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Lymphedema Management in Women’s Health Physical Therapy

This post was written by Debora Chassé DPT, WCS, CLT-LANA, who teaches the course Lymphatic Drainage for Pelvic Pain. You can catch Debbie teaching this course in April in Arizona.

Deborah Hickman

Lymphedema Management in Women’s Health Physical Therapy is a home study module developed for the physical therapist who would like to learn more about lymphedema as well as prepare for the lymphedema portion of Women’s Health Clinical Specialist exam. Complete Decongestive Therapy (CDT) has been used universally to treat lymphedema since the 1800’s. The well-known Foldi Clinic is located in Germany and in the 1990’s CDT was brought to America to train practitioners. You will learn about the anatomy and physiology of the lymphatic system, lymphedema diagnoses, differential diagnoses and the phases and steps involved in CDT. The course manual takes you through the physical therapy initial evaluation for lymphedema following the guidelines for specialty practice. It also contains many case studies designed to enhance your application of CDT. CDT has many concepts and procedures that will additionally help patients with inflammation, autoimmune disorders and pain. It is a must for all physical therapist.

Do you need another tool for treating pelvic pain and pelvic congestion? Manual lymph drainage for Pelvic Pain is a two-day intermediate course that covers the lymphatic system, lymphedema, pelvic pain, manual lymphatic drainage (MLD), and how this procedure is used to reduce inflammation and pelvic pain. The course will reveal the relationship between lymph flow and pelvic pain. Research shows that manual lymph drainage increases venous flow. In one case study, researchers found that using MLD on a patient with pelvic congestion decreased the patient’s symptoms, impairments and pain by 50% following 5 consecutive days of MLD. Another case study reported that a chronic pelvic pain patient had both an increase in energy level and a 50% decrease in abdominal inflammation and pelvic pain. Manual Lymphatic Drainage for Pelvic Pain is a procedure developed by Debora Chassé using MLD techniques on the vulva and in the vaginal vault to stimulate the lymphatics in the vagina to return lymph fluid to the circulatory system. This is a low risk treatment with outstanding outcomes for all pelvic pain diagnoses. This course is an excellent adjunct for clinicians interested in learning how to evaluate the lymphatic function, design an MLD treatment plan and master MLD treatment strokes for pelvic pain patients.

Join Debbie this April!

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Jaime Sepulveda - Featured Certified Pelvic Rehabilitation Practitioner

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Jaime Sepulveda, MD, PRPC.

Jaime Sepulveda

Describe your clinic practice:

I would describe my practice as female pelvic medicine and reconstructive surgery. I treat urinary and fecal incontinence, pelvic organ prolapse, bladder pain syndromes, recurrent urinary tract infections and dysfunctional disorders of the bowel and bladder.

How did you get involved in the pelvic rehabilitation field?

As a surgeon I understand the advantages, benefits, and limitation of surgeries for pelvic organ prolapse, fecal and urinary incontinence. As a clinician I have seen the benefit of non-surgical approaches to pelvic pain and chronic pain pelvic syndromes involving bowel and bladder. Pelvic rehabilitation complements my surgical practice and brings flexibility to the clinical management options that I present to my patients.

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

I was inspired by the gaps in knowledge and the limited scientific data while studying for sub-specialty boards in Female Pelvic Medicine and Reconstructive surgery. I have learned through the care of my patients to use all available tools to enhance their physiological reserves and optimize surgical outcomes.

What patient populations to do you find more rewarding in treating and why?

The most rewarding patients usually require a multimodal approach to improve, cure or simply support. The combination of surgery with rehabilitation is a powerful tool in pelvic floor disorders therapy. Rehabilitation and surgery are not mutually exclusive and actually work in synergy when applied together. As evidence based clinical decisions are made we also have to account for clinical experience. Treating combined pelvic organ prolapse, urinary and fecal incontinence is one of the most rewarding professional experiences when a multimodal approach is appropriately implemented.

Learn more about Jaime Sepulveda, MD, PRPC at his Certified Pelvic Rehabilitation Practitioner bio page. You can also learn more about the Pelvic Rehabilitation Practitioner Certification at www.hermanwallace.com/certification.

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The Format of Sexual Medicine for Men and Women

This post was written by H&W founder and instructor Hollis Herman, DPT OCS WCS BCB-PMD IF AASECT PRPC, who authored and instructs the course, Sexual Medicine for Men and Women. She will be presenting this course this April in New Jersey!

Hollis Herman

This course is perfect to help you, the healthcare professional, feel comfortable and knowledgeable about all sorts of sexual issues. The course is fun, interesting and unlike any other you have taken.It has three parts.

Part 1: The first part is designed to help you get in touch with your attitudes, beliefs, values and biases regarding sexual function. There are questionnaires to fill out and bring with you to the course, movies to watch, and books to read. These questionnaires, movies, videos and books will bring up sexual subject matter, questions, images and ideas that may be controversial to you. You will be exposed to many variations in sexual activity and asked about your reactions, sexual development, upbringing, feelings and worries you may carry around.

In other words, the preparation for this course is designed to bring up issues that are potentially keeping you from being as helpful as possible to your patients, yourself and your own relationship. It sounds scary, but it is not at all because you share only what you want. Therefore, Please be as open and honest as possible when filling out all of the questionnaires and reaction summaries to the movies, videos and books. There are no right or wrong answers and it is for your own self-awareness.

Part 2: The second part of the course is designed to provide you with a solid knowledge foundation regarding the different phases of the female and male sexual response cycles, erectile dysfunction, premature ejaculation, Peyronie’s disease, postnatal body changes, post prostatectomy issues, oral, anal, vaginal sexual practices, LGBT issues, aging and sexual issues, toys, lubricants, sexual, verbal and physical abuse, female and male genital surgeries, psychological practices of Cognitive Behavioral Therapy (CBT) and Eye Movement Disassociate Readjustment (EMDR) . The information will help you confidently answer questions and concerns you and your patients have.

Part 3: The third part of the course contains lab activities to learn clinical manual skills. External manual techniques for the pelvis only.

The underlying premise of this course is that healthy active sexual practices are a vital human right however they play out. As a healthcare professional you can provide education, specific hands on evaluation, treatment techniques and bio-mechanical instruction that no other professional can.

The Goal: Leave with self-awareness, knowledge and tools to promote healthy active sexual function in your patients’ lives and in your own life.

Join Holly in New Jersey this April!

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Katie Middleton - Featured Certified Pelvic Rehabilitation Practitioner

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

Katie Middleton

Describe your clinical practice:

I work in a small outpatient private practice where I am afforded the luxury of getting to see patients for an hour and truly give the patients a comprehensive treatment. Majority of the patients I am seeing are men and women with pelvic floor dysfunction of some degree. I also treat children with voiding dysfunction, although less so at my current setting.

How did you get involved in the pelvic rehabilitation field?

I got involved with pelvic rehabilitation in my search for a “passion”. I wasn’t satisfied with what I was doing so I began exploring my options. I feel unbelievably grateful that I took that first pelvic floor course as it opened a new world for me. I love my career and now I feel passionate about my specialty.

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

The general public inspired me to get and stay involved in pelvic rehabilitation. I saw this strong need for treatment of an underserved population with pelvic dysfunction. It is has been so rewarding to work with the patients who can finally get some attention and treatment for an often longstanding issue.

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

I love treating male patients with Pelvic Floor Dysfunction because I feel they especially are lacking in the care they need from the medical world. They are at a loss on where to turn when pelvic symptoms arise.

What has been your favorite Herman & Wallace Course and why?

I loved Ramona’s visceral courses. What an eye opener. It was a breakthrough for me in terms of opening up new treatment options for patients that otherwise had plateaued.

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

Treating the pelvic floor follows the same principles as treating other parts of the body. Don’t forget the basic skills we learned in PT school when assessing, palpating and treating pelvic floor dysfunction.

What do you find is the most useful resource for your practice?

Fellow colleagues are great resources as we have all had different exposure to different treatment models and what has worked and what hasn’t, .and why. I wish there was more interdisciplinary discussions amongst medical providers but having fellow PTs to run questions by is a great advantage. I also use the Herman and Wallace blog as well as several journals including journal of urology, ACOG, sexual medicine and IPPS. More research is needed and I love reading any new findings.

What motivated you to earn PRPC?

I was motivated to earn PRPC in order to advance the specialty that I am so passionate about. It helped me refine skills but I also think that PTs have to continue to prove themselves as being qualified practitioners and this is one way of doing that. It was not the initials that were important but rather proving to myself that I was becoming the practitioner I knew I wanted to be.

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

It was a great learning opportunity and excellent way to refine skills and refresh on details of pelvic floor rehabilitation that one may not use every day in practice. I say go for it. It is definitely worth it!

What is in store for you in the future?

I would love to team up with some local MDs (urologists, GI, OB, colorectal, urogynecologists, etc) as well as sex therapists and pelvic pain specialists and begin working on a more systematic approach to treatment of patients with an emphasis on better open communication between disciplines. I am also participating in a mechanical infertility research study that will hopefully open the door for more treatment options for patients that have had trouble conceiving for mechanical reasons.

Learn more about Katie Middleton PT, PRPC at her Certified Pelvic Rehabilitation Practitioner bio page. You can also learn more about the Pelvic Rehabilitation Practitioner Certification at www.hermanwallace.com/certification.

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Erica Mack - Featured Certified Pelvic Rehabilitation Practitioner

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

Erica Mack

How did you get involved in the pelvic rehabilitation field?

I was an athlete experiencing urine leakage with impact as early as high school, but never considered telling anyone about it, feeling embarrassed about it and assuming nothing could be done. Even as a PT, I learned almost nothing about the muscles of the pelvic floor. I remember in gross anatomy class that we simply skimmed over the pelvic floor, being taught we “would never be dealing with those muscles anyway.” I think cultural and social taboos kept me from looking at the pelvic floor as I would any other muscle—with the ability to be weak, tight, or have dysfunctional firing patterns. By the time I had my first child and couldn’t return to running without more bothersome leakage, I knew of pelvic rehabilitation as a specialty and sought out a PT.

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

Strangely enough, it was my less than satisfying experience with the first several pelvic rehab PT’s I encountered. I needed at pelvic rehab practitioner that had strong teaching skills, an understanding of evidence-based practice, and above all, strong orthopedic skills. I had the good fortune to see a PT (eventually) that had all of those strengths, as well as compassion, empathy, and a continuous quest for knowledge that keeps her at the top of the field. This is what motivated me to seek the PRPC—I wanted to learn as much as I could to best serve my patients.

Describe your clinical practice:

Currently I work at Discovery Physical Therapy in Port Hadlock, WA. I see a mixture of pelvic and general orthopedic patients, with diagnoses including pelvic pain, PF tension myalgia, vulvodynia, vestibulodynia, pelvic organ prolapse, urinary incontinence, fecal seepage, fecal incontinence, levator ani syndrome, chronic prostatitis, rectal pain, proctalgia fugax, and more.

What has been your favorite Herman & Wallace Course and why?

Pelvic Floor Function, Treatment, and Dysfunction Level 2A. While the bowels aren’t as “sexy” as a topic to some, I find treatment of patients with bowel dysfunction as some of the most rewarding. Number one, it doesn’t get more functional that this. And number two (I couldn’t resist), it takes a brave person usually with a good sense of humor to seek treatment for this, and I admire that in a patient. Often times, just a few good tools and a bit of new knowledge can really make a difference in people’s lives.

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

I helped to host the Rehabilitative Ultrasound Imaging Course instructed by Allison Ariail. I learned that I and every PT I know has been over training our patients. The core muscles we are going for (TA, multifidi, pelvic floor) are subtle, and it is easy to over recruit and overshadow these muscles. Less is more, and seeing was believing while using the real time US technology. Although I don’t use US imaging in my daily practice, I got great ideas about how to improve what I am already doing. Allison also shared several ideas about how to add this to my practice in an affordable way.

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

Motivate a study group. My study group was a diverse group of highly skilled practitioners from across the country. We met via conference call once a week. We split up reading of the articles, presented the content to each other, discussed the strengths/weaknesses of the research, and contemplated the clinical implications. Some folks came up with practice quiz questions and we kept each other disciplined and on schedule. While I am really proud to have earned the PRPC, I am most happy for all I learned, becoming more steeped in the research from different perspectives, and the greater depth I have as a therapist.

What is in store for you in the future?

Looking forward to re-certifying 9 years from now.

Learn more about Erica Mack, PT, PRPC at her Certified Pelvic Rehabilitation Practitioner bio page. You can also learn more about the Pelvic Rehabilitation Practitioner Certification at www.hermanwallace.com/certification.

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“Pads and Diapers are like Walkers and Wheelchairs” and other Useful Analogies: Using Traditional Rehab Concepts to Market Pelvic Floor

This post was written by H&W instructor Heather S. Rader, PT, DPT, BCB-PMD, who authored and instructs the course, Geriatric Pelvic Floor Rehab. She will be presenting this course this June in Florida!

Heather Rader

“I have never heard of pelvic floor rehab before.”

This comment poses an added job requirement for us, my fellow pelvic rehab practitioners! You have a responsibility to make this specialty understandable to your patients, referring providers, and the community at large. Therefore, marketing and education become interchangeable.

Use the fact that traditional rehab is well known to the public to your advantage by creating analogies to accepted concepts about injury and rehabilitation to boost your role as an educator.

1. What profession knows a lot about strength, endurance and coordination? Physical Therapy, right?This concept is a quick and easy way to explain why pelvic floor rehab is more complex than doing Kegels. Grab a side view pelvic floor model or picture. Use your fingers to simulate pelvic floor movement as you explain the following:

If your pelvic floor doesn’t have adequate strength, it can’t pinch the urethra tight enough to hold urine inside the bladder. If it has poor endurance, you might have trouble making it to the bathroom on time. If you have poor coordination, your pelvic floor muscle might not squeeze fast enough to counteract that cough or sneeze. Your average Kegel program is too simple to address these muscle complexities. Bladder control is dependent on the pelvic floor muscles and these muscles can have the same kinds of problems as the muscles in your arms and legs. But, what profession knows a lot about strength, endurance and coordination? Physical Therapy, right? That’s why your doctor wanted you to have pelvic floor rehab.

2. Pads and diapers are like walkers and wheelchairs. People use physical devices to compensate for physical difficulties. Walking aids are used for gait disturbances and absorbent padding for incontinence. Thin pads are like canes, thick pads are like walkers, and diapers are like wheelchairs. Rushing to the bathroom and going “just in case” would be analogous to someone hanging onto furniture for balance as they walk.

Use this analogy to link absorbent padding and assistive devices in the memory of a referring provider. “Doc, if they need pads, they need PT.” This can trigger a referral to PT for incontinence when patients complain of dependence on protective padding during their appointments, just as it might if a patient complained about trouble with a cane. You can also use this analogy as a way to share articles linking incontinence, poor balance, and low back pain.

3. Pelvic organ prolapse and herniated disks have a lot in common. I use this analogy a lot during community education talks, especially during Q&A. Being sent to PT for spinal pain and herniated discs is commonplace. But for a cystocele? Link how tissue failure by overuse can cause prolapse, whether it’s the bladder or the nucleus. Link how weak and saggy back muscles can cause the spinal bones to “fall” out of normal posture, just as weak pelvic floor muscles contribute to a fallen bladder.

I highly recommend using analogy as a marketing and teaching tool in pelvic floor rehab. Analogy works by associating what is known to what is unknown. If they are similar in some ways, they are likely similar is other ways, helping the patient, medical professionals, and the community understand the value of your skills.

These are just a few analogies. What others work for you in your practice?

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Elizabeth Fiser - Herman & Wallace Featured Therapist

Herman & Wallace is proud to feature Elizabeth Fiser, PT, DPT who has completed all four of the Herman & Wallace Pelvic Floor Series courses.

Kelly Carter

Describe your clinical practice

Currently I work in a hospital-based outpatient clinic in Mobile, AL. I see a mixture of patients ranging from urinary incontinence, pelvic pain, sacroiliac joint dysfunction, constipation, to fecal incontinence.

How did you get involved in the pelvic rehabilitation field?

Right after graduation but before I took by licensure boards I took my first Herman & Wallace course which was PF1. Shortly thereafter I moved to Eastern Tennessee where I started working in small, rural community at a hospital based outpatient clinic. I chose this clinic because they were interested in starting a women’s health program with me. After a great deal of planning, marketing and public speaking the program started growing and had an extremely positive impact on this small community.

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

My professors, Tracy Spitznagel and Stacy Tylka at Washington University in St. Louis Program in Physical Therapy inspired me to become involved in pelvic rehabilitation during a lecture they gave. I was fascinated by their presentation and enthusiasm and became eager to share what I had learned from the lecture with anyone who would listen. That being said, anyone who did listen became educated on how to properly sit on a toilet in order to have a comfortable bowel movement.

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

I enjoy treating both urinary incontinence and pelvic pain patients. I find it very rewarding when I am able to empower my patients to overcome a problem in order to improve their quality of life and self-confidence. Frequently my patients have started to isolate themselves from social encounters due to feelings of embarrassment or pain. I really enjoy when a patient starts experiencing success and you can visibly see their personality and outlook on life positively change. Their transition from outwardly discouraged to bright smiles and laughter is very rewarding for me.

If you could get a message out to physical therapists about pelvic rehabilitation what would it be?

So often people, even my co-workers, become uncomfortable or embarrassed when they hear what type of physical therapy I have specialized in. They don’t want to know the “details” of what pelvic therapy entails because it happens behind closed doors. They appreciate how I’m able to help patients but are hesitant to discuss it. I work with skeletal muscles just like everybody else, just the location of these muscles is much more discreet. A functioning pelvis is integral to the movement system but often gets overlooked.

What has been your favorite Herman & Wallace Course and why?

I’d have to say it is the first course I took with Herman & Wallace because it further proved to me how my keen interest in pelvic health would blossom into passion and dedication.

What do you find is the most useful resource for your practice?

My most useful resource is my pelvic floor model named Virginia. It’s one thing to verbally discuss pelvic floor anatomy but to be able to see the pelvis in 3D helps my patients tremendously. It helps orient them to how everything relates to pelvic function. Yes, Virginia is probably about 20 years old and is starting to show signs of aging, but somehow patients seem better able to identify with her because of this. When I’m using her as an educational tool and her pelvic floor bottoms out somehow even the patient that is on the verge of tears from frustration starts to giggle and then they comment on how that is exactly how they feel sometimes, too!

What is in store for you in the future?

I am gearing up to take the two specializations; one from Herman & Wallace and the other from the APTA. I also have a whole list of courses I want to attend.

Sign up for your next Herman & Wallace course!

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"Change is part of the world. Until the last moment, anything is possible."

This post was written by H&W instructor Michelle Lyons, PT, MISCP, who authored and instructs the course, Menopause: A Rehabilitation Approach. She will be presenting this course this February in Florida!

Michelle Lyons

Compared to subject matter that has traditionally been offered in physical therapy curricula, such as musculo-skeletal and neuromuscular coursework, the concept of wellness is a relatively new addition to our skill-set (Fair 2009). ‘A Normative Model of Physical Therapist Professional Education’ includes educational objectives related to wellness, alongside objectives related to orthopaedics and neurology. As patients become increasingly educated about nutrition, complementary and alternative medicine, we as women’s healthcare providers must be able to assist our patients in seeking out healthy lifestyles. Nowhere has this surge in interest been more apparent than in women entering peri-menopause.

Historically, physical therapy has been associated with restoring physical fitness and wellness using manual therapies, exercise instruction and education about healthy lifestyle. Women’s health as a physical therapy specialty was formally established in the U.S. in the late 1970’s by Elizabeth Noble. Initially there was a focus on the reproductive health issues affecting women, primarily obstetrics and gynaecology but today’s physical therapist specializing in women’s health must be well versed in all aspects of menopausal health and wellness to meet the growing demands of women.

The roles of wellness, nutrition and fitness are becoming increasingly recognised by mainstream medicine – the WHO has recognised health as a triad of physical, mental and social well being. Integrative medicine is being hailed as the future of healthcare: The Consortium of Academic Health Centers for Integrative Medicine defines it as ‘the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing’, which for me, has always epitomised the practice of physical therapy and in particular, pelvic rehab.

Nutrition and exercise, alongside complementary therapies such as herbal medicine have become widely used as solutions to some of the signs and symptoms of menopause, especially since the controversies surrounding hormone therapy arose after the publication of the Women’s Health Initiative study. Many physical therapists, especially those working in women’s health, have added wellness services to their clinics, observing the growing demand from women. Even if these are not services you currently offer, if you work with peri-menopausal women, you can expect questions about the benefits of herbs for hot flashes or yoga for osteoporosis.

Peri-menopausal health concerns vary from the signs and symptoms of hormonal fluctuations such as hot flashes and night sweats to osteoporosis, cardiovascular disease and pelvic health concerns including bladder, bowel and sexual health – concerns that today’s well informed physical therapist specialising in women’s health need to be able to discuss and explore. However, the number one killer of post-menopausal women is still cardiovascular disease, so we must look at exercise prescription (and removing barriers to exercise, such as urinary dysfunction).

In ‘Menopause – a Rehab approach’, we will also explore the influence that changing hormone profiles have throughout the female body, from an orthopaedic, cardiovascular and pelvic health perspective. We will discuss the evidence for complementary and alternative medicine (CAM) and how physical therapists can incorporate nutritional advice into their clinical practice supporting peri-menopausal women. Special attention will be given to the role of yoga as an evidence based addition to the skillset of women’s healthcare professionals. We will of course also address the pelvic health concerns particular to the peri-menopausal women and look at how pelvic rehab has much to offer women presenting with urinary, sexual or bowel dysfunctions, along with pelvic organ prolapse. I am very much looking forward to returning to Orlando to teach this new course and hope to see you there!

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Yoga and Mindfulness as Complementary Therapies for Breast Cancer

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.

Susannah Haarmann

It is holistic and forward thinking for medical practitioners, such as physical and occupational therapists, to consider the interconnectedness of mind and body when creating an effective treatment plan. Today, it is generally accepted that stress weakens the immune system and, the American Medical Association reports that “80% of all diseases are stress related,” (1). Prolonged physical and emotional distress triggers the neuroendocrine system to secrete stress hormones which affect the immune system, specifically, decreasing T-cell production and lowering basal and interferon augmented NK cell activity (NKCA). Knowing this unlocks huge potential for cancer patients who wish to actively boost their immune system during treatment; one of these proven techniques is called mindfulness-based stress reduction (MBSR). A study performed by Witek-Janusek et al, demonstrated a significant increase in NKCA levels in breast cancer patients after just one month of participating in a MBSR program; this is significant because elevated NKCA levels correlate with a decreased incidence of lymph node metastasis and improved survival rates in women with breast cancer (6).

MBSR may be compared to meditation and in the west we are seeing an increased acceptance of patients and practitioners looking to eastern philosophy as an adjunct treatment to western medicine. In fact, yoga is one of the most commonly sought after complementary treatments for breast-cancer related impairments among survivors today (4). Yoga, as a practice, blends mindfulness and movement. Physical exercise and mindfulness practices have both independently been shown to have a positive effect on cancer outcomes (3,6), therefore, it makes sense that patients are seeking yoga during treatment and supports why yoga is beneficial for physical and occupational therapists to include in their tool box of effective interventions.

In 2012, the first available systematic review on yoga for breast cancer survivors was published which performed a meta-analysis of twelve random control trials (RCTs) (2). The outcomes reported the following short-term effects: moderate improvements in overall well-being, small differences in quality of life (functional, social and spiritual), and large changes in perceived stress, anxiety, depression and psychological distress. At the moment, there is no evidence for longer term effects due to the limited amount of RCTs with long-term follow-up. In summary, the authors of the article stated that “the clearly positive effects of yoga on psychological health in breast cancer patients should warrant its use in this patient population. Yoga might be particularly recommended as an intervention to improve psychological health during active breast cancer treatment.” Although physical and occupational therapists objectives are geared towards improved physical outcomes with objective gains, we as practitioners value the importance of a quality of life measures when determining the effectiveness of treatment and can attest to the correlation between lessened psychological distress and alleviated symptom burden (2).

Susannah Haarmann’s course, “Rehabilitation for the Breast Cancer Patient,” will touch on yoga as a solution for the physical side effects of breast cancer such as peripheral neuropathy, osteoporosis, lymphatic cording and chest mobility after surgery to name a few. Participants may choose to participate in short, didactic yoga sessions interspersed throughout the course to address these topics. Bring your yoga mats and be prepared to breathe!


1.Chapman, J. Y, YCat YOGA Therapy: Yoga for People with Cancer and Chronic Illness Teacher Training Manual, Yogaville, Buckingham, VA, 2011. 2.Cramer, H., Lange, S., Klose, P., Paul, A., Dobos, G., Yoga for breast cancer patients and survivors: a systematic review and meta-analysis. BMC Cancer, 2012; 12: 412.
3.Denmark-Wahnefried, W., Campbell, K., Hayes,S. Weight management and its role in breast cancer rehabilitation. Cancer, 118 (8). 2277-2287.
4.Fouladbakhsh, J., Stommel, M., Gender, symptom experience, and use of complementary and alternative medicine practices among cancer survivors in the U.S. cancer population. Oncol Nurs Forum, 2010, 37: E7-E15.
5.Rock, C. et al, Nutrition and Physical activity guidelines for cancer survivors. Clinical Journal of Cancer, 2012.
6.Witek-Janusek, L., Albuquerque, K., Chroniak, K., et al. ‘Effect of mindfulness based stress reduction on immune function, quality of life and coping in women newly diagnosed with early stage breast cancer. Brain Behav Immun. 2008. 22(6): 969-981.

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Kelly Carter - Herman & Wallace Featured Therapist

Herman & Wallace is proud to feature Kelly Carter, PT who has completed all four of the Herman & Wallace Pelvic Floor Series courses.

Kelly Carter

Describe your clinical practice.

Physical Therapy Connection, Inc. (PTC) in Mountain Home, AR, is a privately owned clinic set within the beautiful Ozark Mountains. The clinic is comprised of two physical therapists, Rowdy Kelly, an orthopedic specialist, and me, plus a physical therapy tech and two office staff. PTC features private, comfortable treatment rooms and houses a complete wellness center to encourage and assist patients in maintaining the gains made during their PT sessions.

How did you get involved in the pelvic rehabilitation field?

I might label it a midlife crisis, as turning 40 last year made me take a hard look at my life and examine my future work role. I have been a PT for 17 years in varied settings and disciplines but always felt strongly drawn to the specialty of women’s health / pelvic health. I now want to take my career to the next level and that pivotal birthday prompted to secure a quality education in pelvic floor dysfunction and treatment.

What patient population do you find the most rewarding and why?

I have provided PT intervention to patients aged one month to 100 years … and I love them all! Every generation provides me incredible rewards both personally and professionally. I love treating the 90-year-old woman who wants to continue her daily walks, and I love treating the child who walks for the first time. I truly appreciate the differences people present and receive huge personal reward from my patients’ functional progress.

What has been your favorite HW course and why?

Pelvic Floor Level 1 is my all-time favorite course, taught by the great founders/authors/lecturers Holly Herman and Kathe Wallace. They are simply amazing in their knowledge and delivery!!! Their forthright (and humorous) presentation instilled new-found comfort in the subject and provided a wealth of information that fueled my passion to pursue pelvic rehabilitation.

What do you find is the most useful resource for your practice?

I have purchased several Herman & Wallace resource manuals that will allow me to manage my practice more professionally and efficiently and offer me expertly prepared materials to present/hand out when interacting with and instructing patients.

Current Medical Technologies (CMT) has been especially helpful with clinic supplies and computerized biofeedback training. Medbridge is an outstanding online resource for educational courses, patient care, and reference tools.

What role do you see pelvic health playing in general well being?

I am so excited about promoting and providing pelvic health awareness and services to my community. This is currently a largely under-serviced population in this specialty. People who have pelvic floor weakness or dysfunction need to know that they are not alone, their issues are not “normal” for their circumstances, and that there is help for them.

What is in store for you in the future?

I have begun working in an outpatient setting and will be applying all the knowledge gained from the HW pelvic health series courses. I will specialize in the treatment of pelvic floor dysfunction, including pelvic pain, bladder and bowel incontinence, prolapse, etc.

I also intend to acquire my Pelvic Rehabilitation Practitioner Certification (PRPC) in the near future.

Sign up for your next Herman & Wallace course!

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Upcoming Continuing Education Courses

Pelvic Floor Level 1 - Chicago, IL (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Cancer Treatment Centers of America - Chicago, IL

Male Pelvic Floor - St. Paul, MN (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Regions Hospital

Pelvic Floor Level 1 - Boston, MA (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Marathon Physical Therapy

Chronic Pelvic Pain - Kansas City, MO (Rescheduled)

Apr 3, 2020 - Apr 5, 2020
Location: Saint Luke\'s Health System

Pudendal Neuralgia and Nerve Entrapment - Philadelphia, PA (Rescheduled)

Apr 4, 2020 - Apr 5, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Level 2B - Freehold, NJ (Rescheduled)

Apr 4, 2020 - Apr 6, 2020
Location: CentraState Medical Center

Sexual Interviewing for Pelvic Health Therapists - Seattle, WA (Rescheduled)

Apr 4, 2020 - Apr 5, 2020
Location: Evergreen Hospital Medical Center

Pelvic Floor Level 2A - Grand Rapids, MI (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Mary Free Bed Rehabilitation Hospital

Pelvic Floor Level 1- Kansas City, MO (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Centerpoint Medical Center

Oncology of the Pelvic Floor Level 1 - Grand Junction, CO (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Urological Associates of Western Colorado

Mobilization of Visceral Fascia: The Gastrointestinal System - Arlington, VA (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: Virginia Hospital Center

Pelvic Floor Level 2B - East Greenwich, RI (Rescheduled)

Apr 17, 2020 - Apr 19, 2020
Location: New England Institute of Technology

Pilates for the Pelvic Floor - Livingston, NJ (Rescheduled)

Apr 18, 2020 - Apr 19, 2020
Location: Ambulatory Care Center- RWJ Barnabas Health

Pelvic Floor Level 1- Canton, OH (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Aultman Hospital

Pelvic Floor Level 1 - Rochester, NY (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Unity Health System

Pediatric Functional Gastrointestinal Disorders - Ann Arbor, MI (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Michigan Medicine

Lumbar Nerve Manual Assessment and Treatment - Madison, WI (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: University of Wisconsin Hospital

Pelvic Floor Level 2A - Winfield, IL (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Northwestern Medicine

Low Pressure Fitness for Pelvic Floor Care - Trenton, NJ (Rescheduled)

Apr 24, 2020 - Apr 26, 2020
Location: Robert Wood Johnson Medical Associates

Athletes & Pelvic Rehabilitation - Minneapolis, MN

Apr 25, 2020 - Apr 26, 2020
Location: Viverant

Sacral Nerve Manual Assessment and Treatment - Fairlawn, NJ

May 1, 2020 - May 3, 2020
Location: Bella Physical Therapy

Pelvic Floor Level 1 - Fayetteville, AR

May 1, 2020 - May 3, 2020
Location: Washington Regional Medical Center

Pelvic Floor Level 1 - Boise, ID

May 1, 2020 - May 3, 2020
Location: St Luke's Rehab Hospital

Pediatric Incontinence - Duluth, MN

May 1, 2020 - May 3, 2020
Location: Polinsky Medical Rehabilitation Center

Pregnancy Rehabilitation - Corvallis, OR

May 2, 2020 - May 3, 2020
Location: Albany Sport & Spine Physical Therapy

Coccydynia and Painful Sitting - Boston, MA

May 2, 2020 - May 3, 2020
Location: Marathon Physical Therapy

Pelvic Floor Level 1 - Bay Shore, NY (SOLD OUT)

May 11, 2020 - May 13, 2020
Location: Touro College: Bayshore

Pelvic Floor Level 2A - Crown Point, IN

May 15, 2020 - May 17, 2020
Location: Franciscan Health System