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Meet Senior Teaching Assistant: Bethany Blake, PT, DPT, PRPC

Meet Senior Teaching Assistant: Bethany Blake, PT, DPT, PRPC

Blog Senior TA Series 1

Bethany Blake, PT, DPT, PRPC sat down with The Pelvic Rehab Report this week to discuss herself and how she came to TA for Herman & Wallace.

 

Who are you? Describe your clinical practice.
I’m Bethany Blake. I co-own Arkansas Pelvic Health and use social media (@thebladderbaddies previously @thekegelchronicles) to educate about pelvic health.

At Arkansas Pelvic Health we believe everyone should be able to live their life confidently, without pelvic pain or leakage. We believe pelvic therapy should be a standard, not a luxury, and we are on a mission to change this, one pelvis at a time. That's why we started this business, to raise the standard of care in women's health.

As a patient at Arkansas Pelvic Health, you will be paired one-on-one with a Doctor of Physical Therapy, never a tech or computer. You will never be rushed, and your pain and symptoms will be validated. We’re tired of doing things like they've always been done, and we’re tired of women's pain being ignored. We practice evidence-based, patient-centered, compassionate care to get you lasting relief from your pelvic symptoms and get you back to living your life!

What has your educational journey as a pelvic rehab therapist looked like? Where did you start?
I really jumped all in. I took Pelvic Floor Level 1, Pelvic Floor Level 2A, and Pelvic Floor Level 2B all within a month of each other. Very shortly after that, I took a visceral class with Ramona Horton and started teaching courses. I love learning and refuse to settle with not knowing something.

How did you get involved in the pelvic rehabilitation field?
I started my career as an outpatient orthopedic therapist. I picked this site as a clinical rotation because of one therapist in particular, Amanda Brooks-Ritchie. I liked the training that she had and the certifications she was working toward. I had a lot of pregnant and postpartum patients there and worked with a team of pelvic health therapists. Anytime treatment didn’t involve actual vaginal exams, they got “kicked out” to ortho…me. I learned a lot about pelvic health during that time and eventually decided to jump on board the pelvic health ship. I love zooming in and out of the pelvis and bringing the orthopedic background into pelvic health. Soon after I took the courses, I got my PRPC. I realized when studying for that certification, I wanted to merge my orthopedics and pelvic floor, which looked different from how I was practicing at my then-current job. I reached out to a classmate, colleague, and friend, Beth Anne Travis, who had previously approached me about starting a clinic, and told her I was ready to go!

What patient population do you find most rewarding in treating and why?
I love treating pain patients - pelvic pain in general, interstitial cystitis, pudendal neuralgia, and pain with intercourse. It is so rewarding to give people a part of their life back that they hate and to help their bodies work for them instead of against them.

If you could get a message out to physical therapists about pelvic rehab what would it be?
If you suspect pelvic floor issues with your patient, don’t try to manage them yourself.  You are potentially doing more harm than good by blindly issuing Kegels and TA contractions. If you aren’t sure, call your friendly neighborhood pelvic PT, and they would be very happy to help you with your patient. I also love the Cozean pelvic floor screening tool.

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?
Pelvic floor issues are complex. The evaluation is an ongoing process. You won’t know everything for everyone, but you know how to research, you have colleagues you can talk to, and don’t stop trying. Pain is absolutely not part of being a woman.

What do you find is the most useful resource for your practice?
My colleagues. We have a weekly hour where we chat about cases, practice new techniques, and review. It is the best time of the week.

What is in store for you in the future as a clinician?
Arkansas Pelvic Health is growing and expanding. I see opportunities for growth in space and location. I will continue patient care (it’s my favorite part) and also educating the public on social media and through different PT schools.

What books or articles have impacted you as a clinician?
The Interstitial Cystitis Solution
Come As You Are
Headache in the Pelvis
The Body Keeps the Score
Netter’s Anatomy
and many articles!

What has been your favorite Herman & Wallace Course and why?
Pelvic Floor Level 2B is my all-time favorite because I love treating pain conditions. I also really enjoyed the Nutrition Perspectives for the Pelvic Rehab Therapist course.

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?
Progress is not linear!

What do you love about assisting at courses?
I love teaching people about the pelvis, knowing that they will go out and help so many people. I love the updated evidence at the courses, reconnecting with colleagues, and meeting new ones.

What is your message to course participants who are just starting their journey?
Sometimes the load is heavy, but you get stronger, and colleagues help carry it! This is the most rewarding job you will ever have. It is an honor that people let you help them with a vulnerable issue, don’t take it lightly.

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Meet Senior Teaching Assistant Maricel Briones, DPT, CMTPT, OCS

Meet Senior Teaching Assistant Maricel Briones, DPT, CMTPT, OCS

Blog Senior TA Series

Maricel Briones, DPT, CMTPT, OCS sat down with The Pelvic Rehab Report this week to discuss herself and how she came to TA for Herman & Wallace. You can find Maricel this fall TA'ing Pelvic Floor Level 2B in Virginia Beach, VA.

 

Hi Maricel, can you share a little bit about yourself and your clinical practice?
Hi, I'm Maricel Briones, DPT, CMTPT, OCS and I've lived in Virginia Beach, VA my whole life. I graduated from Old Dominion University with a Bachelor in Exercise Science and followed that up with a Doctorate of Physical Therapy degree. I am now a Partner, Area Director, and Co-Leader of Pelvic Health with Ivy Rehab and have been a practicing therapist since 2012. I became an Orthopedic Clinical Specialist and Certified Myofascial Trigger Point Specialist for Dry Needling and recently became a Pelvic Health Therapist in 2020. My current clinic opened in December 2021, located in the Town Center area of Virginia Beach, VA. We are in the middle of expanding. We are a mix of outpatient orthopedic and pelvic health for men and women. My whole clinic is trained to support each other with all cases, even with pelvic health, and work together as a team for each patient's visit.

What has your educational journey as a pelvic rehab therapist looked like? Where did you start?
I started in early 2020 with Herman & Wallace (H&W) Pelvic Floor Level 1 in Virginia Beach, VA, then continued and took Pelvic Floor Level 2B towards the summer. It started a little slow because of Covid but it picked up in October 2022 and has been very busy since. In 2021, I continued taking more H&W courses including Pelvic Floor Level 2A, Male Pelvic Floor, and Pelvic Floor Capstone. I continued to host around 5-7 H&W courses to review the material and encourage local ortho therapists to join the pelvic health world. I eventually became a teaching assistant (TA) for H&W and have been loving it ever since. I became a Senior TA earlier this year.

How did you get involved in the pelvic rehabilitation field?
My regional director first asked and brought it to my attention, but I declined. A year later, she further explained the impact we can have for patients with pelvic floor conditions and got me convinced.  I gave it a shot in 2020 and realized it was where I should be. It's the most rewarding type of treatment we can provide for a patient. We are helping a hidden population that we did not know exists right in front of us. Helping them with critical functions needed in life, voiding, BM, sex, etc.

What patient population do you find most rewarding in treating and why?
Either the pediatric or geriatric population for urinary incontinence (UI). I enjoy teaching them good bladder habits and how to properly contract their pelvic floor muscles. My first patient was an 80-year-old who had urinary incontinence for 20 years and after 1 week of pelvic therapy, she went from changing her pad around 8 times a day to only 2. I had my first pediatric patient who had seen 4 specialists in 1 year for UI. After 2 weeks of pelvic floor rehab, she went from having 4-6 accidents a day to 1-2 every other day.

If you could get a message out to physical therapists about pelvic rehab what would it be?
Don't be afraid of the "V". A lot of PTs are uninterested and do not realize how much pelvic floor muscle training is similar to orthopedic, either stretch it or strengthen it, and provide a lot of education on habits. Also, it's all about functional movement, so connect the pelvic floor with the upper and lower body for optimal outcomes. I did an internal Ivy Rehab Ted Talk in Florida for our Director's Summit in May 2021, titled "Don't be afraid of the 'V'". What you're nervous of or afraid of, may actually be where you are meant to be or do.

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?
Continue to learn no matter what, and never settle. My treatment programs and assessments evolve every year because of continued learning and advice from colleagues. Always be open to different approaches and be patient with all complex cases.

What do you find is the most useful resource for your practice?
Facebook groups such as Global Pelvic Physio (run by Michelle Lyons), Pelvic PT Newbies (run by Jessica and Andrew Reale), Pelvic PT Huddle (run by PelvicSanity and Nicole Cozean), and Pelvic Floor Biofeedback (run by Tiffany Ellsworth Lee) have been my go-to for learning about cases, ideas, etc.

What is in store for you in the future as a clinician?
I plan to take the PRPC exam soon for board certification. I am also working with Ivy Rehab to create a year-long Pelvic Health Specialization program.

What has been your favorite Herman & Wallace Course and why?
Pelvic Floor Level 2B, since I learned more in-depth manual therapy for the pelvic floor and it helped nail down the anatomy of the pelvic region. I also love the manual therapy skills that we learned in Capstone.

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

What do you love about assisting at courses?
It's an information refresher. The more you hear it, the more it sticks. I also love teaching the students the concepts and anatomy that were originally confusing for me.

What is your message to course participants who are just starting their journey?
Continue to take more courses on pelvic floor rehab as there are so many different pelvic health conditions. Take the same concepts you learned about muscle training for any body part and apply them to the pelvic region. Connect the pelvic region to the whole body and focus on actively training it with function. It's not just about motor control of the pelvic floor muscles, it's coordinating it with the abdominals, hips, back, etc. Not all visits are hands-on one-on one-on-one. If you create a robust well-rounded program for them and they will progress quicker than you expect.

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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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