Is your pelvis too busy attending to the other demands of your life?
submitted by: Craig Stasio PT
Thoughts on a physical therapist's role in fertility treatment.
I have been a Physical Therapist since 2004. I graduated with strong foundations in anatomy, physiology, and kinesiology, as well as logic and scientific method. I was given great opportunity to develop skill in palpation and manual therapy. I discovered the importance of finding the deeper roots of the problem, but in ways that make it more simple rather than more complex. I was compelled as a young PT to find ways to test my work; to objectify everything that I was trying to influence change in. I re-tested these measures at the end of each session and again at the beginning of the next session. This process provided me and my patient with valuable information... that I was having a lasting influence on my patient's progress. I felt that in order to be a great PT, I needed to partner with my patient and be as accountable to their progress as they were to my treatment and exercise recommendation. I needed to KNOW that what I was doing was worth every penny in order to find satisfaction in my career.
...pages of objective measurements and each measurements functional influence on pain, posture, gait deviation, movement disorder, muscle imbalance, chronic, acute and surgical conditions. While knowledge in every science grows with experience and practice, there are many predictable measures that exist in the assessment and treatment of orthopedic disorders. These measures may be improving during the course of care, but how would a therapist know until it was re-tested? My choice to re-measure patients in every session has secured cause and effect relationships resulting from my care, as well as develop a confident set of predictive metrics to use in treatment and training.
What I am doing is called physical therapy, and is what any other physical therapist is trained for; whether they do, or not.
So, what does that have to do with fertility?
In the early years of practice, I never claimed to be a womens' health physical therapist or a specialist in internal pelvic disorders such as incontinence, prolapse, interstitial cystitis, endometriosis, pelvic pain disorders, among others. I also never fathomed about fertility.
I found success in understanding the movement needs of the lower half of the body as a dancer, a gymnast, a runner, or bipedal ambulator (two-legged walking person). I focused on movement relationships as the body projected power from our center outward toward the toe. I focused on how the actions of the muscles changed when the body needed to anticipate the impact of the ground and overcome the carriage of the rest of the body solely on the ball (or toe) of one foot as the other foot swung through the air. Surely that toe alone was not capable of propulsion of the rest of the chain. I found that I could measure aspects of trunk position and motion, then pelvic position and motion and with that information and careful observation, I could direct precise treatment recommendations for the benefit of a hip, knee, or foot disorder.
To create change in the dysfunctional runner requires influence on the center: the core and pelvis. To influence the dysfunctional dancer requires change in the core and pelvis. To improve the gymnast requires change of their core and pelvis. And for most other lower body conditions... lasting changes can be secured with changes in the core and pelvis.
We project power outward from our center and then immediately prepare to accept and carry the rest of our body gracefully all over again with the other leg. This repetitive volley of power projection - weight acceptance - power projection - weight acceptance requires a complex choreography of muscle action transmitted into one leg, through the pelvis, into the other leg, through the pelvis and on in a repeating fashion. The effort provided by the trunk and the pelvis, as it projects power through one leg, it is like being alone on a teeter totter. Imagine being the person on one end of that board trying to get the other side to touch the ground. The entire weight of the body, less the weight of one leg planted on the ground, teeters on the balance and level of the pelvis.
The pelvis, core, and muscles of the hip accept this job with every step, just to walk, let alone dance or jump or run. All of that was to say that there is a lot going on with every step, and much to get right.
Is there a chance that at the time a woman is trying to conceive, the pelvis is a little busy attending to other matters?
This is where things start to come together...if you made it this far, keep reading.
So, as I mentioned, I never claimed to be great at treating women's health issues, but why did some runners tell me after a few visits that they no longer were leaking when they ran? Why did some of my back pain patients tell me that they finally were having less painful or less heavy cycles? Why did some sciatica patients tell me that after years of not menstruating, "the craziest thing just happened to me, my period started again! Do you think it has anything to do with treatment?" The number of interesting womens' health related conditions that were improving, or at least changing, was getting my attention and I started taking notes.
I received a phone call from a gynecologist in Grand Rapids. He was acting as a patient's primary care physician and referred one of his patients to me for treatment of low back pain. The patient never mentioned in her evaluation that she also suffered from urinary incontinence, endometriosis, and amenorrhea (abnormal absence of menstruation). I was not in the habit of asking about these conditions at the evaluation in my early years. Most do not offer that information up unsolicited in an initial evaluation. After several visits for low back pain treatment, my patient's pain was doing well. She had a regular follow-up appointment with her gynecologist and discussed with him that not only did her back feel better, but she had also not leaked in several weeks, not had pelvic pain, and her menstrual cycle had started for the first time in years... I had no idea.
The phone call went like this:
Dr.: "Craig, this is Dr. Soandso."
me: "Hi Dr., how can I help you?"
Dr.: "I am calling in regards to Mrs. Mutualpatient. I saw her in my office today and wanted to question you in regards to what you had done with her in therapy."
me (heart rate up a little): "Um...yes, she has done well here with a progression for her abdominals and leg strength. She told me that she was doing well and was pleased with her progress. Is there a problem or concern with the care I provided?" (heart rate spiked)
Dr.: "Did you perform internal pelvic techniques in the treatment of her back pain?"
me: "No sir. Is something wrong?" (chest pounding and feeling that dry cottony feeling in my mouth now)
Dr: "No, its nothing wrong, it is just that she has not only resolved her back pain with you, but in the past four years before she came to you, she also has had women's health PT, surgery, and several fertility treatments in an effort to accomplish what she has gained in the past four months in your clinic."
me: (still unaware of any other benefit than her low back pain progress) "Could you tell me what you mean? What else had she gained?"
Dr: "She has gained hope! Her cycle has started, and she now feels that she has the best chance in four years to conceive a child. I thought you knew. She thanked me for sending her to physical therapy with you."
This is where the thought of fertility enrichment started for me, but I kept it mostly between me and my closest peers; one of whom is my wife Tonya, a fellow PT in Grand Rapids, and my biggest supporter in this and many endeavors.
Much time has passed from the initial thought of that phone call to the present. During that time, I have reviewed notes, compared objective measures, noted similarities, and questioned differences among the patients that experienced unique events in their pelvic and reproductive life during their care, regardless of the diagnosis they were in therapy for. I have collected specific metrics that serve as a framework for fertility enrichment; specific measurements that have shown success in improving the soil for a capable seed to take root.
Once this framework was established, I needed the opportunity to treat patients solely to increase the chances for fertility rather than treating for a pain or movement disorder. It was obvious that many patients of childbearing age naturally are inclined to start or expand their family during this time of life. I needed to know if I treated patients for wellness and fertility enrichment, rather than for pain and movement related dysfunction, if those same metrics would enhance the chances of a pregnancy. I introduced the idea to a couple patients expressing difficulty with fertility.
Well, once one patient was able to get pregnant, word traveled fast. I have had the opportunity to treat multiple patients specifically for the purpose of fertility and treatment has been overwhelmingly successful. There have been patients referred by health professionals, and patients referred by successful friends and family members. I started to treat individuals privately in my clinic without advertising to the public what I was attempting to help them with. There is not widespread research, or even agreement in the capacity of a physical therapist, let alone any holistic bodywork practitioner to aid in a woman's fertility.
I based my decisions on evidence and clinical experience. I had measurable guidelines to follow for inclusion and exclusion in the fertility program. I decided that I would treat each individual in the same manner. I offered a preliminary consultation followed by preliminary measurements on the same or subsequent visit. I compared the objective measurements to normative values and the Fertility Enrichment framework values to determine if the individual was likely to benefit from my approach. If so, treatment was explained and offered. I felt my role in this journey was to guide these patients toward normative values as compared to the preliminary measurements. Once each patient reached the objective measures we had set as goals, I would no longer have a framework to follow and my work would be done. It was then up to the patient and her partner to sow the seed.
I was not sure how many patients needed to become pregnant for me to believe in my own work. I was definitely not sure how many pregnancies there needed to be for anyone else to believe in my work. I have learned that it takes many more pregnancies to make me a believer than it does anyone else. Once one patient became pregnant, it did not take long for another person to call, or for my wife to tell a friend, and then another to call. Those patients that have become pregnant have no trouble believing in the work that I have done. Every woman that has lived with infertility seems to know another woman with a similar journey.
It was at this point that I needed to decide if this would be a program offered in my clinic. I decided that there would need to be concrete evidence that this program was worthy. I needed to see a remarkable success rate, I needed to exceed conventional medical fertility rates of pregnancy, but more, after multiple successful pregnancies were accomplished, I just needed a sign that I was making the right decision for my practice. I remember the patient, that after driving a distance for a fertility enrichment visit with me, not to be treated, but to make a surprise announcement that she and her husband were pregnant (READ THEIR JOURNEY HERE). She asked me, "What are you going to do with this program? When are you going to offer it to the public?" At the time, I was not sure. That night, I asked Him for guidance... I needed a sign. Soon after, I received an email from a woman that soon became a patient. Her infertility journey had been the longest, and most complex of any of the patients that had enrolled in fertility services. She was from out of state and was to fly in for treatment. I decided after her preliminary examination that if this patient had a successful pregnancy following our work together, I would start the SIMIO Fertility Enrichment program. Well...you have read this far. (READ HER JOURNEY HERE)
Some important things to know about Fertility Enrichment at SIMIO:
Fertility Enrichment is not a guarantee of pregnancy. It begins with specific metrics to determine if you are, or are not, a candidate.
Candidates for the program are determined by their objective measurements, in addition to their previous medical history and infertility journey. NOT by their infertility journey alone.
Not all infertility is positively effected by SIMIO Fertility Enrichment.
SIMIO Fertility Enrichment is not harmful, has no lasting side effects (unless you count changing diapers and night-time feedings!), yet often results in improved alignment, strength, muscle balance, bladder control, and decreased pain.
Fertility Enrichment is considered a wellness service and is a non-covered diagnosis in physical therapy health insurance billing. For this reason, we do not bill your health insurance for Fertility Enrichment services at SIMIO.