Myths and Facts
Incorporating pelvic health into your private practice.
By Jennifer Stone, PT, DPT, OCS, CAPP-certified pelvic floor practitioner
Few areas in physical therapy practice are subject to the level of stereotypes, misinformation, and intimidation as that of pelvic health, or what has traditionally been called “women’s health” physical therapy. Most therapists hear the term and approach it with an attitude of “you can not pay me to touch that with a 10-foot pole” and many businesses dismiss it without a second look. However, in so doing, therapists are doing their patients a huge disservice, and businesses are ignoring a huge potential for revenue and growth. Take a look at the following myths and the corresponding reality and perhaps you will reevaluate the level of need for your business.
Myth: Women’s health physical therapy is a niche practice and not an area of need
Reality: The pelvic floor is intricately involved in many dysfunctions commonly treated by orthopedic physical therapists, including low back pain, pelvic girdle sacroiliac (SI) pain, and hip pain. Physical therapists who do not incorporate pelvic floor intervention at some level for these patients are missing out on an opportunity to fully address the underlying cause of their patients’ pain and this may lead to decreased patient satisfaction or patients who believe they tried physical therapy for their back and it did not work for them. Pelvic floor specific pathologies (what most women’s health therapists would say they primarily treat) are extremely common, occurring in up to 67 percent of women and up to 8 percent of men throughout the lifespan-perhaps more, as most practitioners believe these problems are underreported and underdiagnosed.
Myth: You can only address the pelvic floor via an internal exam and intervention
Reality: While many problems with the pelvic floor are most easily and effectively addressed this way, it is possible to treat the pelvic floor from an external perspective. Many pathologies that the majority of clinics say they “do not treat” can be addressed with minimal or no internal work! It would be beneficial to have someone who does internal work in order to offer the full spectrum of care—but any physical therapist can and should be addressing components of the pelvic floor in practice!
Myth: You must have access to expensive equipment to treat the pelvic floor
Reality: The three therapists in my clinic who treat the pelvic floor do so using their hands, gloves, lubricant, and…nothing else. While equipment usage (specifically for biofeedback) has been a popular component of pelvic floor intervention historically, it is quite possible (and I would argue more beneficial) to provide this intervention without making large purchases.
Myth: I live in a rural area—the level of need in my area will not justify the expense of adding a pelvic-floor trained therapist to my practice
Reality: People travel far for pelvic floor intervention. It is quite common for me to have people driving four hours one way to see me every week. The town where I live and practice has about 120,000 people—not exactly a thriving metropolis-and we have three therapists whose schedules are kept very full of patients with pelvic floor dysfunctions. Additionally, the clinic that I run was started exactly three years ago, and in that time, we have grown from one physical therapist (myself) to five full-time employees whose schedules are busy, and we are the most profitable clinic in our system.
Myth: The level of reimbursement for pelvic floor is not higher than other pathologies, and it requires 1:1 intervention, so it is not a business venture that will be worthwhile
Reality: While some aspects of pelvic floor intervention do require 1:1 intervention, there are also components (core retraining, etc.) that could take place in a group setting. Additionally, offering this service is highly likely to create brand-new referral sources for your practice (for which you may have little to no competition) as well as increase referrals from current sources as you become known as the best place in town to go for low back pain, hip pain, and sacroiliac (SI) joint pain-so the real question is, can you afford not to offer this service?
Myth: Pelvic floor physical therapists are much more likely to be sued than other types of physical therapists.
Reality: There is zero evidence to support this statement, and it comes from a faulty assumption that pelvic floor physical therapists are doing something risky, wrong, or unusual in medical care. If the pelvic floor musculature is approached as just another body part (which is exactly what it is) there is no reason for even a theoretical increase in liability.
The pelvic floor is an extremely complex group of muscles, which are an integral part of core control during movement of any type (including breathing!). The fact that physical therapists have relegated this group of muscles to “women’s health therapists only” is a poor reflection on our profession and is likely the primary reason for physical therapy failure in treatment of some dysfunctions. We cannot truly claim to be musculoskeletal experts if we choose to ignore this key group of muscles simply because we are uncomfortable with where they are and how they are accessed.
Offering treatment for patients with pelvic floor pathologies (and offering enhanced treatment for patients with a pelvic floor component to their low back pain) also represents a huge potential business opportunity. Unlike most physical therapy clientele, patients who need treatment for the pelvic floor will drive long distances (increasing your reach and potential referral sources), are much more likely to pay cash if needed for your services, and are typically extremely compliant with their care (cancel no show rates for this patient population hover around 5 percent at my clinic). As health care continues to undergo changes and reimbursement rates continue to change, “outside the box” practice patterns will become more and more necessary-and this one is extremely easy to implement and incredibly effective!