Nicholas Gaffga, MD, MPH, FAAFP sat down with The Pelvic Rehab Report this week to discuss himself and how he came to TA (and teach) for Herman & Wallace. Niko is scheduled to TA next in Birmingham, AL for Pelvic Floor Level 1 scheduled March 4-5 2023, and will be instructing Menstruation and Pelvic Health on February 25-26 2023.

Who are you?
Describe your clinical practice. My name is Niko Gaffga, and I am a family medicine physician seeing patients in Atlanta, GA. Over the 20 years I have been practicing medicine, I have worked in a number of settings: pediatrics, gerontology, emergency room, ICU, HIV prevention in Africa for 4 years, occupational medicine, travel medicine, and obstetrics and gynecology. As I look back over these memories, the area of work where I most feel connected with my patients is women’s health and outpatient gynecology.

How did you get involved in the pelvic rehabilitation field?
My journey in pelvic health physical therapy has been one of the most exciting and rewarding of my career. One day in my clinic I saw a patient who had pelvic pain. When I walked into the room she was crying. Over the next few months, we were able to reduce her IC symptoms considerably with medications and diet modification. And one time when I went into the room to see her, she stood up and smiled and hugged me. This reminded me why I wanted to be a doctor. Along this journey, I realized there were aspects of her experience that I could not address using my training as a physician, so I began investigating other ways to provide more holistic care to my patients. That was when I discovered the world of pelvic floor physical therapy. To understand more, I signed up for PF1. During that 3-day weekend, I saw the power of powerful pelvic floor physical therapy to help patients feel better. Since that time, I have taken all the courses in the Pelvic Floor series, as well as Male Pelvic Floor and three other specialty courses offered at Herman & Wallace. I even overcame my fear and anxiety and signed up to be a teaching assistant. I thought I could never be a TA…but since that time I have been TA 13 times and each time I am grateful for the opportunity to make a difference in other people’s lives. My experience working with pelvic floor practitioners has shown me the power of collaborating among health care professionals with different skills and treatment modalities to offer our patients the most holistic and effective care they can get.

What patient population do you find most rewarding in treating and why?
The most interesting and rewarding aspect of my work is helping patients improve their Menstrual Experience. Menstrual Forums can be difficult to find, but they create opportunities to share knowledge and understanding of the Menstrual Experience to increase Menstrual Optimism, Menstrual Confidence, and ultimately, Menstrual Pride. I have been working for 7 years to create a course that empowers pelvic health practitioners to open a Menstrual Forum with patients to help them better understand and improve their Menstrual Experience. It is a humbling, fascinating, and rewarding experience to walk with someone on a Menstrual Journey.

If you could get a message out to physical therapists about pelvic rehab what would it be?
If there are issues that as a rehab practitioner you are having trouble helping your patients with, explore referring them to a pelvic floor therapist who can help the patient in a whole different way.

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?
There is a simple scenario that profoundly changed how I see my patients. Physicians carrying out gynecological procedures are trained to sit at the foot of the bed to get the best field of view and to be able to carry out procedures on the patient. However, pelvic floor physical therapists usually sit next to the patient for ergonomics and also to be able to detect pain or anxiety on the face of the patient with each procedure that is carried out. This simple change in perspective invited me to be more aware of the effect that the visit is having on the patient and be more mindful of how they experience the encounter.

What do you find is the most useful resource for your practice?
My most useful resource is the ability to communicate with a variety of health professionals who have

What is in store for you in the future as a clinician?
My dream is to work in outpatient gynecology in close collaboration with a pelvic floor physical therapist to provide holistic health care for our patients.

What books or articles have impacted you as a clinician?
The Female Pelvis (Bandine Calais-Germain) for its beautiful informative illustrations that make pelvic anatomy and physiology come to life; In the Flo (Alisa Vitti) and The Rumi Collection (Kabir Helminski) for their new perspective on life; Period Repair Manual (Lara Briden); and The Fifth Vital Sign (Lisa Hendrickson-Jack) for their informative and proactive approach to understanding and improving the Menstrual Experience.

What has been your favorite Herman & Wallace Course and why?
Pelvic Floor Level 1 was life-changing for me because it introduced me to a whole new field of care and a whole different way of seeing patients. Herman & Wallace has been welcoming to me, as a physician and as a male, into a world where I could have potentially felt like an outsider. Thank you.

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?
In the past 3 years, I have worked with 14 different Herman & Wallace instructors as a participant and as TA. I have learned many lessons, but the one that has helped me the most is the encouragement to follow my dreams and to be the best I can be, even if the road seems difficult or unorthodox. There is a world out there waiting to be created.

What do you love about assisting at courses?
Being a TA at Herman & Wallace courses is the highlight of my month. I literally look at my calendar each day to see how soon it will be until the class starts. I love being a part of other people’s journey to learn more about pelvic floor physical therapy, I love helping people find their way in their careers, I love sharing the things that I am passionate about, I love sharing a physician’s perspective, and most of all I love seeing the light bulb turn on in someone’s eyes when they have visualized something in a new and exciting way.

What is your message to course participants who are just starting their journey?
If pelvic floor therapy is a field that you are curious about or find interesting and you feel a calling for, I encourage you to invest time and energy to learn more about it. Your professional options and your ability to help people will only be limited by what you can imagine.

Ziya Altug, PT, DPT, MS, OCS is a board-certified doctor of physical therapy with 32 years of clinical experience treating musculoskeletal injuries. Z currently provides outpatient physical therapy in the home setting in Los Angeles, California, and serves as a continuing education instructor. He received his Bachelor of Science in Physical Therapy at the University of Pittsburgh in 1989, a Master of Science in Sport and Exercise Studies in 1985, a Bachelor of Science in Physical Education in 1983 from West Virginia University, and a Doctor of Physical Therapy from the College of St. Scholastica in 2015. Z is a long-standing member of the American Physical Therapy Association and a member of the American College of Lifestyle Medicine. He has attended workshops in yoga, tai chi, qigong, Pilates, Feldenkrais Method, and the Alexander Technique.

Dr. Altug is the author of the books Integrative Healing: Developing Wellness in the Mind and Body (2018), The Anti-Aging Fitness Prescription (2006), and Manual of Clinical Exercise Testing, Prescription, and Rehabilitation (1993). In 2020, he published the chapter Exercise, Dance, Tai Chi, Pilates, and Alexander Technique in The Handbook of Wellness Medicine. In 2021, he published the article Lifestyle Medicine for Chronic Lower Back Pain: An Evidence-Based Approach in the American Journal of Lifestyle Medicine. Z joins the H&W faculty and is presenting his personally curated course Integrative and Lifestyle Medicine Toolbox for Rehab and Pain Management. This week he sat down with The Pelvic Rehab Report to discuss his course.

What made you want to create this course?
My father was a physician specializing in internal medicine. He specialized in treating conditions such as tuberculosis, chronic obstructive pulmonary disease (COPD), and asthma. Starting in elementary school, I remember discussing with my Dad the importance of nutrition, sleep, stress control, and sustainable activity in healing. Of course, as a ten-year-old, I played with his stethoscope and reflex hammer for hours! My father used “lifestyle medicine” principles to help his patients recover. My Mom introduced me to the benefits of aromatherapy for relaxation. She used to wash our clothes with lavender-scented soaps, and there was lavender-scented potpourri throughout our house. My mother used to say the lavender was to “keep the wolves away so the sheep can sleep.” She also taught me how to prepare and cook healthful meals in high school. Now, I have a fascination with culinary medicine. I am very grateful for all of these childhood experiences.

Before entering PT school, I majored in physical education and exercise science. After I graduated from PT school, I wanted to use my interest in wellness, health, fitness, and self-care strategies to help patients heal and recover. Recently, I have followed the American College of Lifestyle Medicine research and webinars to gain additional knowledge. Currently, I treat patients in their homes and teach continuing education courses in integrative and lifestyle medicine.

What need does your course fill in the field of pelvic rehabilitation?
This course provides practical tools to help clinicians manage pain. For example, my course will cover research, resources, and labs to create clinically relevant pain, anxiety, depression, and stress management strategies using lifestyle medicine, integrative medicine, and expressive and art-based therapies. Participants will be able to practice Tai Chi/Qigong, expressive and art-based therapies including Music, Dance, and Drama Therapy, nature and aromatic therapies, self-hypnosis, and self-massage. All of these strategies may be helpful for clinicians specializing in pelvic rehabilitation.

Who, what demographic, would benefit from your course?
Rehabilitation providers of any experience level would benefit from taking this course.

What patient population do you find most rewarding in treating and why?
I currently focus on orthopedics and geriatrics. I especially enjoy working with older patients in their homes and designing creative home exercise programs they can use to stay healthy.

What do you find is the most useful resource for your practice?
I enjoy using resources from the following organizations:

• American College of Lifestyle Medicine
• American College of Sports Medicine
• International Association for the Study of Pain

What books or articles have impacted you as a clinician?
I enjoyed reading the following three books to expand my knowledge of lifestyle medicine and integrative medicine:

• Lifestyle Medicine by James Rippe
• Lifestyle Medicine Handbook by Beth Frates and colleagues
• Lifestyle Medicine by Garry Egger and colleagues

What is your message to course participants who are just starting their journey?
I recommend all clinicians collaborate with professionals outside their own profession. For example, I recommend physical therapists work with the following:

• Acupuncturists, massage therapists, registered dietitians
• Practitioners in yoga, Pilates, qigong, tai chi, Alexander Technique, Feldenkrais Method
• Specialists in expressive therapies such as dance, music, art, drama, poetry, and play.

Integrative and Lifestyle Medicine Toolbox for Rehab and Pain Management

Course Dates:
January 21, 2023

Price: $125
Experience Level: Beginner
Contact Hours: 4.5

Description: This course was written and developed by Ziya “Z” Altug, PT, DPT, MS, OCS, a board-certified doctor of physical therapy with 32 years of experience in treating musculoskeletal conditions, Brief lectures on the research and resources and labs will cover a toolbox approach for creating clinically relevant pain, anxiety, depression, and stress management strategies using lifestyle medicine, integrative medicine, expressive and art-based therapies, and the impact of nature on health. Participants will be able to practice Tai Chi/Qigong, expressive and art-based therapies including Music, Dance, and Drama Therapy, nature and aromatic therapies, self-hypnosis, and self-massage. 

Janet Drake Whalen, PT, DPT sat down with The Pelvic Rehab Report this week to discuss herself and how she came to TA for Herman & Wallace. Janet is scheduled to TA next at the Doylestown PA for Pelvic Floor Level 1 scheduled January 7-8 2023.

Hi Janet, can you tell us a little bit about yourself and your clinical practice?
I am a physical therapist with 36 years of experience who has spent 34 years of my career in women’s health physical therapy. Over my career, I have been an advocate and continue to promote abdominal and pelvic health for all.  My career led me to become a Lamaze-educated childbirth educator, certified neuroscience practitioner, women’s health coach, and professional yoga therapist. My clinical practice now is in a hospital setting where I am educating outpatient therapy staff, healthcare providers, and physicians on pelvic health.  I am heading the start of a 4th-trimester program and a sexual health program.

What has your educational journey as a pelvic rehab therapist looked like, and how did you get involved in the pelvic rehabilitation field?
My educational journey started after an unplanned cesarean birth of my first son 34 years ago. In 1988 resources for women after delivery was scarce. I started looking into education and found a course taught by a nurse, Jo Laycock, from England. I attended her course sitting with nurses to learn about incontinence. My first women's health physical therapy courses were through the OB/GYN section of the APTA taught by Elizabeth Noble, Holly Herman, Kathy Wallace, Jill Boissonnault, and Marla Bookout. When Holly Herman and Kathy Wallace started their own education company, I started to attend courses through Herman & Wallace. After my vaginal birth after the Cesarean of my second son in 1990, I studied and earned my Lamaze International Childbirth Educator certification. I taught Lamaze for 9 years and continue with my certification. I started as a teaching assistant with Herman & Wallace approximately 15 years ago.

What patient population do you find most rewarding in treating and why?
This is a difficult question for me, although I would have to say that pregnancy and postpartum was my initial passion. Sexual health and whole-body wellness have been my passion for the past 12 years. I enjoy the interdisciplinary approach to sexual dysfunctions and continuing to learn more every year from patients and fellow clinicians.

If you could get a message out to physical therapists about pelvic rehab what would it be?
Every patient has a pelvis with organs and muscles. If you are treating spine and hip patients, you are affecting the pelvic floor muscles and the pelvic floor muscles are affecting your patients’ symptoms. External treatment can be as effective as internal treatment - so take a pelvic health course, you and your patients will benefit!

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?
I've had so many amazing instructors and colleagues over the years. From my therapeutic pain specialty certification to Louis Gifford’s work on what patients really what to know: 4 questions...

• What is wrong with me?
• How long will it take?
• What can I (the patient) do for it?
• What can you (the healthcare provider) do for it?

Also, listen to your patient's story. Meet your patients where they are and ask them open-ended questions.

What do you find is the most useful resource for your practice?
Besides a hi-low table, my ears and my heart.

What is in store for you in the future as a clinician?
To educate as many clinicians and therapists as possible to be ready to hand over the baton in five to seven years. A successful 4th-trimester program and sexual health program at the hospital I am currently employed.

What books or articles have impacted you as a clinician?
This is another tough question for me I have a library of books. But I will say that a textbook that I always have on hand is Anatomy Trains by Tom Myers. Research articles that provide a consensus of terminology and classifications with algorithms that are great to discuss with other clinicians.

What has been your favorite Herman & Wallace Course and why?
Pelvic Floor 3 (now Pelvic Floor Capstone) with Holly Herman piqued my interest in sexual health. Since that time all the visceral and myofascial courses with Ramona Horton have shaped and deepened my practice.

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?
One lesson that has stayed from Nari Clemens is how important it is to take care of yourself. Another from Ramona Horton regarding hands-on treatment is that you are having a conversation with the brain/nervous system.

What do you love about assisting at courses?
What I love about assisting at courses is meeting all the physical therapists from different stages of their careers with an interest in pelvic health. Their energy excites me and reminds me how wonderful our profession is.

What is your message to course participants who are just starting their journey?
If you're just starting your journey, hold on! There is a lot to learn, to practice, to share, and to educate others. You are going to influence so many people’s lives.

Kelley Kukis, DPT, PRPC sat down with The Pelvic Rehab Report this week to discuss herself and how she came to TA for Herman & Wallace.

Who are you? Describe your clinical practice.
I’m Kelley Kukis, DPT, PRPC, and I’m a pelvic PT at East Sacramento Physical Therapy, or East Sac PT as we are referred to locally. East Sac PT has been a pelvic health clinic for over 30 years, and early on the owners, Risa and Jim MacDonald had to educate other medical providers about what pelvic PT was and how it would help their patients. Now the clinic treats adult and pediatric patients of all genders with pelvic dysfunction as well as adult patients with orthopedic conditions.

I also organize the Sacramento Pelvic and Sexual Health Professionals Network (Sac PuSHPiN), which is a network of PTs, MDs, mental health therapists, sex educators, and more, who meet quarterly and share ideas about pelvic and sexual health.

In addition to being a lead TA for Herman & Wallace, I do some guest teaching at my alma mater, California State University, Sacramento (CSUS).

What has your educational journey as a pelvic rehab therapist looked like? Where did you start?
Some of my earliest jobs were movement related. I taught swim lessons, yoga classes, and dance classes in high school and college. I earned a teaching credential and had a  career as an elementary teacher for a few years. Unfortunately, I entered teaching in the midst of a difficult economy. As a newer teacher, I was laid off every year due to uncertain education budgets and had to reapply each fall, which became very stressful after 5 years.

I decided to go back to school to be a school PT because as a teacher, I was familiar with rehab in a school setting, but I was pretty naive about what getting into and completing PT school meant. Because I didn’t have a kinesiology degree, I had to take a few years of prerequisite classes while I worked as a dance instructor and professional dancer. I got into the PT program at CSUS and was exposed to the wide variety of settings available for PTs to practice in. When I did a clinical rotation at East Sac PT, I fell in love with pelvic health and never looked back. I took Pelvic Floor 1 as a student in preparation for my clinical rotation, and I completed the rest of the pelvic series after graduation. I earned my PRPC the following year.

How did you get involved in the pelvic rehabilitation field?
One thing that drew me to pelvic rehabilitation was the amount of time we get to spend really getting to know patients. Patients will often tell us things they haven’t told other medical providers, and I love helping patients solve mysteries about their bodies and make new connections. I also love that the little things we do can make a big difference. I gave a constipated patient an abdominal massage, and she returned and called me a “poop doula”.

What patient population do you find most rewarding in treating and why?
I love treating dyspareunia because it’s often something that people have lived with for a long time and thought was either normal or untreatable. I also love working with the LGBTQIA+ community because as a queer person I know that finding queer-competent healthcare providers is more difficult than it should be.

If you could get a message out to physical therapists about pelvic rehab what would it be?
Ask every patient specific questions about their pelvic health. Often patients won’t tell you that they are having incontinence or pelvic pain unless you ask them specifically. These are things that should be screened for at every PT evaluation. PTs also need to get really comfortable asking these questions because if you as the PT are nervous or embarrassed, your patient won’t be honest with you.

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?
I’ve learned so much from my mentor Risa MacDonald, but one of the most useful things I observed from her is the phrase “you’re right”. She starts nearly every bit of patient education with it, and it’s magic. If you start out telling a patient something they’re right about, they’ll listen to almost anything you have to say after that.

What do you find is the most useful resource for your practice?
I love podcasts. I listen to them while I’m getting ready for work or while I’m working around the house on the weekends. There are so many, but some of the podcasts in my rotation right now are At Your Cervix, Decolonizing Fitness, Foreplay Radio, Pain Science and Sensibility, The Nutrition Diva, The Penis Project, and Tough to Treat. One of my all-time favorite podcasts is Ologies, which is not a pelvic health-specific podcast but which does have some pelvic health-themed episodes, such as “Phallology”, which is what got me hooked.

What is in store for you in the future as a clinician?
I am loving the journey of continuing to learn about different aspects of pelvic health. I’d love to work more in PT education, and I have plans to own a clinic at some point in the future.

What books or articles have impacted you as a clinician?
I’ve just registered for Diane Lee’s ISM series, so I’m working my way back through The Pelvic Girdle and The Thorax right now. Both are such a dense wealth of information that give me new perspectives each time I go through them. I aspire to understand anatomy at as deep a level as Diane Lee.

What has been your favorite Herman & Wallace Course and why?
Megan Pribyl’s Nutrition Perspectives course dramatically changed both the way I eat and the way I talk to patients about nutrition. I recommend it to people every time I TA. I also learned so much in Lila Abbate’s Pudendal Neuralgia course.

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?
I started fermenting things and sprouting grains after taking Megan Pribyl’s course. I’ve also fashioned several pelvic models out of pipe cleaners after taking Jen Vande Vegte’s courses.

What do you love about assisting at courses?
I love meeting other PTs and learning things from them. Our field has so many passionate and talented PTs with so many interesting ideas. It’s also really fun to see how other clinics are set up and run. And even when I’ve TA’ed a course several times, it’s always valuable to hear the material with a new instructor and practice it with a different set of PTs. I learn so many new things each time.

What is your message to course participants who are just starting their journey?
Assume nothing! Even with the most open mind, patients will make you realize the assumptions and biases you’re bringing into the treatment room. Just when you get comfortable, a patient will throw you an absolute curve ball. This is what makes our specialty interesting though!

Bethany Blake, PT, DPT, PRPC sat down with The Pelvic Rehab Report this week to discuss herself and how she came to TA for Herman & Wallace.

Who are you? Describe your clinical practice.
I’m Bethany Blake. I co-own Arkansas Pelvic Health and use social media (@thebladderbaddies previously @thekegelchronicles) to educate about pelvic health.

At Arkansas Pelvic Health we believe everyone should be able to live their life confidently, without pelvic pain or leakage. We believe pelvic therapy should be a standard, not a luxury, and we are on a mission to change this, one pelvis at a time. That's why we started this business, to raise the standard of care in women's health.

As a patient at Arkansas Pelvic Health, you will be paired one-on-one with a Doctor of Physical Therapy, never a tech or computer. You will never be rushed, and your pain and symptoms will be validated. We’re tired of doing things like they've always been done, and we’re tired of women's pain being ignored. We practice evidence-based, patient-centered, compassionate care to get you lasting relief from your pelvic symptoms and get you back to living your life!

What has your educational journey as a pelvic rehab therapist looked like? Where did you start?
I really jumped all in. I took Pelvic Floor Level 1, Pelvic Floor Level 2A, and Pelvic Floor Level 2B all within a month of each other. Very shortly after that, I took a visceral class with Ramona Horton and started teaching courses. I love learning and refuse to settle with not knowing something.

How did you get involved in the pelvic rehabilitation field?
I started my career as an outpatient orthopedic therapist. I picked this site as a clinical rotation because of one therapist in particular, Amanda Brooks-Ritchie. I liked the training that she had and the certifications she was working toward. I had a lot of pregnant and postpartum patients there and worked with a team of pelvic health therapists. Anytime treatment didn’t involve actual vaginal exams, they got “kicked out” to ortho…me. I learned a lot about pelvic health during that time and eventually decided to jump on board the pelvic health ship. I love zooming in and out of the pelvis and bringing the orthopedic background into pelvic health. Soon after I took the courses, I got my PRPC. I realized when studying for that certification, I wanted to merge my orthopedics and pelvic floor, which looked different from how I was practicing at my then-current job. I reached out to a classmate, colleague, and friend, Beth Anne Travis, who had previously approached me about starting a clinic, and told her I was ready to go!

What patient population do you find most rewarding in treating and why?
I love treating pain patients - pelvic pain in general, interstitial cystitis, pudendal neuralgia, and pain with intercourse. It is so rewarding to give people a part of their life back that they hate and to help their bodies work for them instead of against them.

If you could get a message out to physical therapists about pelvic rehab what would it be?
If you suspect pelvic floor issues with your patient, don’t try to manage them yourself.  You are potentially doing more harm than good by blindly issuing Kegels and TA contractions. If you aren’t sure, call your friendly neighborhood pelvic PT, and they would be very happy to help you with your patient. I also love the Cozean pelvic floor screening tool.

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?
Pelvic floor issues are complex. The evaluation is an ongoing process. You won’t know everything for everyone, but you know how to research, you have colleagues you can talk to, and don’t stop trying. Pain is absolutely not part of being a woman.

What do you find is the most useful resource for your practice?
My colleagues. We have a weekly hour where we chat about cases, practice new techniques, and review. It is the best time of the week.

What is in store for you in the future as a clinician?
Arkansas Pelvic Health is growing and expanding. I see opportunities for growth in space and location. I will continue patient care (it’s my favorite part) and also educating the public on social media and through different PT schools.

What books or articles have impacted you as a clinician?
The Interstitial Cystitis Solution
Come As You Are
Headache in the Pelvis
The Body Keeps the Score
Netter’s Anatomy
and many articles!

What has been your favorite Herman & Wallace Course and why?
Pelvic Floor Level 2B is my all-time favorite because I love treating pain conditions. I also really enjoyed the Nutrition Perspectives for the Pelvic Rehab Therapist course.

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?
Progress is not linear!

What do you love about assisting at courses?
I love teaching people about the pelvis, knowing that they will go out and help so many people. I love the updated evidence at the courses, reconnecting with colleagues, and meeting new ones.

What is your message to course participants who are just starting their journey?
Sometimes the load is heavy, but you get stronger, and colleagues help carry it! This is the most rewarding job you will ever have. It is an honor that people let you help them with a vulnerable issue, don’t take it lightly.

Maricel Briones, DPT, CMTPT, OCS sat down with The Pelvic Rehab Report this week to discuss herself and how she came to TA for Herman & Wallace. You can find Maricel this fall TA'ing Pelvic Floor Level 2B in Virginia Beach, VA.

Hi Maricel, can you share a little bit about yourself and your clinical practice?
Hi, I'm Maricel Briones, DPT, CMTPT, OCS and I've lived in Virginia Beach, VA my whole life. I graduated from Old Dominion University with a Bachelor in Exercise Science and followed that up with a Doctorate of Physical Therapy degree. I am now a Partner, Area Director, and Co-Leader of Pelvic Health with Ivy Rehab and have been a practicing therapist since 2012. I became an Orthopedic Clinical Specialist and Certified Myofascial Trigger Point Specialist for Dry Needling and recently became a Pelvic Health Therapist in 2020. My current clinic opened in December 2021, located in the Town Center area of Virginia Beach, VA. We are in the middle of expanding. We are a mix of outpatient orthopedic and pelvic health for men and women. My whole clinic is trained to support each other with all cases, even with pelvic health, and work together as a team for each patient's visit.

What has your educational journey as a pelvic rehab therapist looked like? Where did you start?
I started in early 2020 with Herman & Wallace (H&W) Pelvic Floor Level 1 in Virginia Beach, VA, then continued and took Pelvic Floor Level 2B towards the summer. It started a little slow because of Covid but it picked up in October 2022 and has been very busy since. In 2021, I continued taking more H&W courses including Pelvic Floor Level 2A, Male Pelvic Floor, and Pelvic Floor Capstone. I continued to host around 5-7 H&W courses to review the material and encourage local ortho therapists to join the pelvic health world. I eventually became a teaching assistant (TA) for H&W and have been loving it ever since. I became a Senior TA earlier this year.

How did you get involved in the pelvic rehabilitation field?
My regional director first asked and brought it to my attention, but I declined. A year later, she further explained the impact we can have for patients with pelvic floor conditions and got me convinced.  I gave it a shot in 2020 and realized it was where I should be. It's the most rewarding type of treatment we can provide for a patient. We are helping a hidden population that we did not know exists right in front of us. Helping them with critical functions needed in life, voiding, BM, sex, etc.

What patient population do you find most rewarding in treating and why?
Either the pediatric or geriatric population for urinary incontinence (UI). I enjoy teaching them good bladder habits and how to properly contract their pelvic floor muscles. My first patient was an 80-year-old who had urinary incontinence for 20 years and after 1 week of pelvic therapy, she went from changing her pad around 8 times a day to only 2. I had my first pediatric patient who had seen 4 specialists in 1 year for UI. After 2 weeks of pelvic floor rehab, she went from having 4-6 accidents a day to 1-2 every other day.

If you could get a message out to physical therapists about pelvic rehab what would it be?
Don't be afraid of the "V". A lot of PTs are uninterested and do not realize how much pelvic floor muscle training is similar to orthopedic, either stretch it or strengthen it, and provide a lot of education on habits. Also, it's all about functional movement, so connect the pelvic floor with the upper and lower body for optimal outcomes. I did an internal Ivy Rehab Ted Talk in Florida for our Director's Summit in May 2021, titled "Don't be afraid of the 'V'". What you're nervous of or afraid of, may actually be where you are meant to be or do.

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?
Continue to learn no matter what, and never settle. My treatment programs and assessments evolve every year because of continued learning and advice from colleagues. Always be open to different approaches and be patient with all complex cases.

What do you find is the most useful resource for your practice?
Facebook groups such as Global Pelvic Physio (run by Michelle Lyons), Pelvic PT Newbies (run by Jessica and Andrew Reale), Pelvic PT Huddle (run by PelvicSanity and Nicole Cozean), and Pelvic Floor Biofeedback (run by Tiffany Ellsworth Lee) have been my go-to for learning about cases, ideas, etc.

What is in store for you in the future as a clinician?
I plan to take the PRPC exam soon for board certification. I am also working with Ivy Rehab to create a year-long Pelvic Health Specialization program.

What has been your favorite Herman & Wallace Course and why?
Pelvic Floor Level 2B, since I learned more in-depth manual therapy for the pelvic floor and it helped nail down the anatomy of the pelvic region. I also love the manual therapy skills that we learned in Capstone.

What lesson have you learned from a Herman & Wallace instructor that has stayed with you?
Lengthen before strengthen!

What do you love about assisting at courses?
It's an information refresher. The more you hear it, the more it sticks. I also love teaching the students the concepts and anatomy that were originally confusing for me.

What is your message to course participants who are just starting their journey?
Continue to take more courses on pelvic floor rehab as there are so many different pelvic health conditions. Take the same concepts you learned about muscle training for any body part and apply them to the pelvic region. Connect the pelvic region to the whole body and focus on actively training it with function. It's not just about motor control of the pelvic floor muscles, it's coordinating it with the abdominals, hips, back, etc. Not all visits are hands-on one-on one-on-one. If you create a robust well-rounded program for them and they will progress quicker than you expect.

This week The Pelvic Rehab Report sat down with new faculty member, Emily McElrath PT, DPT, MTC, CIDN, to discuss her pelvic rehab journey and her new course, Pregnancy and Postpartum Considerations for High-Intensity Athletics. Emily is a native of New Orleans, is highly trained in Sports and Orthopedics, and has a passion for helping women achieve optimal sports performance. Emily is also certified in manual therapy and dry needling, which allows her to provide a wide range of treatment skills including joint and soft tissue mobilization. She is an avid runner and Crossfitter and has personal experience modifying these activities during pregnancy and postpartum.

Hi Emily! Can you tell us a little bit about yourself and your clinical practice?

My name is Emily McElrath, and I am an orthopedic and pelvic floor PT. I spent the early years of my career in sports medicine and primarily worked with high school and collegiate athletes, as well as weekend warriors. I myself am a distance runner and Crossfitter and have always had a love for sports. After the birth of my second child, I had a hard time returning to Crossfit due to significant pelvic floor dysfunction and pain. At that time, I became a pelvic floor patient and quickly realized how valuable this specialty was. This began my journey to becoming a pelvic PT.

Since that time almost 4 years ago, I have been blending my orthopedic and pelvic health knowledge and skillset to help women return to the sports they love without pain and pelvic floor dysfunction.  My main goal as a clinician is to educate and empower my patients to feel in control of their own bodies, and to feel confident in daily and recreational activities.

What has your educational journey as a pelvic rehab therapist looked like and how did you get involved in the pelvic rehabilitation field?

It was really a matter of personal experience leading me to the field of pelvic health. I knew the specialty of pelvic health existed, but until I was a patient I did not truly appreciate how valuable it was. Seeing firsthand how significantly pelvic floor physical therapy could improve the quality of a patient’s life gave me a desire to become a pelvic PT. Once I got into my course work with Herman & Wallace, I realized that my background as an orthopedic PT would blend well with pelvic PT. It also gave me a lot of perspective into how significant of a role the pelvic floor plays in the entire kinetic chain. I would even say that my pelvic floor education has helped me be a more thorough orthopedic clinician. It has helped me think outside the box and enabled me to be more thorough in my critical thinking when evaluating patients.

What patient population do you find most rewarding in treating and why?

I have two patient populations that I find most rewarding. The first is HIIT athletes. I find this population so fun to work with. They are some of the most dedicated and compliant patients I have. Their love of their sport is often a driving force for them to get and stay healthy. Many of these athletes will even come to my clinic without having pain or dysfunction. They are strictly coming for education and prevention, which I love. After all, PTs as a profession are huge proponents of wellness and prevention.  I also love teaching a patient that they can, in fact, continue doing exercises they may have been previously told were not safe to do during pregnancy or postpartum. Giving them hope that they can continue doing what they love after they were afraid they may not is very rewarding.

The second population I love working with is my childbirth prep patients. I LOVE education. I feel like these sessions really highlight that part of physical therapy. These sessions not only address any current concerns a patient is having but also provide education to give them the confidence to birth the way they want. I review everything from what to expect during labor, to different positions for pushing, and how to push. I even have partners come to the sessions so they can learn how to best support the patient during delivery. Hearing from patients that their birth experience was beautiful and just as they had hoped always gives me a lot of joy. I feel honored to be able to be a part of that journey.

What do you find is the most useful resource for your practice?

I find other practitioners the most valuable resource in my practice. There is so much that can be gained from collaborating with other pelvic PTs, doulas, midwives, OB/GYN, sex therapists, etc. Pelvic rehab is so multifaceted, that I believe it truly requires a collaborative approach to provide the best patient outcomes.

What books or articles have impacted you as a clinician?

There was a recent article that came out about the prevalence and significance of Levator Ani avulsion tears. This was an interesting article because I have seen this more and more clinically, but there is very little research on the matter. My favorite books as a clinician are: “The Body Keeps the Score”, “Come As You Are”, and “Pelvic Pain Explained”.

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?

 I think the biggest thing I have learned is that the objective findings of our evaluations are only a small part of the puzzle. Pelvic rehab is an intimate type of physical therapy, and many of our patients may have had trauma that is still raw to them. If most of your evaluation is spent talking with the patients to ensure they feel comfortable, that’s ok. I have realized that it’s ok if I don’t get to every objective test and measure in the first session. In this line of work, patient comfort is most important. Building a rapport with your patient must take precedent.

What made you want to create this course, Pregnancy and Postpartum Considerations for High-Intensity Athletics?

I wanted to create this course because I saw a need in the Crossfit community for more education on how to safely train pregnant and postpartum athletes, and I feel physical therapy is a great place to start, after all, PTs are experts in the musculoskeletal system. We are seeing more and more of these HIIT athletes becoming moms and wanting to maintain their athleticism throughout pregnancy & postpartum, and I think that’s great!

With that being said, I think there are nuances to training this athletic population. There are so many hormonal, anatomical, and structural changes to consider during pregnancy & postpartum, and that may affect how well an athlete can tolerate strain. However, most of these changes are not contraindications to training. Therefore, we as rehab practitioners and physical therapists need to fully understand the demands of  HIIT, as well as the specific considerations for this population so that we can keep them safely and effectively doing what they love.

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

By and large, people do not fully understand the demands of HIIT activities like Crossfit unless they personally partake in these activities. This includes healthcare professionals like physical therapists. However, many of our pregnant and postpartum athletes will require the care of a  PT (especially pelvic) at some point throughout their pregnancy, and postpartum journey.

My course, Pregnancy and Postpartum Considerations for High-Intensity Athletics bridges the gap between education and experience, for those healthcare professionals who do not personally participate in HIIT to understand the demands of the sport. It also helps those physical therapists who do not specialize in pelvic health to understand the unique demands of this athlete population from a pelvic health perspective.

Who, what demographic, would benefit from your course?

Any PT, PTA, PT student, OT, COTA, or OT student who is looking to better understand the demands of HIIT,  the special considerations for pregnant and postpartum athletes who participate in HIIT, and how to safely train and treat these athletes to help them continue to do what they love.

If you could get a message out to physical therapists about pelvic rehab what would it be?

Oh man, where do I start? There are so many things I want to shout from the mountain tops about pelvic PT. It truly is a gem in the field of physical therapy, and I think is often a missing link in traditional physical therapy care. Pelvic rehab is so much more than urinary leakage and kegels. It can be so impactful to the quality of life of a patient. There is no other area of the body that is critical to so many functions but is also so vastly overlooked and undertreated. The need for research, education, and development in this field is critical if we are going to have a true “whole body” approach to treatment.

Check out the Herman & Wallace YouTube Channel for the full interview with Dr. Yeni

Dr. Oluwayeni Abraham stumbled into the niche field of fertility. She shares, "I had all of these women who would come in with painful periods that would have significant post-surgical problems and would end up having fertility concerns. As I was picking up my visceral mobilization techniques, I started to see that I was able to help women conceive and help women who maybe have experienced reoccurring miscarriages actually carry to term. That's when I said, "I think I'm doing something here that could be something else." That's when I tried to hone in on the specific skills that were influencing and maximizing the results and outcomes. 

In Dr. Yeni's course, Fertility Considerations for the Pelvic Therapist, she shares manual therapy techniques and a lot of data on hormones, the endocrine system, and other pieces of the puzzle. The language in the fertility world is based on these building blocks. Specific fertility-related diagnoses are discussed that help you formulate a pathway in treatment. Another important thing Dr. Yeni teaches is how to collaborate and work with these other providers that are going to be on this journey with your patients.

When working with fertility it's important to ask ourselves how do we bring value to this puzzle? How do we bring value after someone has had multiple failed IVF cycles? We can't just say we're going to do a bunch of manual work. We also have to speak the language and understand the body in its entirety and how it's playing a role in being able to maximize fertility outcomes. 

When asked what sparks her passion and keeps her so excited about working with this population Dr. Yeni stated, "the outcomes! We're still therapists, and we love to see results."

Fertility Considerations for the Pelvic Therapist - Remote Course

• Feb 5, 2022
• Jun 4, 2022
• Aug 13, 2022
• Nov 5, 2022

This course requires each registrant to have a live model. Due to the nature of labs, please be sure your model or partner is not pregnant and does not have an IUD for safety. Additionally, those with hydrosalpinx will not be able to participate in uterine mobility techniques but can still attend the course.

Dr. Michael Hibner is an international expert on pudendal neuralgia and chronic pelvic pain. Dr. Hibner joins Holly Tanner to discuss his new exclusive course with H&W titled Pudendal Dysfunction: The Physician's Perspective.

Pudendal neuralgia is a painful, neuropathic condition involving the dermatome of the pudendal nerve. This condition is not widely known and often goes unrecognized by many practitioners. Dr. Hibner runs The Arizona Center for Chronic Pelvic Pain (AZCCPP), a comprehensive center for treating chronic pelvic pain, and places a heavy emphasis on working as part of a care team with physical therapists and other pelvic rehab providers.

In this interview Dr. Hibner discusses how he treats pudendal neuralgia, “I treat patients with all reasons for pelvic pain but mostly pudendal neuralgia or patients with mesh injury or had an injury caused by pelvic mesh… I work very closely with physical therapists and I am a great, great believer in physical therapy. I am very happy that you are allowing me to share my perspective on Pudendal Neuralgia, and my perspective on physicians working with physical therapists.”

If I had pudendal neuralgia and I had a choice between surgery, injections, physical therapy, or medication. I would for sure have chosen physical therapy every time…there is no doubt in my mind. You can’t treat the PN without addressing the pelvic floor. What I tell patients is this. The number one thing for repetitive injury is to stop what you’re doing. The number two thing is to choose physical therapy over anything else. By far the majority of patients are helped by appropriate pelvic floor physical therapy.

Pudendal Dysfunction: The Physician's Perspective is scheduled for January 9, 2022. Course topics include pathoanatomy and clinical presentations, basics of surgical techniques, and terminology. The latter half of the course focuses on the physician and the rehab therapist working together and features case studies and clinical pearls from Dr. Hibner, a pioneer, and leader in the field.

In today's interview, Holly Tanner sits down with Stacey Futterman Tauriello, PT, MPT, WCS, BCB-PMD to discuss her approach to pelvic rehabilitation. Stacey received her Master’s Degree in Physical Therapy from Nova Southeastern University in South Florida in 1996. After graduation, she relocated to Chicago where she began specializing in women’s health issues including the treatment of incontinence, pelvic pain, and prenatal/postpartum musculoskeletal issues. She returned to the east coast in 2003 and is now the owner of 5 Point Physical Therapy, a specialty physical therapy clinic for male and female pelvic dysfunction in New York City.

Stacey will be instructing Pelvic Floor Level 2A on December 11-12, 2021 and Pelvic Floor Level 1 on January 22-23, 2022.

What clinical pearls do you have for practitioners working with labral tears?

Return to sport has to be discussed on day one. Figuring out what that path is. It's ok that it is slow, but the patient needs to understand that they are going to progress in a fashion to get them stronger and more stable.

You always have to have stability before you have mobility.

You need that background knowledge of getting them stronger without flaring up their pelvic floor symptoms. You have to release and restore, release and restore, release and restore. You got to understand the "why" component. Why are they having so much pain? What can you do to strengthen without flaring? I think that is huge.

What excites you about exercise approaches?

The first thing that got me excited was that I saw that I was doing a lot of things right. One of the biggest takeaways...was the neuromuscular reeducation portion of the exercise...That really task-specific brain reeducation with every exercise...I often think of neuro as Parkinson's. So a Parkinson's patient if you want them to walk and lift their leg (because they're shuffling), you would put something in front of them and say step over it.

Your daughter is 3 and a half years old now. How has going through pregnancy, birth, and postpartum changed your approach with pregnant and postpartum patients?

I did an interview in 2019 with the Today Show on postpartum motherhood and the pelvic floor, both from the patient and the practitioner's standpoint.

It's changed my perspective completely. From the process of getting pregnant, I was in my 40s, so I was an older mom, to being pregnant, having some issues during pregnancy. And then the actual delivery was...it's not great being a pelvic floor physical therapist trying to push a baby out of your vagina...but you have to go through it. Then you realize too that your postpartum experience is all about healing. As much as it's easy for somebody that's 21 to give birth and bounce back. A lot of the women who are having babies right now are in their 30s and 40s. Their bodies don't respond the same, especially not during covid. 

It's a game-changer right now, things are different. Yeah, I had incontinence after I gave birth, I still struggle. My body, within covid from not exercising and going to the gym and everything still takes a toll. I feel like it made me more empathetic to some of my pregnant patients.

Is there a clinical pearl or fun phrase that comes to mind that you use?

One of the big phrases that I use comes from Pam Downey, and it is "healthy tissue doesn't hurt."