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The following post was contributed by Herman & Wallace faculty member Ramona Horton. Ramona teaches three courses for the Institute; "Myofascial Release for Pelvic Dysfunction", "Mobilization of Visceral Fascia for the Treatment of Pelvic Dysfunction - Level 1: The Urologic System", and "Mobilization of Visceral Fascia for the Treatment of Pelvic Dysfunction - Level 2: The Reproductive System". Join her at Visceral Mobilization of the Urologic System - Madison, WI on June 5-7!

 

My physical therapy training and initial experience were in the US Army, so I had a strong bias toward utilization of manual therapy techniques based on a structural evaluation.  When the birth of my 10 pound baby boy threw me head-long into the desire to become a pelvic dysfunction practitioner, I became plagued by the question: how do you treat the bowel and bladder, without treating the bowel and bladder?  That, along with a mild obsession for the study of anatomy was the genesis of my desire to explore the technique of visceral mobilization.

A few weeks ago, a pelvic course participant shared some sensitive and intimate thoughts about being at a course and being "the biggest girl in class." This week, we will address specific strategies for communicating with your patients and for adapting your exam techniques when appropriate. The following quote is from an educational book for Nurse Practitioners, and echoes a very healthy and realistic sentiment about our role when working with patients in pelvic rehabilitation.

 

"If the exam is limited by obesity, the patient should be told in a clear, non-judgmental manner. Patients have a right and responsibility to understand the findings of the health care visit."

Earlier this week a blog post asked the question "Do male therapists belong in pelvic rehab?" With increased frequency, male therapists are participating in pelvic rehab coursework and practices. Some of the male therapists are even attending coursework as students. I asked Justin Stambaugh, a student from Duke University (who very much impressed me with his command of the material, and his calm, curious, and competent demeanor), a few questions about his path into pelvic rehab. Below are his responses.

 

Tagged in: Male Pelvic Floor

Today's post on the Pelvic Rehab Report comes from faculty member Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC. Allison instructs the ultrasound imaging courses, the next of which will be Rehabilitative Ultra Sound Imaging: Women's Health and Orthopedic Topics in Baltimore, MD on Jun 12, 2015 - Jun 14, 2015.

 

If you area clinic owner, are in a management or leadership position, one of your jobs is making sure your therapists are using best practices. This can be a challenge when best practices are continually being researched and discussed, and when systematic reviews continue to tell us that pelvic rehabilitation research lacks homogeneity and enough high-level evidence to make convincing arguments about interventions. In the absence of this, we can still integrate recommendations from clinical practice guidelines and from best practice statements. The American Physical Therapy Association's (APTA) Section on Women's Health (SOWH) is participating in the APTA's initiative to develop clinical practice guidelines. For current guidelines, check out their page here. To see which guidelines are in development at the APTA, click here.

 

The American Urological Association (AUA) has also developed practice guidelines, including the Guideline on the Diagnosis and Treatment of Interstitial Cystitis/Bladder Pain Syndrome (IC/PBS). Within this guideline, the first line treatments are listed as general relaxation/stress management, pain management, patient education, and self-care/behavioral modification. Second-line treatments include "appropriate manual physical therapy techniques", oral medications, bladder medications (administered inside the bladder), and pain management. What is very interesting about this guideline is that the authors define what types of manual therapy approaches are appropriate, and these include techniques that resolve muscle tenderness, lengthen shortened muscles, release painful scars or other connective tissue restrictions. The guidelines also define who should be working with patients who have IC/PBS and pelvic muscle tenderness: "appropriately trained clinicians". Very importantly, the authors state that pelvic floor strengthening exercises should be avoided.

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Many diagnoses that live under the umbrella of "chronic pelvic pain" have similar symptoms, confounding the differential diagnosis and development of a treatment pathway. Dr. Charles Butrick, in an article published in 2007, suggested that gynecologists "…be alert to…interstitial cystitis in patients who present with chronic pelvic pain typical of endometriosis." The concurrent conditions of bladder pain syndrome (BPS) and endometriosis have been described as "evil twins syndrome" in the realm of chronic pelvic pain. Bladder pain syndrome. also known as Interstitial Cystitis (IC), is a condition commonly associated with pelvic pain, bladder pressure, and urinary dysfunction such as urgency and frequency. Endometriosis can also cause or contribute to pelvic pain, and a variety of pelvic dysfunctions including bowel, bladder, or sexual dysfunction.

 

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Even after teaching for a couple of decades, both in graduate level courses and in continuing education settings (live and online), I am humbled by all there is to learn and relearn about how to teach well. We all teach every day, regardless of what setting or roles we work in, and are required to share our thoughts and knowledge with respect, equanimity, and non-judgement. After teaching a course last month, I received feedback about an important topic that was not clearly addressed from an instructional or clinical standpoint, and the participant who brought it to my attention agreed to share her experience so that we as pelvic rehab providers can do a better job of addressing the issue when needed. The following post was written by Erin B. after I encouraged her to share her own thoughts about the issue.

 

"Having recently participated in the PF1 class after several years out of the classroom-style of continuing education, I made a few observations I felt compelled to share. (I do want to preface this with the fact that I am fully aware that my own insecurities play a role in my experiences and I recognize that they may alter my judgment of the situation.)

Today's post is written by faculty member Allison Ariail, PT, DPT, CLT-LANA, BCB-PMD, PRPC. You can join Allison in her Rehabilitative Ultrasound Imaging: Women's Health and Orthopedic Topics course, which takes place in Baltimore this year, June 12-14.

Since the mid 1990’s the POP-Q has been used to quantify, describe and stage pelvic organ prolapse. A series of 6 points are measured in the vagina in relation to the hymen. In a recent years, translabial ultrasound imaging has been used to look at the pelvic organs and the pelvic floor. A skilled practitioner can view pelvic floor muscle contractions, as well as Valsalva maneuvers and the effects each of these have on the pelvic organs. For example funneling of the urethral meatus, rotation of the urethra, opening of the retrovesical angle, and dropping of the bladder neck and uterus can be viewed using ultrasound imaging of the anterior compartment during Valsalva maneuvers. Pelvic organ descent seen on ultrasound imaging has been associated with symptoms of prolapse.

Today the Pelvic Rehab Report presents a conversation with Dr. Kimberlee Sullivan, DPT. Kimberlee was kind enough to share her thoughts on the importance of pelvic rehab and her experiences in the field.

Today's post is written by faculty member Martina Hauptmann, who instructs the Pilates for Pelvic Dysfunction, Osteoporosis, and Peripartum course. Come learn how to apply Pilates in your practice this September 19-20 in Chicago, IL!

Treating the incompetent pelvic floor (urinary incontinence and pelvic organ prolapse) is a staple of therapists who have specialized in this complex area.

Upcoming Continuing Education Courses

Aug 28, 2015 - Aug 30, 2015
Location: Washington University School of Medicine

Sep 11, 2015 - Sep 13, 2015
Location: Women's Hospital of Texas

Sep 11, 2015 - Sep 13, 2015
Location: University of Utah Orthopedic Center

Sep 12, 2015 - Sep 13, 2015
Location: Marathon Physical Therapy

Sep 12, 2015 - Sep 13, 2015
Location: East Jefferson General Hospital

Sep 19, 2015 - Sep 20, 2015
Location: Kima - Center for Physiotherapy & Wellness

Sep 19, 2015 - Sep 20, 2015
Location: Stay Fit Physical Therapy & Core Wellness, Inc.

Sep 25, 2015 - Sep 27, 2015
Location: Ohio Health

Sep 26, 2015 - Sep 27, 2015
Location: Evolution Physical Therapy

Oct 2, 2015 - Oct 4, 2015
Location: Duke University Medical Center

Oct 3, 2015 - Oct 4, 2015
Location: Cherry Creek Wellness Center

Oct 3, 2015 - Oct 4, 2015
Location: ReNew Physical Therapy

Oct 9, 2015 - Oct 11, 2015
Location: Anne Arundel Medical Center

Oct 16, 2015 - Oct 18, 2015
Location: Middlesex Hospital

Oct 16, 2015 - Oct 18, 2015
Location: Loyola University Stritch School of Medicine

Oct 17, 2015 - Oct 18, 2015
Location: Queen of the Valley Medical Center

Oct 23, 2015 - Oct 25, 2015
Location: Washington University School of Medicine

Oct 24, 2015 - Oct 25, 2015
Location: Marathon Physical Therapy

Oct 25, 2015 - Oct 26, 2015
Location: Touro College: Bayshore

Nov 6, 2015 - Nov 8, 2015
Location: Results Physiotherapy

Nov 6, 2015 - Nov 8, 2015
Location: University of Utah Orthopedic Center

Nov 6, 2015 - Nov 8, 2015
Location: Women's Hospital of Texas

Nov 6, 2015 - Nov 8, 2015
Location: Evergreen Hospital Medical Center

Nov 13, 2015 - Nov 15, 2015
Location: FunctionSmart Physical Therapy

Nov 14, 2015 - Nov 15, 2015
Location: The Everett Clinic

Nov 14, 2015 - Nov 15, 2015
Location: Restore Motion

Nov 15, 2015 - Nov 16, 2015
Location: Touro College

Dec 4, 2015 - Dec 6, 2015
Location: Washington University School of Medicine

Dec 6, 2015 - Dec 8, 2015
Location: Southview Hospital

Dec 11, 2015 - Dec 13, 2015
Location: Scripps Memorial Hospital La Jolla