Ulcerative Colitis (UC) dramatically effects a patient’s livelihood.  UC is often confused with Crohn’s Disease, another major inflammatory bowel disease.  While they do differ in origin, both diseases share similar symptoms, such as blood in a patient’s stool.  Furthermore, like Crohn’s Disease, UC tends to affect young people (those between the ages of fifteen and thirty).

Chronic and often severe, UC has no known cure and, in rare cases, can even be life-threatening to the patient.

The Daily Mail posted a news article about Manchester United’s Darren Fletcher, who recently underwent his third surgery for UC.  Over the last few years, Fletcher has frequently struggled to stay fit.  He has played just thirteen games since December 2011.

Multiple surgeries, as in Fletcher’s case, are not uncommon.  UC spreads and deeply infects the lining of a patient’s colon and rectum.  Although there is no known cure, correctly applied therapy has been known to markedly reduce symptoms and even lead to long-term remission.

Herman & Wallace offered their first on Bowel Pathology and Function in Stony Brook, NY last month and is in the midst of confirming dates for another course in 2014.  Keep a look out for updates!

Urinary Incontinence (UI) is about as pervasive of a condition as any.  Allegro Medical posted a blog recently on “Managing Bedtime Adult Urinary Incontinence.”  As they note in their piece, over “one-third of adults wake up at least twice during the night” to urinate.

Nearly everything that involves the uncontrolled outflow of urine is a type of urinary incontinence.  Meaning, the underlying cause of Urinary Incontinence can be anything from diet to dehydration to weak pelvic floor muscles.

While UI is most pervasive in men over forty, women of all ages, especially pregnant and postpartum women, are affected.  For patients, this can be an exhausting and embarrassing affliction so much so that many do not seek out medical professionals for treatment.

Our Urinary Incontinence Manual is specifically designed to focus on adult UI and includes everything from educational tools for patients to resources for marketing an incontinence practice.  Purchasers receive the product electronically after they purchase, and all forms are customizable with your own clinic’s info and logo.  Check out this and other offerings on our Products page!

Sacroiliac Joint (SIJ) Dysfunction is a common cause of lower-back and pelvic pain.  Although athletes suffer frequently from SIJ Dysfunction, this condition can also affect many others, including and especially pregnant women.  The SMART Clinic wrote a blog post about SIJ Dysfunction recently, explaining that, “Women during pregnancy can experience SI Joint pain due to the release of a hormone called “relaxin” that creates instability (unstableness) within the SI joint.”

Nearly 80% of Americans suffer from lower back pain at some point in their lives, and lower back pain “is the most common cause of job-related disability, and a leading contributor to missed work” in the United States.  For those who suffer from persistent back pain, SIJ is the confirmed point of origin in 13% of cases.

Frequently painful and sometimes debilitating, SI joint dysfunction is surprisingly easy to develop.  Like many other pelvic conditions, everything from bending-over to sitting-down can lead to SI joint dysfunction.  Traumas like sports-related injuries and traffic collisions are other frequent precursors.  SI joint dysfunction can rarely be addressed by surgery (and, even more rarely, should it.)

Herman & Wallace will be putting on a course about treating SIJ Dysfunction in Tampa, FL this October.  This course, focusing on treatment and evaluation of both the sacroiliac joint and the pelvic ring, will focus on what influences and upsets the SI joint.

Seats are limited – register today!

In 2011, the FDA issued a warning to patients and medical professionals that transvaginal mesh implant surgery for pelvic organ prolapse (POP) often created more problems than it solved.  The warning also noted that “there was no clear evidence transvaginal POP mesh repair was more effective than non-mesh repair” for treating POP.  Furthermore, the FDA report emphasized that the mesh itself, rather than surgical error, lead to pelvic pain in many patients.

However, transvaginal mesh implant surgery remains a commonly recommended treatment for POP.  A Justice News Flash post, titled “Don’t Wait In Vain For Pelvic Pain To Resolve After Removal of Mesh Implants”, recently discussed how this surgery often leads to the development of Pudendal Neuralgia in patients, “more often than not [requiring] complete removal of the mesh.”  In short, in lieu of sending these patients to trained physical therapists, and, in spite of FDA warnings, many medical professionals continue to recommend transvaginal mesh implant to treat POP.

Pudendal Neuralgia, already an underdiagnosed, undertreated, and underserviced illness, is noted for how few therapists and other medical professionals have the proper training to treat it.  Peripheral nerve regeneration can take up to six months for patients who developed Pudendal Neuralgia after surgery.

Ultimately, it is the patient who is left to suffer for extended periods of time and go through unnecessary procedures.  Patients with either POP or Pudendal Neuralgia would be much better served by a trained pelvic rehabilitation professional than a doctor who is unaware of, or ignores, alternatives to a surgery that FDA warnings against.

For pelvic rehab professionals, this means that asking about previous surgery, particularly transvaginal mesh surgery, is vital to treating patients who suffer from pelvic pain.

This August, Herman & Wallace is proud to offer a course on Treating and Assessing Pudendal Neuralgia in Altanta, GA.  We hope to see you there!

While on a walk with my son recently, as he was collecting sticks, he casually repeated the phrase "sticks and stones may break my bones, but words can never hurt me..." and it allowed us to have a brief discussion about how words can, and do, hurt people. Parents today are armed with terrific tools to learn about emotional intelligence, and how the power of language can, for example, help preserve a child's self-esteem while the parent still sets up boundaries. How often are we trained as adults to pay attention to the phrases, gestures, or words that we use during adult interactions, or in patient care interactions? Think about a mentor, supervisor, or friend who you admire- who you aim to emulate. What is it about the person's interactions you find inspiring? Is it the command of the situation she has, the compassion she exudes, or the intelligent way she can say things to a patient? Regardless of the trait you are admiring, communication is likely a key factor in the interactions you find pleasing.

A recent MedScape article asks doctors to share words they let fly, only to wish they could take them back. We have all spoken in haste, in frustration, or in jest, only to realize that we have offended a patient, a family member, or a colleague. The most important thing in that situation may be the actions that follow the indiscretion. And as many martial arts traditions teach, the highest form of self-defense is to avoid conflict in the first place, so how can we best position ourselves to avoid using phrases, gestures, or other communications that offend and create barriers between ourselves and the patient? The most critical part of the solution is awareness. We all use phrases that are so commonly part of our everyday life we don't even know we are using them. It could be "cool" or "is that right?" Do you really mean that a patient's response to your intervention is "cool?" And do you really want the person to clarify if what they are saying is true? What if we took the world as literally as some of the children in our lives do? What would our day look like? Looking at some typical, and lazy ways that we talk, is is accurate to say the following?

• I'm starving
• I wanted to die
• He is so worthless
• You'll be fine
How many of us are truly starving in our communities? Is someone worthless simply because you did not get a return phone call? Will the patient be fine, or do you need to say so because you want to feel less worried?
And how do you feel about the person who begins a discussion with these?
Let me be honest with you
Here's what you need to do
I hope this doesn't offend you
I realize this might seem like micromanagement of every single word out of the mouth. I encourage you to try sometime being truly, excruciatingly aware of what you say, even for an hour. If you invite the kind of honesty required to make habit changes, you could ask a colleague if there are any phrases you often say that are annoying, or not useful. You could ask a student to write down phrases you use in patient care and then compare those phrases to more inspiring language you could employ. The next time you give a presentation, ask a trusted colleague how your use of language was perceived. You may be unpleasantly surprised to find out that you used the word "like" as if it were going out of style (and it did...) When we are really comfortable with our patients, perhaps we have treated them off and on for a few years, or they simply are a person we get along well with, dropping into casual conversation, dropping an f-bomb, or confiding personal details can happen. If you find yourself in this situation, you might simply apologize with a smile, and state that you forgot your manners, and request the patient forgive your casual attitude. We are always in a power situation with our patients, and can never assume that a casual attitude is not misconstrued.
Another habit that can cost you a patient, or a promotion for that matter, is using phrases that come across as callous, or using gestures that indicate a lack of sensitivity. Are you someone who holds the imaginary gun to your head and pulls the trigger when you want to express how maddening a situation was? What do you know about the person to whom you are talking? Did a loved one commit suicide? Again, intention does not really matter once you have completed an act that hurts or offends, and only by improving our awareness of every word, every hand gesture, can we work towards always saying what we mean, and being careful with other people's trust. Hand gestures outside of our own cultural awareness is another topic fraught with the potential to make a wrong move. When in doubt, check in with what your hands are doing: hold on tight to your pen, clipboard, or theraband, and avoiding pointing, thumbs up sign, and other common gestures that may not mean what you think it means.
While sensitivity of language and gestures takes effort, awareness, and being able to take feedback with openness, everyone wins in the end.

Total Physical Therapy recently posted two excellent videos on the pelvic “dump”: the Pelvic “Dump” and Muscle Length and the Cure for the Pelvic “Dump”.  The first video describes how the hamstrings, abductors, and the gluteal (“glutes”) muscles affect pelvic “dump”, also known as the pelvic tilt.  The second examines stretching techniques that can ease the tightness and, thus, treat pelvic tilt.

Pelvic tilting occurs when the pelvis is not orientated correctly, and is becoming more and more common as sedentary lifestyles bceome the norm in America.  Daily activities, such as sitting at a computer for example, can often lead to a pelvic tilt.  Resting against the back of one’s chair or leaning forward to read small print can feel more supportive than utilizing the correct muscles required maintain proper posture.  To put it another way, when doing activities many Americans do daily, it is often easier to rest one’s body on another surface for extended period of time than it is to exercise proper biomechanics.

However, this behavior often leaves patients with pain and stiffness in the back, knees, and hips.  Furthermore, if left untreated, these symptoms have a tendency to become more severe over-time.

This August, Herman & Wallace will be presenting a course on the Biomechanics of the Hip & Pelvis. In the course, instructor Steve Dishavi will show a number of videos on proper posture and body mechanics, and instruct on how to analyze a patient’s movement and make corrective recommendations.

Seats are limited.  Register today!

For more than sixty years, Kegel exercises have been a common, albeit rudimentary, form of treatment to strengthen the pelvic floor.  These exercises have become so omnipresent that the pelvic floor is commonly known colloquially as the “Kegel muscle.”  Perhaps best known by the public for their ties to increased sexual function, Kegel exercises are often inappropriately considered the hallmark of pelvic floor wellness.

In a recent Chronogram article, titled “Could Your Pelvic Floor Use a Renovation?”  Wendy Kagan describes the significance of Kegel exercises: “Today they’re a first-line defense against genital prolapse and urinary stress incontinence (i.e., leakage that occurs with jarring movements like coughing, jumping, or lifting). Dreaded by some, championed by others, Kegels are the pelvic equivalent of flossing—something most women know they should do, yet often guiltily do not do.”

The biggest problem with this article is that Kegels are not the “first line of defense”.  Nor are they, necessarily, the best practice for everyone’s daily regimen.  Prescribing pelvic floor strengthening without properly assessing the pelvic floor can be harmful for patients.

Kegels have become more popular in the public sphere.  Popular exercise programs such as Yoga and Pilates often include Kegel exercises as part of their routines.  Some have over-expressed the sexual benefits of Kegels.  One hardly can open a Cosmo without finding an article on Kegel exercises for enhanced performance and pleasure during sexual activity.  Furthermore, for men, Kegels have been prescribed as solutions for everything from erectile dysfunction to premature ejaculation.  As popularity and awareness has grown, many have taken to performing Kegel exercises without speaking to a professional, which is never a good plan for benefiting one’s health.

However, the popularity of Kegels brings with it a public recognition that pelvic floor health is imperative and deserves to be cared for actively.  Though not quite the silver bullet that Kagan’s article suggests, when properly recommended by a PT, Kegels, can be an important tool in treating patients. .  As we examined in a past Pelvic Rehab Report: “Pelvic Floor Muslces: To Strengthen or Not to Strengthen?”, doing Kegels correctly is more than just tightening the muscles: “If a patient presents with pelvic muscle tension, shortening of the muscle, and poor ability to generate a contraction, a relaxation phase, or a bearing down of the pelvic muscles, how in the world will trying to tighten those overactive muscles bring progress?”

Herman & Wallace recently began developing a product to help therapists educate and treat patients on how to properly execute Kegel exercises.  Check out “All About Kegels” to learn breathing techniques and exercises to help patients effectively build pelvic floor strength.

While many prenatal women practice yoga to stay healthy and fit during pregnancy, prenatal yoga is becoming a more and more popular tool to prepare women for labor.  The topic of prenatal pregnancy was recently covered in the Welland Tribune.  The article, titled “Prenatal Yoga Gets Women Ready for Birth,” follows Angela Sacco, a registered nurse and pre- and post-natal fitness specialist. Sacco has attended more than 100 births.  Her eight-week program is specially-tailored to aid pregnant women as they prepare for giving birth.

According to Sacco, “Yoga in the delivery room, be it home or hospital, is meant to relieve pain, build confidence and make it all go quicker.”

Although the fitness benefits – enhanced strength, stamina, and flexibility – are significant, Sacco’s program’s greatest asset may be that it allows participants to understand the natural processes of child-birth.  Furthermore, with this understanding comes vital confidence, intangible equally central to a successful labor.

This September, H&W will be offering a course on Yoga for the Pregnant Patient.  This course is designed to teach therapists on how to safely recommend yoga prescriptions through each stage of pregnancy.

This November, Herman & Wallace is proud to bring our Differential Diagnostics of Chronic Pelvic Pain and Dysfunction to Orlando, FL!  This three-day course is taught by Peter Philip, PT, ScD, COMT.

Pelvic Rehab Report sat down with Peter recently to talk to him about his course.

What can you tell us about this continuing education course that is not mentioned in the “course description” and “objectives” that are posted online?

There are many cause of pelvic pain! For instance, the pudendal nerve is often implicated as the sole source of pelvic pain, and this is simply not true.  This course covers multiple reasons and nerves that can cause pelvic pain and dysfunction, and instructs participants on how to determine the exact tissue at fault when approaching patients with pelvic pain and dysfunction.

The course also covers the multiple factors and etiologies leading to the formation of muscle spasms, so that muscle spasms can be treated and, ultimately, eliminated.

At the course, the clinician will learn to determine the origin along the neuroaxis where his/her patient’s pain initiates, and - more importantly - how to specifically address and remedy the patient’s ailments.

The lecture portion of the course is based on applied anatomy and differential tissue tension. Lab sessions cover palpation strategies.  After the course, there will be no more ‘guessing’ which and what structure is being palpated; the clinician will know.

The clinician will learn how to palpate, test and treat the anterior sacroiliac joint ligament, and learn its role in not only pelvic pain, but lower back pain as well.

The course also covers how to specifically test each sacral nerve, and to determine its contribution to the patient’s pain and dysfunction.

Using these techniques, I expect to have a positive impact on my patient population within three visits. The goal of my course is to teach other clinicians to do this for their patients too.

What inspired you to create this course?

My first patient with pelvic pain took his own life as a result of his persistent pain, and the secondary losses of career and relationships. This had a huge impact on me, and was coupled with a frustration that I felt because there wasn’t a means of accurately determining the exact tissue at fault in the initiation and perpetuation of a patient’s pain and dysfunction.

What resources and research were used when writing this course?

Over fifteen years of research and clinical experience went in to the development and formation of the content and information presented in this course.  I drew from the orthopedic, neurophysiologic, urogynecologic and pathophysiologic practices and research and integrating these practices into a unified, progressive evaluation and treatment strategy.

Can you describe the clinical/treatment approach/techniques covered in this continuing education course?

The general concept is that every pain has a source.  It is up to the clinician to determine what that cause is, and to formulate a treatment strategy that reflects and accurately addresses the tissue(s) at fault.  In doing so, both the clinician and the patient will notice immediate resolution of pain, spasm and dysfunction.

Why should a therapist take this course?  How can these skill sets benefit his/ her practice?

This course provides all clinicians with the opportunity to understand the entirety and complexity of the patient with pelvic pain, and dysfunction.  The clinician will understand the role and interaction of the brain, spinal cord, spinal joints, sacroiliac joint, hip joints, ligaments of the spine and sacroiliac joint, and individual nerve roots have in the initiation and perpetuation of their pain and dysfunction.

This course is a must for clinicians who are eager to learn more about chronic pelvic pain and dysfunction.  Seats are limited so register today!

For the last few months, Herman & Wallace's team of Item Writers have been plugging away at writing the questions and answers that will appear on the multiple-choice certification exam for Pelvic Therapy Practitioner Certification (PTPC). We needed 450 items in the item bank in order to move onto the next step of exam development, and are so excited to announce that, today, we hit 400 items! That means, we have only 50 items to go!

In August, our team of Subject Matter Experts will meet to go through the 450 items to edit them for clarity, accuracy and convention. This is one of the final steps (prior to beta-testing the items after review) before we launch the exam!

Once the first offering of the exam is announced, H&W will be making study guides and other materials available.

The PTPC exam will be multiple-choice and contain 150 questions. Questions will relate to pelvic floor dysfunction in men and women throughout the life cycle. The 150 questions will relate to 8 domains, based on the Test Blueprint created from the Job Task Analysis. The chart below lists the domains, the general percentage of content in the exam for that domain, and the approximate number of test questions pertaining to the given domain.

Those who want to start preparing can review their anatomy and physiology of the pevic floor. Herman & Wallace Pelvic Floor series courses will be the most relevant to the exam, but all courses offered by the Institute cover important aspects of pelvic rehab. Online courses are also an excellent way to review concepts, particulary Functional Applications of Pelvic Rehab Part A and Part B.

Be sure to review information related to pelvic floor in men and women of all ages, as this exam fills the void left by other specializations that focus solely on women's pelvic floor dysfunction, ilke the WCS exam offered by the APTA.

We are so excited to soon be finished with Item Writing and to move on to item reviewing next month. We are even more excited to be able to offer therapists the ability to distinquish themselves with PTPC to show their expertise in treating pelvic floor dysfunciton!