Opinions: a pelvic floor PT perspective
This blog post is based on a podcast I heard the other week, from PelvicPT Rising, titled “$#!t That Needs to Be Said: Volume 1”. As a pelvic health PT who has been doing this for a long time, I have spent a lot of years listening to PTs dance around topics because they don’t want to step on toes or offend other PTs. I find the blunt honesty that Nicole and Jesse Cozean bring to the pelvic PT world refreshing, and although I don’t agree 100% all of the time (is there ANYONE you agree with 100% of the time?), I appreciate them sharing their opinions and bringing these topics up for discussion.
While this post doesn’t discuss all of the items discussed in their podcast, here are the ones that resonated most with me:
#1: “Initial pelvic health courses should have in-person instruction”.
AGREE. My favorite quote from this podcast was when Nicole referred to pelvic PT newbies learning online with other inexperienced PTs as “Just a big free for all, and all we’re doing is putting our fingers inside orifices without any sort of instruction, and that’s not a good look”. Amen!
This terrifies me, quite frankly, and as someone who has taken many courses, both in-person and online, THEY ARE NOT THE SAME!! In fact, I recently took a virtual, self-hosted course on a topic that I actually already had training in, and even as a PT with experience, I won’t be doing that again in the future. There were too many tech problems, volume issues with the speaker, no lab supervision, so, only got feedback from my partner (who was awesome, but not a trained teaching assistant), etc. Plus, it cost the same as when it was offered in-person, so, lower quality without any discount.
I am in favor of many opportunities for education to be on-line - either live or pre-recorded - in many areas of pelvic health, just for the record. But hands-on skills are best acquired when they are taught hands-on! If we want to give our patients the experience they deserve and continue to gain respect from referring providers and other PTs, we need to demand quality instruction and training. Period.
#2: “If you call yourself a pelvic floor specialist, you need to have the training and willingness to do internal work”.
AGREE. Nothing is more frustrating than having a patient tell me they had 10 visits with a “pelvic PT” who just had them do exercises in the gym. Ugh! Internal pelvic floor muscle assessment and treatment is fundamental to the specialty, and pretending otherwise is confusing for patients and providers and makes it harder for people to get the care they need.
When I hear PTs say “I base what I do in treatment on what the patient says, so I don’t need to do an internal pelvic floor muscle assessment,” I think back to all of the patients whom I have made an assumption, based on the person’s subjective report and symptoms, only to be wrong and change my mind after doing an internal assessment.
One example? I had a patient who was postmenopausal with stress incontinence and no complaints of painful sex. I’m thinking, “Finally, a “weak” pelvic floor and we’re gonna do some kegels!!” only to realize after doing an internal assessment - nope! She had tight and painful pelvic floor muscles, no motor control, and was actually doing a valsalva and bearing down when trying to do a contraction. Yikes!
#3: “Pelvic floor PT visits should not be 20-30 min. long and hour-long treatment sessions should be the standard”.
AGREE!!! Pelvic PT sessions that are 20-30 min. Long? WTF!!! This is horrific and we should all be fighting this abomination. Even if you work in a place that offers 60-min. sessions you should be decrying this practice and shouting from the rooftops! Why? Because this is crappy care - patients get poor results and say things like “I tried pelvic PT and it didn’t work for me”. It devalues the entire profession!
The body is complex and there is no way anyone is able to assess the body as a whole, look up and down the kinetic chain, find the drivers of dysfunction, and get to the root cause, in 20-30 min. Even if the person comes in 2-3x/week at that timeframe, it’s still a burden on them for travel, childcare, and “rushing” internal assessments can be traumatic, causing more harm than good.
When my former company first wanted to move all patient visits from multiple insurance companies to 30-minute appointments, initially I refused and actually timed how long it took my patients to take off and put back on their clothing. The average was 5-8 minutes, and this was in a patient population primarily in their 20’s-40’s. Not only is that NOT billable time, it only leaves 22-25 minutes to get subjective information, review goals, revise and upgrade their home exercise program, provide education, AND do any form of manual therapy. Forget it!
Unfortunately, my vote didn’t count and when it came to fruition, I was stressed out, late for everyone, didn’t have time to eat or pee, and felt like I wasn’t helping anyone. Plus I had a ton of notes to catch up on at the end of the day, on my own time. This is what leads to burnout and what drives people to quit pelvic floor PT, and it’s not okay. Thankfully, it drove me to quit and start my private practice, but I believe it’s an unacceptable arrangement that shouldn’t be allowed.
So, check out this podcast episode from PelvicPT Rising and let me know what you think! Do you agree or disagree? Which parts, and why? I’d love to hear your thoughts!! Feel free to DM me on IG at @bethanyhansenpt - I’d love to hear from you!
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