Category Archives: Uncategorized

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

 

 

Y’all, I’m published in Sexual Medicine Reviews!

Last summer, Sara Sauder asked me to collaborate with her and Amy Stein on a submission to Sexual Medicine Reviews, highlighting the role physical therapy can play in helping men and women with sexual dysfunction. I was thrilled to have the opportunity to collaborate with Amy and Sara, and for the next year or so, we worked together to create “The Role of Physical Therapy in Sexual Health in Men and Women: Evaluation and Treatment.”

In this article, Amy, Sara and I discuss the role the pelvic floor muscles play in sexual health and common dysfunctions that can occur. We also discuss the process of physical therapy evaluation and treatment for sexual dysfunction, as well as the evidence regarding the efficacy of such treatments. Submitting to a peer-reviewed journal was humbling and exciting, and honestly, gave me much more respect for the process. I have been wanting to get involved with research for some time now, and I hope that this will be a springboard to more involvement and more writing.

The journal gives authors access to full-text of the article for the next 45 days, and I am excited to have the opportunity to share it with all of you!! Please let me know what you think of the article, and enjoy!

CLICK HERE to access full text of, “The Role of Physical Therapy in Sexual Health in Men and Women: Evaluation and Treatment.” 

All the best,

Jessica

Last Chance to Apply for Small Group Mentoring! Deadline is MON 10/22!

I am so excited for the first small group mentoring session to get started! Thank you to everyone who has already applied and enrolled in the first group!

If you are still on the fence about the program, please feel free to reach out!

For more information on the program and how to enroll, click here!

All the best,

Jessica

Movement, Pain Science & Wisdom: Clinical Expert Interview with Shelly Prosko, PT, PYT,CPI, C-IAYT

This afternoon, while my rambunctious little toddler was attempting (and ultimately failing!) a nap, I had the fantastic opportunity to chat with Shelly Prosko, a physiotherapist and yoga therapist in Alberta, Canada who specializes in working with individuals experiencing chronic pain (including pelvic pain!). Shelly is an all-around incredible human, knowledgeable clinician, and dynamic educator. I hope you all enjoy this interview as much as I enjoyed it!

Shelly and I chatted about some of the incredible content she has online, so I wanted to make sure I shared all of that information with you! If you would like to see the full playlist of her Words of Wisdom (W.O.W.) Chats, click here.
The individual links to the W.O.W. Chats we discussed are located below:
Lorimer Moseley: Pain Science Education vs Understanding Pain (I absolutely loved this one!!) 
Dr. Gabor Mate: Compassionate Inquiry for health providers
Carolyn Vandyken: Cultivating Courage for personal growth
Diane Lee: Connecting with Essence: your injury/pain does not define who you truly are
Mike Stewart: Your Pain is Real. We Believe You.
Shelly’s blog on Self-Care and what it really means to her:
Shelly also shared these resources for all of you:
Online course: PhysioYoga and the Pelvic Floor for healthcare providers, movement specialists, fitness professionals, yoga professionals:
Creating Pelvic Floor Health PhysioYoga video practices on Vimeo:
(Shelly has kindly given all of us this 10% off code: ClientDiscount10 for the “Buy All” option)
Shelly’s Pelvic Floor Resources: 

Are you a physical therapist interested in small group mentoring? Help me out by taking a short survey!

It’s almost here! I have been working on developing a small group mentoring program over the past few months, and it is almost ready to be rolled out!

As an instructor for Herman & Wallace Pelvic Rehabilitation Institute, I have been fortunate to work with hundreds of excellent clinicians who are at various stages of their journeys into the exciting world of pelvic health. While some clinicians enter into the field with a vast network of seasoned pelvic floor experts to support them, others have the additional challenge of being an “island”–basically, being the sole practitioner in their practice, city, and for some, within a 100+ mi radius.

My goal with small group mentoring is to be a facilitator for those journeying into this incredible specialty–to help not only with building the skill, knowledge and clinical reasoning necessary to create outstanding clinicians, but also to help connect clinicians together so no one has to go at it alone.

If this resonates with you, and you’re interested in learning with me, I would love to hear from you! I created this survey to better assess the needs of those interested in small group mentoring. Please take a few minutes to complete this survey, and look out for future announcements when the program is ready for rolling out!

All the best,

Jessica

CLICK HERE TO ACCESS THE SURVEY ON SMALL GROUP MENTORING 

What’s it like to learn to treat pelvic floor dysfunction? A Video Interview

I just got back from a fantastic weekend in Wichita, KS teaching (and really learning with!!) an excellent group of participants from across the country. Heather Radar, PT, DPT, BCIA-PMD, PRPC and I worked with these clinicians across 3 days, helping them learn about evaluating and treating constipation, fecal incontinence and other bowel disorders; coccyx pain; and introduced them to the exciting world of male pelvic floor dysfunction.

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Enjoying some Kansas BBQ after our first full day of teaching. This t-shirt was very fitting for a class teaching anorectal examinations. 😉 

Several of my students agreed to be in a short video interview to share about their experiences at the course and some of their big take-aways. I hope you all enjoy this short video! I plan to continue these at future courses both to demystify pelvic floor courses for clinicians out there, and give patients an insight into the training pelvic PTs pursue to become skilled in this specialty.

From left to right, these are the incredible clinicians who volunteered for our interview! If you are needing treatment in any of these areas, please seek these ladies out!

  • Morgan Clark, DPT: www. summitrehabkc.com
  • Hannah Overfelt, DPT: SERC Physical Therapy, Independence MO
  • Nicole DeBrie, PT, DPT: Foundational Concepts, http://www.foundational concepts.net, nicole@foundationalconcepts.net
  • Jennifer Dickinson, PT, DPT: Fitzgibbon Hospital, http://www.fitzgibbon.org
  • Ashley Vollmar, PT, DPT: St. Luke’s of Kansas City, Plaza location
  • Tarryn Andrews, PT, DPT: Accelacare Physical Therapy, http://www.accelacarept.com
  • Marla J. Jacquinot, PT, FAAOMPT: Marla@coreptkc.com
  • Bethany Wellin, PT, DPT: Via Christi Therapy Center, Manhattan KS, http://www.viachristi.org
  • Anne Clark: Wesley Healthcare Outpatient Therapy, Wichita KS, 316-962-9835
  • Caitlyn Tivy, PT, DPT, OCS: Caitlyntivy.wixsite.com/pelvichealthpt

FAQ: Specializing in Pelvic Health as a New Grad

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By Kit from Pittsburgh, USA (Grads Absorb the News) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons

I just received this question via e-mail from a participant at my most recent Level 1 Pelvic Floor course in Little Rock, Arkansas. (See upcoming course schedule!) As knowledge and exposure about pelvic floor disorders and pelvic PT grows, we see more and more doctoral students attending level 1 courses. And honestly, it makes me so excited about our future! These students are passionate, hungry for knowledge, and can’t wait to enter into the field and help people get better! I have mentored many students and new grads over the past several years, and this particular question frequently arises. I hope this post can be helpful for many new grads and DPT students in the future!

When students ask the questions listed above, they often are hit with well-intended, but often somewhat discouraging advice:

“You should really do orthopedics for a few years first, and then go into pelvic health.” 

“I really don’t think new grads should go straight into the pelvic health specialty” 

“It’s really important that you use all of your other skills first so you don’t lose them.” 

While this advice often means very well–aiming to create well-rounded practitioners, I find that this can feel very disheartening to that passionate-about-pelvic-health new grad. So, in that light, my advice is often a little bit different. I find we are all biased by our own experience, and in reality, many excellent clinicians spent multiple years in different specialties like orthopedics, neuro, acute care etc. prior to specializing in Pelvic PT, so I think there is a tendency to see this as the “best path” to becoming the most skilled clinician. Of course, I am biased the opposite way– I jumped into pelvic PT immediately upon completing my doctorate, and never looked back. Of course, this has meant that I had to do some work to build upon other skill sets that were needed over the years, but this path worked well for me.

So, why am I telling you all of this, excited-soon-to-be-new-grad? Because, honestly, you can do whatever you are passionate about doing! If you want to take some time to practice in another specialty, do it! If you are just too excited and want to jump right in to pelvic health, welcome aboard! Your experience alone is not going to make you an incredible clinician. Rather, it will be your passion, your hunger for learning, and your dedication to your patients that will fuel your path.  So, on that note, here are a few of my top tips for new grads entering into pelvic health!

  1. Choose an employer who will support your learning journey. In many ways, it has become very popular for clinics to build pelvic health programs. This is wonderful for patients (if they are committed to building good programs!) and a great opportunity for those entering the field. So, when you interview with an employer who is excited about your pelvic floor interest, ask questions to find out how much support they will give you along the way. Will they pay $$$ for your continuing education courses? Will the provide you time to work with a mentor? Will they support you by providing adequate time in your schedule for your patients (meaning, 45-60 dedicated minutes, not overlapping patients)?
  2. Negotiate for what you want. This is very very important. When I was first hired as a new grad, I negotiated with my employer for them to pay for me to attend 4 continuing education courses within my first year of employment. This allowed me to complete a full pelvic health curriculum within the year. Now, I realize that may seem a bit ambitious to some, but I considered this my personal “Residency” program and I felt like it gave me the jump start I wanted! So, this can mean negotiating for courses, mentoring time (get it in writing!), or even participation in an online mentoring program (like the one I plan to set up soon!).
  3. Find a good mentor. Of course, my perfect scenario for you involves finding a good job with a good mentor attached to it, but I realize that is not always easy to find. Reach out to local pelvic PTs in your area and connect with someone who is willing and able to be a resource to you! Of course, this can involve meeting periodically for coffee, or could be a more formal mentoring program. If the latter is the case, see point #2.
  4. Don’t be afraid to jump ship. If you start working somewhere and you don’t find that you are supported in the way you need to be, or you just don’t like the place you are working, it is totally ok for you to find a new job. Seriously. Life is too short to be unhappy where we spend our time.
  5. Be hungry for learning. I would encourage you to make a plan for attending coursework to help build your knowledge within the specialty. There are many excellent course series out there– Herman & Wallace Pelvic Rehabilitation Institute, the Section on Women’s Health, Evidence in Motion, among many others. Of course, I teach with H&W, so would love to have you at one of my classes! 🙂 Also, there are so many wonderful opportunities for learning today, outside of traditional continuing education. Read blogs (like this one!). Research conditions and diagnoses that you are not familiar with. Join social media pelvic health groups like Women’s Health Physiotherapy and Global Pelvic Physio (both facebook groups!).  Attend conferences like the Combined Sections Meeting through the APTA, the International Pelvic Pain Society’s Annual Meeting or the International Society for the Study of Women’s Sexual Health’s Annual Meeting. And don’t be afraid to ask for help when you need it!

I hope that is helpful! We are so fortunate to have so many excited and passionate clinicians joining our field! What other tips do you have for those joining this wonderful specialty? What other question do you have my dear PT students?

~ Jessica

 

Happy New Year!

Can you believe it is 2018?! I find that as the years go by, time seems to pass so much more quickly. 2017 was a year full of so many changes for me–both personally and professionally. I successfully kept a small (and super precious) human alive. I joined the faculty of Herman & Wallace Pelvic Rehabilitation Institute and taught 4, 3-day continuing education courses for physical therapists. I cut back on my clinical hours in order to spend more time with the aforementioned small human 😉 and focus on my other professional endeavors. And, I started video content on the blog (although not quite as much as I would have liked).

I am so excited to see what 2018 brings and have so many exciting plans on the horizon, both personally and professionally. I am continuing to work with the Institute teaching continuing education, and would love to see some of you at a future class! I am also actively working on developing new content for this website! This year, I hope to continue diversifying the content you see via written and video blogs and interviews. I am also working to develop both an online mentoring program for clinicians as well as some online program options for those struggling with pelvic floor problems. Keep on the look-out for more information about these programs! If you are interested in either, please be in touch! I would love to hear your thoughts and interests to better develop something you would find worthwhile!

Looking forward to continuing to learn with you and from you in the new year! Thank you as always for your continued support of this endeavor!

Cheers!

Jessica

Biofeedback for Vulvodynia: An Update 

“Do you do Glazer’s protocol?”

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I have been asked this question several times over the past few years, by searching, hopeful women, looking for help after suffering from vulvar pain for far too long. I generally respond with, “I’m familiar with Glazer’s protocol, and would be happy to discuss it with you. Why don’t you come in for an evaluation and we can discuss treatment options specific to you?” This, in place of the, “I know it, but it’s more than likely not appropriate for you.”

Glazer’s protocol was a popular treatment approach, utilizing SEMG biofeedback to teach patients a method of contracting their pelvic floor muscles, to ultimately “fatigue” the muscles, and with the hope that doing so would relieve pain. Dr. Glazer was one of the first to publish research about treating the pelvic floor muscles in helping women with Vulvodynia, and all of us working with men and women with pelvic pain are grateful for his contributions.

However, as time goes on, we learn more and more. Which is awesome. And as we learn more, we hopefully change how we practice to provide the best treatment we can to our patients. Recently, my colleagues Sara Sauder and Amy Stein (2 fantastic clinicians and educators in pelvic pain) wrote an excellent commentary summarizing the evolution of biofeedback in helping women with vulvar pain. I was thrilled to see their commentary, and I thought many of you would benefit from it as well!

Sara and Amy very eloquently explain how the understanding of treatment to the pelvic floor muscles have changed over the years. Glazer’s protocol was based off the idea that frequent contractions of the pelvic floor muscles (both holding contractions and quick ones) would fatigue the muscles and thus lead to relaxation and pain relief. However, our current understanding of the pelvic floor musculature is quite different.

Shortened, Tender Pelvic Floor Muscles 

Amy and Sara go on to explain that as we have learned about the pelvic floor and seen the presentations of women experiencing vulvar pain, we have found that most women actually present with shortened, tender pelvic floor muscles. Typically, when this is found on examination, the optimal treatment includes a combination of relaxation strategies as well as manual treatment vaginally to encourage lengthening of the pelvic floor muscles. And what about fatiguing them by doing lots of kegels? Well, we have found that when shortened muscles do lots of contractions, they can actually get irritated and more shortened!

So, what’s the place for biofeedback? 

First, it is important to realize that the term “biofeedback” is not exclusive to EMG. Really, biofeedback can be any cueing to encourage a patient to perform an exercise accurately. Sara and Amy give a few great examples: a finger in the vagina to encourage and cue the patient to relax and lengthen their muscles. A clinician teaching a patient the optimal way to harness the diaphragm with breathing. All biofeedback. And what about SEMG? It can offer some help for some patients to learn to relax and let go of their muscles. However, it can also be a little tricky because women with shortened muscles may appear “normal” on SEMG. Why? It’s complicated, but in summary, SEMG reads electrical activity… so, when a muscle is held at a shortened position for a long period of time, the body will adjust to this position as the new normal. Thus, this can “trick” a patient or clinician (especially if SEMG is done to replace an internal examination) into thinking the muscles are relaxed and functioning well, when they are actually shortened.

In summary, Glazer was a pioneer who really helped us in the process of better understanding Vulvodynia. But as all treatments and understandings do, we have evolved and changed to better understand what the most effective treatment techniques are for women experiencing Vulvodynia. Biofeedback should be a part of any treatment program… but SEMG biofeedback will have some utility for specific populations and limited utility for others.

I would encourage you to read Sara and Amy’s commentary yourself! You can find it here. If you are a physical therapist treating this population, you have the opportunity to learn from Sara in person! She teaches via Alcove Education, and has an excellent course: Vestibulodynia: An Orthopedic and Pelvic Floor Approach. My clinic is fortunate to host this course in just a few weeks! (Our course is sold out… but you can find upcoming courses here).

Sara and Amy are excellent clinicians, educators and advocates for men and women with pelvic pain. Sara runs a wonderful blog, Blog About Pelvic Pain, and Amy has created fantastic self-help tools, including her book Heal Pelvic Pain and her instructional DVD, Healing Pelvic and Abdominal Pain. I hope you enjoy these resources! 

Have a wonderful week!

Jessica

I’m back! And I have a really really cute baby!

Ok, I know you must be totally shocked to hear from me! But, I am back! For real!

My beautiful daughter, Emma Caroline, was born on October 26th at 1:32 pm, weighing 7 lbs 14 oz and 23 inches long. In case you are super observant, yes, the little girl who threatened to come early actually ended up coming a week late! We delivered her via c-section after 37 hours of labor. Yes, 37. I’m hoping her dramatic streak ends here. I’ll spare you the details now, but I’m sure some will come out along the way as they fit with future posts!

I was so fortunate to spend 12 weeks at home with my little girl, but I am back in the clinic seeing patients now, and back to writing! In fact, I promise you’ll get another post (a real, hopefully educational one!) before the week is through!

2017 is going to be a great year! I have some exciting things planned for the blog (hoping to finally start some fun video posts, more book reviews, and some interviews with colleagues who are super smart!), and I am SO excited to start teaching for Herman and Wallace Pelvic Rehabilitation Institute and continue teaching online webinars! See my “for professionals” section for current course listings! I would love to meet you in-person!

Wishing you and your family a happy and healthy 2017!

Jessica

My sweet little Emma, visiting her mama on my first day back at work!