Over the past year and a half I’ve learned a lot about pelvic health through Evidence in Motion’s Pelvic Health Certificate program.

I will describe my journey with pelvic health, what fascinates me about it, and hopefully help others have more information to consider if they would like more education in this arena. I’ll do this in a self-interview, question and answer format.

Why did I start doing pelvic health?

There are two primary reasons I wanted to start doing pelvic health. First is that pelvic health is largely an orthopaedic treatment. I had done an orthopaedic residency and was in the middle of a fellowship in orthopaedic and manual therapy and could see primary pelvic pain and pain referred from the pelvis was a hole in my knowledge. I noticed patients who I was seeing for low back or hip pain that reported incontinence, constipation, irritable bowel syndrome, interstitial cystitis, or pain with sex didn’t achieve the same results as my other seemingly similar patients.Further, chronic pelvic pain of non-specific etiology is under-treated and I enjoy treating complex pain syndromes.

The second reason is that I live in an area where people with primary pelvic health issues had to drive to Tucson which is an hour and a half away to get treated. One patient told me that she stopped going because going there twice a week for multiple weeks became too difficult since she worked full time and had children.

Thus, I wanted to better help the people I was already seeing who had a pelvic component of their pain that I wasn’t trained well enough to identify/treat and I also wanted to help people with primary pelvic health/pain complaints.

How much pelvic health did I know prior to starting the pelvic health certificate/more training?

I knew the anatomy and that was it. It was sometimes mentioned as a differential diagnosis throughout my training, but since I never was doing training with anyone who treated the pelvic floor specifically it was never chosen as the primary or contributing diagnosis.

What makes pelvic health a unique field?

Pelvic health is extremely unique in that there is so much overlap with medical diagnoses. For instance, constipation could be a primary outlet dysfunction or it could be secondary to medication, diet, or another medical problem problem. The same can be said for many other pelvic health diagnoses as well. Further, common pelvic health diagnoses and pelvic pain are features of central sensitization.

Are there challenges of being a male pelvic health therapist in what has traditionally been female dominated?

I have not run into any in my practice. I’ve treated multiple patients and talked to multiple other providers that treat women’s health (primary care, midwives, OBGYNs) and none wondered if their patients would be alright with a male therapist.

I initially wondered what the reception would be from other therapists with doing the training and from patients. Any concerns I had that other therapists wouldn’t like me doing the training were alleviated when I did my first course and there were a few other men in the course. During the online didactic portion for the next hands on course which involved intrarectal and intravaginal examination and treatment I was the only male. I figured I may be the only male at the hands on course as well, but I didn’t have any inclination that anyone there would have a problem with this due to our online interactions. I actually felt being a man was helpful because female therapists there were treating men in the clinic (an undertreated population and further indication this field shouldn’t be called “women’s health”). The dearth of male therapists makes it difficult to get practice in our training with men.

With patients it hasn’t been a problem either. Male patients haven’t balked. Female patients often have male OBGYNs so this isn’t different for them either. However, if the therapist is uncomfortable or thinks it’s strange then that will be felt by the patient. Each therapist has their own personality and situation. This can’t be emphasized enough. Each practitioner has to find what works for them. I have my own practice so I can control my situation. I have private treatment rooms for my patients; I wear a shirt and tie to the office each day; my patients address me as Dr. Rainey. The key is to be comfortable and confident no matter your gender or the patient’s gender.

Should every orthopaedic therapist specialize in pelvic health as well?

Specialize- no. Knowledge- yes. There’s always more to learn about the human body and we have to pick the areas that we specialize in. However, in every area of the body we need to understand what is appropriate for the care we individually can provide. As we are all taught, we first need to decide if the person is appropriate to be in our clinic. That does not just mean appropriate for conservative care, but appropriate to be in our clinic. There may be patients that are appropriate for conservative care, but that need to be referred to someone with further training in pelvic health issues. Thus, all orthopaedic therapists should be able to recognize pelvic health issues that affect the plan of care. I believe all orthopaedic therapists should be able to treat basic pelvic floor issues that don’t require intrarectal or intravaginal examination and treatment. This includes urinary incontinence exercise and education and constipation exercise and education. All orthopaedic therapists should also be able to recognize when that is needed so they can discuss this with the patient and make the appropriate referral. Prior to being able to recognize this I inappropriately attributed a greater portion of the patients’ symptoms to psychosocial factors than biological factors because I wasn’t able to recognize pelvic floor contributions to the patient’s pain. This would occur with patients who I was able to partially help their low back or hip pain, but not as much as what I would be able to help others with.

In conclusion, treating pelvic health issues has become fascinating for me. The complexity of the conditions and how they interact with orthopaedic conditions is incredible. Patients that I had just attributed to other orthopaedic conditions I was familiar with such as glute medius tendinopathy, anterior hip pain, or S1 radiculopathy I’ve sometimes found significant pelvic floor contributions.