Stephanie & Liz
Next week, the Pelvic Health and Rehabilitation Center will turn NINE. In 2006, Liz and I wanted to be more involved in the field than our current work situation permitted. So, we quit our jobs, hoped we could pay our mortgages and started the Pelvic Health and Rehabilitation Center. We wanted to provide the highest quality of care to our patients, form better relationships with the local medical community, raise awareness about pelvic floor disorders, and teach courses. Initially, PHRC consisted of just Liz and me, no staff. As we got busier and began to hire administrative staff and physical therapists, we realized our next and equally important goal was to create a work environment where our employees would never be treated as poorly as we were previously. As we all know, managing pelvic floor disorders is hard on the people recovering from it and for those of us trying to help. We began hiring motivated, compassionate, independent, fun people. Nine years later, PHRC is now a company: 5 clinics, 15 employees, uncountable courses, lectures, textbook chapters, and soon a book. Liz and I are grateful to have the team and company culture that we wanted, so this week we all answered a few questions about the day-to day inner workings of PHRC.
Every team member of PHRC works closely with each other, but their duties are different depending on if they have administrative responsibilities or therapeutic responsibilities.
Our administrative staff is essential to our operations, ensuring that the day-to-day flows smoothly, helping with social media and marketing outreach, and being the face of PHRC.
Allison & Casie
What do you like about working at PHRC?
Sara: My favorite thing about working at PHRC is being able to help people every day! Whether I’m helping patients by answering questions and scheduling appointments or helping the PTs manage their schedules, I’m always excited to help.Learning is one of my passions and I enjoy working at PHRC because I learn something new everyday.
Jenni: I truly enjoy helping people and I think that PHRC helps many people though direct patient care and through advocacy. I like the collaborative spirit at PHRC. I truly learn something new everyday.
Gabriella: I get to be a part of PHRC’s collaborative efforts to help people, educate, and increase awareness about pelvic pain. Most importantly, I get to witness women and men being empowered everyday as they take control of their health and their lives.
Connie: I like the fact when I wake up in the morning I get to work with a great group of people. I really look forward to coming to work.Becoming part of PHRC has been a great experience not only do I get to be a part of a great group but we all work together to help improve the quality of life for so many people, to see the look on peoples face when they come in & when they are D/C is amazing.
Our physical therapists are some of the best in the world. Their endless dedication to their patients shows in every aspect of their demeanor and care. All of the PHRC physical therapists recognized in one way or another that there was a gap to fill in the field of pelvic floor physical therapy. Here is some more insight into their drive to be pelvic floor physical therapists.
Liz, Rachel, Malinda, Casie, & Stephanie
What do you like about working at PHRC?
Allison: I love the team mentality. We have meetings every week that give us an opportunity to bounce questions/ideas off of each other and ensure that we are able to give the best care possible.
Melinda: I enjoy everyone’s commitment to learning, critical thinking, and staying up to date.
Stephanie: I love the collaborative atmosphere at PHRC. Every person working here is committed to their job, to helping each other, our colleagues, and our patients. From a clinical perspective, I enjoy helping people who think they will never get better, I am from NJ after all and welcome this challenge. It is amazing to watch people regain their lives and to transition from the nervous new ‘patient’ in the waiting room to the healthy person that they were before they developed a pelvic floor disorder.
Rachel: I love how supportive everyone is and that I am always learning something new everyday!
Casie: I love knowing that I work with a group of the most talented clinicians who truly care about getting their patients better. I feel lucky that by working here my access to so many invaluable resources is within such close reach.
Elizabeth: I am grateful for the collaborative environment with caring, smart, and engaged therapists. Being able to talk through a very complex patient with pelvic pain with 7 other therapists is irreplaceable. Our administrative staff is simply the best of the best. Barely a day goes by that one of my patients do not comment on the knowledge, empathy, and responsiveness of our admin staff. Without them none of us would be able to do our job well.
Malinda: The minute I met Liz and Steph, I knew I wanted to work for PHRC. I wanted to be a part of a supportive team with weekly staff meetings, journal club, awesome administrative staff, and a common goal to help people with pelvic pain. I tell people I feel very fortunate to love my job and the people I work with.
Melinda
What inspired you to get started in pelvic floor physical therapy?
Allison: I actually heard about it from my gynecologist. I was having some pelvic floor issues myself and when she referred me to physical therapy I was like-I think this is something I can help other people with.
Melinda Fontaine: I heard an alumni talk about it when I was in PT school, and I liked the idea that I could help with really basic life functions, like peeing, pooping, and having babies.
Stephanie Prendergast: I worked in orthopedics my first year out of physical therapy school. I hated it. I either quit or was fired from 6 jobs within one year. I answered a job ad in the SF Chronicle (a NEWSPAPER!): Pelvic Floor PT wanted. Will train. When I heard that people, who were my age, could not sit down, wear tight pants, have sex, I knew I had to work in this field.
Rachel Gelman: There were two PTs who did pelvic floor at my first full time rotation in PT school. I thought it seemed cool, so I googled it and found PHRC! I contacted Liz and Steph and after spending a day here observing I knew this was what I wanted to do!
Casie Danenhauer: I’ve had my fair share of pelvic floor issues and had the opportunity to become a patient and shadow a therapist while I was in physical therapy school. I was lucky enough to have an elective course where we did our first internal exam and it was then that I realized what an incredible opportunity I had to help people on such basic quality of life issues.
Elizabeth Akinicilar: My desire to stop treating straight orthopedic patients and get into a specialty where I could really develop my manual skills in an environment I felt I could actually make a difference in peoples’ lives.
Malinda Wright: In my last year of PT school, the instructor responsible for placing students in clinical placement wanted to place me in a 2nd round of respiratory therapy. I baulked at this, because in the US we have respiratory therapist and I really wanted to learn about pelvic health. Fortunately, she placed me in a hospital treating women’s health and my interest in this field bloomed. I have never looked back.
Allison and Gabriella
How do you explain to people what you do?
Malinda Wright: I tell people I’m a physical therapist and I specialize in the pelvis. Most people mistakenly think I’m talking about the hips. I typically correct people and say I specialize in urinary, bowel, and sexual dysfunction as well as pain and prenatal/postpartum impairments. I also mention that I treat both men and women with these dysfunctions. Majority of the time people will ask me to explain what urinary, bowel, and sexual impairments are. When I explain, I always explain both sexs’ symptoms. I think it’s important for the public to realize men can have these symptoms too.
Melinda Fontaine: At a social gathering, I like to throw out that I’m a pelvic floor PT to see the reaction. People are either caught off-guard or totally interested in it. When someone asks me what that means, I usually say it’s mostly about the four P’s: Pee, Poop, Pregnancy, and Pain.
Rachel Gelman: My best friend and boyfriend call me the vagina whisperer, but I typically tell people I am a pelvic floor physical therapist and that I treat men and women with pelvic floor dysfunction, which can be pelvic pain, pain with sex, urinary or bowel dysfunction. This is usually followed by looks of confusion and lots of questions and usually ends up with me having to be blunt and say I work on the pelvic muscles internally via the vagina or the rectum
Casie Danenhauer: Two ways- either they drop the topic completely or have A LOT more questions. I try to use telling people about what I do as an educational opportunity because so many people aren’t even aware of what the pelvic floor is, even if they have dysfunction themselves! The conversation usually ends with, “Ya, so I basically have my finger in a vagina or a rectum for at least 50% of my day…”
Stephanie: I tell them that my degree is in physical therapy and I describe the symptoms: burning vaginal pain, UTI and yeast infection like symptoms constantly and in the absence of infection, post-ejaculatory pain, penile pain, inability to sit and wear pants. There is always confusion and often a later conversation because they themselves or someone they know may ‘have something that sounds like that’. I tell people the therapists at PHRC are Masters of Pelvic Disaster and direct them to the right office.
Buddy Cruiser & Abbie
What is your favorite tip to give your patients?
Allison: Sit on the toilet (even in public restrooms).
Malinda: Most of the world squats to poop, but Americans insist on pooping in toilets. Get a Squatty Potty. And stop peeing just in case.
Stephanie: Pee squatting in the shower. It makes the first void of the day less painful.
Rachel: Bowel mechanics and to look at your vagina!! That kegels are not always the answer and to decrease the amount of time you sit, the human body was meant to stand/move!
Casie: Breathe and indulge in self-care!
Elizabeth: Don’t hover above the toilet seat!!!!
Melinda: How to sit properly on the toilet with a squatty potty, and that Dr. Google is not always right.
Casie, Stephanie, & Sara
What advice do you have for patients?
Allison: Try to stay in a healthy mental space.
Melinda: You are your own best advocate. Stay informed. Ask questions.
Stephanie: You can and will get better, because you will. 15 years of experience has taught me that more often than not, certain treatment plans fail and need to be reworked. This can happen over the course of one treatment or several, but there is ALWAYS another option if something is not working or you cannot tolerate it. Stay committed and patient and know that you are not broken if something is not helping right away. Use your local medical providers to help you figure out what will help you.Do not be afraid of medications, when used properly medication can be a therapeutic part of the treatment process. Online forums are often scary and not reflective of the true landscape of healing from pelvic pain. Watch John Oliver. Humor helps everything.
Casie: Know that you are not alone. It can feel very isolating to have pelvic floor dysfunction because it’s not talked about in our society, but there are a lot of people out there with issues similar to yours.
Malinda: Stay informed and write your questions down so you don’t forget them when you walk into the provider’s office.
Elizabeth: Remain hopeful that your medical team will help you reach your goals.
Connie & Malinda
What advice do you have for other pelvic floor PTs?
Allison: Take continuing education classes to build a strong network and community with your peers.
Rachel: Take classes and join any journal clubs/social networks to be able to stay current on the research and discuss cases. Having another set of eyes to look at a case can help you recognize something that you didn’t consider in treating a patient. Plus, this work can be mentally challenging so it is helpful to have a support network of providers who can relate to you.
Casie: Be open to incorporating as many “schools of thought” as you can into your approach for treating patients. For me a strong focus on the mind -body connection feels very important, but I also always have research articles to support what I’m doing from a more scientific perspective.
Malinda: Build a support network to bounce treatment ideas off of and to discuss more difficult cases.
Elizabeth: Work in a practice with other pelvic floor specialists who can mentor you. Make an effort to learn as much as possible about all the medical interventions related to pelvic pain, even if they are not within your scope of practice. Think of yourself as a colleague within the multidisciplinary team and nothing less.
Stephanie: When first starting treatment with a new patient, people do not always tolerate or immediately respond treatments. Think critically to troubleshoot through this. Promise that if you cannot help your patient you will help them find someone who will.
We hope this gave you a glimpse into our company as a whole. We are honored to have helped many people on their journey to wellness and we look forward to helping many more people the upcoming years! To learn more about our team, please visit our PHRC team page.
Kindest Regards,
The PHRC Team
Jenni & Nez
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.
Comments
After having PT done w Stephanie and her staff I can say from experience that you are all awesome!
Diane
Hello Diane,
Thank-you for your kind words!
All my best,
Stephanie
I live in Louisiana and have been trying everything I know to heal after two years. Have read all the best books and love your site. Is it possible for me to come to your clinic?
Hello Marion,
Please contact our office for more information. (781) 577-6648.
Regards,
The PHRC Team.
The staff at PHRC gave me my life back…cliche, I know…but absolute truth! I had a pudendal nerve injury that kept me from sitting for almost 2 years. I traveled from Houston to PHRC in San Francisco as much as I could for about 3 years for treatment and took what I learned from each visit with the staff home where I continued working on myself daily with my husband’s help. The physical treatments were vital, but the emotional support and positive reinforcement telling me that I would get well was invaluable! I am well and back to a normal life. My body and nerve remind me every so often that I need some touch-up work, but I would not be here without Stephanie, Liz, and the team! Let not your heart be troubled when they tell you the healing will take time…it does…some days feeling like the pain will never end….but healing happens! This team knows what they are talking about, and I trust them in all aspects of their profession and treatments! Hugs to you all!
Hello Natalie,
Thank-you so much for your kind words! Helping patients is the reason we love what we do. Best wishes!
Regards,
The PHRC team
Even though I did not use your rehab group, it was through reading your letters and articles that led me to find a local rehab clinic that could help with my CPPS. Thanks for giving me the hope and courage to seek out help and make my life pain free for the first time in decades. Thank You!
Hello Wilburn,
Thank-you for your kind words! Offering encouragement and hope is very important to us, and it is the reason why we strive to offer the best care/information possible. We wish you continued success!
Warmly,
The PHRC Team
i have had trouble having bms since I had a sacral colpopexy in 1998 for pelvic floor descent,cystocyle and rectocele.Was seen at Cleveland Clinic and told that I had an elongated rectum ,advised to use an enema daily.Last 6 months it has been difficult to evacuate even with enema.Have to squeeze back of colon and push up on perineum to empty.Got a squats potty,not much help.After researching think I have some type of outlet constipation as the stool is right inside the anus but won’t come out.I think that I need a pelvic floor PT,do you know of any in WV or any other advice?Wish that I had found you earlier.
Hello Aileen,
We currently do not have a therapist recommendation for WV, but we are located in Waltham, MA. Please contact our office for more information. (781) 577-6648
Regards,
Elizabeth