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.