The pelvis contains several parallel nerve groups. One of which is the lumbar plexus and its sensitive branches. This nerve web arises from the anterior rami of lumbar spinal nerves L1 to L4 and T12 from the thoracic spinal nerve.
Nari Clemons instructs the remote course, Lumbar Nerve Manual Assessment and Treatment, which addresses assessments for the contributory nerves from the lumbar plexus, anatomy, differential diagnosis, and objective findings for specific nerves of the lumbar plexus. This advanced-level course also provides twelve lab techniques for manually treating the nerves of the lumbar plexus.
Osteoporosis is known to be a painless, progressive condition that leads to a weakening of the bones and can lead to a higher risk for broken bones. The upcoming remote course, Osteoporosis Management, scheduled for September 18-19, 2021, will discuss the scope of problems, specific tests for evaluating patients, appropriate safe exercises and dosing, and basic nutrition.
H&W faculty member Deb Gulbrandson recommends using the National Osteoporosis Foundation database for a resource and emphasizes the prevalence of osteoporosis is in a past interview for the Pelvic Rehab Report. "Approximately 1 in 2 women over the age of 50 will suffer a fragility fracture in their lifetime...According to the US Census Bureau, there are 72 million baby boomers (age 51-72) in 2019. Currently, over 10 million Americans have osteoporosis and 44 million have low bone mass."
A well-known consequence of osteoporosis is the increased risk of fragility fractures. A fragility fracture is often the first sign of osteoporosis and can be the cause of pain, disability, and quality of life for the patient. Research by Marsha van Oostwaard provided data that suggests about 13 percent of men and 40 percent of women with osteoporosis will experience a fragility fracture in their lifetime. Men also have a higher rate of mortality from fragility fractures relative to women (1).
The hip flexor muscles include the Iliopsoas group (Psoas Major, Psoas Minor, and Iliacus), Rectus Femoris, Pectineus, Gracillis, Tensor Fascia Latae, and Sartorius. When the hip flexors are tight it can cause tension on the pelvic floor. This can pull on the lower back and pelvis as well as change the orientation of the hip socket, lead to knee pain, foot pain, bladder leakage, prolapse, and so much more. The ramifications of iliacus and iliopsoas dysfunctions are discussed in Ramona Horton's visceral course series:
You can also learn about this in a contemporary and evidence-based model with Steve Dischiavi in his Sacroiliac Joint Current Concepts and Athletes & Pelvic Rehabilitation remote courses.
A common issue with the iliacus and hip flexors is that they can shorten over time due to a lack of stretching or a sedentary lifestyle. When this happens, the muscle adapts by becoming short, dense, and inflexible and can have trouble returning to its previous resting length. A muscle that resides in this chronic contraction can become ischemic, develop trigger points, and distort movement in the body.
The world needs more clinicians who can treat pelvic pain, pelvic organ prolapse, urinary incontinence, diastasis recti, and the many other conditions that constitute pelvic floor/pelvic girdle dysfunction. Most clinicians who specialize in pelvic rehabilitation are Physical Therapists (PT) or Occupational Therapists (OT), though other licenses also allow you to work with patients who have pelvic floor dysfunction. Many doctors, nurses, and internationally licensed medical professionals are beginning to explore the field of pelvic rehabilitation.
In an interview for the Pelvic Rehab Report, faculty and instructor Tiffany Ellsworth Lee MA, OTR, BCB-PMD, PRPC, shared that "Occupational therapists wishing to pursue pelvic floor have a few options. The first thing is to find a pelvic floor clinical setting...or check to see if they can start a women's health program with a strong focus on the pelvic floor. OTs quite often do not start out in pelvic health directly after school. Since this is a newer area as compared to other certifications such as the NDT and PNF, it takes a little bit of research, time, and effort to find one’s exact niche. To get started, an OT should seek out courses that teach the basics of bladder and bowel management. It is important to understand the anatomy and physiology of the bladder, bowel, and sexual systems."
Once you have a license to practice, you can start learning to specialize in pelvic rehabilitation. The best place to start is with the H&W Pelvic Floor Level 1 satellite lab course, which offers immediately applicable clinical skills for evaluating and treating urinary incontinence or the musculoskeletal components of urogynecologic pain syndromes. Most practitioners who take Pelvic Floor 1 return to study in the next courses in the series.
The following is our interview with Mahmoud Shalaby, PT, MS, DPT, PRPC. Mahmoud recently passed the Pelvic Rehabilitation Practitioner Certification (PRPC) exam. He practices at PT of The City in Brooklyn, NY, and is a Teaching Assistant for local New York satellite courses with H&W. Mahmoud was kind enough to share some thoughts about his career with us. Thank you, Mahmoud - and congratulations on receiving your PRPC!
In 2016, I was offered the chance to shadow a senior PT who specialized in pelvic rehab. This specialty was mysterious for me. I didn't think that there was much we could offer to patients with pelvic issues like incontinence, prolapse, IC, and such until I started to treat them. Once I commenced learning more, it never ends.
There is always more to discover and I've always been impressed with the role of physical therapists in assessing and treating pelvic issues. I continue to be very excited to learn more and to develop my experience while further participating in studies to improve my skills and tools in improving people's quality of life.
The majority of practitioners begin their pelvic rehabilitation journey by taking Pelvic Floor Level 1, which is an excellent starting point. This course provides the basics of anatomy, techniques, and knowledge needed to start treating patients.
Another option for your pelvic floor journey is the Oncology of the Pelvic Floor Level 1 remote course. Caring for patients with cancer begins at diagnosis, and as a pelvic rehabilitation practitioner, you are an integral part of the oncology team. This course addresses the issues commonly seen in a patient who has been diagnosed with cancer.
Several cancers can affect the pelvic region and pelvic floor. Such cancers include bladder, colorectal, prostate, and ovarian cancers. Treatments for pelvic cancers include surgery, radiation therapy, hormone therapy, chemotherapy, and pelvic rehabilitation. These treatment options depend on the tumor size, location, or stage and negatively affect pelvic floor function and quality of life.
How do healthcare practitioners improve patient satisfaction? Patient satisfaction is a cognitive evaluation of an emotional reaction to their health-care experience. According to multiple studies, the most significant predictor of patient satisfaction is the quality of their conversations with their medical practitioners.
Patients care about:
This is good news because they are all factors that you can control. Practitioners who take the time to communicate clearly, listen intently, understand each patient as an individual, and respond compassionately can improve their patients’ satisfaction and treatment outcomes. As Lauren Mansell stated in an interview with H&W, you have to “know what questions to ask patients for treatment. Our patients often feel alone, are frustrated with medical treatments, and feel like no one can address their symptoms.”
The following is our interview with Jennifer Eller, PT, DPT, PRPC. Jenni recently passed the Pelvic Rehabilitation Practitioner Certification (PRPC) exam. She practices at Enloe Medical Center in Chico, CA and is a Teaching Assistant for local California satellite courses with H&W. Jenni was kind enough to share some thoughts about her career with us. Thank you, Jenni - and congratulations on receiving your PRPC!
Q: Who are you? Describe your clinical practice.
Portions of this blog are from an interview with Dustienne Miller. Dustienne is the creator of the two-day course Yoga for Pelvic Pain. She passionately believes in the integration of physical therapy and yoga in a holistic model of care, helping individuals navigate through pelvic pain and incontinence to live a healthy and pain-free life.
Have you noticed when you are afraid or don’t want to feel something you hold your breath? Imagine what it's like to have daily pain that limits function and how that could impact rib cage, abdominal and pelvic floor expansion. Dustienne Miller discusses this in her remote course, Yoga for Pelvic Pain, upcoming on July 31 - August 1, 2021. Her course focuses on two of the eight limbs of Patanjali’s eightfold path: pranayama (breathing) and asana (postures) and how they can be applied for patients who have hip, back, and pelvic pain.
Dustienne explains "We teach our patients how breathing patterns inform our digestion, our spine, our emotional state, our pelvic floor, etc. It’s one of the most powerful tools we have to inform our system that we are safe. Despite this knowledge, we will often find ourselves holding our breath or breathing in non-optimal ways without even realizing it." Dustienne focuses her practice on introducing yoga to patients within the medical model. Yoga can be included in pelvic rehabilitation in so many ways, including incorporating yoga home programs as therapeutic exercise and neuromuscular re-education (both between visits and after discharge).
This blog contains an interview with Alyson N Lowrey, PT, DPT, OCS. Alyson treats the pelvic floor patient population through an orthopedic approach, working closely with pelvic floor specialists. Alyson’s clinical interests include evaluation/treatment of chronic pain, lumbar and cervical spine disorders, foot and ankle disorders, pelvic pain, and clinical instruction. Alyson is the co-instructor for the new H&W course, Pain Science for the Chronic Pelvic Pain Population - Remote Course scheduled for July 17-18, 2021.
Q: Who are you? Describe your clinical practice.
A: I work in an outpatient hospital-based clinic where I am able to provide true 1:1 care to patients of all ages and orthopedic conditions. Since pelvic floor therapy came to our clinic, I have developed strong clinical and personal relationships with pelvic floor therapists. We have been able to successfully combine our respective expertise into a wholistic approach for improving patient’s functional outcomes. My knowledge and relationships with pelvic floor therapy have allowed me as an ortho clinician to recognize when a patient’s dysfunction may have a pelvic floor component and refer appropriately. I am also in a unique opportunity where my pelvic floor colleagues will co-treat or transition care of a patient to me to continue to improve their overall function by providing functional strengthening and neuromuscular re-education to the pelvic floor musculature and other supportive muscular systems. This relationship also allows us to treat comorbid orthopedic conditions and pelvic dysfunctions such as low back pain or SIJ dysfunction as well.