Pelvic rehab therapists and physiatrists both focus on the return to life and function. In a recent interview, Allyson Shrikhande shared, “Physiatrists are extensions of physical therapy. We analyze and treat the muscles, nerves, and joints of the pelvis non-operatively.” Physiatrists bring a holistic viewpoint and are trained to look at the interplay between the different organ systems with each other, as well as the muscles, nerves, and joints.

Dr. Shrikhande is joining H&W to bring in the New Year with her short format course, Working with Physiatry for Pelvic Pain, on January 11th. This 4-hour course delves into diagnosis and non-operative treatment options for Chronic Pelvic Pain (CPPS). Allyson believes in an interdisciplinary team approach to treating patients and spends time discussing the interplay between professions for the betterment of patients.

Physiatrists often work with an interdisciplinary team of rehabilitation experts to coordinate a treatment plan that is based on each patient’s personal needs, abilities, and goals. Members of this interdisciplinary team can include several practitioners:

• Rehabilitation nurses
• Physical therapists
• Occupational therapists
• Respiratory therapists
• Gynecologists
• Dieticians

You can find many clinics and healthcare systems that incorporate a variety of professionals and share a multidisciplinary approach. Multidisciplinary typically means that there are multiple providers but not working together in the same way as interdisciplinary teams. The interdisciplinary approach differs from the multidisciplinary approach by focusing on the common patient and team goals, compared with a discipline-specific focus. It emphasizes regular and effective communication, coordination, and integration of care. Interdisciplinary medical teams are able to work together for functional outcomes (1). 

Patients with Chronic Pelvic Pain Syndrome (CPPS) typically experience pain in the abdomen, lower back, and genitals. These patients often experience frequent urination, pain when sitting, and even pain during or after sexual intercourse and impair the function of organs such as the bladder and bowel. 

CPPS is a multifaceted disorder. It is a challenge to health care providers because of its unclear etiology and complex natural history. In this case, a pelvic physiatrist may lead an interdisciplinary team including a gynecologist, psychologist, and physical or occupational therapist. In her course, Dr. Shrikhande shares how important it is to understand the pathophysiology of pain. “Experiencing pain for a long period of time changes how the brain receives and processes pain signals. Essentially there is this amplification of pain. This really describes neuroplasticity. The rehab world is founded on neuroplasticity, meaning your peripheral and central nervous system can change in a positive direction or a negative direction.”

Dr. Shrikhande delves into the important role of the physiatrist and pelvic therapist in CPPS treatment in her course  Working with Physiatry for Pelvic Pain. Physical and occupational therapists are trained in the clinical features of common musculoskeletal pathology and musculoskeletal examination and develop treatment plans, exercise programs, and physical modalities (including heat, cold, TENS). As a pelvic therapist, an evaluation for CPPS is not just of the pelvic floor. It includes other structures including the abdomen, hip complex, diaphragm, ribcage, low back and looks for weakness, difficulty of coordination, and assessing breathing dysfunction. 

As stated by the American Academy of Physical Medicine and Rehabilitation, "Physiatrists, on the other hand, make and manage medical diagnoses and prescribe the therapies that physical and occupational therapists perform. Despite these differences, both therapists and psychiatrists collaborate and communicate to ensure patients are receiving appropriate treatment (2)."

If you have taken Pain Science for the Chronic Pelvic Pain Population, Pudendal Neuralgia and Nerve Entrapment, Yoga for Pelvic Pain, Nutrition Perspectives for the Pelvic Rehab Therapist, Biofeedback for Pelvic Muscle Dysfunction - Satellite Lab Course, or Male Pelvic Floor Function, Dysfunction, and Treatment - Satellite Lab Course you may be interested in attending this course (Working with Physiatry for Pelvic Pain).

Upcoming Working with Physiatry for Pelvic Pain Courses

January 11, 2022

April 5, 2022

September 25, 2022

November 15, 2022

References:

1. Poduri K. R., Vanushkina M. Epidemiology of Aging, Disability, Frailty and Overall Role of Physiatry. Geriatric Rehabilitation. 2018; Pages 1-17. https://doi.org/10.1016/B978-0-323-54454-2.00001-7
2. American Academy of Physical Medicine and Rehabilitation. The Medical Student's Guide to PM&R. https://www.aapmr.org/career-support/medical-student-resources/a-medical-students-guide-to-pm-r/what-is-the-difference-between-physical-therapy-and-physiatry