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?
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!
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!
For the next few weeks, I plan to re-blog/update every Thursday a previous post originally written by me when working in Greenville, SC for the Proaxis Pelvic PT blog (http://proaxispelvicpt.wordpress.com), in hopes of building a comprehensive library of posts at jessicarealept.com. Selfishly- I like having them all in one place since I often refer patients who come to see me in Atlanta for pelvic PT to my old posts to read as “homework.”
That being said, today’s post is one published a while back here, originally titled, “Yes, you have incontinence. No, I do not necessarily want you to do Kegel exercises.” It has been modified/updated for you today 🙂 Enjoy!
Recently, I was fortunate to evaluate a nice middle-aged woman referred to me by her urogynecologist for urinary incontinence. When we first sat down, she looked at me and said, “I’m not sure why I am here. My doctor specifically told me that I have a strong pelvic floor. I really don’t think you can help me.” I smiled. I hear this same thought process on a weekly basis (See my previous article on common misconceptions of pelvic physical therapy) You see, at some point the world became convinced that from a musculoskeletal perspective, stress urinary leakage is always due to a weak muscle. And the best way to fix a failed muscle is to strengthen, strengthen, strengthen. But, if that’s the case, then why do I have so many patients walking into my office telling me that they have done “Kegel” exercises and still leak? Why would a patient like the one above have a “strong” pelvic floor that cannot hold back urine? Why is urinary leakage associated with low back pain and pelvic pain- disorders that we know can often include tight and irritated pelvic floor muscles?
Now, as a caveat to this article, let me say now that it is sometimes totally appropriate for a person to start a pelvic floor strengthening program. In fact, the person with a truly weak, overstretched, poorly-timing pelvic floor will likely be prescribed a strengthening program. With that being said, the truth is that the majority of patients referred to my clinic for evaluation of urinary incontinence are not issued a traditional kegel exercise program. My colleagues and I actually tend to be surprised when we evaluate a new patient who truly needs to start a true “strengthening” program for their pelvic floor at the first visit. The reason behind this is that Stress incontinence is not simply a failed muscle, but a failed system.
The urethra is supported within the continence system by fascia, ligaments, as well as muscular structures. When a downward force is applied to this system as occurs with coughing, sneezing, lifting, bending, etc, these structures function in a coordinated way to compress the urethra and prevent urine from leaking. In fact, Hodges et. al. in 2007 examined musculoskeletal activation occurring when a person performed an arm movement and found that the pelvic floor muscles pre-activated to prepare the body for movement. This helps to demonstrate that our pelvic floor muscles function as a member of the anticipatory core team. This team requires optimal and coordinated function of the diaphragm, the deep abdominal muscles, the deep low back muscles as well as the pelvic floor muscles. My awesome colleague, Julie Wiebe demonstrates that relationship very well in the video below (Note: Julie has an AWESOME blog/website- read more of her stuff here):
When any of these structures are not functioning well, leakage can occur. Now, the tricky part here is that optimal functioning requires both strength, flexibility and proper timing. A tight irritated muscle then becomes equally as dysfunctional as a weak over-stretched muscle. And, a strong, flexible muscle that doesn’t have the right timing contributes to a very dysfunctional system.
So, treatment for incontinence then must include retraining and reconditioning the system to ensure its proper functioning—which for me includes a bit of detective work to truly identify the faulty components. And, when it comes down to it, typically does not include doing 100 kegel exercises a day. More often, it includes learning to relax the pelvic floor and teach the pelvic floor to be a working team member– learning to coordinate the pelvic floor with the diaphragm, eliminating trigger points and restrictions which may be inhibiting this function, and then retraining the motor control of the lumbopelvic girdle as a system.
So, for now, take a deep breath and relax. We’ll save Kegels for another day.