Did you know that HWConnect will feature several Breakout sessions where you can receive hands-on learning from HW faculty?

These Breakouts include:

• Rehabilitative Ultra Sound Imaging of the Bladder and Transverse Abdominis with Allison Ariail, PT, DPT, CLT-LANA, PRPC
• Inclusive Care Roleplay Workshop with Ken McGee, PT, DPT
• Squat Analysis Lab with Brianna Durand, PT, DPT
• Acupressure: Self-Regulation Acupoints with Rachna Mehta, PT, DPT, CIMT, OCS, PRPC, RTY 200
• The Pelvic Rehab Provider’s Role in Infant Care: Managing Reflux, Constipation, and Colicky Babies with Mora Pluchino, PT, DPT, PRPC

On top of this, our Vendor Hall is PACKED! Starting with our event sponsor, CMT. Their booth will include shockwave, and Stacey Roberts will be on hand to demo this modality and answer any questions.

Other booths in the Hall include Intimate Rose, Athelas, SRC Health, Shift MD, Kindra, MedRoots, Raise the Pelvic Floor, and Wallace O'Farrell (Slippery Stuff). Plus Herman & Wallace and non-profits The Kenya Scholarship Foundation and Open Arms Perinatal Services.

Don't miss HWConnect 2025 in Seattle WA on March 28-30, 2025.

Does this scenario sound familiar? You are treating a patient with chronic pelvic pain who isn’t responding to conventional treatments. Maybe you are working with a client who has a prolapse, but no matter what you do, nothing is helping. You’ve tried everything and the underlying cause has you stumped.

You’re not alone. Dr. Julie Baron discusses the diagnosis of what is now known as Pelvic Venous Disorders (PeVD) in this short interview and explains how it is missed every day. "We aren’t taught about it in school or in our continuing education. The concepts that are taught center around outdated research and misleading terms like “Pelvic Congestion Syndrome” that can negatively impact diagnostic imaging selection, treatment, and overall patient outcomes."

Up to 30% of people with chronic pelvic pain have PeVD, yet the average time to diagnosis can take years simply because providers just don’t know any better. One of the biggest risk factors for the development of PeVD is pregnancy. Who better to screen for and identify this often-overlooked condition than you — a pelvic PT/OT?

To learn more about Pelvic Venous Disorders listen to her full video and sign up for her upcoming course Pelvic Venous Disorders scheduled for March 15th.

From antidepressants and anticholinergics to GLP-1 receptor agonists and ADHD stimulants, medications can significantly impact pelvic floor function and rehabilitation outcomes. Pelvic health rehabilitation providers must stay informed about new and existing pharmaceuticals, as many conditions such as overactive bladder, painful bladder syndrome, chronic pelvic pain, and constipation to name a few, are managed with medications that influence neuromuscular function, pain perception, hormonal balance, and urologic or gastrointestinal physiology.

A strong understanding of pharmacology allows pelvic health specialists to anticipate and address medication-related barriers to rehabilitation, such as fatigue, myofascial dysfunction, or altered bladder and bowel function. By integrating this knowledge into clinical practice, providers can tailor interventions, modify exercise prescriptions, manual therapy, and behavioral strategies to align with a patient’s medication profile. For example, muscle relaxants or neuromodulators like baclofen and gabapentin may necessitate adjustments in functional training due to sedation or decreased muscle tone. At the same time, diuretics require careful scheduling of therapy sessions to accommodate urinary urgency.

Pelvic health rehab providers also play a crucial role in patient education, helping individuals understand how medications affect pelvic health and how lifestyle, diet, and therapy can optimize treatment outcomes. Many patients take multiple medications that may either support or hinder their progress, making it essential for providers to recognize drug-induced side effects that could mimic or exacerbate pelvic floor dysfunction.

Staying current with pharmacological advancements enables pelvic health specialists to collaborate effectively with urologists, gynecologists, gastroenterologists, pain specialists, and primary care providers. This interdisciplinary approach ensures comprehensive, patient-centered care, optimizing safety and treatment efficacy. By maintaining a solid foundation in pharmacology and keeping up with emerging research, providers can enhance rehabilitation outcomes, prevent setbacks, and offer more informed, holistic care.

Join Kristina Koch, PT, DPT, CLT, PCES on April 5, 2025, for the remote course "Pharmacologic Considerations for the Pelvic Health Provider" to expand your expertise in managing medications related to pelvic floor dysfunction and broader men’s and women’s health conditions. This course will equip you with the knowledge to evaluate medication-related factors, recognize potential side effects, implement non-pharmacologic management strategies, and collaborate effectively with other healthcare professionals. Strengthen your ability to enhance patient safety, optimize treatment outcomes, and confidently navigate the pharmacological aspects of pelvic health care.

AUTHOR BIO:
Kristina Koch, PT, DPT, CLT, PCES

Kristina Koch, PT, DPT, CLT, PCES (she/her) received her Masters of Science in Physical Therapy in 1996 from Springfield College in Massachusetts. In 2001, while living in the Los Angeles area, Kristina started specializing in the treatment of pelvic floor dysfunction including bowel/bladder issues and pelvic pain, and in 2021, she went on to earn her doctorate of physical therapy from The College of St. Scholastica. During her time in Los Angeles, she was fortunate to work with and, be mentored by fellow Herman and Wallace faculty member, Jenni Gabelsburg, DPT, WCS, MSc, MTC. Kristina is a Board Certified Specialist in Women's Health Physical Therapist (2013-2023) by the American Board of Physical Therapy Specialties. She then received her lymphatic therapist certification (CLT) in 2015.

Kristina has successfully helped establish women’s health and pelvic floor physical therapy programs in San Diego, California and Colorado Springs, CO where she currently works in private practice. Kristina treats men, women, children, trans and gender non-binary individuals in her practice. In addition, Kristina serves as a guest lecturer for graduate physical therapy students at Regis University in Denver, CO and, provides educational lectures to medical providers and local community groups. Outside of work, Kristina enjoys spending time with her husband and two children, skiing, running and hiking.

Menopause represents a transformative phase in a woman’s life, and as pelvic health practitioners, it’s an opportunity for us to make a significant impact. Rather than being the “beginning of the end,” menopause can usher in a new era of freedom and empowerment. Women spend a significant portion of their lives post-menopause, free from the limitations of periods, pain, and hormonal fluctuations, but only if we, as clinicians, provide the tools and education necessary to thrive during this transition.

Historically, women’s health during menopause has been overlooked. In the past century, limited life expectancy meant menopause healthcare and research were rarely prioritized. Combine that with the research gap in women’s health and well-documented medical misogyny, and one can see how generations of women’s health has been neglected. However, with advancements in healthcare and advocacy, that’s changing—and we need to lead the way in reframing menopause management, starting with conservative pelvic health approaches before defaulting to hormonal therapies.

The Overlooked Connection: Hormones, Voice, and Pelvic Floor Health
Among the myriad symptoms of menopause, the interplay between hormonal changes, the voice, and the pelvic floor often goes unnoticed. Hormonal shifts, especially decreasing estrogen levels, significantly impact voice quality, including reduced pitch range, vocal endurance, and an increase in vocal fatigue and dryness. These changes mirror similar phenomena in the pelvic floor, where decreased tissue elasticity, sarcopenia, and altered pressure management can result in incontinence, prolapse, or pain.

The voice is highly sensitive to endocrine changes throughout life. For example:

• Puberty: Testosterone lengthens and thickens the vocal folds, lowering pitch.
• Menstrual Cycle: Dysphonia premenstrualis, linked to inflammation and hormonal fluctuations, reduces vocal range and endurance.
• Pregnancy: Thickened vocal folds and decreased pitch are common due to hormonal and fluid changes.

During menopause, these shifts intensify. A study in Menopause revealed that 46% of postmenopausal women experience voice changes, with 33% reporting significant quality-of-life impacts, such as reduced confidence and professional standing.

Menopause, Hormone Therapy, and the Voice
Take puberty for example, when the presence of testosterone changes the dimensions of the male vocal tract. The vocal folds become thicker and longer and the larynx size increases, which changes the “fundamental frequency of the voice.” By contrast, premenstrual voice changes have also been noted, which is known as dysphonia premenstrualis and is characterized by a loss of ability to achieve high notes, as well as vocal fatigue and reduced vocal range. Some of these changes are driven by inflammation, mucosal dryness, and decreased mucosal secretions caused by progesterone. Other researchers have noted that cervical and laryngeal smears, taken during the premenstrual period phase consistent with progesterone peak, were indistinguishable.

Likewise, women going through pregnancy, and specific to the menopause discussion, experience unique voice changes as well. Vocal abnormalities noted in the literature include vocal fold thickening, lowered vocal pitch, vocal fatigue, reduced vocal range, and failure to reach higher notes. Though anecdotally I have also seen women struggle with mid-range notes rather than high-range notes in clinical practice, which underscores the importance of evaluating each patient case-by-case instead of making broad assumptions about voice and pelvic health during perimenopause and menopause.

Of additional concern is the change that HT can have on the vocal folds, which overall can be positive. HT can improve glandular secretions above and below the vocal folds, enhance mucosal viscosity, increase pitch range, capillary permeability, and overall better tissue oxygenation. Estrogen is also a well-known inflammatory mediator, which can help protect and prevent damage to the vocal folds. Additionally, sarcopenia is known to impact vocal fold shape, which could lead to vocal fold bowing, vocalis atrophy, and subsequent glottal fold closure impairment.

The Voice-Pelvic Floor Connection (V2PF)
The interconnectedness of the voice, respiratory diaphragm, and pelvic diaphragm provides a unique lens for menopause care. These three diaphragms share connective tissue and neuromuscular pathways, which influence pressure regulation essential for vocalization, continence, and core stability.

The V2PF Method offers a systems-based, trauma-informed approach to evaluating and addressing these connections. By focusing on:

1. The orofacial/cervico-laryngeal diaphragm,
2. The respiratory diaphragm, and
3. The pelvic diaphragm,

Clinicians can help patients improve coordination, endurance, and strength across these systems. Techniques like musculoskeletal ultrasound imaging allow practitioners to assess and enhance pressure management strategies, leading to improved vocal and pelvic floor outcomes.

Empowering Women Through Education and Treatment
While hormone therapy (HT) can improve vocal function by increasing glandular secretions and reducing inflammation, among other benefits, it’s not a one-size-fits-all solution. Clinicians should consider HT as part of a comprehensive plan that includes conservative interventions such as manual therapy, exercise, and lifestyle modifications tailored to individual needs. Understanding the hormonal and structural changes of menopause empowers both practitioners and patients. With a holistic and interdisciplinary method like the V2PF approach, we can help women reclaim their voices—literally and metaphorically—during menopause.

Learn More
Join Dr. Garner's course The Voice and the Pelvic Floor at Herman and Wallace scheduled on March 8th and October 5th, 2025 to explore the V2PF method and its applications in pelvic health. Together, we can revolutionize care for women navigating menopause.

Want resources for patient education? Start here: https://youtube.com/playlist?list=PLssRl7MibHhHdVqWHIkrAp51PaYecA9d0&si=nptOLwRPbcpoJAi2

Struggling with vocal and perimenopause or menopause issues as a healthcare provider? Ginger provides first consults free at www.garnerpelvichealth.com

Resources:

1. Afsah, O. Effects of hormonal changes on the human voice: a review. Egypt J Otolaryngol, 40, 22 (2024).
2. Abitbol J, Abitbol P, Abitbol B. Sex hormones and the female voice. J Voice. 1999 Sep;13 (3): 424-46.
3. D’haeseleer E, Depypere H, Van Lierde K, (2013) Comparison of speaking fundamental frequency between premenopausal women and postmenopausal women with and without hormone therapy. Folia Phoniatr Logop 65: 78–83
4. McCarthy, M., Raval, A.P. The peri-menopause in a woman’s life: a systemic inflammatory phase that enables later neurodegenerative disease. J Neuroinflammation, 17, 317 (2020)
5. Bensoussan T, et al. Voice as a predictor of health during menopause. Presented at: Annual Meeting of The Menopause Society; Sept. 10-14, 2024; Chicago.
6. Schneider B, van Trotsenburg M, Hanke G, Bigenzahn W, Huber J. Voice impairment and menopause. Menopause. 2004 Mar-Apr; 11 (2): 151-8.
7. Awan, S. N. (2006). The aging female voice: Acoustic and respiratory data. Clinical Linguistics & Phonetics, 20 (2–3), 171–180. https://doi-org.elon.idm.oclc.org/10.1080/02699200400026918
8. https://www.nursinginpractice.com/clinical/womens-health/menopause-confidence-loss-and-the-voice/?utm_source=chatgpt.com
9. https://hermanwallace.com/blog/trauma-and-the-voice-to-pelvic-floor-connection

AUTHOR BIO:
Dr. Ginger Garner PT, DPT, ATC-Ret

Ginger Garner, PT, DPT, ATC-Ret, is a board-certified specialist in lifestyle medicine and an orthopedic and pelvic health therapist with advanced training in MSK ultrasound, dry needling, visceral and fascial mobilization, integrative, and functional medicine, including yoga, Pilates, mindfulness, and hormone health. A UNC-Chapel Hill graduate, Dr. Garner is the author of multiple textbooks, book chapters, and articles. Based in Greensboro, NC, she owns Garner Pelvic Health, hosts The Vocal Pelvic Floor podcast, and serves in multiple leadership, advocacy, and policy roles at the state and federal levels. Her clinical work focuses on voice to pelvic floor trauma-informed care for complex conditions including endometriosis, perimenopause and menopause care, hypermobility syndrome, and hip dysplasia.

Visit Dr. Garner at her clinical practice, Garner Pelvic Health, Living Well Institute, www.integrativelifestylemed.com, and on Instagram and YouTube @drgingergarner.com.

Continuing education is a crucial investment for medical professionals. Not only are CEUs required to maintain your practitioner's license, but staying updated with the latest knowledge and skills is essential for career growth. One effective way to manage the cost and convenience of ongoing learning is by purchasing pre-paid course credits. Here’s why investing in pre-paid course credits can be a strategic move for your professional development.

1. Cost Savings and Budgeting Benefits
One of the most compelling reasons to purchase pre-paid credits is the financial advantage. Herman & Wallace offers special pricing when you buy credits in bulk. Instead of paying per course at a potentially higher rate, you can secure your learning at a lower cost. This approach also helps in budgeting your professional development expenses for the year, ensuring that you allocate funds efficiently.

2. Encourages Consistent Learning
With pre-paid credits, you are more likely to commit to ongoing education. Having credits available removes the financial barrier that might otherwise cause hesitation when enrolling in a course. Instead of deliberating over each purchase, you can quickly register for courses and continue learning without interruption.

3. Flexibility in Course Selection
Pre-paid credits typically allow you to choose from a variety of courses within a specified timeframe. This flexibility enables you to tailor your learning journey based on your evolving interests and industry requirements. Whether you need to upskill in a particular area or explore a new field, pre-paid credits ensure that you have access to relevant training when you need it.

4. Employer and Organizational Benefits
Many companies encourage employees to take continuing education courses to stay competitive in their respective fields. Organizations that offer pre-paid credits to their staff foster a culture of continuous learning and skill enhancement. Employers benefit from having a more knowledgeable workforce, while employees appreciate the investment in their professional growth.

5. Simplified Administrative Process
For businesses and individuals alike, pre-paid credits streamline the administrative process of enrolling in continuing education. Instead of processing multiple payments or dealing with reimbursement paperwork, you can redeem credits with ease, reducing the hassle of transaction management.

6. Ensuring Compliance and Certification Maintenance
Medical professions require ongoing education to maintain certifications or licensure. Pre-paid course credits ensure that you stay on track with your required training without last-minute scrambling. This proactive approach prevents potential lapses in certification, which could impact career progression or professional standing.

7. Long-Term Investment in Career Growth
Education is an investment in your future. By purchasing pre-paid credits, you demonstrate a commitment to lifelong learning and career advancement. The ability to access courses conveniently keeps you ahead in your field and opens doors to new opportunities.

Pre-paid credits offer numerous advantages, including financial savings, flexibility, and a commitment to continuous learning. Whether you are an individual professional seeking career growth or an employer looking to enhance your team’s skills, pre-paid credits provide a structured yet flexible way to manage continuing education. Investing in education today ensures long-term success and professional excellence.

At Herman & Wallace, pre-paid credit can be used toward continuing education courses, HWConnect, Pelvic Rehabilitation Practitioner Certification (PRPC), and downloadable products.

To find out more check out the Pre-Paid Credit FAQs:
https://hermanwallace.com/frequently-asked-questions#pre-paid-credit

To request an invoice for Pre-Paid Credit visit:
https://www.hermanwallace.com/pre-paid-credit

As I cruise through online Facebook Pelvic Health Mentorship Groups - a weird bedtime passtime that brings me more satisfaction than doom scrolling on TikTok - I hear many providers worried about getting in trouble for patient abandonment. As rehab providers, we have worked hard to get our education, licensure, jobs, and clients that trust us, so it makes sense there would be a fear of losing any of all of those things.

When this concern comes up, I just want to reassure providers and also let them know that there are three continuing education classes in the Herman & Wallace curriculum tailor-made to address other ethical questions and concerns pelvic rehabilitation providers may have:

• Ethical Considerations from a Legal Lens - Scheduled for April 12th
• Ethical Considerations for Pediatric Pelvic Health - Scheduled for July 27th
• Ethical Concerns for Pelvic Health Professionals - Next date TBD

What is patient abandonment? Patient abandonment is a failure of the provider to fulfill their duty of care, leaving a patient without necessary medical support at a critical time. Unlike a patient voluntarily discontinuing care or being referred to another provider, abandonment involves a lack of appropriate communication or planning.

What are some myths surrounding patient abandonment? Some providers believe that any discontinuation of care constitutes abandonment. This is actually untrue if proper steps are followed to end the plan of care. It is also false to assume that providers are legally obligated to see a patient indefinitely. Patient abandonment does not only apply to doctors, it applies to all healthcare providers, including therapists and nurses.

How do I know something would be considered abandonment? For an act to qualify as patient abandonment, several factors must be present including a lack of adequate notice to the patient, no opportunity for the patient to secure alternative care, and abandonment occurring during an ongoing or critical phase of treatment. A provider’s failure to meet their duty of care without justified cause is central to this issue. There is a difference between ethical termination of care and actual abandonment.

How can a provider avoid being accused of abandonment? The provider can give the patient written notice, typically 30 days in advance, and includes referrals to other providers. If a patient consistently refuses to follow treatment recommendations or fails to attend appointments, the provider may have grounds to terminate care. The important take-home here is proper communication, documentation of this communication, and adherence to professional guidelines of your profession and state.

“I had this person call my clinic and I didn’t want to take their case, did I abandon them?” In order for it to even enter the possibility of abandonment, care has to be initiated. This means if someone calls your office, and you decline to treat them, as long as you give them a referral to someone else who might be able to help them, you should be safe.

“I started seeing someone and I want to stop. What do I do?” If you have seen them for a visit and started their care and choose to stop it, for any reason, you must follow some steps to cover yourself legally and ethically. First, consider why you are ending the plan of care. Are they not listening to you? Are their needs outside of your skill set? Are they being inappropriate? Are they not complying with their clinical contract - for example not paying outstanding balances, etc? Second, you must provide reasonable notice to give a patient adequate time to find another provider. Make sure to provide this in writing and verbally, and give a specific end date. Document the reason for termination - for example, non-compliance, missed appointments, not following appropriate clinical behavioral guidelines, etc. Explain the reason to the patient as appropriate while offering referrals, resources, and emergency assistance if it may be needed. When in doubt, a short consultation with a lawyer about the guidelines of your profession and state can save you money and worry in the long run.

“What if I don’t feel safe?” If a patient threatens you or your staff, stopping care is justified for safety reasons, but it must still be handled properly to avoid claims of abandonment. First, get to a safe space physically and emotionally. Document the incident and contact law enforcement and legal help as appropriate. Draft and deliver a formal termination notice where delivery can be confirmed and referrals for other providers should be included within this.

“I don’t want to pass off a dangerous person to someone else.” We must refer out as part of the termination process BUT it does not have to be a fellow therapist. We can send them back to their referring provider as one option. If you feel someone is predatory or engaging in criminal behavior, referral to mental health with the inclusion of law enforcement may be the next step. Having a lawyer to consult with can help you uphold your license, state, and HIPAA responsibilities.

As it goes with many ethical things, there may not be a perfect answer and there is room for nuance as well as “it depends.” But if you follow the principles of giving notice, providing referrals, and documentation of the scenario and actions, this should help you with taking care of your personal and professional safety.

AUTHOR BIO
Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating pelvises and ages with a variety of Pelvic Health dysfunctions. There is not much she has not treated since beginning this journey and she is always happy to further her education to better help her patients meet their goals.

Dr. Pluchino strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at present. In 2020, She opened her own practice called Practically Perfect Physical Therapy to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.

Chronic non-cancer pain (CNCP), defined as pain persisting for more than three months, affects approximately 20% of adults worldwide, with a higher prevalence among vulnerable populations such as the elderly and those from diverse cultural backgrounds. The economic burden of CNCP is substantial, exceeding that of heart disease, diabetes, and cancer in countries like the United States. Beyond the financial implications, CNCP significantly impacts individuals' quality of life, leading to absenteeism, loss of productivity, and increased healthcare utilization.

Traditionally, CNCP management has focused on pharmacological interventions and physical therapies. However, emerging evidence underscores the importance of a holistic, person-centered approach that addresses various lifestyle factors, including nutrition. Healthy eating patterns are associated with reduced systemic inflammation, as well as lower risk and severity of chronic non-cancer pain and associated comorbidities.

Persisting low-grade systemic inflammation is associated with CNCP and multiple comorbid chronic health conditions. Diet plays a complex role in modulating systemic inflammation. Knowledge is expanding rapidly in this area and multiple links between diet and inflammation have been identified. Metabolic mechanisms associated with postprandial hyperglycemia and frequent and prolonged rises in plasma insulin levels, influenced by dietary intake, can produce systemic inflammation.

Nutritional Strategies for Pain Management
Evidence from a number of recent systematic reviews shows that optimizing diet quality and incorporating foods containing anti-inflammatory nutrients such as fruits, vegetables, long-chain and monounsaturated fats, antioxidants, and fiber leads to a reduction in pain severity and interference.

Non-nutritive bioactive compounds such as polyphenols mitigate oxidative stress and inflammation, as well as modulate pain experiences. One such mechanism operates through the inhibition of COX-2 in neuromodulating pathways. Polyphenols are found in a range of foods such as fruits, vegetables, whole grains, cocoa, tea, coffee, and red wine.

Incorporating anti-inflammatory foods into one's diet can be a practical approach to managing CNCP. Emphasizing the consumption of fruits, vegetables, whole grains, and healthy fats, while reducing the intake of processed foods and sugars, can help modulate inflammation and alleviate pain. Additionally, maintaining a balanced diet supports overall health, which is crucial for individuals dealing with chronic pain.

Adopting a healthy, anti-inflammatory diet can reduce systemic inflammation and alleviate pain severity, contributing to improved quality of life for individuals with CNCP. As research in this field continues to evolve, healthcare providers should consider incorporating nutritional strategies into comprehensive, person-centered pain management plans.

To learn more about essential digestion concepts, nourishment strategies, and the interconnected nature of physical and emotional health across the lifespan join Megan Prybil in her upcoming course, Nutrition Perspectives for the Pelvic Rehab Therapist on February 23-24, 2025. Whether at the beginning of your journey or well on your way down the path of integrative care, this continually updated and relevant course is a unique, not-to-be-missed opportunity. 

Resources:

1. Brain K, Burrows TL, Bruggink L, Malfliet A, Hayes C, Hodson FJ, Collins CE. Diet and Chronic Non-Cancer Pain: The State of the Art and Future Directions. J Clin Med. 2021 Nov 8;10(21):5203. doi: 10.3390/jcm10215203. PMID: 34768723; PMCID: PMC8584994.
2. Nijs J, Malfliet A, Roose E, Lahousse A, Van Bogaert W, Johansson E, Runge N, Goossens Z, Labie C, Bilterys T, Van Campenhout J, Polli A, Wyns A, Hendrix J, Xiong HY, Ahmed I, De Baets L, Huysmans E. Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective. J Clin Med. 2024 Jan 23;13(3):644. doi: 10.3390/jcm13030644. PMID: 38337338; PMCID: PMC10855981.
3. Elma Ö, Brain K, Dong HJ. The Importance of Nutrition as a Lifestyle Factor in Chronic Pain Management: A Narrative Review. J Clin Med. 2022 Oct 9;11(19):5950. doi: 10.3390/jcm11195950. PMID: 36233817; PMCID: PMC9571356.
4. Lahousse A, Roose E, Leysen L, Yilmaz ST, Mostaqim K, Reis F, Rheel E, Beckwée D, Nijs J. Lifestyle and Pain following Cancer: State-of-the-Art and Future Directions. J Clin Med. 2021 Dec 30;11(1):195. doi: 10.3390/jcm11010195. PMID: 35011937; PMCID: PMC8745758.
5. Nijs J, Reis F. The Key Role of Lifestyle Factors in Perpetuating Chronic Pain: Towards Precision Pain Medicine. J Clin Med. 2022 May 12;11(10):2732. doi: 10.3390/jcm11102732. PMID: 35628859; PMCID: PMC9145084.

When looking at yoga there are several different types to consider. Some of the most popular are Hatha yoga, Hot yoga, Restorative yoga, Vinyasa yoga, and Yin Yoga. Restorative yoga focuses on relaxing the nervous system and in the 2021 Global Yoga Survey was ranked as the third most popular style worldwide. This survey was given to 10,982 practitioners spanning 124 countries and 29.6% responded that restorative yoga was one of the main styles they practice. (1)

In a dedicated restorative yoga class, a student comes to class, gathers a number of props, and is instructed through 3 to 5 postures, all held for long durations to complete an hour or longer class. Students have various experiences with this type of practice, but over time many begin to feel the need for rest (or restorative practice) in a similar way that one feels thirsty or hungry.

Restorative Yoga and Physical Therapy
The U.S. military, the National Institutes of Health, and other large organizations are listening to, and incorporating, scientific validation of yoga’s value in health care. Numerous studies show yoga’s benefits in arthritis, osteopenia, balance issues, oncology, women’s health, chronic pain, and other specialties. (2)

Restorative yoga can be a valuable adjunct for rehab practitioners in helping patients improve their physical and mental health. It can be especially helpful for people recovering from injuries, surgery, or chronic conditions. Restorative yoga can also be used for active recovery. This practice enables them to be lightly active while allowing their body to heal from strenuous training sessions. Runners, bodybuilders, and other types of athletes can benefit from using restorative yoga for this purpose.

Restorative yoga allows us to access the ventral vagal aspect of the parasympathetic nervous system. This pathway is necessary for healing, stress management, and the ability to choose our actions rather than react. Restorative yoga is an accessible method that may be a new tool in a patient’s toolbox for managing their nervous systems.

The goals of both therapy and restorative yoga are similar in healing and alleviating stress on the body. Remember that restorative yoga teaches people to be more aware of their body and the connection between their body and mind. By combining the two, patients can move forward in their lives and learn how to cope and be aware of what is going on with their bodies.

By adding restorative yoga to your toolkit, you can help your patients learn more about their bodies and pain. It can improve their focus, stability, flexibility, and strength – all of which will improve their results and quality of life.

Join Kate Bailey to learn more about restorative yoga and how to incorporate it into your practice in her upcoming course Restorative Yoga for Physical Therapists (and yes this course is open to all licensed practitioners) on March 22, 2025.

References:

1. The global yoga survey 2021: How and why people practice yoga. DoYou. (2022, April 12). Retrieved January 17, 2025, from https://www.doyou.com/yoga-survey/
2. 9 Benefits of Yoga. John Hopkins Medicine. Retrieved January 17, 2025 from https://www.hopkinsmedicine.org/health/wellness-and-prevention/9-benefits-of-yoga

AUTHOR BIO:
Kate Bailey, PT, DPT, MS, E-RYT 500, YACEP, Y4C, CPI

Kate Bailey (she/her) received her Doctorate in Physical Therapy and Masters of Science in Anatomy from the University of Delaware. Her physical therapy practice is focused on pelvic for all genders and ages. Kate brings over 15 years of teaching movement experience to her physical therapy practice with specialties in Pilates and yoga with a focus on alignment and embodiment. Kate’s Pilates background was unusual as it followed a multi-lineage price apprenticeship model that included the study of complementary movement methodologies such as the Franklin Method, Feldenkrais, and Gyrotonics®. Building on her Pilates teaching experience, Kate began an in-depth study of yoga, training with renowned teachers of the vinyasa and Iyengar traditions. She held a private practice teaching movement prior to transitioning into physical therapy and relocating to Seattle.

I’ve been “on the record saying” I used to be a modalities skeptic. I didn’t think I used them a ton in my practice and when I switched from a big hospital system to my own private practice, I didn’t have access to the larger equipment machines like the big ultrasound or biofeedback devices.

I have, however, always been a fan of gadgets and tools as a pelvic health provider. For anyone who has ever been to a class where I was a teaching assistant, you’ve likely seen me literally roll in with a giant suitcase full of example things - models, pelvic trainers, examples of belts, braces, dilators, wands, weights, lube samples, pelvic organ stuffies etc. I always called it my toolkit and so many of my peers had this as well. When the Content & Curriculum team asked me to be on the team for writing for this project, I was initially unsure. I didn’t think I used modalities enough or valued them enough to create a two-day course on the topic.

Long story short…I was wrong. What I have learned is I was very wrong, and I use them constantly.

As we created the outline for Modalities and Pelvic Function, it became very clear that I had not really understood the definition of a modality. Spoiler alert, we spend the first lecture talking all about this. Once I understood that a modality is basically anything we use to create a change with a patient, I realized I LOVED them and used them all day, every day. I happily settled into writing with the team, reaching out to companies for samples, trial devices, and helped to make this AMAZING toolkit for a class that is like the biggest game of pelvic health show and tell.

I was lucky enough to be one of the instructors for the inaugural class and have been present at every class since. What I did not expect from this class was the “aha” moments and how well these helped students put it all together. Feedback-wise, our team always gets requests to “show more treatment” and “give skills to bring back to the clinic for treatment.” Welcome to two straight days of this for every pelvic topic we could think of in reference to bowel, bladder, and sexual dysfunction while also making room for oddball topics like patient education, models, and handouts.

If you have questions about this course, then look through the following FAQs. If you don’t see your question answered, then reach out to the Herman & Wallace team and they can answer it for you!

Will this class make me buy something?
Nope, no purchase is necessary, but we did work with a whole bunch of companies to get you some free samples or really good discounts if you want your own.

Does my pelvic floor have to be available for this class?
We do two labs with internal sensors so a provider can feel what biofeedback and e-stim feel like. You get to choose your sensor and preferred canal and apply your own device. For those who are a little shy about sharing their pelvis for the sake of science, I’ve been told this has been a really safe feeling option. If you’re not up for an insertable device, we offer external options as well.

What skills will I take home?
You’ll learn all the features of every modality that our writing team could think of all organized by topic and primary treatment usage (don’t worry, we’ll also share our pearls and hacks.) We’ll also talk about ways to teach your patients about these devices including why a device might be indicated, how it can be used, cleaned, etc.

Is this class for newbies or those who are seasoned?
Yes! We’ve had participants of all different experiences and skill levels find this class extremely useful and a great resource for their practice. If you work in pelvic health and are an expert in gadgets already, this may NOT be the course for you unless you’d like to be one of our awesome teaching assistants.

We’ve worked so hard to make Modalities and Pelvic Function a well-rounded learning experience. This class is ONLY in person and tends to be a very intimate group of providers, which was another request from our Herman & Wallace customers. We hope to see you at one of the five offerings of Modalities and Pelvic Function this year!

• Galloway, NJ - February 8-9
• Sacramento, CA - April 5-6
• Houston, TX - July 12-13
• Akron, OH - September 20-12
• Somerset, NJ - October 4-5

AUTHOR BIO

Mora Pluchino, PT, DPT, PRPC

Mora Pluchino, PT, DPT, PRPC (she/her) is a graduate of Stockton University with a BS in Biology (2007) and a Doctorate of Physical Therapy (2009). She has experience in a variety of areas and settings, working with children and adults, including orthopedics, bracing, neuromuscular issues, vestibular issues, and robotics training. She began treating Pelvic Health patients in 2016 and now has experience treating women, men, and children with a variety of Pelvic Health dysfunction. There is not much she has not treated since beginning this journey and she is always happy to further her education to better help her patients meet their goals.

She strives to help all of her patients return to a quality of life and activity that they are happy with for the best bladder, bowel, and sexual functioning they are capable of at the present time. In 2020, She opened her own practice called Practically Perfect Physical Therapy Consulting to help meet the needs of more clients. She has been a guest lecturer for Rutgers University Blackwood Campus and Stockton University for their Pediatric and Pelvic Floor modules since 2016. She has also been a TA with Herman & Wallace since 2020 and has over 150 hours of lab instruction experience. Mora has also authored and instructs several courses for the Institute.

Kathleen D. Gibson, MD, Rachna Mehta PT, DPT, CIMT, OCS, PRPC, RYT 200, and Mora Pluchino, PT, DPT, PRPC are joining our esteemed lineup of speakers and session leaders for HWConnect 2025 scheduled for March 28-30, 2025. Their expertise and unique approaches to healthcare will provide invaluable insights for all attendees.

Kathleen D. Gibson, MD: Pelvic Venous Disease (PeVD) and Chronic Pelvic Pain
Dr. Gibson will be presenting "Pelvic Venous Disease (PeVD) and Chronic Pelvic Pain: A Multidisciplinary Approach to Diagnosis and Treatment." This topic is critical for understanding the complexities of pelvic venous disease, a common yet often underdiagnosed condition that can cause chronic pelvic pain. Dr. Gibson’s presentation will delve into the latest diagnostic methods and treatment options available for PeVD, highlighting the importance of a multidisciplinary approach for optimal patient care. Whether you're a clinician, researcher, or patient advocate, this session will provide practical insights that can make a real difference in your practice.

Rachna Mehta PT, DPT, CIMT, OCS, PRPC, RYT 200: Acupressure Self-Regulation Acupoints
Dr. Mehta, a highly experienced physical therapist and integrative medicine practitioner, will lead a breakout session on Acupressure Self-Regulation Acupoints. This hands-on session will introduce participants to powerful acupressure techniques designed to promote healing, reduce stress, and enhance overall well-being. Attendees will learn how to use acupressure for self-regulation, a simple and effective tool to manage pain, anxiety, and other health concerns. Dr. Mehta’s expertise in integrating physical therapy with traditional healing practices makes this a session you won’t want to miss.

Mora Pluchino, PT, DPT, PRPC: The Pelvic Rehab Provider’s Role in Infant Care
Dr. Pluchino is a leading expert in pelvic rehabilitation, will be presenting "The Pelvic Rehab Provider’s Role in Infant Care: Managing Reflux, Constipation, and “Colicky” Babies." This session is a must-attend for providers looking to expand their practice into the world of infant care and address some of the most common gastrointestinal (GI) challenges affecting newborns and their families. GI distress in infants is a common but often overwhelming challenge for caregivers. As pelvic rehab providers, we’re uniquely positioned to make a meaningful difference in the lives of these families. By learning targeted strategies for infant care, you can expand your skillset, offer more comprehensive services, and positively impact your youngest patients. This session will feature hands-on demonstrations, including abdominal massage for Infants, positioning strategies, as well as play and movement techniques.

The combination of Dr. Gibson's groundbreaking work in pelvic health, Dr. Mehta's holistic approach to self-care, and Dr. Pluchino’s pediatric session on infant care adds a well-rounded, comprehensive experience for anyone interested in improving patient outcomes and understanding new ways to support holistic health. This is a unique opportunity to hear from three thought leaders who bring fresh perspectives to modern healthcare.

Join us at HWConnect 2025 on March 28-30 in Seattle WA to connect, learn, and grow with leading experts in the field! For more information and to register for HWConnect 2025, visit https://www.hermanwallace.com/hwconnect-2025. We can’t wait to see you there!