Ashley Rawlins is a Dallas-based doctor of physical therapy (DPT) with advanced certification in pelvic health and obstetric health. She practices at Origin, leading provider of virtual and in-person physical therapy for women. Dr. Rawlins's areas of specialization include pelvic pain, sexual dysfunction, pregnancy-related pain, postpartum recovery, and bowel and bladder dysfunction. She is a passionate author and educator and enjoys creating educational materials and teaching classes for patients, students, and fellow physical therapists.

I may be biased, but pelvic health is arguably one of the most important specialties in physical therapy. It's well known that pelvic floor muscle dysfunction affects individuals across every age group, life stage, sex, and gender, and can contribute to pain and dysfunction in many other areas of the body. According to research, 23.7% of women have at least one pelvic floor disorder and this percentage only increases with age. (1) So, why aren’t more physical therapists specializing in pelvic health?

A cross-sectional survey completed in 2018 found that the biggest barriers to entering this specialty are “lack of awareness, mentorship, and continued education.” (2) An alarming 59% of physical therapists have received little to no information on pelvic health physical therapy when graduating from their entry-level program. (2)

If you’re a physical therapist reading this, you’ve probably received a peppering of instruction on topics including lymphedema, osteoporosis, pregnancy, and maybe urogenital dysfunction. When I was a student, I only had two lectures covering topics related to pelvic health, plus one afternoon dedicated to observation of the prosected female sex anatomy. Luckily, those lectures and that one afternoon were so fabulous, they got me hooked on this specialty, but it was hardly enough education, given the prevalence of pelvic floor dysfunction.

More awareness of and education on pelvic health is needed so that physical therapists can better care for their patients. At Origin, we’re helping to fill this need by supporting physical therapy students who are interested in pursuing a career in pelvic health, but who may not be able to get the required experience.

Pathways to Pelvic Physical Therapy

There isn’t one specific path to becoming a pelvic physical therapist. Some students will complete a post-professional residency in pelvic health. Some will independently take continuing education courses and pursue certifications or board certifications in pelvic health. Whichever path you take in getting the knowledge and hands-on skills that are critical for safely diagnosing and treating this patient population, one thing is true: It can be both expensive and nerve-wracking!

If you are lucky enough to get a pelvic health clinical rotation, you’ll likely need to complete an advanced training course on pelvic health first. This is so you’re familiar with examination and treatment frameworks. These courses are costly for students in physical therapy school and can make these opportunities an impossibility for those with fewer economic resources.

In addition to being expensive to prepare for, clinical rotations for pelvic health in physical therapy school are intimidating. Yes, it’s exciting to finally be out in the “real world” after being stuck in a classroom for months. But even if you’re didactically prepared, walking through the doors of a new clinic with little more than the name of your clinical instructor (CI) can be terrifying. My clinical rotations felt more like boot camp, at times — I was dropped into the waters of patient care and made to sink or swim, based on my CI’s rules. Looking back, I know this was really more of how it felt versus the reality, but I longed for a rotation that was collaborative and curated to improve my clinical competence.

Educating & Mentoring Students in the Clinical Setting

At Origin, we don’t want finances to be a barrier for those pursuing a career in pelvic health, nor do we want students to feel underprepared or unsupported. We value creating opportunities, providing education, and mentoring those wanting to enter this area of specialty. Much like the patient care standards at Origin, we have worked to create an elevated student clinical experience. Below are some of the ways that we are providing this education and experience in our pelvic health clinics.

Onboarding: We start each clinical rotation with thorough onboarding so every student feels prepared. Prior to the first day in the clinic, students get a Student Handbook which details everything they need to feel prepared in their clinical rotation, from what to wear, to information on our company’s values, mission, and policies. We also take the time to train students on our EMR system, billing practices, telehealth services, and our model of care.

Learning Modules Depending on the length of the clinical rotation, we have developed various training modules for each of the students to complete with their CI. Important topics related to orthopedic and pelvic health physical therapy include infection control, informed consent, internal and external pelvic floor muscle examination, as well as a thorough training on some of the more common conditions that we treat in our clinics—weekly student “check-ins” help to inform the curriculum organization and tailor each student’s experience.

Simulation Experiences: Taking a course in pelvic health in advance of the clinical will set students up for a more in-depth rotation in pelvic health, but if getting this training is a barrier to starting in pelvic health, we’ve developed simulation experiences for the student. Once the students have completed the appropriate learning modules, we pair students to practice on each other, or help in getting volunteer pelvic models. Additionally, skills labs, team Learning and Development meetings, and student in-service assignments help to reinforce concepts learned throughout the clinical rotation.

At Origin, part of our mission to expand access to healthcare includes expanding the community of knowledgeable and expert pelvic health physical therapists. We feel that by improving the student experience and initiating the path to specialization in pelvic health, we can proactively change the status quo of pelvic floor care.

References:

1. Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300(11):1311–1316. doi:10.1001/jama.300.11.1311.

2. Dockter M, Benson S, Zhang Y, Anderson C, Le D. Factors influencing physical therapists to enter into women's health specialty practice. Journal of Women's Health Physical Therapy. 2018; 42(3): 154-164. doi: 10.1097/JWH.0000000000000107.