This week the interviewer becomes the interviewee as Stacey Futterman Tauriello sits down to interview Holly Tanner on the Male Pelvic Floor course.
Stacey Futterman reached out to Holly Tanner back in 2007 through a phone call to see if they could partner on a lecture covering male pelvic pain. The two had never met in person but decided to collaborate on the three-hour APTA National Conference lecture. Holly shares "I still recall the frequent glances I made to match the person behind the voice I had heard for so many long phone calls.”
This presentation was developed into a two-day education course for Herman & Wallace and contained lectures on male anatomy, post-prostatectomy urinary incontinence, pelvic pain, and sexual health and dysfunction. The big question of the time was “should we allow men to attend?” Holly puts this in perspective, “As strange as this question now seems, it speaks volumes about the world of pelvic health at that time; mostly female instructors taught mostly female participants about mostly female conditions.”
The Male Pelvic Floor course was first taught in 2008 and has since been expanded to include 22 contact hours. This current content includes 7 pre-recorded lectures and 2 full days of live lectures and labs, allowing more time for hands-on skills in examination and treatment. The schedule still covers bladder, prostate, sexual health, and pelvic pain, and further discusses special topics like post-vasectomy syndrome, circumcision, and Peyronie’s disease.
Because the course often has providers in attendance who have not completed prior pelvic health training, instruction in basic techniques is included. For the experienced therapists, there are multiple lab “tracks” that offer intermediate to advanced skills that can be practiced in addition to the basic skills. Holly adds, “One of the more valuable conversations that we have in the course is how to create comfort and ease in when for most us, we were raised in a culture (and medical training) where palpation of the pelvis was not made comfortable. Hearing from the male participants about their bodies, how they are affected by cultural expectations, adds significant value as well.”
In 2017 Herman & Wallace faculty member, Heather Radar submitted a blog where she wrote about a note that was left on her doorstep by the wife of an older gentleman who had chronic male pelvic pain. When looking into writing this blog I kept coming back to this past blog by Heather, and I have decided to share an abridged version today to accompany Holly Tanner's short interview discussing the Male Pelvic Floor Satellite Lab Course.
Recently, a note was left at my doorstep by the wife of an older gentleman who had chronic male pelvic pain. His pain was so severe, that he could not sit, and he lay in the back seat of their idling car as his wife, having exhausted all other medical channels available to her, walked this note up to the home of a rumored pelvic floor physical therapist who also treated men. The note opened with how she had heard of me. She then asked me to contact her about her husband’s medical problem. It ended with three words that have vexed me ever since…we are desperate. We Are Desperate.
Unlike so many men with chronic pelvic pain, he had at least been given a diagnostic cause of his pain, pelvic floor muscle dysfunction, rather than vaguely being told it was just a prostate issue. However, the therapists that had been recommended by his doctor only treated female pelvic dysfunction.
My first thought after reading the note was, “I bet shoulder or knee therapists don’t get notes like this on their doorstep.” My next thought, complete with facepalm, “THIS HAS TO STOP! Pelvic floor rehab has got to become more accessible”.
Pelvic floor therapists see all people including men, women, and transgender. They treat the pediatric, adult, and geriatric populations. They treat pelvic floor disorders in the outpatient, home health, and SNF settings. They treat elite athletes and those with multiple co-morbidities using walkers. They can develop preventative pelvic wellness programs and teach caregivers how to better manage their loved one’s incontinence. This is due to one simple fact: No matter the age, gender, level of health, or practice setting, every patient has a pelvic floor.
The pelvic floor should not be regarded as some rare zebra in clinical practice when it is the workhorse upon which so many health conditions ride. It interacts with the spine, the hip, the diaphragm, and vital organs. It is composed of skin, nerves, muscles, tendons, bones, ligaments, lymph glands, and vessels. It is as complex and as vital to function and health as the shoulder or knee is, and yet students are lucky if they get a “pelvic floor day” in their PT or OT school coursework.
I call for every therapist, specialist, and educator to learn more about the pelvic floor. If you only treat pelvic dysfunction in women, please consider expanding your specialty to include men. The guys really need your help. You literally may be the only practitioner around that has the skills to treat these types of problems. Yes, the concerns you have about privacy and feeling comfortable are valid. But, you are not alone in this. Smart people like Holly Tanner have figured all that stuff out for you and can guide you on how to expertly treat in the men’s health arena.
The Silver Lining. Thanks to the champions of pelvic floor rehab education, we’ve come a long way. The good news in this story is that this man’s doctor recognized early that he had pelvic floor muscle dysfunction and recommended that he see a pelvic floor physical therapist. The bad news-it took 2 years before he could find one. The ball is in our court, therapists. Let’s do better. Until there are no more men in the back seat, we still need to #LearnMoreAboutThePelvicFloor.
We need to continue to create more coursework and more clinical training opportunities so that the representation of those treating male patients improves. If you feel ready to take your training to the next level in caring for male pelvic dysfunction, join us for an upcoming Male Pelvic Floor Satellite Lab Course.
Male Pelvic Floor Satellite Lab Course is scheduled on several dates and satellite locations for 2022, including self-hosted course options. Dates include:
In today's interview, Holly Tanner sits down with Stacey Futterman Tauriello, PT, MPT, WCS, BCB-PMD to discuss her approach to pelvic rehabilitation. Stacey received her Master’s Degree in Physical Therapy from Nova Southeastern University in South Florida in 1996. After graduation, she relocated to Chicago where she began specializing in women’s health issues including the treatment of incontinence, pelvic pain, and prenatal/postpartum musculoskeletal issues. She returned to the east coast in 2003 and is now the owner of 5 Point Physical Therapy, a specialty physical therapy clinic for male and female pelvic dysfunction in New York City.
What clinical pearls do you have for practitioners working with labral tears?
Return to sport has to be discussed on day one. Figuring out what that path is. It's ok that it is slow, but the patient needs to understand that they are going to progress in a fashion to get them stronger and more stable.
You always have to have stability before you have mobility.
You need that background knowledge of getting them stronger without flaring up their pelvic floor symptoms. You have to release and restore, release and restore, release and restore. You got to understand the "why" component. Why are they having so much pain? What can you do to strengthen without flaring? I think that is huge.
What excites you about exercise approaches?
The first thing that got me excited was that I saw that I was doing a lot of things right. One of the biggest takeaways...was the neuromuscular reeducation portion of the exercise...That really task-specific brain reeducation with every exercise...I often think of neuro as Parkinson's. So a Parkinson's patient if you want them to walk and lift their leg (because they're shuffling), you would put something in front of them and say step over it.
Your daughter is 3 and a half years old now. How has going through pregnancy, birth, and postpartum changed your approach with pregnant and postpartum patients?
I did an interview in 2019 with the Today Show on postpartum motherhood and the pelvic floor, both from the patient and the practitioner's standpoint.
It's changed my perspective completely. From the process of getting pregnant, I was in my 40s, so I was an older mom, to being pregnant, having some issues during pregnancy. And then the actual delivery was...it's not great being a pelvic floor physical therapist trying to push a baby out of your vagina...but you have to go through it. Then you realize too that your postpartum experience is all about healing. As much as it's easy for somebody that's 21 to give birth and bounce back. A lot of the women who are having babies right now are in their 30s and 40s. Their bodies don't respond the same, especially not during covid.
It's a game-changer right now, things are different. Yeah, I had incontinence after I gave birth, I still struggle. My body, within covid from not exercising and going to the gym and everything still takes a toll. I feel like it made me more empathetic to some of my pregnant patients.
Is there a clinical pearl or fun phrase that comes to mind that you use?
One of the big phrases that I use comes from Pam Downey, and it is "healthy tissue doesn't hurt."