What Drives a Pelvic Floor Therapist: The Values That Keep Us Grounded

To learn more about the Functional Pelvic Practitioner certification, please go here.
To learn more about OT Pioneers: Intro to Pelvic Floor Therapy, please go here.

Resources mentioned in this episode:
Central Sensitization Inventory

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Transcript

Intro New and seasoned OTs are finding their calling in pelvic health. After all, what's more adult than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving O.T. in pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions, and this podcast will give you the answers. We are inspired, OTs. We are out of the box, OTs. We are pelvic health, OTs. I'm your host, Lindsey Vestal, and welcome to the OTs and Pelvic Health Podcast. 

Lindsey Vestal So I am in the middle of doing an entire revamp of what Pioneers the introductory course to help occupational therapists get started. And pelvic health. I've been offering this course since 2018, and throughout the years I have definitely updated added things, changed things. But it was time with the certification coming forward. So I'll be launching in January 2025. That's the first pelvic health certification that's directly aligned with not only a coat standards, which is what university programs look at, but with our routine practice framework. And so I had to take a really hard look at making sure that it was the most evidence based and up to date. And I'm talking from top to bottom underneath the hood, on top of the roof rack, like the whole nine yards. But anyway, in the process of doing that, I kind of wanted to step back and look at some of the values of Pelvic Floor OTs And what really differentiates us or distinguishes us or how I see the over a thousand OTs that I've helped get their start in pelvic health, what kind of unites us? And so this is going to be a fairly short episode that dives into some of those observations that I've seen that honestly just makes me incredibly proud of our profession. 

Lindsey Vestal The first thing I see a lot is this idea of a strength and resilience based approach instead of a deficit first approach. And with this comes an incredible compassion and curiosity. So instead of asking questions that basically imply what's wrong, we ask things like What is your body doing to help you? Where are you resilient, awesome. Let's work on that. And when we approach it from this manner, we're really fostering opportunities for agency and influencing our clients self-talk. I recently went to a evaluation at a therapist's office and there was definitely an emphasis on how is your body, how is your body breaking down? Okay, you're approaching 50. Let's look at some of the things that we can do to to fix you, to make you stronger. And of course, that wasn't exactly phrased in that way. But I think it's the meta messages that are sent when you don't look at things from a strength and resilience based approach. So I encourage us all to take a moment and think about the way we're phrasing our questions. Is there any small tweaks that we can do that just make it a little bit more empowering? And the focus is on resiliency work too. We always ask ourselves, is hands on work appropriate? Right? We can't strengthen muscles that the brain or nervous system isn't using, and sometimes the pelvic floor is not the driver to symptoms, right? Sometimes it's the nervous system. And so if we're immediately putting hands on people without checking in with where their brain and nervous system is, I'm not sure that is the most effective approach. And so this is where I encourage my students to use distressed inventories in their intake forms and a distress inventory such as the central sensitization inventory, which I will link to in the show notes, does help us prioritize hands on work versus starting with the nervous system first approach. 

Lindsey Vestal So basically, if a client scores higher than a 40 on this test, I just tell my students point blank, that's in the moderate category. They do have a sensitized nervous system and they just doesn't make sense to start with any sort of hands on work. So what a great clear cut way to help triage our focus. Couple other things are I love when we recap main areas of concern to our clients and ask if we got it right. What a simple thing to do at the evaluation that causes such a opportunity to realign with. We did get it wrong and it really helps them know they were seen and heard. You got it right and they know it. I also think a strength of ours is not a. Overwhelming our clients. So I always recommend that Pioneer students focus on three takeaways per session or three things to do per session. And then we check in at the next session. How did those three how did those three things go over? How successful was the client? Did they were they able to do it? They find time to do it, and if not working with them, What can we do from a task analysis perspective to make those three things easier, more motivating, more aligned with the occupations they want to get back to? So it's a chance to realign, recalibrate and make sure your client is intrinsically and extrinsically motivated. Some simple questions that we can ask clients are who have you seen for your concern and what has worked that will give us so much insight? Because it's also a generate it it's it's an answer that was generated by them because honestly through it's their perspective that matters the most, right? So what has worked is a really powerful insight to help us realize where our work and our interventions could be aligned. 

Lindsey Vestal OTs Love the whole body approach. It's not just about the pelvis. Even though we're pelvic health therapists, we move away from specific isolating exercises to more global and functional approaches. How I phrase it is we're putting it into the orchestra. It is now part of an entire team, an entire ensemble. When we do it this way. And it's so much more fun than isolation, we look at movement, nutrition, sleep and stress management, and we're always leaning into the power of occupations. We can do this a lot of ways. One of my favorite ways of doing it is kind of anchoring back into our own Led frameworks. The four that I talk about in the new version of Pioneer specifically, and I bring it back to examples of how to use them in pelvic health, our Mojo, the Model of human Occupation. The second one I talk about is the Canadian model of occupational performance and engagement, which include things like spirituality. The third is the p o P, the person environment, occupation, performance. And the fifth, of course, is the car. Now, I have had Christine Springer on an earlier episode on our podcast talking about an entire hour on how she uses the collar with her and with her clients. And it was so beautiful. But I think those four frameworks and there's more, right? But for the sake of simplicity, I really wanted to focus on four. And it's just such an authentic way to make sure that we are leaning into the power of occupations. One of my favorite ways to practice is through a trauma informed lens, and I don't think there's enough emphasis on this in some of our more basic pelvic floor courses. I actually think a trauma informed course should be required before even the Pelvic Health Foundation. 

Lindsey Vestal I think that trauma informed work allows clients to practice autonomy and agency as much as possible. And I think that leaning into the power of explicit versus implicit consent is incredibly important. Now, explicit consent. Okay, so let's actually start with implicit consent. That's the one form checkbox. Yes or no, Do you consent to doing an on an internal exam? Do you consent to doing an internal exam? And then maybe once in your session you're asking again for verbal consent? That's just not enough. That's just frankly, not enough. Explicit consent is explaining what it is they're signing up for, because, as Dr. Kristina Holland says, who's on faculty for the trauma informed pelvic certification that Laura DeRosa and I put together. Yes. Doesn't mean anything if no is not an option. And how can they say yes or no when they have no idea what they're you're asking them? What does it involve? Answering questions like where were you? Touch them with a pelvic model in your hand so you can show them. How long will you be touching them? What can they do if they want you to stop, what can they do if they want you to come out or off of their body? What will you do if someone knocks on the door? Right. Things like this where we can. Be as explicit as possible, even asking, Do you feel like you have the ability to tell me that you want me to stop or to come out? Could you use your voice? Would you rather use a prop? Drop the prop or raise your hand? Really talking them through all of the options they have is the most optimal way to practice pelvic health. I want to take a moment now to reframe some questions that my students have done so beautifully. 

Lindsey Vestal Customizable care. So instead of just handing their home exercise program to them and assuming they know when to do it, where to do it, how to do it, you could ask a question like, Is there any aspect to this home exercise program that you're concerned about? Is there any aspect you have questions about? Where do you see yourself doing this work? Temporarily. When do you see yourself doing this work? I think this is important in any therapy, but specifically in pelvic health, where a lot of the work is private and needs mindfulness. And so when and where are two of the most powerful questions that you can ask in addition to asking? Is there any aspect to this program that you are concerned about when your client walks in your office for either the eval or the treatment? Have you considered doing a somatic check in instead of an intellectual check in? So an intellectual chicken is how are you? Is asking how are you? A somatic check in is what's present for you right now. Leaning into intrinsic motivation is another big focus that I see our profession doing by simply asking this question What would your life look like when you achieve this goal? I love that question because it helps clients visualize where they're heading. It really, really leans into intrinsic motivation, and it also helps them to see some of the other aspects of their life coming together when they're focusing on this singular goal. Because it has a ripple effect, doesn't it? The work we do has a ripple effect, and I think it's so beautifully aligning when we can encourage them to remember that the last thing that comes to mind is that we know that we don't have to have all the tools we know that we can refer out whenever a client needs us to do so. 

Lindsey Vestal And I think that's so empowering. I also think that it is also so humbling because we do not need to have all the answers. We are not the right therapist for every client out there. And just gently reminding yourself of that is just one of the most simple shifts that we can do to empower ourselves and empower our clients. 

Outro Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already, hop onto Facebook and join my group OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic Health Podcast.