Katie McGee, PT, DPT, (they/them) is a pelvic health physical therapist based in Seattle. Katie received their Doctor of Physical Therapy from the University of Washington in 2014 and their board certification as a Women’s Health Clinic Specialist (WCS) in 2018. Their practice, B3 Physical Therapy, centers on transgender care and perinatal rehabilitation. Join H&W and Katie to learn about perinatal mental health in Perinatal Mental Health: The Role of Pelvic Rehab Therapist - Remote Course scheduled for February 5, 2022. 

Due to the COVID-19 pandemic, rates of perinatal mental health conditions—such as anxiety and posttraumatic stress disorder—have risen sharply1. Around 70% of pregnant people are now reporting psychological distress1. With many families under increased stress and financial worry, the odds of developing postpartum depression have jumped from one in seven to one in five(1)!

Fortunately, pelvic rehabilitation therapists can make a difference in the mental health of their perinatal clients. In fact, many pelvic rehab therapists are reducing the risk of perinatal mental health issues without even knowing it! Simply supporting clients in keeping up with physical activity and reducing bodily pain are proven strategies for lowering the risk of perinatal mental health issues (2,3). Pelvic rehab providers can go even further in supporting their perinatal clients’ mental health with some simple actions:

1. Ask – Many birthing people feel shame around negative feelings and thoughts related to pregnancy and postpartum. Asking perinatal clients about their emotional challenges can help break through that shame. A good ice breaker for talking about perinatal mental health is letting your clients know that a mood disorder is the number one complication of pregnancy. Be sure to listen attentively and avoid interruption whenever someone discloses their mental health challenges.

2.Screen – Screening for mental health conditions can guide pelvic rehab therapists to know when it’s time to refer clients to specialized care, such as medication and/or therapy. Pelvic rehab therapists are qualified to use several screening tools in the perinatal period, including the Edinburgh Postnatal Depression Scale, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7. Best of all, these tests are free to use and easy to administer.

3. Gather resources – When a client discloses that they have thoughts of self-harm or are experiencing violence in their home, you want to be prepared with the next steps to help. Collecting resources ahead of time can go a long way in turning what would have been a fumbling offer to help into a confident action plan. Looking to grow your resource list? Check out these three links:

• Perinatal Mental Health Resources: https://www.postpartum.net/
• Intimate Partner Violence Resources: https://www.rainn.org/
• Substance Use Resources: https://www.samhsa.gov/

4. Connect – Racism leads to People of the Global Majority birthing in the United States to experience increased rates of preterm birth and low infant birth weights (4). Both these outcomes have been tied to worse postpartum mental health (5). Research shows that when People of the Global Majority are connected to culturally congruent birth doulas, rates of preterm birth and low infant birth weights fall (6). Other research similarly supports the concept that when people are paired with culturally congruent providers, health outcomes improve (7). Whenever possible, think about how you can offer your clients resources/referrals that match their identity and background to support their mental wellbeing.

5. Learn – Join Katie McGee, PT, DPT (they/them) for the Herman & Wallace course, Perinatal Mental Health: The Role of Pelvic Rehab Therapist - Remote Course scheduled for February 5, 2022. By participating in this remote learning class, you will:

• Develop a basic understanding of perinatal mood and anxiety disorders
• Bolster your listening skills for working with perinatal clients
• Gain additional tips for screening for perinatal mental health issues
• Learn how to help clients create perinatal wellness plans
• Expand your toolbox of coping skills to teach clients

Don’t miss this opportunity to truly change the lives of your perinatal clients!

References

1. Yan H, Ding Y, Guo W. Mental Health of Pregnant and Postpartum Women During the Coronavirus Disease 2019 Pandemic: A Systematic Review and Meta-Analysis. Front Psychol. 2020;11:617001.
2. Mathur VA, Nyman T, Nanavaty N, George N, Brooker RJ. Trajectories of pain during pregnancy predict symptoms of postpartum depression. Pain Rep. 2021;6(2):e933.
3. Marconcin P, Peralta M, Gouveia ÉR, et al. Effects of Exercise during Pregnancy on Postpartum Depression: A Systematic Review of Meta-Analyses. Biology (Basel). 2021;10(12):1331.
4. Andrasfay T, Goldman N. Intergenerational Change in Birthweight: Effects of Foreign-born Status and Race/Ethnicity. Epidemiology. 2020;31(5):649-58.
5. Anderson C, Cacola P. Implications of Preterm Birth for Maternal Mental Health and Infant Development. MCN Am J Matern Child Nurs. 2017;42(2):108-14.
6. Thomas MP, Ammann G, Brazier E, Noyes P, Maybank A. Doula Services Within a Healthy Start Program: Increasing Access for an Underserved Population. Matern Child Health J. 2017;21(Suppl 1):59-64.
7. Towning EJ, Purohit A. Black babies cared for by black doctors less likely to die in the US: revolutionize medical education to tackle the problem in the UK. BMJ. 2020;370:m3783.

Faculty members Jenni Gabelsberg DPT, WCS, MSc, MTC and Jennafer Vande Vegte, PT, BCB-PMD, PRPC along with senior Teaching Assistant Quozette Valera PT, DPT will travel to Africa to teach pelvic health in Nairobi City, Kenya through a partnership between Herman & Wallace and The Jackson Foundation. These instructors will be teaching two modules of comprehensive pelvic health training with the goal of creating a self-sustaining, continuous education program taught and offered locally. In addition to training a cohort of physiotherapists in assessing and treating the pelvic floor, these American faculty members will be mentoring local Kenyan therapists to teach these courses in an ongoing manner. We at the Institute are proud and thrilled to be a part of spreading this knowledge and skillset in this currently-underserved region.

The courses offered will comprise H&W's Pelvic Floor Series, with the addition of content relevant to Kenya, including obstetric fistula and female genital mutilation. According to the Worldwide Fistula Fund, there are ~ 2 million women and girls suffering from fistulas. Estimates range from 30 to 100 thousand new cases developing each year; 3-5 cases/1000 pregnancies in low-income countries. A woman may suffer for 1-9 years before seeking treatment. For women who develop fistula in their first pregnancy, 70% end up with no living children.

Have you ever had a dream hidden so deep in your heart you never even spoke it aloud?

The dream for me, to someday teach internationally will come to fruition in February 2022. Jenni Gabelsberg DPT, WCS, MSc, MTC; Quozette Valera PT, DPT; and I will travel to Africa to teach pelvic health in Nairobi City, Kenya through a partnership between Herman & Wallace and The Jackson Foundation.

Richard Jackson, a prominent clinician, educator, and businessman himself (The Jackson Clinics, Richard Jackson Seminars, and The Jackson Foundation), had his own dream to build the quality of physical therapy in Africa by educating and empowering clinicians through an evidence-based curriculum developed by Richard and taught by his staff. Richard served two years in the Peace Corps in Kenya in the late 70s. He taught PT at Kenya Medical Training College. In 2010 a former colleague of his moved from the US back to Ethiopia to address and equip PT education and educators in the country. This led to a partnership where Richard helped develop the first DPT program in Africa. “We were in Ethiopia for seven years. We started a residency program that turned into a doctoral program in physical therapy. In December 2017, we graduated 17 DPTs and now we are out. It is sustainable. It’s up to them to carry on and they have the curriculum and the skills,” said Richard in this article.

In 2012 the program Richard stated reproduced and blossomed in Nairobi, Kenya. Let’s talk for a second about what the field of PT is like in Kenya. In a country of almost 54 million people, there are about 2,000 PTs. Thirty-five percent (700) are women, as reported by the Kenya Society of Physiotherapists. The degree is a diploma that takes 3 years to earn, and there are 9 programs available.

There is a women’s health section along with other specialty sections. Medical care has both private and public facilities which can have a wide variation in amenities. After offering specialty training in orthopedics and neurology, Richard recognized the need to expand training to pelvic health. Thus, a partnership between Herman & Wallace, The Pelvic Health and Rehab Center, and The Jackson Foundation was born. In 2019 three cohorts of teachers: Nancy Cullinane PT, MHS, WCS, Kathy Golic PT, and Terri Lannigan PT, DPT, OCS taught module one; Kathy Golic, Casie Danenhauer, and Sherine Aubert fielded a second module; and then educated and equipped the first class of 35 pelvic health graduates. The foundation of the Kenyan Pelvic Health Program thus laid; the future looked bright!

Then…covid brought everything to a screaming halt.

Almost three years later, the program will eagerly resume in Nairobi City.

One can imagine in a country with so few therapists, so few female therapists, and even fewer (think under 50!) pelvic health therapists, the desperate need for pelvic health training and treatment is difficult to fathom. Add to that the strain of a rather patriarchal society where women's health may not be readily accepted or addressed.

In her blog about her experience in Kenya, Sherine Aubert reflects, “To me, this two-week course was way beyond teaching pelvic floor physical therapy - it was truly empowering women to speak up for themselves and each other in the medical community. It provided a voice for anyone suffering from pelvic floor issues to seek help.”

As for Jenni, Quozette, and I, we are beyond humbled and excited to be a part of this experience. Per Richard, "Everyone has come back from these experiences profoundly changed." 

 If you would like to support this program, we are open to your ideas, expertise, and connections. You can also make a tax-deductible donation to The Jackson Foundation here.

If you have connections to help us bring donations of pelvic health supplies, please contact one of us at This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it.

For further information:

Read about Richard Jackson.

• https://www.middleburglife.com/world-class-care-at-the-jackson-clinics/
• https://www.orthopt.org/uploads/content_files/files/Jackson.pdf
• https://www.teachandtreat.org/

Read about the 2019 pelvic health training in Kenya:

• https://hermanwallace.com/blog/pelvic-floor-level-1-is-heading-to-kenya
• https://hermanwallace.com/blog/week-one-at-kenya-medical-training-college-in-nairobi-kenya
• https://hermanwallace.com/blog/the-second-course-module-in-nairobi-kenya

Read more about PT in Kenya:

• https://www.physiotherapykenya.com/
• https://world.physio/membership/kenya
• https://www.spinehealthsportsinjuryclinic.com/services/women-health

This article was submitted by Aparna Rajagopal and LeeAnn Taptich. Both practitioners are based out of the Henry Ford Macomb Hospital in Michigan where Aparna Rajagopal, PT, MHS is the lead therapist of their pelvic dysfunction program, and Leeann Taptich DPT, SCS, MTC, CSCS leads the Sports Physical Therapy team. Michigan. They work very closely together at the hospital which gives them a very unique perspective of their patients. Aparna and LeeAnn instruct the Breathing and the Diaphragm course. This remote course explores how the diaphragm, breathing, and the abdominals can affect core and postural stability through intra-abdominal pressure changes.

COVID-19 has been a part of our vocabulary for almost 2 years now and has changed the world we live in. COVID-19 is a virus that affects the cardiovascular, digestive, urinary, and respiratory systems. We still do not have adequate evidence to guide our treatment of COVID -19 patients in their sometimes prolonged recovery phase. Research continues to be made available about the short and long-term effects of the virus on our bodies.

An example of a post-COVID-19 patient was a female with complaints of difficulty taking in a deep breath. She also reported that the physical act of breathing felt like a lot of work/effort. She had undergone all sorts of respiratory and cardiac testing and had been cleared from a medical standpoint. Upon talking to the patient, it was discovered that she wasn't complaining of shortness of breath/dyspnea.

Instead, this patient was complaining about having to expend a lot of energy to perform the mechanical action of breathing. She reported that this had started after she had experienced moderate COVID - 19 symptoms for about a month. The patient did extremely well with a plan of treatment aimed at improving mobility in the soft tissues and joints of the thorax while working on establishing a breathing pattern with a focus on improved overall expansion. An incidental benefit of her treatment was a dramatic reduction in her symptoms of urinary urgency which she had developed during her COVID-19 recovery stage.

Recently, a clinical commentary in the Journal of Women’s Health Physical Therapy talked about the possibilities of pelvic floor dysfunction developing on account of COVID-19 (1). Since COVID 19 affects the respiratory system, we can postulate that something involving the respiratory system will possibly have an effect on the pelvic floor due to the unique relationship shared between the pelvic floor and the diaphragm.

Recovering COVID 19 patients may have changes in their musculoskeletal system. These changes may include increased accessory muscle use, decreased chest wall mobility (including the associated joints and muscles), and altered breathing mechanics due to both the disease process and possibly the immobility of bed rest.

The upcoming Breathing and the Diaphragm course helps practitioners understand the connection of dysfunction pertaining to respiration and how it can affect the pelvic floor. In this course, Aparna Rajagopal and LeeAnn Taptich will instruct you to look at the body as a whole while assessing and treating for mobility deficits, motor control deficits in terms of breathing dysfunction presented by these patients.

References:

1. Siracusa C, Gray A. Pelvic floor considerations in COVID-19. Journal of Women’s Health Physical Therapy. 2020; 44(4): 144-151.

Stacey Roberts is an expert on shockwave therapy and joins Herman & Wallace to present her course Shockwave Treatment: Therapeutic Interventions in Pelvic Health & Demystifying the Research. Over the last year, Stacey Roberts has been analyzing shockwave research extensively to develop clear and concise therapeutic applications in the rehabilitation setting for pelvic health, sexual health, and muscular-skeletal patients. She is finding extraordinary results with her patients using this modality in her practice.

Stacey sat down with us at The Pelvic Rehab Report to answer some of the most asked questions that she gets about shockwave therapy.

What is a Shockwave?

A shockwave is an interesting phenomenon and can be both natural and manmade. The Encyclopedia Britannica defines a shockwave as "a strong pressure wave in an elastic medium such as air, water, or a solid substance, produced by supersonic aircraft, explosions, lightning, or other phenomena that create significant changes in pressure.”

What is Shockwave Therapy?

Shockwaves used in therapeutic settings are produced by modalities that create supersonic waves. These waves penetrate the human tissue and can travel to areas of the body, producing a biological effect. The first therapeutic use of shockwave therapy was lithotripsy. This procedure was first used in the 1970s and utilizes high-energy high-intensity shockwaves to break apart kidney stones without surgical intervention.

Clinics now use low-intensity focused and unfocused shockwaves to exhibit a form of energy within the tissues. The shockwaves are made up of 3 phases: a mechanical phase, a chemical phase, and a biological phase. A true shockwave device impacts the tissue and can increase blood flow, activate connective tissue, modulate the inflammatory response, and contribute to pain relief.

Is there just one type of Shockwave device?

No, there are 3 types of true shockwave devices.

• Electrohydraulic (deepest penetration)
• Electromagnetic (minimal to moderate penetration)
• Piezoelectric (minimal penetration)

Why is Shockwave therapy beneficial?

When a true shockwave device is used, patients often note faster improvement than with manual therapy alone or with other standard modalities such as ultrasound, laser, and radial wave therapies.

In my experience, the depth of penetration also allows my skills as a manual therapist to be used more effectively. By using shockwave therapy, I can now treat an area in 5 minutes that previously would have taken 10-15 minutes. It also tends to be much more comfortable for the patient.

Are radial, pneumatic, or EPAT true shockwave devices?

No, they have been lumped in under the Shockwave umbrella but do not produce the force or effect of a true shockwave. These devices have therapeutic value for superficial musculoskeletal injuries including plantar fasciitis and lateral epicondylitis. However, the energy produced by the mechanical pounding of the tissue from a radial wave device does not produce a shockwave.

The energy produced by radial pneumatic devices disseminates just below the surface of the skin. An electrohydraulic shockwave device can produce energy up to four to six inches from its point of contact, making this particular type of shockwave device is especially useful for pelvic floor therapy.

Electromagnetic shockwave devices can penetrate approximately two inches. This is approximately the same depth as the piezoelectric shockwave device.

I see ESWT in the research a lot. Is that shockwave therapy?

ESWT stands for Extracorporeal Shockwave Therapy. This is a common abbreviation used in the literature that originally was meant to label shockwave devices. However, other non-shockwave devices, such as radial devices, also use ESWT in research studies.

In the true sense of the word, and shockwave definition, a radial device is NOT a true shockwave. There is much confusion in the research that takes time to unravel, so I have dedicated a portion of the Shockwave course to tease out the differences. Many clinicians own a radial device and were told that it was a shockwave device. Unfortunately, that is not completely accurate, according to the International Society for Medical Shockwave Treatment.

What can be treated with true Shockwave therapy related to Pelvic Rehab?

True shockwave therapy has shown to be beneficial for the following issues:

• Erectile Dysfunction
• Peyronie’s Disease
• Chronic Prostatitis
• Chronic Pelvic Pain
• Incontinence 
• Urgency
• Cystitis
• Vaginismus
• Vulvodynia
• Vestibulodynia
• Persistent Genital Arousal Disorder (PGAD)

Other areas of research:

• Dysmenorrhea 
• Endometriosis
• Testicular Pain and Dysfunction
• Premature ejaculation 
• Urinary retention

How is shockwave different from ultrasound?

A wave produced by ultrasound is a sinusoidal wave versus a shockwave that has a strong positive pressure followed by a longer negative pressure wave. See chart:

This results typically in larger cavitation bubbles around the cellular structures and fewer treatments to reach patient goals. Continuous ultrasound produces its effect by heating the tissue, whereas a shockwave device does not cause any heating of the tissue to produce its therapeutic effect.

Is shockwave therapy covered by insurance?

Like other valuable modalities, insurance does not typically cover low-intensity shockwave therapy. However, in times of decreasing reimbursement, patients are increasingly more than willing to pay out of pocket for treatments that result in positive outcomes in shorter periods.

Why should I take your course Shockwave Treatment: Therapeutic Interventions in Pelvic Health & Demystifying the Research?

You should take this course if you are interested in:

• Learning how one of the most effective non-invasive treatment modalities of our time related to pelvic and sexual health produces its results
• Understanding how this modality produces its results and how it is being utilized in clinics to improve treatment outcomes related to pelvic health
• How this modality can enhance results when combined with manual treatment techniques
• How to review the research efficiently without combing through data that may or may not be actual Shockwave research
• Being able to differentiate one machine from another to make an educated decision on which shockwave device may fit into your clinic
• What questions to ask company sales reps that are selling devices to make sure you are talking about a true shockwave device

If you would like to learn more about incorporating shockwave therapy into your daily practice, then join H&W Shockwave Treatment: Therapeutic Interventions in Pelvic Health & Demystifying the Research. This course is scheduled for February 20th and June 26th of 2022.

Happy Holidays to all of you from Herman & Wallace!

Allison Ariail is one of the creators of the Herman & Wallace Oncology of the Pelvic Floor Course Series. Practitioners who took the main Pelvic Floor course still weren’t sure how to handle oncology tissues, what they could do, or how to treat these patients. Thus the oncology series was created to provide additional instruction for treating pelvic cancer patients.

Allison Ariail is a physical therapist who started working in oncology in 2007 when she became certified as a lymphatic therapist. She worked with breast cancer, lymphedema patients, head and neck cancer patients, and the overall oncology team to work with the whole patient to help them get better. When writing these courses, Allison was part of a knowledgeable team that included Amy Sides, Nicole Dugan, Tina Allen, Jennafer Vande Vegte, and Megan Pribyl.

The Oncology Series is comprised of three different courses, with the first course, Oncology of the Pelvic Floor Level 1, designed as an overview of the oncology world. Allison explains that the reason level 1 is an introduction is that “this is because the oncology medical world is so different from what a lot of rehab professionals are used to.”

Oncology of the Pelvic Floor Level 2A addresses colorectal cancers, anal cancers, and cancers that affect male genitalia. New information about how to treat prostate cancers is also discussed. The third course, Oncology of the Pelvic Floor Level 2B, is being launched this year in 2022 and covers gynecological cancers and bladder cancers. The tentative launch will be in November 2022.

There are a lot of labs in all of these courses that are specific to the side effects that these patients have after going through radiation and other surgical treatments. Oncology patients can have a range of problems from radiation fibrosis, range of motion issues, and weakness. While these patients may be seeing a certified lymphatic therapist, that CLT is not going to have time to address these additional issues. Allison Ariail explains, “that is where this knowledge from these courses comes in. Not just as a supplement for that patient, but as a completely different treatment, where that patient really needs to see both therapists. One for lymphedema and one for radiation fibrosis, or weakness, or other side effects, that can affect their quality of life.”

Certified Lymphatic Therapists can skip OPF1 or dive in at OPF2A or OPF2B as long as they have taken the main Pelvic Floor Level 1 course prior.

Oncology of the Pelvic Floor Series 2022 Schedule

Oncology of the Pelvic Floor Level 1

• January 29-30
• July 16-17
• December 3-4

Oncology of the Pelvic Floor Level 2A

• April 2-3
• August 20-21

Oncology of the Pelvic Floor Level 2B

• TBD – course launch is tentatively scheduled for November 2022
• If you are interested in attending this course, please contact us!

Our resolution here at Herman & Wallace is to provide even more course content for you! Our plan is to have a total of 22 new courses from 2021-2022 available and over 400 course events/satellites scheduled! In addition, we at H&W want to take the time to let our faculty, teaching assistants, hosts, and students know how much we appreciate you! As the pandemic continues into 2022, know that we see you. We appreciate all that you do and the efforts that you go to. 

The best way to make an attainable New Year's Resolution is to use SMART goals. Most of us have seen SMART goals used for work and business decisions. Keep the specific, measurable, and time-specific aspects of goal setting while making sure they are attainable and realistic.

Did you set any New Year's Resolutions yet? If not, then here are 5 suggestions!

1. Learn something new. Have fun while challenging yourself to take the next step in your pelvic rehab journey. H&W offers courses that are beginner, intermediate, and advanced levels.
2. Build your confidence. Whether it is in gaining confidence in internal exams, or in treating the lumbar nerve H&W has a course for you.
3. Meditate & Practice Mindfulness in your personal life and practice. H&W recommends joining Restorative Yoga for Physical Therapists or Boundaries, Self-Care and Meditation.
4. Try something that scares you. Push yourself to try things that are out of your comfort zone. Take a new course for a different patient demographic to incorporate into your daily practice such as Bowel Pathology and Function or Transgender Patients: Pelvic Health and Orthopedic Considerations
5. Volunteer. Give back to the Pelvic Rehab Community by TA'ing for a satellite course.

Herman & Wallace wishes you a fresh start with renewed energy and confidence throughout the New Year. Happy 2022!

Pelvic rehab therapists and physiatrists both focus on the return to life and function. In a recent interview, Allyson Shrikhande shared, “Physiatrists are extensions of physical therapy. We analyze and treat the muscles, nerves, and joints of the pelvis non-operatively.” Physiatrists bring a holistic viewpoint and are trained to look at the interplay between the different organ systems with each other, as well as the muscles, nerves, and joints.

Dr. Shrikhande is joining H&W to bring in the New Year with her short format course, Working with Physiatry for Pelvic Pain, on January 11th. This 4-hour course delves into diagnosis and non-operative treatment options for Chronic Pelvic Pain (CPPS). Allyson believes in an interdisciplinary team approach to treating patients and spends time discussing the interplay between professions for the betterment of patients.

Physiatrists often work with an interdisciplinary team of rehabilitation experts to coordinate a treatment plan that is based on each patient’s personal needs, abilities, and goals. Members of this interdisciplinary team can include several practitioners:

• Rehabilitation nurses
• Physical therapists
• Occupational therapists
• Respiratory therapists
• Gynecologists
• Dieticians

You can find many clinics and healthcare systems that incorporate a variety of professionals and share a multidisciplinary approach. Multidisciplinary typically means that there are multiple providers but not working together in the same way as interdisciplinary teams. The interdisciplinary approach differs from the multidisciplinary approach by focusing on the common patient and team goals, compared with a discipline-specific focus. It emphasizes regular and effective communication, coordination, and integration of care. Interdisciplinary medical teams are able to work together for functional outcomes (1). 

Patients with Chronic Pelvic Pain Syndrome (CPPS) typically experience pain in the abdomen, lower back, and genitals. These patients often experience frequent urination, pain when sitting, and even pain during or after sexual intercourse and impair the function of organs such as the bladder and bowel. 

CPPS is a multifaceted disorder. It is a challenge to health care providers because of its unclear etiology and complex natural history. In this case, a pelvic physiatrist may lead an interdisciplinary team including a gynecologist, psychologist, and physical or occupational therapist. In her course, Dr. Shrikhande shares how important it is to understand the pathophysiology of pain. “Experiencing pain for a long period of time changes how the brain receives and processes pain signals. Essentially there is this amplification of pain. This really describes neuroplasticity. The rehab world is founded on neuroplasticity, meaning your peripheral and central nervous system can change in a positive direction or a negative direction.”

Dr. Shrikhande delves into the important role of the physiatrist and pelvic therapist in CPPS treatment in her course  Working with Physiatry for Pelvic Pain. Physical and occupational therapists are trained in the clinical features of common musculoskeletal pathology and musculoskeletal examination and develop treatment plans, exercise programs, and physical modalities (including heat, cold, TENS). As a pelvic therapist, an evaluation for CPPS is not just of the pelvic floor. It includes other structures including the abdomen, hip complex, diaphragm, ribcage, low back and looks for weakness, difficulty of coordination, and assessing breathing dysfunction. 

As stated by the American Academy of Physical Medicine and Rehabilitation, "Physiatrists, on the other hand, make and manage medical diagnoses and prescribe the therapies that physical and occupational therapists perform. Despite these differences, both therapists and psychiatrists collaborate and communicate to ensure patients are receiving appropriate treatment (2)."

If you have taken Pain Science for the Chronic Pelvic Pain Population, Pudendal Neuralgia and Nerve Entrapment, Yoga for Pelvic Pain, Nutrition Perspectives for the Pelvic Rehab Therapist, Biofeedback for Pelvic Muscle Dysfunction - Satellite Lab Course, or Male Pelvic Floor Function, Dysfunction, and Treatment - Satellite Lab Course you may be interested in attending this course (Working with Physiatry for Pelvic Pain).

Upcoming Working with Physiatry for Pelvic Pain Courses

January 11, 2022

April 5, 2022

September 25, 2022

November 15, 2022

References:

1. Poduri K. R., Vanushkina M. Epidemiology of Aging, Disability, Frailty and Overall Role of Physiatry. Geriatric Rehabilitation. 2018; Pages 1-17. https://doi.org/10.1016/B978-0-323-54454-2.00001-7
2. American Academy of Physical Medicine and Rehabilitation. The Medical Student's Guide to PM&R. https://www.aapmr.org/career-support/medical-student-resources/a-medical-students-guide-to-pm-r/what-is-the-difference-between-physical-therapy-and-physiatry

Herman & Wallace has more than 55 different courses with over 200 individual course events scheduled throughout the year to choose from. Our course catalog is growing all the time with new courses, new instructors, more course dates, and even more satellite locations!

In 2022 there are already six BRAND NEW courses available, with more to be planned. H&W is kicking off the new year strong with Dr. Michael Hibner on January 9th with Pudendal Dysfunction: The Physician's Perspective. Kristina Koch is back in 2022 with her newly updated and reformated course, Pharmacologic Considerations for the Pelvic Health Provider which is scheduled for April 10, July 9, and November 19th.

Do you live near Salt Lake City, Utah? Our first live, in-person course since the pandemic will be there on March 12-13, 2022: Dry Needling and Pelvic Health.

• Disclaimer: Due to the nature of this course content, it will be delivered in the traditional "in-person" manner. This means the course instructors will be teaching at a single location, and it will not be possible to join the course remotely via video conference. As with all Herman & Wallace courses, this course content is only intended for practitioners who are licensed appropriately, and for whom dry needling is within their scope of practice. It is the responsibility of every course registrant to check with their state boards to ensure that the content of a Herman & Wallace course that they attend is within their state-specific scope of practice.

Interested in women's health? There are 3 new courses appearing this year: 

• Perinatal Mental Health: The Role of Pelvic Rehab Therapist - February 5, 2022
• Menopause Transitions and Pelvic Rehab - March 5-6, 2022
• Pregnancy and Postpartum Considerations for High-Intensity Athletics - May 21, 2022

Are you thinking about taking a course, but not sure if it is for you? H&W courses are for licensed practitioners interested in the field of pelvic rehabilitation. The most common registrants that we see in our courses include:

• Doctor of Osteopathic Medicine (DO)
• Doctor of Chiropractic (DC)
• Nurse-Midwives (CNM)
• Nurse Practitioners (ARNP)
• Occupational Therapists (OT)
• Occupational Therapists Assistants (OTA)
• Physical Therapists (PT)
• Physical Therapists Assistants (PTA)
• Doctor of Medicine (MD)
• Physicians Assistants (PA)
• Registered Nurses (RN)

H&W courses are classified as Beginner (no prerequisites), Intermediate (one prerequisite), or Advanced (two or more prerequisites). A Beginner course can be taken by a licensed practitioner without prior coursework requisites. Therapists interested in registering for an Intermediate or Advanced course must review the prerequisites on the course description and honestly assess/report their fulfillment of the published prerequisites.

For example, courses that have Pelvic Floor Level 1 as a prerequisite require a working knowledge of performing internal assessments. It is never recommended that a participant skip this introduction without prior training or experience performing an internal exam. Some courses are part of a series and it is not recommended that they be taken out of order. On the Continuing Education Courses page, you can click the Experience Level tab to see courses organized by level of difficulty.

Clinical experience or alternative coursework may be a substitute for the published course requirements, and it is recommended that a therapist considering opting out of a published prereq review the objectives of the required course and assert that said objectives have been met. Review the Course Overview and Objectives on each course page and ask yourself what your treatment goals (in both the long and short term) are and what patient population you are targeting. All courses list the learning objectives, which will give you a lot of information about what you'll be learning at a given course.

If you would like additional guidance on which course offering best fits your goals and target patient population, please contact us! We are here to guide you into an event that best suits your needs.

In an excerpt from a conversation with The Pelvic Rehab Report, Tara Sullivan discusses her course, Sexual Medicine in Pelvic Rehab. She imparts, "As rehab professionals, we are in a unique position to bridge the gap between disciplines with our extensive time for exams and differential diagnoses. Many causes of dyspareunia, vestibulodynia, and IC-type symptoms can be diagnosed by careful observation and testing of the vestibule. This is often the missing link in resolving the patient's symptoms of burning, itching, urgency, and pain."

Sexual Medicine in Pelvic Rehab covers lecture topics that are often taboo in Western cultures, such as hymen myths, female squirting, G-spot, sexual response cycles, hormone influence on sexual function, anatomy and physiology of pelvic floor muscles in sexual arousal, and orgasm. She also discusses vaginismus, dyspareunia, erectile dysfunction, hard flaccid, prostatitis, and post-prostatectomy issues.

So what is Vestibulodynia? Vestibulodynia is a localized form of vulvodynia. The Baylor College of Medicine defines vestibulodynia as "chronic pain or discomfort that occurs in the area around the opening of the vagina, inside the inner lips of the vulva. This area is known as the vestibule."

Tara Sullivan shares, "The vestibule is considered the forgotten organ. Most disciplines completely bypass it in their exams." So how is vestibulodynia treated, especially if there are no visible symptoms? The patient should discuss their symptoms with their primary practitioner to rule out medical issues such as yeast infection or cancer. Pelvic specialists can perform a physical pelvic exam, with patient consent, to examine the vestibule, vulva, and vagina. A cotton swab touch test can also be used to pinpoint areas of sensitivity.

The treatment strategies for vestibulodynia focus on relieving the pain and discomfort of the patient. These strategies include lifestyle changes (looser clothing, changing personal routines), including the use of lubrication or local anesthetic creams for intercourse, and therapy or sexual counseling. Vestibulodynia patients can be referred to a pelvic rehab therapist to learn how to relax the affected muscles and control painful spasms. This therapy can include the use of diaphragmatic breathing, biofeedback, pelvic wands, or pelvic dilators.

Vestibulodynia is only one of the topics that Tara Sullivan discusses in her course, Sexual Medicine in Pelvic Rehab. Participants will learn how to confidently treat sexual dysfunction related to the pelvic floor, refer to medical providers as needed, and instruct patients in the proper application of self-treatment and diet/lifestyle modifications. 100% of participants surveyed in the last class answered YES to "Do you feel this course instructed immediately-applicable knowledge and skills that could be used in the clinic with patients?"

Sexual Medicine in Pelvic Rehab is scheduled for 2022 on January 8-9, April 9-10, July 16-17, and October 15-16.