Sarah Hughes PT, DPT, OCS, CF - L2 has been a practicing physical therapist since 2007 and opened her private practice Arrow Physical Therapy in 2016. She now owns and operates Arrow remotely while residing in the Chicago area and practicing at Outlier Physical Therapy. Her specialties include dance medicine, the CrossFit and weightlifting athlete, and conditions of the hip and pelvis such as femoroacetabular impingement and labral tears. Dr. Hughes earned a BS in exercise science from Gonzaga University and a DPT from the University of Washington, she wrote and instructs Weightlifting and Functional Fitness Athletes.

Modifying exercise, particularly CrossFit and weightlifting exercises, when pregnant is critical to reducing your risk for injury. It’s hard to do for sure. We all want to maintain our fitness and remain competitive. But, the priority during and after pregnancy is the safety and health of both baby and the birthing person.

Remember, just because you aren’t in pain or you are still capable of performing in the way you did pre-pregnancy, you may be doing yourself a disservice by setting yourself up for problems down the line, or at the very least some bad habits as you change your technique with various movements.

Of course, we are not discouraging exercise. In fact, please continue to exercise!! But, just use your best judgment and consider the ways in which you might modify your workouts during your pregnancy.

---

Below are modification examples:

MODIFY OLYMPIC LIFTS:

• Start at the “hang” positions: Modify the lifts by starting from the hang position when the belly increases in size, as this makes it harder to lower the barbell to the ground.
• Finish in the “power” position: Often pregnant people don’t feel comfortable catching in the squat position. You can still work these barbell movements by catching in power positions.
• Forego the barbell: Finally, when the size of the pregnant belly starts to change the bar path (ie. you are swinging that weight way out in front to avoid hitting your bump), consider switching to dumbbells or kettlebells for the Olympic lifts. An improper bar path leads to bad habits and can cause injury.

MODIFY OTHER STRENGTHENING LIFTS:
The biggest thing to note here is that there is no reason to be doing max efforts when you are pregnant. You are probably not going to be setting any records and the cost/benefit may not end up being worth it. However, that is not to say you shouldn’t be lifting, or even lifting heavy. Just be sure that you are managing your breathing and not creating too much pressure with these lifts. You need to be exhaling as you exert effort so as to avoid bearing down into the pelvic floor and abdominals.

A few specific notes:

• when it comes to moving weight overhead, be sure that you are not over-arching your back and instead keeping the weight manageable so that you can maintain the best form.
• if squatting feels vulnerable because the bottom of the position feels weak, you can squat to a box to limit the range of motion. You will still be able to strengthen while protecting your body from an unstable position.
• when deadlifting, really think about dialing weight back in order to avoid using a bearing down Valsava maneuver.

MODIFY KIPPING MOVEMENTS:
Pregnant or postpartum people may experience a “separation” of the abs which we call a diastasis recti. Diastasis recti is caused by a stretching of the linea alba, the tissue that connects the left and right halves of the rectus abdominis muscle. This is a very common condition caused by the growing uterus expanding against the abdominal muscles.

This can happen naturally, just by nature of the abdomen growing. However, if you have a weak core wall or are not properly engaging it during a kipping motion, you might be making the condition worse. It’s not necessarily that you aren’t skilled enough to do the movement, but rather that your core is stretched out (thanks baby!) and the muscles are unable to contract appropriately after a certain point. By continuing to kip when this is the case, you are risking over-stretching your core wall.

• Kipping motions include: pulls up, muscle-ups, toe-to-bars, knees to elbows & knee raises.
• Modify by doing strict motions (band them as needed).
• Pull-ups can be further modified with ring rows.
• Toes-to-bar and knees-to-elbow can take a back seat. Perform Russian swings with a kettlebell if you want a metabolic stimulus and planks if you want a core stimulus.
• The ability to kip will return. You aren’t losing out on anything.

MODIFY MUSCLE UPS:
Muscle Ups: same as above. Let’s stay strict and no Valsalva maneuver. You want to avoid pressure bearing down on the pelvic floor.

If these modifications are out of reach, you can practice muscle-up transitions from your toes or using a band. You can also modify with jumping muscle-ups (stick to the ring as you won’t want your belly to hit that bar).

MODIFY PLANKS AND HOLLOW HOLDS:
If you cannot feel your abs engaging, chances are that they aren’t. You can try side planks perhaps or planks on an elevated surface. At some point, you might just cut them out of your program.

MODIFY BURPEES:
Step out to a plank and back up. You can also do an incline push-up using a bench, plates or boxes. If you are adding a jump over a barbell or other apparatus consider stepping over to avoid a potential fall and to minimize the impact through the pelvis. If burpees lead to incontinence or an “urge sensation”, modify.

A quick guide to common movement substitutions:

• Kipping Pull-Up = controlled kipping without pull-up, strict pull-up, or ring row.
• Kettlebell Swing = may modify to single arm swing for comfort on the back swing, may modify to Russian swing.
• Deadlift = sumo or kettlebell deadlifts may be more comfortable.
• Sit Ups = plank, pallof press, slam ball, side plank, hanging knee raise.
• Bench Press = press, push up (elevated as necessary).
• Handstand Push Up = modified pike on box or floor, dumbbell or barbell press/push press.
• Box Jump = lower box at first, and then step up.
• Snatch/Clean =hang power versions, then dumbbells as necessary once the belly is in the way. Can perform the power version of the movement and then squat under control. Moderate load deadlifts are also a great sub.
• Jump Rope/Running = as far as your level of comfort allows. Rowing is a good sub. Kettlebell swings and/or slam ball for a similar metabolic effect.
• Thrusters/Wall Ball = controlled squat and presses either with a barbell or dumbbells.
• Push Ups/Burpees = on a raised surface like a box, parallettes or a bar in a squat rack.

Of course, there are many many other modifications and these are not meant to be medical advice. Talk to your physical therapist or coach and listen to your body!

Sarah Hughes' original article can be found on the Arrow Physical Therapy website at https://www.arrowptseattle.com/news/crossfitmodificationsforpregnancy.

---

Weightlifting and Functional Fitness Athletes - October 14, 2023
Price: $295
Experience Level: Beginner
Contact Hours: 9

Description: When it comes to Crossfit and Weightlifting, opinions are divided among Physical Therapists and other clinicians. Why is it that these sports cause such strong differences among rehab professionals? In this half-day, remote continuing education course, instructor Sarah Haran PT, DPT, OCS, CF-L2 looks at the realities and myths related to Crossfit and high-level weight-lifting with the goal of answering “How can we meet these athletes where they are in order to keep them healthy, happy and performing in the sport they love?" This course will review the history and style of Crossfit exercise and Weightlifting, as well as examine the role that therapists must play for these athletes. Common orthopedic issues presented to the clinic will be examined. However, while things like urinary function, pregnancy and postpartum, hip impingement, LBP/pelvic pain, prolapse, and diastasis will be touched on, this will not be a course in addressing pelvic health concerns in these athletes. These topics will be more fully addressed in the course: Pregnancy and Postpartum Considerations for High-Intensity Athletics with Emily McElrath.

Labs will introduce and practice the movements of Crossfit and Weightlifting, discussing the points of performance for each movement. The practitioner will not only learn how to speak the language of the athlete but will experience what the movement feels like so that they may help their client to break it down into its components for a sport-specific rehab progression. The goal of this course is to provide a realistic breakdown of what these athletes are doing on a daily basis and to help remove the stigma that this type of exercise is bad for our patients. It will be important to examine the holes in training for these athletes as well as where we are lacking as therapists in our ability to help these individuals. We will also discuss mindset and culture issues such as the use of exercise gear (i.e. straps or a weightlifting belt), body image, and the concept of "lifestyle fitness". Finally, we will discuss marketing our practices to these patients.

The message below is written by HW Senior Faculty Member Jennafer Vandevegte and Elizabeth Akincilar, the Co-Program Directors of the Pelvic Health Physical Therapy Program.
 

 
I am writing to introduce an exciting new initiative that will create scholarship opportunities for Kenyan physical therapists pursuing a degree specializing in pelvic health physical therapy.
 
The Jackson Clinics Foundation was formed in 2012 to fund educational efforts in East Africa. To date, the foundation has sent over 100 faculty members from their clinics and from around the country to teach in East and Central Africa. Some of the best and brightest physical therapists in the United States have volunteered their time to travel to Africa to teach these students and upgrade their education.
 
In 2019 the Pelvic Health Physical Therapy program in Kenya was launched by the Jackson Clinics Foundation and the Kenya Medical Training College with educational content and instructor support from the Herman and Wallace Pelvic Rehabilitation Institute and Pelvic Health and Rehabilitation Center. As you may be aware, pelvic health issues have become increasingly common in Kenya, with millions of people suffering from conditions like urinary incontinence, pelvic organ prolapse, and sexual dysfunction secondary to untreated medical conditions such as vaginal fistulas and the deleterious effects of female genital mutilation and prostate cancer. Unfortunately, there is a lack of trained professionals in this field to provide the necessary care and treatment to those affected. In fact, this program trained the first group of pelvic health physical therapists in all of East Africa.
 
Due to the enormous success of the initial Pelvic Health Physical Therapy program and the growing need for specialized physical therapists, The Jackson Clinics Foundation has created a two-year degree specializing in Pelvic Health. This program will become available to Kenyan physical therapists in 2024. This advanced degree will provide extensive training in assessing and treating various pelvic health conditions for adults and children. Additionally, graduates of this program will also learn how to teach their medical colleagues about pelvic health issues, bringing much-needed attention to the grossly untreated pelvic health conditions in East and Sub-Saharan Africa.

The tuition costs for this program are the primary obstacle preventing therapists from pursuing this advanced degree; therefore, we have established the Pelvic Health Physical Therapy Scholarship Fund. The fund will provide financial assistance to physical therapists in Kenya who are interested in pursuing their specialized training in Pelvic Health.
 
The scholarship fund seeks to raise $36,000 over the next year. We would be honored if you could contribute any amount towards this goal. Your tax-deductible contribution will go directly to the scholarship fund and will be used exclusively for pelvic health program scholarships.
 
Please visit our website to donate to this fund. Click on the dropdown menu to select Pelvic Heath. We appreciate any support you can offer us.
 
Thank you for considering this request. The infrastructure is in place, and the programs are ever-expanding and improving. These initiatives have one purpose: To improve human lives. We function under one premise, "Teach One - Treat Many." Together, we can create a healthier and more vibrant future for Kenyan communities.
 
 
Sincerely,
 
Elizabeth Akincilar                                                      Jennafer Vandevegte
Co-Program Director                                                  Co-Program Director

 

---

The Herman & Wallace Pelvic Floor Series and the Pregnancy and Postpartum Series course content will comprise the two-year degree and are being adapted for this audience by Senior H&W faculty member Jennafer Vande Vegte, Program Co-Director along with Elizabeth Akincilar. This degree will also include information from other contributors, including H&W faculty members Dawn Sandalcidi (on Pediatrics) and Ramona Horton (on visceral mobilization). 

If you would like to learn more about this program, Jennafer and Elizabeth will be at HWConnect 2023, where a booth will be devoted to fundraising and spreading information about this incredible opportunity to bring pelvic rehab education to a greater audience across the globe. 

 

Jennafer Vande Vegte, MSPT, BCB-PMD, PRPC began her career as a physical therapist at Spectrum Health in Grand Rapids, MI. Since 2002 Jen has focused her professional attention on treating women, men, and children with pelvic health disorders. She has been faculty for Herman and Wallace Pelvic Rehabilitation Institute since 2009 and loves to inspire other rehab professionals treating pelvic floor dysfunction. She is an author of the chapter, “Manual Therapy for the Pelvic Floor” which was published in the book, “Healing in Urology.” Jen was a contributing writer for the Pelvic Floor Capstone curriculum and also co-authored the continuing education course, “Boundaries, Self-Care and Meditation” with Nari Clemons. 

 

Do you ever feel like you put more care into treating your patients than do for themselves?

Do you often have patients reaching out to you via phone or email outside of their appointment times?

Do you feel alternatively burdened by patient care/documentation and proud of the way you give 100% to your work?

Do you often give your all to your patients and come home depleted and even grumpy with the people you love?

As rehab professionals, we had to work really hard, and strive even, to get really good grades in high school and college to be accepted into our rigorous and demanding training programs.  We developed strong work ethics and were praised for our success.  During those years, self-care may not have been a priority.  Maybe we were single, childless with significantly fewer responsibilities.  We could put the pedal to the proverbial metal and keep on going. 

Did anyone in school teach us about energy preservation?  Offer up the idea that if we continued to work that hard, and give that much it would lead to job DISsatisfaction, compromise our relationships and our health and lead to burnout. 

Probably NOT.

So we kept working and striving in our jobs, even though now our LIVES were getting more complicated.  Maybe we found a life partner.  Perhaps we bought a home.  We found pets to care for.  Maybe we had children.  And we found ourselves utterly exhausted. 

If this story sounds familiar to you, Nari Clemons and I would love to invite you to a different way to practice.  A different way to live.  We designed our class “Boundaries, Self-Care and Meditation” for YOU to find joy in work-life balance.  To love what you do, but leave work with energy for all the things you love OUTSIDE of work. 

Using a shared responsibility model, you will gain skills in allowing patients to own the responsibility for their recovery.  You will illuminate where you are losing energy and develop the skillfulness to shift.  Meditation and mindfulness will become a means to a healthier, more balanced nervous system for yourself as well as for your patients. 

In short, this class can be LIFE-CHANGING.  For both you and your relationships with your patients and the people in your life. 

We invite you into a new way.  Come join us this fall.

---

Boundaries, Self-Care, and Meditation Part 1 - September 9, 2023
Price: $400

Experience Level: Beginner
Contact Hours: 12.5

Description: This course is a two-part series intended to be completed in order. Participants should register for Part 1 and Part 2 at the same time, or complete Part 1 and wait to complete Part 2 at a later date. This course was developed by Nari Clemons, PT, PRPC, and Jennafer Vande Vegte, PT, PRPC, and was "born out of our own personal and professional struggles and our journey to having a life and a practice that we love and can sustain." The intention of this class is deep, personal, and professional transformation through evidence-based information and practices.

The instructors recommend completing this series in two parts to allow time to process and implement one leg of the journey before undertaking the next. Both Part One and Part Two have a significant amount of pre-work to digest and practice before meeting via Zoom. Please plan for up to 12 hours of pre-course work. This sets the stage for you to find your path to experiencing more joy, energy, and balance.

In Part One. participants begin their process of study, meditation, and self-reflection in the weeks prior to the start of the class. Pre-work includes a focus on the neuroscience of pain, trauma, PTSD, and meditation. Participants will learn about the powerful influence both negative and positive experiences have on our nervous system’s structure and function. Personal meditation practice and instruction will create changes in the participant's own nervous system. Participants will also learn how to prescribe meditation for various patient personalities and needs, as well as analyze yourself through inventories on coping, self-care, empathy, burnout, and values as well as track how you spend your time. Commitment to pre-work will facilitate rich discussion as we put what you have learned into practice around building a shared responsibility model of patient care, language to support difficult patients, and both visualizing and planning steps to create new, healthier patterns in your life and in your practice.

 

Boundaries, Self-Care, and Meditation Part 2 - November 4, 2023
Price: $400

Experience Level: Beginner
Contact Hours: 13

Description: This course is a two-part series intended to be completed in order. Participants should register for Part 1 and Part 2 at the same time, or complete Part 1 and wait to complete Part 2 at a later date. This course was developed by Nari Clemons, PT, PRPC, and Jennafer Vande Vegte, PT, PRPC, and was "born out of our own personal and professional struggles and our journey to having a life and a practice that we love and can sustain." The intention of this class is deep, personal and professional transformation through evidence-based information and practices.

The instructors recommend completing this series in two parts to allow time to process and implement one leg of the journey before undertaking the next. Both Part One and Part Two have a significant amount of pre-work to digest and practice before meeting via Zoom. Per the instructors "This sets the stage for you to find your path to experiencing more joy, energy, and balance."

Part Two continues the focus on personal and professional growth for the participant, with a deeper dive into meditation and self-care practices. Yoga is introduced as a means of mindful movement and energy balance. Participants will learn to identify unhealthy relational patterns in patients and others and skills on how to use language and boundaries to create shifts that keep the clinician grounded and prevent excessive energic and emotional disruptions. There is a lecture on using essential oils for self-care and possibly patient care. Learning new strategies to preserve energy, wellness, and passion while practicing appropriate self-care and boundaries will lead to helpful relationships with complex patients. This course also includes a discussion of energetic relationships with others as well as the concept of a "Higher Power". Discussion will also include refining life purpose, mission, and joy potential, unique to the individual participant. The goal is that the participating clinician will walk away from this experience equipped with strategies to address both oneself and one's patients with a mind, body, and spirit approach. 

Mora Pluchino is instructing her new course, Pediatric Pelvic Floor Play Skills, which is scheduled to debut on October 22, 2023. This short course is targeted to pelvic health providers looking for specific “child-oriented” treatment techniques for pediatric pelvic health patients. This class will cover some basic challenges and changes for a new or experienced pelvic health provider entering the realm of treating pediatric patients with pelvic floor diagnoses. Pediatric Pelvic Floor Play Skills is intervention focused and does not delve into specific pediatric diagnoses.

 

As an only child, I have lived my life working to be surrounded by children. From the age of 11 when I could take the Red Cross’s babysitter training, I worked as a mother’s helper, babysitter, and nanny. I never even had a “real” job until beginning my career as a physical therapist in 2009. Before I entered the world of treating pelvic floors, I was a physical therapist who spent the beginning years of my career caring for mostly pediatric and neurological patients. I was in charge of a pediatric program and helped with their specialty programs for kids including cardiopulmonary, feeding, and robotics.

I got brave and jumped into pelvic floor treatment in 2016 and have never looked back.

Because I had so much “kid” experience both personally and clinically, I quickly took Dawn Sandalcidi’s course Pediatric Incontinence and Pelvic Floor Dysfunction (now called Pediatrics Level 1 - Treatment of Bowel and Bladder Disorders). I started treating these kiddos and realized that being a pediatric therapist and being a pelvic floor therapist can feel like two completely different “hats.” I would have internal conversations like “I want to teach this child to bear down, but they’re two years old and on the autism spectrum and cannot even tolerate sitting on a toilet - what do I do?”

Having a pediatric background and skills made me feel like I had tools in my toolbox to create ideas to address my plan of care. I found my colleagues who did not have as much pediatric experience really struggled with taking the pelvic floor skills they had and applying them to working with children in the clinic.

Here is an example of calls I get from fellow pelvic floor practitioners…

“A 5-year-old child presenting with bedwetting, stool staining, and daytime urinary urgency. Limited food choices - eats mac and cheese, grilled cheese, quesadillas, chicken nuggets, hot dogs, and goldfish - no veggies, fruit choices - bananas and strawberries only. The child does not drink water but will drink juice, Coke, and chocolate milk. The child does not like sports and prefers to read and watch TV. The child avoids sitting on the toilet for BMs and complains they are painful. Parents are willing to try anything but don’t know where to start. The child is very motivated to please caregivers and loves stickers and watching YouTube videos of cute cats. On assessment, the child has a weak core, poor sitting posture without back support, and has trouble bearing down when asked.”

The therapist and I talked about how these symptoms all screamed “pediatric constipation” with a little bit of core weakness and poor pelvic floor coordination mixed in. She knew what would happen with an adult. She knew that increasing fiber and water intake as well as activity were all great lifestyle changes to start. She mentions that utilizing a squatty potty and regular toilet sits are also indicated. But HOW do you get a 5-year-old to do these things? How do you teach parents to implement these changes? How do you make these changes easy and peaceful for busy parents and potentially resistant children?

 In the case of this kiddo, we created the following plan:

1. Referral for feeding therapy to address problem feeding - SOS Program with an OT at local children’s hospital with reinforcement and collaboration from a PF therapist.
2. Spoke to the pediatrician about dietary changes including using higher fiber options of preferred foods and eliminating foods that are bladder irritants or known to be constipating.
3. Pelvic floor therapy working on core and pelvic floor coordination with functional play utilizing the child’s preferences.
4. Review of HEP with family including ILU massage, time voiding (created a child-friendly routine), and implementation of a reward system for child’s compliance with the program.
5. Daily check-ins with family to make sure they and their child are able to stay compliant with the prescribed changes.

If you are looking at this plan thinking “BUT HOW” this may be a great class for you. Pediatric Pelvic Floor Play Skills is an intervention-focused one-day remote class is targeted to pelvic health provider looking for specific and “child-oriented” treatment techniques for the pediatric pelvic health patient (it does not delve into specific pediatric diagnoses). This class will cover some basic challenges and changes for a new or experienced pelvic health provider entering the realm of treating pediatric patients with pelvic floor diagnoses.

The course goal is to review topics related uniquely to treating the pediatric population and then review treatment skills for different age groups. Get ready to learn basic pediatric care topics such as postural, developmental, feeding, and behavioral considerations. The labs will include both observational and interactive lab experiences designed to teach ANY therapist multiple treatment and play techniques to incorporate into their pediatric practice. The in-person aspect of this course involves movement and play, so be ready to observe and then practice some kid-friendly activities.

 

---

 

Pediatric Pelvic Floor Play Skills

Course Dates: October 22

Price: $275
Experience Level: Beginner
Contact Hours: 10

Description: This one-day remote continuing education class is targeted to any pelvic health provider looking for specific and “child oriented” treatment techniques for the pediatric pelvic health patient. This class will cover some basic challenges/ changes for a new or experienced pelvic health provider entering the realm of treating pediatric patients with pelvic floor diagnoses. This class is intervention focused and does not delve into specific pediatric diagnoses.

This course will begin with a combination of lectures on basic pediatric care topics such as postural, developmental, feeding, and behavioral considerations. The labs will include both observational and interactive lab experiences designed to teach ANY therapist multiple treatment and play techniques to incorporate into their pediatric practice. The in-person aspect of this course involves movement and play, so please plan your space and clothing accordingly.

This course will be instructed by Mora Pluchino, PT, DPT, PRPC who is a physical therapist with experience in both pelvic health, pediatrics, and pediatric pelvic health. This class is designed for a clinician who has already taken pelvic floor education including Pelvic Floor Level 1 and/or Pediatrics Level 1 -Treatment of Bowel and Bladder Disorders or something equivalent and is looking for play oriented treatment ideas.

 

Caitlin Smigelski, PT, DPT is a pelvic floor physical therapist in Portland, OR. She focuses in the treatment of bowel and bladder dysfunction and complex pelvic pain and specializes in transgender health and the treatment of patients who are pregnant or postpartum. Caitlin values active treatment approaches and teaching individuals ways to manage and improve their symptoms. She is active with the Academy of Pelvic Health Physical Therapy and serves on the CAPP-OB committee and is also a member of the World Professional Association for Transgender Health (WPATH). Caitlin and Sandi Gallagher traveled to Argentina to present at the 2018 WPATH Symposium on Physical Therapy in People Undergoing Vaginoplasty. 

 

As Pride Month comes to an end, it’s important to reflect on how healthcare providers can promote a safe and inclusive environment for all patients. Members of the transgender community face discrimination and increased barriers to accessing healthcare. According to a 2022 survey by the Kaiser Family Foundation of transgender adults

• ●     38% report it is somewhat or very difficult to find a healthcare provider who treats them with dignity and respect.
• ●     47% report healthcare providers know “not too much” or “nothing at all” about providing care to trans people
• ●     31% report having to teach a provider
• ●     29% have been asked unnecessary or invasive questions by a healthcare provider

Healthcare providers need to improve the care it provides the transgender community. By being an active ally in your clinic, you can facilitate positive change. Active allyship is when a person with privilege and power supports people who are marginalized. It requires more than just solidarity, but taking action. Below are just a few steps you can take to improve the experience of a transgender person in your clinic.

1. Pronouns:

○      Share your pronouns verbally, on your ID badge, bio, business card etc. This normalizes the act of sharing one’s pronouns and creates a safer space for all.

○      Ask all of your patients for their pronouns via an intake form or during the interview.

○      Never assume someone's gender identity based on their appearance, and don't hesitate to ask individuals for their pronouns.

○      Correct coworkers if they misgender a patient, even when the patient is not present.

1. Gender-neutral language:

○      Edit intake forms for inclusivity. Ask about sex assigned at birth, gender identity and pronouns followed by a blank space for the patient to fill in.

○      Avoid gendered language in the clinic such as guys and ladies and gentlemen. Instead use terms like folks, y’all, people, everyone etc.

○      Only use gendered terms like Sir, Ma’am, Mr. and Ms. once someone has shared their gender and pronouns.

○      Don’t assume the relationship or gender of a person who comes with your patient to an appointment

1. Bathrooms:

○      If your facility has single stall bathrooms, make them gender-neutral.

○      If a single-user restroom is not an option, post signs and have a written policy that supports people to use the bathroom that matches their gender identity.

1. Policies and Statements

○      Use your voice to advocate for inclusive policies within your healthcare institution. Encourage the adoption of policies that protect transgender patients from discrimination, such as:

■      the availability of gender-neutral bathrooms

■      gender-affirming documentation processes

■      non-discriminations policies inclusive to transgender individuals

■      publishing statements supporting health care for transgender people and youth

■      staff trainings

○      Encourage your professional organization to publish a statement in support of transgender healthcare. Many professional organizations have already issued statements, including the AMA, AAP, ACOG, ANA, ACNM, and WHO.

○      Learn about laws and policies affecting transgender people where you live. When discriminatory and harmful laws are present, call or email your representative or sign a petition to support positive change.

1. Educate yourself and your coworkers

○      A key step towards becoming an active ally is to educate yourself about transgender identities, experiences, and healthcare needs. Understanding the unique challenges faced by transgender individuals will enable you to provide compassionate and informed support.

○      Read books, articles, and research papers written by transgender authors or experts in the field. 

○      Take a course specific to rehabilitation. Herman and Wallace offers two remote courses: Transgender Patients: Pelvic Health and Orthopedic Considerations (17 contact hours) and Inclusive Care for Gender and Sexual Minorities (15.5 contact hours)

○      Learn from online resources. A few examples include the National LGBTQIA+ Health Education Center through the Fenway Institute, the World Professional Association for Transgender Health, the University of California San Francisco Gender Affirming Health Program, and the National Center for Transgender Equality

○      Share key information with all clinic staff including those in non-clinical roles

By cultivating a welcoming and inclusive environment, advocating for policy changes, and seeking new learning opportunities, you can make a significant difference in the lives of transgender people by helping to create a healthcare system that is truly inclusive and affirming for all.

---

Transgender Patients: Pelvic Health and Orthopedic Considerations

Price: $500.00          Experience Level: Beginner          Contact Hours: 17 hours

Course Dates:  August 19

Description: This course is appropriate for any physical rehabilitation professional, regardless of their specialty area, who has an interest in better serving people who are gender diverse. There is specific content aimed at teaching pelvic health therapists how to expand their skills for working with people of all gender identities. There will be particular education regarding gender-affirming genital surgeries as well as a discussion of other gender-affirming surgeries and medical interventions that people transitioning might choose.

Often times therapists think of genital surgeries and sexual function when contemplating work with transgender people. Therapists have far more to offer transgender patients. For providing optimal care, knowledge of the intricacies of gender transition is essential. We provide that overview in this course. Topics covered include:

• Societal influence on gender transition including interactions with healthcare providers
• Recognizing the difference between sex, sexuality, and gender
• Understand the complexities of the legal system for the person transitioning gender
• Tips and tools for a trauma-informed intake and examination
• Health effects of hormones for gender transition as related to differential diagnosis in rehabilitation
• Supporting healing after gender-affirming surgery
• Operative procedures for face and chest
• Operative procedures for masculinizing and feminizing genital surgery
• Pre-operative evaluation, treatment, and education issues
• Post-operative evaluation, treatment, education and follow-up for genital surgeries
• Outcome measures with rehab focus for people undergoing gender-affirming surgeries
• Fertility and pregnancy in gender-diverse people.

Faculty member Christine Stewart, PT, CMPT began her career specializing in orthopedics and manual therapy and became interested in women’s health after the birth of her second child. Christine joined Olathe Health in 2010 to further focus on women’s health and obtain her CMPT from the North American Institute of Manual Therapy. She also went through Diane Lee's integrated systems model in 2018. Her course, Menopause Transitions and Pelvic Rehab is designed for the clinician that wants to understand the multitude of changes that are experienced in the menopause transition and how they affect the aging process.

  

What was your motivation for creating this course?
As I was entering my mid-40s, I started to experience some physiological symptoms that were a bit unnerving.  My sleep was inconsistent.  My menstrual cycle which used to be every 35 days now was every 21 – and it changed. It lasted longer and was much heavier than before.  I also started to experience heart palpitations.  I sought out care from my primary care doctor, who ran labs and referred me to a cardiologist.  I was placed on a halter monitor and underwent a cardiac ultrasound.  The tests all came back..... normal.  But I didn’t feel normal.  What was happening with my body and why didn’t any of the health professionals that I consulted seem to have any answers?  That was where my journey began.  I started reading and researching.  What I soon learned was that these symptoms, while bothersome and a little unnerving, were common.  They often begin as the ovary is changing in its ability to produce hormones.  I learned there are ways to manage symptoms through lifestyle choices and treatments that can help in a stage of life that can last for over 20 years.  I then started to listen, really listen, to what my patients were telling me about their bodies.  I had answers for them about what they were experiencing and could offer some solutions and referrals to the appropriate healthcare providers.  While they were all very grateful, I kept hearing the same frustrations. Why don’t more healthcare providers know about perimenopause and menopause?  Why am I being told that I must live with my symptoms?  Why aren’t more providers well-versed in treatment options?  That was my “aha” moment.  If more healthcare providers knew about these changes and the symptoms that manifest as a result, hundreds if not thousands of patients could get the care that they need.  I wrote Menopausal Transitions and Pelvic Rehab in an effort to bridge the gap in knowledge that currently exists for many of the health care providers treating this patient population.  It is a culmination of hours of research into hormones, physiology, health impacts, and treatment options during this time.

Who do you think should take this class?
I truly believe all providers can benefit from taking this course! Nearly 50% of the population can spend most of their lifespan in perimenopause and menopause.  Gaining a thorough understanding of this phase of life allows providers to educate and lead their patients down a path of more successful aging. They need this information and are eager to learn!   In addition, the knowledge gained about lifestyle modifications can be extrapolated to all patients treated daily, not just those in the menopausal transition. 

What is your go-to resource for questions about menopause?
One of the most exciting things to see is how the paradigm regarding menopause is changing.  There are books, Instagram influencers, Facebook groups, and featured stories appearing in mainstream media.  The dialogue surrounding menopause seems to be shifting in a positive way which is great!  However, misinformation and false narratives are still being propagated.  My resource for the most accurate information is the North American Menopause Society. It is a great site for finding efficacy with treatment options and for debunking much of the fear and myths about menopause.

What has been some of your favorite feedback from participants?
I love to hear about how participants have gained an understanding of their own symptoms and what is happening in their bodies.  Getting feedback that they have learned treatment strategies in this course that they will implement in their own lives as well as in the lives of their patients is so exciting. Knowing that clinicians are educating their patients and co-workers on this transition is so meaningful.  It thrills me to know the message is going forward!

---

Menopause Transitions and Pelvic Rehab

Price: $475.00          Experience Level: Beginner          Contact Hours: 16.75 hours

Course Dates:  August 27-28 and November 11-12

Description: This two-day course is designed for the clinician that wants to understand the multitude of changes that are experienced in the menopause transition and how they affect the aging process. According to the North American Menopausal Society, by the year 2025, 1.5 billion people will be in menopause worldwide. Despite the large population in this transition, health care providers are often unsure of how to treat patients experiencing menopause (Kling 2019). 

As clinicians, this is an excellent opportunity to understand the physiological consequences to the body as hormones decline, in order to assist our patients in lifestyle habits for successful aging. Topics will include cardiovascular changes, metabolic syndrome, bone loss and sarcopenia, neurological changes (headache, brain fog, sleeplessness), Alzheimer’s risk, and urogenital changes. Symptoms and treatment options will also be discussed, including hormone replacement, non-hormonal options, dietary choices and exercise considerations. Upon completion of this course, participants will have a basic understanding of the hormonal changes during menopause, the impact on various health systems and interventions that can assist with improving this transition.

Kate Bailey, PT, DPT, MS owns a private practice in Seattle that focuses on pelvic health for all genders and ages and works under a trauma-informed model where patient self-advocacy and embodiment are a priority. In addition to being a physical therapist, I’ve been teaching Pilates for nearly 20 years and yoga for over 10. Kate’s course, Restorative Yoga for Physical Therapists, combines live discussions and labs with pre-recorded lectures and practices that will be the basis for experiencing and integrating restorative yoga into physical therapy practice. Kate brings over 15 years of teaching movement experience to her physical therapy practice with specialties in Pilates and yoga with a focus on alignment and embodiment.

 

Stress is a primary topic of conversation in all domains of our lives. Are we getting the right nutrition and exercises? Are we “balancing” our lives well? How are we attempting to stave off burnout whether we are a clinician or a patient? The stress of having medical needs, particularly when they are complex can be overwhelming: multiple appointments to juggle with education from a wide variety of medical perspectives (hopefully aligning relatively well), and then just trying to keep up with normal adulting responsibilities. If you are a clinician the idea of burnout and being drained emotionally is likely a familiar one. 

When thinking about stress and overwhelm, there are a plethora of physiological consequences ranging from small, workable symptoms to severe mental and physical outcomes. In this blog we’ll look at cognition from two studies: one that looked at those experiencing breast cancer related cognitive impairment and a second looking at third year medical student wellbeing. 

Cognition can be separated into two domains: Fluid intelligence and crystallized intelligence. 

Fluid intelligence is the ability to process new information and solve novel problems in real time. Think about having to come up with questions for your doctor when managing medications, or simply learning what that medication does and what possible side effects to watch out for. Fluid intelligence is the domain in which we learn new precautions after a surgical procedure or learn about what to do if in a pain flare. Fluid intelligence includes learning, problem solving and comprehension. 

Crystallized intelligence is the ability to use knowledge that was previously acquired through education and experience. This is how we use past experience to inform decision making. How we start at entry level education and then build on that with continuing education. Its how people who have dealt with chronic illness or pain can approach new medical issues in perhaps a more adaptable manner. 

In a study by Deng et al. fluid and crystallized intelligence changes were studied using two different kinds of yoga as the catalyst. Restorative yoga compared to Vinyasa yoga, said another way, a restful practice versus a vigorous practice. The restorative group had no improvements in crystallized cognition. But they did have statistically significant improvements in fluid cognitions with effect sizes growing from participants being in the 42nd percentile to the 55th percentile among the general population after 24 weeks of practice. The change in ability to learn, comprehend and problem solve whilst working through cancer related cognitive impairment is incredibly important. The vinyasa group had no statistically significant changes in fluid cognition, but did have improvements in crystallized cognition. Thus depending on which cognitive domain is troubling the patient more, you can offer a bit of support in that decision making process. 

While much of the continuing education offered to clinicians is in regards to how to become more skillful for your patients, we also need support for clinicians to ensure their own wellbeing. This can come in the form of boundaries, support groups, mental health counseling, etc. It can also come in the form of establishing a simple weekly practice of restorative yoga. In a study by Adesanya et al, 3rd year medical students were offered a 45 minute restorative class once a week for 6 weeks. This is the time in a medical student’s life where a primary focus on didactics transitions into clinical care. With this practice, once a week, medical students reported improved wellbeing marked by increased relaxation and reduced stress related to decision making. It was also noted that the efficiency of the practice was more feasible for the clinical life of having to decide how to spend one’s time outside of work. While restorative yoga is not a substitute for aerobic, strength and mobility training, it is imperative to see the cognitive benefits of this practice and how that might improve our decision making in the domains of our selfceare (nutrition, exercise, sleep), as well as our mental and relational health (friendships, partnerships, colleagues). 

Resources:

1. Deng, G., Bao, T., Ryan, E. L., Benusis, L., Hogan, P., Li, Q. S., Dries, A., Konner, J., Ahles, T. A., & Mao, J. J. (2022). Effects of Vigorous Versus Restorative Yoga Practice on Objective Cognition Functions in Sedentary Breast and Ovarian Cancer Survivors: A Randomized Controlled Pilot Trial. Integrative Cancer Therapies, 21, 153473542210892. https://doi.org/10.1177/15347354221089221
2. ‌Adesanya, O., Thompson, C., Meller, J., Naqvi, M., & TetyanaL Vasylyeva. (2023). Restorative yoga therapy for third-year medical students in pediatrics rotation: Working to improve medical student well-being. 12(1), 76–76. https://doi.org/10.4103/jehp.jehp_1027_22

---

Restorative Yoga for Physical Therapists

Price: $275.00          Experience Level: Beginner          Contact Hours: 10.75 hours

Course Dates:  August 12, 2023

Description: This course is an online course that combines live Zoom discussions and labs, pre-recorded lectures, and pre-recorded practices that will be the basis for experiencing and integrating restorative yoga into physical therapy practice.

It is well known that stress is an important contributor to overall quality of life, chronic pain, and disease risk. Our society’s focus on high productivity and achievement often creates chronic fatigue and reduced ability to regulate our nervous systems. Sleep may be the only time a person actually rests during the day. For those who have survived trauma, even sleep is not restful. And so we stay in a state of stress that is difficult to manage.

Restorative yoga is an accessible practice that can teach patients (and practitioners) how to rest systematically, for short periods of time, on a regular basis to encourage the parasympathetic nervous system to balance with the sympathetic nervous system for improved neuroregulation. We will also talk about the difference between meditation and restorative yoga, and how they can support each other in order to support the ability to drop into relaxation.

Designed for the virtual classroom, the lectures are pre-recorded for viewing at convenience. A set of restorative postures, each taking 20-30 minutes are offered prior to the live meetings so that participants can experience what a patient might experience when restorative yoga is a component of their home program. We will then discuss participant experiences, questions and strategize how to reduce barriers to relaxation so that patients can integrate this practice into their lifestyle. There will also be live labs for breathing techniques and specific meditations that may be helpful to patients working with an unregulated nervous system.

Ziya “Z” Altug, PT, DPT, MS, OCS, is instructing his course, Integrative and Lifestyle Medicine Toolbox, scheduled for July 29. This remote course covers a toolbox approach for creating clinically relevant pain, anxiety, depression, and stress management strategies using lifestyle medicine, integrative medicine, expressive and art-based therapies, and nature-based therapies.

Ziya is a Board-Certified Orthopedic Clinical Specialist and a Doctor of Physical Therapy with 32 years of experience treating musculoskeletal conditions. He utilizes lifestyle and integrative medicine strategies in his clinical practice. Ziya is the author of Integrative Healing: Developing Wellness in the Mind and Body (Cedar Fort, Inc, 2018). He has been a longstanding member of the American Physical Therapy Association for the past 29 years and a member of the American College of Lifestyle Medicine since 2017. He is finishing the book Lifestyle Medicine Toolbox (Jessica Kingsley Publishers, London) for publication in early 2024.

Ziya's book Lifestyle Medicine Toolbox is available for pre-order on Amazon!

According to the ACSM’s Guidelines for Exercise Testing and Prescription (American College of Sports Medicine 2022) book from the American College of Sports Medicine, “exercise programs that incorporate individual tailoring, supervision, stretching, and strengthening, coupled with client preference and practitioner expertise, are associated with the best outcomes.”

The American College of Lifestyle Medicine defines lifestyle medicine as (American College of Lifestyle Medicine 2023), “Lifestyle medicine is the use of evidence-based lifestyle therapeutic approaches including:

• • a whole food, plant-based eating pattern
  • regular physical activity
  • restorative sleep
  • stress management
  • avoidance of risky substances
  • positive social connection

as a primary therapeutic modality, delivered by clinicians trained and certified in this specialty, to prevent, treat, and often reverse chronic disease.”

Lifestyle medicine may play a role in managing chronic low back pain (Altug, 2021). For example, a retrospective longitudinal study by Roberts and colleagues (2022) found that “people who adopt optimal lifestyle behaviors and positive emotional factors are more likely to be resilient and maintain high levels of function despite suffering from low back pain.” Furthermore, a study by Williams and colleagues (2019) in the European Journal of Pain found that a healthy lifestyle intervention consisting of weight loss, physical activity, and diet may be cost-effective compared to usual care for managing chronic low back pain. Moreover, a cohort study by Bohman and colleagues (2014) found that healthy lifestyle behaviors appear to decrease the risk of back pain among women.

Case Study Patient Description:

The patient is a 50-year-old female referred to physical therapy by her family physician:

• • Primary Complaints: Gradual onset of back pain 2-8/10
  • Secondary Complaints: Shortness of breath with stairclimbing at home and fatigue with walking greater than 20 minutes
  • Past Medical History: Osteopenia, prediabetes, overweight
  • Pain History: Progressive back pain for the past 6 months with no known cause
  • Pain Aggravating Factors: Sitting greater than 30 minutes, walking greater than 15 minutes, bending to clean and refill the cat food dish
  • Pain Easing Factors: Resting in a reclining chair, self-massage to the back
  • Medications: Ibuprofen, as needed
  • Prior Therapy: None
  • Work History: Accountant for a large company. Performs mainly seated computer-related tasks. The patient has a one-hour commute to work in each direction.
  • Social History: She lives in a two-level home with her husband and two children. She volunteers at a community center on Saturdays.
  • Exercise History: No formal program
  • Lifestyle History: No smoking or alcohol use. The patient has difficulty sleeping greater than 5 hours secondary to work-related stress and long commute.

Interventions:

After a comprehensive assessment, a physical therapist treated the patient in the clinic and provided her with the following home program guidelines:

• • Exercise Program: Since the patient has a long commute, she did not have time to exercise after work. The patient was encouraged to initiate a short-bout outdoor walking program at work. She performed 10 minutes of walking in the morning upon arrival at work, 10 minutes of walking during lunch, and 10 minutes of walking as she returned to her car at the end of her workday. The therapist also instructed the patient in simple core stabilization exercises she could perform at her office.
  • Office Program: The patient was advised to stand and perform several stretches for one minute every 30 to 45 minutes. The patient also spoke to her supervisor and switched to remote work from her home twice weekly.
  • Sleep Hygiene Program: The patient was issued sleep hygiene guidelines to help improve sleep. She was instructed in a mindfulness meditation routine to be performed before bedtime.
  • Stress Management: Since the patient was saving four hours of commute time per week due to two days of remote work, she applied this time to work in her garden during the week and on the weekend. She found gardening and being in nature helped reduce her stress and improve her sleep.

In addition to the formal home program, the physical therapist encouraged the patient to consider creating a small home gym and take a cooking class at a local community college on the weekend to further establish sustainable, healthful habits.

Conclusion:

After three months of following her home program instructions, the patient’s back pain decreased to 0-2/10 with activities of daily living, her body weight was reduced by 10 pounds, and she no longer had shortness of breath with stairclimbing and fatigue with walking. This case shows that simple and cost-effective clinical recommendations using the lifestyle medicine approach may effectively help treat back pain.

References:

1. Altug Z. Lifestyle medicine for chronic lower back pain: an evidence-based approach. Am J Lifestyle Med. 2021;15(4):425-433.
2. American College of Lifestyle Medicine. Available at: https://lifestylemedicine.org. Accessed May 2023.
3. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription, 11^th ed. Philadelphia, PA: Wolters Kluwer; 2022.
4. Bohman T, Alfredsson L, Jensen I, Hallqvist J, Vingård E, Skillgate E. Does a healthy lifestyle behaviour influence the prognosis of low back pain among men and women in a general population? A population-based cohort study. BMJ Open. 2014;4(12):e005713. 
5. Roberts KE, Beckenkamp PR, Ferreira ML, et al. Positive lifestyle behaviours and emotional health factors are associated with low back pain resilience. Eur Spine J. 2022;31(12):3616-3626.
6. Williams A, van Dongen JM, Kamper SJ, et al. Economic evaluation of a healthy lifestyle intervention for chronic low back pain: A randomized controlled trial. Eur J Pain. 2019;23(3):621-634.

Further Readings:

1. Arippa F, Nguyen A, Pau M, Harris-Adamson C. Postural strategies among office workers during a prolonged sitting bout. Appl Ergon. 2022;102:103723.
2. Jakicic JM, Kraus WE, Powell KE, et al. Association between bout duration of physical activity and health: a systematic review. Med Sci Sports Exerc. 2019;51(6):1213-1219.
3. Madjd A, Taylor MA, Delavari A, Malekzadeh R, Macdonald IA, Farshchi HR. Effect of a long bout versus short bouts of walking on weight loss during a weight-loss diet: a randomized trial. Obesity (Silver Spring). 2019;27(4):551-558.
4. Menardo E, Di Marco D, Ramos S, et al. Nature and mindfulness to cope with work-related stress: a narrative review.Int J Environ Res Public Health. 2022;19(10):5948.
5. Rusch HL, Rosario M, Levison LM, et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019;1445(1):5-16.

---

 Integrative and Lifestyle Medicine Toolbox

Price: $125.00          Experience Level: Beginner          Contact Hours: 4.5 hours

Course Dates:  July 29, 2023

Description:  Brief lectures will focus on the research and resources and labs will cover a toolbox approach for creating clinically relevant pain, anxiety, depression, and stress management strategies using lifestyle medicine, integrative medicine, expressive and art-based therapies, and the impact of nature on health. Participants will be able to practice Tai Chi/Qigong, expressive and art-based therapies including Music, Dance, and Drama Therapy, nature and aromatic therapies, self-hypnosis, and self-massage.

This course was written and developed by Ziya “Z” Altug, PT, DPT, MS, OCS, a board-certified doctor of physical therapy with 32 years of experience in treating musculoskeletal conditions. Ziya utilizes lifestyle and integrative medicine strategies in his clinical practice. He is the author of the book Lifestyle Medicine Toolbox from Jessica Kingsley Publishers (London: United Kingdom, 2024). Ziya Altug is a member of the American Physical Therapy Association and the American College of Lifestyle Medicine. He has taken workshops in yoga, Pilates, tai chi, qigong, meditation, Feldenkrais Method, and the Alexander Technique.

Tara Sullivan, PT, DPT, PRPC, WCS, IF has specialized exclusively in pelvic floor dysfunction treating bowel, bladder, sexual dysfunctions, and pelvic pain since 2012. Alyson N. Lowrey, PT, DPT, OCS became involved with pelvic rehabilitation through working in a clinic with Tara and is a board-certified orthopedic specialist and primarily works with the ortho patient population. Tara brought along the pelvic floor population to the clinic where she and Alyson joined forces. Alyson, with her ortho perspective, is better able to recognize that in some of her orthopedic patients, a lot of their pain was coming from the pelvic floor. The pelvic pain patient population crosses over from physical therapy to the orthopedic and occupational therapy worlds. By treating their patients wholistically Tara and Alyson have been able to make a huge difference to both of their practices.

 

How do you explain pain to a patient?

 This is the question that Tara Sullivan, PT, DPT, PRPC, WCS, IF, and Alyson N Lowrey, PT, DPT, OCS address in their new course Pain Science for the Chronic Pelvic Pain Population. By focusing specifically on the topic of pain science in their new course, Tara and Alyson delve into the true physiology of pain including the topics of central and peripheral sensitization. Pelvic specialists that can benefit from this course are those whose patients have chronic pelvic pain including endometriosis, interstitial cystitis, irritable bowel syndrome, vaginismus, vestibulodynia, primary dysmenorrhea, and prostatitis. The biggest thing is to learn how to recognize if there is a sensitization component to your patient’s pain.

 

Pain is in the Brain

Acute pain can indicate specific injury to the body. Chronic pain is very different. With Chronic Pelvic Pain (CPP) the initial injury has healed, but the pain continues because of changes in the nervous system, muscles, and tissues. Recognizing that the nervous system influences pain perception, especially in the chronic pelvic pain population, is the first step in treating these patients, but is it enough? The chronic pain population is often dismissed or misled that they have something drastically wrong with them, or worse, nothing wrong with them at all. Alyson and Tara share that “this population often has the most functional deficits and the worst clinical outcomes. We want to change that.”

The medical definition of pain is an unpleasant feeling that is conveyed to the brain by sensory neurons. Pain is a universal experience that serves to alert the brain to potential damage to the body. It performs the function of triggering avoidance to preserve itself from harm. Oddly, the strength and unpleasantness of pain are not directly related to the nature or extent of the damage. 

When the pain signal remains active in the nervous system for longer than six months and persists after the triggering event has healed, then it is cataloged as chronic pain. There is another layer when experiencing chronic pain known as central sensitization. This is an increased responsiveness of the nervous system that results in hypersensitivity and an increased pain response outside the area of injury. Pain itself can produce systematic and chemical brain changes resulting in more pain from fewer stimuli.

Pain Science for the Chronic Pelvic Pain Population offers tools to recognize when sensitization may be playing a role and provides the framework needed to apply pain science to the chronic pelvic pain population. In this course, you will gain an understanding and expand your knowledge on how pain science specifically presents in patients suffering from endometriosis, interstitial cystitis, primary dysmenorrhea, pelvic floor muscle overactivity, vulvodynia/vestibulodynia, vaginismus, and prostatitis. 

Case studies and specific intervention techniques, including how to explain pain to a patient, are discussed so participants leave with the confidence to address the missing link in treating your patient’s chronic pelvic pain. We will also discuss how common rehab interventions such as manual therapy, dry needling, biofeedback, graded exposure, and therapeutic exercise assist in downregulating the nervous system.

Alyson shares that being able to recognize chronic pain in the patient is huge, that this is “not your regular patient who has a peripheral injury and we just need to rehab them through that process. It’s a whole different ballgame when we’ve got our nervous system in a hypersensitive state.” She continues, “a huge part of the treatment is educating your patient about pain and trying to decrease the fear around movement…and how we use our words to decrease fear is huge.” This course also discusses how to desensitize the nervous system through dry needling, diaphragmatic breathing, sleep hygiene, and bowel and bladder retraining.

 

---

Pain Science for the Chronic Pelvic Pain Population

Price: $400.00          Experience Level: Beginner          Contact Hours: 12 hours

This remote course is designed for the pelvic rehab specialist who wants to expand their knowledge, experience, and treatment in understanding and applying pain science to the chronic pelvic pain population including endometriosis, interstitial cystitis, irritable bowel syndrome, vaginismus, vestibulodynia, primary dysmenorrhea, and prostatitis. This course provides a thorough introduction to pain science concepts including classifications of pain mechanisms, peripheral pain generators, peripheral sensitization, and central sensitization in listed chronic pelvic pain conditions; as well as treatment strategies including therapeutic pain neuroscience education, therapeutic alliance, and the current rehab interventions' influence on central sensitization. This evidence-based course will provide the rehab professional with the understanding and tools needed to identify and treat patients with chronic pelvic pain from a pain science perspective.

Lecture topics include the history of pain, pain physiology, central and peripheral sensitization, sensitization in chronic pelvic pain conditions, therapeutic alliance, pain science and trauma-informed care, therapeutic pain neuroscience education, the influence of rehab interventions on the CNS, and specific case examples for sensitization in CPP.

Course Dates:  July 22-23

---

Allison Ariail, PT, DPT, CLT-LAANA, BCB-PMD is one of the creators of the Herman & Wallace Oncology of the Pelvic Floor Course Series. Allison Ariail is a physical therapist who started working in oncology in 2007 when she became certified as a lymphatic therapist. She worked with breast cancer, lymphedema patients, head and neck cancer patients, and the overall oncology team to work with the whole patient to help them get better. When writing these courses, Allison was part of a knowledgeable team that included Amy Sides and Nicole Dugan among others.

June is National Cancer Survivor Month. When individuals talk about “survivorship,” they are referring to the process of navigating their life experiences and the difficulties that they have as a result of their cancer diagnosis. Survivorship begins at the time of diagnosis and includes those individuals that are undergoing treatment, those after treatment with no signs of cancer, those undergoing extended treatment to control the cancer, those undergoing extended treatment to reduce the risk of the return of cancer, and those individuals with advanced cancer. According to cancer.net, there were 18 million people in the United States living with a history of cancer.¹ Considering the number of people surviving cancer, and the degree of medical treatment can vary for each of them, there will be a wide range of needs from cancer survivors.  Rehabilitation professionals are in a unique position where we can help patients in many different ways to help improve their function, ability to participate in activities that they enjoy and improve their quality of life. 

There are multiple studies that show how rehabilitation can help cancer survivors. The research varies in its focus; it could be examining specific side effects such as chemotherapy-induced peripheral neuropathy, looking at the effects of fatigue after treatment, or to sexual health after cancer diagnoses. In January of this year, a study came out that showed a physical rehabilitation program of moderate intensity promoted a relief of general and physical fatigue.² This is huge for cancer patients! Fatigue is an immense problem that survivors suffer from. Another study from 2019 showed that a 12-week exercise-based training program can negate some of the deficits that occur in strength and physical function that occur from the medical treatment of cancer.³ The exercise program, which included both aerobic and resistance training, helped both middle-aged and older adults improve their physical function and strength. In 2018 Dennet et al performed a qualitative study of cancer survivors’ experiences of an exercise-based rehabilitation program. They determined that an exercise-based cancer rehabilitation program was important in facilitating a ‘return to normal’ and helped patients increase their ability to participate in physical activities.⁴ 

We as clinicians should embrace this research and work to get these patients referred to us for rehab! As we can see from the above research, this is a population that could greatly use rehabilitation, yet they may not be getting the referrals they need. In 2022, Thorsen et al surveyed almost 1000 young adult survivors. They found that a large proportion of long-term young adult cancer survivors report needing information about lifestyle and rehabilitation more than a decade after they completed their treatment.⁵ Let’s get these and other aged survivors in for treatment so we can help them feel better and get back to living their lives! Working with oncology patients can be very rewarding. When asked how therapy has influenced her, one patient responded “My PT has played a significant role in my recovery from surgery and the side effects of cancer treatment. She pays attention to and treats ‘the little things’ that are often forgotten about but yet have the biggest impact on my quality of life. She is there helping me long after my other doctors are done treating me.”

Herman & Wallace offers an Oncology Series that can help you gain the knowledge and skills to be able to help these patients.  In Oncology of the Pelvic Floor Level 1, we cover general oncology. In this course, we learn about cancer treatment, short-term side effects, and long-term side effects, and learn rehab techniques to help these patients. In Oncology of the Pelvic Floor Level 2A and Oncology of the Pelvic Floor Level 2B we go more in-depth with pelvic-related cancers.  In Level 2A we cover topics related to testicular cancer, prostate cancer, penile cancer, and colorectal cancers while in Level 2B we cover topics related to gynecological cancers and bladder cancer. In both courses, you learn hands-on treatment techniques to help patients recover function, and feel better. Please join us by taking this series to be able to help these patients!

Resources:

1. What is cancer survivorship? Cancer.net.  7/2021  https://www.cancer.net/survivorship/what-cancer-survivorship
2. Penna GB, Otto DM, D Silva T, et al. Physical rehabilitation for the management of cancer-related fatigue during cytotoxic treatment” a systemic review with meta-analysis. Support Care Cancer 31 (2023).  https://doi.org/10.1007/s00520-022-07549-7
3. Dittus K, Toth M, Priest J, et al. Effects of an exercise-based oncology rehabilitation program and age on strength and physical function in cancer survivors. Support Care Cancer 28, 3747-3754 (2020). https://doi.org/10.1007/s00520-019-05163-8
4. Dennett AM, Peiris CL, Taylor NF, et al. “A good stepping stone to normality’: a qualitative study of cancer survivors’ experiences of an exercise-based rehabilitation program.  Support Care Cancer 27, 1729-1736. (2019). https://doi.org/10.1007/s00520-018-4429-1
5. Thorsen L, Bohn SK.H, Lie HC, et al. Needs for information about lifestyle and rehabilitation in long-term young adult cancer survivors.  Support Care Cancer. 30, 521-533 (2022).  https://doi.org/10.1007/s00520-021-06418-z

---

---

*Certified Lymphatic Therapists may skip Oncology of the Pelvic Floor Level 1 and move on to the Level 2A and Level 2B courses.*

Oncology of the Pelvic Floor Level 1
No partner needed for registration

Price: $550.00          Experience Level: Beginner          Contact Hours: 17.5 hours

Description: The course will address issues that are commonly seen in a patient who has been diagnosed with cancer such as cardiotoxicity, peripheral neuropathy, and radiation fibrosis. Some holistic medicine topics, including yoga and mindfulness, will be discussed in order to fully prepare the participant to be able to competently work with cancer survivors.

The basics of the lymphatic system will be covered, as well as when to refer the patient to a lymphatic specialist for further treatment. Red flags and warning symptoms will be discussed so the participant feels comfortable with knowing when to refer the patient back to their medical provider for further assessment.

This introductory course is aimed to get the participant comfortable with working with oncology patients and as part of an interdisciplinary oncology team.

Course Dates: July 8-9 and December 2-3

 

Oncology of the Pelvic Floor Level 2A
Participants MUST register with a partner, or plan to have a volunteer available to work on during course labs.

Price: $495.00          Experience Level: Intermediate          Contact Hours: 17.25 hours

This course was designed to build on the information that was presented in Oncology of the Pelvic Floor Level 1.

Description: Information will be provided focusing on male pelvic cancers, colorectal cancer, and anal cancer including risk factors, diagnosis, and prognosis. The participant will also understand the sequelae of the medical treatment of cancer and how this can impact a patient’s body and quality of life. Other topics will include rehabilitation and nutritional aspects focusing on these specific cancers, as well as home program options that patients can implement as an adjunct to therapy.

Course Dates: September 23-24

 

Oncology of the Pelvic Floor Level 2B
Participants MUST register with a partner, or plan to have a volunteer available to work on during course labs.

Price: $600.00          Experience Level: Intermediate          Contact Hours: 19.25 hours

This course was designed to build on the information that was presented in Oncology of the Pelvic Floor Level 1.

Description: Information will be provided focusing on gynecological and bladder cancers including risk factors, diagnosis, and prognosis. The participant will also understand the sequelae of the medical treatment of cancer and how this can impact a patient’s body and quality of life. Other topics include rehabilitation and nutritional aspects focusing on these specific cancers, as well as home program options that patients can implement as an adjunct to therapy.

Course Dates: December 9-10