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Special Considerations for Pregnant and Postpartum Athletes - A Conversation with Emily McElrath

Special Considerations for Pregnant and Postpartum Athletes - A Conversation with Emily McElrath
PPHIA

This week The Pelvic Rehab Report sat down with new faculty member, Emily McElrath PT, DPT, MTC, CIDN, to discuss her pelvic rehab journey and her new course, Pregnancy and Postpartum Considerations for High-Intensity Athletics. Emily is a native of New Orleans, is highly trained in Sports and Orthopedics, and has a passion for helping women achieve optimal sports performance. Emily is also certified in manual therapy and dry needling, which allows her to provide a wide range of treatment skills including joint and soft tissue mobilization. She is an avid runner and Crossfitter and has personal experience modifying these activities during pregnancy and postpartum.

McElrath 2022

Hi Emily! Can you tell us a little bit about yourself and your clinical practice?

My name is Emily McElrath, and I am an orthopedic and pelvic floor PT. I spent the early years of my career in sports medicine and primarily worked with high school and collegiate athletes, as well as weekend warriors. I myself am a distance runner and Crossfitter and have always had a love for sports. After the birth of my second child, I had a hard time returning to Crossfit due to significant pelvic floor dysfunction and pain. At that time, I became a pelvic floor patient and quickly realized how valuable this specialty was. This began my journey to becoming a pelvic PT.

Since that time almost 4 years ago, I have been blending my orthopedic and pelvic health knowledge and skillset to help women return to the sports they love without pain and pelvic floor dysfunction.  My main goal as a clinician is to educate and empower my patients to feel in control of their own bodies, and to feel confident in daily and recreational activities.

 

What has your educational journey as a pelvic rehab therapist looked like and how did you get involved in the pelvic rehabilitation field?

It was really a matter of personal experience leading me to the field of pelvic health. I knew the specialty of pelvic health existed, but until I was a patient I did not truly appreciate how valuable it was. Seeing firsthand how significantly pelvic floor physical therapy could improve the quality of a patient’s life gave me a desire to become a pelvic PT. Once I got into my course work with Herman & Wallace, I realized that my background as an orthopedic PT would blend well with pelvic PT. It also gave me a lot of perspective into how significant of a role the pelvic floor plays in the entire kinetic chain. I would even say that my pelvic floor education has helped me be a more thorough orthopedic clinician. It has helped me think outside the box and enabled me to be more thorough in my critical thinking when evaluating patients.

 

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

I have two patient populations that I find most rewarding. The first is HIIT athletes. I find this population so fun to work with. They are some of the most dedicated and compliant patients I have. Their love of their sport is often a driving force for them to get and stay healthy. Many of these athletes will even come to my clinic without having pain or dysfunction. They are strictly coming for education and prevention, which I love. After all, PTs as a profession are huge proponents of wellness and prevention.  I also love teaching a patient that they can, in fact, continue doing exercises they may have been previously told were not safe to do during pregnancy or postpartum. Giving them hope that they can continue doing what they love after they were afraid they may not is very rewarding.

The second population I love working with is my childbirth prep patients. I LOVE education. I feel like these sessions really highlight that part of physical therapy. These sessions not only address any current concerns a patient is having but also provide education to give them the confidence to birth the way they want. I review everything from what to expect during labor, to different positions for pushing, and how to push. I even have partners come to the sessions so they can learn how to best support the patient during delivery. Hearing from patients that their birth experience was beautiful and just as they had hoped always gives me a lot of joy. I feel honored to be able to be a part of that journey.

 

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

I find other practitioners the most valuable resource in my practice. There is so much that can be gained from collaborating with other pelvic PTs, doulas, midwives, OB/GYN, sex therapists, etc. Pelvic rehab is so multifaceted, that I believe it truly requires a collaborative approach to provide the best patient outcomes.

 

What books or articles have impacted you as a clinician?

There was a recent article that came out about the prevalence and significance of Levator Ani avulsion tears. This was an interesting article because I have seen this more and more clinically, but there is very little research on the matter. My favorite books as a clinician are: “The Body Keeps the Score”, “Come As You Are”, and “Pelvic Pain Explained”.

 

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?

 I think the biggest thing I have learned is that the objective findings of our evaluations are only a small part of the puzzle. Pelvic rehab is an intimate type of physical therapy, and many of our patients may have had trauma that is still raw to them. If most of your evaluation is spent talking with the patients to ensure they feel comfortable, that’s ok. I have realized that it’s ok if I don’t get to every objective test and measure in the first session. In this line of work, patient comfort is most important. Building a rapport with your patient must take precedent.

gym

What made you want to create this course, Pregnancy and Postpartum Considerations for High-Intensity Athletics?

I wanted to create this course because I saw a need in the Crossfit community for more education on how to safely train pregnant and postpartum athletes, and I feel physical therapy is a great place to start, after all, PTs are experts in the musculoskeletal system. We are seeing more and more of these HIIT athletes becoming moms and wanting to maintain their athleticism throughout pregnancy & postpartum, and I think that’s great!

With that being said, I think there are nuances to training this athletic population. There are so many hormonal, anatomical, and structural changes to consider during pregnancy & postpartum, and that may affect how well an athlete can tolerate strain. However, most of these changes are not contraindications to training. Therefore, we as rehab practitioners and physical therapists need to fully understand the demands of  HIIT, as well as the specific considerations for this population so that we can keep them safely and effectively doing what they love.

 

What need does your course fill in the field of pelvic rehabilitation?

By and large, people do not fully understand the demands of HIIT activities like Crossfit unless they personally partake in these activities. This includes healthcare professionals like physical therapists. However, many of our pregnant and postpartum athletes will require the care of a  PT (especially pelvic) at some point throughout their pregnancy, and postpartum journey.

My course, Pregnancy and Postpartum Considerations for High-Intensity Athletics bridges the gap between education and experience, for those healthcare professionals who do not personally participate in HIIT to understand the demands of the sport. It also helps those physical therapists who do not specialize in pelvic health to understand the unique demands of this athlete population from a pelvic health perspective.

 

Who, what demographic, would benefit from your course?

Any PT, PTA, PT student, OT, COTA, or OT student who is looking to better understand the demands of HIIT,  the special considerations for pregnant and postpartum athletes who participate in HIIT, and how to safely train and treat these athletes to help them continue to do what they love.

 

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

Oh man, where do I start? There are so many things I want to shout from the mountain tops about pelvic PT. It truly is a gem in the field of physical therapy, and I think is often a missing link in traditional physical therapy care. Pelvic rehab is so much more than urinary leakage and kegels. It can be so impactful to the quality of life of a patient. There is no other area of the body that is critical to so many functions but is also so vastly overlooked and undertreated. The need for research, education, and development in this field is critical if we are going to have a true “whole body” approach to treatment.


Join H&W and Emily McElrath on May 21st to learn more about this patient demographic in Pregnancy and Postpartum Considerations for High-Intensity Athletics
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How Do We Bring Value to This Puzzle - A Conversation with Dr. Oluwayeni Abraham

How Do We Bring Value to This Puzzle - A Conversation with Dr. Oluwayeni Abraham

A Conversation with Dr. Oluwayeni Abraham

 

Check out the Herman & Wallace YouTube Channel for the full interview with Dr. Yeni


Dr. Oluwayeni Abraham stumbled into the niche field of fertility. She shares, "I had all of these women who would come in with painful periods that would have significant post-surgical problems and would end up having fertility concerns. As I was picking up my visceral mobilization techniques, I started to see that I was able to help women conceive and help women who maybe have experienced reoccurring miscarriages actually carry to term. That's when I said, "I think I'm doing something here that could be something else." That's when I tried to hone in on the specific skills that were influencing and maximizing the results and outcomes. 

In Dr. Yeni's course, Fertility Considerations for the Pelvic Therapist, she shares manual therapy techniques and a lot of data on hormones, the endocrine system, and other pieces of the puzzle. The language in the fertility world is based on these building blocks. Specific fertility-related diagnoses are discussed that help you formulate a pathway in treatment. Another important thing Dr. Yeni teaches is how to collaborate and work with these other providers that are going to be on this journey with your patients.

When working with fertility it's important to ask ourselves how do we bring value to this puzzle? How do we bring value after someone has had multiple failed IVF cycles? We can't just say we're going to do a bunch of manual work. We also have to speak the language and understand the body in its entirety and how it's playing a role in being able to maximize fertility outcomes. 

When asked what sparks her passion and keeps her so excited about working with this population Dr. Yeni stated, "the outcomes! We're still therapists, and we love to see results."


Fertility Considerations for the Pelvic Therapist - Remote Course

This course requires each registrant to have a live model. Due to the nature of labs, please be sure your model or partner is not pregnant and does not have an IUD for safety. Additionally, those with hydrosalpinx will not be able to participate in uterine mobility techniques but can still attend the course.

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A Physician's Perspective on Pudendal Neuralgia: An Interview with Michael Hibner

 

Dr. Michael Hibner is an international expert on pudendal neuralgia and chronic pelvic pain. Dr. Hibner joins Holly Tanner to discuss his new exclusive course with H&W titled Pudendal Dysfunction: The Physician's Perspective.

Pudendal neuralgia is a painful, neuropathic condition involving the dermatome of the pudendal nerve. This condition is not widely known and often goes unrecognized by many practitioners. Dr. Hibner runs The Arizona Center for Chronic Pelvic Pain (AZCCPP), a comprehensive center for treating chronic pelvic pain, and places a heavy emphasis on working as part of a care team with physical therapists and other pelvic rehab providers.

In this interview Dr. Hibner discusses how he treats pudendal neuralgia, “I treat patients with all reasons for pelvic pain but mostly pudendal neuralgia or patients with mesh injury or had an injury caused by pelvic mesh… I work very closely with physical therapists and I am a great, great believer in physical therapy. I am very happy that you are allowing me to share my perspective on Pudendal Neuralgia, and my perspective on physicians working with physical therapists.”

If I had pudendal neuralgia and I had a choice between surgery, injections, physical therapy, or medication. I would for sure have chosen physical therapy every time…there is no doubt in my mind. You can’t treat the PN without addressing the pelvic floor. What I tell patients is this. The number one thing for repetitive injury is to stop what you’re doing. The number two thing is to choose physical therapy over anything else. By far the majority of patients are helped by appropriate pelvic floor physical therapy.

Pudendal Dysfunction: The Physician's Perspective is scheduled for January 9, 2022. Course topics include pathoanatomy and clinical presentations, basics of surgical techniques, and terminology. The latter half of the course focuses on the physician and the rehab therapist working together and features case studies and clinical pearls from Dr. Hibner, a pioneer, and leader in the field.

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Stability Before Mobility, an Interview with Stacey Futterman Tauriello

In today's interview, Holly Tanner sits down with Stacey Futterman Tauriello, PT, MPT, WCS, BCB-PMD to discuss her approach to pelvic rehabilitation. Stacey received her Master’s Degree in Physical Therapy from Nova Southeastern University in South Florida in 1996. After graduation, she relocated to Chicago where she began specializing in women’s health issues including the treatment of incontinence, pelvic pain, and prenatal/postpartum musculoskeletal issues. She returned to the east coast in 2003 and is now the owner of 5 Point Physical Therapy, a specialty physical therapy clinic for male and female pelvic dysfunction in New York City.

Stacey will be instructing Pelvic Floor Level 2A on December 11-12, 2021 and Pelvic Floor Level 1 on January 22-23, 2022.

What clinical pearls do you have for practitioners working with labral tears?

Return to sport has to be discussed on day one. Figuring out what that path is. It's ok that it is slow, but the patient needs to understand that they are going to progress in a fashion to get them stronger and more stable.

You always have to have stability before you have mobility.

You need that background knowledge of getting them stronger without flaring up their pelvic floor symptoms. You have to release and restore, release and restore, release and restore. You got to understand the "why" component. Why are they having so much pain? What can you do to strengthen without flaring? I think that is huge.

What excites you about exercise approaches?

The first thing that got me excited was that I saw that I was doing a lot of things right. One of the biggest takeaways...was the neuromuscular reeducation portion of the exercise...That really task-specific brain reeducation with every exercise...I often think of neuro as Parkinson's. So a Parkinson's patient if you want them to walk and lift their leg (because they're shuffling), you would put something in front of them and say step over it.

Your daughter is 3 and a half years old now. How has going through pregnancy, birth, and postpartum changed your approach with pregnant and postpartum patients?

I did an interview in 2019 with the Today Show on postpartum motherhood and the pelvic floor, both from the patient and the practitioner's standpoint.

It's changed my perspective completely. From the process of getting pregnant, I was in my 40s, so I was an older mom, to being pregnant, having some issues during pregnancy. And then the actual delivery was...it's not great being a pelvic floor physical therapist trying to push a baby out of your vagina...but you have to go through it. Then you realize too that your postpartum experience is all about healing. As much as it's easy for somebody that's 21 to give birth and bounce back. A lot of the women who are having babies right now are in their 30s and 40s. Their bodies don't respond the same, especially not during covid. 

It's a game-changer right now, things are different. Yeah, I had incontinence after I gave birth, I still struggle. My body, within covid from not exercising and going to the gym and everything still takes a toll. I feel like it made me more empathetic to some of my pregnant patients.

Is there a clinical pearl or fun phrase that comes to mind that you use?

One of the big phrases that I use comes from Pam Downey, and it is "healthy tissue doesn't hurt."

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Short Interview Series - Episode 6 feat. Sandra Gallagher

Holly Tanner Short Interview Series - Episode 6 featuring Sandra Gallagher

In today’s interview, Sandra discusses some of the intricacies of working with transitioning patients, her path in working with the LGBTQ+ community, and her new course with H&W. Transgender Patients: Pelvic Health and Orthopedic Considerations is a remote course created by Sandra Gallagher and Caitlin Smigelski. This course provides specific content aimed at teaching pelvic health therapists how to expand their skills for working with people of all gender identities.

Sandra Gallagher has served on varied committees and boards at the state and national level, most recently as the chair of the CAPP-OBC committee for the Academy of Pelvic Health of the APTA. She has presented on the role of PT in gender-affirming vaginoplasty at UCSF Transgender Health Summit, APTA Combined Sections Meeting, and at the 2018 international meeting of the World Professional Association for Transgender Health (WPATH).

In a research study that Sandra facilitated with other colleagues, it was concluded that “Pelvic floor physical therapists identify and help patients resolve pelvic floor-related problems before and after surgery. We find strong support for pelvic floor PT for patients undergoing gender-affirming vaginoplasty.”(1)

Often therapists think of genital surgeries and sexual function when contemplating work with transgender people. However, therapists have far more to offer transgender patients. For providing optimal care, knowledge of the intricacies of gender transition is essential.

Join H&W on October 30th for Transgender Patients: Pelvic Health and Orthopedic Considerations to learn more about gender-affirming genital surgeries and medical interventions that people transitioning might choose.

 


  1. David Jiang, Sandra Gallagher, Laura Burchill, Jens Berli, Daniel Dugi 3rd. Implementation of a Pelvic Floor Physical Therapy Program for Transgender Women Undergoing Gender-Affirming Vaginoplasty. Obstet Gynecol. 2019 May;133(5):1003-1011. doi: 10.1097/AOG.0000000000003236.
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Short Interview Series - Episode 4 feat Brianna Durand

Holly Tanner Short Interview Series - Episode 4 featuring Brianna Durand

Inclusive Care for Gender and Sexual Minorities is a remote course created by faculty member Brianna Durand. This course is for anyone, even if you are unsure about the pronouns or the terminology to use. Brianna created this course to provide the basic foundational knowledge around inclusive and gender-affirming care. The second day of the course provides detailed physiological considerations from the pelvic health and general health standpoint for folx undergoing medical transition.

Brianna became interested in pelvic health research pertaining to the LGBTQ+ community when she was in grad school. She was struck by how the community was not mentioned in most formal education and wanted to meet this knowledge gap.

Gender-affirming care describes ideal medical, surgical, and mental health services sought by transgender, non-binary, and gender non-conforming people. This can range from hormone therapy, to top or bottom surgery, facial hair removal, modification of speech, reduction thyrochondroplasty (tracheal cartilage shave), and voice surgery (1). Also common is the practice of genital tucking or packing, and chest binding. All of which the World Professional Association for Transgender Health lists as medically necessary procedures(2).

Hormone therapy is a common medical intervention and allows for the acquisition of secondary sex characteristics which are more aligned with the individual's gender identity. Research, such as that by Gómez-Gil et al, concludes that there are psychological improvements after gender-affirming treatments such as hormone therapy and surgery (3). Likewise, the denial of access to gender-affirming care is associated with worsened psychological health and high-risk behaviors (4).

Inclusive Care for Gender and Sexual Minorities attendees can expect to be gently guided into the sometimes confusing realm of gender and sexual orientation and identity. This course will provide a safe space to ask all the questions about caring for LGBTQ+ patients and practicing the skills needed to help advance your practice.

Inclusive Care for Gender and Sexual Minorities is scheduled for October 9-10 and covers pelvic floor physical therapy specifically, however it is appropriate and useful for any medical professional as we all have patients in the LGBTQ+ community.


  1. Madeline B. Deutsch, MD, MPH. Overview of gender-affirming treatments and procedures. UCSF Transgender Care & Treatment Guidelines. June 17, 2016
  2. WPATH Clarification on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage for Transgender and Transsexual People WorldwideWPATH. Transgender Health Information Program. [cited 2014 Jan 21].
  3. Gómez-Gil E, Zubiaurre-Elorza L, Esteva I, Guillamon A, Godás T, Cruz Almaraz M, et al. Hormone-treated transsexuals report less social distress, anxiety, and depression. Psychoneuroendocrinology. 2012 May;37(5):662-70.
  4. Sevelius JM. Gender Affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex Roles. 2013 Jun 1;68(11-12):675-89.
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An Interview with New Author, Mora Pluchino

An Interview with New Author, Mora Pluchino

Mora Pluchino

This week The Pelvic Rehab Report sat down with senior teaching assistant and author, Mora A Pluchino, PT, DPT, PRPC, to discuss her new book “The Poop Train”. Mora works at the Bacharach Institute for Rehabilitation and in 2020, she opened her own "after hours" virtual practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016, as well as a TA with Herman and Wallace since 2020 with over 150 hours of lab instruction experience!

 

What or who inspired you to write this book?

My nine-year-old daughter has had issues with constipation since she was two. Our household is no stranger to talking about poop and all things related to poop to manage her tummy issues. I always tried to explain to her the purpose of habits like eating fiber and drinking water, as well as how poop moves through the body. One day my daughter started telling me that her “poop train wasn’t ready to leave the station” and I got the idea for the story!

 

Can you tell me about your book and the title?

I wanted a title that would be silly but interesting to a child. My goal was to create a book to be easy to read and understand the story about how food enters and leaves our body with resources within and after the book for parents to help manage their child’s bowels. I wanted it to be something that would be fun to read while on the potty, preparing for potty training or if a child is having an issue.

 

What does your daughter think of “The Poop Train”?

I just asked her and she took my computer over to answer. “I think that you are crazy and you talk about poop way too much! I also think that your book is super cute and even kind of funny. Kids and adults alike are going to love it because it talks about all the parts it needs to but it is not creepy or embarrassing.” - Nina P.

 

What’s your favorite thing about your book?

I am honestly in love with the illustrations. I had this idea for a few years and couldn’t do anything with it because I’m not good at drawing. I finally connected with the sister of a dear friend who shares my love poop talks and happens to be a talented artist. She brought my idea to life in adorable, inclusive, and simple images!

 

How do you think writing this book has impacted you as a PT and parent?

Taking Pelvic Floor Level 1 changed my life as a parent. This career path gave me the tools to help my daughter manage her constipation and resultant pelvic floor issues like post-void dribbling and bed-wetting. I wrote this book to help other parents who had similar struggles.

 

Were there any surprises along this book journey?

Funny story, I proofread my book multiple times along with my husband and a friend. My daughter read the book for the first time and found a TYPO! At that point, it was too late so my book became practically perfect. Hint - the typo is in the resource section!

 

What advice do you have for other PTs who are interested in writing?

I’d encourage anyone interested in writing something to go for it. Take your idea and nurture it until you can create it! Talk to others if you get stuck. I did this and found the illustrator of my dreams shortly after. And proofread a million times!

 

Do you think you’ll write another book?

I am finalizing the manuscript for my second pelvic health book. I was so happy with how Elizabeth Wolfe was able to capture the style I wanted that I asked her to work on a second project a few days after we finished our first. “Practically Perfect Pelvic Health 101: A Visual Tour of the Pelvic Floor” will be going to print soon!

 

How do I get a copy of this book?

The Poop Train” is available in paperback on Amazon! I am also happy to send copies to fellow pelvic health professionals at a discount. I can be contacted by email at This email address is being protected from spambots. You need JavaScript enabled to view it.!

 

Mora Pluchino (She/Her)

practicallyperfectpt.com

@practicallyperfectpt

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Faculty Interview: Kate Bailey

Faculty Interview: Kate Bailey

Kate Bailey

This week The Pelvic Rehab Report sat down with Kate Bailey, PT, DPT, MS, E-RYT 500, YACEP, Y4C, CPI to discuss her career as a physical therapist and upcoming course, Restorative Yoga for Physical Therapists, scheduled for September 11-12, 2021. Kate’s course combines live discussions and labs with pre-recorded lectures and practices that will be the basis for experiencing and integrating restorative yoga into physical therapy practice. Kate brings over 15 years of teaching movement experience to her physical therapy practice with specialties in Pilates and yoga with a focus on alignment and embodiment.

 

Who are you? Describe your clinical practice.

My name is Kate Bailey. I own a private practice in Seattle that focuses on pelvic health for all genders and ages. I work under a trauma-informed model where patient self-advocacy and embodiment are a priority. My dog, Elly, assists in my practice by providing a cute face and some calming doggy energy. My patients often joke that they come to see her just as much as to see me, which I think is great. In addition to being a physical therapist, I’ve been teaching Pilates for nearly 20 years and yoga for over 10. They are both big parts of my practice philosophy and my own personal movement practice

 

What books or articles have impacted you as a clinician?

I have a diverse library of Buddhist philosophy, emotional intelligence, trauma psychology, human behavior, breathwork/yoga, and sociology and, of course, a bunch of physical therapy pelvic floor books. I also love a children’s book on emotional regulation or inclusion, even for adults. One of my favorite finds is the Spot series that gives kiddos different ways to use their hands to help deal with different emotions. I’ve used it for adults who need physical self-soothing options. There are so many, and I find that it's the amalgamation of information that really impacts my practice the most.

 

How did you get involved in the pelvic rehabilitation field?

I have a deep interest in the human experience and how culture and dissociation create mass-disembodiment and how hands-on work can be profound in how we experience our body. Pelvic rehab allowed me the opportunity to work more closely with people on areas that bring up the most shame, disembodiment, and trauma, and therefore have some pretty amazing possibilities to make an impact not only in their lives but how they act in culture. In many ways, I see my work in pelvic rehab as a point of personal activism in creating a more embodied, empowered, and powerful culture.

 

What has your educational journey as a pelvic rehab therapist looked like?

I knew I wanted to go into pelvic health from my second year in PT school. I’ve always been at bit…well, let’s call it driven. I did an internship with great therapists in Austin and then only considered full-time pelvic floor positions once licensed. I took as many courses as I could handle in my first couple years of practice, which worked well for me, but understandably is not the right path for all those entering this field for a number of reasons. I went through the foundational series, and then into visceral work as well as continued my yoga and Pilates studies. I continued my education in trauma and emotional intelligence which is both a personal and professional practice. I found that a blend of online coursework and in-person kept me satisfied with my educational appetite.

 

What made you want to create your course, Restorative Yoga for Physical Therapists?

I was a yoga teacher long before I became a PT. When I found my way into the specialty of pelvic floor physical therapy, this particular part of my yoga teaching became incredibly useful for patients who had high anxiety, high stress, and difficulty with relaxation and/or meditation. This course was a way for me to share some of my knowledge of restorative yoga with the community of health care providers, where it could not only be used as a means of helping patients, but also as a means to start valuing rest as a primary component of wellbeing.

 

What need does your course fill in the field of pelvic rehabilitation?

Learning about yoga as a full practice and understanding that it has many components is very useful in deciding which component would be a good match for a pelvic health patient. Is it strengthening from an active practice? Is it meditation or pranayama (breath manipulation)? Or is it supported rest? This particular course focuses on the lesser-known aspects of the yoga platform: breath, restorative practice, and a bit of meditation. I have clients all the time struggle with meditation because their nervous systems aren’t ready for it. So we look at breathing and restorative yoga both as independent alternatives, but also as a way to get closer to meditation. Learning how to help people rest, the different postures, how to prop, and how to dose is an important component of this class. As a bonus, giving the clinicians another skill for their own rest practice can be useful when feeling tired, overwhelmed, or burned out. All this under a trauma-informed, neuro-regulation-focused model is a lovely way to deepen one’s physical therapy practice.

 

What demographic, would benefit from your course?

People who are stressed out or who work with people who are stressed out. In particular, clinicians who work with people who have pelvic pain or overactivity in their pelvic floors.

 

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

I love working with female-identifying patients that struggle with sexual health or those who are hypermobile and trying to figure out movement that feels good. I love working with all genders generally and do so regularly. There’s nothing quite like helping a male-identifying patient find embodiment and understanding of their pelvis in a new way. I think for me, working to dismantle female normative structures for those identifying as female, particularly in the realm of sexual health feels inspiring to me because it combines physical, emotional, spiritual health with going against the cultural standards of how those identifying as women fit into society, and being able to sit with the trauma of all types that so many people face.

 

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

A pelvic floor model is great. The most important part of my practice is a conversation about consent, not only for internal work but for everything I offer during visits and also for patients to understand that they can give or retract consent with any medical provider for just about any service. Emergency procedures are a smidge different, but I hope my patients walk away with the understanding that the medical community is here to serve their embodied experience. My newest favorite resource is a series of metal prints that depict the emotional intelligence grid used in the RULER syllabus. I have a magnet that patients can use to identify how they are feeling and help develop their language for emotional and then somatic or interoceptive knowledge.

 

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

There was nothing quite like PF1. I don’t think I’ll ever forget it. The instructors were Stacey Futterman Tauriello and Susannah Haarmann. I was still in grad school prepping for my internship and ended up being the model for labs which falls squarely in line with my upbringing as a dancer who wanted to understand everything from the inside out. It was a challenging weekend on pretty much every level. I went through phases of dissociation and total connection. It made me realize that my decision to enter health care after having a career in movement was the right one.

 

What lesson have you learned from a course, instructor, colleague, or mentor that has stayed with you?

Meet the patient where they are at first and validate that they live in an incredibly intelligent body. I think sometimes it’s so exciting to see the potential that patients have because, as clinicians, we’ve seen the progress of others. In yoga, there is a practice of the beginner’s mind. It asks the student to sit with an empty cup of knowledge and experience each practice with the curiosity of someone just being introduced to yoga. I have knowledge that may be helpful to patients. Patients have so much knowledge of their own body from their life experiences, some of which are conscious and so much of which is subconscious. The fun part is seeing how my experience and their experience match (or don’t sometimes) to then assess how to craft the care plan.

 

If you could get a message out to other clinicians about pelvic rehab what would it be?

That it's so much more than pelvic rehab. We get to talk to people about things that aren’t talked about and normalize the human experience. Pelvic rehab gives safety to patients to experience their bodies in all the sensations that come from having a nervous system: from sadness to joy to relief to fear. It's all in there and when we learn about those sensations from pelvic rehab, my hope is that it can flood into other areas of life.

 

What is in store for you in the future as a clinician?

Refining, learning, and seeing what else comes. Hoping to publish a book of cartoon organs shortly. But most importantly to create a safe space for patients to feel cared for and supported in my corner of Seattle.

 

Kate Bailey (She/Her)
Pelvic Floor Physical Therapy
Yoga & Pilates

 

This email address is being protected from spambots. You need JavaScript enabled to view it.

www.kbwell.org

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Mia Fine, MS, LMFT, CST Launches a Course on Sexual Interviewing for Pelvic Health Therapists

Mia Fine, MS, LMFT, CST Launches a Course on Sexual Interviewing for Pelvic Health Therapists

Mia Fine, MS, LMFT, CST joins the Herman & Wallace faculty in 2020 with her new course on Sexual Interviewing for Pelvic Health Therapists! The new course is launching this April 4-5, 2020 in Seattle, WA; Lecture topics include bio-psycho-social-spiritual interviewing skills, maintaining a patient-centered approach to taking a sexual history, and awareness of potential provider biases that could compromise treatment. Labs will take the form of experiential practice with Bio-Psycho-Social-Spiritual-Sexual Interviewing Skills, case studies and role playing. Check out Mia's interview with The Pelvic Rehab Report, then join her for Sexual Interviewing for Pelvic Health Therapists!

Mia Fine, MS, LMFT, CSTTell us about yourself, Mia!
My name is Mia Fine, MS, LMFT, CST and I’ve been a Licensed Marriage and Family therapist for four years. I am an AASECT Certified Sex Therapist and my private practice is Mia Fine Therapy, PLLC. I see these kinds of patients: folks with Erectile Dysfunction, Pre-mature Ejaculation, Vaginismus, Dyspareunia, Desire Discrepancy, LGBTQ+, Ethical Non-monogamy, Anxiety, Depression, Trauma, Relational Concerns, Improving Communication.

What can you tell us about the new course?
This course will offer a great deal of current and empirically-founded sex therapy and sex education resources for both the provider as well as the patient. This course will add the extensive skills of interviewing for sexual health. It also offers the provider a new awareness and self-knowledge on his/her/their own blind spots and biases.

How will skills learned at this course allow practitioners to see patients differently?
Human beings are hardwired for connection, intimacy, and pleasure. Our society often tells us that there is something wrong with us, or that we are defective, for wanting a healthy sex life and for addressing our human needs/sexual desires. This course will broaden the provider’s scope of competence in working with patients who experience forms of sexual dysfunction and who hope to live their full sexual lives.

What inspired you to create this course?
This course was inspired by the need for providers who work with pelvic floor concerns to be trained in addressing and discussing sexual health with their patients.

What resources were essential in creating your course?
Becoming a Licensed Marriage and Family Therapist and a Certified Medical Family Therapist requires three years of intensive graduate school. Additionally, a minimum of two years of training to become an AASECT Certified Sex Therapist and hundreds of hours of direct client contact hours, supervision, and consultation. I attend numerous sex therapy trainings and continuing education opportunities on a regular and ongoing basis. I also train incoming sex therapists on current modalities and working with vulnerable client populations.

How do you think these skills will benefit a clinician in their practice?
It is vital that providers working with pelvic floor concerns have the necessary education and training to work with patients on issues of sexual dysfunction. It is also important that providers be aware of their own biases and be introduced to the various sexual health resources available to providers and patients.

What is one important technique taught in your course that everybody should learn?
Role playing sexual health interview questions is an important experience in feeling the discomfort that many providers feel when asking sexual health questions. This offers insight not only into the provider experience but also the patient’s experience of uncomfortability. Role playing this dynamic illustrates the very real experiences that show up in the therapeutic context.


Sexuality is core to most human beings’ identity and daily experiences. When there are concerns relating to our sexual identity, sexual health, and capacity to access our full potential, it affects our quality of life as well as our holistic well-being. Working with folks on issues of sexual health and decreasing sexual dysfunction encourages awareness and encourages healing. Imagining a world where human beings don’t walk around holding shame or traumatic pain is imaging a world of health and happiness.

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Meet Laura Meihofer - Author of "Gender Diversity and Pelvic Health"

Meet Laura Meihofer - Author of "Gender Diversity and Pelvic Health"

Herman & Wallace is excited to announce an upcoming course on pelvic rehab for the gender diverse patient, written and instructed by Dr. Laura Meihofer, DPT, ATC. As Dr. Meihofer indicated in a recent blog, "[t]he number of individuals who identify as transgender is growing each year. The Williams Institute estimated in 2016 that 0.6% of the U.S. population or roughly 1.4 million people identified as transgender (Flores, 2016)... With the rise of individuals who identify as transgender, gender non-binary and intersex, healthcare professionals have equally seen an influx of patients who require care throughout their discovery and transition."

The new course from Dr. Meihofer is called "Gender Diversity and Pelvic Health: Comprehensive Care for Transgender Men and Women", and it will be debuting on May 29-31, 2020 in Livingston, NJ.

Dr. Meihofer was kind enough to share some thoughts about the new course, her practice, and herself with The Pelvic Rehab Report. Thank you, Laura!

Tell us about yourself, Laura!
My name is Laura Meihofer and I’ve been a physical therapist for 7 years. I work at Mayo Clinic and I see patients throughout the gender spectrum who most commonly struggle with pelvic floor dysfunctions relating to overactive muscles such as: chronic and acute pelvic pain, urinary frequency/urgency/incontinence/hesitancy, constipation, pain with intercourse, low back and hip pain.

Laura Meihofer, DPT, ATCWhat can you tell us about your new course, "Gender Diversity and Pelvic Health"?

Currently there are roughly 1.25 million transgender identified individuals in the United States and this number is growing. This course will help to dispel the idea of “other” when treating this demographic and demonstrate how much sameness there is when treating pelvic floor dysfunction.

These skills will greatly benefit any practice as this population is so underserved, they are looking for allies that are not just nice but competent. When you are able to successfully treat gender diverse patients, they spread the word about the great care they received and you now have a strong referral base. Taking this course opens up a whole new referral base of amazing people.

This course will not only feature videos from thought leaders in the field but will also highlight testimonials from patients and caregivers who have undergone their own gender transitions.

What essential skills does your course add to a practitioner’s toolkit?
I think the most important technique that attendees will learn will be how to assess a trans women and trans man after they have undergoing genital reconstruction surgery. Attendees will gain competence in the care of the gender diverse patient at any stage during their gender transition.

What was your inspiration to create this course for trans-identified patients?
Working at a major medical institution, I found that it was difficult finding providers in a patient’s area that were competent in care of a transgender patient. As I talked more and more with various physical therapists I realized they were thirsty for knowledge on how to serve these individuals. So I created the course!

What prepared you to create this course?
The most important thing I have done for this course is treat hundreds of patients who are trans identified throughout their gender journey. This allowed me to not only see all the medical interventions they went through but also to hear their personal journey of transition. These experiences expanded my empathy for what they go through and inspired me to search within myself on how I can be better for them. This desire to improve opened a creative well inside of me from which this course grew.

Discuss the effect conditions covered in your course have on a patient’s quality of life, your experience treating patients with this condition, and how their quality of life has increase after successful treatment.
Individuals who identify as transgender suffer from pelvic floor dysfunction just like our cis gender folks. There is no current data to capture the prevalence of pelvic floor issues in this specific population to date, however there is research to support the overall lack of care these individuals receive. Based on the results from the U.S. Transgender Survey which surveyed 28,000 respondents, the numbers in the health care field were staggering.

33% of respondents had at LEAST one negative experience with a health care provider in the last year due to being transgender. Negative experiences were qualified as verbal harassment, refusal of treatment or having to teach the health care provider about transgender people to receive appropriate care. 23% of respondents did not see a doctor when they needed to due to fear of being mistreated as a transgender person.

This course aims has two primary aims:
1) Educate providers on the unique concerns that transgender individuals experience related to hormone replacement and surgical techniques.
2) Equip attendees to provide competent care for this demographic

Join Dr. Meihofer for Gender Diversity and Pelvic Health this May 29-31, 2020 in Livingston, NJ!

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Upcoming Continuing Education Courses

Mobilization of the Visceral Fascia 2: The Reproductive System of Men and Women - Medford, OR Satellite Location

May 13, 2022 - May 15, 2022
Location: Asante Rogue Valley Medical Center

Mobilization of the Visceral Fascia 2: The Reproductive System of Men and Women - Cranford, NJ Satellite Location

May 13, 2022 - May 15, 2022
Location: Ivy Rehab Physical Therapy (Cranford, NJ)

Mobilization of the Visceral Fascia 2: The Reproductive System of Men and Women - Ottawa, ON Satellite Location

May 13, 2022 - May 15, 2022
Location: BodyWork Physiotherapy and Massage Clinic

Pediatric Functional Gastrointestinal Disorders - Remote Course

May 14, 2022 - May 15, 2022
Location: Remote Course

Pelvic Floor Level 1 - Self-Hosted

May 14, 2022 - May 15, 2022
Location: Self-Hosted Course

Pelvic Floor Level 2A - Lansdale, PA Satellite Course

May 14, 2022 - May 15, 2022
Location: Ivy Rehab (Lansdale, PA)

Pelvic Floor Level 2A - Self-Hosted

May 14, 2022 - May 15, 2022
Location: Self-Hosted Course

Pelvic Floor Level 2A - Charlotte, NC Satellite Course

May 14, 2022 - May 15, 2022
Location: Ivy Rehab HSS Physical Therapy Center of Excellence

Pelvic Floor Level 2A - Omaha, NE Satellite Course

May 14, 2022 - May 15, 2022
Location: Nebraska Medicine

Pelvic Floor Level 1 - NYC - Flatiron, NY Satellite Location (SOLD OUT)

May 14, 2022 - May 15, 2022
Location: 5 Point Physical Therapy - Flatiron

Pelvic Floor Level 2A - Washington, DC Satellite Course

May 14, 2022 - May 15, 2022
Location: The George Washington University Hospital

Pelvic Floor Level 2A - Columbia, MO Satellite Course

May 14, 2022 - May 15, 2022
Location: Boone Hospital Center

Pelvic Floor Level 1 - Garden City, KS Satellite Location

May 14, 2022 - May 15, 2022
Location: Accelacare Physical Therapy

Pelvic Floor Level 1 - Gadsden, AL Satellite Location

May 14, 2022 - May 15, 2022
Location: TherapySouth Gadsden

Pelvic Floor Level 1 - Waterford, CT Satellite Location

May 14, 2022 - May 15, 2022
Location: Lawrence and Memorial Hospital

Pelvic Floor Level 2A - Jacksonville, NC Satellite Course

May 14, 2022 - May 15, 2022
Location: Peak Performance Sports & Physical Therapy - Jacksonville NC

Pelvic Floor Level 1 - Woodbury, NY Satellite Location

May 14, 2022 - May 15, 2022
Location: STARS Rehabilitation - Woodbury

Pelvic Floor Level 2A - Orange City, FL Satellite Course

May 14, 2022 - May 15, 2022
Location: Direct Physical Therapy - Orange City

Pelvic Floor Level 2A - El Paso, TX Satellite Course

May 14, 2022 - May 15, 2022
Location: Border Physical Therapy

Bowel Pathology and Function - Remote Course

May 15, 2022 - May 16, 2022
Location: Remote Course

Biofeedback for Pelvic Muscle Dysfunction - Leesburg, VA Satellite Location

May 15, 2022
Location: Shenandoah University Division of Occupational Therapy

Biofeedback for Pelvic Muscle Dysfunction - Self-Hosted

May 15, 2022
Location: Self-Hosted Course

Biofeedback for Pelvic Muscle Dysfunction - Wichita Falls, TX Satellite Location

May 15, 2022
Location: Wichita Falls Regional Airport

Rehabilitative Ultrasound Imaging: Orthopedic Topics - Self-Hosted

May 20, 2022 - May 21, 2022
Location: Self-Hosted Course