptions and an experience of aliveness can occur that can never happen when we are lost in distraction. Danna Faulds expresses this beautifully in her poem "Walk Slowly":

 


Upcoming Continuing Education Courses

Menopause: A Rehabilitation Approach - Orlando, FL
Feb 21, 2015 - Feb 22, 2015
Location: Florida Hospital Sports Medicine and Rehabilitation

Breast Oncology - Phoenix, AZ
Feb 21, 2015 - Feb 22, 2015
Location: Spooner Physical Therapy

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

Special Topics in Women's Health - San Diego, CA
Feb 28, 2015 - Mar 01, 2015
Location: Comprehensive Therapy Services

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
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