Meet the Instructor of the Harnessing the Diaphragm and Pelvic Floor Piston course!

Meet the Instructor of the Harnessing the Diaphragm and Pelvic Floor Piston course!


This fall, Herman & Wallace is proud to again offer the course Harnessing the Diaphragm and Pelvic Floor Piston for Rehab and Fitness, instructed by Julie Wiebe. The course will be offered November 2-3 in San Diego, CA

Our pelvic rehab report blogger sat down with Julie to hear more about her course.

PRR: What can you tell us about this continuing education course that is not mentioned in the “course description” and “objectives” that are posted online?

JW: The biggest thing to understand is that this is not just a course for traditional women’s health practitioners, nor is it simply about the pelvic floor, or incontinence. The course as a great introduction for all specialties to the pelvic floor, it is a “gateway drug” to a mysterious muscle group that many have held at arms length. A neuromuscular approach is presented, not a pure strengthening model, with the intention of linking the brain, sensory, motor and IAP systems again to create a coordinated central stability system that is responsive versus statically held. Finally, the course material links that powerful and responsive central foundation to the rest of musculoskeletal system for optimized movement, function, and performance.

The course has practical, manageable, and external intervention strategies to help non-women’s health practitioners integrate the pelvic floor linked with the diaphragm into current programming. For traditional women’s health therapists the course offers integrative ideas to expand their clinical tools and external options for patients that are reticent about or can’t tolerate internal therapies.

PRR: What inspired you to create this course?

JW: Initially, my goals were to share with my ortho and sports med colleagues how incredible the pelvic floor muscle group is, and how to integrate it as a powerful ally in their programming. The pelvic floor really needs new PR, and many practitioners just assume that ‘typical” women’s health issues and anything pelvic floor related aren’t their department. But the evidence is clear that the pelvic floor is a player in the “core” and in all of our movements. The pelvis, and pelvic stability are part of both the upper and lower extremity kinetic chain. So adding pelvic floor integrative tools to the skill set of all practitioners is critical.

Along the way I found traditional women’s health practitioners who were hoping to link their specific pelvic floor interventions to the rest of the musculoskeletal system, with an eye on fitness. So I saw the course as a way to bring both specialties to the middle. Now more and more neuro therapists are coming to the course in search of alternative approaches for creating central stability and continence solutions for their patient populations, which is exciting!

What resources and research were used when writing this course?

The course presents an integrative approach sourced from research, books, articles, and interaction/coursework with top practitioners in multiple fields: sports med, orthopedics, womens health, pediatrics, neuro, cardio pulm, and pain science. A bibliography is available upon request.

Can you describe the clinical/treatment approach/techniques covered in this continuing education course?

First the course introduces the evidence and thought process behind a new way of thinking about how the pelvic floor and its functional partners work together. Then step-by-step, it builds on that understanding to advance a clinical model that adheres to the evidence. This involves identification of the pelvic floor and each of its teammates, using that team integratively to provide a dynamic, responsive central stability system, then linking that deep system from the inside out to the rest of the postural system and extremities in movement and function. This builds a powerful foundation for exercise progressions and return to fitness. The treatment progression is experienced and internalized by each participant and applied in a live demonstration throughout the course. The treatment progressions are experienced and internalized by each participant and applied in a live demonstration throughout the course. Case studies and small group learning opportunities are provided to assist with information synthesis and prep for return to the clinic on Monday morning.

Why should a therapist take this course? How can these skill sets benefit his/ her practice?

To an ortho or sports med practitioner : The pelvic floor is an essential part of the core, come learn external techniques to integrate it into your programming.

To a neuro therapist: The pelvic floor and diaphragm are part of the postural control system, and this approach accesses central stability system through breath, which allows a natural access point for your patients not provided by traditional core programs.

To the women’s health practitioner: This is an opportunity to learn to move the pelvic floor from isolation to integration with its functional, postural, and performance partners.

Don't miss the chance to learn more from Julie - register for the November course today!

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Pelvic Floor PT gets a Shout Out on the Today Show!

Earlier this week, everyone here at the Institute was thrilled to see pelvic rehabilitation and the important role of the physical therapist in addressing pelvic floor dysfunction highlighted in an article in Elle magazine.

This morning, we were equally excited to see pelvic physical therapy mentioned on The Today Show's "Gross Anatomy" segment, during which a gynocologist from Norwalk, CT answered a woman from the audience's question about her weak bladder with advice to seek out a good pelvic physical therapist.

It's wonderful to see pelvic PT getting mainstream attention in women's glossy magazines and morning talk shows. We hope these will be venues to get the word out to patients: "You are not alone and we can help you!"

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H&W gets a Shout-Out in Elle Magzine!

H&W gets a Shout-Out in Elle Magzine!


Recently, Elle magazine did a feature story on a woman suffering from pelvic pain who ultimately found relief from her debilitating and excrutiating symptoms through pelvic-floor physical therapy.

The article mentions Herman & Wallace, our founders Kathe and Holly, and H&W-trained therapists Amy Stein (of Heal Pelvic Pain fame) and Sarah Emmanuel.

We appreciate the shout-out, but - more importantly - we think it's wonderful to see in-depth and awareness-raising articles about pelvic floor dysfunction and the role of the physical therapist in a widely-read women's glossy like Elle.

Kudos to Amy and Sarah and to the writers of Elle for continuing to spread the word on the important role of Pelvic Rehab!

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Intensive Seminar Series for Men with Prostate Surgery - an Update

Intensive Seminar Series for Men with Prostate Surgery - an Update

Richard Sabel

Bill Gallagher

Herman & Wallace instructors Bill Gallagher PT, CMT, CYT and Richard Sabel MA, MPH, OTR, GCFP are currently leading a four-session workshop for men who recently underwent prostate surgery. They recently completed the second two sessions and shared their story and experience with Pelvic Rehab Report:

You can read their dispatch from Sessions 1-2 here.

The group was a rousing success. In fact, the opening narration to Star Trek, with some modification, can be used here: The pelvic floor program was, for many, the final frontier. It’s 4-week mission: to explore strange and unusual sensations, to boldly go where man has never gone before, works well. Everyone had fun. There were lots of laughs, but some cognitive dissonance too - especially the first week when we were learning the pelvic breath. However, by the end, most were smiling as they felt the dance between their respiratory and pelvic diaphragms.

In fact, the pelvic breath led to some interesting discoveries. Everyone found it relaxing, and a majority, for the first time, could sense the movement and dimensionality of pelvic floor, thereby making it easier to differentiate the front, back, left and right quadrants. Some additional discoveries were 1) only noticing movement on one side, 2) feeling the whole pelvic floor move, but discerning differences among the quadrants, 3) those with pelvic pain found it easier to pinpoint and release, 4) one participant discovered he was breathing paradoxically and 5) several of the participants were surprised to hear that the front quadrant is where the “action is” for improving urinary incontinence and sexual function. Everyone agreed that the pelvic breath lesson helped fine-tune their practice.

Prior to our workshop, Kegels was the exercise of choice, or rather lack of choice. Most were given a piece of paper with the instructions. A couple were actually taught the exercise, but not always given good information. One member was told by the urologist to squeeze his anus during the exercises. Learning that there were other exercises - or lessons, as we like to call them - surprised some participants who thought Kegels was their only option.

The Tai Chi lesson also created some cognitive dissonance as participants tried to maintain the pelvic breath in Standing Stake. There were also some unprintable comments on what some felt in their quadriceps after being in the form for a minute, but by the end, 2-3 minutes was, as one participant said, “no problem.” All of the participants could sense how softening the knees and dropping the tailbone - key elements of Standing Stake - reduced the stress in their lower back, freed the pelvic region and made it easier to breathe and sense the pelvic hammock.

The final session, which focused on learning to use the pelvic floor in everyday activities such as lifting, standing, bridging in bed, was met with pleasant surprise. Sensing how engaging the pelvic floor made each of these movements easier, clarified the contribution these muscles make in day-to-day activities. As one participant said, “although it felt funny at first, using my pelvic muscles added a little propulsion to helping me stand.” After four weeks, although the stress incontinence had not resolved, most noticed an improvement, meaning less leakage and pads. Everyone felt more hopeful now that they had more tools at their disposal.

We plan to meet with the group for 2 follow-up sessions late in the fall. At that time we’ll have a “check –in” to see how everyone is doing, review the lessons and based upon the needs of the group, teach 1-2 new lessons.

Eight weeks after the program we bumped into “Jack” - he was the paradoxal breather and, at 82, he was the oldest participant. “Jack” shared:

“I’ve been practicing your program and didn’t force my breathing to change. I kept working gently like you recommended, and after 4 weeks it changed (his breathing) and hasn’t come back. By the way I’m no longer incontinent. That went away too.”

When we asked Jack how often he practiced, he said everyday, which obviously was the key to his success. Unfortunately, too many give up too soon.

All of the lessons came from our “Integrative Techniques for the Pelvic Floor & Core Function: Weaving Yoga, Qigong, Feldenkrais & Conventional Therapies” online courses and live program. As mentioned in our previous blog, the lessons can be used one-to-one or in groups. From our experience, the group format is extremely effective for pelvic floor work. Participants learn from each other as much as they learn from us. Most of all, groups lend themselves to everyone having fun, which keeps the work light and playful. Not a bad thing when focusing on the “down under.”

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PTPC Update - We are almost done writing Items!

For the last few months, Herman & Wallace's team of Item Writers have been plugging away at writing the questions and answers that will appear on the multiple-choice certification exam for Pelvic Therapy Practitioner Certification (PTPC). We needed 450 items in the item bank in order to move onto the next step of exam development, and are so excited to announce that, today, we hit 400 items! That means, we have only 50 items to go!

In August, our team of Subject Matter Experts will meet to go through the 450 items to edit them for clarity, accuracy and convention. This is one of the final steps (prior to beta-testing the items after review) before we launch the exam!

Once the first offering of the exam is announced, H&W will be making study guides and other materials available.

The PTPC exam will be multiple-choice and contain 150 questions. Questions will relate to pelvic floor dysfunction in men and women throughout the life cycle. The 150 questions will relate to 8 domains, based on the Test Blueprint created from the Job Task Analysis. The chart below lists the domains, the general percentage of content in the exam for that domain, and the approximate number of test questions pertaining to the given domain.

Category # of Questions
Anatomy (15%)
22 or 23
Physiology (20%)
Pathophysiology (20%)
Pharmacology (5%)
7 or 8
Medical Intervention & Tests (5%)
7 or 8
Tests & Measures (10%)
Interventions (20%)
Professional & Legal (5%)
7 or 8

Those who want to start preparing can review their anatomy and physiology of the pevic floor. Herman & Wallace Pelvic Floor series courses will be the most relevant to the exam, but all courses offered by the Institute cover important aspects of pelvic rehab. Online courses are also an excellent way to review concepts, particulary Functional Applications of Pelvic Rehab Part A and Part B.

Be sure to review information related to pelvic floor in men and women of all ages, as this exam fills the void left by other specializations that focus solely on women's pelvic floor dysfunction, ilke the WCS exam offered by the APTA.

We are so excited to soon be finished with Item Writing and to move on to item reviewing next month. We are even more excited to be able to offer therapists the ability to distinquish themselves with PTPC to show their expertise in treating pelvic floor dysfunciton!

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Holly Herman to Return to Saudi Arabia

Holly Herman to Return to Saudi Arabia

Jennafer Vande Vegte

In February of 2012, Herman & Wallace founder and faculty member Holly Herman traveled to Riyadh, Saudi Arabia, where she educated the first class of 34 female physical therapists in the art and science of women's health physical therapy. She was accompanied by instructor and H&W friend Fatima Hakeem, PT. You can read more about that adventure here.

Following this intensive 11-day seminar in Riyadh, she returned to the Middle East last Decemeber to teach a similar intensive seminr in Dubai, UAE. You can read more about this trip here.

This winter, Holly will return to Riyadh to teach a six-day intensive offering of Herman & Wallace's Pregnancy and Postpartum series of courses. This course will be targeted towards female physios in the region and will be the first of it's kind.

Stay tuned to Pelvic Rehab Report for more updates on our international travels!

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H&W Instructors run Intensive Seminars for Men with Prostate Surgery

H&W Instructors run Intensive Seminars for Men with Prostate Surgery

Richard Sabel

Bill Gallagher

Herman & Wallace instructors Bill Gallagher PT, CMT, CYT and Richard Sabel MA, MPH, OTR, GCFP are currently leading a four-session workshop for men who recently underwent prostate surgery. They recently completed the first two sessions and shared their story and experience with Pelvic Rehab Report:

For the past few weeks, we’ve had a unique experience: leading a four-session workshop for 22 men recovering from prostate surgery. This experience was unique in that it's rare to get a group of men together to discuss health issues- it happens...about as often as congress reaches a bipartisan agreement!

So far it's been an amazing journey. At the first session we did a quick go round, well, actually not so quickly, as each participant had a story to tell. Things picked up when one participant mentioned he was using a penile clamp. Sex, sports, politics couldn't compete in that moment for the groups attention. (Perhaps the details will be shared in another blog.) For now, the key point we'd like to make is that groups work well for this type of practice. Obviously, individual treatment is imperative, but groups help foster the "new habits" learned in therapy and, perhaps more importantly, from other group members. The mutual support and sharing of information can't be beat.

Given there are only four one-hour-and-fifteen minute sessions, choosing the "lessons," took a little thought. Ultimately we selected four from the Integrative Techniques for the Pelvic Floor & Core Function: Weaving Yoga, Qigong, Feldenkrais & Conventional Therapies live course and online course series that aims to reintegrate of the pelvic floor with the core and full body movement. Below is an overview of each lesson:

Lesson 1 - The Pelvic Breath: The pelvic breath serves as the foundation for the program. In this lesson, participants begin to develop an awareness of the pelvic floor; sense how it moves in relation to the respiratory diaphragm; gently contract and release the pelvic floor as a whole and in sections: right, left, front and back. This focus helps participants develop a keener awareness of the pelvic region and notice differences such as the right side is tighter than the left, how one side can be sensed more clearly, or noticing that while doing Kegel exercises how the back, anal portion, was contracting, not the front.

The pelvic floor is also referred to as the pelvic diaphragm. Given we breathe in and out over 20, 000 times per day, reeducating the pelvic floor to dance with the respiratory diaphragm, is key to maintaining the pelvic floor’s suppleness. By focusing on the breath, this lesson also promotes the relaxation response.

Lesson 2 – Standing Stake: Standing Stake, which goes by a variety of names, is practiced within Tai Chi Quan and Qigong and is an important part of internal martial arts training. In Standing Stake, the participant stands with their feet shoulder width apart, toes straightforward. The hips and knees are slightly bent. The tailbone is released down as if it a weight was attached to the coccyx. The chin is slightly tucked while imaging the head floats upward. The arms are protracted, as if hugging a wide tree, while keeping the shoulders relaxed down and out. There are a few more adjustments, but this gives you an idea, which might have you asking…and how does this relate to the pelvic floor? First, after developing an awareness of the pelvic breath in the first lesson, is it possible for the participant to allow the pelvic diaphragm to move in concert with the respiratory diaphragm, while the upper and lower extremities are engaged? Can the rest of the body maintain a relatively relaxed state in this form? If not, can the holding or tension be identified and released? Standing Stake ups the ante, helping the nervous system relearn that the pelvic breath can be available even when other parts of the body are actively engaged.

Participants are also guided through a short experiential comparing how locked versus slightly bent knees impacts their breath, lower back/pelvic comfort and stability. Participants typically report that when the knees are slightly bent, the breath is deeper, the pelvis and back feel more comfortable and easy to move, the feet are more grounded and…they “feel” their quadriceps. Many people experiencing pelvic discomfort tend to lock their knees and this is an effective strategy to foster the “new Habit”…of keeping the knees slightly bent when doing everyday activities such as microwaving food or waiting on a line at the store. Not bad for one activity.

Lesson 3 - Coordination of the Pelvic Floor with the Obturator Internus and Adductor Muscles: This lesson builds on the integration of the pelvic floor with the core, obturator internus and adductor muscles. The participant first learns to coordinate the pelvic breath while contracting the obturator internus and adductor muscles and then adds pursed lip breathing or Ujjayi breath to activate the abdominals. On the first go round; it can feel like juggling three or more balls, but by having participants work gently and easily, the coordination begins to emerge.

Lesson 4 - Integrating the Pelvic Floor into Everyday Movements: How many people adhere to their home exercise program? Not enough. In this final lesson, the participants learn to engage the pelvic floor into everyday movements such as sit-stand, lifting objects, bridging and going up stairs. After all that’s the goal…to help the nervous system relearn how to use the pelvic floor muscles in everyday activities, which will help maintain their strength and suppleness.

Broadly speaking this work can also be seen within the context of energy conservation and joint protection, as the powerful muscles of the pelvic floor “reassume” their role in everyday movements, thereby contributing to the health, function and well-being of our clients.

So far, two weeks into the program, we’ve covered the first 2 lessons and all is going well. Our next blog will highlight the participants’ reaction and comments, along with any other interesting anecdotes that arise.

If you would like to contact Bill or Richard, you can do so through their website,

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Meet the Instructor of our Sexual Health Clinical Toolkit! Course

Meet the Instructor of our Sexual Health Clinical Toolkit! Course


Our Pelvic Rehab Report blogger sat down with Dr. Heather Howard, the instructor of our Sexual Health Clinical Toolkit course, to talk about her course, her practice, and the experience and knowledge she brings to the field of pelvic rehab. Here's what Heather had to say:

What inspired you to create this course?

This course was inspired by my gratitude to the physical therapists who helped me through my own debilitating pelvic pain crisis. The support I received, coupled with the lack of sexuality research and resources for the sexual effects of my condition, led me to become a sexologist and mind-body health facilitator. My mission as a sexologist is to improve sexual health care for all people. In my clinical practice, I help people meet their sexual goals by providing relevant education and skills training. I can help even more people by sharing my tools, resources, and clinical perspective with women's health care providers.

What resources and research were used when writing this course?

In over a decade of collaborating with women's health PTs as a client, researcher, clinician and educator, I have learned the extent to which patients are looking to their PTs for sexual advice, and how PTs are providing sexuality education and counseling on a daily basis. I have also learned about the challenges new and experienced PTs face in providing sexual solutions and what training they would most appreciate in this area. Many of those challenges were revealed in the natural course of my collaboration, and I decided to gain a thorough understanding by conducting a mini-study which consisted of asking co-investigating PTs in my dissertation research about what tools and training they would find helpful in supporting their clients with the sexual challenges they face. There were 12 PTs in the 9 co-investigating PT and medical practices for my dissertation, and I created a list of requested tools and training from those interviews. I have covered most of those requests in this course. I also conducted extensive literature reviews for both my dissertation on integrating sexual response in interventions for pelvic pain, and for a published article on sexual adjustment counseling for women with chronic pelvic pain. The literature establishes what is needed, such as what most of us see in clinical practice: that patients with CPP report more sexual problems than patients with any other type of chronic pain; that a multimodal, multidisciplinary approach is to optimal for treating pelvic pain; that pain management and psychotherapy do not necessarily lead to improved sexual function for people with pelvic pain; and what elements of are needed in sexuality education to implement change. I will address the elements contained in this course later in this interview, which were determined based on the literature and my own interviews with women's health PTs. While research describes what this large population is missing in terms of sexuality adjustment support, it offers few practical solutions for the problem. Clinical protocols and educational resources for sexual rehabilitation for people with chronic health conditions are not well defined or researched yet, so I have built my own educational and clinical approach based on well-established sexuality counseling and embodiment techniques. The sexuality information I teach is based on the research and methodologies of experienced sexuality researchers and counselors that date back to Alfred Kinsey, William Masters and Virginia Johnson, Helen Sanger Kaplan, Jack Annon, and William Hartman and Marilyn Fithian. The experiential mind-body health approaches that I utilize borrow from the traditions of Voice Dialogue, Body Dialogue, Mindfulness, and Somatic Experiencing, all of which are taught in Somatic Psychology programs. I hope to conduct more clinical research soon to add to the literature.

What can you tell us about this continuing education course that is not mentioned in the "course description" and "objectives" that are posted online?

This course provides attendees with a personalized clinical toolkit, which consists of a framework for sexual health management, as well as practical sexual solutions for patients. Attendees improve their ability to conduct sexual health assessments and suggest innovative and relevant sexual solutions and resources. We also discuss approaches to facilitate patient embodiment, which is an important component for pain management and sexual satisfaction. Even the most experienced providers gain new approaches and a deeper understanding of the problems they see every day.

Can you describe the clinical/treatment approach/techniques covered in this continuing education course?

Sexual health is a vast topic and the majority of the courses out there focus on teaching sexuality information. The problem is that information alone is rarely sufficient for health care providers to integrate what they have learned in a course into their clinical practices. Research has shown that the elements of sexuality education that are needed for effective implementation are as follows:

1. Sexuality information (aimed at improving knowledge and resources)

2. Sexuality attitudes self-assessment (aimed at helping providers become more comfortable with a broad spectrum of sexual attitudes and behaviors, and more aware of their personal biases and "blind spots," so that they can provide a safer space for sexual discussions)

3. Sexuality counseling practice and supervision (aimed at improving professional confidence and appropriate practical solutions)

I am most concerned about optimizing clinical implementation, so I offer some of all 3 elements in this course, with an emphasis on #3. This course complements other available courses in sexuality information (such as the upcoming H&W ISSWSH course on sexual medicine), sexuality attitudes assessment (such as the H&W Sexual Spectrum Education course coming soon), and sexuality counseling (AASECT conferences).

Why should a therapist take this course? How can these skill sets benefit his/ her practice?

Patients look to their women's health care providers for sexual advice, and most providers offer excellent support and advice with little formal training in the area of human sexuality. Patients benefit from a methodical approach to care, and a sound methodology is never more important than with a topic as sensitive as sexuality. My more than 1500 class hours of training in human sexuality have helped me see sexuality problems from a broad perspective and re-framing client problems is often as important as the specific rehabilitation solutions we offer. As a result, many providers who take this course see sexuality through a new lens, which can have benefits on a professional and personal level. They also become familiar with the variety of tools and solutions available to help their patients, many of which they integrate into their own practices.

Don't miss the chance to learn more from Heather! The next offering of this course is in San Diego, CA on June 22-23 - Register today!

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My Experience at the Pediatric Course - an OT's perspective

My Experience at the Pediatric Course - an OT's perspective


Last weekend, Pelvic Rehab Report guest-blogger, Erica Vitek MOT, OTR, BCB-PMD, attended H&W's Pediatric Incontience and Pelvic Floor Dysfunction course in Madison, WI. This course was developed and is instructed by Dawn Sandalcidi. Erica had this to say about her experience in the course:

The most recent Herman & Wallace course I attended was Pediatric Incontinence course taught by Dawn Sandalcidi. I had been patiently waiting for this course to come to the Midwest/Wisconsin area and when it did I signed up immediately.

I have been treating women's and men's health patients for just over 8 years. Since I took the level 1 pelvic floor course with Herman and Wallace, I have been so impressed with the layout and organization of the material. The take-away information from each course allowed me to return to the clinic on Monday and begin treating patients in new and different ways. I've found that the ideas presented can be immediately implemented and improve the quality of life of all the individuals in need of such specialized treatment. As an occupational therapist coming into the field of pelvic floor disorders, I needed the additional depth and focus on pelvic structure and anatomy since this was not a main focus of my underlying educational degree and I can not say enough about how much their coursework prepared me.

Prior to last weekend's course, I had always treated pelvic floor dysfunction in adults but would get the occasional phone call from a parent looking for help with a child who had bowel or bladder issues. The parents sounded so desperate to find help and I struggled to locate someone in my immediate area that could help them. Since generalized pediatric evaluation and treatment is not something with which I have experience, I was not sure if this course would be able to provide me with all the things I would need to get going. If anything, I thought, this course might help me to better understand my adult patients and even get some additional ideas to help them. The pediatric course exceeded all of my expectations! Dawn packed the two days with all the diagnoses for which pediatric patients would be referred, reseached based data with up-to-date terminology, endless practical ideas for behavioral modification specific to children, medical testing interpretation, the psychological considerations, start-to-finish clinic video evaluations of pediatric pateints, and an affordable start-up list of things to purchase to get going right away. Dawn put a passion in me to widen my base of referrals to include pediatrics and give children and parents with these problems somewhere to turn. Changing a child's life in this way could mean all the difference.

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Core Rehab without "Going There"

Core Rehab without "Going There"

In January, H&W faculty member Elizabeth Hampton PT, WCS, BCB-PMD presented at the APTA’s Combined Sections Meeting in San Diego, CA in a presentation sponsored by the Orthopedic Section. The presentation was called “Core Rehab without ‘Going There’: Evidence Supporting Direct and Indirect Evaluation and Treatment of PFM Dysfunction.”

In her talk, Elizabeth discussed contributing factors to pelvic health and continence, including muscular, fascial, neural, biomechanical and motor control factors. She also noted a pilot study done by HW’s own Stacy Futterman, PT, MPT, WCS, BCB-PMD, which prompted a wonderful discussion about the role hip labral tears and femoral acetabular impingement has on the pelvic floor.

Elizabeth was gracious enough to share details about her presentation with Pelvic Rehab Report. Below is what she had to say about this topic.

Elizabeth Hampton PT, BCIA-PMDB

EH: In this talk, I focused on pelvic health and continence being a distinct specialty within orthopedic manual therapy. Considering the interrelationship between musculoskeletal, urinary, colorectal and sexual function, I believe an integrative understanding of all systems is required for autonomous, direct-access physical therapists as we look towards Vision 2020. Indeed, IFOMT’s definition of orthopedic manual therapy correlates directly to the women’s health physical therapist.

In my talk, I proposed that a comprehensive pelvic health and orthopedic manual therapy evaluation is required for the evaluation and treatment of pelvic pain and pelvic health conditions. I noted (and the audience agreed) that the reality is that not all PTs will have a comprehensive pelvic health knowledge base. Key items for a pelvic pain exam have not been standardized for physical therapists that do not have training in direct pelvic health and continence evaluation and treatment methods. Barriers to clinician evaluation of pelvic floor function and dysfunction can include education, apprehension, aversion, risk management concerns and knowing how and when to include pelvic health questions during client history- taking.

One example of a lack of comprehensive pelvic health knowledge base is the therapist who instructs on pelvic floor contractions - without prior assessment by the therapist - during a clinician- designed core rehabilitation program. Without evaluation, the competence of pelvic floor muscle contraction is in question. Cueing a muscle contraction without assessment, therefore, is not a skilled intervention in and of itself.

This prompted a discussion of whether a direct pelvic floor evaluation is indicated with all clients needing core rehabilitation. We also discussed external (i.e. indirect) assessment via the Ischiorectal fossa or client’s hand on their sacrum/ischii as options for a general screening. Further research is needed to determine when direct (internal) or indirect (external) evaluation methods of PFM contraction/relaxation are appropriate.

I encouraged all clinicians to attend the minimum of a Level One Pelvic Floor course through Herman & Wallace or the APTA. Regardless of the long term clinical interest of each PT in pursuing pelvic rehab as a focus, a Level One PF course would enable each clinician to perform a fundamental history, effective bowel and bladder screening and an understanding of the anatomy of the pelvic ring, even if they chose not to perform direct PFM assessment and treatment in the clinic.

I observe that the attitude of ‘us’ vs. ‘them’ still persists between clinicians who do have women’s health PT skillset and those who do not. This attitude has the potential to impair clinical collaboration and the inclusion of PTs of other specialties into the study of pelvic health, continence and women’s health physical therapy. Our profession would be well-served to focus on meeting the needs of the clients through a comprehensive orthopedic/ biomechanical/ urogyn/ colorectal knowledge base, rather than by separating client treatment according to clinician toolbox (i.e. women’s health vs. orthopedic.)

The Description of Specialty Practice for the Women’s Clinical Specialty includes a highly-detailed orthopedic skillset. Likewise, women’s health physical therapy is a highly-specialized field within orthopedic manual therapy. Both toolboxes are required for comprehensive evaluation and treatment of clients with women’s health, pelvic health and continence dysfunction.

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