What made me decide to specialize in pelvic health?

By far, the number one question I get as a PT is, “So, what made you want to specialize in this area?” This usually is when I get a strange look from the person as they gesture towards their region “down there”. Now, I’m sure these people don’t ask their gynecologist or colorectal doctor this question, but I enjoy it, because: they have genuine curiosity, they have a comfort level with me to even ask, and I love to tell my story.

First, let me just say that I had no idea what the pelvic floor was when I left graduate school and passed the board exam to become a licensed Physical Therapist. The only thing we were taught in school was a few lectures on working with people after having cancer, radiation, and lymphedema care. That’s it. Nothing about pelvic floor musculature, how these muscles interact with the rest of the musculoskeletal system, diagnoses, treatment options, or the fact that everyone, not just people with vulvas, has a pelvic floor. Now, that was many years ago, almost 18 at this point, so I am hoping things have improved since then!!!

So, the credit goes to the pelvic health PTs at my first job at Loyola Outpatient Physical Therapy & Rehabilitation in Maywood, IL. I remember being asked by my boss if I was interested in "Woman's health" because they needed more people to specialize in this area. As a clinic, they had a long wait-list of patients with pelvic floor dysfunction. I thought, sure, I'm a woman, I want to learn more and become a specialist, why not? 

Mind you that I had already done some continued education (CE) for spine, knee, and shoulder and these classes were HUGE - I was one of many, many PTs in attendance. They were all taught by men and seemed to focus on men pro-athletes, men’s sports injuries, and basically, I felt like I was in a room full of bros. Now, I’m not saying there wasn’t any women sport/injury-related content at all, it’s just the primary focus was on male sports injuries, and it just wasn’t my jam. I am fully supportive and the biggest cheerleader for all of the providers trying to draw focus, improve research, and provide updated treatment to all athletes who have been underserved. But for me, at that time and in that environment, it just didn’t light a fire under me.

So, I agreed to see if “women’s health” would be a good fit and was quite surprised (ok, kind of shocked) when I first shadowed a pelvic floor PT at my clinic. We were in a private treatment room, not the huge open gym, and the patient had given her consent for me to be there. She was not wearing clothes from the waist down and was covered with a sheet. I said, or maybe just thought, "Um, is this gynecology?" It was so foreign to me and I had never considered that there were muscles, or at least any muscles of importance, in that area! 

As I’m racking my brain trying to remember if I knew anything about the pelvic floor musculature from my training in gross anatomy (cadaver dissection), the treating PT whips out her pelvic model, which shows the bones, joints, ligaments and muscles in the pelvis. She hovers it over the patient and says something like, "Here are the pelvic floor muscles. PTs treat musculoskeletal dysfunctions. Some muscles are in a less obvious area".  The patient, who obviously knew way more than me, nodded knowingly and smiled, saying "After going to so many doctors and trying so many different medications, this is the only thing that has helped me!!! "

Person after person, I kept hearing the same feedback:

“I’ve seen 4 PTs in the past and ____ is the only person who has relieved my pain!”
”The doctor said I would for sure need surgery but now I don’t feel my prolapse anymore thanks to pelvic floor PT!”
”I’ve had bladder pain for YEARS but my doctor sent me here. At first I was mad because I thought they were just dumping me, but now I know why. I am not pain free, but sooooo much better! I feel like I have my life back!”

So, back to my story. With my orthopedic patients, I had people coming in every 30 minutes, notes to document, support staff (aide, athletic trainer) to coordinate with, and referring doctors to connect with, and it was exhausting! I felt burned out after only one year and didn’t feel like I had the time to help anyone. With pelvic health, these patient had complex problems and we were allowed the time (all our visits were 60 min. one-on-one) to “peel the onion”, hear their stories and work with them to problem-solve and find solutions, validate their symptoms and emotions, hold space with them, provide varied hands-on treatments, and this made such a big difference! Now, I’m not saying EVERYONE met their goals, became pain-free, and it was all rainbows and sunshine. I finally felt like I was able to make a difference in people’s lives.

Often these people had spent years being dismissed by doctors because they couldn’t find anything “wrong” when nothing showed up on scans, weren’t believed, had symptoms down-played, or had only seen people who had no idea how to educate or help them. Plus, it’s scary when you have no idea what is going with your body and you don’t know where to go to find help! Think about it: if you ask any person who has knee pain what they think MIGHT be the cause, they may say arthritis, bursitis, meniscal injury, etc. They are also going to be more likely to know who to go to for help, orthopedic PT, possible orthopedic doctor, possible x-ray or MRI, etc. But for pelvic pain with an unknown cause? Bladder pain without an infection? Painful sex (especially in a society that doesn’t talk about sexual dysfunction regularly and thinks pain with sex is somewhat “normal”)? Where do they go to get help? The biggest issue has been public awareness. For years, every person that I saw said the same thing “I’ve never heard of pelvic floor PT before!” or “my doctor told me to just do kegals” (no matter what the problem was). Now, over the past 3-5 years, thanks to social media and word-of-mouth, awareness has improved and I frequently have people seeking out pelvic floor PT to address their problems.

So, back to my story. I switched from treating primarily orthopedic problems, to 50/50 ortho/pelvic floor, and then 10 years ago, to primarily pelvic floor dysfunction. Because the pelvic floor is involved in so many other areas, I continue to frequently treat low and middle back pain, SIJ dysfunction, hip pain, rib pain, etc. Pelvic floor PTs don’t just treat at the pelvis! I’ve had years of courses, mentors, mentees, jobs in a variety of settings, and I never get bored. In fact, I am humbled almost every day, so the beauty is that I never want to stop learning. There is always new information out there that I can learn that may further help my future clients. After years of talking with people and hearing about their various occupations, I can honestly say that I am 100% happy that I chose to be a physical therapist and a specialist in pelvic health!

If you want to learn more about pelvic health physical therapy, reach out to me!