BIG NEWS: I’m opening my own practice!!!

Ok, so I have been SO excited to share this with all of you, but needless to say, I’ve been a little busy with nursing, diapers, and keeping a very active toddler happy.

My two little lovebugs!

Over the past 10 years, I’ve had the chance to treat hundreds of patients in a few different job settings. I’ve also helped to educate hundreds of other health care providers as they journey into pelvic health rehabilitation. I have learned so much through these experiences– both about patient care and creating a positive, motivating and enjoyable clinic environment for patients and clinicians alike!

So, I am thrilled to announce that I will be opening my own practice this fall! I have soooo many more details to share, but for now, I can tell you that I will begin seeing clients on October 1st, and will open scheduling in mid August! (If you want to be contacted first when the schedule opens, send me a message now!)

If you have any questions, please feel free to reach out!! Can’t wait to share more details with all of you in the next few weeks/months!!

~Jessica

Your First Visit to See a Pelvic PT

I started writing this post a few different ways. Over the past several years, I have had handouts and brochures detailing out what is included in a first visit with a pelvic PT, but I liked the idea of something a little less formal. So, I started writing a letter to that new pelvic PT patient, and I hope it helps you (and your patients!!) feel more comfortable getting started! 

Hello there soon-to-be pelvic health PT patient:

We are SO thankful you are trusting us in partnering with you in your healing journey. We’re very glad you’re here. I realize that taking this step and actually scheduling a visit with a pelvic floor specialist can be nerve-racking, and you should be quite proud of yourself for taking this important step! I want to take a few minutes to talk with you about your first session in pelvic PT. I find that much of the fear and uncertainty people may feel with a first visit is often connected with this “unknown.” So, I hope today I can take some of that away, so you can feel more comfortable on that first day. So, let’s get started:

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Your arrival to the clinic 

Before you arrive to the clinic, you likely had a good amount of paperwork to fill out (Sorry about that!). Some of it is the standard healthcare type stuff, but there also is a more specific questionnaire. This questionnaire gets fairly personal. You’ll see questions in it about your bladder health (how often you pee? what do you drink? are you leaking urine?), your bowel function (are you constipated? do you strain when you have a bowel movement? do you leak stool?), your sexual function (are you sexually active? do you have difficulties with pain during sexual activity? problems with arousal or orgasm?), and any pain you’re experiencing (where is your pain? what worsens or improves it? how much does it hurt?) I’ll also ask you about your medical history, your medications, and if it applies to you, your history of pregnancies and childbirth, etc. I know this is a lot of detail, but this is very helpful for me in providing your care! Please feel free to put as much or as little detail on this as you feel comfortable doing. We will have a chance to discuss all of this in person.

Nice to meet you, let’s get personal!

After you and I meet, I will take you back to a private room, and we will chat about what’s going on. This is when we’ll talk about your story, what brought you here,  what are the challenges you have been facing, what has been your journey, and what are your goals you want to reach. We’ll also discuss the questions you answered on that detailed questionnaire, and I may ask you some other questions to get more information about the challenges you have been dealing with. I know it can feel a little weird for some people to share details about your bowel habits or sexual function with a person you just met, but believe me, for those of us who practice in this specialty, we talk about these things all the time. As we are chatting, please feel free to tell me anything at all that you think might be important. Don’t hold back…believe me, I most likely have heard all of this before. On that note, please know that I want you to feel comfortable and safe in the clinic, and if you would prefer not to discuss something, that is totally okay too. Just let me know!

Your Exam

After we chat, I will talk with you a little bit about what I think may be going on from a musculoskeletal, movement, and/or behavioral (habits) standpoint. At this point, I usually pull out some images, a model of a pelvis, etc. and will talk with you about what normal anatomy and physiology looks like in the pelvis and about what I think may be happening with the problems you are experiencing. Then, I will let you know what I am recommending we examine to get a better idea of your function. This often includes:

  • A “Big picture” movement exam: I will watch you walk, stand, sit, and move in many different directions. I will look at how your spine moves (from your neck down), your shoulders, hips, knees, and ankles. I also look at your balance and preferred postures, and I’ll even watch how your breathe (yes, breathing really does matter!). While we do this, you’ll also let me know if any movements are challenging for you or lead to any pain, and this helps me understand how your body as a whole is moving.
  • Specific tests/movements: After the global movement screen, we may go through some specific tests. This can include tests to see how you transfer forces or control pressure through your pelvis by lifting a leg or moving in a certain way, tests to see  how the nerves in your spine glide and move, or tests to see what structures are contributors to pain you may be experiencing.
  • Myofascial palpation: Next, we’ll see what tissues are tender or not moving well around your abdomen, pelvis, or elsewhere if we need to. This includes gently touching the muscles around the belly, hips,  and legs to see if anything feels uncomfortable, and may include lifting and moving the skin and tissues under the skin to see where there may be restrictions in tissue movement.
  • Pelvic floor examination: After that, we will look more closely at the muscles of your pelvic floor. Because the muscles of the pelvic floor live inside the pelvis, the best way to examine them is by doing an internal vaginal or rectal examination. For this exam, you would undress from the waist down and lie down on a mat table, covered with a sheet. We don’t tend to use stirrups for our exams (which most people are grateful for!). We start by looking at the outside tissues. We’ll ask you to contract and relax your pelvic floor muscles, and gently bear down to see how your muscles move (Don’t worry if you’re not sure what to do, we can help teach you!). We may ask you to cough to see how the muscles move reflexively. Then, we often will lightly touch on the outside of the muscles to see if anything feels uncomfortable or sensitive to you. We may check how certain tissues move, if that applies to the problems you are experiencing. After that, we can examine the muscles in more detail by inserting one gloved and lubricated finger into the vaginal or rectal canal. We can then feel the muscles to see if they are tender or uncomfortable, assess the muscle strength and endurance, and assess muscle coordination.  *NOTE: While an internal exam is a very valuable examination technique, some people do not feel quite ready for this, or would prefer not to have an internal exam. If that’s the case, be sure to let me (or your pelvic PT) know, and we can offer some other options.  Also, remember that our exam should not be a painful experience for you. Your pelvic PT should tailor the examination to your needs, so that you leave feeling confident and comfortable, not flared-up and in pain.

Our Plan 

After we finish the exam, we should have a clear picture of what areas we can address to work together to help you achieve your goals (whether your goals are to have less pain, stop leaking, start pooping, or something different all together!). So, our next step is to talk about our plan– what you can get started on today, and what our steps will be to help you reach the goal you want to reach.  We also will talk about how often I am recommending you to come see me, and how long I think we might work together. Sometimes I’m really good at estimating this, but sometimes I’m wrong. We can adjust along the way if we need to.

I hope this helps you to feel more comfortable and more confident when coming in for pelvic PT! If you need help finding a skilled pelvic PT in your area, please check out this previous post. 

Please let me know if you have questions at all I can help answer! Have a wonderful week!

~Jessica

 

 

Pelvic Floor Safe Options for Fitness

Exercise has so many incredible benefits for overcoming pain, optimizing cardiovascular health, and facilitating psychological well-being. Unfortunately, for many struggling with pelvic floor dysfunction (whether it is in the form of pelvic pain, urinary/bowel dysfunction, or pelvic organ prolapse), thoughts of exercise and fitness are often accompanied by fear. Fear that moving incorrectly will lead to a worsening of their symptoms. Fear of a set-back. Fear of creating a new problem. Finding an exercise program that will not only be safe, but actually aid in a person’s recovery and pelvic floor health is a fine art. Seeing a skilled pelvic floor physical therapist can be a good step in finding an individualized exercise program, but many may not have the luxury of working with a professional.

Recently, I did some research to help a few my patients find on-demand options for guided fitness that were pelvic floor friendly. I am grateful to have such an incredible community of pelvic health professionals to learn from and learn with, and I wanted to share these fantastic resources with you here. As always, please know that what works well for one person may not work well for another, thus, an individualized assessment is always the best option to determine the most appropriate exercise program for you.

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By http://www.localfitness.com.au – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=3910805

For those with pelvic pain or pelvic floor tension (often the case in cases of pelvic pain, constipation, overactive bladder):

For those with pelvic floor weakness (often the case–but not always! in situations like urinary incontinence, pelvic organ prolapse, diastasis rectus, fecal incontinence):

  • Mutu System: This is an excellent post-partum recovery program. Very helpful for those with pelvic floor weakness or diastasis rectus after having a baby. This is often my “go-to” for people having these problems that are unable to travel to see a pelvic PT. She does a great job at encouraging appropriate referral for further evaluation as well.
  • Fit2B: This is an online program with options for purchasing specific programs or for membership. It has a postpartum series, diastasis recti series, prenatal workshop, and foundational courses. I have had patients use this program who really enjoyed it.
  • The Pelvic Floor Piston: Foundation for Fitness by Julie Wiebe: Julie has an excellent course for individuals with pelvic floor dysfunction that incorporates education, exercises, as well as strategies for movement. It is a self-paced 90 minute video.
  • Your Pace Yoga by Dustienne Miller: Dustienne has expanded her video library to include videos such as “Optimizing Bladder Control” which includes sequences to support pelvic floor engagement through yoga.
  • Creating Pelvic Floor Health with Shelly Prosko: Part B Pelvic Floor Muscle Engagement. “40 minute practice that includes engagement of the pelvic floor muscles with various mindful movements and yoga postures integrated with the breath pattern.” Shelly was kind enough to offer blog viewers 10% off her combined package using the discount code: ClientDiscount10
  • FemFusion Fitness by Brianne Grogan: Brianne has an excellent video series (free too!) on youtube called, “Lift” Pelvic Support. This series includes a progression for safe progression through strengthening to better support the organs in the pelvis.
  • Pelvic Exercises by Michelle Kenway: Michelle has done excellent work creating videos and ebooks on safe exercise progressions for pelvic floor muscle weakness, prolapse, bowel dysfunction and surgical recovery. Check out her excellent videos here.

I hope these resources are helpful! Did I leave anything out? If you have other wonderful home exercise options that are “pelvic floor friendly” please let me know in the comments below!

~Jessica

Finding a Pelvic PT

Now, before I get started, I have to say that there are many, many websites/blogs with information on how to find a pelvic PT. But, I felt it necessary to have a post here so that people reading this site who needed a pelvic PT have a quick resource to understand how best to find one, and how to “shop around” and know that the person he or she is seeing is skilled. I hope it is helpful to someone at some point! So, once you have determined you would like to see a Pelvic PT or a Women’s Health PT, how do you find one? 

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Databases and PT Locators: 

There are two main PT locators for Pelvic Physical Therapists and they are: The American Physical Therapy Association’s “Find a PT”  and Herman & Wallace Pelvic Rehabilitation Institute’s Practitioner Directory. The APTA’s directory requires an APTA membership and H&W’s is open to any practitioner. The benefit of these directories is that they will help you locate a practitioner nearby and will provide information on any credentials or areas of specialty that person has designated.  The limitations are of course that there is no guarantee that a person listed is skilled in your specific need, so you will have to do a little more work from here. The APTA’s directory does provide a space for the PT to put more practice information, etc–so you get a little more information there.

Ask a friend…or the mafia: 

Social media is amazing and has truly revolutionized healthcare. Now, patients are really able to have experts at their fingertips with facebook, twitter, linkedin etc. Asking for a personal recommendation can be a great way to find a skilled PT. Patient groups online are also great resources for finding someone skilled in your particular need.

The #pelvicmafia is a twitter community of pelvic PTs who are truly doing great things to advance patient care, share research, and improve practice patterns across the board. Feel free to ask us for a recommendation by tweeting #pelvicmafia after your question. If we know of someone skilled living near you, we will be more than happy to share!

Also, know that most pelvic PTs are happy to help you if you ask! I have gotten several random phone calls from patients living in different areas, and I am always happy to give a recommendation if I have one! Find a reputable clinic anywhere in the US, and most PTs will be happy to do the same!

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Finding the right PT for you: 

Once you locate a PT, you’ll want to reach out and talk with her to make sure she is a good fit for you. First, what’s in a name? There are a few specializations/credentials you may need to be aware of.  Let’s go through the basics:

  • Entry-level degree- BS, MSPT, or DPT: The first few letters behind the PT’s name basically just give you some information on when that person received his or her initial degree. A while back, becoming a physical therapist just required a bachelor’s degree (4 years of study)–then it became a master’s degree (6 years of study)–then became a doctorate (7 years of study) ~ 10 years ago. That being said, many people who originally had a BS or MS have gone on to receive additional education to attain a transitional doctorate degree.
  • WCS (Women’s Health), OCS (Orthopedic), SCS (Sports), etc. Clinical Specialists: These letters will be behind someone’s name who has either 1) completed a residency in that specialty and passed a written examination or 2) had 2000 hours of experience within that specialty, completed a case study reviewed by a board, and passed a written examination. The current field of women’s health includes not just pelvic floor disorders in women and children, but also includes evaluation and treatment of breast cancer related musculoskeletal dysfunction, lymphedema, osteoporosis, fibromyalgia as well as female athletes. The WCS has been around for about 8 years (my educated guess).
  • BCIA-PMDB: This is a certification for using EMG biofeedback for pelvic floor muscle disorders through the biofeedback certification international alliance. Becoming certified requires 28 hours of education, a 4 hour personal training session and 12 hours of mentoring time reviewing 30 cases with a mentor. This also requires passing a certification exam. This has been around for a longer period of time in terms of the Pelvic specific certifications.
  • PRPC: This refers to the Pelvic Rehabilitation Practitioner Certification through Herman & Wallace. This test is offered to other health care practitioners as well, but of note requires  2000 hours of patient care and a written exam to attain. This certification is specifically focused on treating pelvic floor disorders and has only been around for about 1 year.
  • Other letters: I could spend quite a chunk of time defining all of the letters out there and still probably would miss quite a few!! Fellowships, certification programs, and even some continuing education courses will assign letters that a person can put after his or her name. I recommend looking at those letters, then typing them into google and finding out what they mean and whether they apply to you.

After you have decoded the PT’s name, ask about any continuing education the PT has had after graduation. This will give you insight into how that person has chosen to advance his or her education. In my mind, this is one of the most important pieces for many reasons.

  • Most entry-level programs have minimum to no training included on evaluating and treating pelvic floor dysfunction. I graduated from Duke University which has more training than most–but even that only included a few lectures and a short elective course. That being said, most Pelvic PTs end up being trained while on internship, residency or after graduating from school via continuing education courses.
  • The largest continuing education training programs are the APTA Section on Women’s Health (SOWH) and Herman & Wallace Pelvic Rehabilitation Institute. I am involved with both, have taken courses through both, and think both are wonderful programs! Both include training for internal examinations and treatments which is so important and both have plenty of lab assistants to help make sure participants know what they are doing. I lab assist for H&W and I am on the Educational Review Committee for SOWH. SOWH also has a certification option called “CAPP” for both Pelvic and Obstetrics to indicate a person has gone through the series of courses and passed a reviewed case study. Note: Although not all pelvic floor dysfunctions require internal vaginal or rectal treatment, I do believe that having formal training in this is important for a PT who is specifically treating pelvic floor disorders.
  • Internships: Some students who are interested in pursuing pelvic health or women’s health will choose to do internships working with clinicians in those fields. I did this as a student and worked with Darla Cathcart, PT, DPT, WCS in Shreveport, LA for 5 months (She’s awesome!) . I have taken 2 students from Duke University myself. These internships are a great way to learn and give you information that the person you are seeing has had one-on-one training.
  • Residencies: These are 1-year programs focused on treating women’s health physical therapy. There are less than 10 of these in the country, so if your PT has done a residency, it shows a strong commitment to education, in my opinion.
  • Other Continuing Education: I really think this is so important so cannot emphasize this enough. There are so many options for education including courses, conferences and national meetings. Feel free to ask the PT to see his or her resume or CV to see which courses have been attended and how they fit with what you need.

Hopefully this information helps you shop around and find a PT who fits what you need! Please do not feel lost or hopeless if you cannot find a pelvic PT who lives close by– the unfortunate thing is that there are way more people who need pelvic PTs then there are currently PTs to treat them! In the field of physical therapy, it is one of the “newer” specialties, so we definitely have room to grow! If you find a PT who may not have the training you desired– don’t fret! All of us had to begin somewhere, and there is so much to be said for a passionate, dedicated person who desires to learn! I have known PTs with less than 1 year of pelvic experience who I would easily refer to because of their passion and dedication alone!