One Frequently Asked Question that I have received since launching Pelvic Resilience: How does what you do differ or compare to the work of a Pelvic Health Physiotherapist (PHPT)?
The first thing that I want to say is that this is a question that I have grappled with a great deal. I have been a vocal advocate of PHPT…and will continue to be! Switching gears to promote my own skills and services has been a process. My understanding of my role as an Occupational Therapist (OT) offering pelvic health services will definitely continue to evolve as time goes by and new research emerges. This blog (which is mostly for my own benefit) is a sense of where I stand with this question in this moment…
- No Internal Assessment. One difference between OT and PT in pelvic health is that, IN ONTARIO, OTs (unlike PTs) are restricted from training to provide internal assessment and treatment of the pelvic floor muscles. I have struggled with this a great deal. However, the more I have learned about pelvic health, the more apparent it has become that pelvic health issues are whole body and whole health issues. The health of our pelvic floor muscles is influenced by so many factors that can be addressed externally to improve quality of life (alignment, movement, breathing, brain map/connection/awareness of core muscles, recruitment patterns, weakness and tension held in other parts of the body, body image, stress, hormones, mental health, human connection & relationships, trauma….the list goes on!).
Internal assessment and work is absolutely an important piece of the puzzle in pelvic health…I do not want to minimize it! But it is certainly not the only piece of the puzzle. And maybe it doesn’t have to be the starting point for everyone to receive impactful information and care?
Is anxiety or discomfort about internal work what is stopping you from getting help for a pelvic health issue? Maybe you are newly postpartum and feeling “touched out” or maybe you have had a negative experience with past internal assessments, maybe you have experienced sexual or birth related trauma and are uncomfortable with the idea of internal work at this stage of life. OT could be a wonderful resource for you to get some quality information and holistic strategies in place to promote your pelvic health and overall wellness.
- OTs work from a Function 1st perspective. An incredible PHPT put it to me this way… “As much as you are insecure about not offering internal work for pelvic health, I am insecure about sessions sometimes being consumed by internal work and therefore not always addressing functional impact, emotional impact and quality of life with clients”. I so appreciated this wonderful soul for her willingness to talk openly and transparently with me about how we work and what we offer. This was a huge light bulb moment for me. OTs, like PTs, are well versed in human movement and physiology, and there certainly will be overlap in our strategies. Maybe the major difference lies in our vantage points, making both disciplines wonderful resources depending on individual preferences and where someone is feeling stuck in their rehabilitation. PTs OFTEN work from a zeroed in perspective (where is the discomfort/issue happening?) and work their way out to address function. Whereas an OT typically starts with function. What are the tasks, movements, occupations that are causing symptoms or being effected by symptoms? How is it influencing your life roles, your emotional wellness and quality of life? This often gives us great insight into what is important to you and where we can make a meaningful difference at the onset of treatment. We can then zero in on addressing the problematic “drivers” (or root cause) of your symptoms.
PHPT has been demonstrated to be an effective, conservative approach for many pelvic health issues. For those folks that don’t see improvement with PT, surgery is often the next step. But…what if a different vantage point or perspective is the next logical step?
OTs can help with:
- Integrating a rehabilitation program into a hectic life
- Adapting important tasks or activities to minimize symptoms
- Maybe finding time for an exercise program is just not going to happen at this stage in your life. We can bring mindfulness to and tweak the ways that you are moving throughout the day or daily habits (i.e. carrying a little one, pushing a stroller, how you bend and lift, climbing stairs, toilet and bedtime routines) to achieve meaningful results in your recovery.
- Transferability of an exercise program into functional movement/ergonomics to achieve lasting results.
- Exploring and addressing life stressors that could be impacting or stalling your recovery.
- Emotional and Psychological support. In Ontario, OTs ARE permitted to practice psychotherapy. This can be delivered in a traditional counselling format or therapeutic strategies integrated into a physical rehabilitation program. Pelvic health and mental health are inextricably linked. For many individuals, symptoms of a pelvic health issue can cause distraction, preoccupation, hypervigilance and significant distress. Unfortunately, the deep muscles in our core and pelvic floor can be greatly impacted by distress. Our posture changes when we are in distress and we can hold a lot of tension in these deep muscles, making symptoms worse and thus creating even more distress. It can become a vicious cycle of worsening physical and emotional wellness. Therefore, a biopsychosocial approach (that is treatment addressing physical, emotional, psychological and social wellness) to treating pelvic health is often considered the gold standard of care. As I am often the lone OT in the room at trainings related to pelvic health, I quietly smile to myself when this topic inevitably is brought to light and I feel validated that I can be of service! This is how we, as OTs, have been trained. Looking at someone and their situation through a holistic lens is lesson #1 in OT school. We are well versed in providing a biopsychosocial approach to care and therefore well positioned to provide impactful pelvic health services.
OTs and PTs both have a lot to offer! There is overlap but there are also some differences that make both disciplines invaluable resources. We have a wonderful network of PHPTs in our community and I do believe that working in a collaborative model is possible, if you so choose to captain a team of supporters for your health!
Consider OT for your pelvic health if:
- You have a pelvic health issue and want to address it!
- You are distressed about the idea of an internal assessment.
- You have felt stuck with another rehabilitation program and are looking for a new perspective.
- You live a busy life and the idea of a “Function 1st” approach for your pelvic health is appealing to you.
- You have a complicated relationship with your pelvic health and are really struggling with social and functional impact, meaningful relationships, anxiety, depression, body image, or other forms of distress.
If any of this resonates, Pelvic Resilience is absolutely for you!
Lara Desrosiers OT Reg. (Ont.), Psychotherapist