This week The Pelvic Rehab Report sat down with faculty member Ken McGee, PT, DPT. Ken (they/he) is a queer transmasculine pelvic health physical therapist based in Seattle whose mission is to bring greater awareness to the pelvic health needs of the LGBTQIA2S community. Their practice, B3 Physical Therapy, centers on transgender and perinatal rehabilitation. Ken also provides peer bodyfeeding support and doula care, and can be found on Instagram at @b3ptcob3ptco.

You can join Ken in their remote course, Perinatal Mental Health: The Role of the Pelvic Rehab Therapist, scheduled for October 22, 2022.

Who are you? Describe your clinical practice.
Experiencing inadequate care for my own pelvic health conditions as a teenager motivated me to become a pelvic health physical therapist. Being a member of the queer community further drove me to offer trauma-informed care and develop better access to care through home visits. Currently, I split my time between providing gender-affirming physical therapy and serving as a birth doula.

What lesson have you learned (in a course, from an instructor, or from a colleague or mentor) that has stayed with you?
Very few clients will remember detailed biomechanical explanations or every exercise you teach them. However, each client will remember how you treated them and how you made them feel. Asking clients about their preferences for care and following up go a long way in establishing rapport.

What do you find is the most useful resource for your practice?
One of my favorite resources is Decolonizing Fitness. It is an educational platform by Ilya Parker, PTA, (he/they). It provides a catalog of exercises and trainings for people looking to improve their care of gender-diverse people and People of Global Majority.

What books or articles have impacted you as a clinician?
The healthcare field regularly puts people in boxes to determine care. For example, many providers might determine care based on whether someone is a transgender woman or man. However, gender is actually someone’s individual experience rather than a category. Kate Bornstein’s My New Gender Workbook is a good starting point for understanding gender as uniquely one’s own, rather than part of a treatment algorithm.

What made you want to create this course, Perinatal Mental Health?
I wanted to create this course because, as a parent and physical therapist, I see both the challenges that the perinatal period presents, as well as the ways that rehabilitation providers can support mental health. In developing the content, I drew upon my background as a volunteer for a perinatal mental health warm line.

What need does your course fill in the field of pelvic rehabilitation?
Pelvic rehabilitation providers regularly interact with people who have mental health challenges. However, there are very few courses that specifically address the needs of the pelvic health providers serving folks in the perinatal period. This course looks at perinatal mental health from the perspective of pelvic rehabilitation providers, while offering specific actions providers can take to support their clients.

Who, what demographic, would benefit from your course?
Rehabilitation providers of any experience level would benefit from taking this course. Providers who are new parents or considering becoming pregnant may also find the content personally enriching. While the research discussed in this course focused on the perinatal period, much of it can be extrapolated to other populations.

What is your message to course participants who are just starting their journey?
For people just starting in pelvic rehabilitation, I would recommend focusing on patient education. For me, I find that the greatest amount of client improvement comes through reviewing the basics. It’s okay to still be developing skills in manual therapy.

Perinatal Mental Health: The Role of the Pelvic Rehab Therapist

Price: $150

Contact Hours: 5.75

Course Date: October 22, 2022

Description: This one-day remote course covers mental health considerations in pregnancy and postpartum and is targeted to the pelvic rehab clinician treating patients in the peripartum period. Topics include common mental health concerns in the postpartum period including depression, anxiety, OCD, and PTSD, as well as the connectedness between mental health and physical dysfunction. The course will introduce useful screening tools and how to connect patients to resources and diagnosing professionals. Labs will include partnered breakout sessions to practice listening and dialogue skills. The course also includes a review of coping techniques to support mental health and physical symptoms.

Rachna Mehta PT, DPT, CIMT, OCS, PRPC, RYT 200 has a personal interest in various eastern holistic healing traditions, and she noticed that many of her chronic pain patients were using complementary health care approaches including acupuncture and yoga. Her course Acupressure for Optimal Pelvic Health brings a unique evidence-based approach and explores complementary medicine as a powerful tool for holistic management of the individual as a whole focusing on the physical, emotional, and energy body.

There is worldwide concern over the increasing rates of pharmacologically induced labor, opioid use, and operative birth. Women are seeking holistic non-pharmacologic options to avoid medical and surgical interventions in childbirth which has led to the popularity of Complementary and Alternative Medicine (CAM) therapies. Despite CAM existing outside of conventional heath systems, a substantial number of women have been found to use CAM to manage their health during pregnancy¹.

Among CAM therapies, Acupuncture and Acupressure have been found to be helpful for pregnancy-related symptoms such as nausea, breech presentation, and labor induction with post-partum recovery considerations as well. Acupressure has roots in Acupuncture and is based on more than 3000 years of Traditional Chinese Medicine (TCM). TCM supports Meridian theory and meridians are believed to be energy channels that are connected to the function of the visceral organs. Acupoints located along these meridians transmit Qi or the bio-electric energy through a vast network of interstitial connective tissue connecting the peripheral nervous system to the central viscera.

A systematic review published by Smith et al² looked at the use of Acupuncture or Acupressure for pain management during labor. They noted that the pain women experience during labor can be intense, with body tension, anxiety, and fear making it worse. The data included a total of 3960 women and found that Acupressure may reduce pain intensity in women experiencing labor pain.

Another RCT published by Levett et al included 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics. They incorporated six evidence-based complementary medicine techniques: Acupressure, visualization and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomization occurred at 24–36 weeks’ gestation, and participants attended a 2-day antenatal education program plus standard care, or standard care alone.

The study found a significant difference between the two groups with the study group having decreased epidural use (23.9%) compared to the standard care group (68.7%). The study group participants also reported a reduced rate of cesarean section and length of the second stage among other measures.

An article published by Debra Betts³ discusses several key considerations for promoting physiological Labor with Acupuncture. Multiple studies have cited the effectiveness of Acupressure by stimulating these powerful Acupoints as well. The author states that the suggestion of Acupoints cited below are based on both her clinical practice and midwifery feedback and are by no means an exhaustive list. The practitioner is encouraged to explore Traditional Chinese Medicine to promote efficient physiological labor in women.

Key considerations for promoting natural physiological labor include:

Is the baby in an optimal anterior position? The author states “Women can become involved in their own treatment by learning proactive positioning. This involves a woman keeping her knees lower than her hips when sitting, in order to assist gravity in moving her baby into the best possible position. Bucket‑type seats such as car seats and comfy sofas, therefore, need to be abandoned in favor of birthing balls, sitting astride chairs (with the arms resting on the back).” Key acupuncture points that can be stimulated include Bladder 60 ( BL 60), Spleen 6 (Sp 6), and Bladder 67 (BL 67). Bladder 60 (BL 60) is considered an empirical induction point. Midwifery feedback suggests that this is a useful point for promoting an optimal position of the baby for birth. Bladder 67 (BL 67) is considered an extremely important point if the baby is not in an anterior position.

Is the woman emotionally prepared for labor? While most women have some level of underlying anxiety or fear about the approaching birth, it is essential to address any significant emotional disharmony. The hormone oxytocin is released several weeks prior to labor, initially stimulating uterine contractions at night, with increasing production then aiding the transition into labor. Stress hormones such as adrenaline and noradrenaline have a direct inhibiting effect on natural oxytocin release, and therefore play a very significant role in inhibiting contractions². Key acupuncture points that can be stimulated include Kidney 1 (KD 1), Liver 3 (Liv 3), and Pericardium 6 (P6) among others. Kidney 1 (K1) is useful for women who are experiencing fear of induction or childbirth itself. Liver 3 (Lv 3) is helps in improving Liver chi. Pericardium 6 (P6) is helpful for nausea, regulating the heart and calming.

Is the woman physically prepared for labor? Women may be physically exhausted or have pre-existing physical conditions that, once addressed, will help to promote physiological labor². Key acupuncture points that can be stimulated include Bladder 43 (BL 43) and Stomach 36 (St 36). Bladder 43 ( BL 43) is A point that tonifies and nourishes the Lung, Heart, Kidneys, Spleen, and Stomach. Stomach 36 (ST 36) is a useful point to reinforce if the woman is exhausted, due to its qi-tonifying and blood-nourishing properties.

Stimulating contractions:  Debra Betts also notes that key points of the Bladder meridian that are located on the sacrum are crucial in initiating contractions. While Traditional Chinese Medicine (TCM) does consider some Acupuncture points like Large Intestine 4 (LI 4), Gall Bladder 21 (GB 21), and Spleen 6 (Sp 6) should not be stimulated in pregnant women, the opposite is true when we want to initiate labor and these points can be additionally used to assist in stimulating contractions.

Acupressure can also be used in the post-partum period for overall generalized well-being, promoting a sense of bonding with the baby, calm, and relaxation.

Acupressure can be used to stimulate key energy points also known as Acupoints in various meridians and as hands-on musculoskeletal specialists, we can use and teach this modality to our patients. Acupressure requires no equipment, is easy for clinicians to teach and for patients to self-administer when taught correctly, and is an empowering self-care tool to promote optimal health outcomes.

The course Acupressure for Optimal Pelvic Health focuses on powerful Acupressure points in key Meridians including the Kidney, Bladder, Spleen, and Stomach meridians. It also explores Yin Yoga as an integrative intervention with Acupressure. Yin Yoga, a derivative of Hath Yoga is a wonderful complimentary practice to Acupressure. Yin Yoga is a slow and calm meditative practice that uses seated and supine poses that are held for three to five minutes with deep breathing. It stimulates the energy flow through the meridian channels by creating tension along specific meridian lines.

This course is curated and taught by Rachna Mehta. To learn how to integrate Acupressure into your clinical practice, join the next scheduled remote course on June 25- 26, 2022.

References

1. Steel A, Adams J, Sibbritt D, Broom A. The Outcomes of Complementary and Alternative Medicine Use among Pregnant and Birthing Women: Current Trends and Future Directions. Women’s Health. May 2015:309-323. doi:10.2217/WHE.14.84.
2. Smith CA, Collins CT, Levett KM, et al. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev. 2020;2(2): CD009232.
3. Betts, Debra. Inducing Labour with Acupuncture–Crucial Considerations. Journal of Chinese Medicine. 2009;90: 20-25.
4. Atkins KL, Fogarty S, Feigel ML. Acupressure and Acupuncture Use in the Peripartum Period. Clin Obstet Gynecol. 2021;64(3):558-571. doi:10.1097/GRF.0000000000000636.
5. Levett, Kate M., Smith, C.A., Bensoussan, A. & Dahlen, H.G. Complementary therapies for labour and birth study: a randomized controlled trial of antenatal integrative medicine for pain management in labour.  BMJ Open, 2016 Jul 12;6(7):e010691. DOI: 10.1136/bmjopen-2015-010691.
6. Schlaeger JM, Gabzdyl EM, Bussell JL, et al. Acupuncture and Acupressure in Labor. J Midwifery Women's Health. 2017;62(1):12-28. doi:10.1111/jmwh.12545.

Acupressure for Optimal Pelvic Health 
Instructor: Rachna Mehta PT, DPT, CIMT, OCS, PRPC, RYT 200

Price: $450
Experience Level: Beginner
Contact Hours: 12.5

Course Dates: June 25-26, 2022 and October 15-16, 2022

Course Description:
This continuing education course is a two-day seminar that offers participants an evidence-based perspective on the application of Acupressure for evaluating and treating a host of pelvic health conditions including bowel, bladder, and pelvic pain issues. The course explores a brief history of Acupressure, its roots in Acupuncture and Traditional Chinese Medicine (TCM), and presents current evidence that supports the use of complementary and alternative medicine as an adjunct to western medicine. TCM concepts of Meridian theory and energy channels are presented with scientific evidence of Acupoints transmitting energy through interstitial connective tissue with potentially powerful integrative applications through multiple systems.

Lectures will present evidence on the use of potent Acupressure points and combinations of points for treating a variety of pelvic health conditions including chronic pelvic pain, dysmenorrhea, constipation, digestive disturbances, and urinary dysfunctions to name a few. Key acupoints for decreasing anxiety, and stress and bringing the body back to a state of physiological balance are integrated throughout the course.

Participants will be instructed through live lectures and demonstrations on the anatomic location and mapping of acupressure points along five major meridians including the spleen, stomach, kidney, urinary bladder, and gall bladder meridians. Key associated points in the pericardium, large intestine, small intestine, lung and liver meridians as well as the governing and conception vessels will also be introduced. The course offers a brief introduction to Yin yoga and explores Yin poses within each meridian to channel energy through neurodynamic pathways to promote healing across multiple systems. Participants will learn how to create home programs and exercise sequences and will be able to integrate acupressure and Yin yoga into their orthopedic and pelvic health interventions.

Special Considerations and Lab materials
The labs for this course will involve external whole-body palpation and mapping of acupressure points. Please wear fitted t-shirt and leggings or yoga pants for acupressure point mapping. Participants should buy a pack of 1-inch diameter white circle stickers to be used in Labs for mapping acupressure points.

Participants are encouraged to use a Yoga mat if available and any other props they may have at home including yoga blocks, small blankets, towels and pillows to be used in the guided Yin Yoga Lab portion of the course.

Recommended resources: It is recommended that participants purchase an Acupressure Point Chart for ease of following the course work and labs in this course. Since the accuracy of points and content may vary on different charts, it is recommended to buy a copy at https://acupressure.com/products/acupressure-charts/

Target Audience:
This continuing education seminar is targeted to rehabilitation professionals who use manual therapy as a treatment modality. Knowledge of acupressure points with specific anatomical landmarks will enable clinicians to add to their toolbox skills for treating a variety of pelvic health conditions related to the bowel, and bladder and treatment of pelvic pain.

Prerequisites:
It is recommended that the participants have a working knowledge of the functional anatomy of pelvic floor muscles as well as various associated pelvic health conditions. Pelvic Floor 1 through Herman & Wallace is strongly recommended.

The Birth Healing Summit is a virtual summit that runs from April 4th through April 14th. Faculty member Nari Clemons will be speaking on Sunday, April 10th!

H&W is partnering again this year to bring the Birth Healing Summit virtually to you. Lectures throughout the summit present practical information, instruction, and tools that can be implemented in your practice right away. The summit is scheduled to run from April 4th to April 14th with 2 recordings going live each day with the intention to help practitioners to help moms heal body, mind, and spirit after birth! Also, twice during the summit, there will be a LIVE Facebook Q & A which is a great opportunity to speak to the experts and ask any questions you may have.

You can register for the summit now or get more information on the website here:
https://courses.instituteforbirthhealing.com/birth-healing-summit/ibh/77

As physical therapists and bodyworkers, the majority of training is focused on anatomy, physiology, and techniques to apply force to the body. While this is an effective way to treat the body, the summit is going to explore “out-of-the-box” solutions to achieve deeper healing. All 20 interviews will introduce you to a new approach to treating the common postpartum issues that women face.

These interviews are so packed with valuable information, instruction, and tools that you will want to listen to them over and over again. The All-Access Pass – Video or Video Plus, will allow you to review each at your own convenience or refer back to the information for a specific client case. It’s like having a reference library at your fingertips whenever you need it.

DAILY ACCESS: You receive 20 interviews with experts, plus their gifts for FREE!
Here is how it works:
- Starting April 4th, 2 speaker video-recorded interviews will be released each day.
- You will have 48hr to view, learn and enjoy the interviews.
- Sorry, no CEU’s available

VIDEO ALL-ACCESS PASS: You receive immediate access to all 20 interviews and the gifts.
Here is how it works:
- Starting March 21, you can purchase to gain full access to all the video-recorded interviews and gifts.
- You will have lifetime access to learn and enjoy the interviews.
- Sorry, no CEU’s available.

VIDEO PLUS ALL-ACCESS PASS: You receive immediate access to all 20 interviews and the gifts.
Here is how it works:
- Starting March 21, you can purchase to gain full access to all the video-recorded, audio, and transcripts plus the gifts.
- You will have lifetime access to learn and enjoy the interviews.
- Sorry, no CEU’s available.

Herman & Wallace's own Nari Clemons will be one of the 20 speakers talking about 'Mediation and Intention as Tools to Decrease Burnout' which is close to her heart! If you join Nari's lecture and enjoy the subject, she also co-instructs a course with Jennafer Vande Vegte for H&W to further deep dive into this topic called Boundaries, Self-Care, and Meditation which can be found on the H&W Online Courses page.

A few of the other lecturers and topics that you may be interested in:
- Lynn Schulte, PT - Pregnancy and Postpartum Impact on the Organs
- Rachel Shapiro, CNM - The Uterosacral LIgament - Sex and Postpartum Wellness
- Kathleen Kendall Tackett A New Paradigm for Depression in New Mothers
- Raylene Phillips, MD - Preventing and Minimizing Birth Trauma
- Rixa Freeze - Making Breech Birth Safe Again


Better support your client's pregnancy and labor and speed up their recovery by listening in. H&W hopes to see you at the Summit! Join the Summit Here: https://courses.instituteforbirthhealing.com/birth-healing-summit/ibh/77