Yesterday, star athlete and Seahawks wide receiver, Percy Harvin, suffered a hip labrum tear.? His injury may require surgery, as one of his physicians has suggested.

The labrum is vital in such basic functions shock absorption and joint lubrication.? As described on the Mayo Clinic?s website, ?The labrum acts like a socket to hold the ball at the top of your thighbone (femur) in place.?? It?s easy to see why hip labrum tears are not uncommon among athletes.

Percy Harvin received a $67 million dollar contract when he was traded to Seattle from the Minnesota Vikings last spring.? His career has been hampered by injuries.? Frequently missing games because of migraine headaches, Harvin missed most of last season with an ankle injury.

Of course, you don?t have to be a star football player to suffer from labral tears, and acetabular labral tears are reported to be a major cause of hip dysfunction in young patients and a primary precursor to hip osteoarthritis. Herman & Wallace offers a course on Extra-Articular Pelvic and Hip Labrum Injuries.? The next course-event will be offered next year? Stay tuned for our 2014 schedule!

Inflammatory bowel disease (IBD) is an idiopathic disease estimated to affect 1.4 million people in the United States. The two main types of IBD are Chrohn's disease and ulcerative colitis (UC). Chronic inflammation occurs in all or part of the digestive tract. Symptoms related to chronic bowel inflammation include diarrhea, rectal bleeding, bowel urgency, abdominal pain, constipation and incomplete emptying of the bowels. Constitutional symptoms such as fever, weight loss, fatigue, night sweats, and changes in menstrual cycle can also be reported. To read more about the symptoms, treatment, and research updates about IBD, the Crohn's and Colitis Foundation of America (CCFA) is an excellent resource. The CCFA has a variety of events aimed towards support, education, and fundraising, and you can look for events in your part of the world by going to this page on their website.

Other resources for increasing your own knowledge and awareness and for patient education purposes are listed below.

• IBD Fact Sheet from womenshealth.gov that can be printed and shared.
• Mayo Clinic pages with information on diagnosis, treatment and management.
• Terrific collection of IBD endoscopic images from Atlanta South Gastroenterology.
• American Gastroenterological Association IBD pages.
• Patient brochures from the American Society of Colon and Rectal Surgeons
• Information for parents, kids and teens about bowel disease at kids health.org
• American Academy of Pediatrics information about bowel disorders.

These conditions are different from Irritable Bowel Syndrome primarily due to the inflammation that occurs. While the etiology of IBD is still unclear, what is known is that the body's immune system response is abnormal. The condition is more common in patients who are caucasian, and there is also a familial link. Structural abnormalities including inflammation, lesions, ulcers or tearing are common. While Crohn's can affect any part of the gastrointestinal tract, ulcerative colitis affects the lining of the colon. If a patient of any age presents with symptoms of bowel dysfunction, a worsening of or lack of improvement of bowel complaints, he or she should be referred to an appropriate medical provider to rule out inflammatory conditions of the bowel. In children, IBD can affect growth and development, so the sooner the condition is managed, the better for overall health. The presentation of IBD can be cyclical, with flare-ups that occur, and while pelvic rehabilitation providers are a valuable part of the team treating the symptoms and functional bowel dysfunction related to IBD, we also must be astute in recognizing when a patient requires the evaluation of a medical provider.

Herman & Wallace is excited to announce that Institute founder and instructor Hollis Herman, PT, DPT MS, OCS, WCS, BCB-PMD will be going to Chile this September to teach a comprehensive educational seminar on pelvic floor dysfunction!

This four-day seminar will cover everything from basic terminology to advanced treatment. Much of the seminar will focus on topics taught in our popular Pelvic Floor Series as well as our Pregnancy and Postpartum Courses.

For Holly, this is her second time visiting Chile to speak this year. In April, she presented on women?s health topics to students at Universidad del Desarrollo in Santiago.

Holly is a physical therapists with more than 35 years of experience.? She owns her own practice, Healthy Women Healthy Men, in Cambridge, MA.? On top of that, Holly is an internationally renowned lecturer and speaker on physical therapy for women and men, co-author of ?How to Raise Children without Breaking Your Back,? as well as a contributor to numerous chapters and peer-reviewed articles on sexual medicine, geriatric foot care, pelvic pain, urinary and fecal continence and pregnancy and postpartum evaluation and treatment.

The September trip will be the first of two journeys to Chile to teach pelvic rehabilitation. Holly will return to Chile in 2014 to present a follow-up course to the same group.

This October, Herman & Wallace is excited to bring a new course, Rehabilitation for Breast Cancer Patients, to White Plains, NY!  This course will be taught by Susannah Haarmann, PT, CLT, WCS and Christine Cabelka, MPT, CLT, WCS.

Pelvic Rehab Report sat down with Susannah and Christine to ask them a bit about the course.

What can you tell us about this continuing education course that is not mentioned in the course description and objectives that are posted on-line?

Susannah: I would say that even though this course is entitled, “Rehabilitation for the Breast Cancer Patient,” much of the knowledge and skills learned in this course will transfer to other oncology populations. For example, we address fatigue, neuropathy, cardiomyopathy and osteoporosis, which are side effects many oncology patients report. I believe the demand for rehabilitation oncology programs will rise in the future. Clinicians attending this course have so much to bring to the table in terms of their current knowledge and skill-sets. It is my hope that blending the information and treatment approaches in this course with other specialty knowledge will bring about great inspiration and a whole host of creative treatment ideas!

Christine: We’re so excited to be teaching this course.  We’re hoping to take the participants on the journey that the patients go through.  Throughout the course the participant will be provided with multiple examples of what they may see in the clinic so they can begin building that image of a patient in their heads.  They’ll be provided with the insight and reflection from real patients regarding their journey through breast cancer diagnosis, treatment, and recovery.

What inspired you to create this course?

C: Working with cancer patients inspired me to co-create this course.  Seeing the lack of comfort from my colleagues working with the cancer population I wanted to create something that would provide any practitioner the knowledge and confidence to work with cancer patients, even if they don’t have training in lymphedema management.  Not all patients will have access to therapists with advanced training in the oncology population, so being able to provide a high-quality course designed to train more practitioners will hopefully provide patients with better access to care.

S: When breast cancer patients and health care practitioners become aware of the potential of oncologic rehabilitation and the positive impact we can make, the current lack of services in this area is often seen as a travesty. Skilled rehabilitation providers are rare, and in-depth education addressing medical intervention and lab-based treatment approaches is difficult to find.  As a result, many preventable side effects are not being addressed, referrals are not being made, and many patients are missing out on receiving these beneficial services.

My initial inspiration for creating this course came while working as a resident at Duke University and Medical Center. As a therapist at an educational institution, we received referrals from states away. Many times our patients were commuting hours to consult our rehab services or living locally on a short-term basis for treatment. Our team would make every attempt to find therapists in the patient’s area who were skilled in oncologic care and lymphedema treatment, but often times our searches were futile. In addition to being a rare commodity, often times I found confusion among therapists regarding medical interventions or standardized treatment approaches. I was inspired to create the course in order to ‘connect-the-dots’ for rehab professionals passionate about oncology care.

However, I feel my greatest inspiration for creating this course will come while teaching it; I can make a splash by treating one patient at a time, but educating practitioners who can then go out into the world and treat, we can really make waves!

What resources and research were used when writing this course?

S: Oh my goodness, the time performing literature reviews and collaborating with expert health care practitioners in the area of breast oncology was immense! With that said, I still feel like we only scratched the surface and I am very dedicated to the evolution of this course as new findings and materials are born! Specifically, the American Cancer Society’s journal ‘Cancer’ published a special issue entitled, “A Prospective Surveillance Model for Rehabilitation for Women with Breast Cancer;” the article reviews and expert opinions in these synopses were a great starting point. As a certified lymphedema therapist through the Norton School of Lymphedema, I definitely found myself delving into former course materials. Some of the best leads and most rewarding learning opportunities, however, came from collaborating with other practitioners within the field, such as nurse practitioners in plastic surgery, breast cancer nurse navigators, nutritionists, Pilate’s instructors, etc.   Rehabilitation for the breast cancer patient truly is an integrative approach and we have a lot to learn from each other!

C: Numerous research articles were reviewed and cited.  Issues and supplements of the Cancer journal are presented.  We also were able to gain permission to use material from public cancer sources such as the American Cancer Society, National Institute of Health, National Lymphedema Network, and Chemocare.com.

Can you describe clinical/treatment approach/techniques covered in this continuing education course?

C: We’ll be covering a mix of everything from evaluation to treatment techniques.  Based on the side effect of treatment being discussed we’ll be providing and/or reviewing techniques for evaluation of sensation, balance, and screening for lymphedema.  We’ll also be providing instruction on manual techniques for treatment of axillary webbing.  Specific intervention ideas for each treatment side effect will be covered.

S: Treatment techniques for this course run the gamut from exercise prescription for core strengthening status post breast cancer reconstruction to hands-on manual therapy for lymphatic cording. Although treatment approaches are impairment-based, this course supports the Prospective Surveillance Model which aims at preventative styles of treatment as well.

Why should a therapist take this course? How can these skill sets benefit his/her practice?

S: I have many answers to this question, but I will choose my top 3:

1. YOUR SERVICES ARE NEEDED!

A therapist should take this course because breast cancer is the most commonly diagnosed cancer among women, rehabilitation for the oncology patient is underutilized, and I guarantee there are cancer patients in your area that would greatly benefit from your services.

2. CHANGE LIVES!

I think that many therapists shy away from working with the oncology population because it may be considered depressing. However, the work can be incredibly rewarding and that is why this is one of my favorite populations! It is so evident to me on a daily basis how much my abilities as a therapist impact my breast cancer patients’ lives and often in a very short period of time. Frequently my oncology patients say therapy is their favorite form of treatment and that makes me smile!

3. GENERATE REFERRAL SOURCES!!!

A therapist who successfully completes this course, and makes a good relationship with an oncologist in their area, may create the potential for a greater number of referral sources to their clinic, thereby adding value and demand to their practice.

C: Therapists should take this course to build on their existing skills and give themselves the confidence to work with this patient population.  We’re hoping to provide the tools needed for a therapist to recognize the need for early lymphedema intervention.  Also to provide the skills to be able to work with breast cancer patients at any stage, from early on in the diagnosis, to 5 years into their survivorship.

This course is a must for clinicians who are eager to learn more about breast cancer rehab.  Seats are limited – register today!

Although pelvic organ prolapse (POP) affects ?50% of women [who] have had children? (according to a Yale School of Medicine Presentation, ?Female Urinary Disorders and Pelvic Organ Prolapse? few realize that childbirth could lead to POP.

Maternal Goddess, an educational support community for soon-to-be and new moms, posted a blog, ?Down and Out ? identifying pelvic organ prolapse.?? This blog examines the importance of early detection and prevention for POP. ?Often, POP can occur without showing any usual symptoms.? However, because there are often so few symptoms, POP is often missed.

POP stems from weakened pelvic floor muscles.? Risk factors include stress on the pelvic floor from childbirth, aging, injury, or heavy lifting.? Pelvic floor exercises and internal treatment can often relieve symptoms; however, in some cases, surgery may be required.

This is the best time for treatment to begin.? When symptoms do show up, POP is usually at a stage at which it can dramatically affect the wellness of the patient and can require more advanced treatment: ?Early stage prolapse is often reversible and very manageable, however once the prolapse progresses to a stage 3 or 4 it becomes life altering, and may require surgery ? surgery that can in turn cause other challenges.?

Herman & Wallace?s course Pelvic Floor Level 2B offers and in-depth look into evaluating and treating POP.? Coming next to St. Louis this December, this course is ideal for therapists interested in learning about POP as well as other urogynecological conditions.? Seats are limited ? register today!

Last Friday, The Atlanticpublished a blog titled ?How Long Can You Wait to Have a Baby??, written by Jean Twenge.? Twenge, herself a woman who entered motherhood in her mid-30s, talks about the panic brought on by a number of articles citing studies which implored women not to wait ?too long?.

Twenge?s article focuses on an article from TIME Magazine, titled ?Making Time for Babies,? written in 2002 that expressed the dangers of waiting too long to have children.? ?Within corporate America, 42 percent of the professional women interviewed?had no children at age 40, and most said they deeply regretted it.?

Twenge speaks from personal experience about the ticking clock-driven sense of urgency and her own feelings of panic over ?time running out?. She then examines ways in which the data from the 2002 study was flawed, and how decline in fertility for women in their late twenties has been exaggerated based on that data.

While much of her article boils down to an expos? on how statistics can be contextualized to spread misinformation, more striking in her piece is the way Twenge?s voice captures the deeply personal and emotional way women view fertility, motherhood, and the ?biological clock?.

Herman & Wallace is currently vetting a product concept called Pregnancy After 30.? This product explains the lifestyle changes that occur in women over thirty as well as plans for diet and exercise and educational tools that can help fulfill the special needs of women who conceive in their thirties and forties.? The product can be purchased at a discounted rate before August 16^th!

Amy Stein, MPT, BCB-PMD is a long-time friend of Herman & Wallace.? As the founder of Beyond Basics Physical Therapy, in NY, has been working in pelvic rehabilitation for more than ten years.? Amy Stein?s work outside of the clinic has made her a pioneer in the field.? She co-founded Alliance for Pelvic Pain, an educational retreat for patients, as well as penned several books on pelvic pain and dysfunction.? Her most recent book, Heal Pelvic Pain, is a significant resource for patients and practitioners suffering from or interested in pelvic pain and dysfunction.

Heal Pelvic Pain

By: Amy Stein

Heal Pelvic Pain describes the many types of pelvic pain and pelvic floor dysfunction (PFD). ?It also encourages an array of treatments that blend exercise, massage, nutrition, and other self-care practices in lieu of surgery.? There is a need for a broader discussion of pelvic pain, its prevalence, and alternative treatment options.? Heal Pelvic Pain does just that.

For patients and practitioners, Stein?s book clearly articulates many different types of PFD as well as encourages natural healing.? Furthermore, its accessibility allows anyone to understand the consequences of untreated pain or dysfunction.

This summer, Herman & Wallace began creating products with a new process that we call ?Pre-Funding?.? We want to produce products only if they are useful to therapists, and who better to tell us than you, the pelvic rehab therapist.? The idea behind Pre-Funding is simple: we create an idea for a product (called a Product-Concept offer it for a trial period at a discounted price, and if enough people pre-fund the concept, we proceed with building the product.? This gives us an opportunity to get critical feedback from therapists before the product is developed, thereby allowing us to generate a higher quality product before we send it out. So far, this program has been a big hit!

Every product from our last round of pre-funding was fully funded and built.? This would not have been possible without the participation of therapists who pre-funded.? The feedback was invaluable, enabling us to generate better, more useful products.? We hope to receive the same comments on our future product concepts!

This week we released a new group of product concepts.? The Male Kegel is a tool to help PTs educate male patients about the pelvic floor muscles and how to exercise them.? Self-Stretching the Pelvic Floor illustrates appropriate stretches for different types of pelvic floor dysfunction.? Pregnancy After 30 examines how pregnancy differs for women over thirty, as well as describing the special considerations for over-thirty moms-to-be.? Our Advanced Breathing Techniques product concept is another resource to help therapists teach patients about the respiratory system and different breathing techniques.

The trial period only lasts thirty days, at which time the pre-fund discount will expire.? Please check out our Products Page before time runs out!

For PTs growing or beginning their private practices, treating patients can be the easy part. Because we went to PT school to learn to help patients, not become business men and women, the business side of things is often much more difficult.  For therapists trying to promote their practices, using social media can be an effective and free tool for promoting oneself as a clinician.

Advance Healthcare  recently published an excellent article on physical therapy and social media, titled “PTs Going Social.”  The article touches on many of the benefits of utilizing social media as a method to generate referrals for one’s private practice.

The assumption is that social media can change how businesses advertise and remain relevant in today’s market.  Facebook, Twitter, LinkedIn, and even Pinterest offer users the chance to quickly and easily generate content and post it on the web.  However, effectively generating content to best promote one’s practice online is no mean feat.

With over a billion active users, Facebook has become the figure-head of the social media.   Websites like Facebook offer great marketing opportunities.  They’re easy to use.  In about a minute, one can go from clicking “Sign Up” to creating content to promote his/her practice for free.  Seems perfect right?

The truth is much more complicated than that.  Generating and tailoring content on the web often takes the back seat when there are demanding patients and bills to pay.  Simply put, with everything else going on at one’s practice, it’s easy to see why grappling with a new marketing tool takes a backseat.

However, for PTs who do take the time to become familiar with and utilize social media, it can reap huge rewards.  Posting videos of exercises to Facebook or re-tweeting a relevant comment made by a colleague on Twitter build’s one presence within the community.  With each share and post comes potential referrals.  Although a post might not land one a new client on its own, it can certainly help build those relationships. Or as Ian Manning puts it in the article, “it’s the first step towards making the call.”

Furthermore, participating in this community is a “two-way street…[F]ollowing other physical therapists on Facebook” is an easy, effective way to have news, clinical knowledge, and information come right to your Facebook page.

In order to help the therapist navigate the many avenues for marketing, Herman & Wallace recently developed a product for Marketing Your Women’s Health/Pelvic Floor practice. This presentation will equip you to build your referral business and appropriately harness new marketing tools.

Herman & Wallace also offers an online course, through Medbridge, titled, Physical Therapy Marketing with Passion!  This course is taught by H&W instructors, Brandi Kirk, PT, BCB-PMD and Teri Elliott-Burke, PT, MHS, BCB-PMD.  Try it today!

Ulcerative Colitis (UC) dramatically effects a patient’s livelihood.  UC is often confused with Crohn’s Disease, another major inflammatory bowel disease.  While they do differ in origin, both diseases share similar symptoms, such as blood in a patient’s stool.  Furthermore, like Crohn’s Disease, UC tends to affect young people (those between the ages of fifteen and thirty).

Chronic and often severe, UC has no known cure and, in rare cases, can even be life-threatening to the patient.

The Daily Mail posted a news article about Manchester United’s Darren Fletcher, who recently underwent his third surgery for UC.  Over the last few years, Fletcher has frequently struggled to stay fit.  He has played just thirteen games since December 2011.

Multiple surgeries, as in Fletcher’s case, are not uncommon.  UC spreads and deeply infects the lining of a patient’s colon and rectum.  Although there is no known cure, correctly applied therapy has been known to markedly reduce symptoms and even lead to long-term remission.

Herman & Wallace offered their first on Bowel Pathology and Function in Stony Brook, NY last month and is in the midst of confirming dates for another course in 2014.  Keep a look out for updates!