This post was written by H&W instructor Michelle Lyons, PT, MISCP, who authored and instructs the course, Menopause: A Rehabilitation Approach. She will be presenting this course this February in Florida!
Compared to subject matter that has traditionally been offered in physical therapy curricula, such as musculo-skeletal and neuromuscular coursework, the concept of wellness is a relatively new addition to our skill-set (Fair 2009). ‘A Normative Model of Physical Therapist Professional Education’ includes educational objectives related to wellness, alongside objectives related to orthopaedics and neurology. As patients become increasingly educated about nutrition, complementary and alternative medicine, we as women’s healthcare providers must be able to assist our patients in seeking out healthy lifestyles. Nowhere has this surge in interest been more apparent than in women entering peri-menopause.
Historically, physical therapy has been associated with restoring physical fitness and wellness using manual therapies, exercise instruction and education about healthy lifestyle. Women’s health as a physical therapy specialty was formally established in the U.S. in the late 1970’s by Elizabeth Noble. Initially there was a focus on the reproductive health issues affecting women, primarily obstetrics and gynaecology but today’s physical therapist specializing in women’s health must be well versed in all aspects of menopausal health and wellness to meet the growing demands of women.
The roles of wellness, nutrition and fitness are becoming increasingly recognised by mainstream medicine – the WHO has recognised health as a triad of physical, mental and social well being. Integrative medicine is being hailed as the future of healthcare: The Consortium of Academic Health Centers for Integrative Medicine defines it as ‘the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing’, which for me, has always epitomised the practice of physical therapy and in particular, pelvic rehab.
Nutrition and exercise, alongside complementary therapies such as herbal medicine have become widely used as solutions to some of the signs and symptoms of menopause, especially since the controversies surrounding hormone therapy arose after the publication of the Women’s Health Initiative study. Many physical therapists, especially those working in women’s health, have added wellness services to their clinics, observing the growing demand from women. Even if these are not services you currently offer, if you work with peri-menopausal women, you can expect questions about the benefits of herbs for hot flashes or yoga for osteoporosis.
Peri-menopausal health concerns vary from the signs and symptoms of hormonal fluctuations such as hot flashes and night sweats to osteoporosis, cardiovascular disease and pelvic health concerns including bladder, bowel and sexual health – concerns that today’s well informed physical therapist specialising in women’s health need to be able to discuss and explore. However, the number one killer of post-menopausal women is still cardiovascular disease, so we must look at exercise prescription (and removing barriers to exercise, such as urinary dysfunction).
In ‘Menopause – a Rehab approach’, we will also explore the influence that changing hormone profiles have throughout the female body, from an orthopaedic, cardiovascular and pelvic health perspective. We will discuss the evidence for complementary and alternative medicine (CAM) and how physical therapists can incorporate nutritional advice into their clinical practice supporting peri-menopausal women. Special attention will be given to the role of yoga as an evidence based addition to the skillset of women’s healthcare professionals. We will of course also address the pelvic health concerns particular to the peri-menopausal women and look at how pelvic rehab has much to offer women presenting with urinary, sexual or bowel dysfunctions, along with pelvic organ prolapse. I am very much looking forward to returning to Orlando to teach this new course and hope to see you there!