I am excited to share a series of great conversations that have occurred in the social media sphere via an extravaganza of tweets, blogs, commentaries, Facebook posts, and Linked-In discussions. The conversation participants, we like to refer to ourselves as the #pelvicmafia, are a global group of Musculoskeletal practitioners that integrate the pelvic floor into their approach, Internal Pelvic Floor Specialist PTs, and Women’s Health advocates.  We have come together to inspire one another and our global physical therapy colleagues to reconsider old ideas about the pelvic floor, consider new concepts, ask tough questions, seek answers, break down thought walls, and ban together to promote best practice for women (and men) in our care!! No egos, just constructive discussion.

Over the next few weeks/months I will be sharing, some highlights, questions, insights and comments generated by the group and my responses. You, too, can join the conversation by weighing in here on my blog, and following the links to the blogs of others, Linked In, Facebook, etc. Don’t be shy!

One question really started it all.

Antony Lo (@physiodetective) posed this question on twitter:

What specific conditions do you think need specialist Women’s Health care?

My twitter response: I think the answer [to] that can’t be a formula and I think if we can change how we address MSK [musculoskeletal] & pelvic floor and treat them together from the get go then women wouldn’t end up [with] the really awful stuff that internal [physios] have to sort thru. When I give courses I equate it to a drafty window that eventually turns into a huge reno project [because] the true issue wasn’t addressed early. Let’s normalize the pelvic floor, integrate it early in MSK and see if we can avoid the major reno projects internal therapists are seeing. Your thoughts?

Antony followed up with a  great blog on the subject! He discussed the pelvic floor as the primary or  secondary (“the victim”) source or manifestation of dysfunction.

My blog response (partial):

I liked how you distinguished between the primary pelvic floor vs secondary pelvic floor manifestation of a global dysfunction. I am very clear with folks [that I treat] when I think their symptoms are a primary pelvic floor issue what their options for treatment are, and that we should see fast results if I have the right skill set for them. If the results aren’t happening then we need to collaborate with an internal therapist.

While I like the distinction you made, I also see the secondary pelvic floor issues as well, primary. This is due to the critical role of the pelvic floor in rebalancing how our movement system functions as a whole, not just as it relates to a typical women’s health type diagnosis. I also consider even some of the primary pelvic floor issues (true pathophysiology) as more global issues. Even a PF tear or damage say due to a delivery should ultimately have a global or systems solution b/c the pregnancy contributed to creating dysfunction in the relationship of the PF to the rest of the musculoskeletal system and in the woman’s alignment in the first place.

I don’t have a cool graphic like Diane Lee’s rubric ( I too, am a huge fan of hers!), but I have a few additional things I look at and address with my patients before referring them on or even giving manual care. Specifically I integrate the pelvic floor back in with the rest of the neuromuscular system, and the IAP pressure system. I train it as a foundational component of an inside-out force production in movement patterns and functional activities with optimized alignment. This addresses both the secondary and primary issues with a whole body solution. I start there for ALL diagnoses whether they are primary or secondary pelvic floor issues – jaws, knees, incontinence, prolapse, even shoulders (see a blog on that here http://bit.ly/bWQWdG).  And as you said if the results aren’t happening fast I am missing something or it is time for a different set of skills and eyes.

As your previous blog stated…we all need to move more toward the center…women’s health and musculoskeletal. Integration, integration, integration!!

The conversation then moved to Linked In where physiotherapists, chiropractors, and osteopaths from Australia, Canada and the US weighed in. So grab a cup of coffee, check it out and join the #pelvicmafia!

Stay tuned for more great highlights coming soon!