By Elizabeth Akincilar, MSPT, Cofounder, PHRC Merrimack, Kim Buonomo, DPT, PHRC
Lexington, Molly Bachmann, DPT, PHRC San Francisco
The Pelvic Health and Rehabilitation Center recently returned from their second trip to Nairobi, Kenya to teach a pelvic health course to a second cohort of physical therapists. We taught the first cohort of physical therapists in February 2020 and unfortunately COVID delayed our return until October 2022. Several members of the PHRC staff have contributed to the development of the comprehensive curriculum in this course, including Jandra Mueller, DPT, Melinda Fontaine, DPT, Jillian Giannini, DPT, Kim Buonomo, DPT, Molly Bachmann, DPT, Shannon Pacella, DPT, Melissa Patrick, DPT, and Elizabeth Akincilar, MSPT. Elizabeth Akincilar, MSPT, Kim Buonomo, DPT, and Molly Bachmann, DPT had the privilege of traveling to Nairobi for the in-person portion of the course through the Jackson Clinics Foundation and the Kenya Medical Training College (KMTC) in Nairobi, Kenya. Liz, Molly and Kim spent the first week teaching the second cohort of students in class and the second week in the clinic serving as mentors.
The focus of our course is on the physical therapy management of pelvic pain, including male pelvic pain, and an introduction to pediatric pelvic health.
The program at KMTC was started approximately eight years ago by physical therapist Richard Jackson and the Jackson Clinics Foundation. Initially the program’s focus was to teach orthopedic manual therapy but shortly after they also began offering a neuro based program. In the spring of 2019 they offered the first women’s health program. This program consists of three, two week courses. PHRC was fortunate to be part of teaching the first cohort of physical therapists in this program. Pelvic health education for physical therapists in Africa is extremely limited. This program is the first of its kind in East Africa. The goal of all the programs the Jackson Clinics Foundation offers is for the KMTC faculty to eventually teach all of these specialty courses. The orthopedic program has transitioned to being entirely taught by KMTC physical therapists. This transition has begun for the Women’s Health program. We were excited to include students from the first Women’s Health cohort as Teaching Assistants in the second cohort of students.
When Richard Jackson presented this opportunity to PHRC in 2019 we immediately knew we wanted to be a part of this program. Educating the community and our fellow professionals is a primary tenet of PHRC’s Mission Statement. We’re grateful for the many opportunities we’ve been given over the years to participate in educational programs across the western world. To be given the opportunity to share our knowledge and skills with a professional community that has such limited resources to this type of education is especially exciting and meaningful.
This project is a significant undertaking and humanitarian effort. All instructor time, course materials, and supplies are donated. Donations can be made online at the Jackson Clinics Foundation and are tax deductible. Herman and Wallace Pelvic Rehab Institute has graciously agreed to support the women’s health program with curriculum and instructors.
From PHRC Cofounder Liz Akincilar:
Once again, this experience has affirmed my interest and commitment to this project. Returning for the second time, I had the unique opportunity to reconnect with many of the students in the first cohort as a mentor, seeing patients with them in the clinic. It was particularly enjoyable to see the first students of this program utilize the skills and knowledge they acquired and appropriately evaluate and treat pelvic health patients. I loved seeing their excitement and pride in their ability to educate and treat patients suffering with various pelvic complaints knowing that prior to this program coming to Kenya, this type of physical therapy treatment was not available anywhere in East Africa. Some of the students from the first cohort are even educating their physical therapy colleagues in Kenya and surrounding East African countries about pelvic health! I’m grateful to the Jackson Clinics Foundation for the opportunity to be involved in this project and immensely proud of the students who are now able to offer pelvic floor physical therapy within Kenya.
This project was successful, in large part, due to the time, knowledge, and commitment of our team. Many thanks to the PHRC staff who contributed to the curriculum and educational resources: Jandra Mueller, Melinda Fontaine, Jillian Giannini, Shannon Pacella, and Melissa Patrick. A very special thank you to my co-instructors, Kim Buonomo and Molly Bachmann, who were not only excellent instructors, but exemplary ambassadors for pelvic floor physical therapy, whom I was proud to teach alongside.
From PHRC San Francisco Molly Bachmann:
International travel has always been a part of my personal life. I love adventures, new cultural experiences, and connecting with the community wherever I can find it. I never dreamed that teaching, let alone an international teaching experience, would be a part of my professional journey. When Liz asked me to join her on the next trip to Kenya Medical Training College, it was a very easy “Yes!”
One of the most significant takeaways from this trip has been realizing just how desperate people all over the world are to know about their bodies (Including the United States). Having accurate health information is often lifesaving, and that includes accurate information about pelvic health. The physical therapists we worked with wasted no time sharing their enthusiasm for this information and passion for sharing with their patients and communities. Many had already begun to set up stands at markets, hold meetings with community leaders and arrange to speak at conferences. It was so inspiring to work with them.
Their courage to be the first to start this specialty in Kenya, trailblazing a new generation of PTs, was an incredible thing to bear witness to. It has renewed my spirit in ways I didn’t know needed to be renewed. Our interactions and sessions reminded me of the value of community centered care and culturally sensitive healthcare. These kinds of models are needed to have a complete biopsychosocial approach and this is something that they do well. I have learned so much from them.
Asante sana to Kenya Medical Training College for welcoming us into your home, shepherding new friendships and for your openness in embarrassing this specialty. Your generosity will never be forgotten.
From PHRC Lexington Kim Buonomo:
This has been truly one of the greatest experiences of my life, and is the highlight of my career thus far. Before this, I’d never traveled outside of North America. It was a privilege to know I am playing a role in bringing needed pelvic health information to East Africa and it was transformative from a personal standpoint to participate in the Kenyan cultural experience.
I am honored to have been given this opportunity, and I was thrilled to share this experience with my incredible colleagues Liz and Molly and the amazing Kenyan PTs who we worked with. I was consistently impressed with the students’ commitment, insightfulness, and openness when learning material that was so new to them, especially since this material can often be difficult to discuss. Seeing the students grow and develop as pelvic health providers was truly a privilege.
One special memory from the trip was when one of the students and I treated a patient, who said that her constipation had tremendously improved after her first visit with the student. The patient’s entire family exuberantly expressed their gratitude, going so far as to request a picture with us. When they left, the student smiled so widely, hugged me, and thanked me for teaching her how to help the patient. The student really helped that patient, and she deserves the pride and confidence that comes from knowing she had a role in improving someone’s quality of life. That joy is why I work in this field, and it is infectious! It was empowering to relive how I felt in the moments of helping my first pelvic patients and to see her experience that joy. It is humbling to see so tangibly the impact that this project makes in lives across the world and I’m proud that I was able to take part in it.
I’m grateful to the Jackson Clinics Foundation for spearheading this project and to PHRC for allowing me the opportunity to take part in it. I’m especially grateful to Liz and Molly who are the best co-instructors I could have wished for, and to the students that I got to know, teach, become friends with, and learn from on the trip.
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Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.
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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.