How do you explain pain to a patient? How do you reeducate the nervous system to be less sensitive? These are the questions that Tara Sullivan, PT, DPT, PRPC, WCS, IF, and Alyson N Lowrey, PT, DPT, OCS address in their new course Pain Science for the Chronic Pelvic Pain Population. The chronic pain population is often dismissed or misled that they have something drastically wrong with them, or worse, nothing wrong with them at all. Alyson and Tara share that “this population often has the most functional deficits and the worst clinical outcomes. We want to change that.”

Tara has specialized exclusively in pelvic floor dysfunction treating bowel, bladder, sexual dysfunctions, and pelvic pain since 2012. Alyson became involved with pelvic rehabilitation through working in a clinic with Tara Sullivan. She is a board-certified orthopedic specialist and primarily works with the ortho patient population. When Tara came into the clinic she brought along the pelvic floor population and they joined forces. Alyson, with her ortho perspective, is better able to recognize that in some of her orthopedic patients, a lot of their pain was coming from the pelvic floor. The pelvic pain patient population crosses over from physical therapy to the orthopedic and occupational therapy worlds. By treating their patients wholistically Tara and Alyson have been able to make a huge difference to both of their practices.

By focusing specifically on the topic of pain science in their new course, Tara and Alyson delve into the true physiology of pain including the topics of central and peripheral sensitization. Pelvic specialists that can benefit from this course are those whose patients have chronic pelvic pain including endometriosis, interstitial cystitis, irritable bowel syndrome, vaginismus, vestibulodynia, primary dysmenorrhea, and prostatitis. The biggest thing is to learn how to recognize if there is a sensitization component to your patient’s pain.

Alyson shares that being able to recognize chronic pain in the patient is huge, that this is “not your regular patient who has a peripheral injury and we just need to rehab them through that process. It’s a whole different ballgame when we’ve got our nervous system in a hypersensitive state.” She continues, “a huge part of the treatment is educating your patient about pain and trying to decrease the fear around movement…and how we use our words to decrease fear is huge.” This course also discusses how to desensitize the nervous system through dry needling, diaphragmatic breathing, sleep hygiene, and bowel and bladder retraining.

Pain Science for the Chronic Pelvic Pain Population is scheduled for February 19-20, May 21-22, and September 10-11. This course is targeted to physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals. The full interview with Tara Sullivan and Alyson Lowery is available on the Herman & Wallace YouTube channel.

This blog contains an interview with Alyson N Lowrey, PT, DPT, OCS. Alyson treats the pelvic floor patient population through an orthopedic approach, working closely with pelvic floor specialists. Alyson’s clinical interests include evaluation/treatment of chronic pain, lumbar and cervical spine disorders, foot and ankle disorders, pelvic pain, and clinical instruction. Alyson is the co-instructor for the new H&W course, Pain Science for the Chronic Pelvic Pain Population - Remote Course scheduled for July 17-18, 2021.

Q: Who are you? Describe your clinical practice.

A: I work in an outpatient hospital-based clinic where I am able to provide true 1:1 care to patients of all ages and orthopedic conditions. Since pelvic floor therapy came to our clinic, I have developed strong clinical and personal relationships with pelvic floor therapists. We have been able to successfully combine our respective expertise into a wholistic approach for improving patient’s functional outcomes. My knowledge and relationships with pelvic floor therapy have allowed me as an ortho clinician to recognize when a patient’s dysfunction may have a pelvic floor component and refer appropriately. I am also in a unique opportunity where my pelvic floor colleagues will co-treat or transition care of a patient to me to continue to improve their overall function by providing functional strengthening and neuromuscular re-education to the pelvic floor musculature and other supportive muscular systems. This relationship also allows us to treat comorbid orthopedic conditions and pelvic dysfunctions such as low back pain or SIJ dysfunction as well.

Q: How did you get involved in the pelvic rehabilitation field?

A: I became involved with pelvic rehabilitation through working in a clinic with Tara Sullivan. Her knowledge is immense and our working relationship has shaped and changed how I assess patients. My practice has expanded drastically knowing so much more about pelvic floor dysfunction. I also have personal struggles with pelvic pain, which has given me a patient’s perspective as well on how important pelvic rehabilitation is.

Q: If you could get a message out to other clinicians about pelvic rehab what would it be?

A: I would encourage all ortho clinicians to educate themselves on pelvic rehab. Pelvic rehab is not yet fully integrated into our DPT curriculums and is often treated as a very separate area of dysfunction. Integrating pelvic floor function and dysfunction into my ortho world has drastically changed how I see and treat many patients.

Q: What made you want to create this course, Pain Science for the Chronic Pelvic Pain Population?

A: Tara and I wanted to create this course to help other clinicians become more proficient at treating chronic pain. A large portion of our caseloads is chronic pain both generally and with pelvic conditions. Patients with these conditions are often overlooked and not treated appropriately by the medical system at large. They are often dismissed or mislead that they have something drastically wrong with them, or worse, nothing wrong with them at all. This population often has the most functional deficits and the worst clinical outcomes. We want to change that.

Q: What need does your course fill in the field of pelvic rehabilitation?

A: There is a need in rehabilitation and medicine to understand pain from a biopsychosocial approach and to treat chronic pain conditions from that perspective. Pain is complex, and treatment is complex. Chronic pelvic pain is a subdivision of prevalent chronic pain that is not talked about or treated often enough.

Q: Who, what demographic, would benefit from your course?

A: Any clinician who treats chronic pain conditions can benefit from this course.

If you would like to learn more about chronic pelvic pain, you can join Alyson at Pain Science for the Chronic Pelvic Pain Population - Remote Course scheduled for July 17-18, 2021.