September 8th is World Physical Therapy Day!
To celebrate, we wanted to do a little Q&A about pelvic floor physical therapy and what it’s like to be a pelvic floor physical therapist!
What is pelvic floor physical therapy?
In a nutshell pelvic floor physical therapy (PFPT) is the branch of physical therapy that is focused on conditions that relate to and include the pelvic floor. This includes, but is not limited to, urinary function, bowel function, pregnancy and postpartum, pelvic pain, and sexual function. What sets PFPT apart from other fields of physical therapy is that pelvic floor physical therapists are trained to perform internal pelvic floor muscle exams.
PFPT must be a new thing because most people haven’t heard of it, right?
Actually it’s been around for a while now. In 1977, Elizabeth Noble started the Section on Obstetrics and Gynecology as part of the American Physical Therapy Association (APTA). Its name would be changed to the Section on Women’s Health in 1995 and eventually to the Academy of Pelvic Health Physical Therapy in 2019. However, I still hear from patients at least two to three times a week that before they were referred to PFPT, they had never heard of it before!
What does it take to become a pelvic floor physical therapist?
First things first all pelvic floor physical therapists have to go to physical therapy school just like every other physical therapist. Physical therapy school is usually three years long (there are some accelerated programs that are two years). After successful graduation from physical therapy school, all physical therapists must take and pass the National Physical Therapy Exam (NPTE) which is a five-hour 250-question multiple choice test. At this point, if a physical therapist wants to become a pelvic floor therapist, they would also need to get specialized training in pelvic floor evaluation and about pelvic floor disorders. Many physical therapy schools have very little in their curriculum about pelvic health. I got three lectures on pelvic floor physical therapy in a special populations class and that was more than previous years, however in my year, pelvic floor anatomy had been taken out of the anatomy class. Like other physical therapists, pelvic floor physical therapists complete continuing education requirements, as dictated by their state physical therapy board to maintain their license.
If you are interested in getting into pelvic floor physical therapy, a pelvic floor level one class from either Herman and Wallace or the APTA Academy of Pelvic Health Physical Therapy are a good place to start. If you are looking to deepen your pelvic floor education, PHRC physical therapists have developed two different classes on management of complex pelvic health disorders.
Advanced Management of Complex Pelvic Pain Syndromes – After a five year break from traveling, lecturing, and teaching courses Liz and I are excited to announce that we are re-entering the classrooms! Many people who know us or follow us on social media know our work promoting pelvic floor physical therapy at medical conferences, my leadership role as the first physical therapist to be the President of the International Pelvic Pain Society, our book Pelvic Pain Explained, and our popular course, Demystifying Pudendal Neuralgia. We developed the course in 2006 and taught it over 40 times in four countries between then and 2014. Learn more on the linked blog.
Lj Powerhouse and Jandra Mueller of PHRC: IG Live Endometriosis Q&A – Q&A will accompanying IG Live linked into this blog
One-on-One Pelvic Floor Physical Therapy Mentoring – One-on-one mentorship is tailored to your exact needs, right now. Want to discuss one of your current complex pain patients that you’ve hit a plateau with? Need to discuss whether it makes sense to refer your patient to an interventional pain management specialist or back to their surgeon for a surgical consultation? Looking for tips on how to talk to a local physician colleague about suggesting a treatment for your patient? Whatever it is you need to discuss, we’re game. Whatever challenge you’re facing, chances are, we’ve been there too and have ideas for you on how to tackle it. Specializing in this field the last 20 years has taught us how to navigate many of those tough questions we so often get from our colleagues. Let us help you troubleshoot those complex patient cases and navigate the particular challenges we often face in our field.
Integrative Health & Nutrition Services – Find a detailed list of services and what entails a nutrition appointment in the linked blog
Why do you love being a pelvic floor physical therapist?
My favorite silly answer to this question is “because I get to talk about pee, poop, and sex all day!” My much more serious answer to this question is that I love being able to help people overcome often silent conditions that have huge impacts on their lives. It’s not uncommon that we are the first medical professionals that someone has told about what they have been going through or that knows how to help them. Also, the pelvis and the pelvic floor are, in my opinion, some of the most interesting structures in the body! For more information on what we treat here at PHRC, check out our services!
How do you tell people what you do?
When people ask me what kind of physical therapy I do, it’s usually an interesting moment for me. I usually have to make a decision about the person when I don’t know them very well: do I spring it on them or slowly draw them in? If I decide on the former I say “I’m a pelvic floor physical therapist!” and if it’s the latter I say “I’m a pelvic physical therapist.” Now, you might think there isn’t a big difference between those two, but having had this conversation many times I can tell you there’s a difference. Usually pelvic floor PT gets to the point quicker but if someone isn’t ready to hear that or about what we do, they will usually back out of the conversation pretty quickly and I’ve lost the chance to educate someone about our field, which I love doing! Now if I start by saying “pelvic physical therapist” the person will usually mistake that for a traditional ortho physical therapist who treats hip or back pain, which is fine! From there it’s just a slow reveal starting with talking about orthopedic PT a bit then casually slipping in something about how we also treat incontinence and postpartum issues. From there, if I’m sensing someone is interested, I’ll start talking about how we also treat bowel and pelvic pain before finally rounding it out with talking about sexual health conditions. Usually by the end of the conversation if all is going well, I have someone convinced that pelvic floor physical therapy is one of the most interesting medical professions they have never heard of before!
What’s a typical day like for a pelvic floor physical therapist and how is it different from any other physical therapist?
At PHRC we see patients for about an hour each once a week, so every day is a little different. If you are interested in what a typical session looks like, take a look at this blog post. Often people coming in to see us for the first time can be a little nervous. I like to break the ice with bad jokes, poop jokes, and dad humor. Usually once our patients realize that we’ve probably heard it all before, they realize we’re just people but with very different work problems and google search history. Here is a short list of weird work problems and google search queries I’ve had lately:
- Since the pandemic started, we’ve had to change the brand of gloves that we use because of supply limitations and when I put lubricant on the new gloves it tends to slip off which it didn’t with the old gloves. Like I said, very different work problems.
- Accidentally pumping lubricant onto my hands instead of hand sanitizer.
- Google search query: “anatomical term for butt crack” – Result: “intergluteal fold.”
Here are a few other unusual things about pelvic floor physical therapists. We’ve likely seen most of our colleagues with their pants off and vice versa. We are always training and learning new techniques so we practice on each other! Personally I think this helps us be able to relate to our patients, because we know the vulnerability of being the person on the table with only a thin paper drape.
Finally, what are some of the funny things pelvic floor physical therapists say?
When trying to get patients to perform a pelvic floor contraction:
- Pull in like you are zipping up a tight pair of jeans
- Nod the clitoris
- Wink the anus
- Pick up a marble with the vagina
- Pretend you are in a crowded elevator and you are trying not to pass gas.
When trying to helps patients learn how to relax their pelvic floor:
- Imagine a lotus blooming out of the vagina/anus
- Imagine a balloon inflating in your pelvis
- Relax your anus like you are letting out a fart
Miscellaneous funny utterances and thoughts of pelvic floor physical therapist:
- I wish I had a lubricant warmer
- I wish I had a headlamp to better see the vulvar skin
- Remember how you saw your boss without pants on your first day of work, that was funny!
- What was my “executive hole count” for the day? (when talking about my job to a friend, they actually asked me this question and I thought it was hilarious!)
- Are my fingernails short enough to make sure I don’t stab someone’s rectum?
Happy World Physical Therapy Day to everyone who provides or has benefited from physical therapy and especially pelvic floor physical therapy!
______________________________________________________________________________________________________________________________________
Are you unable to come see us in person? We offer virtual physical therapy appointments too!
Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.
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.
PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical therapist at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836.
Do you enjoy or blog and want more content from PHRC? Please head over to social media!
Like us on Facebook,
Subscribe to our YouTube Channel,
and follow us on Twitter, Instagram, Tik Tok and Pinterest!
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.