Fun Fact: I got 33 stitches across my forehead in high school.
What is pelvic physical therapy?
I never would have guessed that my first clinical rotation would land me in rural Montrose, Colorado with a Clinical Instructor who specializes in pelvic health. I walked in on the first day absolutely terrified and with no idea what pelvic PT entailed. It turns out that pelvic physical therapy encompasses a wide range of diagnoses ranging from pre/post-surgery (hysterectomy, prostatectomy, C-section, etc.), pregnancy, sexual trauma, interstitial cystitis, urinary and fecal incontinence, rectal/uterine prolapse, and—essentially—anyone who is experiencing pelvic pain. We treat both women and men; we practiced manual therapy externally and internally using our hands and various tools.
Your pelvic floor has two main purposes: it is a network of muscles that stabilize your entire pelvis and hips—so it affects your back and down to your knees—and it also relaxes and contracts at the appropriate times; this allows you to jump, run, and laugh without urinating or having a bowel movement when you don’t want to. If your pelvis is out of alignment or the muscles of the pelvic floor are not firing correctly, it throws off your entire body and is extremely painful. Just like you can get knots in the muscles of your neck and back, you can also get knots within your pelvic floor.
It was a world of PT that I didn’t even know existed. My CI was a Regis graduate and her treatment revolves mainly around manual therapy—specifically, trigger point release and soft tissue massage. She also uses biofeedback: by putting electrodes around the rectum, patients are given a visual of how strong or weak their pelvic floor muscle contractions are. The first four weeks of my rotation were spent mostly observing my CI. Every once in a while, she’d let me palpate external muscles that felt abnormal. By the fifth week, I had a foundation strong enough to be able to assess and treat some patients entirely on my own!
Did I feel prepared?
Yes and no. Who remembers the origin, insertion or innervation of the bulbocavernosus? I sure didn’t; a lot of our pelvic floor knowledge came from the first semester of PT school, and it took a little bit of time to refresh on the details. On the other hand, I had a tool belt filled with knowledge that I could draw from: I used the lower quarter scan we learned in our PT Exam class, manual muscle testing, motivational interviewing and, most importantly, palpation. Palpation allowed me to do an external assessment of posture and pelvic alignment despite not having a thorough background of pelvic health.
My first clinical rotation gave me my “breakthrough moment.” We all start school questioning whether or not we deserve to be here, whether or not we’re as smart as our peers, and whether or not we’re going to be good practitioners. For the past year, I wasn’t sure of any of those things until my fourth week of this first clinical. I had an overwhelming feeling of gratitude from my patients and a feeling of capability that reignited my passion for PT and reminded me of why I started the whole journey in the first place.
And, if you ever find yourself exploring the Western Slope, make sure to check out Telluride, Ouray, Black Canyon National Park, and the breathtaking Blue Lakes!