This blog includes portions of an interview with Ramona Horton. Ramona serves as the lead therapist for her clinic's pelvic dysfunction program in Medford, OR. Her practice focuses on patients with urological, gynecological, and colorectal issues. Ramona has completed advanced studies in manual therapy with an emphasis on spinal manipulation, and visceral and fascial mobilization. She developed and instructs her visceral and fascial mobilization courses for the Herman & Wallace Pelvic Rehabilitation Institute, and presents frequently at local, national, and international venues on topics relating to women’s health, pelvic floor dysfunction, and manual therapy.

How did you start in pelvic rehabilitation and visceral mobilization?

My PT training was through the Army-Baylor program, I was all in for orthopedics and sports medicine until October of 1990. I gave birth to my second child, an adorable, but behemoth, 9lb 9oz baby boy. His delivery, a VBAC (vaginal birth after cesarean) was very traumatic on my pelvis, I sustained pudendal nerve injury and muscular avulsion. When I queried the attending OB-GYN about my complete lack of bladder control his response and I quote “do a thousand Kegels a day, and when you’re 40 and want a hysterectomy, we’ll fix your bladder then.”  As for the desire to study visceral mobilization, that reflects back to my PT training through the US Army which was 30 years ago, when the MPT was just getting started. It was an accelerated program, to say the least. We received a master's in physical therapy with 15 months of schooling. Given the very limited timeline, which included affiliations and thesis, the emphasis in our training was on critical thinking and problem solving, not memorization and protocols which in 1985 was not the norm. I can still hear the words of our instructors “You have to figure it out, I am not going to give you a cookbook."

Erika Vitek is kicking off the new year with her remote course Parkinson Disease and Pelvic Rehabilitationscheduled for January 14-15, 2022. In this course, she explains that akinesia is a term to describe the movement dysfunction observed in people with Parkinson Disease (PD). Akinesia is defined as poverty of movement, impairment or loss of the power to move, and slowness in movement initiation. This is observable in the loss of facial expression, associated nonverbal communicative movements, arm swing with gait, and overall small amplitude movements throughout all skeletal muscles in the body.

The cause of this characteristic profile of movement is due to loss of dopamine production in the brain, which causes a lack of cortical stimulation for movement(1). If the loss of dopamine production in the brain causes this poverty of movement in all skeletal muscles of the body, how does the pelvic floor function in people with PD, and what should the pelvic floor rehabilitation professional know about treating the pelvic floor in this population of patients?

Common pelvic floor dysfunctions often involve functions controlled through reflexes and voluntary actions such as bladder, bowel, and sexual functions. PD-related pelvic floor dysfunctions impact the non-motor portion of the bladder, bowel, and sexual functions. A recent study by Gupta et al. showed that “urinary dysfunction and constipation, manifestations of pelvic floor dysfunction are common sources of disability and impaired quality of life in women with PD(2).” This study concluded that pelvic floor dysfunction is underreported and undertreated in people with Parkinson's Disease.

Holly Tanner Short Interview Series - Episode 2 featuring Deb Gulbrandson

Holly Tanner and Deb Gulbrandson sat down to discuss the Osteoporosis Management Remote Course and why it is important for practitioners to recognize and know how to safely treat and manage osteoporosis patients in their practices.

Deb Gulbrandson shares the goal of the Osteoporosis Management remote course: "This course is based on the Meeks Method created by Sara Meeks, PT, MS, GCS...we have branched out to add information on sleep hygiene, exercise dosing, and basic nutrition for a person with low bone mass. Knowing how to recognize signs, screen for osteoporosis, and design an effective and safe program can be life-changing for these patients."

Join H&W at the Osteoporosis Management remote course, scheduled for September 18-19, 2021, to learn more about treating patients with osteoporosis.