More than a year ago, after working on updating the pelvic floor series courses PF1, 2A and 2B, the Institute turned our attention to the final course in our popular series, PF3. To determine what content our participants wanted to learn about in the last continuing education course of the series, we asked that exact question. From a large survey of therapists who had taken all or most of the courses in the pelvic core series, we collected detailed data from therapists about what was needed to round out their comprehensive training. The results of that survey guided hundreds (and hundreds!) of hours of work completed by a team of instructors. This month, in the beautiful city of Denver, the three instructors who created the Capstone course will share their wisdom, clinical experiences, as well as their thoughtfully-designed lectures and labs. You will have an opportunity to learn in depth about topics covered in the prior courses in the series. 

Such topics include lifespan issues and health issues common to different ages, conditions of polycystic ovarian syndrome, endometriosis, infertility, pelvic organ prolapse and surgeries, pelvic fascial anatomy, pharmacology and nutrition. Lab components are detailed and comprehensive for working with specific common implications from conditions in pelvic dysfunction or surgery. This course focuses on the female pelvis, including diving into the complexities of female pelvic health issues. The instructors have all worked in the field for many years, are experienced in working with complex patient presentations, and all excel at manual therapies. I asked each of them to briefly share thoughts about the Capstone course that they each dedicated the last year in developing; following you can read their thoughts.

Nari Clemons

The American Society of Clinical Oncology convened their 2016 annual meeting over the weekend, and several of the presentations suggest new methods of preventing breast cancer recurrence.

Extended Hormone Therapy Reduces Recurrence of Breast Cancer

Breast cancer patients who are treated with aromatase inhibitor therapy are generally prescribed the the estrogen drugs for a five year course. A new study has suggested that by doubling the length of hormone therapy, the recurrence rate for breast cancer survivors drops by 34%. The study included 1,918 women who underwent five years of hormone therapy with the drug letrozole. After five years, half of the group switched to a placebo while the other half were given an additional five year treatment.

Congratulations to Jane Blair Johe, PT, PRPC on becoming one of the newest Certified Pelvic Rehabilitation Practitioners! Read our interview with Blair below.

Tell us about your clinical practice
I work in a free standing outpatient PT center of a large 4 hospital affiliation. 70% lymphedema 30% pelvic floor rehab.

How did you get involved in the pelvic rehabilitation field?
I was already the lymphedema PT (LANA cert.) when I moved to WV. The women's health PT was moving to another state and asked me to please pick up her bladder incontinence patients.

The following guest post comes to us from Angie Johnson, a physical therapist with Kaiser Permanente in Portland, OR.

Did you know that the pelvic floor muscles are actually quite thin? “Pelvic floor muscles are able to produce enough force to overcome changes in intra-abdominal pressure during less rigorous activities of daily living,“ but in activities such as coughing and jumping, “intra-abdominal pressure clearly exceeds the maximum force generated by pelvic floor muscles alone.”¹ But we know that people are continent of urine during these activities, so it begs to question what structures help support the pelvic floor during high force events?

In our journey of pelvic rehabilitation and evidence-based medicine, researchers have determined that contributors to pelvic floor function include trunk stabilization² and co-contraction of the abdominal wall (especially transverse abdominus)^3,4. But this is only the beginning of the story. To add to this picture, new research, recently published in the Journal of Women’s Health Physical Therapy (January/April 2016) validates what we as practitioners already know; hip muscles play a crucial role in optimal pelvic floor functioning.

Dr. Peter Philip, a faculty member with the Herman & Wallace Institute, has published a new book! "Pelvic Pain and Dysfunction: A Differential Diagnosis Manual" is available now through Thieme Medical Publishers. We caught up with Dr. Philip to learn a bit more about his project.
Peter is also the author and instructor of two courses offered through Herman & Wallace. Sacroiliac Joint Evaluation and Treatment is an opportunity to learn an exercise and stabilization approach to pelvic girdle, sacroiliac joint, and pelvic ring dysfunction. This course is available twice in 2016; May 21-22 in Austin, TX and later on November 6-7 in Bayshore, NY. Peter's other course, Differential Diagnostics of Chronic Pelvic Pain: Interconnections of the Spine, Neurology and the Hips, expands the practitioner's diagnostic toolkit for complicated chronic pelvic pain patients. This course is available on August 19-21 in Nashville, TN. Don't miss out!

H&W: Thanks for doing this interview, Peter! What's new?
Dr. Philip: After years of research, and writing, my textbook has been published and is ready for the public.

H&W: That's great! What can you tell us about the book?
Dr. Philip: It's called Pelvic Pain and Dysfunction; a Differential Diagnosis Manual, and it has been published by Thieme. Thieme is based out of Stuttgart Germany and is the world’s largest distributor of medical textbooks and journals! The purpose of the book is to answer the questions that so many clinicians have as it relates to their patient’s pain, such as:

The following is a guest post from Isa Herrera, MSPT, CSCS owner of Renew Physical Therapy in New York, NY. Isa recently launched her new online course "Low Level Laser Therapy For Female Pelvic Pain Conditions" found at www.PelvicPainRelief/laser.

Physical therapists deal with chronic pain that can be problematic to treat and manage on a daily basis. There is an arsenal of tools, exercises and techniques at their disposal, but many times using a modality can help accelerate the pain-relieving process for their patients. Pelvic floor physical therapists in particular treat an extremely difficult type of chronic pain loosely classified under the umbrella term "pelvic pain." Pelvic pain can express itself as vulvodynia, clitorodynia, provoked vestibulodynia, pudendal nerve neuralgia, vaginismus and/or dyspareunia. These conditions are common, with 1 in 3 women suffering from pelvic and/or sexual pain in the United States. It is estimated that approximately 30 million suffer from this silent epidemic. As physical therapists we are on the first line of defense and we must be prepared to provide the pain relief that these women so desperately seek.

Secret Weapon for Pelvic Pain Is Finally Here

Chronic pelvic pain is very different from other types of pain because it's intimately connected to our emotional, spiritual and psychological states, and can involve the nervous, endocrine, visceral, gynecological, urological and muscular systems. It can be very difficult to treat, and can require anywhere from six months to one year of physical therapy, depending on patient presentation and history.

Today we are honored to present our featured Certified Pelvic Rehabilitation Practitioner Jessica Dorrington, PT, MPT, OCS, PRPC, CMPT, CSCS! Jessica was kind enough to answer a few questions about her role in pelvic rehab.

Describe your clinical practice:
Our clinic practice is an outpatient orthopedic private practice. We are committed to making individual results accessible through compassionate therapeutic care. Our practice spans treating men, women and children through a realm of urologic, gynecologic, obstetric, and colorectal conditions- as well as orthopedic conditions.

How did you get involved in the pelvic rehabilitation field?
Initially, I was an outpatient orthopedic physical therapist. Within the first few months of my career, the clinic I was working at needed someone to just “teach Kegel exercises”. When I realized the impact that you could have on someone’s life, I was immediately drawn to the pelvic rehabilitation field. I saw getting someone even 75 percent improvement was a whole different success than getting a shoulder patient 75 percent better that could now throw their ball to their dog. It was restoring relationships, saving marriages, and giving women the freedom to go do things they could not do before.

Congratulations to Dr. Sarah Capodagli, DPT, our featured practitioner of the week! Dr. Capodagli owns and operates CorrEra Physical Therapy, and she is in the process of expanding her practice in Buffalo, NY. We were curious to hear more from her about running a practice in Buffalo, and Sarah was kind enough to write in. Thanks, Sarah!

Although Buffalo is considered the second largest city in the state of New York, we often operate like a small town. We value community and for just about any business, the best marketing tool is word of mouth. If you need a new roof, new car, or a good doctor, well, ask around and I guarantee that you will find someone who “knows a guy,” to help or advise. I cannot speak for every city, though when I think of Buffalo, NY, I think of family. When you see your family in need, you help.

A few years ago I was working in a large oncology hospital and one of my primary roles was running the pelvic floor rehabilitation program for men living with or being treated for prostate cancer. I loved this work; however, I saw greater need in our community for not only the proper conservative care and treatment, but also for the information about pelvic health to be shared more publicly with men and women. Although opening my own clinic in a suburb of this “City of Good Neighbors” was not always the plan, when given the opportunity to grow into my own practice by a chiropractor friend, I jumped at the chance and have never looked back. It was a big jump, but for me, the fear of regret in never trying was so much worse than the fear of failure.

The following comes to us from Felicia Mohr, DPT, a guest contributor to the Pelvic Rehab Report.

Vaginal mesh kits were used frequently early in the millennium as they led to high initial anatomic success rates with peak use between 2008 and 2010. Objectively they seemed to help elevate women’s pelvic organs to appropriate anatomical locations. Unfortunately there has been a high rate (10% according to a review of current literature on PubMed^{Barski 2015}) of mesh erosion causing recurrent prolapse and/or stress urinary incontinence. Also there are cases when the mesh product perforates surrounding organs causing numerous dangerous complications. The rate of mesh-related complications according to current research is 15-25%. As a result, the FDA has reclassified the risk of synthetic mesh into a higher risk category so that the public has an increased awareness of the risk involved in these types of surgeries.

A systematic review and meta-analysis, published in 2015, reviewed the risk factors for mesh erosion following female pelvic floor reconstructive surgery ^{(Deng, et al)}. They concluded the following factors increase risk of mesh erosion: younger age, more childbirths, premenopausal states, diabetes, smoking, concomitant hysterectomy, and surgery performed by a junior surgeon. Moreover, concomitant POP surgery and preservation of the uterus may be the potential protective factors for mesh erosion.

The following is a guest post from Nancy Fish, LCSW, MPH who will be presenting at the Alliance for Pelvic Pain Retreat on May 20-22 in Ellenville, NY. Check out this flier to learn more about the retreat.

Gaining a Sense of Hope and Empowerment

Nancy Fish, LCSW, MPH (co-author, with Deborah Coady,M.D. of Healing Painful Sex)
About the Alliance For Pelvic Pain Retreat, May 20-22, 2016, Ellenville, NY

When thinking about registering for the Alliance for Pelvic Pain Patient Retreat, I imagine you are asking yourself “Why would a person suffering from pelvic pain, with more medical appointments than is humanly possible to handle, add another item on an already overwhelming “to do” list?” It would be completely understandable if that is your initial reaction. So why is this retreat a must in your path to physical and emotional healing? There are so many reasons why this retreat can be a life-altering event but I’ll just name a few compelling ones. As a psychotherapist who specializes in pelvic pain (I am also a pelvic pain patient) the primary challenges I hear from most of my clients are: