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Debra Goldman - Featured Certified Pelvic Rehabilitation Practitioner

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Debra Goldman P.T., M.A. PRPC

Debra Goldman

Describe your clinical practice:

My clinical practice includes men and women with pelvic pain, nerve entrapments, incontinence, sexual dysfunction and much more. It’s dedicated to helping men and women holistically restore their bodies’ ability to move and function without pain. My motto is, recover, restore, move forward. In other words, don’t be a lifelong patient. The whole body approach I use helps me to determine if their pelvic floor dysfunction is related to a structural problem in the back, hips or the way they exercise, just to name a few. I do a thorough examination of the spine, hips and pelvis and pelvic floor to assess joint and soft tissue restrictions, specific weaknesses and faulty movement patterns. My treatments integrate manual therapy, specific exercise and mind-body retraining.

How did you get involved in the pelvic rehabilitation field?

After many years in treating patients in sports medicine/ orthopedic settings in NYC, I opened a practice in NYC’s only freestanding, midwifery run childbirth center. I saw many of the pregnant and post-partum clients, including the midwives. Treating their back and pelvic pain, I began to recognize that I was missing a critical part of the body, which was the pelvic floor. But It was a year later after moving to Montclair, NJ that I was contacted by a urogynecologist starting his practice who encouraged me to become a pelvic floor therapist. I signed up for Pelvic Floor Level 1 and was hooked.

If you could get a message out to physical therapists about pelvic rehabilitation what would it be?

It’s really time to get over any embarrassment in screening a patient for pelvic floor dysfunction. A simple questionnaire and a follow up chat can go a long way in helping therapists identify patients who might need to be referred to a pelvic health practitioner. A basic course on bladder, bowel and sexual dysfunction can really help give an orthopedic therapist a great overview and understanding.

What has been your favorite Herman & Wallace Course and why?

I have to give credit again to PF 1, because it’s really the foundation for everything that follows. I also had the opportunity to TA a few entry level classes and help new therapists start their process. I love Ramona Horton’s courses and recently repeated level 2 again. I am a lifelong learner and have been involved in studying visceral mobilization with her and others. But without my friend and “male” mentor, Stacey Futterman, I’d be lost. Her classes are outstanding and she has really helped me professionally from very early on.

What do you find is the most useful resource for your practice?

Having a community of colleagues with Herman& Wallace and elsewhere, going to conferences and continuing to study as much as I can is a great resource. But the patients themselves and their stories are the heart of my practice. I learn so much from them. Working with each person is often an opportunity for me to be a better listener, a more skillful evaluator and develop even more delicacy in my treatment approaches.

What motivated you to earn PRPC?

Throughout the years, Holly and Kathe talked about a certificate so when it came to pass, I knew I wanted to do it. Like so many I have worked really hard to achieve the level of competence in this field that I have, so I wanted to be first in line!

I also feel it gives me a special recognition that I am truly a specialist in my field.

What makes you the most proud to have earned PRPC?

For myself, that I was able to put so much into this study over the course of many years and then distinguish myself with this recognition.

I am very proud when my patients see that certificate and ask me what it means.

Learn more about Debra Goldman P.T., M.A. PRPC at her Certified Pelvic Rehabilitation Practitioner bio page. You can also learn more about the Pelvic Rehabilitation Practitioner Certification at www.hermanwallace.com/certification.

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Mindful Awareness

This November, Herman & Wallace is thrilled to be offering a brand-new course instructed by Carolyn McManus, PT, MS, MA, called Mindfulness-Based Biopsychosocial Approach to Chronic Pain. This course will be offered November 15-16, 2014 in Seattle, WA. We sat down with Carolyn to learn more about her course.

Carolyn McManus

The constant flood of information in today’s interconnected, wired world trains the mind in distraction and away from the immediate experience of life. Many people spend hours gazing down at quickly changing images on the small frame of an electronic device and only notice the body when it has its aches and pains! Mindful awareness offers us a skillful way to pay attention, build body awareness, touch life fully and provides a healing antidote to information overload.

Mindful awareness invites us to rest the mind in the present moment with openness, friendliness and curiosity. This is not our natural tendency and requires training. Often we are caught in a struggle with the present moment, perceive it as flawed, find fault with ourselves and constantly drive ourselves to run, do and achieve. When mindful, we still have our plans, goals and to-do list, but this is not an obstacle to resting the mind here and now. We can stop the struggle with the present moment, touch life fully and open to the potential for ease and insight in the midst of things just as they are. New perceptions and an experience of aliveness can occur that can never happen when we are lost in distraction. Danna Faulds expresses this beautifully in her poem "Walk Slowly":

It only takes a reminder to breathe,
a moment to be still, and just like that,
something in me settles, softens, makes
space for imperfection. The harsh voice
of judgment drops to a whisper and I
remember again that life isn’t a relay
race; that we all will cross the finish
fine; that waking up to life is what we
were born for. As many times as I forget to catch myself charging forward
without even knowing where I am going,
that many times I can make the choice
to stop, to breathe, and be, and walk
slowly into the mystery.

I began practicing mindfulness meditation to help manage stress and heal from a back injury. I found the practice easily translated to patient care and helped my patients build body awareness, detach from maladaptive thinking habits and experience inner calm and relaxation. They gained insight into the reactions, behaviors and situations that escalated and de-escalated their symptoms. Research shows that mindfulness improves attention regulation and executive function, body awareness and emotional regulation. (1) I am excited to share with my colleagues what I have learned through the practice of mindfulness and its applications to both self-care and patient care in my November course.

Learn more about Carolyn's course and join her this November in Seattle to attend her Mindfulness course!

1. Holzel BK, Lazar SW, Guard T, et al. How Does Mindfulness Meditation Work? Proposing Mechanisms of Action From a Conceptual and Neural Perspective. Perspect Psychol Science. 2011;6: 537–559.

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Avulsion Fractures and Pelvic Pain

PelvicHip

Avulsion fractures refer to a forcible separation, or tearing away of bone due to a sudden and powerful contraction of muscle. This injury is most common in adolescents, with the as yet developing growth plates being a likely location of avulsion. A systematic review of the literature published in 2011 describes the pathology of pelvic avulsion fractures as "highly prevalent" among adolescent athletes. Additionally, patients who have mature skeletons and who have a history of prior surgical interventions to the bones are also at risk for pelvic avulsion fractures.

Avulsion fractures appear to occur most commonly during the eccentric phase of muscle activity during sporting activities. Pre-existing pain in hip or pelvis may be present, but is not a reliable predictive sign of subsequent fracture. Included in this review article were 48 case reports and case series of which 88% related to physical activity and the remaining 12% related to previous surgical procedures. Within the cases related to physical activity, the mean age of fracture in subjects was 16.8, with 84% being male. Activities in which subjects were involved involved included soccer, gymnastics, and running sports. In the cases related to surgery, mean age of fracture was 56.4, and 100% were female. All of the surgery-related cases presented in the literature were treated with conservative measures. Conservative care described included a period of bed rest for 3 days progressing to walking with crutches until the patient was able to walk without significant pain.

Symptoms reported by patients who have suffered an avulsion fracture of the pelvis may include reporting a popping sensation, local pain, and difficulty walking. Having had a bone harvest from the iliac crest may also predispose a patient to a subsequent avulsion fracture. The authors state that surgery may be considered when there is greater than 2 centimeters of displacement of the avulsion or if the ischial tuberosity is involved.

Rehabilitation therapists should be alert to the age, activity levels, and histories of patients who present with pelvic and hip pain, as an avulsion fracture may be the source of pain. Radiographic imaging will provide further information upon which a plan of care can be made. If you would like to learn more about diagnosing pelvic pain, join your colleagues at one of our courses aimed towards identifying sources of pelvic pain. Peter Philip's continuing education course titled Differential Diagnostics of Chronic Pelvic Pain will next be offered in July of next year in Arlington, VA. Another popular course called Finding the Driver in Pelvic Pain was created by faculty member Elizabeth Hampton and will be offered in April in Milwaukee, WI.

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Jamie Besante - Featured Certified Pelvic Rehabilitation Practitioner

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Jamie Besante DPT, PRPC

Vicki Lukert

What patient population do you find most rewarding in treating and why?

I find my generation and my younger clients the most rewarding because I have seen myself in them and they are so brave. They knew something wasn’t right with their bodies and they stood up and asked for help and solutions. I have seen many clients with years of dysfunction, pain and suffering and to be able to prevent this in my younger clients means so much. I always say I sleep so easy at night because I feel that I have done my best to help as many people as I can that day.

How did you get involved in the pelvic rehabilitation field?

While earning my entry-level doctorate in physical therapy, we had a brief lecture on “Women’s Health” physical therapy that resonated with me as a young women who suffered from pelvic dysfunction. I asked to complete one of my student affiliations in Women’s Health and I fell in love with the field, treating both men and women.

What/who inspired you to become involved in pelvic rehabilitation?

I was initially driven by self-affliction, but was then inspired by my clinical instructor, Vicki Lukert. My clients and their successes continue to be the best inspiration. Vicki taught with a hands-on and practical method that took a whole-person approach that clicked with me instantly. She helped cultivate my hands into skillful and healing tools.

What makes you the most proud to have earned PRPC?

When my clients see me, they usually ask how old I am and how long I’ve treated. I am proud to say I’ve earned this certification that distinguishes me as a part of the specialists in my chosen field.

If you could get a message out to physical therapists about pelvic rehabilitation what would it be?

Know your anatomy and when to refer to a pelvic health specialist. My co-workers have been a great referral source for when the pelvis comes into play. They ask questions and consult me so our patients get fantastic comprehensive care.

What do you find is the most useful resource for your practice?

I utilize the Herman & Wallace blog posts by Holly Tanner, colleagues, and my course binders.

What advice would you give to physical therapists interested in earning PRPC?

Go for it. It’s going to make you better, whether you pass on the first try or not. It’s going to force you to study and learn. Also, it’s a great opportunity to brush up on new medications and the latest research.

What is in store for you in the future?

I hope big things. In the near future, I plan to be an investigator in a nation-wide study in mechanical infertility as a follow-up larger study to Mary Ellen Kramp’s successful pilot study. I also hope to continue lab assisting with the Herman & Wallace institute because it was the perfect combination of learning and teaching.

Learn more about Jamie Besante DPT, PRPC at her Certified Pelvic Rehabilitation Practitioner bio page. You can also learn more about the Pelvic Rehabilitation Practitioner Certification at www.hermanwallace.com/certification.

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Yoga Encourages Optimism and Wellness

pregnant yoga

Do women who participate in yoga during pregnancy feel more optimistic, more powerful, and more well? Yes! This is the reply from a study involving 21 women who enrolled in a yoga class for six weeks. While twelve of the women had previously practiced yoga, none were currently practicing. The format of the class involved the following components: checking in (sharing the prior week's experiences), centering (visualization and breathing exercises), warm-up (neck rolls, shoulder exercises, and side stretches), yoga flow (yoga standing positions such as sun salutation), standing postures (balance, wall positions), mat work (seated postures and hip exercises), Savasana (modified to left side lying), and meditation.

Outcomes tools utilized in this study included the Life Orientation Test-Revised for measuring optimism, the Power as Knowing Participation in Change Tool version II for measuring sense of power, the Short-Form 12 Version 2.0, and the Well-being Picture Scale. Participants in the study were also given a journal to document time spent practicing yoga, and how they felt after practicing yoga, both physically and emotionally. The authors conclude that yoga as a self-care practice can be used to promote self-care and well-being in women who are pregnant.

Why are feelings of power, well-being, and optimism valuable for women who are pregnant? The authors discuss the literature which has suggested higher levels of adaptive coping in women with high-risk pregnancies, and the concept that optimism is associated with physical health. Previous studies about using yoga during pregnancy have proposed benefits to the mother both during her pregnancy as well as during labor and delivery. The authors of the study also describe power within the perspective of Rogers' science of unitary human beings, with sharing of interesting philosophical concepts such as resonancy, integrality, and diversity of the human-environmental field.

Because yoga is a popular activity with pregnant women, the study adds to the growing body of research about yoga in the peripartum period. If you are interested in learning how to apply yoga concepts for patients who are pregnant, come to Ginger Garner's continuing education course Yoga As Medicine for Pregnancy and the next opportunity to take this course is next month in New York!

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Vicki Lukert - Featured Certified Pelvic Rehabilitation Practitioner

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Vicki Lukert PT, PRPC

Vicki Lukert

Describe your clinical practice:

I work at the University of Florida Health Rehab Centers at Magnolia Parke and Medical Plaza, an outpatient clinic which is part of the large teaching hospital in Gainesville, FL. I head up the Pelvic Health team which consists of seven therapists. We treat pelvic and abdominal conditions in females, males and children. It is very exciting to be a part of such an enthusiastic, knowledgeable and creative team. Due to the fact we are a teaching hospital we get to see some of the most complex patients imaginable which come from all over.

How did you get involved in the pelvic rehabilitation field?

At a time in my life when I was returning to the full time work force I was offered a position if I would “help” with the Pelvic Health program. When I found myself in charge of the program I realized just how little I knew and started taking additional courses. As I gained experience and started making a difference in the lives of patients who thought there wasn’t any hope for them, I became very passionate about this incredible field of physical therapy.

If you could get a message out to physical therapists about pelvic rehabilitation what would it be?

Pelvic Health is NOT a taboo area. It is just another area of the body which needs to be treated. It is nothing more than bones, joints, ligaments, tendons, organs and fascia. It is like any other area of the body; to be able to treat the area effectively you have to know the anatomy, function and dysfunction. I think of pelvic rehabilitation as being the stranger at the party who is sitting watching everyone, who no one wants to talk to because they appear different … and then they find out it was actually Johnny Depp. (who I personally find to be a fascinating man).

For all therapists the pelvic floor can play an important role in the full rehabilitation in a lot of their patients including those with persistent back, sacral and hip problems. All therapists should feel comfortable in asking questions of their patients that would lead to an appropriate consultation with a pelvic health therapist.

For the Pelvic Health practitioner, my message would be to not stop learning. A lot of the practitioners focus on the women’s health and I would encourage everyone to be open to treating all genders and possibly all ages. Even if you see something you have not treated before remember to trust your intuition in addition to the tools you have already.

One of my most favorite mentors told me once, “If you try something and it doesn’t work it is called evaluation. If you try something and it does work it is called treatment.”

What has been your favorite Herman & Wallace Course and why?

Pelvic Floor Level 3 with Holly Herman. It was a smaller group and we got to spend 4 days with the charming, funny, intelligent, insightful and charismatic Holly Herman.

What motivated you to earn PRPC?

Due to the fact that I am the leader of the Pelvic Health team I felt it was important for me to be a role model and inspiration for the rest of the team. I have been waiting for a long time for the certification to become available so am very happy to finally have that as an accomplishment.

What makes you the most proud to have earned PRPC?

I am so very proud to have earned the PRPC. I felt as a very seasoned and experienced therapist I knew a lot. It wasn’t until I started studying that I realized how many details I had forgotten. It took a lot of studying for this older brain to retain the information but I still found the exam to be very difficult. It was with much trepidation that I opened the email letting me know whether I had passed or not, and I was very relieved and excited to see I had passed.

What advice would you give to physical therapists interested in earning PRPC?

Because the PRPC concentrates on “pelvic health” as opposed to “women’s health” I feel as a pelvic health practitioner it is an important certification to get because it covers the pelvis in both genders. My advice is to study, study, and then study some more.

What is in store for you in the future?

Education of fellow providers, educating up-and-coming practitioners within PT schools, and education to the public and physicians to broaden the awareness of pelvic health interventions. Education within all associations to broaden the scope of what “Pelvic Health” means. I intend to continue to learn and provide excellent care to all patients.

Learn more about Vicki Lukert PT, PRPC at her Certified Pelvic Rehabilitation Practitioner bio page. You can also learn more about the Pelvic Rehabilitation Practitioner Certification at www.hermanwallace.com/certification.

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The Danger of Laxatives

Earlier this year, the Food and Drug Administration issued a warning about serious side effects of laxatives if not used according to the label or when used in the presence of certain comorbities. Sodium phosphate laxatives, according to the label, are to be taken as a single daily dose, and for no more than three days. In addition to the warning to contact a physician if the patient has kidney disease, cardiac conditions, or dehydration, the FDA advises patients to ask their physician before taking the drug with age older than 55, or when taking certain medications. These medications include: diuretics, angiotensin-converting (ACE) inhibitors, angiotensin receptor blockers (ARBs), and nonsteroidal anti-inflammatory drugs (NSAIDs).

Laxatives are grouped into different classes and have varied effects on a person's gastrointestinal system. The following is adapted from the Mayo Clinic's website and describes the main types of laxatives.

Laxative Type
Action
Brand Example

Oral osmotics Draw water into the colon to improve passage of stool Miralax
Oral bulk formers Absorb water to form soft, bulky stool Metamucil
Oral stool softeners Add moisture to stool Surfak
Oral stimulants Trigger rhythmic contractions of intestinal wall Senekot
Rectal stimulants Trigger rhythmic contractions of intestinal wall Dulcolax

Because laxatives can interact with medications, asking about medication lists (including supplements and herbals) is important for pelvic rehabilitation providers. Even the teas available at the grocery store that are marketed to help with digestion and specifically, constipation, may work well and may interact with a patient's medications. If you are interested in learning more about laxatives, constipation, and promotion of bowel health with rehabilitation techniques, sign up for the Bowel Pathology and Function continuing education course. This course, written by faculty member Lila Abbate, has been well-received and aims to further the knowledge of therapists who are treating patients with bowel dysfunction. The next course is coming up next month in California!

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Kim Krueger - Featured Certified Pelvic Rehabilitation Practitioner

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Kim Krueger, MPT, BCB-PMD, PRPC

Kim Krueger

Describe your clinical practice:

I work at Courage Kenny Rehabilitation Institute in Stillwater, MN. It is an out-patient clinic specializing in treating clients with neurological and general orthopedic conditions. My pelvic rehabilitation practice includes both women and men with referrals from several Ob-Gyn groups, Urologists and general practice physicians. Our facility also has a large, warm water pool in which I spend the other half my day treating clients primarily with chronic pain and orthopedic conditions. I have a very interesting mix of clientele and am never bored!

How did you get involved in the pelvic rehabilitation field?

Shortly after I graduated and took my first job, I was encouraged by my supervisor to attend a pelvic floor course to learn how to treat urinary incontinence. As a new therapist, I was initially not thrilled that this was my first Continuing Education course! After completing the course and some simple marketing, I began receiving PT referrals and the word spread. I quickly found myself treating more complex pelvic rehabilitation clients and found the need for more continuing education. Another colleague recommended the Herman and Wallace courses which include internal palpation and differential diagnoses as well as internal soft tissue treatment. These courses have helped to mold my practice and I look forward to taking more in the future.

What patient population do you find most rewarding in treating and why?

I love treating new moms with pelvic pain and prolapse. They are usually referred to me fairly early post-partum and, despite being crazy busy with their newborns and older children, they’re usually very motivated and see results quite quickly. I have had great success using visceral mobilization techniques with these women that I learned in Ramona Horton’s Visceral Mobilization Level 2 class. I have seen some amazing results including improved prolapse and diminished pelvic pain using visceral mobilization and internal soft tissue techniques.

If you could get a message out to physical therapists about pelvic rehabilitation what would it be?

Educate your clients. So often my clients comment that they have never been educated about their bladders, bowels and sexual organs until they walked into my office. I truly believe that the first step in healing and recovery is educating the client about their condition and including them in their plan of care. Empowering our clients can provide better outcomes and improved client satisfaction. Provide your patients with the resources they need and get to know some pelvic practitioners in or near your practice to refer to if a client needs more specialized therapy.

What makes you the most proud to have earned PRPC?

I am very proud to say that I was part of the first group of therapists to sit for the inaugural PRPC exam. The other practitioners in my study group, from all over the country, are all such terrific therapists. We researched and discussed the assigned topics, reviewed journal articles and research, and shared experiences about our practices. On our weekly phone conferences, I learned so much from these ladies and feel much gratitude towards all of their hard work in helping us all preparing for the exam. I am confident that being part of a study group helped us all better prepare for the exam and ultimately helped to establish the standards for a passing grade on the PRPC exam.

Learn more about Kim Krueger, MPT, BCB-PMD, PRPC at her Certified Pelvic Rehabilitation Practitioner bio page. You can also learn more about the Pelvic Rehabilitation Practitioner Certification at www.hermanwallace.com/certification.

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Female Chronic Pelvic Pain and the Mind

meditation

What are the spontaneous mental images that women who have chronic pelvic pain report, and how might the positive or negative mental images relate to chronic pelvic pain? These questions are the focus of research published by authors from the UK in the journal Pain Medicine. Mental images are distinguished in this study from thoughts, or thinking in words, as mental images are "cognitions with sensory-perceptual qualities." These qualities are often visual, and may also be related to smell, touch, taste, and hearing. Ten women were interviewed, 8 of whom had a diagnosis of endometriosis or adenomyosis. The researchers explained that they wanted to learn more about the women's thoughts when in pain, and asked about any images that popped into their heads when in pain. Researchers asked other questions about images related to specific categories, while attempting to avoid offering any leading words during their interview. The patients' most significant mental image (chose by the patient) was then explored for content, triggers, related emotion, meaningfulness, activity impairment, and related behavioral changes.

Other data collected included the Brief Pain Inventory short form, the Pain Catastrophizing Scale, the Spontaneous Use of Imagery Scale, the Hospital Anxiety and Depression Score, and the Mini-International Neuropsychiatric Interview. The range of pain duration in the subjects was 3-20 years, with a mean age of 36.2. While every one of the ten women reported that pain was a trigger, other triggers for a negative mental image included movement, social gatherings, exercise, babies, anxiety, sex, sleep, talking about pain, and reminders of surgery or menstruation- in other words, common daily activities or experiences. The content of the most significant mental images included being raped, having "malicious demons" playing around the pelvis, bright lights in an operating room, being terrorized, feeling sad, helpless, anxious, angry, panicky, guilty, disgusted, horrified, and revulsed. The associated meanings were usually also quite negative in nature. The women reported active avoidance of the triggers when able, limiting activities such as social outings or physical activity. Positive or "coping" images were also reported, with images such as putting the pain into a box, mentally "rubbing pain" medication on the body, or imagining a loved one.

What does this information have to do with pelvic rehabilitation? This study utilized a cognitive-behavioral (CBT) framework, and aspects of CBT are tools that rehabilitation professionals utilize in daily practice. Simply put, a cognitive-behavioral approach addresses how a person's thoughts and feelings affect behavior. In rehabilitation, research studies have described how CBT is utilized in the physical therapy setting, and how therapists can be trained to use skills in CBT to help patients . We can engage patients in conversations about what negative images may be impacting movement, and what positive images may be utilized as healthy coping strategies. For more information about the mind and patient education, join us at Carolyn McManus's continuing education course Mindfulness-Based Biopsychosocial Approach to the Treatment of Chronic Pain which takes place next month in Seattle.

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Kristi Ayars - Featured Certified Pelvic Rehabilitation Practitioner

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Kristi Ayars, PT, DPT, PRPC.

Kristi Ayars

Who/what inspired you to become involved in pelvic rehabilitation?

I knew it could be done, so after moving from Washington back home to California in late 2003, when a patient came in with a chief complaint of leakage I asked around and found out nobody here was doing pelvic physical therapy. I jumped right in. I took the Level 1 class and every other pelvic floor class that came along for the first 5 years while seeing an ever-increasing number of people needing pelvic floor therapy. Then, I had to restrain myself to only one or two classes a year. Now, almost 11 years later, just having done a huge literature update and after passing the PRPC I have a renewed sense of awe that there is so much to offer people based on evidence.

What patient population do you find most rewarding in treating and why?

I like the kind of patient who comes in having researched stuff ahead of time, who has a list of questions every visit, who demands logical answers and pursues understanding of what physical therapy can or cannot do to help. These people do better than others, often faster than average. They love to hear about the latest research, and use everything they learn to better themselves.

If you could get a message out to physical therapists about pelvic rehabilitation what would it be?

There are no short cuts. You have to take time to carefully reason through it, test everything, treat and then re-test. Never assume. Once you’ve established what works with that individual, you have to take time to teach it from the bottom up. (No pun intended).

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?

Holly Herman and Kathe Wallace themselves emphasized the need for confidently articulating to the patient what was going to happen, and what was going on during the exam and treatment. Many of my patients, at least the women, seem to appreciate this, and not just for pelvic floor treatment. Working with people is a process to bring the body to better movement habits and it requires constant dialog.

What do you find is the most useful resource for your practice?

I particularly like the documentation templates available after each class. For example, after both the Level 1 and the pediatric classes, I was thrilled to be able to purchase and download the module, put my logo on all the handouts, and have them ready on the computer for my patients.

What makes you the most proud to have earned PRPC?

Once I embarked on the study process, it was clear that this was as hard or harder than Boards. I studied diligently, learning something every night that I could use to better help my patients. The five-hour test was grueling, like problem-solving for every worst-case scenario I’d ever had in 16 years of physical therapy practice. I am very proud of my credential.

What is in store for you in the future?

More learning, of course. We can never know it all, but we can keep striving. I thoroughly enjoy working with each of my patients and seeing them reach their goals. I’d like to see more physicians regularly recommending our conservative approaches for pelvic floor issues and sooner for those patients. At some point I will turn towards educating or mentoring younger PTs. It would be nice to use my knowledge base to reach out to the community to try to increase health literacy.

Learn more about Kristi Ayars, PT, DPT, PRPC at her Certified Pelvic Rehabilitation Practitioner bio page. You can also learn more about the Pelvic Rehabilitation Practitioner Certification at www.hermanwallace.com/certification.

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Upcoming Continuing Education Courses

Pediatric Incontinence - Duluth, MN (Postponed)

Oct 23, 2020 - Oct 25, 2020
Location: Polinsky Medical Rehabilitation Center

Pediatric Incontinence and Pelvic Floor Dysfunction- Remote Course (SOLD OUT)

Oct 23, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Parkinson Disease and Pelvic Rehabilitation - Remote Course

Oct 23, 2020 - Oct 24, 2020
Location: Short Form Remote Course

Pelvic Floor Level 2A - Braintree, MA Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Peak Physical Therapy

Pelvic Floor Level 2A - New York, NY Satellite Location (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: 5 Point Physical Therapy

Pregnant and Postpartum Rehabilitation Special Topics - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Washington DC (POSTPONED)

Oct 24, 2020 - Oct 25, 2020
Location: George Washington University Hospital Outpatient Rehabilitation Center

Pelvic Floor Level 1 - Troy, NY Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: The Green Room Physical Therapy

Pelvic Floor Level 2A - Atlanta, GA (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 2A - Greenville, SC Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Restore Pelvic Health and Wellness

Pelvic Floor Level 1 - Self-Hosted

Oct 24, 2020 - Oct 25, 2020
Location: Self-Hosted Course

Peripartum Advanced Topics - Somerset, NJ (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Sports Medicine Institute

Pelvic Floor Level 2A - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Washington DC Satellite Location (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: George Washington University Hospital Outpatient Rehabilitation Center

Pelvic Floor Level 2A - Minnetonka, MN Satellite Course (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: Viverant

Pelvic Floor Level 2A -Decatur GA Satellite Course (SOLD OUT)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 2A - East Norriton, PA Satellite Course

Oct 24, 2020 - Oct 25, 2020
Location: Core 3 Physical Therapy

Pelvic Floor Level 1 - Satellite Lab Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Akron, OH Satellite Location (Sold Out)

Oct 24, 2020 - Oct 25, 2020
Location: Summa Health Center

Pelvic Floor Level 2A - Self-Hosted

Oct 24, 2020 - Oct 25, 2020
Location: Self-Hosted Course

Pelvic Floor Level 2A - Athens, GA Satellite Course (Rescheduled)

Oct 24, 2020 - Oct 25, 2020
Location: Thrive Integrative Medicine

Pelvic Floor Level 2A - Tampa, FL Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Optimal Performance and Physical Therapies

Pelvic Floor Level 2A - Monroe, LA Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: Ouachita Physical Therapy

Manual Therapy Techniques for the Pelvic Rehab Therapist - Atlanta, GA (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Emory Healthcare

Pelvic Floor Level 1 - Goodyear, AZ Satellite Location

Oct 24, 2020 - Oct 25, 2020
Location: STI Physical Therapy & Rehab

Breastfeeding Conditions - Remote Course

Oct 24, 2020 - Oct 25, 2020
Location: Replacement Remote Course

Pelvic Floor Level 1 - Akron, OH (Postponed)

Oct 24, 2020 - Oct 25, 2020
Location: Summa Health Center

Manual Therapy for the Abdominal Wall - Remote Course (Postponed)

Oct 25, 2020
Location: Short Form Remote Course

Mobilization of the Myofascial Layer - Medford, OR Satellite Location

Nov 6, 2020 - Nov 8, 2020
Location: Asante Rogue Valley Medical Center