Pelvic Health Physical Therapy Level 2 (PH2)

Open to: Licensed Physical Therapists, Physical Therapist Assistants, 2nd Year and 3rd Year Student Physical Therapists. We recommend students have some orthopedic/musculoskeletal coursework in their curriculum prior to attending the course.

Pre-requisites: Successful completion of the Pelvic Health Physical Therapy Level 1 course. Experience of 6 months or more in regularly managing patients with pelvic physical therapy, or working in a clinic with other experienced pelvic physical therapists, is strongly recommended prior to attending this course; lack of experience may greatly inhibit participant comprehension and attainment of skills during the course.

Requirement:  In order to proceed to the Pelvic Health Physical Therapy Level 3 course, you must complete the Pelvic Health Physical Therapy Level 2 Bowel Dysfunction AND the Pelvic Health Physical Therapy Level 2 Pelvic Pain course. Both courses must be taken to fulfill the Level 2 requirement.

Attendance: Participants are expected to stay through the entire course; please make your travel plans accordingly. Deduction of contact hours hours and ineligibility to participate in the CAPP process (for those attending CAPP courses) will occur for participants who leave the course early.

Lab Participation & Consent: Participants will be working in groups of 2 during labs. This course includes extensive labs with intra-vaginal & intra-rectal assessment & examination. The Internal Consent & Release Form.pdf must be filled out and turned in to the instructor on Day 1 of the course (this form is provided on-site). If the course participant does not turn in the completed form on Day 1, he/she will not be permitted to take the course. All participants must participate in labs as both “therapist” & “patient.” Participants who cannot participate as lab subjects are required to provide their own lab partners. Failure to participate as a lab subject, or to provide required lab partner if needed, will result in forfeiture of course completion and registration costs. If you are not sure whether you need a medical model or if you are unfamiliar with the process of obtaining a medical model, please read: Medical Models for Internal Pelvic Assessment.pdf. Participants that MUST provide their own lab partners include (but are not limited to):

• ALL Male participants
• Pregnant women (except with written physician permission for FULL participation)
• Active vaginal infections
• Active STD or herpes lesions
• Active bladder or rectal infections
• Severe pelvic/vaginal/rectal pain that inhibits examination
• Lack of prior vaginal exam by a physician
• Active OB/GYN cancer

Pre-Reading Assignments: Pre-readings are articles and cases that must be read and reviewed prior to Day 1 of the course. Pre-readings will be provided electronically to course participants prior to the course.

English Language Proficiency: If you are a foreign-educated physical therapist/assistant, you will need to pass the TOEFL(Test of English as a Foreign Language) and meet the score requirements. There are some exemptions to the TOEFL requirement for individuals who are exempt under the USCIS regulations. TOEFL scores must be reported directly to SoWH for the purposes of determining eligibility for course attendance. The minimum TOEFL scores we require are the following: Reading: 21; Listening: 18; Writing: 24; Speaking: 26.

2-day Bowel Dysfunction Version

Day 1: 7:30 am – 5:30 pm *Registration begins at 7:00 AM*
Day 2: 7:30 am – 5:30 pm

Contact Hours: 17.25 hours

2-Day Pelvic Pain Version

Day 1: 7:30 am – 6:00 pm *Registration begins at 7:00 AM*
Day 2: 7:30 am – 5:30 pm

Contact Hours: 17.75 hours

This evidence-based 2-day course provides clinically relevant information and training in the examination, evaluation and intervention of bowel dysfunction. Labs offer skills immediately applicable in the clinic and include complete internal rectal pelvic floor muscle and external abdominopelvic examination and treatment techniques. Lectures include the anatomy, pathophysiology and physical therapy evaluation/treatment of pelvic floor dysfunction-related bowel dysfunction. Concepts of pelvic floor muscle motor control training, rectal balloon training, coccygeal mobilization, and clinical application of modalities will be reviewed. Clinical decision-making and an integration of skills acquired at CAPP Pelvic Health Level 1 will be included.

Upon the completion of this course, participants will be able to perform the following:

EXAMINATION AND EVALUATION

1. Describe the anatomic, physiologic and neurological components of defecation and dysfunctional defecation.
2. Perform an appropriate evaluation of a patient with bowel disorder diagnoses to include fecal and anal incontinence, irritable bowel syndrome, constipation and obstructed defecation.
3. Demonstrate ability to perform rectal pelvic floor muscle examination for patients with bowel dysfunction.
4. Assess coccygeal function and joint mechanics for patients with pelvic pain or bowel dysfunction.

DIAGNOSIS/PROGNOSIS

5. Differentiate between musculoskeletal impairments related to bowel dysfunction and signs and symptoms associated with non-musculoskeletal pathology requiring further medical examination.
6. Develop functional goals for musculoskeletal impairments identified in patients with bowel disorders based on a systematic interview and examination of the patient.
7. Demonstrate understanding of colon and anorectal function testing for bowel disorders.

INTERVENTION

8. Develop an evidence-based and appropriate plan of care for physical therapy intervention of musculoskeletal impairments for patients with bowel dysfunction.
9. Perform manual myofascial release techniques, trigger point release techniques, coccyx mobilization for the treatment of patients with bowel dysfunction.
10. Describe and perform appropriate clinical application of surface electromyographic (sEMG) biofeedback for bowel dysfunction diagnoses.
11. Describe and perform appropriate clinical application of digital rectal biofeedback and rectal balloon biofeedback as an intervention for patients with bowel dysfunction.
12. Provide behavioral intervention strategies to improve bowel function such as diet, lifestyle changes, and proper toileting techniques and posture.

This evidence-based 2-day course provides clinically relevant information and training in the examination, evaluation and intervention of female pelvic pain. Labs offer skills immediately applicable in the clinic and include complete internal vaginal pelvic floor and external abdominopelvic examination and treatment techniques. Lectures include the anatomy, pathophysiology and physical therapy evaluation/treatment of pelvic floor dysfunction related to pelvic pain in the female patient. Basic concepts of myofascial release, female sexual response and sexual dysfunction, and clinical application of modalities will be reviewed. Clinical decision-making and an integration of skills acquired at CAPP Pelvic Health Level 1 will be included.

Upon completion of this course, participants will be able to perform the following:

EXAMINATION/EVALUATION

1. Describe the anatomic, physiologic and neurological components of pelvic pain diagnoses.
2. Perform an appropriate evaluation of a patient with pelvic pain diagnoses to include pudendal neuralgia, vulvodynia, vaginismus, painful bladder syndrome, endometriosis and coccydynia.
3. Demonstrate ability to perform a vaginal pelvic floor muscle examination for patients with pelvic pain diagnoses.
4. Describe the female sexual response and demonstrate understanding of sexual dysfunction.

DIAGNOSIS/PROGNOSIS

5. Differentiate between musculoskeletal impairments related to pelvic pain and signs and symptoms associated with non-musculoskeletal pathology requiring further medical examination.
6. Develop functional goals for musculoskeletal impairments identified in patients with pelvic pain based on a systematic interview and examination of the patient.

INTERVENTION

7. Develop an evidence-based and appropriate plan of care for physical therapy intervention of musculoskeletal impairments for patients with pelvic pain.
8. Perform manual myofascial release techniques, trigger point release techniques and abdominopelvic interventions for the treatment of patients with pelvic pain.
9. Describe appropriate clinical application of modalities for pelvic pain diagnoses.
10. Perform external manual therapy techniques and rigid taping techniques to address pain and dysfunction related to the coccyx.
11. Provide behavioral intervention strategies to manage pelvic pain including lifestyle changes, diet, and proper posture.

The Certificate of Achievement in Pelvic Health Physical Therapy is an optional route if you wish to take a bigger step towards your career. Section on Women’s Health (SoWH) has developed the Certificate of Achievement in Pelvic Physical Therapy (CAPP) to certify that a physical therapist has completed a comprehensive education, training, and testing program for the management of patients with diagnoses of pelvic health dysfunction, such as urinary incontinence and pelvic pain.  The CAPP is awarded to physical therapists who complete four courses of training in pelvic physical therapy (Level 1, Level 2 PP & PH2 BD, Level 3), pass written and clinical testing requirements at each level, and successfully complete a written case report. To learn more, please visit: www.womenshealthapta.org/capp.