Experience Level: Intermediate
Contact Hours: 22.5
This is a satellite offering of our course Pelvic Floor Level 2B. A satellite means that participants will be gathering in a given location and watching the instructor present remotely on the same screen. During labs, participants will pair up and be guided by the local lab assistants at the satellite course location.
This three day (8 hours of online content, plus 2-days of in-person learning) intermediate-level continuing education course further defines skills and knowledge learned in the foundational Pelvic Floor Level One course. Specific, advanced examination techniques such as pelvic muscle mapping and interventions including downtraining of overactive muscles is instructed. With a specific focus on urogynecologic conditions including prolapse and pelvic organ descent, various pelvic pain diagnoses, and abdominal wall rehabilitation, the participant will be able to learn specific skills to treat these conditions that have a significant negative impact on a woman's health. Evidence-based references and case studies will be presented for thorough understanding of current medical evaluation and management of each condition.
Instruction in female urogynecologic anatomy occurs throughout this continuing education course, along with education in current terminology and clinical models related to trunk and pelvic control. Detailed internal vaginal and external perineal examinations are included in the practical lab activities, during which the participant will have several experienced lab assistants as guides. An entire lecture is dedicated to the management of prolapse and pelvic organ descent so that the pelvic rehabilitation provider will be able to develop clinical and home program strategies for the patient who presents with conditions such rectocele, cystocele, or uterine prolapse.
Common conditions associated with female pelvic pain are included throughout the three days of education. Such diagnoses may include vulvar pain, vestibulitis, interstitial cystitis or bladder pain syndrome, episiotomy, dyspareunia, lichen sclerosis, lichen simplex, or lichen planus. Both abdominal and pelvic muscle tenderness is higher in patients who have chronic pelvic pain, and increased pelvic muscle tender points have been noted to correlate with higher rates of depression, dyspareunia (pain with sexual function), and bowel dysfunction. (Montenegro et al., 2009; Montenegro et al., 2010) Assessment and treatment of pelvic and abdominal wall tender points is instructed along with abdominopelvic nerve dysfunction and relaxation training- all are strategies that the clinician can employ immediately following completion of this continuing education course. The important and sensitive topic of sexual abuse and trauma as it relates to pelvic dysfunction and to care of the patient is discussed.
Please note, the Pelvic Floor series of courses typically fill up about 2-3 months before the scheduled course date. Satelllite lab courses are often limited to very small groups of around ten, meaning seats are scarce. It is highly recommended you sign up as soon as you are able so you do not miss out on a seat. It is expected that participants will only register for satellites in which they are within driving distance, and adhere to all state and local COVID guidelines, including wearing a mask at all times during the course.
As this continuing education course includes extensive lab work, all course attendees should come prepared to participate as both clinician and patient. Vaginal pelvic floor muscle examinations will be taught in labs. Labs will be conducted under the supervision of instructors and teaching assistants. There will be a ratio of at least one instructor/assistant for every ten participants. Past participants have found that wearing comfortable clothing that is easy for changing (such as skirts or athletic shorts) is very useful for labs. Due to temperature variations from clinic to clinic we would recommend wearing comfortable layers.
The Herman & Wallace Institute welcomes all professionals who are appropriately licensed at our courses. Being born with a vagina and other female anatomy is not a prerequisite for attending or participating fully in our courses. No one participant will be required to partner with any other one participant during labs.
Vaginal examination and internal myofascial manual therapy prior to 32 weeks gestation is not the common standard of medical practice. Participants who are pregnant who wish to participate fully in the entire course including in lab must bring a clearance letter from their physician allowing them to participate in the labs is required. Participants who are pregnant also have the option of bringing their own lab model for examination, or they have the option of working in a group of three during lab times.
PLEASE NOTE: This course includes internal assessment and exam techniques, which will be practiced in partnered pairs in lab time. H&W strives to foster an environment that is safe and supportive. Survivors of past trauma should be aware that performing or experiencing internal exam may be triggering, and that many, regardless of their histories, feel strong emotions when practicing these techniques. In order to foster an environment that is non-triggering and safe for all participants, we recommend all participants consider the emotional impact they may experience during the course, and consider consulting a trauma counselor or therapist prior to attending.
Pelvic Floor Level 1, through Herman & Wallace or Pelvic PT 1 through the APTA is required. Exceptions to this policy may be granted on a case-by-case basis, to inquire about such exceptions please contact us.
This continuing education seminar is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.
In order to derive the most benefit from this course, we ask our participants to be sure to internalize the material and to review any areas of knowledge that are recommended as foundational and prerequisite skills:
1. Stress Urinary Incontinence and Pelvic Load Transfer by Diane Lee and Linda-Joy Lee
2. Read the articles from the National Vulvodynia Association website on vulvodynia and its diagnosis
3. Painful Bladder Syndrome/Interstitial Cystitis by Jane M. Meijlink
4. Review the anatomy of the pelvis and perineum
5. The Standardization of Terminology of Pelvic Floor Muscle Function and Dysfunction Report from the Pelvic Floor Clinical Assessment Group of the ICS
6. Gray's Anatomy for Students - Ebook available at a 20% discount at the preceding link (use discount code ELS25OFF). Registrants who already own a copy, are not required to purchase an additional one. Please Contact Us with any questions about the use of this text as a required reading in this course.
De Souza Montenegro, M. L. L., Mateus-Vasconcelos, E. C. L., Silva, J. C. R. E, Nogueira, A. A., Dos Reis, F. J. C.,& Poli Neto, O. B. (2010). Importance of pelvic muscle tenderness evaluation in women with chronic pelvic pain. Pain Medicine, 11(2), 224-228.
Montenegro, M. L. L. S., Gomide, L. B., Mateus-Vasconcelos, E. L., Rosa-e-Silva, J. C., Candido-dos-Reis, F. J.,
Nogueira, A. A., & Poli-Neto, O. B. (2009). Abdominal myofascial pain syndrome must be considered in the differential diagnosis of chronic pelvic pain. European Journal of Obstetrics & Gynecology and Reproductive Biology, 147(1), 21-24.
Recorded Lecture: Watch Before the In-Person Component of the Course
Pelvic rehabilitation concepts, anatomy (30 mins)
8:00 Questions from Day 1, review post-test
Upon completion of this continuing education seminar, participants will be able to:
1. Identify anatomy/pathophysiology of the female reproductive and urologic systems with reference to vaginismus, vulvodynia, dyspareunia, pelvic organ prolapse and interstitial cystitis/painful bladder syndrome.
2. Identify specific pelvic floor muscle locations with external and internal vaginal examinations.
3. Perform internal vaginal myofascial and soft tissue treatment techniques to the pelvic muscles.
4. Describe and teach three neuromuscular relaxation training techniques for the pelvic muscles.
5. Perform an SEMG pelvic floor muscle assessment and interpretation for appropriate treatment intervention.
6. Perform external perineal examinations appropriate for vaginismus, vulvodynia, dyspareunia, pelvic organ prolapse and interstitial cystitis/painful bladder syndrome.
7. Perform patient related education and behavioral instruction pertaining to discussed urogynecologic conditions.
8. Demonstrate muscle assessment tests to identify anterior and posterior vaginal wall relaxation (pelvic organ prolapse).
9. Develop treatment plans for pelvic pain syndromes.
10. Complete appropriate screening and referral as needed for patients who are healing from sexual trauma.
Dr. Jenni Gabelsberg, DPT, MSc, MTC is a women's health physical therapist specializing in urinary incontinence and pelvic pain since 1994. She strives to empower patients through education and self-awareness to encourage them to take responsibility for their own health. She believes that a physical therapist's education forms the cornerstone of her care. She attended the University of Vermont and earned a Bachelor of Science, Physical Therapy, in 1994. She went on to earn a Manual Therapy Certification (MTC) awarded by the Institute of Physical Therapy in 1995. Dr. Gabelsberg next earned an Advanced Masters in Orthopedic Physical Therapy from the University of Saint Augustine for Health Sciences in 1999, and a Doctorate in Physical Therapy in 2003.