Working with Pelvic Health PTs: Connecting Professions
This blog is specifically for physical therapists, chiropractors, personal trainers, and coaches. I have an idea: Let’s stop channeling our old professors/instructors, admit that we need each other, and change the world, one pelvic floor at a time!
If you belong to one of the aforementioned professions, at some point you have likely judged one of the other listed professions. You may have thought they were telling everyone and their dog to rep 100 kegels 3x/day, or that they were educating their patients to bear down during a lift, or that they were trying to get their clients back to “pre-baby” body too hard, too fast. As a pelvic health PT, I will admit that I’ve judged each of those professions (including my own).
It’s high time to cut that shit out, get over yourself, and start asking questions.
We. Need. Each. Other.
Our patients need us to need each other. Let me tell you my “get over yourself” story.
I met Dr. Erica Boland three years ago at a pelvic health journal club. I was a pelvic health PT at a large health care institution and had invited her to our journal club. I had heard of her as the “pelvic floor chiropractor” in town. I am not going to lie, I was a bit, “Hmmm, does she really know what the pelvic floor is doing without an internal pelvic exam?” and “what is this BIRTHFIT thing anyway, workouts for pregnant gals?”.
But she showed up into what was essentially a shark tank: 10 Pelvic Health PTs, a Pelvic Health MD, a Urologist, and a Urology PA. So, I let my guard down and listened to her, I stopped judging her and her profession and watched how she interacted with the other providers. I also sent her comforting vibes as her newborn son Maclin pooped all over himself about 10 minutes after they entered the room. After leaving to clean up her little boy (and swaddling his naked little butt in a blanket because she didn’t have an extra outfit), she CAME BACK to the shark tank. She continued to contribute to our journal club with a passion for women’s health that matched my own. She was the only chiropractor, the only one from outside of our healthcare institution, and the only one with a poopy baby. At that moment, I said to myself, “Get over yourself and go meet that woman! She obviously has a passion for pelvic health and for her mission in order to subject herself to this (and with a poopy kid nonetheless), she must be one badass human being!” (I found out soon after that, she is indeed, one badass human being.)
Three years (and a whole lot of coffee and lunch meetings) later, I am Co-Regional Director of BIRTHFIT Wisconsin, I am owner of O’Brien Physical Therapy, which is a cash-based Pelvic Health PT clinic, and I share office space with Erica and her husband, Kyle.
I am now in the minority: BIRTHFIT comprises a lot of chiropractors and coaches, but not nearly as many physical therapists. I’m diving in head-first, but like Erica, I’m forging ahead whether I’m intimidated or not! I want to bridge the gap. I want us to work together. I want us to sit down and ask questions. I want us to hear the answers with the intention of learning from each other. Three years ago Erica and I did this: we met and had coffee. We started talking, we asked questions, we figured out that our differences were TINY compared to how much we agreed upon. We decided to work together, to continue to learn from each other, and to help all of those amazing mamas who needed us to figure our shit out.
Erica and I developed a special relationship, and lots of chiropractors and coaches have wanted to know how to find a pelvic health PT that they could also work closely with; I was enlisted to help answer this question. Though our conversations covered much more territory than this, here are a few questions that you may want to ask when starting a conversation with a Pelvic Health PT.
- Hi, what’s your name?
Yes, it’s that simple, just ask them who they are! What’s your name? What’s your story? Why PT? Why pelvic health PT? Where did you go to school? You will more than likely find some commonalities within those few questions that can get the conversation started.
- Tell me about your pelvic health training.
This will give you a lot of information. Have they had formal training in Pelvic Health Physical Therapy through a reputable organization? How many levels have they completed? Through Herman and Wallace and the American Physical Therapy Association, Level 1 is a great foundation, but ideally, they would have at least 2-3 advanced courses under their belt or have the plan to do so in the near future. Do they have a focus within pelvic health (only females, males, kiddos, pelvic pain, bowel dysfunction, pregnancy/postpartum)?
- What is your typical patient population?
It is not necessary or ideal for their patient population to be 100% pelvic health. Having a strong orthopedic background in addition to the advanced pelvic health training and education is by far the best-case scenario (in my opinion). The pelvic floor is not an island, therefore assessment and treatment of the pelvic floor needs to not address it as such. Which leads me to my next question:
- What do you typically assess on your initial visit? Visits 2 and 3?
This depends on a lot of factors, but you will be able to tell if they are able to think outside of the box (the box being the pelvic floor, of course). An internal exam is extremely important, but it may not be necessary or appropriate on the initial visit. Based on a detailed subjective assessment – it may be more important to focus on their nutrition, their breath, or their spine – depending on where the first layer of dysfunction lies. The Pelvic Health PT should be asking specifics in regard to nutrition, bowel and bladder patterns, sexual function (if appropriate), and getting a detailed OB/GYN history. They should be assessing the spine, the pelvis, the nervous system, and breathing mechanics – this would be a great place to discuss intra-abdominal pressure (IAP). IAP is simply what happens during inspiration as the diaphragm contracts and moves down into the abdominal cavity, increasing the pressure within the cavity, but many practitioners equate IAP with bearing down or bulging of the pelvic floor. Ask the questions, break it down, figure it out: it may be the terminology that is the barrier, not the fundamentals.
- What is your ideal patient?
This will hopefully lead you into discussion on how you can help each other. Find out their strengths and their passion. Tell them about yours. Find what you have in common. How can you help each other? How can you work together to reach the common goal: to help all of those amazing mamas who need us to work together?
Working with other professions requires us to set our egos aside and put the good of our patients and clients first. We may not agree 100% of the time, but the more we sit down and have coffee (which is a huge bladder irritant, by the way), the more questions we ask, the more we hear each other, the more we will realize that we really are on the same team.
Jill O’Brien, MPT, DPT, OCS
Co-Regional Director of BIRTHFIT Wisconsin
200 hr-RYT Palm + Pine Yoga Studio and School