A recent on-line, national survey completed in Australia asked women who had completed treatment for breast cancer to answer questions about exercise. 432 women were surveyed about their perceived exercise barriers as well as potential benefits. Although the answers may not be entirely surprising to practitioners who work with women who are participating in cancer rehabilitation, we may be able to learn about ways to support women who are interested in increasing their exercise activities. Women reported challenges of feeling weak, lacking self-discipline, and not making exercise a priority as barriers to exercising. Women also reported enjoying exercising, having improved sense of well-being, and decreased tension and stress when participating in exercise. The authors in this study describe the potential physical benefits of exercise in survivors of breast cancer to include improved cardiorespiratory fitness, strength, energy levels, more effective weight management, and decrease in risk of heart and circulatory disease. Further benefits towards emotional and psychological health are also described in the study and include improved self-esteem, decreased anxiety and depression, and better mood.

With all of these known benefits, what limits exercise participation in women? Consider that a woman who is already dealing with cancer-related fatigue has a small reserve of extra energy. If she participates in exercise, will she have enough energy to prepare healthy foods, or to finish her work, or to interact with her family? Even though the exercises may in the long run increase a woman's energy levels, understanding the choices that she has to make on any given day can help guide the therapist's recommendations. How can you help a patient avoid procrastination, one of the largest perceived barriers to exercise in this study? Perhaps you can help her trouble-shoot the obstacles that she may face in her day and give examples of actions that can set her up for success. These strategies might include preparing her exercise clothing to bring with her for a lunch time walk, or taking a nap at work so that she has enough energy to exercise in the evenings. Engaging a friend to join her for exercise activities or helping her find a comfortable bra- one of the commonly mentioned barriers in the referenced study- may help a woman participate in exercise.

Many pelvic rehabilitation providers are working with women who are dealing with the challenging recovery associated with oncology issues such as breast cancer. Although women may know that exercise is beneficial, the barriers to exercise can limit participation in lifelong healthy habits such as daily exercise. Regardless of the type of cancer a woman is woman is recovering from, being able to dialog about perceived barriers to exercise is valuable. If you are interested in working with more women who are recovering from cancer, or in general would like to know more about exercise and oncology issues, the Institute has an oncology series with topics in breast cancer and pelvic cancer, among others.

The HW admin team has been hard at work filling speaker spots, building breakout sessions, and creating fun new experience ideas for the upcoming 2025 conference.

If you're into pelvic health then this is the conference for you. HWConnect was created to provide a top-tier networking event for pelvic rehabilitation practitioners that focuses on providing a safe environment for professional development, exposure to new products, and sharing inspiration for all things pelvic health.

HWConnect features keynote speakers, breakouts, labs, and educational sessions. Topics range from pediatrics with Dawn Sandalcidi to gender-affirming care with Ken McGee. HWConnect is all about connection - the name says it all. Network. Learn. Grow. Repeat.

Registering is as easy as 1, 2, 3!

1. Complete online registration.
2. Book travel and lodging. HWConnect will be held at the Hilton Seattle Airport & Conference Center and HW has special pricing set up for attendees.
3. Show up, and don't forget to stop by and say hello to all of your favorite HW team members!

Need More Information?

• Keynote Speakers are the indomitable Dawn Sandalcidi, PT, RCMT, BCB-PMD (she/her), Nancy Norton, RN (she/her), and Leticia Nieto, PsyD, LMFT, TEP (she/her).
• Speakers include Ken McGee, PT, DPT (they/he), Dr. Cindy Mosbrucker (she/her), Meryl Alappattu, PT, PhD (she/her), and Carole High Gross, PT, DPT, PRPC (she/her).
• Breakout sessions, workshops, and labs include yoga, meditation, rehabilitative ultrasound imaging, squat analysis, and MORE - all led by your favorite HW faculty including Dustienne Miller, Nari Clemons, and Allison Ariail.
• HW proudly welcomes second-time conference sponsor CMT.
• Vendor Hall featuring exhibitors including Intimate Rose, Slippery Stuff, and Raise the Pelvic Floor.
• Non-profit booths feature the Kenya Scholarship Foundation and Open Arms Perinatal Services. Read this past blog to learn more about the Kenya Scholarship Foundation.
• Special Podcast Guests feature Callie and Rachel from Pelvic Service Announcement (PSA) and Courtney from Raise the Pelvic Floor.

For more information and a full lineup check out the HWConnect 2025 page!

Already Coming to HWConnect?

Herman & Wallace would love your help spreading the word about HWConnect 2025 and the chance to connect with the amazing people in our community. Check out this page where you can review and share all the programming we’ve booked thus far. https://hermanwallace.com/connect-2025

We look forward to seeing you at HWConnect 2025!

Congratulations on completing Pelvic Function Level 1 (PF1) and entering the world of pelvic rehabilitation. Are you ready for your next course but not quite sure which one to take? Well, you’re not alone. Everyone’s pelvic health educational journey is different based on their interests and patient demographics and there are a lot of course options available.

I’m going to zero in on the intermediate-level courses in the Pelvic Function Series for you as HW does recommend that practitioners take at least one or two of these. If you’ve looked at the course page you’ve noticed that there are three courses with a Level 2 designation – as well as a lab course. What does this mean? These courses are designed to be a progression of knowledge and skills learned in the foundational course Pelvic Function Level 1.

Here are the intermediate courses:

• Pelvic Function Level 2A (PF2A) - Colorectal Pelvic Health, Pudendal Neuralgia, and Coccyx Pain
  • Labs provide an introduction to internal anorectal examination for all genders.
• Pelvic Function Level 2B (PF2B) Urogynecologic Examination and Treatment Interventions
  • Labs provide external abdominal and pelvic and internal vaginal approaches.
• Pelvic Function Level 2C (PF2C) Men’s Pelvic Health and Rehabilitation
  • Labs provide external abdominal, gluteal, perineal, and internal anorectal approaches.
• Modalities and Pelvic Function (PFMOD) The Pelvic Health Toolkit
  • Labs provide supervised instruction to practice modalities.

Ready for a more in-depth look at the courses? Here is a more detailed breakdown:

Pelvic Function Level 2A (PF2A) Colorectal Pelvic Health, Pudendal Neuralgia, and Coccyx Pain
This course is intended for the pelvic health clinician who treats patients with common functional gastrointestinal (GI) dysfunctions and is interested in learning internal anorectal examination and the use of balloon re-training.

In this course, you will learn about common functional gastrointestinal (GI) dysfunctions including irritable bowel syndrome, fecal incontinence, and constipation. Course topics provide an introduction to nutrition for bowel health, colorectal conditions, and oncology. Participants will be educated on how diagnoses such as hemorrhoids, fistulas, fissures, and anorectal pain including pudendal neuralgia and coccygodynia may be improved with pelvic rehabilitation.

Practical, trauma-aware, hands-on labs provide supervised instruction of pelvic function evaluation with external observation, palpation, and internal anorectal examination of pelvic skeletal and soft tissues. These labs include an external perineal and internal anorectal approach as well as education in the use of balloon re-training.

Pelvic Function Level 2B (PF2B) Urogynecologic Examination and Treatment Interventions
This course is intended for the pelvic health clinician who treats patients with conditions including urinary incontinence, chronic pelvic pain (CPP), and pelvic organ prolapse.

In this course, you will learn, with increased specificity, evaluation for urogynecologic conditions as well as an overview of medical management, and multi-disciplinary pelvic healthcare. Course topics provide a more in-depth understanding of urinary incontinence, chronic pelvic pain (CPP), and pelvic organ prolapse.  Participants will be educated on how diagnoses such as interstitial cystitis/painful bladder syndrome (IC/PBS), urinary tract infections, vaginismus, vulvar pain, dyspareunia, polycystic ovarian syndrome (PCOS), and endometriosis may be improved with pelvic rehabilitation.

Practical, trauma-aware, hands-on labs provide supervised instruction of pelvic structures in relationship to the vaginal canal and surrounding structures such as the lumbopelvic nerves, the uterus, urethra, bladder, and rectum. Interventions instructed will include patient management of trunk and pelvic pressure, relaxation training, breathing, and manual therapies for a variety of pelvic dysfunctions. These labs include an external abdominal and pelvic and internal vaginal approach.

Pelvic Function Level 2C (PF2C) Men’s Pelvic Health and Rehabilitation
This course is intended for pelvic health clinicians who are interested in treating male pelvic health conditions.

In this course, you will learn critical detailed information about men’s pelvic health conditions including post-prostatectomy urinary incontinence, erectile dysfunction, and chronic pelvic pain (CPP). Participants will be educated on how diagnoses such as hard/flaccid, urgency/frequency, scrotal, testicular, and penile pain may be improved with pelvic rehabilitation.  

Practical, trauma-aware, hands-on labs provide supervised instruction of pelvic health evaluation with external observation, palpation, and internal anorectal examination of pelvic structures and soft tissues. These labs include an external abdominal, gluteal, perineal, and internal anorectal approach. 

Modalities and Pelvic Function (PFMOD) The Pelvic Health Toolkit
This course is for the pelvic health clinician who has the opportunity to use modalities as an adjunct to their patient's care and goes beyond the "Big 3" (E-Stim, Biofeedback, and Ultrasound).

In this course, you will learn about and practice a variety of modalities. Modalities in PFMOD include biofeedback, cold laser/light therapy, electrotherapy, real-time ultrasound imaging, belts, braces, supports, lubricants, myofascial tools/techniques, and “special topics” that can be used to assist in relaxation, bowel and bladder health, and sexual function. Specialized knowledge from experts in different subjects will be shared throughout the course. 

Certain modalities that are impractical to practice live will be shared and demonstrated via video. These Interventions include shockwave, rehabilitative ultrasound imaging, dry needling, and light therapy. 

Practical, trauma-aware, hands-on labs provide supervised instruction to practice utilizing biofeedback and other modalities to allow kinesthetic learning before prescribing and recommending them to patients. 

Previous course sponsors who have provided samples and products have included:

• Nix
• Flyte
• OhNut
• Replens
• RockTape
• Bellies Inc.
• Ice Soothers
• BabyBellyBand
• Intimate Rose
• The Pro Group
• Good Clean Love
• Cushion Your Assets

If you are interested in taking an intermediate-level Pelvic Function Course but still have questions, then please contact us.

Herman & Wallace offers a number of downloadable products on our website for your clinical practice, and we want to put you in charge of deciding which new products we create and offer!

What is a Prefund?
The HW philosophy is that we should only be making products that are useful to our practitioners. In our efforts to create the most valuable products and keep the price as low as possible, we have launched a new Prefund product development program.

Need more information? Check out the Prefund FAQs.

Here is how it works:

1. Herman & Wallace creates a product concept, a description of the product and its contents, without fully creating the product.
2. The product concept can be found on the HW Product Page as a “Prefund” product for a limited period of 7 days. In this case, the products will be available from May 22, 2024 until midnight on May 28, 2024.
   •  All product concepts include:
     • A description of the product
     • Product content list: patient forms, PowerPoint files, handouts, mapping tools, etc
     • Standard retail price of the product once it is launched
     • Prefund retail price of the product - which is 40% lower than the retail price
3. Practitioners who would like to buy the product can prefund the product concept at a 40% discount on the standard retail price in exchange for receiving the product upon Herman & Wallace completing its development.
4. If you see a product you'd like to purchase, then prefund it! If the product gets enough pre-funders, then HW will develop the product.
5. Once the product is developed, we'll email your product to you.

There is NO RISK!
Prefunding a product carries NO RISK. If the product does not receive enough prefunding by the end of the trial period, Herman & Wallace will refund 100% of the amount contributed by each prefunder.

Product concepts to choose from:
Prefund and Downloadable Products are available on the HW Product Page.

• Inclusivity for Beginners
  • Pricing: Prefund $45, Standard $75
  • This product includes tips and pearls of wisdom to enhance your understanding of diversity, equality, and inclusivity as well as tools like up-to-date terminology and definitions to help practitioners create a safe and welcoming environment for clients.
• Birth Prep for Pelvic Health Clients
  • Pricing: Prefund $90, Standard $150
  • This product will make it incredibly easy for you to host a Birth Prep class for any audience.
• Trauma Informed Care Checklist
  • Pricing: Prefund $45, Standard $75
  • This product will help you review the concepts of trauma-informed care and check in with yourself and the practices of your workplace. It will then provide guidelines and tips to provide the best possible trauma-informed care to your clients.
• Hosting a Pelvic Floor Student
  • Pricing: Prefund $60, Standard $100
  • This is the perfect document to help prepare any clinician for a pelvic health student.
• Quick Reference Treatment Checklists
  • Pricing: Prefund $45, Standard $75
  • These quick informative checklists include topics like constipation, stress incontinence, urge incontinence, pelvic organ prolapse, hemorrhoid management, and painful insertion.

Carpe Diem
By prefunding a product, you are helping guide what resources HW creates. This keeps prices lower on all products by assuring we don’t spend resources creating products that our audience does not value. If a prefund concept does not get funded, you get a 100% refund. If it does meet the minimum, you will receive the product concept you prefunded at a significant discount!

Did you know that the Pelvic Rehabilitation Practitioner Certification (PRPC) is celebrating its 10th anniversary? That's right, the first PRPC examination was administered in 2014 and since then, over 700 practitioners from all over the world have earned their certification.

Are you ready to join the ranks of these proficient professionals? Becoming PRPC certified allows you to proudly display the designation "PRPC" after your name, establishing you as an expert in pelvic rehabilitation.

Not sure if you qualify to sit for the PRPC examination? Don't worry, here are some frequently asked questions that may help clarify your eligibility.

What is the PRPC?
The certification available through the Institute is called the Pelvic Rehabilitation Practitioner Certification (PRPC). Earning the PRPC Certification is a professional achievement that demonstrates your dedication and expertise in the field. Through a specialized exam, you'll validate your knowledge and join an exclusive community of respected practitioners.

The PRPC was the first-ever certification exam for therapists seeking distinction for treating pelvic dysfunction in all genders throughout the life cycle.

Who can sit for the exam? Do I have to be a physical therapist?
While a license to practice skills in pelvic rehabilitation is required for the PRPC exam, you don't have to be a physical therapist to apply. In fact, HW welcomes a diverse group of professionals including Physical Therapists (PTs), Physical Therapist Assistants (PTAs), Physicians (MDs), Registered Nurses (RNs), Occupational Therapists (OTs), Occupational Therapist Assistants (OTAs), Doctors of Osteopathic Medicine (DOs), Doctors of Chiropractic Medicine (DCs), Advanced Registered Nurse Practitioners (ARNPs), Nurse Midwives (CNMs), Doctors of Naturopathic Medicine (NDs), and Physician Assistants (PA-Cs) with an active state-board license.

Do I have to take certain Herman & Wallace courses?
There are no course prerequisites for taking the PRPC exam. A valid certification exam tests demonstrable knowledge and skills, which can be gained from a combination of coursework, clinical experience, professional mentorship, etc.

Therapists considering applying should have a comprehensive skill set, which is often gained through several beginner, intermediate, and advanced courses in pelvic function and dysfunction. These can include the Pelvic Function Series, from Level 1 to Capstone, as well as specialized courses for bowel, bladder, sexual, and pelvic pain dysfunctions, depending on your interests and patient demographics.

Pricing for PRPC is discounted for those who have completed at least one course through Herman & Wallace.

How much pelvic rehabilitation experience do I need?
To be eligible to sit for the exam, all applicants must have completed a minimum of 2000 hours of direct pelvic patient care within the past 8 years, with at least 500 of those hours completed in the last 2 years. It's important to note that these patient care hours must come from a licensed clinician and cannot include any hours spent before becoming licensed.

A general guideline for what qualifies as direct pelvic patient care is any time spent directly impacting the care of a specific patient. These activities include (but are not limited to) examination, evaluation, diagnoses, treatment plans, and intervention for conditions related in whole or in part, to the health and function of pelvic structures and the pelvic floor. This includes seeing patients for pelvic pain, pelvic girdle dysfunction, and conditions of bowel, bladder, and sexual dysfunction and includes the care for pediatric, adolescent, adult, and aged patients of any gender.

Where can I find more information?
All the details of the PRPC can be found on our website through the Certification Tab. You can find sample questions, pricing information, and even some study resources!

Are you ready to take your clinical practice to the next level?
Don’t miss this opportunity to become PRPC Certified! Remember - this is the only certification that encompasses pelvic rehabilitation for ALL people across the lifespan. The next testing administration is November 1-15, 2024. The registration cut-off date is October 1st, and the sooner you get your application approved, the faster you can be connected to like-minded practitioners who want to study with you for the exam!

While the exam itself may not be "fun" (let's be honest), the studying process is where you truly elevate your expertise. Immerse yourself in a wealth of knowledge, expand your skills, and refine your techniques - all while preparing for the exam. Good luck on your journey to becoming a certified expert in pelvic rehabilitation!

A testimonial from Erika Darbro, PT, DPT, PRPC
"As a perpetual learner, I recognize the importance of staying up to date with the latest advancements in the field. Each year, I actively participate in numerous continuing education courses, a practice that reflects my dedication to providing the highest quality of care. It was a natural next step to take my commitment a step further by pursuing the Pelvic Rehabilitation Practitioner Certification (PRPC) in 2020.

"Choosing to become certified was not a decision made lightly. The PRPC certification stood out as the perfect fit for my clinical ethos – to treat all genders. Unlike some certifications that focus solely on women's health, the PRPC encompasses pelvic health topics for all populations. This alignment with my values was a driving force behind my choice, emphasizing my dedication to being an inclusive pelvic health practitioner.

"Obtaining the PRPC certification was not just about acquiring a credential; it was a statement of my commitment to being an expert in the pelvic health field. It serves as a recognition of my passion for treating the pelvic health population and reinforces the idea that I don't merely dabble in pelvic health.

"The pursuit of certification was also a personal challenge. It pushed me to elevate my skills, deepen my knowledge, and continually evolve as a practitioner. By challenging myself, I hope to inspire other healthcare professionals to embrace continuous learning and strive for excellence in their field." 

There are currently two scheduled course offerings available for Modalities and Pelvic Function: Philadelphia PA in April 6-7 and Manchester NH in August 24-25. If neither of these work for your location or schedule then consider hosting! The hosting requirements and interest form can be found on the Host a Course page. 

The new Modalities and Pelvic Function - Pelvic Health Clinical Toolkit is an in-person two-day continuing education course targeted to pelvic health clinicians covering frequently used modalities in pelvic health, including biofeedback and EStim. This course was designed to answer the clinician’s need to understand how to choose and access the right tools, both for in-clinic care and for patient self-care application.

One of the course co-creators, Mora Pluchino shared “This class will be unlike one you've taken before. The H&W curriculum team sat down and thought about how we could make this the most interactive, hands-on, and practical course while still staying evidence-based and professional. This will be an in-person learning opportunity with 2 days of lab, demonstration, and interactive learning opportunities. If there is a modality that exists in pelvic health, it will likely have a debut here. This class is made for anyone who wants to learn to apply modalities in the variety of uses possible for pelvic health!"

Biofeedback and electrical stimulation are covered in this course, as are introductions to understanding tools such as shockwave, dry needling, real-time ultrasound, laser, and electrotherapies. With hands-on lab time and learning modules grouped into tools specific to pelvic health conditions such as bowel dysfunction and sexual health challenges, practitioners will have the opportunity to trial various tools and applications that previously may have only been available as an image in a presentation.

When our popular Pelvic Function Level 1 course, which introduces participants to the world of pelvic health, was transitioned to a satellite lab course one of the content pieces that was left out was the modalities focus - simply because the equipment was too difficult to ship to multiple satellite locations around the country. Herman & Wallace is thrilled to announce that not only have we solved this issue, but designed a way for clinicians to learn about dozens of modalities in an environment that allows the clinician to move beyond theoretical and soundly into the practical delivery of a variety of technologies and tools.

Current Medical Technologies will be in-person with us as we design this learning experience and will be available to answer your questions about products and clinical set-up. The interactive environment has been designed to be stimulating and allow the clinician to apply a variety of learning strategies including tactile opportunities to try things on themselves or a lab partner. This is a unique course that provides a foundational understanding of technology and tools, clinical practice research, and recommendations in an in-person environment. Many equipment providers have been generous in providing sample products for trial and even some giveaways to take home!

We believe this Modalities course is so foundational to our skillset in pelvic health that we have added it to our core Pelvic Function Series. This course is intended to be taken after Pelvic Function Level 1 and can be taken at any point following the introductory course as you work your way through the PF Series. If you’re wondering “When should I take this course?” the answer is “as soon as you can!”  

We are pleased to announce the following changes and additions to our core series of courses. These changes are being undertaken by our Curriculum Development Team based on evolving realities of our field and the body of evidence and literature. In keeping with the way the field has evolved, we will be making the following changes to our core coursework.  

Two courses will be joining our Pelvic Function Series: 

1. Pelvic Function Modalities - This brand new course is an in-person two-day continuing education course targeted to pelvic health clinicians covering frequently used modalities in pelvic health, including biofeedback and EStim. Hands-on labs using a variety of equipment necessitate that this course be offered in-person, where participants can practice using the equipment.
2. Pelvic Function Level 2C: the Male Pelvic Floor and Men’s Pelvic Health - formerly the stand-alone course, Male Pelvic Floor Function Dysfunction and Treatment, this course is now being adapted and reformatted to be a part of the Pelvic Floor Series, reflecting the inclusive stance of H&W core series instructing in the care of all patients. This course will be offered as satellite, self-hosted, and in-person options in order to provide the most flexible pathway for participants.

In addition to these two new offerings, you will see greater inclusion of all genders throughout the series, starting with PF1. The modified titles and topics will be as follows: 

Pelvic Function Level 1: Introduction to Pelvic Health - this course will provide a thorough and comprehensive introduction to anatomy and physiology of the pelvis and surrounding structures in all genders. Includes an introduction to performing intra-vaginal exam. This course will be offered in satellite and in-person formats.

Pelvic Function Level 2A: Colorectal Pelvic Health and Pudendal Neuralgia, Coccyx Pain. In labs, anorectal internal exam will be introduced. This course will be offered in satellite and in-person formats. 

Pelvic Function Level 2B - Urogynecologic Topics in Pelvic Health. This course will be offered in satellite, self-hosted and in-person formats

Pelvic Function Series Capstone - Integration of Advanced Concepts in Pelvic Health. This course will remain targeted to the advanced clinician. A greater emphasis on workshopping clinical case studies will be incorporated. This course will be offered in satellite, self-hosted and in-person formats.

Questions: 

What courses will be required in order to advance to the Capstone course? 

As we understand the “advanced pelvic floor clinician” may have a variance of experience and focuses, the following course “journeys” can all be taken in order to take the Capstone course:

PF1

PF2A

P2B and/or PF2C

The Modalities course is strongly recommended, but not required, in order to take the Capstone course. 

Why is the series being expanded and updated in this way? . 

It is a reality of our field that pelvic rehab evolved from a tradition of “women’s health physical therapy”, and that is reflected in the vulvovaginal emphasis of the current coursework. As the scope of pelvic rehab has expanded to encompass men’s health and care for all genders, it is important that all pelvises be incorporated at every level of our series, and that men’s health be a foundational part of our curricula, rather than being siloed as a specialty offering. 

I have already started my PF series coursework, where do I go now? 

If you have taken only PF1, you should advance to PF2A, 2B or 2C in any order. You may also wish to take the Modalities course in order to learn evidence-based use of modalities and practice biofeedback and Estim in a hands-on, in-person setting. The best way to choose which course to take next will be determined by who shows up in your clinic after completing PF1 and beginning to see your first pelvic patient caseload. 

If you have taken PF1 and 2A - take either 2B or 2C or both in any order to advance to Capstone. If you took PF1 following the pivot to the satellite model, you may also wish to take the Modalities course in order to practice hands-on biofeedback and Estim labs. 

If you have taken PF1 and 2B, you must take 2A prior to Capstone. You may take the 2C course to learn men’s health topics if seeing male and male-identifying patients is part of your clinical goals. If you took PF1 following the pivot to the satellite model, you may also wish to take the Modalities course in order to practice hands-on biofeedback and Estim labs

If I have taken PF1, 2A, and 2B - you may advance to Capstone or you may take the 2C course to learn men’s health topics if seeing male and male-identifying patients is part of your clinical goals. If you took PF1 following the pivot to the satellite model, you may also wish to take the Modalities course in order to practice hands-on biofeedback and Estim labs

If you have taken PF1, 2A, 2B and Capstone but have not taken the former Male Pelvic Floor course, you may take the 2C course to learn men’s health topics if seeing male and male-identifying patients is part of your clinical goals. 

If you have taken PF1, 2A and the Male Pelvic Floor course, you may advance to Capstone

If you have taken PF1, 2A, 2B and the Male Pelvic Floor course, you may advance to Capstone

Am I required to take more courses in order to complete the PF series now? 

No. Previously, there were three prerequisite courses for taking the advanced Capstone course: PF1, 2A and 2B. Following the changes to the series, the prerequisite courses for taking Capstone will be PF1, 2A and 2B OR 2C (or both, depending on one’s target patient population). The Modalities course is a strongly encouraged, but not required, level of the PF series.

As before, participants should choose their next course based on the patient needs they are seeing in the clinic. Following PF1, many may see patients with fecal incontinence or coccyx pain and may choose to prioritize PF2A as the next step in their journey. Others may see patients with penile pain or incontinence post-prostatectomy and may choose to take 2C as their next step.  

As before, there are no required courses in order to sit for the Pelvic Rehab Practitioner Certification Exam. 

Why aren’t there self-hosted options for PF1 and PF2A? 

PF1 is most learners’ first introduction to performing intra-vaginal assessment and therefore we believe the best learning experience will be under the guidance of either an HW faculty member or trained teaching assistant at an in-person or satellite course. Similarly, PF2A is most learners’ first experience performing anorectal exam, which should also take place under the supervision of an experienced clinician. In PF2B, 2C, and Capstone, these techniques are refined and it is therefore appropriate to allow self-hosted options for those who have already learned these skills and are comfortable with independent learning. 

I see that there will be options for a few in-person as well as satellite offerings for much of the series. Will HW continue to offer both formats? 

We understand that many people appreciate the flexibility and accessibility of the satellite model as an improvement over the days when all series courses were sold out with long waitlists and lengthy travel was often required to attend our courses. We also understand that some folks simply prefer the format in which instructors are present at the course. Our intention is to offer formats that accommodate everyone’s needs, which is why the PF series will be available in-person as well as in the satellite format starting in 2024. Because of the hands-on equipment needs of the Modalities course, this will be available exclusively in person. 

Why is PF1 required for 2C if it wasn't for MPF? 

Historically, the Male Pelvic Floor course was a stand-alone course, meaning that many participants would take this course after beginning their journey with PF1 and after already seeing patients with pelvic floor dysfunction. Others, often male and male-identifying practitioners who did not feel their goals were met by the vulvovaginal-centered PF series, would take the Male course as their first ever introduction to pelvic health. This resulted in course attendees being in vastly different places in terms of experience, which often results in a sub-optimal learning experience for all. 

As part of our push to see more information about patients of all genders incorporated at every level of the core series, PF1 which contains foundational information on all pelvises and core concepts in pelvic rehab, will be a prerequisite for 2C, which will build on those core concepts as they apply specifically to the male and male-identifying patient. 

Who can act as a Teaching Assistant for the series courses in the new format? 

PF1 - must have PF1, and ⅔ of the Level 2s (2A, 2B, and 2C)

PF2A - must have 1, 2A, and 2B or C

PF2B - must have 1, 2B 

PF2C - must have 1 and have taken the Male Pelvic Floor in 2016 or later

Capstone - must have 1, 2A, 2B or 2C, and Capstone

HW is excited to announce the addition of a brand-new course to our Pelvic Function (PF) Series! 

Pelvic Function Level 2C (PF2C): the Male Pelvic Floor and Men’s Pelvic Health

• In Person Course
• Satellite and Self-Hosted Courses

Formerly the stand-alone course, Male Pelvic Floor Function Dysfunction and Treatment, this course is now being adapted and reformatted to be a part of the PF Series, reflecting the inclusive stance of H&W core series instructing in the care of all patients. This course is intended for the pelvic health clinician who treats patients with conditions including post-prostatectomy urinary incontinence, erectile dysfunction, and chronic pelvic pain (CPP). 

This course will be offered as satellite, self-hosted, and in-person options in order to provide the most flexible pathway for participants. 

It is a reality of our field that pelvic rehab evolved from a tradition of “women’s health physical therapy”, and that is reflected in the prior vulvovaginal emphasis of the existing coursework. As the scope of pelvic rehab has expanded to encompass men’s health and care for all genders, it is important that all pelvises be incorporated at every level of our series, and that men’s health be a foundational part of our curricula, rather than being siloed as a specialty offering. 

It is now our expectation that providers who want to care for patients around topics provided in the men’s health course will now take our introductory course, Pelvic Function 1. This is a necessary change reflecting growth and progression of our field of pelvic healthcare. Over the years, it was helpful to offer a course focusing on post-prostatectomy dysfunction, pelvic and genital pain and sexual health and function that was open to all levels. However, while participants who took the former Male Pelvic Floor course developed competence in the instructed skills, by missing the rest of the series, foundational conversations including physiology of urinary function, discussion of trauma-aware care, and bowel health basics that often affect other pelvic functions were abbreviated. Including men’s health within the rest of the foundational series resolves the missed content from our foundational course. Attendees to our PF1 course will find that it has been elevated to be a more inclusive course that covers information about pelvic health which will allow a beginning pelvic health practitioner to immediately apply introductory principles of care to all genders. 

More questions about changes to the PF series? Please see this FAQ page: https://hermanwallace.com/frequently-asked-questions#2024-PF-Series-Update

Herman & Wallace is celebrating Memorial Day Weekend! 

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I have always enjoyed working with the peripartum population. However, the longer I worked in pelvic rehabilitation the more I heard the same story over and over when interviewing patients. For example, when working with a patient with urinary incontinence or prolapse, I would say: “when did this start” and some of my elderly patients would laugh and say “when Johnny was born” and I would say “how old is Johnny” they would reply “40!” Many of the pelvic patients I was treating had symptoms originating around the time of childbirth and they had been suffering for decades. So, I figured, let’s get to the root of the problem and focus on earlier intervention.    

What is the root of the problem? In my opinion, it is the lack of postpartum care. Pregnant patients are often inundated with birth education programs and information about pregnancy and childbirth. Additionally, there is a battery of prenatal visits, prenatal testing, and preparations for birth. All of which are wonderful to help prepare for birth. Conversely, the resources and guidance to help with physiological and musculoskeletal healing postpartum are lacking. Patients are counseled about serious signs and symptoms, but clear guidance to help to return to daily functional activities including recreation and exercise is often not provided. As musculoskeletal and exercises experts we are in a wonderful position to help patients reduce pain and improve function following the birth of a child.

Prior to 2018, the first post-partum checkup was six weeks following birth. Barring any severe problems, this was often the last contact with a medical provider for the parent. Patients were not provided specific guidance on how to return to daily activities, let alone higher-level activities such as running, exercising, and/or lifting weights.

In 2018, the American College of Obstetrics and Gynecology (ACOG) revised its guidelines, which now support earlier and more frequent postpartum visits. It is recommended that the first contact between patient and obstetric care provider occur in the first three weeks following birth and that subsequent visits are scheduled as needed in an ongoing fashion¹. This is important, as many consider the patient is still healing from birth up to 12 weeks (definitions vary). Depending on their knowledge and experience, a patient may not immediately realize they have a musculoskeletal problem. A new parent is busy adapting to their role as a care provider and may not be thinking about themselves. Additionally, they may not know what “normal” is for their body postpartum, including vaginal, abdominals, and/or bowel, and bladder functions. For example, the patient may be experiencing urinary incontinence (UI) which they “think” is normal postpartum, therefore, they may not bring it up to their provider. Patients often seek advice from family and friends who may even joke about peeing their pants when they sneeze or laugh or play with their children. Urinary incontinence is not ever “normal”, however, is it common in the postpartum period. Availability of vetted resources and a relationship with a healthcare provider are essential to cure these misconceptions.       

According to a systematic review, the prevalence of urinary incontinence is 33% at three months postpartum² and remains at 29% four years postpartum³. This means about one-third of women have urinary incontinence postpartum and remain that way without intervention. We also know the prevalence of urinary incontinence is strongly related to increasing age and underreported. This example highlights a common misconception: pelvic dysfunction is a normal part of the after-birth stage. However, with intervention, these problems can be alleviated, and we can improve the quality of life for these patients. 

According to the American College of Physicians (ACP) clinical practice guidelines for non-surgical management of UI there is high-quality evidence that strongly recommends pelvic floor muscle training as the first-line treatment for stress incontinence.⁴

So why isn’t pelvic assessment and rehabilitation recommended for all people who birth in our country? In several European countries, pelvic rehab is standard postpartum care for anyone who births. Over the last two decades, I do see more postpartum patients referred for rehabilitation for their musculoskeletal impairments. However, I still think we need more skilled providers assisting these patients and spreading the word about the interventions rehabilitation professionals provide. These can range from common orthopedic complaints (e.g neck or back pain from repetitive baby care) to specific bladder and/or bowel dysfunction, such as leakage and/or constipation, abdominal separation (Diastasis Rectus Abdominus-DRA), prolapse, pelvic pain, perineal tearing, and/or pain with intercourse.    

When developing this four-course postpartum series, I wanted rehabilitation providers to have more advanced skills to provide examination and treatment to this special population. This includes techniques to assess and treat the abdominals and pelvis, as these areas are physiologically impacted by pregnancy and birth over a relatively short amount of time. To effectively treat this population, one needs to be familiar with physiological changes from pregnancy, and stages of labor and birth to understand the journey of your patient. There is so much we can do to help these patients over a range of complaints, from acute breast and perineal care to DRA and pelvic dysfunctions.  As with any special population, postpartum patients have unique red flags and concerns to monitor, and due to our more frequent patient contact, it is imperative to be proficient in screening for these conditions. These topics and more are included in the course series. 

I am grateful and appreciative of this collaboration between Herman & Wallace and Medbridge to provide a platform for clinicians to progress their knowledge. Hopefully, this improves access to postpartum care and increases referrals for rehabilitation services to improve the function and quality of life for parents. Together we can reduce chronic impairments stemming from the childbirth period.

Resources:

1. Accessed on 5/9/2022: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/05/optimizing-postpartum-care
2. Thom, D. H., & Rortveit, G. (2010). Prevalence of postpartum urinary incontinence: a systematic review. Acta obstetricia et gynecologica Scandinavica, 89(12), 1511-1522.
3. Gartland, D., MacArthur, C., Woolhouse, H., McDonald, E., & Brown, S. J. (2016). Frequency, severity and risk factors for urinary and faecal incontinence at 4 years postpartum: a prospective cohort. BJOG: An International Journal of Obstetrics & Gynaecology, 123(7), 1203-1211.

4. Qaseem, A., Dallas, P., Forciea, M. A., Starkey, M., Denberg, T. D., Shekelle, P., & Clinical Guidelines Committee of the American College of Physicians*. (2014). Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 161(6), 429-440.

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