Two weekends ago in San Diego, Herman & Wallace offered the first course event of our brand new course, Care of the Pregnant Patient. This course is part of a new series on pregnancy and postpartum, written and developed by Herman & Wallace faculty members (as we call them, our "Preg-perts").

Lisa Lahr, DPT attended this course and wrote of her experience:

The course Care of the Pregnant Patient was a wonderfully put together course. The course outline and handouts were wonderful, easy to follow and gave the right amount of information. Many physical therapist work with pregnant patients who have pain during their pregnancy. We have all had the patient for whom we run out of ideas how to help and have thought that she would feel better once the baby is born. After this class, I do not feel like I will ever have to feel this way again. I have learned so many things that I can try and teach my patients to help with their pain during pregnancy.

Another key part of the class was discussing ways to market to providers and the community to grow a strong program for pregnant patients to attend. We also discussed ways to improve relationships between providers and therapy for this patient population.

Jenni Gabelsberg is a wonderful instructor with a very strong knowledge base in women’s health and pregnancy patients and she provided great examples of what we talked about in class.

Overall, this class allowed me to leave with many new “tricks in my tool bag” and a new appreciation for the things that we can do for a pregnant patients. I look forward to attending the Care of the Postpartum Patient and would highly recommend this class to anyone that treats pregnant patients.

We will be offering this course two more times in 2013: in April in Houston, TX and in September in Winter Park, FL.

In March of this year, H&W is thrilled to be offering a brand new course on Pudendal Neuralgia. Our Pelvic Rehab Report blogger interviewed the two instructors Loretta J. Robertson, PT, MS and Tracy Sher, MPT, CSCS about their course.

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

Loretta: First, I just want to say we are both thrilled to be able to present this course and share all that we have learned in working with these patients. I have always wanted instructors in continuing education courses to “walk me through” their thinking processes. “Why did this patient history and presentation guide you toward diagnosis or treatment A as opposed to B?” So we are going to incorporate that information throughout the entire course.

Tracy: Yes- this is exciting for us to have this opportunity to blend anatomy and science with clinical decision making. We both see patients from all over the country (and world) who are concerned about having pudendal nerve entrapment or pudendal neuralgia. We have seen pudendal decompression surgery patients pre-op and post-op; and we have also helped patients avoid unnecessary surgeries. They are desperate for answers. What we find is that often times patients are misdiagnosed and go through many procedures or surgeries that may not be effective or necessary. Class participants will receive valuable information regarding clinical insight about appropriate evaluation strategies and clinical decision-making. Is it really a pudendal issue? Now what?

2. What inspired you to create this course?

L: PN is often misdiagnosed. These patients see on average 5-10 medical professionals before getting diagnosed and often suffer for years without help. I love teaching and would like to pass on all that I have learned so more therapists and patients can benefit. Also, at the hospital, we see patients from around the country and often other countries. I am often asked by PT’s how to help these patients. I thought it would be easier to put the information into a course because playing phone tag with multiple therapists is getting difficult!

T: We are both so passionate about what we do and see daily how we can make such a profound effect on patients and their families dealing with pudendal neuralgia. I agree that we need more therapists evaluating and treating this population, armed with exceptional clinical reasoning skills. In addition to the typical didactic environment, we hope to foster discussions by sharing case studies and allowing participants opportunities to share questions and comments about complex cases. We have seen a need to share this knowledge. Let’s do this!

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

L: We both strongly believe in an eclectic approach to treatment, so we will not be focusing on any one specific modality. I have found these patients really need a comprehensive approach to care – so we will incorporate education, ther-ex, manual therapy, functional activities and the latest information on research into chronic pain and the central nervous system.

T: We also want participants to recognize when less is more. Some manual treatment approaches can be too aggressive. There are times when it’s important to back away from traditional manual treatments and focus more on integrative neural reeducation and desensitization strategies. Informing patients about the reasons behind this treatment approach are important for buy-in and patient compliance and treatment success.

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

L: Physical Therapists are often the first medical practitioners correctly identifying patients with pudendal neuralgia. We desperately need more PT’s who can recognize the diagnosis and start treatment with these patients early. I am always searching for therapists around the country where we can refer patients. Also, having this knowledge allows the therapist to start appropriate care and help the patient avoid unnecessary tests, injections and often surgery.

T: In relation to Loretta’s statement, sometimes the opposite is true as well. Physical Therapists are treating patients thinking that they have pudendal neuralgia, but have not properly ruled other out other issues. This is why we are so excited to share more insight about this area of pelvic therapy. I am often not the first therapist to see these complex pelvic pain patients. Sometimes they have seen two to three others before they find me. I am always surprised by how many important clinical findings are missed. This is not because the therapists are unwilling to do the best evaluation or treatments. They simply have not had advanced training or exposure to approaches in this area. We want the class participants to have the right clinical knowledge and skills to efficiently and effectively know how to treat these types of patients. This is complex stuff- Is it biopsychosocial, neural, local tissue or nerve irritation or a combination of all of this?

5. How has this knowledge and skill set benefited you in your own practices?

L:I can honestly say, this has changed my practice completely. I am now an integral part of a medical team and have an equal voice with the physicians in helping to decide the best medical approach for each patient. I also have far too many patients!

T: Loretta works with one of the leading surgeons dealing with pudendal issues. He admits openly and regularly that he relies on Loretta for her clinical judgment for the right plan of care with patients. Similar to Loretta, I am either the first person to finally point the patient in the right direction or brought on by a physician or healthcare team to play an integral role in care. This is because we are really able to discern possible driving factors of the symptoms and find conservative ways to treat these patients who have complex histories of pain and/or pelvic floor dysfunction.

6. What resources and research were used when writing this course?

L: We reviewed mountains of research articles, and the information on Chronic Pain came from the books, courses and personal conversations with Lorimer Moseley and David Butler. As previously mentioned, I also work with one of the physicians specializing in PN for the last 7 years. Through this time we have come to understand more, improved our diagnostic skills and treatment ideas. Our daily problem solving discussions have helped us improve our care. I will bring all that we have learned – both the successes and failures to the course.

T: There’s not a lot of research specific to evaluation and treatment of pudendal nerve diagnoses yet, but this is moving in a forward direction. Also, some of the criteria for determining these diagnoses are often misleading. We want to help direct the participants to find good research on pelvic pain diagnoses and the brain/pain connection. We are excited to present pelvic pain and brain research in conjunction with our clinical experience and outcomes.

We are thrilled to announce that Part B of our brand new online course series, Medical Therapeutic Yoga is now available!

This course was written and is instructed by Ginger Garner, MPT, ATC and presents an evidence- based method for using yoga as medicine in rehabilitation and wellness. Part B is intended as a completment Part A . Topics covered include respiration for optimal patient outcomes, applied biomechanics in asana, and achieving structural balance. Neurophysiology, stability, and joint function in practice are also covered, as well as myofascial release and soft tissue mobilization as they relate to medical therapeutic yoga.

In addition to these brand new online courses, H&W will be sponsoring two live seminars taught by Ginger in 2013: Yoga as Medicine for Labor and Delivery and Postpartum, which will be offered in Arlington, VA in October, and Yoga as Medicine for Pregnancy, which we will be offeing in Greenville, SC in September.

We are thrilled be offering these brand new courses!

In addition to all the great things our faculty will be up to at this year's APTA Combined Sections Meeting (CSM) - read THIS ENTRY of Pelvic Rehab Report for an update on the happenings in San Diego - H&W faculty members Bill Gallagher and Richard Sabel will be presenting at two upcoming conferences.

On April 24th, Bill and Richard will present "Explore the Pelvic Floor Plus More: The Foundation of Health in the Body" at the American Occupational Therapy Aassociations's Annual Conference and Expo in San Diego CA.

In June, these two will present a similar seminar, this one geared towards the yoga therapist at the Symposium on Yoga Therapy and Research conference in Boston, MA. This seminar will cover how, by bringing awareness, strength, and suppleness to thes muscles of the pelvic floor, yoga therapists can not only address incontinence, sexual fulfillment, pregnancy and postpartum health issues, but can also alleviate pain in the pelvis, hips, knees, and back, improve respiration, and facilitate functional activities.

Congrats and thanks to Bill and Richard for spreading the "good word" on the pelvic floor!

We are thrilled to announce the launch of Part A of our brand new online course series, Medical Therapeutic Yoga!

This course was written and is instructed by Ginger Garner, MPT, ATC and presents an evidence- based method for using yoga as medicine in rehabilitation and wellness. Ginger has been lecturing on this topic throughout the United States since 2000. Her medical yoga graduate and post-graduate program, Professional Yoga Therapy, which teaches non-dogmatic, evidence-based care through fostering an east/west multi-disciplinary team approach, is a first of its kind in the US.

In addition to this brand new online course, H&W will be sponsoring two live seminars taught by Ginger in 2013: Yoga as Medicine for Labor and Delivery and Postpartum, which will be offered in Arlington, VA in October, and Yoga as Medicine for Pregnancy, which we will be offeing in Greenville, SC in September.

We are thrilled be offering these brand new courses!

There are only five seats left in the Pelvic Floor Level 2A course in Boston on March 22-24!

This course will be offered at Marathon Physical Therapy and is the designed as a next step (after Pelvic Floor Level One) in completing the clinicians’ ability to comprehensively evaluate the female and male pelvic floor by learning colorectal examination and treatments.

Don't miss this chance to build you clinical skill set and take advantage of the only Northeast offering of this course in 2013 - REGISTER today!

Our host asked the participants of the most recent 11-day pelvic rehab training seminar in Dubai, United Arab Emirates to hold the flag of their home country. Look at the "global village" that attended this course! These physiotherapists will be returning to their home countries as Herman & Wallace-trained "Pelvic Ambassadors".

There's Institute-founder, Holly Herman, who instructed this course, in the middle.

The first ever Herman & Wallace course in the United Arab Emirates wraps up next week, and the Institute is eagerly looking forward to brining our mission to some other exciting international locations in the next few months.

In early January, Herman & Wallace faculty member Michelle Lyons will be teaching Oncology and the Pelvic Floor, a course covering gynocological, colorectal, prostate and testicular cancers and current cancer treatments and their implications for the pelvic floor at Mullingar General Hospital in Westmeath, Ireland.

Following that course, Michelle will be traveling to Kuwait City, Kuwait to teach a similar seminar to a group of women's health physiotherapists. The Kuwait course will focus on Oncology and Women's Health and will cover gynocologic, colorectal and breast cancer treatment.

In February, Michelle will return to Ireland to teach Herman & Wallace's Pelvic Floor Level One course at the School of Health Sciences at the University of Ulster.

We are so proud to have an international faculty member spreading the pelvic rehab gospel across the globe!

If you would like to catch Michelle teaching stateside, she will be instructing Care of the Pregnant Patient in Houston, TX in April and Care of the Postpartum Patient in Salt Lake City in October, two courses she helped develop with the rest of our team of faculty Pregnancy and Postpartum experts, or, as we call them, "Preg-perts". These courses are brand new in 2013 and we are excited to be offering these expanded course topics!

The Women's Action Initiative is an organization whose mission is to "empower women to prioritize pelvic and perinatal health as an integral element of their overall well being and quality of life". Founded in 2008 by Angela Hughes Halliwell, a mother of two, the WAI is currently waging a campaign to combat the effects of obstetric fistula in the Democratic Republic of Congo.

Currently, millions of women in the Congo are living with unrepaired obstetric fistula caused by inadequate medical care during labor and delivery. The consequent tearing between the vagina and bladder, the vagina and rectum, or both causes leakage between the tissue that results in urinary and fecal incontinence.

Women with fistula are often mocked, ridiculed and isolated for their incontinence, and are sometimes abandoned by their families and husbands.

The WAI is currently raising money to send a team of three women's health physical therapists and a urogyn surgeon to Goma to treat, rehabilitate and educate these women. Their goal is to raise $50,000 for this endeavor.

Herman & Wallace support this mission and has made a donation towards this project. If you would also like to donate, you can do so here.

Institute founder and faculty member Holly Herman is jet-setting yet again! This time, she is teaching an 11-day intensive seminar on women's health and pregnancy and postpartum for physiotherapists in Dubai, United Arab Emirates.

There are 26 participants in this course, all of them women, who hail from India, Pakistan, Baharain, Indonesia, UAE, Saudi, UK, and Oman.

The intensive course will cover topics from Herman & Wallace's Pelvic Floor Level 1, 2A and 2B and 3 courses, as well as our Pregnancy and Postpartum series of courses. For the first time ever this country, female physiotherapists will learn internal evaluation and treatmetn techniques for female patients, as well as using biofeedback to assess pelvic floor patients.

We are elated to be able to bring the mission of the Institute to such a broad audience across the globe!