Sexual dysfunction is often multifactorial, and while pelvic floor muscle impairments are a common contributor, dermatological conditions can also play a significant role. Two important but sometimes overlooked conditions, lichen sclerosus (LS) and lichen planus (LP), can dramatically affect sexual health, patient comfort, and overall quality of life.

For pelvic health providers, recognizing the symptoms and understanding when to refer is essential to providing comprehensive care.

What are Lichen Sclerosus and Lichen Planus?

• Lichen sclerosus (LS): A chronic, inflammatory skin condition that often affects the vulva or penis. LS can cause itching, burning, white patches of thin skin, and, over time, scarring may restrict function and contribute to painful intercourse.
• Lichen planus (LP): Another inflammatory condition that may affect skin, mucous membranes, and genital tissue. LP can cause redness, erosion, and pain that interfere with both daily activities and sexual function.

Both conditions are underdiagnosed, frequently misunderstood by patients and doctors, and often mistaken for recurrent infections or generalized pelvic pain.

Key Research Highlights

• High Prevalence of Sexual Dysfunction in LS
  • A systematic review and meta-analysis reported that nearly 60% of women with vulvar lichen sclerosus experience sexual dysfunction, with dyspareunia (pain during intercourse) being the most common issue (1).
• Impact on Quality of Life and Physical Activity
  • A cross-sectional study of 603 women with LS or LP found significant decreases in quality of life, overall health status, and physical activity, highlighting how genital dermatologic conditions can profoundly affect daily functioning and mobility (2).
• Sexual Distress in Genital Erosive Lichen Planus (GELP)
  • Research involving women with erosive genital LP showed high levels of sexual distress and reduced quality of life, with many participants scoring above thresholds that indicate serious impact on sexual well-being (3).
• Psychosexual Counseling Improves Outcomes
  • A randomized controlled trial found that combining psychosexual counseling with usual medical care led to significant improvements in sexual function and overall quality of life for women with LS, particularly in domains directly related to sexual well-being (4).
• Pelvic Floor Physical Therapy as a Supportive Strategy
  • According to a summary from a Pelvic Health PT blog, pelvic floor physical therapy, including techniques like myofascial release, soft tissue mobilization, clitoral hood mobilization, and breathwork, can alleviate dyspareunia and improve tissue mobility in individuals with LS (5).

The Pelvic Rehab Provider’s Role
Unrecognized dermatological conditions can prolong suffering, worsen pelvic pain, and contribute to psychological distress around sexual health. As part of a multidisciplinary team, pelvic rehab providers are instrumental in improving outcomes for patients with these complex conditions.

While pelvic health professionals do not diagnose dermatological conditions, they are often the first, or sometimes the only, clinicians who take the time to observe and inspect the vulva as part of a comprehensive evaluation. This makes the Q-tip test a critical component of the pelvic health exam. Through careful observation, we can identify tissue changes, localized pain responses, or dermatological conditions that may otherwise go unnoticed. Incorporating this exam allows us not only to guide treatment appropriately within the scope of pelvic rehabilitation but also to recognize when referral to gynecology, dermatology, or another specialist is necessary. This ensures patients receive timely and comprehensive care for conditions that directly impact pelvic health and quality of life. Common clinical presentations include:

• Patients report persistent pain, itching, burning in the vulva, and tearing (especially at the posterior fourchette) during sexual activity.

• Observation of skin changes in the perineal or vulvar region during external pelvic exams. This can present as waxy, shiny, thin, and similar appearance to vitiligo.
• Patients with pelvic pain who have not responded to traditional pelvic rehab approaches.

By identifying potential signs of LS or LP, PTs can facilitate timely referral to dermatology or gynecology/urology, ensuring patients receive the medical care they need. Once managed medically, pelvic rehabilitation can then help restore comfort, optimize pelvic floor function, and improve confidence in sexual activity.

Want to expand your skills in treating sexual dysfunction related to pelvic floor health?
Join us for Sexual Medicine in Pelvic Rehab, a remote course on September 27–28, 2025, where Tara Sullivan, PT, DPT, PRPC, WCS, IF will dive deep into evidence-based strategies for addressing sexual dysfunction, including conditions like lichen sclerosus and lichen planus.

Register today to enhance your clinical expertise and confidence in this essential area of practice.

References

1. Pope R, Lee MH, Myers A, Song J, Abou Ghayda R, Kim JY, Hong SH, Lee SB, Koyanagi A, Jacob L, Smith L, Shin JI. Lichen Sclerosus and Sexual Dysfunction: A Systematic Review and Meta-Analysis. J Sex Med. 2022 Nov;19(11):1616-1624. doi: 10.1016/j.jsxm.2022.07.011. Epub 2022 Sep 15. PMID: 36115787.
2. Dietz RJ, van de Berg NJ, van der Vegt AJ, van den Berg CB, van der Marel IC, van Wijk FH, Maliepaard M, van Beekhuizen HJ, van Doorn HC. Impact of vulvar lichen sclerosus and lichen planus on quality of life, mobility, bicycling, physical activity, and health. Maturitas. 2025 Aug;199:108651. doi: 10.1016/j.maturitas.2025.108651. Epub 2025 Jun 26. PMID: 40592218.
3. Skullerud, Kristin Helene MD1; Gjersvik, Petter MD, PhD2; Eberhard-Gran, Malin MD, PhD1; Pripp, Are Hugo PhD3; Qvigstad, Erik MD, PhD2; Vangen, Siri MD, PhD1; Helgesen, Anne Lise Ording MD, PhD4. Sexual Distress and Quality of Life in Women With Genital Erosive Lichen Planus—A Cross-sectional Study. Journal of Lower Genital Tract Disease 29(1):p 72-75, January 2025. | DOI: 10.1097/LGT.0000000000000847
4. Vittrup G, Westmark S, Riis J, Mørup L, Heilesen T, Jensen D, Melgaard D. The Impact of Psychosexual Counseling in Women With Lichen Sclerosus: A Randomized Controlled Trial. J Low Genit Tract Dis. 2022 Jul 1;26(3):258-264. doi: 10.1097/LGT.0000000000000669. Epub 2022 Mar 25. PMID: 35333024; PMCID: PMC9232275.
5. Dy, Debbie (2025, August 29). Lichen Sclerosus & Pelvic Floor Physical Therapy: How to Manage Symptoms & Improve Vulvar Health. Femina Physical Therapy. https://feminapt.com/blog/lichen-sclerosus-pelvic-floor-physical-therapy-how-to-manage-symptoms-improve-vulvar-health

We are excited to share that Allison Ariail, PT, DPT, CLT, BCB-PMD, PRPC, longtime faculty member and Content Developer, is stepping into the role of Director of Education at Herman & Wallace.

Allison has been teaching with H&W since 2011 and has played a major role in developing courses such as the Capstone, Oncology series, Anorectal Ballooning, and the Peripartum series. With 25 years of clinical experience and expertise in oncology, lymphedema, and rehabilitative ultrasound, she brings both depth and vision to this position.

This transition follows Holly Tanner’s decision to step away from the role after 15 years of leadership. Holly’s contributions include co-developing the PRPC certification, guiding new course and faculty development, and helping to steer H&W through the COVID pivot to online learning. Her impact has shaped the education of more than 30,000 therapists and we are deeply grateful for her dedication.

 Allison shares, “Working with Herman & Wallace these past 15 years has been one of the most satisfying aspects of my career. It is a privilege and honor to be Director of Education, and I look forward to meeting many more passionate pelvic floor practitioners and furthering the profession together.”

Please join us in celebrating Holly’s legacy and welcoming Allison to her new role!

Eating disorders affect 2–5% of individuals worldwide, with a higher prevalence among females (Attia & Walsh, 2025). These disorders carry significant medical and psychiatric complications, high outpatient care costs, impaired daily functioning, and reduced quality of life (Attia & Walsh, 2025; Almeida et al., 2024).

Types of Eating Disorders
Anorexia Nervosa (AN):
A persistent restriction of food intake leading to low body weight, intense fear of weight gain, and distorted body image. AN has two subtypes:

• Restrictive (AN-R) – primarily limited intake.
• Binge-Eating/Purging (AN-BP) – restriction combined with purging behaviors.

AN can result in severe medical complications and even be life-threatening (Moore & Bokor, 2023; Uniake et al., 2020).

Binge Eating Disorder (BED):
Recurrent episodes of consuming unusually large amounts of food (within 2 hours or less) with a sense of loss of control. Unlike bulimia, BED does not involve compensatory behaviors such as purging. Episodes often lead to shame, guilt, and distress (Berkman et al., 2015).

Bulimia Nervosa (BN):
Characterized by recurrent binge eating followed by compensatory behaviors like vomiting, laxative use, diuretics, fasting, or excessive exercise. These behaviors aim to prevent weight gain and carry serious health risks (Jain & Yilanli, 2023).

Other Specified Feeding and Eating Disorders (OSFED):
A category for individuals who don’t fully meet criteria for AN, BN, or BED but still experience significant symptoms. Examples include atypical anorexia, purging disorder, sub-threshold bulimia, sub-threshold BED, and night eating syndrome. OSFED, however, can cause symptoms that result in the same severity, health risks, and distress (Attia and Guarda 2024)

Avoidant/Restrictive Food Intake Disorder (ARFID):
Marked by apparent lack of interest in eating or food low appetite, extreme avoidance based on the sensory characteristics of food (such as texture, appearance, color, or smell), or fear of negative consequences of eating (fear of choking, nausea, vomiting, constipation, allergic reactions). ARFID can lead to nutritional deficiencies, weight loss, impairments of psychosocial functioning, impaired growth in children, and the need for supplements or tube feeding. It often begins in childhood but can present at any age (Ramirez & Gunturu, 2025).

Gastrointestinal Symptoms and Eating Disorders;
Gastrointestinal symptoms are common in those with eating disorders, often caused by malnutrition, anxiety, somatization, or pre-existing GI conditions. Common complaints include:

• Nausea
• Abdominal bloating and pain
• Early satiety and prolonged fullness
• Constipation and straining
• Pelvic organ prolapse symptoms
• Fecal incontinence (Gibson et al., 2021; Almeida et al., 2024)

A systematic review by Gibson et al. (2021) found that GI symptoms not only result from eating disorders but can also perpetuate disordered eating behaviors.

Multiple factors may contribute to the onset or perpetuation of the continuation of eating disorders or eating disorder behaviors. Medical conditions with GI predominant conditions also may contribute to eating disorders or disordered eating patterns (Gibson et al, 2021). These conditions can include:

• Celiac
• Irritable bowel disease
• Disorders of Gut-Brain Interaction (DGBI) - also called functional gastrointestinal disorders (FGID) in past literature (Almeida, 2024).
• Pelvic dysfunction
• Ehlers-Danlos Syndrome also may contribute to eating disorders or disordered eating patterns (Gibson et al, 2021).

DGBI / FGIDs include disturbances of the microbiome, hypersensitivity of gut viscera, altered processing of the brain and the enteric nervous system, and/or altered immune and mucosal function (Gibson et al. 2021). In addition, GI-related symptoms may also be a result of the physiological and medical complications to malnutrition (Gibson, 2021). The process of nutritional rehabilitation can cause severe GI distress as food is introduced in larger or more frequent amounts to an impaired GI system.

Interestingly, in the conclusions of Gibson et al’s systematic review, the authors recommended that additional research is necessary to “investigate those therapeutic modalities” to treat the FGID components, such as pharmacologic agents to treat GI pathophysiologic changes. Rehabilitation-based strategies should be considered a first-line approach with these individuals.

Building on this, Almeida et al. conducted a retrospective cohort study (2010–2020) of 344 individuals with eating disorders who sought gastrointestinal care. More than 75% had an eating disorder diagnosis prior to their GI consultation, with functional and motility disorders being the most common findings. The study suggested that eating disorders may contribute to gastrointestinal symptoms through their effects on the enteric, central, and autonomic nervous systems.

Additionally, weight loss and malnutrition can create pathological changes in gastrointestinal function, further worsening symptoms (Almeida et al., 2024). In this cohort, more than half of the participants were diagnosed with IBS, functional dyspepsia/gastroparesis, or constipation. While the pathophysiology of Disorders of Gut-Brain Interaction (DGBIs) is still being clarified, current evidence suggests that dietary restriction and compensatory behaviors such as purging are likely contributing factors (Almeida et al., 2024).

Why Pelvic Rehabilitation Matters
Pelvic rehabilitation professionals bring a unique skillset to this population:

• Enhancing quality of life by addressing pelvic floor and GI dysfunction.
• Recognizing warning signs of eating disorders in patients referred for GI or pelvic symptoms.
• Facilitating referrals to appropriate medical and mental health professionals.

While we do not diagnose eating disorders, pelvic health clinicians can play a pivotal role within a multidisciplinary treatment team by supporting patients physically, identifying red/yellow flags, and advocating for integrated care.

Learn More
Join me on October 4–5, 2025 for Eating Disorders and Pelvic Health Rehabilitation, a comprehensive course on eating disorders and pelvic health. Together, we’ll explore:

• Signs, symptoms, and medical complications of eating disorders.
• Multidisciplinary treatment strategies.
• Pelvic rehabilitation techniques to support individuals living with eating disorders.

Register today for Eating Disorders and Pelvic Health Rehabilitation to expand your skills and make a difference in this complex, underserved population

References

1. Almeida, M. N., Atkins, M., Garcia-Fischer, I., Weeks, I. E., Silvernale, C. J., Samad, A., Rao, F., Burton-Murray, H., & Staller, K. (2024). Gastrointestinal diagnoses in patients with eating disorders: A retrospective cohort study 2010-2020. Neurogastroenterology and motility, 36(6), e14782. https://doi.org/10.1111/nmo.14782
2. Attia, E., & Guarda, A. S. (2024). OSFED Subtypes: The Need for Better Definitions. The International journal of eating disorders, 57(10), 2053–2055. https://doi.org/10.1002/eat.24275
3. Attia, E., & Walsh, B. T. (2025). Eating Disorders: A Review. JAMA, 333(14), 1242–1252. https://doi.org/10.1001/jama.2025.0132
4. Berkman ND, Brownley KA, Peat CM, et al. Management and Outcomes of Binge-Eating Disorder [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Dec. (Comparative Effectiveness Reviews, No. 160.) Introduction. Available from: https://www.ncbi.nlm.nih.gov/books/NBK338301/
5. Jain A, Yilanli M. Bulimia Nervosa. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562178/
6. Gibson, D., Watters, A., & Mehler, P. S. (2021). The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?-A systematic review. The International journal of eating disorders, 54(6), 1019–1054. https://doi.org/10.1002/eat.23553
7. Guarda A. (2023, February). What are eating disorders?org. https://www.psychiatry.org/patients-families/eating-disorders/what-are-eating-disorders
8. Moore CA, Bokor BR. Anorexia Nervosa. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from https://www.ncbi.nlm.nih.gov/books/NBK459148/
9. Ramirez Z, Gunturu S. Avoidant Restrictive Food Intake Disorder. [Updated 2024 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK603710/
10. Substance Abuse and Mental Health Services Administration. Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 3.33, DSM-IV to DSM-5 Avoidant/Restrictive Food Intake Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t33/
11. Uniacke, B., Slattery, R., Walsh, B. T., Shohamy, D., Foerde, K., & Steinglass, J. (2020). A comparison of food-based decision-making between restricting and binge-eating/purging subtypes of anorexia nervosa.The International journal of eating disorders, 53(10), 1751–1756. https://doi.org/10.1002/eat.23359

AUTHOR BIO
Carole High Gross PT, DPT, PRPC

Carole High Gross, PT, MS, DPT, PRPC earned her Doctorate of Physical Therapy from Arcadia University in 2015, and her Master of Science in Physical Therapy in 1992 from Thomas Jefferson University. Carole earned her Pelvic Rehabilitation Practitioner Certification and enjoys working as a Pelvic Clinical Rehabilitation Specialist for Lehigh Valley Health Network.

Carole serves as a Lead Teaching Assistant for the Herman & Wallace Pelvic Rehabilitation Institute for pelvic floor education courses. She is also an instructor with the Herman and Wallace Institute for Eating Disorders and Pelvic Health Rehabilitation: The Role of a Rehab Professional. Carole serves on the Pelvic Workgroup of the Ehlers-Danlos International Consortium. Carole has a special interest in working with individuals living with eating disorders and hypermobility throughout the pregnancy and postpartum journey. In addition, Carole enjoys working with all genders with pelvic, bowel, bladder, and abdominal issues. Carole is passionate about lifelong learning. She resides in Bucks County, Pennsylvania, and enjoys spending time with her family and pups.

How Did It All Get Started?
When I first began treating children with bowel and bladder issues, my focus was on the obvious physiological concerns: bedwetting, dysfunctional voiding, vesicoureteral reflux, constipation. Over time, though, I noticed consistent musculoskeletal patterns - children with increased thoracic extension, hyper lordosis a protruding abdomen, increased rib angles, and weak core stability.

It became clear that these pressure and postural issues were impacting their normal developmental patterns. That realization changed everything about how I approached treatment.

Why Did I Create This Course?
Not every therapist wants to specialize in pediatric bowel and bladder disorders. But every therapist who works with kids should be able to recognize the musculoskeletal consequences that often accompany these issues.

My goal in creating this course, Pediatric Pelvic Floor ,Diaphragm, and Postural Development, was to bridge the gap: to help therapists identify and treat the postural, respiratory, and core stability challenges these children face—without requiring them to become bowel and bladder experts.

The relationship goes both ways:

• Children with special needs or musculoskeletal asymmetries often have weak cores, postural compensation, and develop poor bowel and bladder habits.
• Children with unresolved bowel and bladder dysfunction often develop weak cores and abnormal movement patterns as a result.

A few examples stand out:

• A non-verbal child with spastic quadriplegia was experiencing up to 11 daily “episodes” and difficulty sleeping. Once his constipation was addressed, his episodes dropped to 1–3 per day, and he began sleeping through the night.
• Another child with low tone withheld stool out of fear and discomfort on the toilet, eventually developing fecal incontinence. What looked behavioral was truly physiologic, and once addressed, his core stability and pressure system improved significantly.

These cases remind me: sometimes we’re detectives. And when we get it right, families see life-changing results - often in a short time.

What’s In This Course?
As I dug deeper into these patterns, I followed fascinating paths of developmental physiology. I learned how the diaphragm, ribcage, and pelvic floor interact as a pressure system, shaping core stability, continence, and postural development. The puzzle pieces came together—and I began creating fun, pediatric-friendly exercises to target these issues with purpose.

In this course, you will:

• Gain understanding of the development of the diaphragm and pelvic floor muscles (PFM) as they relate to core function and continence in children.
• Learn how to connect the ribcage, diaphragm, and pelvic floor for proper core activation.
• Receive instruction in the anatomy and development of the diaphragm and its relationship to the pelvic floor/core.
• Focus on assessment and treatment and connection of the core, thoracic spine, ribcage, breathing, and PFM.

By the end, you’ll be equipped with practical strategies to recognize musculoskeletal consequences of pressure dysfunction and confidently address them, helping kids regain function, stability, and independence.

To learn more, sign up to attend the upcoming Pediatric Pelvic Floor, Diaphragm, and Postural Development scheduled for September 21, 2025.

AUTHOR BIO
Dawn Sandalcidi PT, RCMT, BCB-PMD

Dawn Sandalcidi is a trailblazer and leading expert in the field of pediatric pelvic floor disorders. She graduated from SUNY Upstate Medical Center in 1982 and is actively seeing patients in her clinic Physical Therapy Specialists, Centennial CO.

Dawn is a national and international speaker in the field, and she has gained so much from sharing experiences with her colleagues around the globe. In addition to lecturing internationally on pediatric bowel and bladder disorders, Dawn is also a faculty instructor at the Herman & Wallace Pelvic Rehab Institute. Additionally, she runs an online teaching and mentoring platform for parents and professionals.

In 2017, Dawn was invited to speak at the World Physical Therapy Conference in South Africa about pediatric pelvic floor dysfunction and incontinence. Dawn is also Board-Certified Biofeedback in Pelvic Muscle Dysfunction (BCB-PMD). She has also been published in the Journals of Urologic Nursing and Section of Women’s Health.

In 2018, Dawn was awarded the Elizabeth Noble Award by the American Physical Therapy Association Section on Women's Health for providing Extraordinary and Exemplary Service to the Field of Physical Therapy for Children.

CPT code 97110 describes a therapeutic exercise procedure used in physical and occupational therapy to develop strength, endurance, range of motion, and flexibility for one or more body areas.

Herman & Wallace Senior Faculty member Pam Downey, PT, MSPT, DPT, WCS, BCB-PMD, PRPC, CSCS has been integrating Pilates into the treatment of pelvic floor and spine dysfunction for more than 20 years. She explains, “I use Pilates every day in practice to teach patients that movement is therapeutic and accessible—even for those who feel overwhelmed by their diagnosis.”

Pilates offers clinicians a unique lens for evaluating movement dysfunction. Because many patients are unfamiliar with Pilates, these exercises often reveal compensatory patterns that may be contributing to their symptoms. Dr. Downey highlights how equipment like the Reformer allows her to adapt spring tension - providing support when needed or adding challenge for patients further along in their rehab journey.

A Clinical Pearl from Dr. Downey
One of Dr. Downey’s go-to strategies involves using Pilates Footwork and Hamstring Arc strap work in the treatment of a short, tight pelvic floor.

Patients with restricted adductors, hip flexors, or hip rotators—often the result of prior injury or habitual postures - can inadvertently create excessive tension in the pelvic floor. When this is paired with dysfunctional breathing patterns (such as upper chest breathing), intra-abdominal pressure (IAP) regulation becomes compromised.

By integrating breathwork into supine strap exercises, patients experience both a sensory and motor connection to lengthening the pelvic floor. This helps them achieve the sought-after “drop” during volitional pelvic floor movement.

Dr. Downey reflects, “Patients really understand it once they feel their muscles stretch and release on the equipment. The best reward for me is when they return with improved movement patterns and reduced pelvic floor symptoms.”

Is This Course Right for You?
This Pilates-focused rehabilitation course may be a fit if you:

• Want to explore Pilates, but don’t know where to start. You’ll be introduced to the original 34 mat exercises and select Reformer activities, with an emphasis on safety and clinical application. This course is not a replacement for formal Pilates certification, but rather a way to build on your existing clinical expertise.
• Have strong pelvic health knowledge, but want patients to be more active in their care. Learn strategies to take patients beyond the treatment table and empower them through movement.
• Prefer hands-on, movement-rich learning. This course offers a lab-heavy format focusing on problem-solving within the lumbopelvic-hip complex. Even experienced Pilates practitioners will benefit from the discussion on integrating Pilates into pelvic health treatment.

By weaving Pilates into therapeutic exercise (CPT code 97110), clinicians can reclaim the therapeutic intent of movement - empowering patients with strategies that are safe, accessible, and transformative.

Ready to integrate Pilates into your pelvic health practice?
Join Pilates Therapeutic Exercise for Pelvic Health with Pamela Downey, PT, MSPT, DPT, WCS, BCB-PMD, PRPC, CSCS on September 20–21, 2025.

AUTHOR BIO
Pamela Downey, PT, MSPT, DPT, WCS, BCB-PMD, PRPC, CSCS

Pamela A. Downey is a Board-Certified Specialist in Pelvic Health Physical Therapy, Board-Certified in Biofeedback for Pelvic Muscle Dysfunction, and a Certified Pelvic Rehabilitation Practitioner. She has more than 25 years of experience treating individuals with pelvic pain, including neuralgias of the lumbosacral plexus, voiding and sexual dysfunction, pregnancy-related and post-partum musculoskeletal dysfunction, including diastasis recti, sacroiliac joint pain, and dyspareunia. She has extensive experience in applying Pilates therapeutic movement in physical therapy and pelvic health practice. Dr. Downey’s private practice, Partnership in Therapy, is located in Miami, FL, and welcomes all people from adolescents to octogenarians for personalized one-on-one care.

Dr. Downey is an adjunct professor in the Physical Therapy Program at the University of Miami Miller School of Medicine in Coral Gables, Florida. She received her Bachelor of Arts from Sarah Lawrence College and her Master of Science, Doctorate in Physical Therapy, and is ABD in her Doctor of Philosophy from the University of Miami Miller School of Medicine.

Dr. Downey has presented research and lectured nationally and internationally at professional conferences and has authored a book chapter on pelvic pain in the medical text Women’s Health Physical Therapy. She is actively involved in the Academy of Pelvic Health of the American Physical Therapy Association, a Polestar Pilates Rehabilitation Educator, and Senior Faculty in the Herman & Wallace Pelvic Rehabilitation Institute.

When you think of the physical shape of Downward Facing Dog, what comes to mind? Do you think of a long upside-down V with the heels touching the ground and knees straight? That might be the way the shape looks on some people, but for many folks, downward dog can take many different forms - all of which are still accomplishing the same energetic purpose of this inversion posture.

Using the language customizing instead of modifying might help some patients realize they are not “doing less” by not being able to comfortably attain the physical shape of what they think they should be able to do. In fact, it is an opportunity to be rewarded for listening to one’s inner wisdom about how the body wants to move in that particular moment. We are not robots, and our bodies’ energy and pliability can change greatly during the day and from week to week, especially for people experiencing hormonally influenced persistent pain.

From a clinical perspective, customization emphasizes patient empowerment. For example, patients with pelvic pain often present with increased muscle guarding in the pelvic floor, hips, or abdominals. Asking them to force their heels to the floor or straighten their knees in Downward Facing Dog can increase tension and exacerbate symptoms. Instead, inviting them to bend their knees, widen their stance, or elevate their hands on blocks or a chair creates a version of the pose that is supportive and therapeutic. This allows patients to access the benefits of the posture - inversion, elongation, breath awareness—without reinforcing pain patterns.

This shift in perspective also serves the nervous system. Persistent pelvic pain frequently involves central sensitization and heightened protective responses. When patients hear that creating the shape of a posture that serves them is not only allowed but encouraged, the perceived threat decreases, and there may be less fear-avoidance. Clinicians can use language such as, “Notice how your body feels with the knees bent,” or “Try widening your stance and see there is less neural tension.” These cues guide patients toward building interoceptive awareness, giving them tools for self-regulation that extend beyond the clinic.

Customization also highlights the principle that yoga is not one-size-fits-all. Each patient comes with a unique history - postpartum recovery, endometriosis, hip impingement, abdominal surgery, hypermobility, etc. The physical shape of a posture that is accessible for one person may be provocative for another. By offering variations and inviting exploration, clinicians can encourage self-efficacy and reduce fear-avoidance behaviors. This builds confidence in movement and often translates into improved participation in daily activities outside of therapy.

For rehab professionals, integrating yoga in this way reinforces biopsychosocial care. By blending mindful movement with therapeutic exercise, you can help patients reframe movement as safe, adaptable, and nourishing. Consider weaving in reflective questions during sessions: “How do you know this version feels better for you?” or “What would make this position feel even more supported?” These simple prompts deepen the patient’s awareness and reinforce the therapeutic alliance.

Ultimately, customizing yoga postures is not about diluting the practice but about making it clinically relevant. When patients learn that the value of a pose lies not in how closely it matches a picture in a yoga text but in how it supports their body and nervous system in that moment, the practice becomes inclusive and sustainable. For people with pelvic pain, this can be a turning point: shifting from frustration with limitations to curiosity, agency, and resilience in movement.

Clinician Takeaways: Customizing Yoga for Pelvic Pain

• Use empowering language: Swap out “modification” for “customization” to reduce stigma and emphasize patient agency.
• Prioritize nervous system safety: Encourage patients to notice what feels supportive rather than pushing into shapes that increase tension or pain.
• Offer accessible variations: For Downward Dog, consider bent knees, wide stance, hands on blocks, or using a wall/chair.
• Cue interoception: Ask reflective questions like, “What do you notice in your body?” or “Can you breathe with more ease here?”
• Honor individuality: Recognize that each patient’s pelvic health journey is unique; customize postures according to surgical history, musculoskeletal patterns, and pain triggers.
• Blend yoga with rehab principles: Use posture customization to reinforce body awareness, reduce fear-avoidance, and build resilience in movement.

Want to deepen your understanding of how yoga can support patients with pelvic pain? Join Yoga for Pelvic Pain with Dustienne Miller, PT, MS, WCS, CYT on September 13–14, 2025. This remote course offers practical, evidence-informed strategies to integrate yoga into pelvic health care. Register here.

AUTHOR BIO
Dustienne Miller MSPT, WCS, CYT

Dustienne Miller MSPT, WCS, CYT (she/her) is the creator of the two-day course, Yoga for Pelvic Pain, and an instructor for Pelvic Function Level 1. Born out of an interest in creating yoga home programs for her patients, she developed a pelvic health yoga video series called Your Pace Yoga in 2012. She is a contributing author in two books about the integration of pelvic health and yoga, Yoga Mama: The Practitioner’s Guide to Prenatal Yoga (Shambhala Publications, 2016) and Healing in Urology (World Scientific). Prior conference and workshop engagements include APTA's CSM, International Pelvic Pain Society, Woman on Fire, Wound Ostomy and Continence Society, and the American Academy of Physical Medicine and Rehabilitation Annual Assembly.

Her clinical practice, Flourish Physical Therapy, is located in Boston's Back Bay. She is a board-certified women's health clinical specialist recognized by the American Board of Physical Therapy Specialties. Dustienne weaves yoga, mindfulness, and breathwork into her clinical practice, having received her yoga teacher certification through the Kripalu Center for Yoga and Health in 2005.

Dustienne's love of movement carried over into her physical therapy and yoga practice, stemming from her previous career as a professional dancer. She danced professionally in New York City for several years, most notably with the national tour of Fosse. She bridged her dance and physical therapy backgrounds, working for Physioarts, who contracted her to work backstage at various Broadway shows and for Radio City Christmas Spectacular. She is currently an assistant professor of jazz dance at Boston Conservatory at Berklee.

Dustienne passionately believes in the integration of physical therapy and yoga within a holistic model of care. Her course aims to provide therapists and patients with an additional resource centered on supporting the nervous system and enhancing patient self-efficacy.

What if a seemingly harmless prescription were quietly undermining the very therapy intended to restore a patient's function and quality of life? Could the side effect of one medication be the missing puzzle piece in an unresolved case of pelvic pain? Might an overlooked drug interaction complicate recovery or hinder treatment progress, despite the best efforts of the therapist?

Understanding medications and their complexities is not just helpful, but essential in rehab.

What Role Do Medications Play in Pelvic Health Rehab?
Medications are everywhere in modern healthcare. But are rehab providers fully aware of how the drugs their patients take may influence treatment outcomes? For patients with pelvic floor dysfunction, benign prostatic hypertrophy (BPH), breast cancer, and those navigating the unpredictable terrain of menopause, pharmaceuticals can serve as both an ally and an adversary.

Pelvic floor dysfunction, for instance, is rarely the result of a single cause. Pain, incontinence, urgency, and sexual dysfunction are symptoms that overlap with other conditions—often managed with medications that can influence outcomes. For example, anticholinergic drugs prescribed for an overactive bladder may reduce urgency but can also cause constipation, dry mouth, and cognitive changes. Are we asking the right questions or thoroughly reviewing the medication list to fully understand the clinical presentation?

In the case of breast cancer, medication regimens are typically complex. Patients might be prescribed chemotherapy, hormone blockers, steroids, bisphosphonates, antiemetics, and more. These drugs come with a host of possible side effects including joint pain, neuropathy, lymphedema, muscle weakness, or even cardiovascular complications. How might these adverse effects alter a patient’s ability to engage in, or respond to, rehab interventions?

Similarly, menopausal symptoms—whether naturally occurring or induced by cancer therapies—are often treated with hormone replacement therapy, antidepressants, and non-hormonal agents. Each can carry risks and benefits that impact the tissues, joints, and sense of well-being.

Understanding Medication Side Effects
Medication side effects can present as a new or worsening symptom. If someone receiving treatment for breast cancer develops sudden muscle or joint pain, is it from increased activity, chemotherapy-induced arthralgia, or perhaps an aromatase inhibitor?

Consider a patient with endometriosis who is prescribed a gonadotropin-releasing hormone (GnRH) agonist to manage their symptoms. While these medications can effectively reduce pelvic pain, they can cause symptoms commonly seen in menopause. The side effects of these drugs may not only affect the patient’s comfort and daily activities but can also create new challenges in rehab, such as increased risk of bone injury or exacerbation of emotional distress. Recognizing and managing these medication effects is crucial for optimizing both patient safety and treatment success.

Drug Interactions and Rehab Challenges
The average patient with pelvic health dysfunction takes several medications, sometimes prescribed by different specialists. How are these drugs interacting, or are some combinations quietly sabotaging progress? A comprehensive understanding of medication interactions and pharmacological principles is essential for delivering appropriate patient care and facilitating effective communication with other healthcare professionals.

Pharmacologic Knowledge Empowers Rehab Providers
A deeper pharmacologic awareness enables therapists to better treat, educate, and advocate for their patients. Understanding the nuances of medication management allows therapists to adapt rehabilitation goals and strategies to the patient’s current medication profile. This knowledge also enables them to help patients recognize symptoms that require urgent attention and reduce frustration and confusion when symptoms do not resolve as expected.

Therapists with a strong knowledge of medications can communicate well with doctors and pharmacists, helping ensure safer, more effective treatment outcomes.

Real-World Challenges
Clinicians often encounter challenges in pharmacology because of the large number of drugs, ongoing introductions of new medications, and the diversity of patient responses. Many rehab providers receive limited pharmacology training, focusing more on anatomy, physiology, and therapeutic techniques. As patients present increasingly complex medical histories, it is essential for rehab providers to maintain comprehensive knowledge and understanding.

It is also common for patients to underreport, forget, or misunderstand their medication regimens. Rehab providers must ask probing questions: "Have you started any new medications recently?" "Have you noticed changes in your symptoms since beginning this treatment?" "Are you taking any over-the-counter drugs, supplements, or herbal products?"

Rehab providers can help ensure patient safety by carefully reviewing medication and supplement lists. By identifying interactions and side effects, and collaborating closely with physicians and pharmacists, therapists contribute to safer, more effective, and patient-centric care.

Join Kristina Koch, PT, DPT, MS, CLT, PCES on September 13, 2025, for the two-day, virtual course offering of Pharmacologic Considerations for the Pelvic Health Provider. Day 1 includes self-paced, pre-recorded lectures, while Day 2 is a live, interactive Zoom session for Q&A, clinical implications, and case-based scenarios.

Your patients are more than their symptoms. And the answers aren’t always in the pelvic floor—they may be hiding in the medication list!

AUTHOR BIO:
Kristina Koch, PT, DPT, CLT, PCES

Kristina Koch, PT, DPT, CLT, PCES (she/her) received her Master of Science in Physical Therapy in 1996 from Springfield College in Massachusetts. In 2001, while living in the Los Angeles area, Kristina started specializing in the treatment of pelvic floor dysfunction, including bowel/bladder issues and pelvic pain, and in 2021, she went on to earn her doctorate of physical therapy from The College of St. Scholastica. During her time in Los Angeles, she was fortunate to work with and be mentored by fellow Herman & Wallace faculty member, Jenni Gabelsburg, DPT, WCS, MSc, MTC. Kristina is a Board Certified Specialist in Women's Health Physical Therapist (2013-2023) by the American Board of Physical Therapy Specialties. She then received her lymphatic therapist certification (CLT) in 2015.

Kristina has successfully helped establish women’s health and pelvic floor physical therapy programs in San Diego, CA and Colorado Springs, CO where she currently works in private practice. Kristina treats men, women, children, trans, and gender non-binary individuals in her practice. In addition, Kristina serves as a guest lecturer for graduate physical therapy students at Regis University in Denver, CO, and provides educational lectures to medical providers and local community groups. Outside of work, Kristina enjoys spending time with her husband and two children, skiing, running, and hiking.

Pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are common conditions affecting people with a vagina across the lifespan, often leading to significant impairments in quality of life. Conservative management is increasingly prioritized, particularly among those who are not surgical candidates, wish to delay surgery, or are managing symptoms during pregnancy or postpartum recovery. Pessaries, intravaginal devices used to support the pelvic organs or compress the urethra, represent a cornerstone of conservative pelvic health management. Their safe, relatively non-invasive nature and growing evidence base make them essential tools in a clinician’s pelvic health toolkit. Pessaries are considered relatively safe for many patient populations and are well tolerated when a proper fit is achieved (Rogers 2017). Well fit pessaries are expected to allow people with POP to participate in a full range of physical activities and exercise comfortably (O’Dell 2012).

This essay explores the current evidence on pessary use, including types, indications, contraindications, patient selection, fitting considerations, and integration with pelvic therapy. Emphasis is placed on empowering pelvic health providers to incorporate pessaries confidently and collaboratively in clinical practice.

Clinical Indications
Pessaries can be used for a range of pelvic health conditions, including:

• Pelvic organ prolapse (POP), this includes management of symptomatic cystocele, rectocele, uterine prolapse, or vault prolapse.
• Stress urinary incontinence (SUI): Especially in cases where the patient is participating in pelvic therapy and making gains in pelvic floor function but continues to have symptoms during lifting or during high-impact activities.
• Pregnancy-related prolapse or urinary symptoms: Providing support during gestation. This is prescribed by a birth provider including an MD, NP, or CNM.
• Postpartum recovery: For temporary support during tissue remodeling.

Types of Pessaries and Their Functions
Pessaries are broadly categorized into supportive and space-filling devices. The selection of type depends on the specific condition being treated, the degree of prolapse, and the patient’s anatomy and functional goals.

1. Support Pessaries

These include the ring pessary (with or without support) and are generally used for mild to moderate prolapse or stress urinary incontinence. Ring with support is frequently used in patients with a widened introitus some apical loss of support (either the cervix or the cuff in the event of hysterectomy). Ring without support can be a good choice for patients with mild to moderate cystocele and/or rectocele with generally good pelvic floor muscle tone.

2. Space-Filling Pessaries

Designed for more advanced prolapse or when support pessaries fail, these include Gellhorn, Donut, and Cube pessaries. The Gellhorn is often used in cases of more severe prolapse (stage III or IV prolapse). For stress urinary incontinence, the incontinence dish or ring with knob can elevate the urethra and reduce leakage under load of the knob.

Contraindications and Cautions
Although pessaries are safe, contraindications and red flags must be observed. They include:

• Active vaginal infections (e.g., candidiasis or bacterial vaginosis) should be treated prior to fitting.
• Severe vaginal atrophy may increase the risk of erosion and should be managed with topical estrogen before long-term use.
• Noncompliance with prior use and cleaning, or cognitive impairment may limit self-care ability unless caregivers are trained.
• Allergy to pessary material (e.g., latex, silicone), though rare, must be considered.

Fitting Process: A Collaborative and Individualized Approach
Proper fitting is essential for comfort, function, and adherence. The process typically includes a pelvic exam to assess prolapse stage, vaginal length, introital laxity, and tissue integrity. Additionally, trial and error during fitting with a range of pessary sizes and types is common. The right pessary should sit comfortably behind the pubic symphysis and under the cervix or vaginal vault without protruding or causing discomfort.

Functional testing during the fitting process is helpful to ensure comfort and optimal use for the patient. To do this, ask the patient to stand, bear down, cough, and walk around the office to ensure stability and effectiveness.

Patient education: On insertion, removal, cleaning, and signs of complications.
Follow-up after a pessary is fit is usually done after 1–2 weeks, then at 3-month intervals depending on patient autonomy and tissue health. Patients should also be instructed in managing complications and problem solving. Most pessary complications are minor and manageable, including:

• Increased vaginal discharge
• Odor or irritation
• Light bleeding or spotting, especially in estrogen-deficient tissues
• Expulsion or shifting of the pessary
• Urinary retention (rare, more common with space-filling devices)

Management strategies:

• Encourage regular removal and cleaning (daily to weekly for self-managing patients; every 1–3 months for clinician-managed).
• Use vaginal estrogen for tissue health in postmenopausal patients.
• Resize or switch device types if discomfort or expulsion occurs.
• Refer for evaluation to a physician or nurse practitioner if persistent bleeding, pain, or infection is noted.

Patient Empowerment and Adherence
Patient-centered education improves long-term success with a pessary. Education that pessaries are not permanent and can be removed at any time often alleviates anxiety that they may be feeling. Additionally, pessaries do not stretch or weaken the vagina; in fact, they often support pelvic rehabilitation efforts in conjunction with pelvic health therapy. Additionally, self-care is safe and achievable with practice and symptom relief can be immediate, as the patient works on restoring mobility, confidence, and function. Offering video tutorials, printed guides, and in-person instruction increases adherence and reduces fear or confusion.

Conclusion
Pessaries are a powerful, evidence-based tool for managing pelvic organ prolapse and stress urinary incontinence. When thoughtfully integrated into a multidisciplinary pelvic health plan, they provide a non-invasive, low-risk option that empowers patients while supporting tissue healing and function. Pelvic health providers play a crucial role in identifying appropriate candidates, facilitating fittings, and supporting ongoing care, especially when combined with targeted physical therapy. Understanding the nuances of pessary selection, education, and monitoring will continue to elevate care standards and improve outcomes in this essential area of women’s health.

References:

1. O’Dell K, Atnip S. (2012). Pessary Care: Follow Up and Management of Complications. Urologic Nursing.32 (3), 126-145. 
2. Rogers, R. G., & Fashokun, T. B. (2017). Pelvic organ prolapse in women: Epidemiology, risk factors, clinical manifestations, and management. Waltham, MA: Wolters Kluwer.

AUTHOR BIO
Dr. Amanda Olson

Dr. Amanda Olson is a pelvic health physical therapist, entrepreneur, author, and global educator with a passion for empowering men and women and advancing conversations around pelvic health. She has dedicated her career to breaking stigmas around pelvic health, supporting patients with conditions including cancer, incontinence, pelvic pain, cancer, pelvic organ prolapse, endometriosis, and MRKH, and developing innovative solutions to improve quality of life.

Dr. Olson is the president of Intimate Rose, a successful pelvic health device company that includes tools for managing pelvic pain, holds multiple patents, and has authored six peer-reviewed journal articles as well as the book Restoring the Pelvic Floor for Women. She is also the recipient of the Elizabeth Nobel Award, the highest honor bestowed in the field of pelvic health. She has collaborated with clinics worldwide, transforming lives through her tools, teaching, and consulting. As an advocate for patients with sensitive issues, and medical innovation, Dr. Olson is committed to bridging the gap in pelvic and women’s healthcare and bringing education to underserved patient populations.

People with idiopathic Parkinson disease (PD) commonly experience lower urinary tract symptoms (LUTS), referred to as neurogenic bladder, with a prevalence reported between 27-80% (Cheng, B., et al., 2023). The neuroanatomical degeneration in the dopaminergic system is one of the main precipitating factors for LUTS and other autonomic dysfunction. The most common LUTS reported are urgency/frequency (detrusor hyperreflexia) and nocturia. As the disease progresses or in cases when the individual has atypical Parkinsonism, urinary incontinence and urinary retention (detrusor hyporeflexia, detrusor sphincter dyssynergia, bladder outlet obstruction/benign prostatic hypertrophy) become more prevalent. Taken together, these storage and voiding symptoms increase the risk of developing a urinary tract infection (UTI). Additionally, PD is considered an age-related disease, occurring most often in people over 60. Generally, the risks for UTIs increase with age, in particular, affecting aging women more due to age-related changes in the lower urinary tract after menopause.

UTIs are a leading cause of hospitalization, morbidity, and mortality in people with PD. These individuals happen to be twice as likely to be admitted to the hospital for a UTI in comparison to age-matched controls, 48% to 23% respectively (Su, C., M., et al., 2018). Additionally, UTIs seem to occur in equal proportions between older men and women with PD. This gives implication to the theory that there may be something about PD itself that overrides the typical age-related female UTI risk. Additionally, the literature reports a dramatic elevated risk in UTIs for people with PD undergoing orthopedic surgeries, with 1/3 developing a UTI after knee arthroplasty. We can also examine the inverse relationship of the person with PD experiencing UTI, inducing motor and cognitive dysfunction, especially with systemic infection causing a “UTI-induced neurotoxicity,” leading to falls and orthopedic injury with surgical repair (Hogg, E., et al., 2022). UTIs happen to be the single most frequent underlying cause for PD motor symptoms exacerbation, accounting for 25% of exacerbations (Zheng, K.S., et al., 2012). UTI-related sepsis is of very large concern as people with PD are twice as likely to experience a hospital stay longer than 3 months, and it is a leading cause of morbidity in PD.

Several other compounding factors can also increase the risk of UTI in people with PD. First, it is reported that greater than 80% of people with PD experience gastrointestinal symptoms, referred to as neurogenic bowel, with the most common being constipation. Constipation in PD is complex and is often due to both slow motility and dyssynergic defecation, leading to the risk of microorganisms entering the urinary tract. Second, is the use of anticholinergic bladder medication, especially since PD motor symptoms medications cause anticholinergic side effects, which will then be compounded and potentially increase constipation and potential urinary retention. Third, immobility and frailty affect getting to the bathroom regularly and safely, increasing the risk of urinary incontinence and pad use. There may be challenges with self-hygiene and an increased chance of long-term care facility admission, where there is an increased risk of being exposed to antibiotic-resistant bacteria. Fourth, is cognitive impairment, which ranges from mild cognitive impairment (MCI) to dementia and is 2.5-6 times more likely to develop in the person with Parkinson disease (Aarsland, D., et al., 2021). This may lead to difficulty expressing toileting needs, difficulty expressing symptoms of UTI, leading to over or under treatment, and potentially catheterization, further increasing the risk. Fifth, it may be related to the urinary tract microbiome in individuals with neurogenic bladder. A shift from a healthy microbiome to overgrowth of pathogenic species is theorized to worsen with antibiotic overuse and catheterization. There is, however, a research gap in this area, especially with PD subjects.

Multiple modifiable and non-modifiable risk factors have been identified, resulting in the person with PD being more susceptible to UTI. As pelvic health therapists, we have the opportunity for prevention education and recommendations, from lifestyle modifications to formal holistic assessment, treatment, and specialist referral. Join me for my course, Parkinson disease and Pelvic Rehabilitation, as we explore how to optimize your treatment plan for modifiable risk factors of UTI.

Resources:

1. Aarsland, D., Batzu, L., Halliday, G. M., Geurtsen, G. J., Ballard, C., Ray Chaudhuri, K., & Weintraub, D. (2021). Parkinson disease-associated cognitive impairment. Nature reviews Disease primers, 7(1), 47.
2. Cheng, B., Huang, S., Huang, Q., Zhou, Z., & Bao, Y. (2023). The efficacy and safety of medication for treating overactive bladder in patients with Parkinson's disease: a meta-analysis and systematic review of randomized double-blind placebo-controlled trials. International Urogynecology Journal, 34(9), 2207-2216.
3. Gerlach, O. H., Winogrodzka, A., & Weber, W. E. (2011). Clinical problems in the hospitalized Parkinson's disease patient: systematic review. Movement Disorders, 26(2), 197-208.
4. Hogg, E., Frank, S., Oft, J., Benway, B., Rashid, M. H., & Lahiri, S. (2022). Urinary tract infection in Parkinson’s disease. Journal of Parkinson’s Disease, 12(3), 743-757.
5. Su, C. M., Kung, C. T., Chen, F. C., Cheng, H. H., Hsiao, S. Y., Lai, Y. R., ... & Lu, C. H. (2018). Manifestations and Outcomes of Patients with Parkinson’s Disease and Serious Infection in the Emergency Department. BioMed Research International. 2018; 2018: 6014896.
6. Zheng, K. S., Dorfman, B. J., Christos, P. J., Khadem, N. R., Henchcliffe, C., Piboolnurak, P., & Nirenberg, M. J. (2012). Clinical characteristics of exacerbations in Parkinson disease. The neurologist, 18(3), 120-124.

AUTHOR BIO:
Erica Vitek, MOT, OTR, BCB-PMD, PRPC

Erica Vitek, MOT, OTR, BCB-PMD, PRPC (she/her) graduated with her master’s degree in Occupational Therapy from Concordia University Wisconsin in 2002 and works for Aurora Health Care at Aurora Sinai Medical Center in downtown Milwaukee, Wisconsin. Erica specializes in female, male, and pediatric evaluation and treatment of the pelvic floor and related bladder, bowel, and sexual health issues. She is board-certified in Biofeedback for Pelvic Muscle Dysfunction (BCB-PMD) and is a Certified Pelvic Rehabilitation Practitioner (PRPC) through Herman and Wallace Pelvic Rehabilitation Institute.

Erica has attended extensive post-graduate rehabilitation education in the area of Parkinson disease and exercise. She is certified in LSVT (Lee Silverman) BIG and is a trained PWR! (Parkinson’s Wellness Recovery) provider, both focusing on intensive, amplitude, and neuroplasticity-based exercise programs for people with Parkinson disease. Erica is an LSVT Global faculty member. She instructs both the LSVT BIG training and certification course throughout the nation and online webinars. Erica partners with the Wisconsin Parkinson Association (WPA) as a support group, event presenter, and author in their publication, The Network. Erica has taken a special interest in the unique pelvic floor, bladder, bowel, and sexual health issues experienced by individuals diagnosed with Parkinson disease.

In preparation for this blog, I searched Burnout in the Facebook group Global Health Physio. Here are some snippets. See if you can relate?

The struggle is real and relatable.

Then this comment held me in contemplation...

“Within our profession as physical therapists there is a PERVASIVE culture of giving away too much of ourselves and our time. Corporations have long taken advantage of our giving/helping nature by overloading our schedules and demanding impossible productivity standards such that we end up not feeling good about the care we provide, and we do documentation on our personal time. “

In last session’s Boundaries Meditation and Self Care class we were all relating to the fact that we tend to care TOO much, spend too much time with patients and paperwork piled up leaving us stressed and depleted in both time and energy.

This led to Nari (Clemons, my bestie and brains behind this class we developed and co-teach) vibrantly encouraging us all to “channel our inner Selfish B****” to the result of a Zoom full of laughter!

Nari went on to explain that our ability to accurately judge ourselves for healthy boundaries with patients was skewed or even broken. Holding a HEALTHY boundary with our time or energy was to US going to FEEL LIKE we were being totally selfish! And so why not just allow that bass a** chick to have a much-needed voice!

So, what does being a (tongue-in-cheek) “Selfish B” look like in clinical practice??

Developing a model of clinical practice that values YOU the clinician and your health and well-being as MUCH (or MORE) than that of our patients.

Some behaviors to strive for:

• Finish sessions 5 mins early or spend the last 5 minutes documenting your intervention.
• Hold that “one last thing” you want to do with that patient and put it in the plan for the next visit.
• Actually, take your WHOLE lunch time to refresh yourself, finish paperwork, eat, move, rest, breathe or connect with coworkers.
• Be proactive in setting up a shared model of care with your patients on an initial visit.
• Say things like:
  • Our time is up, and my next patient is here, I look forward to (answering your questions, furthering your program, seeing you, etc) in our next appointment.
  • I don’t take phone calls, but you may email me concerns and we can talk about them at your next visit.

Let’s be honest about a few things. We serve a population of patients that can be emotionally taxing, medically challenging, and complex on all levels. AND while we learn excellent clinical skills, no one teaches us energetic, emotional, and behavioral skills to manage this level of patient care and interaction.

Until NOW.

If you’ve been struggling with burnout, exhaustion, time management, energy depletion or your own Selfish B is struggling to find her voice, come join us on a journey of healing and equipping.

We promise you won’t regret the investment in YOU and your future.

Boundaries, Self-Care, and Meditation (scheduled for September 27-28) is a course built from the combined experience of me and my bestie, Nari Clemons, as we navigated the complex task of Burnout recovery. 

This course is for anyone who finds themselves over-giving, spending too much time on paperwork, not having energy for their life outside of work, knowing something is not working, but not knowing how to change.

We explore how to set boundaries with time, energy, and patient care. We reframe the narrative of what it means to be a therapist, a giver, an empath. This course is one part equipping through shared information, and one part deep reflective soul search tied up in story, values, intentions, and accountability.

AUTHOR BIO
Jenna Ross, PT, BCB-PMD, PRPC

Jennafer Ross PT, BCB-PMD, PRPC, (she/her) After graduating from Ithaca College, Jenna began her career as a physical therapist at Spectrum Health in Grand Rapids, MI. Since 2002, she has focused her professional attention on treating women, men, and children with pelvic health disorders. She is energized through education and enjoys her position as adjunct faculty at Grand Valley University, speaking at community events, organizing a regional pelvic floor mentorship and study group, and didn’t necessarily enjoy but survived part-time home-schooling her two daughters. She has been faculty for Herman & Wallace Pelvic Rehabilitation Institute since 2009 and loves to inspire other rehab professionals treating pelvic floor dysfunction. She is the author of the chapter, “Manual Therapy for the Pelvic Floor,” which was published in the book, “Healing in Urology.” Jenna was a contributing writer for the Pelvic Floor Capstone curriculum and also co-authored the continuing education course, “Boundaries, Self-Care and Meditation” with Nari Clemons. She is certified in pelvic floor rehabilitation and biofeedback for pelvic floor disorders. Outside of teaching and treating patients, Jenna loves to spend time with family and friends, run, cook, travel, do yoga, and snuggle with her doggo.