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In today's interview, Holly Tanner sits down with Stacey Futterman Tauriello, PT, MPT, WCS, BCB-PMD to discuss her approach to pelvic rehabilitation. Stacey received her Master’s Degree in Physical Therapy from Nova Southeastern University in South Florida in 1996. After graduation, she relocated to Chicago where she began specializing in women’s health issues including the treatment of incontinence, pelvic pain, and prenatal/postpartum musculoskeletal issues. She returned to the east coast in 2003 and is now the owner of 5 Point Physical Therapy, a specialty physical therapy clinic for male and female pelvic dysfunction in New York City.

Stacey will be instructing Pelvic Floor Level 2A on December 11-12, 2021 and Pelvic Floor Level 1 on January 22-23, 2022.

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Herman & Wallace is excited to announce a collaboration with Dr. Michael Hibner, an international expert on pudendal neuralgia and chronic pelvic pain. Dr. Hibner is presenting a new remote course on January 9, 2022, titled Pudendal Dysfunction: The Physician's Perspective. Pudendal neuralgia is a painful, neuropathic condition involving the dermatome of the pudendal nerve. This condition is not widely known and often goes unrecognized by many practitioners. Dr. Hibner runs the Arizona Center for Chronic Pelvic Pain (AZCCPP), a comprehensive center for treating chronic pelvic pain, and places a heavy emphasis on working as part of a care team with physical therapists and other pelvic rehab providers.

In a recent publication by Dr. Hibner, he shares that “the International Pudendal Neuropathy Association estimates the incidence of this condition to be 1/100,000; however, most practitioners treating patients with this condition feel the actual rate of incidence may be significantly higher.” Many patients go an average of 10-15 years attempting to get a diagnosis for their pain. Diagnosis of this condition is heavily based on the utilization of Nantes Criteria in conjunction with clinical history and physical findings.

Dr. Hibner began his career as a urogynecologist. In the early 2000s, some of his patients presented with a vulvar burning pain that didn’t fit any known criteria. When he reviewed the histories of these patients, he found that the only thing in common between these patients was kickboxing. Further research then led him to pudendal neuralgia.

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Lila Abbate PT, DPT, OCS, WCS, PRPC is the creator and instructor of Bowel Pathology, Function, & Dysfunction and Coccydynia and Painful Sitting. She also co-wrote the course Pudendal Neuralgia and Nerve Entrapment with fellow H&W faculty member Pamela Downey. 

Often pelvic health physical therapists are nervous about treating patients with bowel dysfunction and constipation. Lila Abbate's mentor, Elise Stettner, is proud to be a PT who treats bowel conditions. “Any PT can treat urinary symptoms. The patients who are really suffering are those with bowel dysfunctions.” She passed this passion on to Lila, who is the creator and instructor of the Bowel Pathology, Function, & Dysfunction scheduled next on November 13-14, 2021.

Bowel dysfunctions and constipation are often embarrassing for those who suffer from them and thus are often under-reported, which may lead to statistical underrepresentation. The statistics that we do have show that the average prevalence of constipation worldwide in adults is 16%, and for adults over the age of 60 is over 33.5%. (1) Everyone has a different normal for bowel habits which makes it hard to define a normal frequency. Constipation can generally be defined as less than three bowel movements per week and can present as infrequent bowel movements or difficult passage of stools that lasts for several weeks.

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An interview with Frank Ciuba.

Frank Ciuba, co-instructor of Osteoporosis Management< alongside Deb Gulbrandson, explains that practitioners need the information provided in their course. "This course is the latest up-to-date research compiled by my partner Deb Gulbrandson and myself in the management of osteoporosis for clinicians." He shares that similar to learning about the pelvic floor, "when physical therapists go to school they get only a small amount of what osteoporosis is and very little on how to treat a patient."

Frank explains that he became interested in teaching osteoporosis management when he learned "that one in four men statistically will get osteoporosis or an osteoporosis-related fracture in their lifetime and they're really not being identified." Osteoporosis Management provides an exercise-oriented approach to treating these patients and it covers specific tests for evaluation, appropriate safe exercises and dosing, basic nutrition, and ideas for marketing your osteoporosis program.

In pelvic health rehabilitation, it's seen that osteoporosis-related kyphosis (curvature of the spine) can affect pelvic organ prolapse, breathing, and digestion. Patients who go through the osteoporosis management program with Frank and Deb, are shown that they reduce the likelihood of compression fracture by 80%.

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A different approach to treating prostatectomy patients.

The Pelvic Rehab Report sat down with Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC to discuss her upcoming courses Rehabilitative Ultrasound Imaging - Orthopedic Topics and Rehabilitative Ultrasound Imaging: Women's Health and Orthopedic Topics scheduled for November 12-14, 2021. Allison specializes in the treatment of the pelvic ring and back using manual therapy and ultrasound imaging for instruction in a stabilization program. She also specializes in women’s and men’s health including conditions of chronic pelvic pain, bowel and bladder disorders, and coccyx pain.

 

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Proper breathing is discussed and taught in many ways and forms. All of this is a step in the right direction, but what if the person physically can not lengthen tissues to expand certain key structures that are essential to the breathing mechanism? In the remote course, Breathing and the Diaphragm, Aparna Rajagopal and Leeann Taptich teach different methods to identify breathing patterns, dysfunctional breathers, and how to determine motor control issues from mobility or strength issues.

Breath is utilized widely in the exercise world. Pilates uses breath for core stability. Yoga utilizes breath to help connect the body. Strength and conditioning coaches and personal trainers emphasize breath to provide power to lift. Breathing mechanics, aka proper breathing, is also core to any type of abdominal exercise.

Respiratory muscles are directly involved in these core abdominal strengthening, stability, and stretching exercises (1). Research led by DePalo, way back in 1985, concluded that the diaphragm is actively recruited during resistance exercises such as sit-ups (2). Inefficient breathing can lead to muscular imbalances, and motor control changes that can affect motor quality. Therapists are taught at length about tissue and joint mobility versus motor control or strength issues. These same principles can be applied to assess and treat the diaphragm, breathing, and abdominals.

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Holly Tanner Short Interview Series - Episode 6 featuring Sandra Gallagher

In today’s interview, Sandra discusses some of the intricacies of working with transitioning patients, her path in working with the LGBTQ+ community, and her new course with H&W. Transgender Patients: Pelvic Health and Orthopedic Considerations is a remote course created by Sandra Gallagher and Caitlin Smigelski. This course provides specific content aimed at teaching pelvic health therapists how to expand their skills for working with people of all gender identities.

Sandra Gallagher has served on varied committees and boards at the state and national level, most recently as the chair of the CAPP-OBC committee for the Academy of Pelvic Health of the APTA. She has presented on the role of PT in gender-affirming vaginoplasty at UCSF Transgender Health Summit, APTA Combined Sections Meeting, and at the 2018 international meeting of the World Professional Association for Transgender Health (WPATH).

In a research study that Sandra facilitated with other colleagues, it was concluded that “Pelvic floor physical therapists identify and help patients resolve pelvic floor-related problems before and after surgery. We find strong support for pelvic floor PT for patients undergoing gender-affirming vaginoplasty.”(1)

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Holly Tanner Short Interview Series - Episode 5 featuring Sarah Haran

This week The Pelvic Rehab Report sat down with new faculty member Sarah Haran. Sarah instructs the new Weightlifting and Functional Fitness Athletes remote course scheduled for October 16, 2021.

Who are you? Describe your clinical practice.

My name is Sarah Haran and I have been a PT in Seattle, WA since 2007. I graduated from the University of Washington and have been working in outpatient orthopedics ever since. I opened my private, cash practice, Arrow Physical Therapy in 2016 and we specialize in CrossFit athletes, weightlifters, dancers, and patients with hip impingement. I also teach courses on practice development and coach physical therapist entrepreneurs alongside Dr. Kate Blankshain through our business consulting company, Full Draw Consulting.

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Holly Tanner Short Interview Series - Episode 4 featuring Brianna Durand

Inclusive Care for Gender and Sexual Minorities is a remote course created by faculty member Brianna Durand. This course is for anyone, even if you are unsure about the pronouns or the terminology to use. Brianna created this course to provide the basic foundational knowledge around inclusive and gender-affirming care. The second day of the course provides detailed physiological considerations from the pelvic health and general health standpoint for folx undergoing medical transition.

Brianna became interested in pelvic health research pertaining to the LGBTQ+ community when she was in grad school. She was struck by how the community was not mentioned in most formal education and wanted to meet this knowledge gap.

Gender-affirming care describes ideal medical, surgical, and mental health services sought by transgender, non-binary, and gender non-conforming people. This can range from hormone therapy, to top or bottom surgery, facial hair removal, modification of speech, reduction thyrochondroplasty (tracheal cartilage shave), and voice surgery (1). Also common is the practice of genital tucking or packing, and chest binding. All of which the World Professional Association for Transgender Health lists as medically necessary procedures(2).

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Aparna Rajagopal, co-author of the Breathing and the Diaphragm: Orthopedic Therapists remote course, shares "I have used breathing and evaluation of the diaphragm as a part of pelvic care for several years now...Through my interactions, I have come to realize that although many of the therapists are aware that the diaphragm and breathing are important, they are unsure of how to assess for dysfunctions and address those dysfunctions."

Pelvic floor patients who may benefit from diaphragmatic breathing exercises include those who present with pelvic pain, incontinence, prolapse, and cervical/thoracic/scapular/lumbar pain. The Breathing and the Diaphragm: Orthopedic Therapists remote course will expand the participant's knowledge of the diaphragm and breathing mechanics. This course offers a different perspective on back pain and alignment, along with the ability to assess and connect breathing and the diaphragm to core stability, continence issues, and the autonomic nervous system.

The autonomic nervous system is in charge of those bodily processes that do not require conscious thought. These include digestion, temperature, blood pressure, and breathing. The autonomic nervous system can be hacked or manipulated with deep breathing exercises such as diaphragmatic breathing.

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Upcoming Continuing Education Courses

Pelvic Floor Level 2A - Self-Hosted (Sold out)

Dec 11, 2021 - Dec 12, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2A - Little Rock, AR Satellite Location

Dec 11, 2021 - Dec 12, 2021
Location: Core Pelvic Physical Therapy

Breathing and the Diaphragm: Orthopedic Therapists - Remote Course

Dec 11, 2021 - Dec 12, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - New York, NY Satellite Course (SOLD OUT)

Dec 11, 2021 - Dec 12, 2021
Location: KNOSIS Center for Physiotherapy & Wellness

Pelvic Floor Level 2A - Ann Arbor, MI Satellite Course (SOLD OUT)

Dec 11, 2021 - Dec 12, 2021
Location: Probility Physical Therapy/St. Joseph Mercy

Pelvic Floor Level 2A - East Norriton, PA Satellite Course (SOLD OUT)

Dec 11, 2021 - Dec 12, 2021
Location: Core 3 Physical Therapy

Pelvic Floor Level 1 - Arlington, MA Satellite Course (SOLD OUT)

Dec 11, 2021 - Dec 12, 2021
Location: Synergy Physiotherapy & Wellness

Pelvic Floor Level 1 - Asheville, NC Satellite Location (SOLD OUT)

Dec 11, 2021 - Dec 12, 2021
Location: Cornerstone Physical Therapy of North Carolina

Pelvic Floor Level 2A - Santa Cruz, CA Satellite Course

Dec 11, 2021 - Dec 12, 2021
Location: Alliance Physical Therapy and Rehabilitation Services, Inc.

Pelvic Floor Level 1 - Bismarck, ND Satellite Location

Dec 11, 2021 - Dec 12, 2021
Location: University of Mary

Pelvic Floor Level 2A - Jefferson, LA Satellite Course

Dec 11, 2021 - Dec 12, 2021
Location: Ochsner Therapy and Wellness/Ochsner Health System

Pelvic Floor Level 2A - El Paso, TX Satellite Course (CANCELED)

Dec 11, 2021 - Dec 12, 2021
Location: Border Physical Therapy

Pelvic Floor Level 1 - Milwaukee, WI Satellite Location (SOLD OUT)

Dec 11, 2021 - Dec 12, 2021
Location: Ascension - Milwaukee

Pelvic Floor Level 1 - Self-Hosted

Dec 11, 2021 - Dec 12, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - Syracuse, NY Satellite Course (SOLD OUT)

Dec 11, 2021 - Dec 12, 2021
Location: Onondaga Physical Therapy

Pelvic Floor Level 2A - Novato, CA Satellite Course

Dec 11, 2021 - Dec 12, 2021
Location: Renew Physical Therapy of CA

Sexual Medicine in Pelvic Rehab - Remote Course

Jan 8, 2022 - Jan 9, 2022
Location: Replacement Remote Course

Pelvic Floor Level 1 - Rochester, NY Satellite Location (SOLD OUT)

Jan 8, 2022 - Jan 9, 2022
Location: Evolve Physical Therapy of Rochester

Pelvic Floor Level 1 - Concordia

Jan 8, 2022 - Jan 9, 2022

Pelvic Floor Level 1 - Salt Lake City, UT Satellite Location (SOLD OUT)

Jan 8, 2022 - Jan 9, 2022
Location: Dynamic Physical Therapy

Pelvic Floor Level 1 - Howell, MI Satellite Location (SOLD OUT)

Jan 8, 2022 - Jan 9, 2022
Location: Ivy Rehab Physical Therapy - Howell, MI

Pelvic Floor Level 1 - Cranford, NJ Satellite Location

Jan 8, 2022 - Jan 9, 2022
Location: Ivy Rehab Physical Therapy (Cranford, NJ)

Bowel Pathology and Function - Remote Course

Jan 8, 2022 - Jan 9, 2022
Location: Replacement Remote Course

Pelvic Floor Level 1 - Queens, NY Satellite Location

Jan 8, 2022 - Jan 9, 2022
Location: Hands of Hope Physical Therapy

Pelvic Floor Level 1 - Zion, IL Satellite Location

Jan 8, 2022 - Jan 9, 2022
Location: Cancer Treatment Centers of America

Pelvic Floor Level 1 - Self-Hosted

Jan 8, 2022 - Jan 9, 2022
Location: Self-Hosted Course

Pelvic Floor Level 1 - New Bern, NC Satellite Location

Jan 8, 2022 - Jan 9, 2022
Location: Peak Performance Clinics

Pelvic Floor Level 1 - Orange City, FL Satellite Location

Jan 8, 2022 - Jan 9, 2022
Location: Direct Physical Therapy - Orange City

Pelvic Floor Level 1 - Oklahoma City, OK Satellite Location

Jan 8, 2022 - Jan 9, 2022
Location: Oklahoma Physical Therapy

Pudendal Dysfunction: The Physician's Perspective - Remote Course

Jan 9, 2022
Location: Short Form Remote Course