Pelvic Health Physical Therapy Blog
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Dr. Larry Nasser’s Conviction and Women’s Pelvic Floor Physical Therapy

Recently, I have been asked for my thoughts on the matter of the Dr. Larry Nassar conviction. Let me start by saying that it is extremely upsetting to me that Dr. Nassar was abusing these young women and trying to pawn off his disgusting behavior and abuse as a legitimate treatment. Even worse is how this abuse was overlooked and/or dismissed despite being reported many times.

As a woman, a mother and Physical Therapist that specializes in this important area of medical treatment, I am disgusted in Dr. Nassar’s actions and the lack of investigation by Michigan State University and USA Gymnastics. I agree with the article in the Huffington Post, by Lori Mize, PT “Nassar’s Atrocities Stigmatize A Legitimate Medical Treatment”, when she says:

“It is my duty to women like these to ensure Nassar’s abuse does not, in addition to all the other damage it has done, prevent others from getting the care they need. It is critically important for women’s health professionals to ensure the horror of the Nassar case does not feed public fear and misconceptions about pelvic PT or stop women who need health care from walking through our doors.”

Many have asked why was Dr. Nassar’s behavior dismissed by authorities and allowed to go on for so long. I’ve asked myself the same question, and I still don’t know the answer for sure….but here’s what I do know, as a Physical Therapist for 21 years who specializes in the Pelvic Health Physical Therapy area:

The type of treatment – pelvic floor physical therapy – isn’t understood by the general public. If patients don’t even know what the treatment is SUPPOSED to entail, how do they know what it is NOT supposed to be? There are not many pelvic health PTs in our country – not enough…yet. And in general – people don’t like to discuss the types of issues typically dealt with through pelvic floor PT.

Some might think that Dr. Nassar’s conviction could make me nervous to practice this type of specialty now that the general public might have negative feelings on this. However, it makes me even more passionate about getting the word out about WHAT pelvic health physical therapist do, how it is legitimate and how this information is crucial to living a healthy, active life for most women.

How has this case changed the way I treat females with pelvic floor issues? It hasn’t. Why? Because what he did to these girls/women was not therapy. It was abuse. How does what he was doing differ from pelvic health physical therapy? Let me count some of the ways…. Here we go…

1) CONSENT: Before assessing or treating this area, consent must be given. ALWAYS! At the first visit and each visit along the way. If a woman is not comfortable with an internal vaginal/rectal assessment/treatment for ANY reason (or just says no with no reason) or at ANY time – there will be none. It is always ONLY performed with consent. Additionally, it is mandatory that a patient who is a minor has a parent or guardian with them. In fact, a woman of ANY age may have a chaperone if so desired.
2) TRAINING: I, in addition to other pelvic health physical therapists, have significant amounts of training, continuing education or certifications from the state that demonstrate knowledge and proficiency in treating this population.
3) KNOWLEDGE: A detailed explanation of anatomy, contributing factors and rationale for these treatments are always explained. Most of the time, intravaginal/rectal treatments are not the primary area of time spent during therapy. Most times during therapy, there is a large portion of education and treatment is spent on coordination of breathing, pelvic floor, abdominal wall/back, posture, body mechanics, strategies for daily tasks and strength/coordination.
4) WE LISTEN: Listen, Listen, Listen and then Listen some more. A Pelvic Health PT performs a detailed assessment of the entire body’s strength, flexibility, coordination and muscle balance. We have a detailed relative conversation about the patients health & wellness, sickness, any diseases, surgeries, food sensitivities, bladder and bowel logs/performance, food/liquid ingestion diaries, childbirth/pregnancy histories, broken bones, surgeries, pain with intercourse, medical testing outcomes, medications/supplements/vitamins….many more topics…Many of these aspects play a role in the dysfunction. We integrate all of the information compiled, discuss objective measurement findings and what the patients goals are from treatment. We talk about this together with the patient and come up with a treatment plan that will address these issues. We then agree upon this treatment together or it will be adjusted. Treatment always includes a lot of Homework. Some of which might be posture, keeping a log of certain information, paying attention to certain things, exercises and breathing. As a PT, our goal is the goal of Patient.
5) SAFETY/INFECTION CONTROL: Dr. Nassar didn’t wear gloves! – ARE YOU KIDDING ME? Physical Therapists performing medically necessary intravaginal/rectal treatments ALWAYS wear gloves. Safety goes both ways: gloves to protect the provider and the patient. Prior to and during the internal assessment/treatments, the patient is educated on what to expect and how/why this is being done, so that they know what is going on. Proper internal manual therapy is often combined with verbal/manual instruction regarding breathing, relaxation, imagery and/or activation of certain muscles.

Knowledge is power. The more women understand how their pelvic floor and pelvic health work together with the rest of their bodies, the more power they have for success with their work, sport, daily life, taking care of children/parents, or just getting out of the house without wearing an incontinence pad.

Many times, women will tell me that they learned so much about their body at our Physical Therapy sessions. I often hear, “Why didn’t they teach us this stuff about our bodies in school?” It would be awesome if they did, wouldn’t it?

I will end with a quote from Maya Angelou, “Do the best you can until you know better. Then when you know better, do better.”

Now that you know more about Pelvic Health Physical Therapy – let’s spread the word so that everyone can know “better” and do better.

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