Julie Wiebe and I go waaaaay back! Flash back to over 3 years ago when there was no #SolvePT, #BizPT, and about 20 or so of us on social media. I reached out to her and others like Ben Fung who were on twitter at that time. Since then I have learned quite a bit from her posts and videos as well as her webinars. Read below how the pelvic floor is more than just for pelvic pain or incontinence.
- Tell us a little about yourself and how you transitioned from a Sports PT to a Women's Health PT
I
practiced in orthopedics and sports medicine with recreational and
professional athletes until I had my first child almost 11 years ago.
During the pregnancy I remember having the conscious, and very
arrogant, thought that if anything went wrong with my body during the
pregnancy or after I would just fix it. I was quickly humbled by the
physical challenge of recovery and the sense that something just
wasn’t right inside my body after I had my daughter. I recognized
that if I was having trouble recovering with my professional
background, the climb for other women had added challenge.
So,
I began to investigate what happens to a woman’s body during
pregnancy and beyond. The “core” was just coming on the scene
around then, and it was clear that the loss of connection with the
deep core elements was a critical and underlying issue for many of
the typical pregnancy and post partum complaints. The pelvic floor is
a part of that core system, so there was an existing, natural link
between the women’s health and the “core crazy” sports medicine
worlds. Bringing those two worlds together became my passion, and my
clinical niche became helping women across the lifespan recover from
injury and pregnancy and return to fitness and sport. What I have
learned from helping women rebuild a solid central foundation, can be
applied in multiple populations, because everyone needs a central
stability for efficient, effective and powerful movement and fitness.
(Please note: I don’t like to use the word “core” anymore…means
too many different things to different people. So I use words now
like foundation, central stability, postural control, and sturdy
anchor.)
- You have told me in the past you do not use much if any manual therapy techniques any more, why is that and what has replaced them?
I
think that the best way to answer this is to talk about it in terms
of when
I
apply manual therapy. What I have learned along the way about how our
foundation functions has led me a systems model for creating central
stability. This involves working towards a balance of the brain, the
neuromuscular, musculoskeletal, structural, postural, and sensory
systems. I start at the center for all my patients, reorganizing that
foundation through an integration of those systems and build movement
and sport specific patterns from there. In other words, I work from
the inside-out and love the integrative principle “If they fire
together, they wire together”.
Once
we have re-estabilished and optimized that foundation, then I see
what is left to handle with my manual skills. In many cases, there is
not much left to work out. IMHO that tight muscle, stuck joint or
whatever we see or feel that we want to address with our manual
skills got that way somehow. So I try to figure out how it got that
way first, before I apply my manual skills. Otherwise, I can manual
therapy it ‘til I am blue in the face, but it will likely come back
because I have never addressed the reason it got that way in the
first place. I just like to begin with seeing what the body and brain
can do for itself first, my job is to create the right environment to
allow that. A practitioner that attended one of my courses,
summarized that thought beautifully:
“Trust
that the body is a self righting organism. Our job is to guide the
process.” Norene Christesen, PT, DSc, CLT, OCS, President Wyoming
Chapter APTA
This
is also great for home carryover, I didn’t make them better, they
made changes in how they thought about, used or moved their body and
saw results. That’s pretty powerful. And it is great for my hands!
Having said all that…I still think manual therapy has an important
place so don’t misinterpret this as anti-manual therapy. I just
watch and guide before I intervene with my hands.
- Why is the diaphragm and pelvic floor important for not only women's health but all populations?
What
we have come to understand as research has evolved is that all four
muscles of the deep core, diaphragm, TA, pelvic floor and multifidus,
work together as a team to provide the muscular support and regulate
the intra-abdominal pressure that contribute to setting up a sturdy
center (not just the TA and multifidus). They actually interact like
a Piston. On inhale the diaphragm lowers, and the TA and pelvic floor
need to give, or open to allow this to happen. This builds IAP, which
gives us inhalation stability and elastically loads the TA and pelvic
floor. On exhale when the diaphragm rises, and the pressure is
relieved, the TA and pelvic floor use that elastic loading and recoil
up and in to more actively contribute to central stability. It is a
dynamic interplay between these moving parts that gives stability
that is also dynamic and responsive to the demands of function. This
is a great study that demonstrates that relationship:
http://1.usa.gov/1ibumrS
. For a visual, I demonstrate their Pistoning interrelationship here
http://bit.ly/1nlybxF
. So our stability system actually runs off the breath cycle, how
cool is that! And the pelvic floor is parallel in its action to the
diaphragm, they work together, so it is important that clinicians
know how to integrate them along with the TA and multifidus into
their programming for stability, strengthening, balance, etc.
Let’s
bring this home in another way, and link my thoughts from question 2
to these ideas. Here is an interesting study (http://1.usa.gov/MgTBOf
) that created an asymmetrical activation of the pelvic floor and
noted significant displacements of bony landmarks, with the largest
displacements being of the femoral head, the innominate and coccyx on
the same side. Applying that clinically, a patient may be utilizing
their PF asymmetrically leading to what we might assess as a pelvic
obliquity for example. Instead of addressing it with our hands first,
we can teach the patient to optimize recruitment of the PF in a
proper relationship with the diaphragm and restore a more balanced
recruitment pattern. Building movement patterns on that improved
recruitment, will help with carry over and reinforce the balance.
Then we see what is left to address with our hands. And the flip side
of that, is if we have imposed some increased movement or alignment
with our hands, then the pelvic floor is uniquely positioned to help
maintain it if we can teach our patients to access it and use it with
it’s functional partners. The pelvic floor is a very powerful (and
currently underestimated) ally in our care of musculoskeletal issues.
You
have recently completed some research, can you give us any details?
The
Pistoning system that is a key to creating that sturdy foundation is
the same system that works to maintain continence. I designed a
webinar to take women step by step through applying this approach to
rebuilding that foundation from the inside-out (Pelvic
Floor: From Zero to Fitness) and we put it to the test in a
telehealth research study throughout the Fall of 2013. We were
answering the question can women independently access and use a
pelvic floor education program via the internet (feasibility) and
benefit from it. We just closed data collection! I can’t reveal all
the results, they will be available this Spring, but I can give you a
glimpse:
- Based on raw data collection***, 79% of the study participants had never had treatment for stress urinary incontinence. This is my target, the women who have never had treatment either due to reluctance to seek help, lack of access to help, lack of awareness that help exists, or time restraints.
- A strong majority of women either agreed or strongly agreed that they liked getting pelvic floor information online (82%), were able to perform the exercises on their own (85%), and understood the instructions they were given (88%). 97% would recommend the program to a friend!
- We used a brief incontinence likert scale, validated and reliable for incontinence, to measure outcomes and found that of the women that returned surveys, 85% noted an improvement in symptoms (61.8%= A little bit better; 23.5%= Much Better). Please note that these improvements were experienced with independent practice over only 3 weeks! The thrust of the program is creating a balanced coordinated action (i.e. neuromuscular homeostasis) of all the elements of the Pistoning system vs. a traditional strengthening model, with positive, immediate results.
This
was a preliminary study with a focus on feasibility. We kept it
simple to promote participation and survey return. We feel like it is
a good start to looking at the impact of both using an online
telehealth format for pelvic health promotion and an integrative
program for restoring pelvic health. I am hoping to do a follow-up
that measures participant’s response to the program at longer
intervals 6-8 weeks, and 6 months.
An
exciting follow-up study is already brewing through an awesome
collaboration with two women’s health physios in the Sultanate of
Oman. They plan to translate the webinar into Arabic, and repeat the
study with women in their country. A blog about my amazing experience
in Oman over the holidays is forthcoming, but for now you can read
about it and see pictures on my Facebook feed.
***
These numbers are based on raw data collection only, and applies to
the respondents. The numbers and meaning behind them will be clearer
as we analyze the data.
- Where can we find out more information on your live and online seminars?
Thanks
for asking!
My
website is chalk full of more information through my blogs and vlogs
here:
https://www.juliewiebept.com/blog/
.
Upcoming
live course information can be found here:
https://www.juliewiebept.com/events-for-professionals/
Webinar/Online
Seminars can be found here:
Dr
E and I talked about creating a discount for the webinars for the
fine folks that frequent his blog. So please use discount code: DrE
(case sensitive) for 10% off my new webinar. And if you are a rehab
or fitness pro new to the information I am sharing consider the
already discounted Professional Webinar Bundle which that combines
two webinars, the first with the theory and evidence behind the
approach, and then this new one that takes you step by step through
how I teach it to and apply it to women.
- What is your favorite aspect of blogging and social media?
I
love to educate, it is my passion. I also like to shake up the status
quo! So blogging is such an awesome way to communicate with many and
to make people think! But in order to write a blog, I have to be
continually be learning myself, and I am incurably curious. Writing
about where my nerdy curiosity takes me is fun.
Social
media helps to feed that curiosity. Done well, SoMe is like having a
research team in your back pocket. There is so much literature to get
through and it is nice to have trusted sources online that share what
they have found. As a solo practitioner, it is great to have
developed a network of pros that I can go to with questions or
looking for ideas.
- What about social media negatives?
- Closing thoughts?
As
I re-read my answers, particularly the one about using the PF to
address pelvic obliquity, likely many readers thought: I’ll use my
manual acumen to get it organized and then send them out to a women’s
health therapist for that pelvic floor stuff.” I just wanted to let
you know that I am not a classically trained women’s health
therapist, I don’t do internal. I evaluate the participation and
responsiveness of the pelvic floor externally, and so can you. The
pelvic floor is part of the system we use to stabilize our centers
and it is a part of every move that we make. As therapists it
behooves us to understand this muscle group as just that, a muscle
group. It isn’t scary or oogey. It is an ally. Please note, there
are circumstances that absolutely require a referral to a women’s
health specialist (I refer out too!). But I think we have too much
evidence for the physical therapy community to continue to set the
pelvic floor aside from all of our other strengthening, movement
patterning, and training programs. Time to see the pelvic floor in a
new light.
Make sure to visit Julie's site for more information. She is great for Q&A and is also available for courses.
Keeping it Eclectic....
Post a Comment
Post a Comment