(646) 355-8777

Herman & Wallace Blog

Peter Philip - Featured Herman & Wallace Instructor

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with Herman & Wallace instructor Peter Philip, PT, ScD, COMT, PRPC

Peter Philip

How did you get started in pelvic rehab?

While treating an MD, OB-GYN, he asked me a question regarding a patient that he was treating that was suffering from dyspareunia. I’d just completed my Master's in orthopedic physical therapy and realized that there was an entire section of the body that was "full of muscles, ligaments and nerves” of which I had virtually no knowledge. This bothered me, so I began my own independent research, study and application of skills learned through continuing education, and application of what are typically considered to be ‘orthopedic’ techniques to the pelvic pain/dysfunction population. To my (continued) wonderment, the patients responded exceptionally well, and efficiently.

Who or what inspired you?

Dr. Russell Woodman and Dr. Holly Herman have provided me with the foundational skills and motivation to help and heal those patients suffering.

What have you found most rewarding in treating this patient population?

Many patients have suffered for years prior to ‘finding’ me. Many are despondent, and have given up hope for a cure; resigning themselves to a life of pain. Providing the means of restoring comfort and wellness is gratifying, rewarding and quite frankly, humbling. What an honor it is to help those that suffer regain the life that they thought they’ve lost.

What do you find more rewarding about teaching?

Having the opportunity to assist clinicians (MDs, PTs, DCs) more effectively, efficiently evaluate and treat their patients provides me with the same gratification that treating the patients myself. This, in addition to being able to help those that have not been helped attain their wellness and health they’ve been seeking, often for years.

What was it like the first time you taught a course to a group of therapists?

The first course I taught was in NYC. The air conditioning was broken, and the office had a few, small windows. The ambient temperature was upper nineties, and no breeze. Through the tortuous temperatures, and ‘first time jitters’ I persevered, and the staff were incredible hosts and provided me with guidance that I appreciate to this day!

What trends/changes are you finding in the field of pelvic rehab?

Manual medicine and non-surgical interventions are being more recognized as very viable means to address, and eliminate pain while improving biomechanics and function. Medical practitioners from all fields are consulting with specialists in the field of pelvic pain to better address their patients' suffering. We are at the forefront of interventional treatments, and patients are seeking effective means to eradicate their pain and dysfunction.

If you could get a message to all therapists about pelvic rehab, what would it be?

Review, re-read, re-learn all the anatomy, neuroanatomy, kinematics and never forget to think, think, think.

Continue reading

Michelle Lyons - Featured Herman & Wallace Instructor

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with Herman & Wallace instructor Michelle Lyons, PT, MISCP

Michelle Lyons

How did you get started in pelvic rehab?

Like a lot of therapists whom I talk to when I travel and teach, it was after the birth of my daughter, when I realized what an under-served population postpartum women are! After childbirth, the focus almost entirely shifts to the baby, and poor old Mum is left, by and large, to fend for herself. Now, more than ever, when we are looking at shorter hospital stays and the lack of maternity leave, we as pelvic therapists need to grow awareness of the needs of women throughout the life cycle and what we have to offer. Pelvic rehab is a high touch, low risk, cost effective and highly effective (yet under used) treatment option. I am passionate about spreading the Pelvic Rehab Gospel!

Who or what inspired you?

Holly Herman. The woman is a pelvic legend. If you get the chance to take one of her course, do it. An amazing breadth, width and depth of expertise and experience.

What do you find more rewarding about teaching?

Confession: I am a pelvic nerd. I just love talking about the fascinating interplay of anatomy, physiology, psychology, form and function. I am (almost) never happier than when I get to spend a weekend with a group of therapists exploring diagnoses, assessments, interventions and outcomes with a like minded group of pelvic health professionals. Whenever I teach, I always learn something too – I really like the classes I teach to be conversational and we tend to have some interesting sidebars and tangents! But I think that just adds to the learning experience – we have all had different pathways educationally, personally and professionally, and I think that looking at different perspectives and approaches can only be a good thing, especially for the patients we treat.

How did you get started teaching pelvic rehab?

My background was in sports medicine and MSK dysfunction. I come into the wonderful world of pelvic health about 15 years ago. Now I look on that background as being incredibly important – I think in order to be a great pelvic therapist, you really need a solid orthopedic expertise. You can’t treat the pelvic floor without looking at the pelvic girdle (and spine and hips and feet and …..!)

What trends/changes are you finding in the field of pelvic rehab?

I think we are learning more and more about Pain Science – sometimes on a daily basis. I think one of our primary role as pelvic therapists can be as educator – I often say to classes that most people know more about their phones than they do about their own bodies! So having anatomical models, books and learning aids can be a great way to empower our patients. I always emphasize including biopsychosocial approaches in working with patients, talking about issues like central sensitisation, the effects of chronic pain and worry on the brain etc BUT I do think we have to be careful, too, that we don’t ignore the biomedical. Sometimes I worry that the pendulum is swinging too far – we have to be sure that we are addressing the physical problems as well!

The other big trend I see is engagement on social media! Just over a year ago, after I taught a course in the UK, I set up a Facebook group with my friend & colleague, Gerard Greene, called Women’s Health Physiotherapy. We now have over 2300 members from all over the world and it is so heartening to see international colleagues from the US, the UK, Australia, the Middle East and Ireland talking, sharing ideas, questions, resources and clinical reasoning. So reassuring to know that others have dealt with the same problems we may be facing in our daily patient caseloads! The Facebook group has been a great success and in fact we submitted a poster based on the group looking at how SoMe can benefit physiotherapists internationally and it has been accepted for presentation at WCPT in Singapore in May.

If you could get a message to all therapists about pelvic rehab, what would it be?

You have such an amazing skillset – you have the power to effect HUGE change in your patients’ lives. The CSP (the governing body for Physiotherapists in the UK) acknowledges that pelvic health is one of the few growth areas within our profession. I think as pelvic therapists, we have the ability to integrate gynaecological, obstetric, orthopaedic, hormonal, oncological and biopsychosocial systems. We are skilled interviewers, skilled manual therapists and skilled exercise/lifestyle precribers. We have the ability to take our patients from being passive recipients to active participants in their own healthcare. It is the best job in the world!

If you could make a significant change to the field of pelvic rehab or the field of PT, what would it be?

I would love to see our role more widely understood and acknowledged. Most of our medical colleagues don’t know what we do! The other big change I would love to see in the U.S. is national registration – I hear from so many therapists how restrictive individual state licensure is and how it can hold them back from job opportunities. I do understand that this is an issue that is hopefully on the horizon, and I think that will be a huge boost to our profession!

What have you learned over the years that has been most valuable to you? Never stop learning! There are always more books to buy, articles to read and courses to attend, but it is just as important to take time to assimilate new knowledge and always ask yourself – ‘Does this change how I would practise? How? Why?' Got to love that clinical reasoning skill set!!

What is your favorite topic about which you teach?

So….this is a tricky one! I teach the Pelvic Floor series and the Pregnancy series. I have developed a number of specialty topics for Herman & Wallace over the years – The Athlete & the Pelvic Floor, Menopause – a rehab approach, Special Topics – Endometriosis, Infertility & Hysterectomy and Oncology & the Male Pelvic Floor and Oncology & the Female Pelvic Floor. To pick just one is impossible! I truly love teaching them all, but if I had to narrow it down I would have to have joint winners. PF1 because I really see this course as the ‘gateway drug’ to a career in pelvic health – I just love to watch as participants move from that first scary lab session (!) to the end of Day 3 and feeling of ‘Yes! I get this! I love pelvic rehab!’. The other joint winner would have to be Oncology & the Female Pelvic Floor – we have so much to offer the survivors of gynaecological cancers. However, unlike our well publicized and relatively well researched role in prostate cancer rehab, gynae cancer survivors are often left to deal with problems encompassing orthopedic, soft tissue, lymphatic, sexual and continence function issues. We have work to do in raising our profile in cancer survivor-ship programs for these women. So, talking about the effects of cancer and cancer treatment on life with and after cancer is an issue I feel very strongly about.

Continue reading

Jennafer Vande Vegte - Featured Herman & Wallace Instructor

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with Herman & Wallace instructor Jennafer Vande Vegte, MSPT, BCB-PMD, PRPC

Jennafer Vande Vegte

How did you get started in pelvic rehab?

A supervisor of mine suggested that I go to a course and develop a pelvic floor program. I thought she was nuts. As a late twenty-something, I wanted to work with athletes. Finally she convinced me to go. Imagine my surprise when I felt like a duck in the water in the Pelvic Floor Level 1 class.

Who or what inspired you?

Truly I was smitten by Holly Herman at PF1. Her unique teaching style combining her incredible knowledge and fascinating stories with compassion and clarity is something to behold. Later I met Kathe at PF2A and was so inspired by both of these amazing women.

What have you found most rewarding in treating this patient population?

It is such an honor and a privilege to do what we do. At times we share a facet of our patients lives that even their spouses or best friends don't know about. It is not rare for someone to tell me, "I've never told anyone that before." Being trusted to share in these private experiences with others is a blessing to me.

What do you find more rewarding about teaching?

That's easy! I love the "ah-ha" moment when the light comes on in someone's eyes. When they "get it", whether it's finding the ATLA for the first time or understand another treatment direction for a complex patient, this is the moment that I love. I also treasure being around other people who love to do what I love to do!

How did you get started teaching pelvic rehab?

My hospital hosted the PF series years ago and I got to TA. I invited Holly and Kathe out to dinner and basically begged them to think of me if they ever had a teaching position open. Luckily the company was growing and I was shocked to have an opportunity to teach PF2B within a year. I was thinking maybe in 5 years, but I jumped at the chance.

What was it like the first time you taught a course to a group of therapists?

I was SO nervous. I studied like crazy for 6 months! I thought I did a horrible job until I read the reviews at the end of the course and realized I did okay.

What trends/changes are you finding in the field of pelvic rehab?

The amount of knowledge and research in our field is exploding. There are amazing blogs and recourses online for both patients and therapists to get information. Patients are coming in much more educated. Doctors seem to be getting the message that pelvic floor PT is a good first line option for their patients.

If you could get a message to all therapists about pelvic rehab, what would it be?

Every therapist should know a pelvic floor therapist and know when a consult would be appropriate. All therapists should try to feel more comfortable asking appropriate patients about elimination and sex.

If you could make a significant change to the field of pelvic rehab or the field of PT, what would it be?

I would love to see more of a team approach between physicians, PTs, therapists, pain clinics, nutritionalist, etc. especially in treating complex pelvic pain.

What have you learned over the years that has been most valuable to you?

Oh so much. Listen to your patient and hear what he or she or he is telling you. Don't feel like you have to have everything figured out on the initial evaluation. Treat what you find and continue to evaluate and listen.

What is your favorite topic about which you teach?

I think it changes each time, but right now I am really interested in relaxation techniques and down training especially as we understand more about the brain's involvement in pain responses.

Continue reading

Holly Tanner - Featured Herman & Wallace Instructor

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with Herman & Wallace instructor Holly Tanner PT, DPT, MA, OCS, WCS, PRPC, LMP, BCB-PMB, CCI

Holly Tanner

How did you get started in pelvic rehab?

I joined Apple Physical Therapy as an orthopedic outpatient clinic manager back in 2000. The previous manager had begun treating women who had urinary incontinence and we had this (huge) old biofeedback unit. I told the company owners that I would be willing to take a course in treating urinary incontinence, which I quickly did. I also quickly learned that to do a great job in pelvic rehab, and to serve the patients well, you need to keep taking classes to learn about all the other issues that make pelvic rehab so potentially complex and engaging.

What have you found most rewarding in treating this patient population?

The fact that patients are so trusting and share their most intimate issues that may be difficult to discuss. Patients with pelvic dysfunction are so profoundly grateful for the help they receive, and that in turn inspires me to want to be helpful.

What do you find most rewarding about teaching?

I love providing a groundwork upon which the therapists can build through their own practices and through other coursework and knowledge they bring to the table. There is never one approach or one course that can provide an answer for each patient, and as an instructor for Herman & Wallace, I have the privilege of standing on the platform that Holly Herman and Kathe Wallace established when they founded the Institute. I feel that I get to fast-track the therapists by sharing what I have learned through experience and all the training that I have received, and then they can keep expanding the knowledge and skills within our field. I also learn a lot myself through the generosity of the therapists who bring their knowledge and experience to the courses.

If you could get a message to all therapists about pelvic rehab, what would it be?

Shadow a pelvic rehab therapist for half a day. That's all it will take to see the world that opens up in front of you, to feel inspired by the amount of issues that go "missing" and how to address them, and also how to notice how simple and meaningful it is to offer some guidance or hope to a patient who has pelvic dysfunction.

If you could make a significant change to the field of pelvic rehab or the field of PT, what would it be?

Now that more therapists are joining the ranks of pelvic rehab, I hope that we see more of them move into treating men and children. As Dawn Sandalcidi (who teaches about pediatrics for the Institute) shares with us, many of the pelvic dysfunctions start in childhood, and we must get to the kids as soon as possible.

What is your favorite topic about which you teach?

My favorite condition to treat and lecture about is definitely scrotal pain. There is such a paucity of awareness about the potential causes of scrotal or testicular pain, and men have been suffering way too long when they have this issue. In my experience, men can respond very quickly and completely with intervention.

Continue reading

Elizabeth Makous - Featured Certified Pelvic Rehabilitation Practitioner

In our weekly feature section, Pelvic Rehab Report is proud to present this interview with newly certified practitioner Elizabeth Ann Makous, MS, PT, CLT, PRPC

How did you get involved in the pelvic rehabilitation field?

I graduated from the University of Florida in 1992 with three degrees, BS in Neurobiological Science, MS in Exercise Physiology and my Physical Therapy degree. I received an excellent education but at that time PT schools were not even introducing the thought that PTs could treat the pelvic floor. After practicing in an orthopedic outpatient therapy clinic for about a year, I had a pelvic pain patient who I kept treating with external soft tissue as well as joint mobilization techniques. This worked temporarily but did not solve her problem. Then one day she told me that the pain was really deep inside. Intuitively, I put on a glove to find the problem. I released her pelvic floor and her problem was solved. Well, needless to say, I was excited and called all over the county to see if anyone was doing this. That was when I discovered Herman and Wallace who had just started teaching together. I took the courses they offered and that began my exciting journey into the realm of treating pelvic floor dysfunctions.

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

I have to say my father, a physician, and mother, an RN. This field was a natural fit for me given the fact that my dad was a family doctor who treated the whole person, delivered babies and performed minor surgeries. My dad always discussed interesting and complicated medical cases and how they were resolved. When in high school, I was allowed to volunteer in the office and observe pelvic exams and colonoscopies. This opened a natural doorway for me into the uncharted territory of pelvic floor therapy.

Describe your clinical practice:

I have been a PT for over 20 years and have always enjoyed working with complex and challenging patient problems. My patient load tends to include men and women with chronic pain (head, TMJ, spine, SIJ, extremities); pelvic floor dysfunctions (fecal and urinary incontinence, pelvic pain including genital and anal pain, sexual dysfunctions, painful bladder syndromes); lymphedema (primary or secondary-due to cancer treatments, post-surgical scars or injuries), lipodema, and venous insufficiency edema issues. I also cast for Function Foot Orthosis when necessary. My broad and extensive therapy experience allows me to appropriately assess and treat the musculoskeletal dysfunctions caused by and/or contributing to a patients pelvic floor symptoms.

I work for Interstate Rehab in an outpatient physical therapy clinic affiliated with Henry Mayo Hospital in Santa Clarita, CA. I am blessed to work for a company that focuses on individualized quality care for each patient. We have private rooms because of the nature of the above diagnoses, the specialty equipment required, as well as infection control for my patients undergoing chemotherapy. Treatments are also individualized and include manual therapy, use of home dilators or electrical stimulation units, advice on appropriate external compression garments and support binders, as well as progression into a safe, appropriate home exercise program. For my pelvic and lower extremity lymphedema patients, they will also receive Complete Decongestive Therapy.

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

It is hard to narrow this down. My first thought is pelvic pain in abuse victims because it is so challenging and there is such a great need. However, I guess I would have to say I just love that fact that every pelvic floor dysfunction patient is unique, challenging and critically necessary. Any problem with the pelvic floor can lead to devastating quality of life issues affecting a patients walking, sitting, sleeping, pregnancy and delivery, as well as bladder, bowel, and sexual function. I love the fact that my work days are always an adventure with a goal of helping men and women with problems that no one wants to talk about. This is even truer with the sub-specialty of patient for whom the Lord has really given me a heart for, abuse victims including adult rape as well as childhood incestuous and ritualistic sexual abuse victims. For me, there is no greater calling than to help these men and women!

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

Step out of your comfort zone, there is so much need and you will never have a boring day in the clinic again. However, if you are the type that likes to follow rules and protocols for treatment or you like having a 9 to 5, leave-your-work-at-work kind of job then you probably should not consider pelvic floor therapy. For me, it is just as much a ministry as it is a job. Of course, this is just my opinion and I look forward to hearing from many other PTs!!!

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

I really enjoyed the new course on Pudendal Neuralgia because their instruction provided a wonderful framework to clarify terminology in the field and provided an opportunity to share experiences and treatments. The most interesting thing for me was learning about the latest surgeries being performed to treat Pudendal Neuralgia. This course was invaluable in helping me find just the right surgeon to refer one of my patients to.

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

I have enjoyed all of Herman and Wallace's instructors because they clearly have a passion for this field and always teach using clinical examples. I like the way they present the latest research and then teach the class how they would apply that knowledge to a patient problem. I also like how the instructors open the floor to therapist sharing ideas for our complex patients.

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

The Herman and Wallace Pelvic Rehabilitation Institute is the most powerful resource for continuing education courses and for sharing knowledge on the blog site. I also find that attending International Pelvic Pain Society meetings and the International Continence Society meetings are a wonderful way to keep up on the effectiveness of the latest medications and surgeries.

What motivated you to earn PRPC?

I always love learning and challenging myself to be a better therapist. I thought this would be a great way to test my knowledge base about the newest research and industry treatment standards.

What makes you the most proud to have earned PRPC?

I am proud of the fact that I challenged myself to review the details of basic pelvic floor knowledge and to study all the newest research in the pelvic floor therapy industry. The test was a great way to confirm and enhance my knowledge.

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

Start studying now. Cramming is too hard with a full time work schedule and family obligations. And, of course, continue treating patients so you can apply your book knowledge to real patients! This is the most rewarding aspect of preparing for the test.

What role do you see pelvic health playing in general well-being?

I believe that pelvic health is the core to general systemic health. After all, when your pelvic girdle joints, muscles and nerves are not functioning in perfect coordination we lose our kinetic stability for all functional activities. When the dysfunction further effects an individual’s bowel, bladder and sexual function their quality of life can be devastated! Pelvic Floor PTs are blessed to have a unique opportunity to bring back a person’s sense of well-being and hope for a normal quality of life.

What is in store for you in the future?

I plan to continue, as I always, to attend as many courses as possible and keep up on the latest research. I have recently been making more of an effort to educate my MD, PA and RNP referral sources on the many diagnosis we can treat. Patients often tell me how frustrated they are that their doctors did not send them earlier. We as a profession have a responsibility to focus on this education.

Learn more about Elizabeth Ann Makous, MS, PT, CLT, 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.

 

Continue reading

Upcoming Continuing Education Courses

Dec 6, 2019 - Dec 7, 2019
Location: Swedish Covenant Hospital

Dec 6, 2019 - Dec 8, 2019
Location: Swedish Covenant Hospital

Dec 6, 2019 - Dec 8, 2019
Location: Franklin Pierce University

Dec 6, 2019 - Dec 8, 2019
Location: Florida Hospital - Wesley Chapel

Jan 10, 2020 - Jan 12, 2020
Location: Dominican Hospital - Physical Therapy

Jan 17, 2020 - Jan 19, 2020
Location: Spooner Physical Therapy

Jan 17, 2020 - Jan 19, 2020
Location: Banner Physical Therapy and Rehabilitation

Jan 17, 2020 - Jan 19, 2020
Location: Our Lady of the Lake Children's Hospital

Jan 24, 2020 - Jan 26, 2020
Location: Nova Southeastern University

Jan 24, 2020 - Jan 26, 2020
Location: UCLA Health

Feb 1, 2020 - Feb 2, 2020
Location: Evergreen Hospital Medical Center

Feb 1, 2020 - Feb 2, 2020
Location: Ochsner Health System

Feb 7, 2020 - Feb 9, 2020
Location: FunctionSmart Physical Therapy

Feb 22, 2020 - Feb 23, 2020
Location: Pacific Medical Centers

Feb 28, 2020 - Mar 1, 2020
Location: Inova Physical Therapy Center

Feb 28, 2020 - Mar 1, 2020
Location: University of North Texas Health Science Center

Feb 28, 2020 - Mar 1, 2020
Location: Novant Health

Feb 28, 2020 - Mar 1, 2020
Location: Rex Hospital

Feb 28, 2020 - Feb 29, 2020
Location: Rex Hospital

Mar 6, 2020 - Mar 8, 2020
Location: 360 Sports Medicine & Aquatic Rehabilitation Centers

Mar 6, 2020 - Mar 8, 2020
Location: Heart of the Rockies Regional Medical Center

Mar 6, 2020 - Mar 8, 2020
Location: University of Missouri-Smiley Lane Therapy Services

Mar 6, 2020 - Mar 8, 2020
Location: Princeton Healthcare System

Mar 6, 2020 - Mar 8, 2020
Location: Ochsner Health System

Mar 7, 2020 - Mar 8, 2020
Location: Veterans Administration - Salt Lake City

Mar 7, 2020 - Mar 8, 2020
Location: GWUH Outpatient Rehabilitation Center

Mar 13, 2020 - Mar 15, 2020
Location: Sentara Therapy Center - Princess Anne

Mar 13, 2020 - Mar 15, 2020
Location: Thomas Jefferson University

Mar 13, 2020 - Mar 15, 2020
Location: Franklin Pierce University

Mar 14, 2020 - Mar 15, 2020
Location: Park Nicollet Clinic--St. Louis Park