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Post-Traumatic Stress Disorder

The first time I experienced the effects of Post-Traumatic Stress Disorder (PTSD) was when my patient dissociated during a treatment session and relived the rape that had occurred when she was ten years old. It was devastating. I didn’t know what to do. She was unresponsive to my intervention. Her eyes didn’t see me, alternating between wide-eyed, horrified panic and clenched-closed, lip biting excruciating pain. It was my late night and I was alone in the clinic. I sat helplessly next to my sweet patient hoping and praying that her torture would end quickly. When she finally stopped writhing, she slept. Deep and hard. Finally she woke up disoriented and scared. She grabbed her things and left. For me, this experience was my initiation into the world of trauma.

Approximately 5-6 % of men and 10-12% of women will suffer from PTSD at some point in their lives. Researchers believe that 10% of people exposed to trauma will go on to develop PTSD. The expression of PTSD symptoms can present differently in men and women. Men may have more externalizing disorders progressing along a scale that includes vigilance, resistance, defiance, aggression and homicidal thoughts. Women tend to present with internalizing disorders such as depression, anxiety, exaggerated startle responses, dissociation, and suicidal thoughts. The research is clear that both men and women with PTSD display changes in brain function. The mid brain (amygdala, basal ganglia and hippocampus) tends to be overactive in sounding alarm signals while the prefrontal cortex fails to turn off the mid brain when a threat is no longer present. Since the prefrontal cortex is not always functioning correctly, traditional talk therapy may not be as effective for treating PTSD. Instead, say many researchers, breath and movement exercises may help regulate brain functioning. Yoga, Tai Chi, and meditation have been shown to have a positive impact on down regulating the mid brain and improving cerebral output. As pelvic floor therapists we deal with trauma on a daily basis, whether we know it or not. Although we are not trained in psychology, understanding PTSD and equipping ourselves with tools to support our patients is imperative for both our patients and ourselves.

You might be wondering what happened after that frightful night in the clinic? My patient was determined to get better. She had a non-relaxing pelvic floor. She was a teacher and was plagued by urinary distress. She either had terrible urgency or would go for hours and not be able to empty her bladder. So we met with her therapist to learn strategies to help us to be able to work together without triggering dissociation. It was a slow road, but the three of us working together helped my patient not only reach her goals but to be able to be skillful enough to maintain her gains using a dilator for self-treatment.

If you would like to learn more about PTSD, meditation, yoga, chronic pain, psychologically informed practice and self-care for patients and providers please join Nari Clemons and I in Tampa in January as we present a new offering for Herman and Wallace, “Holistic Intervention and Meditation.” We would love to see you there.


Bremner, J. D. (2006). Traumatic stress: effects on the brain. Dialogues in clinical neuroscience, 8(4), 445-461.
Kerr, C. E., Jones, S. R., Wan, Q., Pritchett, D. L., Wasserman, R. H., Wexler, A., ... & Littenberg, R. (2011). Effects of mindfulness meditation training on anticipatory alpha modulation in primary somatosensory cortex. Brain research bulletin, 85(3), 96-103.
Morasco, B. J., Lovejoy, T. I., Lu, M., Turk, D. C., Lewis, L., & Dobscha, S. K. (2013). The relationship between PTSD and chronic pain: mediating role of coping strategies and depression. Pain, 154(4), 609-616.
Olff, M., Langeland, W., & Gersons, B. P. (2005). The psychobiology of PTSD: coping with trauma. Psychoneuroendocrinology, 30(10), 974-982.
The Role Of Yoga In Healing Trauma

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Upcoming Continuing Education Courses

Mobilization of Visceral Fascia 2: The Reproductive System - Medford, OR Satellite Location

Oct 1, 2021 - Oct 3, 2021
Location: Asante Rogue Valley Medical Center

Oncology of the Pelvic Floor Level 2A - Remote Course

Oct 2, 2021 - Oct 3, 2021
Location: Replacement Remote Course

Pregnancy Rehabilitation - Remote Course (SOLD OUT)

Oct 2, 2021 - Oct 3, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A - Marietta, GA Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 2A - Self-Hosted

Oct 9, 2021 - Oct 10, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2A - Livonia, MI Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Mendelson Kornblum Physical Therapy

Pelvic Floor Level 1 - Torrance, CA Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Women's Advantage Inc

Pelvic Floor Level 2A - Smyrna, TN Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Benchmark Physical Therapy - Smyrna, TN

Pelvic Floor Level 2A - Columbia, MO Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Mizzou Therapy Services

Pelvic Floor Level 1 - Little Rock, AR Satellite Course

Oct 9, 2021 - Oct 10, 2021
Location: Core Pelvic Physical Therapy

Inclusive Care for Gender and Sexual Minorities - Remote Course

Oct 9, 2021 - Oct 10, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2A Satellite Lab Course - Tacoma, WA - Octomber 9-10 2021 (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Olympic Sports and Spine

Sacral Nerve Manual Assessment and Treatment - Remote Course

Oct 9, 2021 - Oct 10, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Doylestown, PA Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Doylestown Hospital

Pelvic Floor Level 2A - Tallahassee, FL Satellite Course

Oct 9, 2021 - Oct 10, 2021
Location: Be Strong Therapy

Pelvic Floor Level 2A - Kenosha, WI Satellite Course

Oct 9, 2021 - Oct 10, 2021
Location: Aurora Sports Health Pershing

Pelvic Floor Level 2A - Birmingham, AL Satellite Course (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: TherapySouth

Pelvic Floor Level 1 - Baltimore, MD Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Sparks Physical Therapy

Pelvic Floor Level 1 - Syracuse, NY Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Onondaga Physical Therapy

Pelvic Floor Level 1 - El Paso, TX Satellite Location (SOLD OUT)

Oct 9, 2021 - Oct 10, 2021
Location: Border Physical Therapy

Pelvic Floor Level 1 - Self-Hosted

Oct 9, 2021 - Oct 10, 2021
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Gastrointestinal System - Self-Hosted

Oct 15, 2021 - Oct 17, 2021
Location: Self-Hosted Course

Mobilization of Visceral Fascia: The Gastrointestinal System - Medford, OR Satellite Location

Oct 15, 2021 - Oct 17, 2021
Location: Asante Rogue Valley Medical Center