We are thrilled to announce that the results of the November 2014 administration of the Pelvic Rehabilitataion Practitioner Certification (PRPC) are in! Thirteen incredible therapists have joined the ranks of Certifed Pelvic Rehabilitation Practioners!
Huge congratulations to the follwing dedicated experts who sat for and passed the exam this fall:
Lauren Calabrese, PT, DPT
Nancy Corvigno, MSPT
Rhonda Fiorello, PT, MPT
Andrea Goldberger, PT
Natalie Hickenbotham PT
Lisa Hu, PT
Rene Lawson, PT
Holly Moody, PT
Susane Mukdad, DPT
Heather Rader, PT, DPT, BCB-PMD
Elizabeth Sellhorn, PT
Reeba Varghese, DPT
Rebecca Wilcox, MPT
Check back on our list of Certified Practitioners to learn more about these therapists, as well as the other professionals who already hold this distinction.
If you are interested in learning more about certification, check out our Certification page to download the application, learn about the requirements, and access study resources. The next administration of this exam will be May 1-15, 2015.
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!
This fall, Herman & Wallace will be debuting a brand new course, Integrating Meditation and Neuropsych Principles to Maximize Physical Therapy Interventions, in Winfield, IL. We sat down with the course instructor, Nari Clemons, PT, to learn more about this brand new offering.
What inspired you to create this course?
There is so much more to pain management than just manual techniques, and with meditation we can help patients with a mental shift to facilitate healing. Everyone is always telling patients to work on stress management, but so few people are really able to give patients usable, practical, useful tools to do so. We all know those patients who come in so keyed up or so caught up in playing the same tape in their heads, that we are not sure what we can do to help them. I meditate every day, and it has helped my life (and my patients) beyond measure. I know how many times I use meditation as a way for patients to benefit more from their treatment. In most of the Herman Wallace courses, we talk about using down training and stress management for conditions like overactive pelvic floor, constipation, urinary urge, dyspareunia etc. (even for Interstitial cystitis, the first line of treatment is now relaxation training) but, so few practitioners have access to these tools or this knowledge, so how are they able to help patients? I want to help bridge that gap.
What can you tell us about this course not mention in the description and objectives?
This course is, above all, extremely practical. It takes away the mystery and lack of approachability of meditation, by taking the idea of centering, self-care, healing, and balancing the mind from something esoteric, vague and mystical to step-by-step tools that therapists can use. I hope attendees will use these simple techniques in their own lives and with their patients to help manage conditions of pain, tension, and anxiety. Because the aspects of health for this course border on both the realm of mental health and physical therapy, this course will be co-instructed by Dr. Shawn Sidhu, psychiatrist and meditator, who will provide info on current mental health perspectives.
Can you describe the clinical/treatment approach/techniques covered in this course?
These are all techniques that the clinician can use with the patient and the patient can use on their own. This is the piece you can give a patient to do at home. Most of these techniques can also be used as a part of treatment (ther act or neuro re-ed) to retrain muscle resting levels. I will have a CD that comes with the course that can also be used for patients at home, if the patient needs more guidance. There will be a variety of techniques, all within the realm of mind/body. Centering, observation, visualization, using mantras, affirmations, grounding, breath counting, breath control will all be addressed in a very practical and usable format.
What resources and research were used when writing this course?
I have been meditating: both learning and practicing techniques for decades, as has Shawn. I can’t tell you how many meditation and yoga workshops, books, videos and classes I have experienced over the years. I pulled heavily from that experience and my experience in the clinic and as a yoga teacher. I also bought a book that had 20 plus years of catalogued research in the fields of health and meditation to find the most clinically relevant research for PT’s. Also, I used the typical sources: pub med, medical journals. Finally, I bought all kinds of cd’s to see what was currently available. Again, I chose what I found most practical, usable (not annoying), and clinically relevant, as well as choosing a variety of styles to match different personality types/mind types.
Why should a therapist take this course? How can these skill sets benefit his/her practice?
I feel any therapist can benefit from this course because of the strength of the mind/body connection. Research has shown us that pain perception is not directly correlated with degree of injury or dysfunction. By helping your patient be in the present, rather than reacting to the past or anticipating future issues, your outcomes with your already existing manual skill set will be maximized. Similarly, as a therapist, if you can be in the present, really hear your patients, notice more with your hands, and be fully present, your interventions are certainly more directed than when you are distracted or stressed yourself. Above all, as a therapist practicing these skills, you may find yourself leading a more balanced life and less stressed by work. Certainly, not “taking our patients home with us” benefits our own health and our own families. Staying in the present moment in our own work days and our own lives ( as providers), allows us to enjoy our own lives and work days more…and who of us does not want to enjoy life more?
Want to learn more from Nari and Shawn? Join us in September for this cutting-edge course!
Recently, I was lucky enough to attend a 3-day frozen cadaver (no formaldehyde) dissection course that sparked an inquiry in my ever-inquisitive mind. While we were working on our cadaver, the coroner who was working on the other side of the complex invited us over. She wanted to show us what Crohn’s disease looks like. She had small intestines on the table and they were dissected in order to show the inside lining. The terminal ileum, where the Crohn’s disease was located, had patches of red inflamed tissue in it. The coroner proceeded to say that there was a significant amount of adhesions along the cecum, around the ileocecal valve and into the terminal ileum stemming from a prior appendectomy. Of course my mind cannot just let this information go by without some analysis…. could the appendectomy have contributed to the development of Crohn’s disease?
Travel along this thought process with me for a moment. The field of science has, to date, not found the actual cause of Crohn’s disease. With the new information I gained at my dissection course, I began to formulate a theory. My theory? Maybe the adhesions and scar tissue created by the appendectomy began to cause issues in the terminal ileum, ileocecal valve and cecum. One issue could be a decreased flow in undigested or digested food particles/chyme that causes stagnation in the terminal ileum, and over time irritation and then an inflammation of the inner mucosa. The second issue could be that the adhesions could additionally cause a decrease in circulation and lymphatic flow in the area, which also could cause an inflammatory condition.
Evidently, I’m not the only one with an inquisitive mind in the medical community! When I got home from the course, I did a search on “appendectomy and Crohn’s disease.” There is actually research that has already been completed on the topic. Some of my findings were: Appendix surgery cause Crohn’s disease? This article discusses the January 2003 issue of Journal Gastroenterology where it was found that people who had their appendix removed were 47% more likely to develop Crohn’s disease than those who did not have surgery. Badgut.org: “ IBD and Appendectomy” This article discusses the appendix having an influence over the immune system and thus appendicitis increasing the risks of Crohn’s disease. IBD and Your Appendix: This article discusses two studies on this topic. The first one showed an increase risk of Crohn’s disease within the first 20 years after an appendectomy and that women were at a higher risk than men. Unfortunately, the article did not share why the women were at higher risk than men. The second study showed a hypothesis that the original attack of appendicitis may actually be the first flare of Crohn’s disease. Potentially the patient always had Crohn’s, which went undiagnosed until the disease progressed enough. It was stated that more research is definitely needed on this correlation.
So what does this mean for practicing therapists, who are treating patients who are suffering from Crohn’s disease? If the patient has had an appendectomy, we should start there. Use all of your manual therapy skills such as visceral manipulation, myofascial release, scar massage and connective tissue manipulation in that area. In my clinical experience, which is correlated to research findings, the pelvic musculature in patients with Crohn’s disease tends to be hypertonic. These muscles need to be treated, but only after you address all of the abdominal restrictions. Through my dissection course, I was able to expand my vision about how connected the human body is. I’m afraid that as “pelvic therapists,” we tend to get tunnel-vision and we tend to blame those poor little pelvic muscles that are usually just doing their job. Yes, in the patient with Crohn’s disease they will be hypertonic, but why? They are just trying to guard and protect! They will still have to be released, but maybe not as the first step in your treatment plan. Once you release some of the fascial restrictions and improve the movement of the intestines and improve the circulation and lymphatic flow, then the pelvic muscles will not have a reason to become hypertonic again after you release them.
So let’s try to keep in mind the correlation between appendectomies and Crohn’s disease and treat those fascial restrictions first before you treat the compensatory pelvic muscles.
The first round of certification candidates have completed their testing, and we will soon announce the test takers who will be awarded with the letters "PRPC" for Pelvic Rehabilitation Practitioner Certification. Just over 70 candidates sat for the exam during our inaugural 2014 testing window, and are now eagerly awaiting their results (we thank them for their patience!)
Each step of this vigorous (and often tedious) process has been guided by Kryterion, a company who specializes in certification development. We want to give you an update about where we are in the process as many are interested in finding out how they performed on the test.
The "cut score" for passing the exam and earning the certification can only be determined after all the examinees have completed the exam, so we could not begin our work until the testing window closed on March 1st. Then, a group of 11-14 SME's (Subject Matter Experts) are gathered together on phone and web conferences to review each item. A SME is a person who meets the criteria to take the PRPC exam but cannot be someone who took the exam this year. Many of the SME's are therapists who have been involved in the process from the beginning, others have joined the group specifically for this last step, the review process.
Prior to the phone and web conferences, the each SME completes a training in rating the difficulty of items. She then independently rates every single item based on this thought: "what percentage of minimally acceptable candidates would get this item correct?" The criteria for a minimally acceptable candidate was determined in the exam development process and constitutes what a therapist should know or be able to do at a minimum to earn the credential. During our review phone calls the SMEs are all presented with the given ratings for each item, discuss the ratings as needed, and then an average rating for each item is created. At this time, we have completed over 4 hours of conferences together and have approximately 3-4 hours more to complete. As the SMEs live across the United States (and across several time zones), work full time jobs, attend school, and are raising families, this process is quite a challenge to coordinate and a sacrifice on the part of the SME.
Despite the hard work and sacrifices, the subject matter experts are committed to finalizing the cut score process within the next couple weeks. Once this is completed the cut score is determined based on the review and rating process, and we will be able to present therapists whose exam scores meet or exceed the cut score with their new designation. Participants who meet the criteria and earn a score at or above the cut score will be notified by email of their status. If you are currently awaiting notification of PRPC status, please be patient; we are very close to having the information that we need to finalize this rigorous process. We will also announce on our Facebook page and in a newsletter once we have completed the rating process, so stay in touch with us and watch your email.
If you are considering applying for the PRPC exam, all the information that you need to know can be found here. The next opportunity to sit for the exam happens in November of 2014. Thank you to everyone who has been a part of the process, from the administrative to the clinical to the test taking side! The PRPC exam is the only certification currently available that recognizes expertise in pelvic rehabilitation, a distinction that will serve to set a therapist apart and acknowledge all of the hard work that he/she has completed.
This post was written by H&W faculty member Teri Elliott-Burke, PT, MHS, BCB-PMD. Teri will be teaching Pelvic Floor Level 2A in Maywood, IL next month.
A new product has hit the stores – Butterfly Body Liners. These pads are specifically designed to deal with fecal incontinence (aka ABL – Accidental Bowel Leakage). The good news is that advertisements for these pads bring fecal incontinence out in the open. The ads promote discussion of this topic and offer one solution for this condition. A patient first brought this product to my attention. So I thought it would be a good idea for all of you to know about them as well (as I have discussed the concept of the pad with other patients they have liked the idea). However, I would also like to voice two concerns: One is that the pads seem pricey ($.30 each) especially for patients who have to change them often or are on a fixed income. My second reaction is that for some people these small pads don’t have enough capacity to deal with the problem.
I am grateful for the development of pads for this condition, however I find myself frustrated with this advertisement, as well as advertisements for urinary incontinence pads. I find myself wanting to strangle celebrities touting the use of pads (notice so far none of them are willing to own up to fecal incontinence). The pads, which are a necessity for some, offer only a passive solution. The fact that this condition can be accurately diagnosed and treated is never mentioned. Of course, mentioning an active solution doesn’t sell the products. Therefore, we need to be the voices out there letting people know there is an active solution to this issue. This includes marketing to physicians to let them know of the treatment we can provide.
Another “product” related to fecal incontinence is the newly developed Fecal Incontinence and Constipation Questionnaire. (Check out the February 2004 Physical Therapy Journal (PTJ) article that addressed the formation of this questionnaire). This is an exciting development in the area of outcomes questionnaires to address the specific patient population of fecal incontinence and constipation. Although there are other questionnaires available this one was developed specifically for patients seeking put patient rehabilitation services for pelvic-floor dysfunction. This questionnaire has two subscales Fecal Incontinence (FI) and Fecal Constipation (FC). Analysis showed sound psychometric properties of this scale, although further fecal constipation items were recommended to increase content coverage. Reminder: For those of you how are APTA members the PTJ has a app.
If you are treating patients with urinary incontinence, but are not adequately addressing fecal incontinence or constipation you are missing out on giving relief to many people. Make your way to PF2A where issues of constipation and fecal incontinence are addressed.
This post was written by guest-blogger, H&W faculty member Michelle Lyons, PT, MISCP, who will be teaching her brand-new course, The Athlete and the Pelvic Floor, in Columbus,OH in August..
‘I approached my advisor and told him that for my PhD thesis I wanted to study the pelvis." He replied ‘That will be the shortest thesis ever…there are three bones and some ligaments. You will be done by next week.’ I told him ‘I think there is more to it’. (Andry Vleeming Phd 2002)
In sports medicine, the primary source of specialist consultation is the orthopaedic surgeon, who may perform a wide ranging assessment of the musculo-skeletal system with no real evaluation of the pelvic girdle or pelvic floor musculature. The patient is unlikely to be asked about urinary, bowel or sexual dysfunction and often does not volunteer this information unless prompted (Jones et al 2013)
The patient will more than likely then be referred to physical therapy but again, unless we as therapists have the knowledge to combine our orthopaedic, sports medicine and pelvic rehab skillsets, we may not be meeting the needs of our athletic patients.
In my new course for Herman & Wallace, The Athlete and the Pelvic Floor, I will be looking at how specific hip and groin injuries can impact the pelvic girdle and pelvic floor. We know that the most common site of strain is the musculo-tendinous junction of the adductor longus or gracilis muscle, and this is also the most common cause of groin pain in the athlete (Reid 1992). In cases where the athlete recalls a specific traumatic event, the diagnosis is more straightforward, but care must be taken to differentiate between muscle strains and tendonoses/ tendonitis from osteitis pubis, sports hernias and nerve entrapment, which can present with similar symptoms, especially if the athlete presents with insidious onset.
We will investigate differential diagnoses including acetabular tears, a recently recognised source of anterior hip, groin and pelvic pain (Lewis and Sahrmann 2006). Studies have indicated that 22% of athletes with groin pain (Narvani et al 2003) and 55% of patients with mechanical hip pain of unknown aetiology (McCarthy et al 2001) have a labral tear. Athletic pubalgias or sports hernias, are another controversial diagnosis. Although more commonly seen in men, but the female proportion, age, number of sports and soft tissue structures involved have all increased recently (Meyers et al 2008) We will also take into account nerve compressions and look specifically at cycling and genito-urinary symptoms in men and women, the potential mechanisms involved and how we as pelvic therapists can intervene.
It will be an intense two days in Ohio this August as we look at integrating the best of current practices in sports medicine with pelvic assessment and rehabilitation – I hope to see you there!
Reid, D.C. (1992) Sports Injury Assessment and Rehabilitation. Churchill Livingstone, Edinburgh
Lewis, C.L. & Sahrmann (2006) Acetabular labral tears. Physical Therapy 86 (1), 110-121 Narvani et al (2003) Prevalence of acetabular labral tears in sports patients with groin pain Knee surgery, Sports Traumatology & Arthroscopy 11 (6) 403-408
Meyers et al (2008) Experience with sports hernias spanning two decades Annals of Surgery 248 (4)
When I first began working as a pelvic floor PT in the early 90’s (the 1990’s that is), I spent a great deal of time marketing my program to physicians with less than stellar results. Sure, I got the odd referral here and there, but they were mostly the desperation patients that had run out of options. Not to be daunted by lack of success, I opted to present my message directly to the public; I took my “dog and pony show” on the road to senior health fairs, medical study groups and even civic organizations. Any group that was willing to put their comfort level aside and talk about their nether regions was fair game. Over time, the word got out to the physicians (mostly through their patients); our program grew and the need for marketing became a distant memory.
While reading a recent blog post on the subject of students in the pelvic floor rehab clinic by HW faculty member Bridgid Ellingson, I reflected on my current relationship with students in that same setting. Although I have had the traditional senior PT students, I am currently working with those of other medical professions. Yes, it seems the world has come full circle; one of those physicians I annoyed incessantly 20+ years ago until she started sending me patients is now serving as a preceptor for several medical schools. She supervises 4th year medical and PA students for their OB-GYN rotation. During this 6 week rotation, they have clinic hours, deliver babies, observe surgeries and spend a day with me in a pelvic rehab clinic. I try to arrange my schedule to have both male and female patients, a full new patient evaluation, sEMG session, manual therapy, use of RTUS imaging, and exercise programs.
The best part of this arrangement is that the medical students are from two Osteopathic schools. I will unashamedly admit that I am an osteopath wannabe and freely share this with my students. The DO students have a tremendous appreciation for the application of manual therapy techniques such as fascial release and visceral mobilization in the treatment of the uro-gyn patient; this is not a part of their curriculum in osteopathic medical school and are impressed at the level of manual therapy PTs are performing on this population. Both the medical and PA students give positive feedback to their preceptor that they feel this is a worthwhile experience. They are quite amazed to discover the extent to which a pelvic PT can impact bowel, bladder and pain issues, all report that this is completely new, useful information and will impact their referral patterns.
While I occasionally have the reticent patient, in general they are quite willing to allow the students to be present during their treatment session, in fact some even invite the students to palpate or observe their dysfunctions. A number of my patients have been on a long journey to find help for their pelvic issues and welcome the knowledge that they are assisting in educating practitioners of the future. I schedule an observation student about every 6 weeks. There is no paperwork or student evaluation to deal with, all of the education and explanation makes for a long day, but the return is more than worth it. I strongly encourage any who know physicians that precept medical, NP or PA students to offer them time in your pelvic rehab clinic.
This experience has made me realize that students of other professions may indeed be the best untapped marketing tool we can harness without ever opening a single power point file. This experience carries with it a two-fold gain. By educating future practitioners about the value of PT for the treatment of pelvic dysfunction, not only are we planting a seed that will further our profession but more importantly we are providing a more direct route for those seeking care in the maze that is our medical system.
This post was written by guest-blogger, H&W faculty member Michelle Lyons. You can catch Michelle teaching our Pregnancy and Postpartum series courses, Pelvic Floor Series courses, as well as our new courses on Oncology and the Pelvic Floor and the Athlete and the Pelvic Floor. Michelle lives in Ireland and was an integral part of bringing Institute founder, Holly Heman, to the UK to teach two courses this spring.
Two weeks ago, Institute founder Holly Herman took London by storm and presented Pelvic Floor Level 3 to an enraptured audience. Twenty one unsuspecting British and Irish physiotherapists gathered in the Chelsea and Westminster Hospital for an unprecedented weekend of pelvic health assessment and treatment techniques. They may have been surprised at the breadth and width of topics covered, from orthopaedics, hormones and surgery, but they weren’t the only ones who got a surprise that weekend.
The night before we started, Holly and I were at the hotel, preparing slides and tweaking the schedule, when a very familiar head popped around the corner – Diane Lee! To say that Holly was surprised would be something of an understatement (I had been sworn to secrecy for months beforehand – dire threats had been issued!) The hilarity and bonhomie that ensued set the tone for the rest of the weekend.
We had a mix of clinicians – physiotherapists who just treated women, those who specialised in all areas of pelvic health and a couple of brave musculoskeletal physios for whom this was their first pelvic floor course! We were lucky to have a great presentation by Jenny Burrell, of Burrell Education, the UK’s leading provider of continuing education to fitpro’s, who highlighted how her profession works with pelvic floor issues with an entertaining and dynamic presentation, and the legendary Diane Lee also gave a presentation on her latest work and research on diastasis. Diane was generous with her time and knowledge throughout the course and I think gained a new insight into the world of pelvic rehab!
Holly also gave a three hour presentation during her time in London, to a large audience containing physiotherapists, doctors, midwives and fitpro’s, including a very dynamic theraband demonstration of the role of the pelvic floor in all aspects of health and function. Special mention must go to Mr Gerard Greene, who played the role of the clitoris with aplomb!
Holly worked tirelessly throughout the weekend to make sure that everyone left on Sunday evening enthused and excited about pelvic rehab and our role as part of the multi-disciplinary team. While British and Irish physiotherapists have traditionally enjoyed more autonomy in the private practice setting (there is a long history of direct access), there is common ground between US therapists and their Irish & English counterparts when it comes to highlighting the broad role of pelvic rehab providers to our medical colleagues and our communities – a great deal of enthusiasm for the international roll out of the PRPC process was observed.
Compliments were flowing throughout the weekend, not only regarding Holly’s fantastic teaching style but on the hugely beneficial resource that the PF3 manual was sure to become. Plans are already afoot for future HW courses on this side of the pond.
This post was written by H&W faculty member Elizabeth Hampton, who will be debuting her course, Finding the Driver in Pelvic Pain, in May at Marquette University.
Your client presents with a referral from an OBGYN for evaluation and treatment of vulvodynia. During your evaluation, you confirm that she has pubic symphysis instability and that her vulvar pain reduces by 90% with use of a pelvic compression belt. How do you screen for musculoskeletal dysfunction as well as specific urogyn/colorectal and pelvic floor issues in these complex clients? How do you develop the clinical reasoning methods to prioritize evaluation and treatment interventions? If you send a report back relating her pain to pubic symphysis instability, will the physician think that they sent this client to a PT who doesn’t understand the pelvic floor?
Your next client presents with stress urinary incontinence during box jumps and running, however she has no pelvic floor laxity and her strength is 4/5 bilaterally. She denies leaking with coughing, sneezing, lifting, bending. You notice that she has failed load transfer with jumping, weak abductors and marked anterior pelvic tilt that becomes more exaggerated with jumping. Her thorax is rigid and her habitual breathing method is with full abdominal wall relaxation. She demonstrates that a ‘core contraction’ means to her and she holds her breath and bears down. Is this an unstable urethra due to fascial incompetence, poor motor control or is it driven by her poor shock absorbtion with plyometrics?
Part of the joy of working with clients with pelvic floor dysfunction is the ability to sleuth out musculoskeletal dysfunctions as a contributor and (at times) the primary driver of pelvic floor dysfunction. How do you assess a client who may have much co-morbidity that contributes to her pain? It can feel like there is so much to do and it is hard to know where to start.
The good news is that Herman Wallace has many educational resources to fill your toolbox relating to this topic. In the new course I am debuting through H&W, Finding the Driver in Pelvic Pain, fundamental screening tests for spine, pelvic ring, hip tests are integrated with direct PFM assessment to determine all factors in the evaluation of pelvic floor dysfunction.
Clinical Reasoning is an essential tool in the evaluation and treatment of clients with pelvic floor dysfunction as it enables differential diagnosis and prioritization of treatment interventions. The majority of clients with pelvic floor dysfunction have associated co-morbidities which may include labral tear, femoral acetabular impingement (FAI), discogenic low back pain (LBP), altered respiratory patterns, nerve entrapments, fascial incompetence or coccygeal dysfunction. These complex clients require the clinician to have a comprehensive toolbox to screen both musculoskeletal as well as pelvic floor dysfunctions in order to design an effective treatment regimen. This intermediate- level, 3-day course is designed for rehabilitation professionals treating pelvic pain and elimination disorders who seek additional skills in the evaluation and treatment of musculoskeletal co-morbidities as well as clinical reasoning with prioritization of interventions. Participants will be provided with differential diagnosis and clinical reasoning that can be applied to their clients immediately. Internal and external pelvic floor assessment is critical for evidence based evaluation and treatment of pelvic pain and elimination disorders. This data, along with the musculoskeletal screening, can determine if the pelvic floor dysfunction is the outcome or the cause of the problem. This intermediate level course is an excellent adjunct for clinicians interested in learning how to evaluate and prioritize the treatment interventions of clients with pelvic floor associated musculoskeletal dysfunction.
Want more from Elizabeth? Join us at Marquette University in Milwaukee, WI in May!