Intelligence and Emotions: How can we use all of our Skills to Diagnose Patients More Quickly?

You went through Herman and Wallace’s Pelvic Floor 1 course and were ready to treat your clients with incontinence and prolapse……….then you started getting referrals for clients with pelvic pain.

You have 45-60 minutes (or longer if you are lucky) to create a safe and comfortable environment, skillfully establish trust and rapport and gather objective and subjective data to get to the bottom of their pain. You want to give them the summary of your findings, their rehab road map and something to work on at home. By the end of the visit, you need to have completed their problem list and plan of care. Where do you start?

No pressure, right?

Clinicians are under a huge amount of pressure to get clients better and faster, which can result in rushing treatment before differential diagnosis is complete. A thorough approach enables us to say, with confidence, what the drivers of their condition are or at the very least what they are not. It is safe to say that no one single issue drives pelvic pain: it is a condition that is unique to each individual and requires a right AND left brain toolbox to unravel the ball of yarn that is pelvic pain.

A client with severe groin and labial pain was referred to my office for a second PT course of care. Her previous course of PT (by an outstanding clinician) focused on intrapelvic visceral work and postural corrections. The client’s pain had remained unchanged. Her visceral mobility, posture, joint biomechanics, neural upregulation, core muscle inhibition, myofascial trigger points, dysfunctional voiding and deconditioning were most definitely significant factors. The initial evaluation aligned with severe OA with a labral tear being the primary driver of her pain. I am no guru: it was with evidence-based sensitive and specific testing I was confident that this woman needed a new hip and that no amount of physical therapy could improve her pain as quickly or efficiently as a hip replacement. She DID need a customized PT pre-op course of care to prepare her for a great outcome. When she got a new hip, we incorporated all key factors into her post op rehab and she is back to her goals of hiking and having sex with her husband. (But not at the same time, as far as I know.)

Before you jump to conclusions, I am not a surgery happy PT. I work with orthopedic surgeons and interventional pain docs as frequently as I work with Reiki healers, craniosacral therapists and acupuncturists. I want to fill my toolbox with right as well as left brained tools, from the most subtle of manual interventions and precise movement re-education to dynamic mobilization and strengthening interventions. As a profession we are called to utilize evidence-based treatment as well as innovative interventions that may be researched one day. Every evidence-based practice was once an unresearched clinical intervention based on clinical reasoning and perhaps gut instinct.

As pelvic health therapists, our work requires high EQ as well as IQ to earn client trust as well as differential diagnosis abilities to design their plan of care. Before we can ask for more visits, we need to justify the reasons behind the request based on solid clinical reasoning including objective data. Certainly in 45 minutes it can be difficult if not impossible to perform a comprehensive pelvic health and musculoskeletal evaluation. That being said, we need to address main categories of foundational evaluation testing to capture their data in a thorough manner.

“Finding the Driver in Pelvic Pain” is a course that enables the clinician to perform a foundational comprehensive musculoskeletal and pelvic health exam to find the evidence based factors in the client’s pain. We are called to deliver care that integrates both the art and science of physical therapy and healing. If we just use the ‘art’, or only the ‘science’, we miss key elements in our differential diagnosis which could delay the client getting better.