France has it right when it comes to treating the pelvic floor of postpartum women.

On Monday, The New York Times published an article, ?The Re-Education of My Perineum.?? In it, author Ruth Foxe Blader tells the story of her experience in France after giving birth.? As she tells it, her experience in France is close to ideal.? Her physical therapist, Aude, handles the reality of pelvic rehab with the professionalism that is needed:

?Aude politely suggested that I insert the sonde, a tampon-like metal-and-plastic contraption with a long wire she would hook up to the computer. When I flinched, she reiterated the importance of perineal re-education. She delivered this practiced discourse with an air of utter professionalism, flicking through computer exercises with a mouse, her back pin straight. Thankfully. Because had she so much as cracked a smile, I wouldn?t have survived the ensuing psychic trauma.?

Physical therapists play a key role in pelvic rehabilitation.? More often than not, ignoring the role of a therapist in treatment can cause more problems for a patient in the long run.

Blader puts the significance of the therapist brilliantly: ?Four years later, I can say with confidence that the exercises, far more extensive than the standard Kegels that American gynecologists mention offhandedly, worked. Unlike in the United States, where a hypermedicalized pregnancy is followed by a perfunctory six-week follow-up, in France women aren?t left treading water in a sea of untold postnatal soreness.?

Considering Beyond Kegels was published more than fifteen years ago, it is amazing that there is a persistent attitude that pelvic rehab professionals are just Kegel doctors.

Herman & Wallace offers a series on treating pregnant and postpartum patients, a time at which injury to the pelvic floor is common.? Care of the Pregnant Patient, Care of the Postpartum Patient, and Peripartum Special Topics each focus on the special considerations a therapist must have for patients during these distinct times surrounding motherhood.

For those interested in learning more about treating this population, each of these courses has at least one course-event between the now and the end of the year.? Sign up today!

It is a reality in the world of pelvic rehab that too few patients are comfortable discussing their genitalia, anus, or the functions of any pelvic organ when things are going smoothly, much less when something goes amiss.? Often, questions about them are more likely to give blushes than honest answers.

Role/Reboot, a blog that focuses on gender roles and relations, published a blog this July titled ?The Sex Education I Wish I Had.?? In it, author Marianne Cassidy catalogues some of the main problems with sexual education.? While much of the piece is a litany of ?I wishes? for sexual education, Cassidy?s piece reminds me of the wonderful ?Camp Gyno? video Pelvic Rehab Report discussed two weeks ago. ?It?s refreshing to read a blog that is both honest and to the point about perfectly normal things like menstruation and masturbation.

At the end of her litany of ?I wishes,? Cassidy drives home the ultimate point of this blog, ?Most of all, I wish I?d grown up in an environment where my peers and I felt comfortable discussing sex and asking questions, because then maybe none of the above would ever have been scary or mysterious. ?I wish we had classroom discussions about sex and exams on sex and reflective essays on sex and it was all as normal and interesting and important as algebra or poetry.?

Truly, a medical professional?s duty is to treat patients.? Therefore it?s vital for pelvic therapists to be able to speak frankly to their patients.? However, it is equally important to do so without passing judgment about the gender, sex life, or sexuality of a patient.

Herman & Wallace offers a course that focuses on treating sexual concerns for pelvic wellness patients, titled Sexual Health Clinical Toolkit.? This course was last offered in June 2013 in San Diego, California and is currently being planned for 2014.? Keep your eyes peeled for our 2014 calendar (coming this September)!

The Las Vegas Guardian published an article yesterday titled, ?Pregnancy Yoga Magic,? that articulates the benefits of yoga for pregnant patients.? Yoga, the article explains, ?can be the perfect choice for helping to increase endurance little by little, as well as improving muscle strength and honing one pointed focus ? important for birth preparation.?

This article does an excellent job illustrating that, while exercise is important for everyone, pregnant women must find exercise that is effective without being harmful: ?Pre-natal yoga practices are often geared to tune women into their pelvis and the flexibility therein as well as breath control and leg strength ? all critical tools to have during labor and delivery.? Unlike walking, weight-lifting or other ?regular? exercise, pre-natal yoga is fine-tuned to specifically prepare women for the birthing experience and to empower them into the knowledge that they can do this.?

However, few moms-to-be get as much exercise as they should: ?as many as 75% of pregnant women don?t do any type of exercise.?? This means that it is critical for anyone working with pregnant patients to emphasize the how crucial of a role exercise takes for both their health and the health of the child.

This September Herman & Wallace will be offering a course on Yoga for Pregnancy.? This course is geared toward therapists who wish to utilize yoga to treat patients with both complicated and healthy pregnancies.? Yoga for Pregnancy is less than two months away so register today, before the Early Bird Discount expires!

The Border Mail, an Australian newspaper, published an article today following Brian Costello, a man who underwent a prostatectomy.? Surgery for prostate cancer often leaves patients suffering with erectile dysfunction and incontinence.? However, Brian?s physicians did not send him into outpatient rehab, leaving him and his wife Jill, ?on their own.?

The piece titled ?Sex and Secret Men?s Business,? outlines how important pelvic floor and penile rehabilitation is, as well as how few hospitals are prepared to treat outpatients who survive prostate cancer.

Brian?s wife and daughter Leah started ManUp!, an advocacy organization meant to promote better prostate care in Australia.? All too often they hear stories like Brian?s; physicians who show ?no interest in what happens to their patients after prostate cancer treatment.? One man left impotent and incontinent after his robotic surgery[, and] was told the doctor?s job was simply to deal with the cancer.?

One of the many reasons that erectile dysfunction and incontinence are under-serviced conditions though is that patients frequently do not bring it up: ?it?s hard for busy practitioners to keep up to date with the recently developed erection treatments.? It?s also a two-way street, with some men finding it difficult to talk about these issues,? says Prem Rashid, a urologist and associate professor at the University of NSW.? ?Issues surrounding erectile dysfunction following prostate cancer treatment are complex and multi-factorial and often require the help of a multidisciplinary team,? - a team in which pelvic PTs play an important role.

Herman & Wallace will be offering a course on The Male Pelvic Floor in Minneapolis this September.? Participants in this two-day course will learn how to treat conditions such as sexual dysfunction, pelvic pain, and incontinence.

Pelvic Rehabilitation is often incorrectly considered a women?s health issue. ?This is because, as this wonderful video from Aligned and WellTM demonstrates, ?childbirth often gets blamed for pelvic floor disorder.?? Male or female, hip and pelvic biomechanics play an important role in the functioning of the pelvic floor.

Tucking one?s pelvis while sitting or favoring one leg when you stand can have a tremendous effect on the strength of one?s hip and pelvic muscles.? Weakened pelvic floor muscles often correlate with or cause such common conditions as urinary/fecal incontinence and sexual dysfunction, as well as chronic lower back and pelvic pain.

However, as Jessica Powley, PT, DPT, WCS, says in a recent blog post on Pelvic Guru, "rehabilitation for the pelvis is much more involved than simply strengthening a muscle group. It involves restoring function?improving muscular support around the pelvis, improving behavioral/dietary habits, and re-training body movements to allow for optimal organ and structural function"(emphasis added). ?In short, by focusing on the biomechanics, practitioners can better educate patients on treatment.

This August, Herman & Wallace will be presenting a course on the Biomechanics of the Hip & Pelvis. In the course, instructor Steve Dischiavi will demonstrate how one?s biomechanics affect the pelvis and hip, enabling clinicians to better instruct patients on treatment.

This course is less than one month away - register today!

The Great Falls Tribunepublished a piece Tuesday about McKenna Fromm, an eighteen-year-old girl who suffers from interstitial cystitis, pudendal neuralgia, and levator ani syndrome. Alone, each of these conditions can be debilitating, leaving patients in pain. Often each of these conditions is coupled with urinary or fecal incontinence. This piece, titled ?Great Falls Teen Fighting Three Painful Pelvic Conditions,? elucidates the struggle of patients who suffer from these conditions.

Each of these conditions is known to be difficult to diagnose, particularly interstitial cystitis which has ?[n]o specific diagnostic tests.?? Sometimes these conditions require surgery.? Other times, treatment includes ?a ?cocktail? of medications that include topical anesthesia or anti-inflammatory.?

However, one aspect of this article fails to truly emphasize is the role of physical therapy in treatment.? Stephanie Prendergast, president of the International Pelvic Pain Society, demonstrated this point well in a Facebook post about the Tuesday article.

?More often than not, pelvic pain syndromes are driven by the musculoskeleture of the pelvic floor. That said, when something goes amiss with the pelvic floor all of the many systems that make up this unique part of the body will most likely become involved--the muscles, nerves, organs, and derma of the area become locked in a vicious pain cycle that needs to be broken. Physical therapy has an important role to play in the unwinding of this pain cycle. That's because a PT is in the best position to uncover and treat any musculoskeletal impairments that are contributing to a patient's pain/symptoms?

??What often happens in these cases is that the patient's pelvic floor muscles guard in response to the pain of the infection; however, once the infection clears, the muscles remain in this tight, guarded state causing a lack of blood flow to the area and the formation of trigger points, both of which can cause the symptoms that McKenna presents with. What a PT can do in such a case is to manually relax any tight muscles, and treat any trigger points or other musculoskeletal impairments contributing to the patient's pain. That said, to date, there is no standard of care when it comes to pelvic floor PT. It is my opinion that manual, hands-on treatment under a multidisciplinary setting is the best approach to treating pelvic pain for a patient like McKenna. I am hoping that this is the kind PT that McKenna is currently receiving.?

Well said, Stephanie.? We completely agree.? The more people know about these conditions and realize the role PTs have in treatment, the better off patients will be.

This November, Herman & Wallace is excited to bring a new course, Manual Lymphatic Drainage for Pelvic Pain, to Houston, TX!  This course will be taught by Debora Hickman, DPT, WCS.

Pelvic Rehab Report sat down with Debbie to learn more about her upcoming course.

What can you tell us about this continuing education course that is not mentioned in the course description and objectives that are posted on-line?

This course is a must for physical therapists performing women’s health physical therapy.  I have found there is a need to reduce inflammation in pelvic pain patients either prior to beginning intravaginal treatment or following intravaginal treatment. In both cases, inflammation is prevalent.  Patients who are in an acute state of pain will be more tolerant of intravaginal treatment and those who flair up following treatment will have less discomfort and inflammation.

What inspired you to create this course?

I developed treatment protocols for a variety of diagnoses in women’s health that included MLD for patients with pelvic pain and inflammation.  A physical therapy expert on pelvic pain,who is a colleague of mine from Herman and Wallace, intimated other therapists attending her courses expressed an interest in learning techniques to treat inflammation in pelvic pain patients.  Her high regard for Herman and Wallace and the apparent need for a course motivated me to develop this program.

What resources and research were used when writing this course?

During my Klose Lymphedema Training Course, I learned the benefits of MLD included decreasing inflammation and pain.  Additionally, as I researched treatment for pelvic pain, I frequently observed that the primary treatment goals were to decrease pain and inflammation.  With my extensive knowledge of the lymphatic system combined with the current research on pelvic pain, I connected the idea that to improve the patient out come and decrease the duration of physical therapy treatment, manual lymphatic drainage needs to be apart of the treatment protocol.

Can you describe clinical/treatment approach/techniques covered in this continuing education course?

The clinical treatment approach, following a comprehensive women’s health physical therapy evaluation, includes how to decrease pain and inflammation.  You will be able to apply MLD for the pelvis and genitals to your current treatment protocol for your pelvic pain patients.  The seminar will cover emptying lymph node groups to receive additional lymph, making path ways to transport lymphatic fluid, and transporting lymph fluid from the pelvis, genitals and thighs to the terminus. When you have completed this course, you will have a general understanding of the lymphatic system, know when to use manual lymph drainage, and demonstrate how  to perform manual lymph drainage for the pelvis and genitals.

Why should a therapist take this course? How can these skill sets benefit his/her practice?

You will want to take this course to improve quality care and decrease pain and inflammation in your pelvic pain patients.  It is effective and gentle to use as a stand  alone treatment if needed due to patients in ability to tolerate more aggressive therapy.  Following this course you will be able to return to your clinic and begin   using MLD on your pelvic pain patients.

This course is a must for clinicians who wish to expand their knowledge of treating pelvic pain.  Seats are limited – register today!

The JAMA Internal Medicine recently published a study that illustrated how physicians are suggesting physical therapy and over-the-counter medicine less and less frequently. According to PT in Motion, the JAMA study illustrates that, ?[d]espite published guidelines that call for physical therapy or medications such as ibuprofen or acetaminophen for first-line management of most back pain, other treatments such as imaging, narcotics, and referrals to other physicians have increased.?

The study also concluded that ?Early physical therapy following a new primary care consultation was associated with reduced risk of subsequent health care compared with delayed physical therapy.?

This report appeared on the JAMA website yesterday.? The study, identifying ?23,918 visits for spine problems,? demonstrated that both treatment with narcotics and physician referrals have grown drastically since 1999, while ?[n]onsteroidal anti-inflammatory drug or acetaminophen use per visit decreased from 36.9% to 24.5%?. During this time, the percent of therapist referrals has remained roughly the same.

Herman & Wallace instructor, Ginger Garner, articulated the problem clearly in her blog: ?What was startling about the study was that while narcotic prescription, referrals for diagnostic tests, and other physician referrals all increased, patient quality of care and back pain outcomes decreased.?? Sometimes PTs are better suited to treat patients than physicians.

The study concluded that, ?[b]ecause more than 10% of visits to primary care physicians relate to back and neck pain, and the treatments recommended by guidelines generally are less costly than those being used increasingly, the financial implications in the health care market are significant.?

Patients now have direct access to PT in all 50 states, but it is important to get the word out to patients and referring physicians that PT is supported as the standard of clinical care for typical low back pain management.

Yesterday, star athlete and Seahawks wide receiver, Percy Harvin, suffered a hip labrum tear.? His injury may require surgery, as one of his physicians has suggested.

The labrum is vital in such basic functions shock absorption and joint lubrication.? As described on the Mayo Clinic?s website, ?The labrum acts like a socket to hold the ball at the top of your thighbone (femur) in place.?? It?s easy to see why hip labrum tears are not uncommon among athletes.

Percy Harvin received a $67 million dollar contract when he was traded to Seattle from the Minnesota Vikings last spring.? His career has been hampered by injuries.? Frequently missing games because of migraine headaches, Harvin missed most of last season with an ankle injury.

Of course, you don?t have to be a star football player to suffer from labral tears, and acetabular labral tears are reported to be a major cause of hip dysfunction in young patients and a primary precursor to hip osteoarthritis. Herman & Wallace offers a course on Extra-Articular Pelvic and Hip Labrum Injuries.? The next course-event will be offered next year? Stay tuned for our 2014 schedule!

Herman & Wallace is excited to announce that Institute founder and instructor Hollis Herman, PT, DPT MS, OCS, WCS, BCB-PMD will be going to Chile this September to teach a comprehensive educational seminar on pelvic floor dysfunction!

This four-day seminar will cover everything from basic terminology to advanced treatment. Much of the seminar will focus on topics taught in our popular Pelvic Floor Series as well as our Pregnancy and Postpartum Courses.

For Holly, this is her second time visiting Chile to speak this year. In April, she presented on women?s health topics to students at Universidad del Desarrollo in Santiago.

Holly is a physical therapists with more than 35 years of experience.? She owns her own practice, Healthy Women Healthy Men, in Cambridge, MA.? On top of that, Holly is an internationally renowned lecturer and speaker on physical therapy for women and men, co-author of ?How to Raise Children without Breaking Your Back,? as well as a contributor to numerous chapters and peer-reviewed articles on sexual medicine, geriatric foot care, pelvic pain, urinary and fecal continence and pregnancy and postpartum evaluation and treatment.

The September trip will be the first of two journeys to Chile to teach pelvic rehabilitation. Holly will return to Chile in 2014 to present a follow-up course to the same group.