Pelvic Health & Orthopedic Physical Therapy
Addressing your questions about pelvic, women's, and musculoskeletal health. Health is a journey. Movement is healing!
You are 30 years old and one day your back just starts to ache. You went to your doctor, you were prescribed some muscle relaxants, but they really haven't done much to help ease your pain. In fact your pain continues to build. You have stopped doing the things you enjoy, running, hiking, and playing with your kids because you are worried it will make your back hurt more. They only thing that seems to help is lying down. You get an MRI of your back and get the worse news, you have a "bulging disc". Your "back looks 10 years older" than your age. You are sent to Physical Therapy for your "bad" back.
How would you feel if you are the individual in the story? Scared? Leary to move? Worried to return to the activities that you enjoy? Perhaps anxious about the current and future status of your back? Words create a story and are impactful. I remember learning early on in middle school and high school about bias, specifically bias created by language. It is not always evident how words create bias, but the choice in words can change the way a person thinks or behaves. The same is true in the health field. Even in health care the type of language that practitioners use can alter how people think and behave about their diagnoses. Choice of language is paramount in discussing pain and reasons people believe contribute to their pain. As Physical Therapists it is important to listen and empathize when someone is disclosing about pain they are experiencing because pain experiences are very real and personal. However, it is also important to be cognizant of the language PTs utilize with patients as to not perpetuate biases about pain and to properly educate patients about their body and rehabilitate them in order to instill confidence to return to the activities that give their life purpose and joy. In the instance above the individual's Physical Therapist would know that there have been studies showing that some individuals with bulging discs do not exhibit any symptoms of back pain and that a thorough musculoskeletal exam should be completed to determine the source of the pain. These studies includes a literature review performed by Brinjikji et al 2014 where in the studies 40% of the individuals who where 30 years old had imaging done demonstrated a bulging disc without any symptoms of pain. So while diagnostic imaging can certainly be helpful when appropriate at times it may reveal more about a patient's body than may be necessary. For instance, as a healthy 25 year old female if someone took images of my back they may see a bulging disc, but I am not experiencing any symptoms of back pain. Thus a bulging disc is not always primarily causative. The PT would then need to start addressing the patient's possible fear of movement and avoidance. It would also be crucial to start building the individual's confidence in their ability to move and start dispelling the belief that they have a "bad" back. Peter O'Sullivan does a lot of research and education on pain science. He spoke to Dr. Karen Litzy on her Healthy, Wealthy, & Smart podcasts a few months ago about re-examining the way Physical Therapists address pain processes with patients. I highly recommended listening to the full interview! Which you can access here:
http://podcast.healthywealthysmart.com/2017/03/262-prof-peter-osullivan-reconceptualizing-pain/
​References:
Brinjikji, W., P. H. Luetmer, B. Comstock, B. W. Bresnahan, L. E. Chen, R. A. Deyo, S. Halabi, J. A. Turner, A. L. Avins, K. James, J. T. Wald, D. F. Kallmes, and J. G. Jarvik. "Systematic literature review of imaging features of spinal degeneration in asymptomatic populations." AJNR. American journal of neuroradiology. U.S. National Library of Medicine, Apr. 2015. After having a child, women in the United States return to their OB-GYN approximately 6 weeks after having a typical birth for a check-up. The physician performs an internal examination and check how you are healing from the birthing process. They may mention the importance of performing Kegel exercises or the issue of rehabilitation is skimmed over. At this point in time referring women to see a women's health or pelvic health PT following the birth of a child is not the standard of care in the US. It really should be. There are a lot of aspects of rehabilitation from birth that need to be managed (ie changes to pelvic floor structures). I mean think about it, birth is a huge process for a body to go through! A PT should be part of the team managing postpartum care with such a complex process that alters the musculoskeletal system. The pelvic floor is often overlooked in the recovery process and as a result down the road this can lead to urinary incontinence issues, prolapse, or issues with intercourse.
Now compare this to the model in other countries. In France after giving birth women are given up to 20 visits with a women's health PT to rehabilitate. It is also a common standard of care in the UK, Netherlands, as well as Australia to visit a "physiotherapist" (the equivalent of a Physical Therapist) for postpartum care. In the United States the Section on Women's Health (the professional organization representing the PT's treating women's health and pelvic health patients) is one of the smallest, but fastest growing physical therapy specialties. There still need to be more PT's in this specialty field in the US as in some parts of the country access to PT's practicing this specialty is limited. So what can you do? As a patient you can and should advocate for your healthcare. At your postpartum 6 week appointment with your OB-GYN you can ask your physician for a script to a women's health PT in your area to assess your rehabilitation needs. Don't be afraid to research what this postpartum PT care involves and talk to your physician about why you are interested in pursuing this care. |
AuthorHello! I am Caitlyn, Doctor of Physical Therapy and Board Certified Women's Health Physical Therapist working in St Louis, Missouri. Faculty in developing residency program. Endowarrior Categories
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