Faculty member Ginger Garner PT, DPT, ATC/L is offering a new short course, The Voice and The Pelvic Floor. This course introduces foundational concepts needed to be able to use vocal techniques to treat the pelvic floor and core. Dr. Garner is a clinician, educator, and longtime advocate committed to making physical therapy services accessible, affordable, and equitable, especially for pelvic health.

When you think of pelvic health, what comes to mind? Obvious variables like the pelvic floor & girdle, abdominals and related synergists, mental health, and gut and respiratory health are probably at the top of your list. 

But how often do we consider the voice as a biomarker of pelvic health? It can impact all of the variables above and more. 

Historically, speech-language pathologists’ study of vocal health has stopped at the respiratory diaphragm, while physical and occupational therapists’ study of pelvic health has stopped, well, in the same place. Neither has traveled beyond that until recently. 

However, there is a third diaphragm beyond the respiratory and pelvic, the laryngeal diaphragm. It’s also known as the cervical, cervico-thoracic, vocal, and/or thoracic diaphragm. The three diaphragms include: 

• The Laryngeal Diaphragm - is responsible for neurological optimization of stress response and physiological control of swallowing and communication; but, it also influences vagal tone for cardiorespiratory functioning and respiratory and pelvic diaphragm functioning. It contains the muscles that are responsible for phonation, which includes intrinsic variables such as the arytenoids, but also extrinsic components which have a direct impact on the vocal fold health, such as the suprahyoid muscles.
  
  
• The Respiratory Diaphragm - is the connecting point between cephalad and caudad diaphragms and is the main muscle influencing pulmonary function. However, the respiratory diaphragm exacts a major influence on mind-body health, which goes far beyond pressure regulation of the vocal and pelvic diaphragms.
  
  
• The Pelvic Diaphragm - is the terminal end of the tri-diaphragmatic (3D) system, and can bear the brunt of trauma and impairment if dysfunction is present in the two upstream diaphragms. The pelvic diaphragm contains the levator ani, coccygeus, and related synergists, pelvic fascia, and neurovascular structures, which in turn can work with or against breathing and voicing tasks. 

The diaphragms are in constant movement and none work in isolation. Together, their intersectional action provides us with the key to both internal and external biopsychosocial stability and structure of the mind-body. 

The laryngeal diaphragm has a supradiaphragmatic vagal impact, while the pelvic diaphragm exacts subdiaphragmatic vagal health, chiefly through afferent and efferent input, respectively. The 10th cranial nerve lives up to its namesake, “the wandering,” as it touches each of the three diaphragms on its journey, harnessing the capacity to lessen pelvic and visceral pain, while also improving vocal quality and lung function, and changing pain, mood, and digestive function. 

The mind-body interface of the 3D system has been further defined in recent years, broken down into a voluntary motor system (the one we spend all our time studying and treating), and the “emotional motor system,”  and the implications are profound. Anatomists and researchers tell us that in order to generate speech, we need both motor systems to function. But specifically, our emotional motor system must first perceive safety before speech can be produced or produced well.  

To get a feel for your own emotional motor system health, try this brief exercise: 

1. Think about a recent incident that made you feel nervous, or anxious. 
2. How well could you breathe? 
3. Talk? 
4. Sing or hum? 
5. Engage in intimacy with someone? 

Not very well, right? This feeling is the fallout from your emotional motor system perceiving danger or threat. It’s what Dr. Stephen Porges means by the phrase, “neuroception.” Neuroception is the ability to detect risk - but it’s not just the ability to detect it - neuroception is the ability to accurately detect risk. 

Here lies the problem: 

If we cannot detect external risk or internal threat accurately, aka if our neuroception wiring is faulty, then we may move to 1 of 4 default modes for behavior: fight, flight, freeze, or fawn. If we are left in this state of reactivity, courtesy of the sympathetic nervous system, then polyvagal theory predicts we will enter into a dissociative state, termed a dorsal vagal response (DVR). The DVR drives self-preservation in severe trauma states, which can preserve life; but it is also to blame for bradycardia and left unchecked, death. Especially now post-COVID, it’s imperative that all therapists understand how to recognize, screen for, and help nurture healthy self-regulatory strategies via trauma-informed care.  

We must also learn how to create a therapeutic landscape conducive to healthy neuroception, one that appeals to the “safety switch” of the emotional motor system. Establishing this healthy therapeutic alliance with our patients and clients is critical in pelvic health because the same motor system that controls the creation of sound, dictates everything associated with pelvic health, including micturition, defecation, partuition, stress response, and sexual function.

Understanding the basis of “3D” neurophysiology makes targeting the voice a perfect alternate but necessary pathway for successful comprehensive pelvic health care. The ability to create sound literally determines how we interact with the world around us, and whether or not we can do so with empathy and safety. Additionally, the success of our intervention as pelvic health therapists is also determined by the degree to which we are using a biopsychosocial model, which has long been supported as the most effective and cost-effective way to manage pain and tackle chronic disease and impairment. 

What does including the voice look like in pelvic health? 

For starters, the first step is evaluating the orofacial and vocal health of the patient or client. Second, and perhaps surprising to some, is the evaluation of the therapist’s own voice as a therapeutic agent. These assessments work to identify red flags that place undue stress through the downstream diaphragms and stress response system. More complex assessment can include lumbopelvic ultrasound imaging as well, which provides a more comprehensive way to individualize therapy prescription. 

Assessment is essentially a 4-pronged process - The first two prongs consist of building on existing evaluation skills in respiratory, core, and pelvic floor and girdle assessment. The final two include an assessment of the physiological functioning of the orofacial area and voice and an evaluation of psychosocial determinants which would influence cranial nerve and vocal functioning. The voice is an incredible tool for improving pelvic health outcomes, if we learn how to harness its frequency and power. 

Join Dr. Ginger Garner for a virtual short course, The Voice and the Pelvic Floor scheduled for October 1, 2022, to learn more.

Sources 

1. HOLSTEGE, G., 2016. How the Emotional Motor System Controls the Pelvic Organs. Sexual Medicine Reviews, 4(4), pp. 303-328.
2. HOLSTEGE, G. and SUBRAMANIAN, H.H., 2016. Two different motor systems are needed to generate human speech. The Journal of comparative neurology, 524(8), pp. 1558-1577.
3. Speer LM, Mushkbar S, Erbele T. Chronic Pelvic Pain in Women. afp. 2016;93(5):380-387. 
4. Miciak M, Gross DP, Joyce A. A review of the psychotherapeutic “common factors” model and its application in physical therapy: the need to consider general effects in physical therapy practice. Scand J Caring Sci. 2012;26(2):394-403. doi:10.1111/j.1471-6712.2011.00923.x
5. Padoa A, McLean L, Morin M, Vandyken C. The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients. Sex Med Rev. 2021;9(1):76-92. doi:10.1016/j.sxmr.2020.04.002
6. Wijma AJ, van Wilgen CP, Meeus M, Nijs J. Clinical biopsychosocial physiotherapy assessment of patients with chronic pain: The first step in pain neuroscience education. Physiother Theory Pract. 2016;32(5):368-384. doi:10.1080/09593985.2016.1194651
7. Porges SW. The polyvagal perspective. BiolPsychol. 2007;74(2):116-143.

Rachna Mehta, PT, DPT, CIMT, OCS, PRPC is the author and instructor of the new Acupressure for Pelvic Health course. Rachna brings a wealth of experience to her physical therapy practice and has a personal interest in various eastern holistic healing traditions. Her course Acupressure for Optimal Pelvic Health brings a unique evidence-based approach and explores complementary medicine as a powerful tool for holistic management of the individual as a whole focusing on the physical, emotional, and energy body.

Constipation is a common functional gastrointestinal disorder, with prevalence in the general population of approximately 20%. In the elderly population, the incidence of constipation is higher compared to the younger population, with elderly females suffering more often from severe constipation (1).

Is there a magic button in the perineum that makes it easier to defecate? In case you have wondered, the answer is YES!!!

A study done recently by Dr. Ryan Abbott and colleagues at UCLA’s Department of Medicine found just that. A randomized control trial was conducted with 100 subjects who had functional constipation, half randomized to treatment and half to the control group. The treatment group received training in self perineal acupressure along with standard treatment options. The control group only received information about standard constipation treatment options.

Perineal self-acupressure technique was found to be remarkably effective with statistically significant and clinically meaningful improvements in Patient Assessments of Constipation Quality of Life (PAC-QOL All), modified Bowel Function Index (BFI), and the Short-Form Health Survey (SF-12v2). Patients in the treatment group also reported substantial satisfaction with perineal self-acupressure technique:

• 72% of the treatment group reported that the perineal pressure technique helped them to “break up, soften, or pass stools."
• 54% reported that the technique helped them to “avoid having hemorrhoid or lessened the impact of existing hemorrhoid."
• 72% reported that the technique helped them to “avoid or better manage the effects of constipation."
• 82% of the treatment group patients indicated that they would continue to use the technique, and 72% indicated that they would recommend the technique to family and friends (2).

In this study, perineal acupressure was applied at the Acupressure point Huiyin or CV 1 located at the perineum. Huiyin is used in Traditional Chinese Medicine (TCM) not only to treat constipation, but also a variety of conditions including impotence, hemorrhoids, rectal prolapse, and dysmenorrhea. In addition, there are several key Acu-points like St 36 on the Stomach meridian and CV 6 which can help with constipation and digestive disorders.

Acupressure is based on Traditional Chinese meridian theory in which acupuncture points are pressed to stimulate the flow of energy or Qi and these points reflect disorders of visceral conditions and organs.

Acupuncture meridians are believed to form a network throughout the body, connecting peripheral tissues to each other and to the central viscera. This tissue network is also continuous with more specialized connective tissues such as periosteum, perimysium, perineurium, pleura, peritoneum, and meninges (3).

Dr. Abbott’s study suggests that clinicians should consider incorporating perineal self-acupressure technique as a first-line treatment for constipation, along with conventional interventions such as increased exercise and dietary fiber intake. Benefits include being non-invasive and non-pharmacological treatment intervention for constipation with likely a lower risk for side effects and complications than commonly used medications such as stool softeners, fiber supplements, stimulants, laxatives, and lubricants (2).

As medical providers, we are uniquely trained to combine our orthopedic skills with mindfulness-based holistic interventions to empower our patients by giving them the tools and self-care regimens to live healthier pain-free lives.

The upcoming remote course Acupressure for Optimal Pelvic Health, scheduled for July 24-25, 2021, brings a unique evidence-based approach on the use of potent Acupressure points for treating a wide variety of pelvic health conditions including chronic pelvic pain, dysmenorrhea, constipation, digestive disturbances and urinary dysfunctions to name a few.

The course also offers an introduction to Yin yoga and explores Yin poses within each meridian to channelize energy through neurodynamic pathways with powerful integrative applications across multiple systems.

References

1. Vazquez Roque M, Bouras EP. Epidemiology and management of chronic constipation in elderly patients. Clin Interv Aging. 2015;10:919-930.
2. Abbott R, Ayres I, Hui E, Hui KK. Effect of perineal self-acupressure on constipation: a randomized controlled trial. J Gen Intern Med. 2015;30(4):434-439.
3. Kaptchuk TJ. 2000. The web that has no weaver. Understanding Chinese medicine. Chicago: Contemporary Publishing Group, Inc.

Instructor Sarah Hughes, PT, DPT, OCS, CF - L2 sat down with The Pelvic Rehab Report to answer a couple of questions about treating the Crossfit and weightlifting community. Dr. Hughes earned a BS in exercise science from Gonzaga University and a DPT from the University of Washington.

Sarah's specialties include dance medicine, the CrossFit and weightlifting athlete, and conditions of the hip and pelvis such as femoroacetabular impingement and labral tears. She began coaching other PTs who wanted to start their own practices in 2017 and co-founded Full Draw Consulting with her partner Dr. Kate Blankshain.

Sarah teaches Weightlifting and Functional Fitness Athletes, which s scheduled for August 7th and October 15th of this year.

What are three things you wish you knew when you first started treating the athletic community?

First, I wish that I had had the confidence to treat these athletes the way I saw fit earlier in my career. For a long time, I felt weird treating CrossFit athletes in the clinics I worked in because I felt that my peers were judging me. My colleagues (and many PTs at the time) were wary about the sport and believed it was dangerous for patients. This is a viewpoint I am working to change in our profession.

Secondly, I wish I knew more about how to scale movements in a way that is relevant to the patients and the stimulus they are striving for. For example, if a patient wants to be able to do kipping pull-ups in a workout, giving them banded strict pull-ups as a substitute is not the only option. What about the metabolic conditioning part of the equation? What about looking at the volume and how that is impacting the tissue of concern? This is a big topic that we discuss in my course.

And finally, I wish I knew that being an effective therapist for these athletes does not mean being the top athlete in the gym. In fact, just as with coaching, you do not have to be a great athlete to be a great PT. Again, this is something that I want to change as far too few physical therapists are comfortable treating these or advertising that they treat these athletes because they are not Crossfit athletes (or are not ELITE Crossfit athletes) themselves.

What lesson have you learned in a course, from an instructor, or from a colleague or mentor that has stayed with you?

One important lesson that has stayed with me came from a colleague in Seattle who started her business a year before I started mine. She told me that I needed to listen to my gut when it came to treating these athletes. She reminded me that my experience with CrossFit as a sport, as an athlete, as a coach, and as a PT put me in a position to be an expert on how to help these folks. What I did not need was to allow other physical therapists to sway my thinking and cause me to doubt myself by insisting that we should not be condoning the sport. TRUST YOUR GUT. If you think you are doing what is right for the patients, you are. You might not be right for every patient and that is OK! I am certainly not the right therapist for everyone, but I am indeed right for the community I serve.

Weightlifting and Functional Fitness Athletes - Remote Course

When it comes to Crossfit and Weightlifting, opinions are divided among Physical Therapists and other clinicians. 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 reviews the history and style of Crossfit exercise and Weightlifting, as well as examines the role that therapists must play for these athletes. Labs will introduce and practice the movements of Crossfit and Weightlifting, discussing the points of performance for each movement. Practitioners will learn how to speak the language of the athlete and 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 cultural 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.

Course Dates: August 7th and October 15

Congratulations to Dr. Mia Fine (they/she) for achieving their Ph.D. in Clinical Sexology and on their book titled 'From Unwanted Pain to Sexual Pleasure: Clinical Strategies for Inclusive Care for Patients with Pelvic Floor Pain' for their dissertation doctoral project.

Dr. Fine was gracious enough to share a draft of their dissertation with Herman & Wallace and to answer a couple of questions about how this impacts their practice and what they hope other practitioners will take away from their book and course Sexual Interviewing for Pelvic Health Therapists.

Mia's course is for the pelvic rehab therapist and others in the medical profession who work with patients experiencing pelvic pain, pelvic floor hypertonicity, and other pelvic floor concerns and would like to learn applicable skills from the sex therapist's clinical toolkit. The next course date for Sexual Interviewing for Pelvic Health Therapists is August 13-14,

How does Trauma-Informed Care apply to the skills that you teach in your Sexual Interviewing course?

When I utilize the term ‘trauma-informed’ I am referring to therapeutic work that communicates expectations clearly (including prioritizing people’s access needs with this communication), invites clients awareness of their own agency, and is upfront about my scope of practice and my therapeutic approach, offers mutuality in inviting of questions and ongoing conversation about our work together, awareness that an individual can end therapy at any time, and share information at any time in our therapeutic space. 

The modalities I utilize when working with clients who have experienced trauma include Eye Movement Desensitization and Reprocessing (EMDR), Polyvagal Theory, Somatics, and Developmental Theory. While I integrate various theories and modalities into my work with clients, the methods above are empirical in their data to support healing from trauma wounds.  

Trauma-informed means humility regarding cultural, racial, gender, sexual, and other minority experiences. I will not know all of the things but I will do my best to self-educate and not leave that responsibility to my clients. When I make a mistake I will appropriately, directly, and compassionately apologize for the harm I caused and invite opportunity for repair should the client be interested. Trauma-informed means collaboration in exploring therapy together, co-creating a space that feels safer to the client and checking in with them when I notice non-verbal cues that indicate activation, honoring a client’s pacing, and bringing awareness to the reality that as a therapist I hold power and while I don’t know a person’s full story there is always the potential for me to unintentionally activate a client so to share this possibility with clients and continuously check in about how our therapy is working for them. I keep my client’s well-being at the forefront of our work and I center their needs at all times while maintaining boundaries that keep everyone as safe and secure as possible. 

It is up to us as trauma-informed and inclusive providers to explore a person’s experience of pain by asking questions about onset, process, location, and impact, in addition to offering psychoeducation about anatomy, physiology (arousal, interest, desire), and self-regulation. This must be done alongside commitment to our patient’s co-regulation, normalization, and informed consent concerning the therapeutic process—all of which are needed for comprehensive trauma-informed care. 

Can you explain how expanding what 'normal' is to practitioners can impact the patients and clients that they work with?

Sex is not supposed to be painful. How many people have come to me having had painful sexual intercourse for years and reported “pushing through”? The first time having intercourse does not necessarily have to be painful, but when our cultural narratives tell us “the first time having sex is painful for everyone” we end up ignoring the signals our bodies are offering because we have convinced ourselves that the pain is both okay and normal. The “pushing through” is a reflection of misogyny: people assume the first experiences people have with penetration are supposed to be painful. How is this misogynistic? Well, who benefits from a person “pushing through” pain? The partner with the penis. Important to note here as well is that enthusiastic consent is ableist and ignores the mind-body connection because it does not take into account masking or fawning which are common experiences for many.

A quarter of people who experience sexual health concerns share this with their providers. Why such a small fraction? Fear. Fear of embarrassment and shame. Fear that there is something “abnormal” about them that mutates into the shame humans tend to experience in response. Fear that the concern won’t be held or taken seriously by their provider. Fear that, if it is addressed, will be at such a high financial cost that the treatment will be unaffordable. Fear that there’s not enough time or that they won’t be taken seriously. Fear of exclusivity, feeling othered, or misunderstood by their provider. Fear of the unknown because the reality is that people are afraid of what we don’t understand. 

One of the major cultural issues we have in the US is the perpetuation of sexual stigma which is largely associated with a lack of comprehensive sex education. People don’t have access to basic information about their own bodies which influences our beliefs about sex, pleasure, agency, communication, and self-awareness. Sex education should be a birthright, and yet we are so far behind the curve that it sometimes feels impossible to break down the barriers.

When I first started in this career it would often take clients months of working with me to feel comfortable enough to talk about where they felt pain during sex, but in developing the tools to co-create safety in our therapeutic relationship and the skills to ask the important questions with compassion and patience, I learned how to better hold space for healing.

Patients don’t often know what information is important for them to share with us (which is why offering visuals of where the pain is located is important). How could they know what information is important to offer when mental and sexual health are so deeply stigmatized? The stress of shame and embarrassment that people feel about their bodies is emotional pain that further exacerbates the physical pain that they came to therapy to address in the first place. It’s a terrible and self-perpetuating cycle. 

I teach people the difference between a vulva and a vagina one thousand times a year. If a client does not know the terminology for labia, vulva, vagina, and clitoris, how are they supposed to know when their sexual health is of concern? If a person enters sex therapy with “sexual pain” but is unable to distinguish the difference between their labia and vagina (that they are different body parts, where they are located, and what their functions are) we cannot expect them to accurately articulate the location of pain or comprehend potential solutions. “What is your hygiene process when cleaning your vulva?” may activate the fight or flight response in clients if they do not know what their vulva is or that there could be a good hygiene process, in addition to the shame of not knowing. How are they supposed to know where or to whom they may ask for help?

An online search for “anatomical vulva”, “pelvic floor pain”, “vaginismus treatment” and 99% of the images and figures you will see are those of hairless, slender bodies with white/light skin and small labia. Racism and white supremacy are present everywhere. The anatomical depictions of vulvas are of white bodies, the people modeling in vaginismus treatment advertisements are white, and the language is geared toward and written for white people. I was intentional about not featuring white vulvas in this book because white bodies should not be the default of what is mainstream. This lack of diversity in skin tone and variation of body type is another reflection of racism called “colorism”. White and light skin bodies are viewed as more ‘normal’ and when we continue to center white bodies in visuals “because that is what is available” we perpetuate white supremacy. One goal is to disrupt the idea and practice of whiteness as the default. This is what it means to practice anti-racism and attempt to divorce ourselves from white supremacy. 

The impact of shame shows up in the pervasive erotophobia rampant in our society. Erotophobia can be broadly defined as a “fear of sex” or more specifically a “fear of intercourse”. When erotophobia is judgment as a result of societal shame and stigma, we can navigate it by deconstructing the etiology and impact of messages received; when it is a result of a mental health condition such as Obsessive Compulsive Disorder (OCD) or Post Traumatic Stress Disorder (PTSD), we do deep trauma and/or anxiety/exposure work. Because of the vast impact of shame, people fear sharing sensitive information about themselves with others,  including therapists who are trained to help them. Often, therapists are untrained in sexual health which also can contribute to erotophobia and shame. When therapists have not done their own work on sexuality, and remain untrained in these areas, they may be afraid to discuss sex with their clients which reinforces the belief that topics regarding sex are shameful. 

When people do not have the language to articulate what is happening in their body, as significant as the pain or discomfort might be, talking about sex with a provider is often the last item on a long list of concerns they bring to a medical appointment. Symptoms of sexual pain may be hidden by other “more pressing” concerns such as anxiety, depression, PTSD, or sleep issues. While these are of course vital for a medical provider to know, having 20 minute appointments with a physician who will prioritize the “presenting concern” that they came in to seek treatment for leaves very little time to discuss unwanted sexual pain. After 15-20 minutes of a medical appointment (if it goes well), a patient might feel comfortable enough to bring up their sexual concern, but this might leave 1 minute for it to be acknowledged and no time to conduct a comprehensive assessment or develop an intentional plan. We call these last-minute oh-by-the-way’s “door-knobbing” for a reason. This is a call for medical clinics to have training in sexual health so they can create intake documentation that explores clients’ sexual health and ask the questions that are vital to gather necessary information ahead of time. 

In the same way that people lack language and anatomic understanding, people also lack awareness of the mind-body relationship. Due to the ableist sex-negative culture in which we live, people are often not taught to have knowledge of or listen to our own body. We’re not taught that pain is a signal from the body telling us that something’s wrong. 

This week Ramona Horton sat down with Holly Tanner to discuss manual therapy and her course Mobilization of the Myofascial Layer: Pelvis and Lower Extremity. The following is an excerpt from her interview.

What do we really know about manual therapy? We have decent evidence that shows that asymmetry matters. The tenet of the myofascial course is an osteopathic tenet called ARTS:

• Asymmetry
• Restriction of Mobility
• Tissue Texture Changes
• Sensitivity

The whole myofascial course is designed around looking for ARTS. When you find the asymmetry within the myofascial system then that’s where you direct your efforts and energy.

Often patients have already tried breathing, yoga, medication, etcetera – and it’s the manual therapy piece that they often have not had. It’s not that uncommon for me to be someone’s second or third therapist. Some patients may have tried some type of manual therapy but it was more things like ischemic compression where the problem was that the manual therapy was triggering nociception.

So in the myofascial course, we start with ARTS but we also have an idea where we flip ARTS on its head and we go to STAR. In STAR, you take sensitivity and put it at the top of your list. That becomes the highest portion in your paradigm. Then we use simple techniques that are not non-nociceptive. Indirect technique versus direct technique, such as something as simple as positional inhibition.

The whole idea of the myofascial course is to teach people to think and problem solve. Then have a very broad spectrum way of you find an inner articular issue where this joint is moving and this one is not. Learn to not chase the booboo. Just because it hurts on the right doesn’t mean that you’re going to treat the right. It might hurt on the right because there is a hypo-mobility on the left. Let’s treat where the brain is protecting the tissue, and holding, and guarding the tissue. Trust in the belief that the body is a self-righting mechanism. The body will then normalize itself.

In manual therapy, our job is to get the body moving like it's supposed to. It’s not to fix the ‘booboo.’ The issue is not in the tissue. If the tissue is tight, it’s tight because the brain is keeping it that way. The way I teach manual therapy is the fascial system gives us access to the nervous system. By utilizing the fascial system in a non-nociceptive manner, what we’re really doing is just having a conversation with the brain. We’re not fixing the tissue. That’s the whole premise of the course - to get people to understand and change their thinking and their paradigm to ask what the brain is protecting and utilizing the fascial system.

• Brooklyn, NY
• Columbia, MO
• LaPorte, IN
• Medford, OR
• Newtown, PA
• Omaha, NE

• Self-Hosted - for groups of at least 2 qualified practitioners. 

Herman & Wallace is committed to providing courses on pelvic rehabilitation for all people across the spectrum. This week the featured courses are those focused on women's health!

Take a look and see if there is one that is a good fit for you.

Breastfeeding Conditions Remote Course - Remote Course
July 16 and November 19

This course provides a thorough introduction to the physiology of the lactating breast, dysfunction and treatment interventions, the therapist's role in breastfeeding and pumping support, as well as when to refer to other health professionals.

Lectures will include the anatomy and physiology of lactation, blocked ducts and mastitis, and breast pain through a biopsychosocial lens. During labs, participants will have the opportunity to systematically assess the breast and practice therapeutic breast massage and manual milk expression. Participants will learn to assess and treat breast inflammation and pain such as mastitis, blocked ducts, milk blebs, and cracked nipples.

Breastfeeding Conditions - July 16-17, 2022

Breastfeeding Conditions - November 19-20, 2022

Menstruation and Pelvic Health - Remote Course
July 16-17, 2022

Menstruation and Pelvic Health is a two-day remote course is designed for clinicians who want to obtain advanced knowledge and skills to educate patients on non-hormonal, non-surgical, and non-prescription interventions for improving the Menstrual Experience. Developed by Nicholas Gaffga, MD, MPH, FAAFP, and presented together with Amy Meehan, PT, DPT, MTC, this course is geared toward the pelvic rehab provider looking to impart Menstrual Interventions that:

• Put control in the hands of people who menstruate to identify and carry out the interventions that are appropriate to them
• Use a holistic approach and advanced knowledge and familiarity with body and mind
• Emphasize healthy practices that can positively impact the Menstrual Experience and beyond, in areas such as mental health and chronic diseases
• Discover root causes of issues, rather than quick fixes, to have benefits that are sustainable across the lifespan.

• Menstruation and Pelvic Health - July 16-17, 2022

Postpartum Rehabilitation - Remote Course
offered monthly through November

The client who is postpartum may be one of the most overlooked clients in health care. Knowing the specific rehabilitation needs to help with common problems and prevent future problems is the goal of this beginner-level course. For the orthopedic-based practitioner, this course will solidify awareness of the common orthopedic needs of the postpartum client. For the non-orthopedic practitioner, this course will provide a foundation for working with clients experiencing common postpartum-related musculoskeletal conditions.

This course will cover examination considerations and modifications specific to postpartum, as well as specific questions to ask during history taking and methods for identifying red flags in postpartum. More comfortable positions during the examination/treatment and common posture/gait/balance changes during postpartum are covered. The participant in this course will understand necessary biomechanics training for daily activities, child care, and breastfeeding. As an expansion from the pregnancy rehabilitation course, participants will be taken through progression in diastasis rectus abdominis (DRA) assessment and rehabilitation, including DRA exercises in lecture and lab. 

Postpartum Rehabilitation - July 23-24, 2022

Postpartum Rehabilitation - August 20-21, 2022

 Doula Services and Pelvic Rehab Therapy - Remote Course
August 6 and December 10

A growing number of pelvic health therapists are recognizing the importance of preparing their clients for the physical and mental challenges of labor and delivery. In some cases, this is extending to a desire to be present during labor for support as a Doula. The purpose of this course is to present the unique challenges of merging a rehab practice with Doula services in order to help the participant better discern whether or not this is a journey worth taking.

Doula Services and Pelvic Rehab Therapy - August 6, 2022

Doula Services and Pelvic Rehab Therapy - December 10, 2022

Fertility Considerations for the Pelvic Therapist - Remote Course
August 13

This course is for practicing pelvic rehabilitation therapists and covers the role of rehabilitation therapists in optimizing female fertility. This course was written and will be instructed by Dr. Yeni Abraham, who is a Dallas-Ft.Worth-based Pelvic Physical Therapists specializing in the treatment of Gynecologic and Fertility related conditions. Lecture topics include medical infertility labs, pertinent information on charting cycles, assisted reproductive technologies and their impact on treatment, hormone regulation, the relationship between inflammation and infertility, amongst other topics. Lab activities/break-out sessions will include manual techniques to influence uterine and ovarian Mal-positions.

*This course will require that each student have a live model that will allow participants to practice the lab techniques on a human body. Due to the nature of labs, please be sure your model partner is not pregnant and does not have an IUD for safety. Additionally, those with hydrosalpinx will not be able to participate in uterine mobility techniques but can still attend the course.

Fertility Considerations for the Pelvic Therapist - August 13, 2022

Menopause Transitions and Pelvic Rehab - Remote Course
August 27-28th and November 12-13th

Menopause Transitions and Pelvic Rehab is a 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. 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.

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.

Menopause Transitions and Pelvic Rehab - August 27-28, 2022

Menopause Transitions and Pelvic Rehab - November 12-13, 2022

Medical Perspective in Peripartum Care - Remote Course
September 17-18th

Medical Perspective in Peripartum Care is a two-day course instructed by Dina Gordon, MD, FACOG, a practicing OB/GYN in the Seattle area, and will discuss common conditions encountered in the peripartum period from the medical perspective. Topics include medical screening; medical management of high-risk patients (bed rest, activity limitations, medications, surveillance); and interventions common in the peripartum period

The course is built from the medical perspective, the design of the course aims to share knowledge so that rehabilitation care planning is optimized.

Medical Perspective in Peripartum Care - September 17-18 2022

 Pregnancy and Postpartum Considerations for High Intensity Athletics
September 11

The main focus of this course will be to learn how exercising throughout pregnancy, or returning to exercise postpartum may look different for a high-intensity athlete versus a non-HIIT athlete. Participants will discuss how anatomical and hormonal changes affect training for the pregnant and postpartum athlete, review various modifications for this population, learn how various stresses placed on the body during these activities may affect pelvic floor muscle function, and review various pressure management strategies that can be utilized during high-intensity interval training. This one-day remote continuing education course is designed to educate practitioners on the unique considerations of pregnant and postpartum athletes engaging in high-intensity interval training (HIIT).

During the pregnancy lab, we will review specific exercise modifications for pregnancy, utilization of breathwork to properly support the pelvic floor during pregnancy and review how to assess for and tape for diastasis recti. In the postpartum lab, we will review how to determine proper activity modification based on the ability to manage pressure, review specific activity modifications and breathwork, review accessory work for return to activity, and discuss how to assess pelvic organ prolapse in standing.

Pregnancy and Postpartum Considerations for High Intensity Athletics - September 11, 2022

Perinatal Mental Health: The Role of the Pelvic Rehab Therapist
October 22

This one-day continuing education course covers mental health considerations during pregnancy and postpartum and is targeted to the pelvic rehab clinician treating patients in the peripartum period. Topics include common mental health concerns in the postpartum period including depression, anxiety, OCD, and PTSD, as well as the connectedness between mental health and physical dysfunction.

The course will introduce useful screening tools and how to connect patients to resources and diagnosing professionals. Labs will include partnered breakout sessions to practice listening and dialogue skills. The course also includes a review of coping techniques to support mental health and physical symptoms.

Perinatal Mental Health: The Role of the Pelvic Rehab Therapist - October 22, 2022

Pregnancy Rehabilitation - Remote Course
October 29-30 and November 5-6

Learn how to safely examine and treat the pregnant patient in this beginner-to-intermediate course.

Lectures cover terminology, fertilization, trimesters, medical testing/interventions, imaging, and medications. Participants will learn to differentiate between false labor, progressive labor, and other musculoskeletal pain as well as learn to understand typical hormonal and systemic changes during pregnancy. Examination, evaluation, and treatment of common lumbopelvic conditions will be provided with an introduction to diastasis rectus abdominis, pelvic floor dysfunction, breathing, and deep core assessment/treatment.

Discussions also include general examination considerations and modifications specific to pregnancy, including a discussion of modalities and manual therapy techniques considered safe or precautioned during pregnancy, with further lectures on pelvic girdle examination, diagnosis, and treatment strategies. Finally, to prepare the pregnant client for labor and birth, instruction in perineal stretching, hip and trunk flexibility activities and TENS for labor will be discussed. Lab practice will include labor and birthing positions, with a focus on consideration for positional strategies for women with pre-existing musculoskeletal problems.

Pregnancy Rehabilitation - October 29-30, 2022

Pregnancy Rehabilitation - November 5-6, 2022

The following is an excerpt from the short interview between Holly Tanner and Tara Sullivan discussing her course Sexual Medicine in Pelvic Rehab. Watch the full video on the Herman & Wallace YouTube Channel.

Hi Tara, can you introduce yourself and tell us a little bit about your background?

Sure! So I’m Tara. I’ve been a pelvic health rehab therapist for about 10 years now. I started right out of PT school and I got a job at a local hospital where they were looking to grow and build the pelvic rehab program. So of course, I found Herman & Wallace and started taking all of the classes there that I could and just kept learning over the years. Now the program is expanded across the valley, we have nine different locations, and it’s been very successful and fulfilling. It’s my passion.

Recently, I would say the past four to five years of my career, I’ve started getting more into sexual dysfunctions. I was always into pelvic floor dysfunction in general - bowel, bladder, sexual dysfunction, and chronic pelvic pain, but I  didn’t get specifically into the sexual medicine side of it until recently. I did the fellowship with ISSWSH that really pulled all of that information together with what I’ve learned through the years.

Can you explain what ISSWSH is and how that combined with the knowledge base that you already had?

I feel like ISSWSH for me, where I came full circle. I finally was like “I get it.” ISSWSH is the International Society for the Study of Women’s Sexual Health and it’s all the gurus like Dr. Goldstein, Rachel Rubin, and Susan Kellogg that have been around forever doing the research on sexual medicine. I started attending their conferences, became a faculty member, and presented at their annual fall meeting here in Scottsdale. Then I ended up doing their fellowship. Every year I would attend the conference, but it took a couple of years for all of that knowledge to soak in and for me to be able to really apply it.  For example, that patient with that sticky discharge, maybe that is lichen planus – that’s the kind of medical side that you don’t necessarily learn in physical therapy school.

That for me just really helped my differential diagnosis which means that you can get the patient’s care faster. Get them to that resolution faster because you are working with a team of people and we all have our roles. As PTs and rehab practitioners, we have the time to sit with our patients. We are so blessed to have an hour, and the medical doctors don’t, for us to really take that time to figure out the patient’s history and what they’ve been through, and what could be the cause of it. We have the time to be the detective and help them get the care they need. Whether it’s with us, or in conjunction with something else. My goal is to never tell someone that I can’t help them because it’s not muscular.

How has this knowledge helped you in your collaboration with other practitioners in your practice?

I feel like this knowledge was the missing link for me. It brings it all together for the patient. So the patients come here and the urologist says “that’s not my area,” and then the gynecologist says “that’s not my area.” Then they come to you and you’re like “it’s kind of my area, but I can’t prescribe the medication that you need.”

My practice got so much better, just in the sense of the overall quality of care, when I was able to develop those relationships with the doctors. I could pick up the phone and say “Hey, that patient that you sent me – I think they have vestibulodynia, and I think it’s from their long-term use of oral contraceptive pills. I think that they might benefit from some local estrogen testosterone cream.” They would say, I don’t know about that, and I’d respond “let me send you some articles. Let me tell you what I’ve learned.”

Now I can just pick up the phone or send them a text asking them to prescribe so and so. It really helped bridge that gap. The doctors now will say “Ok. I know something’s going on, but I don’t know if it’s muscular or tissue. I don’t have that training, what do you think?” So it’s just been such a collaboration, it’s been so great. Then I’ll go the reverse of that and watch them do a surgery, watch them do a procedure.

For our patients, we need to take that time and work with the physicians and develop that relationship with them, because it’s easy to pass it off as “that’s not my job.” Especially the vestibule! The gynecologist goes right through it and looks into the vaginal canal and then the urologist is like I’m going to look at the urethra but I’m not looking around it, let me just stick that scope in. This knowledge and ability to use differential diagnosis, for me just brings it all together.

Does your course have an online, pre-recorded portion as well as a live component?

Yes. There are about nine lab videos on manual techniques because everyone wants to know what to do. For me, it’s more about what you know. What can you identify and differentiate with the differential diagnosis. Then we have about two hours of just the basic lectures on general pain and overactivity of the pelvic floor so that we can spend our time in the live lecture getting into the very specific conditions that we as PTs are, not necessarily diagnosing, but recognizing and sending for further care. That’s really where I wanted this class to fill the gap between the urologist, the gynecologist, and the PT.

Is your course primarily vulvo-vaginal conditions or are there some penile, scrotal, or other conditions?

It is both male and female dysfunctions, and I have a few transgender cases. I don’t personally treat the transgender population very often so I only have a couple of examples of that. I have a lot of examples where I’m trying to get practitioners to recognize the problem by what the patient is saying and their history, and how to funnel this into their differential diagnosis. Case studies include different types of vestibulodynia and causes, all the different skin conditions…and it’s not necessarily something that they didn’t learn in one of the Pelvic Floor Series courses, but I wanted one class where they could just talk about all the sexual dysfunctions and get into some of the ones that we don’t see as often but are present.

We also talk about PGAD (persistent genital arousal disorder), and with male dysfunctions, we talk about spontaneous ejaculation and urethral discharge, post vasectomy syndrome. All of these things that you might not see every day, but when you see them you’ll recognize them so that you can help patients talk to the doctor and get the proper care. There are a lot of random, not as obvious, conditions that are not as prevalent. Then there are the common conditions that we see every single day like lichens.

What is the biggest takeaway that practitioners have who come into your class?

It is really being able to access and effectively use differential diagnosis. A lot of practitioners in the course are like “I always wondered what that was.” I have a ton of pictures that I share, and I’m like, I know you guys have seen this before. I think a lot of it is the differential diagnosis. The feedback that I get from every class is “I feel like I can go to the clinic on Monday and apply what I learned.” “I’m going to go buy a q-tip and start doing a q-tip test because now I know what to do with that information.” They feel that confidence of really being able to apply it, talk to the patient, talk to the doctors, and figure out that meaningfulness.

2022 Course Dates:
July 16-17 2022 and October 15-16 2022

Sexual Medicine in Pelvic Rehab is designed for pelvic rehab specialists who want to expand their knowledge, experience, and treatment in sexual health and dysfunction. This course provides a thorough introduction to pelvic floor sexual function, dysfunction, and treatment interventions for all people and sexual orientations, as well as an evidence-based perspective on the value of physical therapy interventions for patients with chronic pelvic pain related to sexual conditions, disorders, as well as multiple approaches for the treatment of sexual dysfunction including understanding medical diagnosis and management.

Lecture topics include hymen myths, female squirting, G-spot, prostate gland, female and male sexual response cycles, hormone influence on sexual function, anatomy and physiology of pelvic floor muscles in sexual arousal, orgasm, and function and specific dysfunction treated by physical therapy in detail including vaginismus, dyspareunia, erectile dysfunction, hard flaccid, prostatitis, post-prostatectomy, as well as recognizing medical conditions such as persistent genital arousal disorder (PGAD), hypoactive sexual desire disorder (HSDD) and dermatological conditions such as lichen sclerosis and lichen planus. Upon completion of the course, participants will be able to confidently treat sexual dysfunction related to the pelvic floor as well as refer to medical providers as needed and instruct patients in the proper application of self-treatment and diet/lifestyle modifications.

Audience:
This continuing education course is appropriate for physical therapists, occupational therapists, physical therapist assistants, occupational therapist assistants, registered nurses, nurse midwives, and other rehabilitation professionals of all levels and experience. Content is not intended for use outside the scope of the learner's license or regulation. Physical therapy continuing education courses should not be taken by individuals who are not licensed or otherwise regulated, except, as they are involved in a specific plan of care.

The following is an excerpt from an interview between Niko Gaffga, MD, FAAFP, MPH (NG) and Holly Tanner (HT) about why he is interested in women’s health and the menstrual experience. Niko and Amy Meehan, PT, DPT, MTC have co-authored a specialty course for H&W all about Menstruation and Pelvic Health – to learn more join us in the upcoming remote course on July 16th-17th, 2022. You can watch the full video interview below, or on the Herman & Wallace YouTube Channel.

HT – So menstruation as a topic, what is it that got you so passionate about this particular topic?

NG -Throughout my career and my training, women’s health and OB have been one of my favorite parts of my job. In recent years there was a patient who really inspired me. I came into the room, and she was sitting in the corner in the exam room of the clinic where I worked and she was crying. I came in and I asked, she only spoke Spanish…and  I asked her “ How are you doing? What’s happening?” and she was very reluctant to say anything.

I found out through a little bit of discussion that she was feeling pain, and she couldn’t make the pain go away. That she had seen many doctors about it and no one had been able to help her. She was reluctant to show me where on her body – maybe it’s because I’m a man, or maybe it was because she was from a different country – she didn’t feel secure. So I drew a little picture on a piece of paper, and I said “Just point to me on this paper where you feel the pain.” After a while of pointing, talking, and smiling I got to a point where she could explain to me what was happening.

 It turns out that she had painful bladder syndrome, or interstitial cystitis, and we worked over the months to get that better. And I have to say, that the next time that I walked into that the next time that I walked into that same room and she was there – she was smiling. She stood up and she gave me a hug – and I said to myself, “This is why I do medicine.”

I think really the breakthrough came when I met her where she was. I took the time to talk to her in her language, show her a piece of paper, and wait for her to say what she felt. Cause many doctors, you know how they only have two or three minutes to talk with their patients. When I met her halfway, she was able to talk to me about the pain she was feeling, about her menstrual cycles – which I don’t think she had ever discussed with any doctors before.

So that started me down the road in being interested in what can I do – what more can I do to help women. When I see women in the clinic a lot of them don’t want to say anything about their menstrual cycle, and again maybe it’s because I’m a man. Maybe it’s because it’s just a difficult topic to discuss, but I realize that in society we don’t have a lot of chance as men or women to talk about the menstrual cycle.

I feel that it is a disservice to women that they don’t have a chance to talk about things that genuinely interest them, are concerning to them, or have questions and are curious about. I feel that there is a stigma, and I think that this course will begin to address it within a small group. But I think eventually, training and working with healthcare providers is one step in making that message available to other people, and to other patients all around the country. So that is how it evolved for me.

One of the most important things for me is that talking about the menstrual experience and women’s health, in general, allows me to change, to give people information, to make decisions in their life that are in alignment with the way that they see the world. I think that not many professions can say that. You know medical professions, physical therapists, doctors, and many other professions - we help people do what they want to do for themselves, and that’s powerful. That’s very powerful.

I think that the most important thing is that I can make a difference in someone else’s life. I’ve seen it when talking to women in the clinic who I’ve seen before. Discussing their menstrual cycle and having them tell me this is the first I’ve spoken about to anyone, much less to a female or a male provider. Hearing someone say that is meaningful. It is a lot of trust that they place in someone to tell them these kinds of things because they are difficult topics. Seeing that you can make a difference in someone else’s life...it means a lot to me, and this is the reason why [I’m so passionate about women’s health and the menstrual experience].

Menstruation and Pelvic Health - July 16-17 2022

The Menstrual cycle is one of the most natural of all human processes and is experienced by half of the population of the world. At any given time, 800 million individuals are menstruating. The Menstrual cycle occurs roughly once a month for roughly 35 to 40 years in a lifetime. That ends up being almost 3000 days, or about 8 years of menses. Many menstruators experience “period shaming” and other forms of socialized stigma around the menstrual experience. It is therefore important to become familiar with this experience and provide care to patients that takes into account their Menstrual Experience.

This two-day remote continuing education course is designed for clinicians who want to obtain advanced knowledge and skills to educate patients on non-hormonal, non-surgical, and non-prescription interventions for improving the Menstrual Experience. Developed by Nicholas Gaffga, MD, MPH, FAAFP, and presented together with Amy Meehan, PT, DPT, MTC, this course is geared toward the pelvic rehab provider looking to impart Menstrual Interventions that:

1. Put control in the hands of people who menstruate to identify and carry out the interventions that are appropriate to them
2. Use a holistic approach and advanced knowledge and familiarity with body and mind
3. Emphasize healthy practices that can positively impact the Menstrual Experience and beyond, in areas such as mental health and chronic diseases
4. Discover root causes of issues, rather than quick fixes, to have benefits that are sustainable across the lifespan.

Amanda Davis, PT, DPT, PRPC can be found online at https://www.makeandmanifest.com/. She has generously shared her recent blog with The Pelvic Rehab Report. "Got 30 Minutes? 4 Underestimated Daily Practices to Make Your Lunch Break More Life-Giving" can be found in its original post on her website here: http://www.makeandmanifest.com/blog-lunchbreak/.

Hey there, I'm Amanda. Pelvic rehab therapist, endo warrior, girl mama (despite that whole endo thing), and creator of this space where I'm sharing the story of practicing what I preach and the wins and losses I gather along the way. I love early morning espresso, podcast binging, yoga pants, and scrolling Pinterest for my next obsession (heyyyy fellow libras!). My mission is to help women see the difference between "common" and "normal" and to take their physical, mental, and emotional health beyond the "that's just the way it is" mentality.

Hats off to my fellow 9-5ers who head home after a long day to jump right into their 5-9. If you’re like me, that second “career” includes (but definitely is not limited to) caregiver, dog walker, master gardener, professional organizer, chef, and housekeeper to name a few. Add in friendships that need energy, relationships that need time, those hobbies you swore you’d keep alive, and self-care you promised yourself you’d do…aaaaand the whole multi-passionate, multi-talented, multi-hyphenate thing can get overwhelming quick.

After a glorious five-month maternity leave, I’ve officially been a working mom for a year. I love my job and I love my girl, and while trying to fit both in a 24 day is challenging and exhausting, it’s what’s right for me in the season I’m in. Plus there’s something about pursuing my calling outside of the home and knowing Sloan’s watching me do it.

RELATED POST: 9 Ways to Practice Self-Love as a New Mom on Maternity Leave

We’ve all chased that ultimate goal of a *perfect* balance and ~seamless~ blend between work and home, but in full disclosure, I’ve gotta tell ya— it’s hard for me to do. I’ve found myself coming home drained, dying for a break, wishing I could just lock myself in a quiet room, and feeling guilty for all of the above.  Being with my daughter is the best part of my day, but I’m often just too depleted to enjoy it.

Maybe you can relate? Maybe you’re also trying to work to live but find those words flipping themselves around more than you care to admit.

I recently took an online course called Boundaries, Self-Care, and Meditation for the Pelvic Rehab Therapist, Part 1 (part 2 is on June 12). As a PT I’m required to take continuing education to keep my skillset relevant and knowledge fresh, but the pending burnout I shared with you above led me to [this] course instead. To put it simply, it was [insert explosion sound here] mind-blowing; and call me dramatic, but I consider my practice, my patients, and myself as a person and professional forever changed because of it.

While I could write at least ten posts on all the things I learned in this class, the concept that’s been most life-altering for me was how I spend my lunchtime. Yep!…just a few tweaks to those 30 minutes mid-day and not only are my afternoons more pleasant and productive, but I’m going home refreshed, renewed, and ready to spend my time and energy on alllllllllll the other people and things that mean the most to me.

RELATED POST: Your Day Starts at Bedtime: 25 Easy Habits for a Better Night’s Sleep

RELATED POST: Promote Health + Prevent Burnout: A Pelvic Rehab Therapist’s Guide to the ~Perfect~ Self-Care Day

What you’ll find next is how I structure my lunchtime for life-giving success— a strategy that serves me most. We all have different work environments, different physical and mental needs, and different priorities. As long as your cup feels full(er) at the end of your break, I can confirm you’re doin’ it right.

SHUT YOUR DOOR
I fully realize that not everyone has an office door they can shut during lunchtime, but as long as you can get somewhere semi-quiet and remotely alone, that should do the trick (heck…I’ve been known to go out to my car in a pinch). Creating a calm and centered environment has proven paramount to taking a true “break” from the day and will make all of my recommendations to follow that much more enjoyable.

If you’re worried about appearing “selfish” or “standoffish”…I was too. But after a week’s worth of lunches behind a closed door, I realize the positives of this practice far outweigh the negatives I was creating in my head. I’m still a team player. My coworkers still know where I am if they need me. But I’m a better colleague the other eight hours of the day when I take these 30 minutes to myself, and to my knowledge, there have been no complaints so far.

STOP TO EAT
To my fellow multi-tasking queens— if you only read one part of this post, let [this] be it as I believe this one change has made the biggest difference.

I used to spend my lunch catching up on paperwork, tending to emails, paying bills, online shopping, and then resort to scrolling social media if all of that was done. But I was eating during all of it and realized that not only was it taking me twice as long to complete tasks, but I wasn’t tasting, appreciating, or ultimately enjoying my food, all huge components of appetite, digestion, and ultimately nutrition and health.

My lunches aren’t anything fancy; in fact, 99% of the time they’re leftovers from earlier in the week (helloooooooo my trusty 3-day-old grilled chicken). But stopping to eat with intention and nothing other than a little music or podcast playing in the background has surprisingly, but positively, affected how much I consume, how my gut feels afterward, and the amount of energy I have for the rest of the day.

PS- What you eat can make a huge impact here too. I aim for whole, quality foods full of healthy fats and filling proteins to set me up for success. I’m someone who can eat the same thing again and again, so you’ll typically find my lunchbox full of that good ol’ grilled chicken, boiled eggs, fruit, cheese, and rice noodles if I’m feelin’ feisty.

LEARN
On top of that podcast I have playing while I eat, I’ve started spending ten to fifteen minutes learning during lunch. I literally set a timer, pull out a book, and read about something that fuels my brain.

In order to make these minutes a 10/10, here’s a few tips to uplevel the experience:

• Get comfortable. Find a place to prop your feet up or lean that car seat back (this is in part why I set a timer…juuuuuuuust in case I fall asleep). Have water nearby, a blanket tucked away if it’s cold, and don’t hesitate to indulge in all the ways even if for just a short period of time.

• Read about something unrelated to your occupation. For instance…I’m a pelvic rehab therapist but you won’t see me catching up on the latest research in anatomy and physiology. I typically grab a book on self-improvement, business and marketing, or homesteading, and my brain feels so much more recharged when it gets to focus on something that builds me up as a passionate person outside of my profession.

• Use a physical book. Seriously…no kindle, no phone apps, no audiobooks. Chances are you’re looking at a screen, listening to people talk, or a combo of the two all day long. Digging into an actual hard copy will access other parts of your brain that you may not be tapping into as regularly and result in faaaaaaaar more feel-good-ness.

When I became a mom I went from devouring a few books a month to being able to count my yearly reads on one hand. Reading on my lunch break has made me excited to learn again and reminded me of who I am outside of motherhood too (in turn making me a better mama). Even if reading isn’t your “thing”, at least give this one a try. Bonus if you utilize your local library because their books just smell better and we’re going for indulgent here…remember?

MOVE
Eat…ten minutes. Learn…ten minutes. If you’re like me and have ten more minutes to spare, then I encourage you to move your body with that time. While the options are endless, I try to avoid sweating too much in the middle of the work day, so walking, stretching, and even deep breathing exercises are more my speed. Whatever you decide to do, make sure you have the shoes, yoga mat, or whatever it is you need ready to go.

RELATED POST: Easy + Impactful Ways to Use Your Time Confetti to Improve Your Pelvic Floor Health

Not only does research show that movement improves your mood and elevates your energy, but there are also the physical benefits (duh!) and mental resilience that comes with knowing you’re taking care of yourself when you could be doing something else. Once fearful of wasting precious energy, I now consider my mid-day movement the boost I need to ensure I’m ready to go when I get home because let me tell ya…one year olds don’t quit.

One look at my Pinterest boards and you’ll see I’m a girl who has a lot she wants to accomplish (I see you dream house, list of must-reads, vacation itineraries, and yummy recipes just dyyyyyying to be made). But with a 24-hour day divided in thirds between work, sleep, and “other”, I have to use my time wisely to see success in a life where I’m more often than not choosing the option of (D) ALL OF THE ABOVE.

I don’t mean to be dramatic, but hacking my 30-minute lunch has ~literally~ changed my life and I’m a better physical therapist, caregiver, dog walker, master gardener, professional organizer, chef, and housekeeper (to name a few) because of it. There’s a saying that if you can’t go big, go home, but this is an instance where you can’t underestimate the power of a few minutes spent intentionally where it counts.

I’d love to hear in the comments what you do for work, if these strategies work for you, and ways you’ve made them your own. And don’t hesitate to share this one with a coworker who could use these strategies too! Nothing makes me happier than picturing us all spending half an hour in that 11-2 time frame-filling our cups for full-day success. I have a feeling you’ll be surprised at the impact this can have, and I can’t wait to watch you grow one lunchtime at a time.

Boundaries, Self-Care, and Meditation - Part 2 - Remote Course - June 12, 2022

This course focuses 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". The 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.