A very dear friend of mine suggested to me earlier this year that I should use a “more artistic” version of the pelvis for the logo of Foundations Physical Therapy. “It kind of looks like a gremlin,” he said, referring to the image I had chosen. But I didn’t want to change the logo – partly because it had taken a long time to arrive at the current design, and partly because I’m stubborn. But the main reason I didn’t want to “soften” the pelvis image is because of the mission of Foundations Physical Therapy, which is: 

Foundations Physical Therapy helps return people to the life they want to live by providing equitable, accessible, and trauma-informed physical therapy for individuals with pelvic muscle dysfunction.

My well-meaning friend suggested I ought to use a line-drawing version of the pelvis, with smoothed edges, or an image of the pelvis shaped like a butterfly. Aside from the fact that I’ve helped people with their pelvic pain and incontinence issues for over a decade now, and view the pelvis very differently from most people, my main goal in using the actual anatomical image of the pelvis was to demystify the pelvis.

To me using an anatomically correct pelvis picture in the Foundations Physical Therapy logo says, “here’s a pelvis, and it’s ok to talk about the pelvis.” Because of a variety of factors involving cultural influences, people often have a difficult time talking about all things pelvic – we tend to avoid talking about sex, and sexual problems, especially pelvic pain. This is true of conversations in larger groups as well as between couples. Bladder leakage is something that is laughed about as normal, and “just a regular part” of having a baby. And fecal leakage or bladder leakage in people after a prostatectomy? It’s just not mentioned.

I believe we should and can improve our ability to discuss the mysterious pelvis. If your pelvis hurts somewhere, I want you to feel ok bringing that up with me or your medical provider. If you have bladder or bowel leakage, you don’t have to live with it forever. If you feel afraid of pressure in your pelvis or are scared to move for fear that you will put something out of alignment, we should be able to talk about that.

Here are a few interesting facts about the Foundations Physical Therapy logo and pelvis anatomy to get the conversation started:

• The pelvis in the Foundations Physical Therapy logo is a female-sex pelvis. You can tell because of the wider angle in the center-front of the pelvis (and yes, I’m a big fan of the television series “Bones”)
• A wide variation in pelvic shapes among the sexes exists despite many medical and midwifery programs still teaching Caldwell-Malloy classification (1), which was well established in the 1950s and has been criticized as being overtly racist (2)
• The shape of your pelvis doesn’t necessarily determine the outcome of your birth (1)
• The colors of the Foundations Physical Therapy logo were chosen to represent inclusivity (special thanks to Fiona Martin, science illustrator with Visualizing Science for the artwork)
• Fusion of some parts of the pelvis (3) is not fully complete until age 30
• The pubic symphysis (the joint in the front of the pelvis) and the sacroiliac joints (the joints where the sacrum fits inside the pelvis at the backside) are extremely strong joints that are well adapted to handle daily loads
• The roughness of the joint surfaces of the sacroiliac joints gives those joints the greatest ability to resist movement out of any joint in the human body (4)​

Do you wish you could talk more about the pelvis? Do you have unanswered questions or pelvic problems? If so, please comment below, contact me using the contact form, or call Foundations Physical Therapy at (928) 350-8270. I look forward to helping you figure out how to live the life you want to live, without being limited due to pelvic floor muscle problems.
 
References:

1. Kuliukas A, Kuliukas L, Franklin D, Flavel A. Female pelvic shape:  distinct types or nebulous cloud? British Journal of Midwifery. 2015;  23(7):  490-496.
2. Geller PL, Stockett MK. Feminist Anthropology:  Past, Present and Future. 1st ed. University of Pennsylvania Press; 2006.
3. Broome DR, Hayman LA, Herrick RC, Braverman RM, Glass RBJ, Fahr LM. Postnatal maturation of the sacrum and coccyx:  MR imaging, helical CT, and conventional radiography. AJR. 1998; 170:  1061-1066.
4. Vleeming A, Stoeckart R, Volkers AC, Snijders CJ. Relation between form and function in the sacroiliac joint. Part I:  Clinical anatomical aspects. Spine. 1990; 15(2):  130-132.

This is a continuation of the initial blog series I have written to answer some of the most common questions I get about being a pelvic physical therapist and what our treatment involves. I hope you enjoy reading these posts, and if you have any questions after reading them, please feel free to contact me by leaving a comment below the post, filling out the contact form on the website, or by calling the office at (928)350-8270.
 
A pelvic floor physical therapy session is really quite similar to any other physical therapy session, except we also talk about and treat problems with muscle function “below the belt.” As you may have read in last week's post, problems with pelvic muscle function can create a lot of barriers with engaging in the activities we enjoy doing. 

I think one of the big questions people really want to know the answer to is, “does pelvic floor physical therapy involve an internal examination, when does it happen, and what is it like?”
 
Here are some facts about that internal pelvic muscle assessment that we pelvic floor physical therapists are specifically trained to provide: 
 

• Only with your informed consent and when clinically appropriate, an internal pelvic muscle exam can be performed by a physical therapist with specialized training to assess your pelvic floor muscle function.
• The internal pelvic muscle exam involves a gloved and lubricated finger to assess for pain in the pelvic floor muscles and surrounding structures, as well as strength, endurance, and coordination of a muscle contraction. I can also assess pelvic organ prolapse during an internal pelvic floor muscle assessment.
• The pelvic floor muscle examination can help us understand if your pelvic floor muscles need strengthening exercise, relaxation training, or a combination of both interventions. 
• Not everyone coming to pelvic floor physical therapy needs an internal muscle examination.
• The pelvic floor muscle exam does not always occur during the first appointment (or the second, third or fourth). It occurs when it is clinically important, and you have provided your full, informed consent.
• This exam is not really like a pap smear for those who are used to that procedure.
• There is no speculum involved in the internal muscle exam.
• You have the right and are encouraged as needed, to have a support person with you during a pelvic floor muscle exam. 
• You do not have to agree to participate in the internal muscle exam, even when it is clinically indicated. People have many different reasons for not wanting to participate in an internal pelvic floor muscle assessment, and as a compassionate and trauma-informed care provider, I fully respect this. There are many other methods for assessing your pelvic floor muscle function. 

 
On your first visit you should expect that we will talk (a lot) and for me to ask (a lot) of questions, and hopefully you will feel comfortable asking (a lot) of questions too! We will figure out your physical therapy goals together and then do an examination (which may or may not involve that pelvic floor muscle assessment), and you will go home with some homework.
 
Follow up sessions will look similar, but with less examination or assessment time and more treatment time. We will check in with how your homework went, discuss progressing your exercises when appropriate, and changing some of your homework if you had difficulty with it. Honesty is important during physical therapy sessions, because if an exercise really increases your pain, I can very likely modify it. If you are not doing your home program because life is busy, we’ll talk about that and figure out some solutions together.
 
As always, I look forward to helping you achieve your goals with pelvic floor physical therapy, or perinatal physical therapy (for those during and after birth). Please contact me if you have any questions about this post, by sending me an email at [email protected], or calling the office at (928)350-8270.

Another question I often encounter is:  what made you want to become a pelvic floor physical therapist? Why did you get into this field? 

I am a pelvic floor physical therapist because no one shouldhave to limit their physical and social activities because of pelvic floor problems. And no one should have to feel the embarrassment or shame that often accompanies pelvic floor issues:

• No one should have to cover up their wet backside with a tied-on jacket or sweater due to leaking with sneezing, coughing or because they couldn’t get to the bathroom on time. 
• No child should have to experience the embarrassment or shame that comes with having to wear a different pair of pants from the school nurse’s office due to wetting themselves at recess or in class.
• No one should have to feel embarrassed or worried about smelling bad at work or with friends because of incontinence.
• No one should have to modify their daily routine or travel because they can’t make it more than 30 minutes without having to find a bathroom.
• No one should be afraid to go out with friends and family or afraid to exercise because of leakage. 
• No one should have to be careful when carrying and caring for their newborn due to fear that their muscles aren’t strong enough or due to pelvic discomfort or pain. 
• No one should have to be afraid of daily activities or sexual activities due to pelvic pain. 

These are just some of the many reasons that drive me to be the best pelvic floor physical therapist I can each day. These very real lifestyle limitations are often minimized by medical professionals and people in general as issues that “come with aging,” or “come with having a baby,” or “he/she/they’ll grow out of it.” But these are very real issues and limitations that significantly impact a person’s life and they are why I do what I do: help people with their pelvic pain, their incontinence, and their strength during and after pregnancy. 

To learn more about the why, what, and how of pelvic floor physical therapy, please contact me through the website or call Foundations Physical Therapy at (928)350-8270. I look forward to helping you figure out how to live your best life without limitations due to pelvic floor problems.
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