Understanding the Scope of Pelvic Floor Physiotherapy
By Melissa Wong, Reg. PT
Pelvic health physiotherapy (a.k.a. pelvic floor physiotherapy) is a specialized and unique type of therapy. I often get asked how I found myself practicing in this field. My personal journey into the world of pelvic health is beyond the scope of this blog, so I will describe how most people become physiotherapists (PTs), how most with become pelvic floor PTs, and why all pelvic health physiotherapists are not created equal.
Currently in Canada, most physiotherapists will complete an undergraduate degree in any area of study (often, but not always, science related). After an undergraduate degree, and provided that you have the pre-requisites for physiotherapy school, a physio-hopeful will apply to a physiotherapy program at a Masters level. This process is quite rigorous and may include essay writing, in-person interviews or aptitude testing. Physiotherapy school in Canada is currently a two-year Master of Science program that includes mandatory hands-on clinical placements.
More-seasoned physiotherapists (probably ones who graduated before or around the early 2000’s) likely completed an undergraduate degree in Physiotherapy. Internationally trained physiotherapists will often go through a bridging program to help bridge their previous knowledge and skills to the Canadian Healthcare landscape.
All physiotherapists in Canada complete both a written and a practical national licensing exam. Provided successful completion, physiotherapists are then eligible to register with their provincial college regulator. Physiotherapists will generally work in 1 of 3 areas of practice: orthopedics, neurology or cadiorespiratory.
Although somewhat improving, most physiotherapy schools do not spend much time teaching about the pelvic floor specifically. In my case, we essentially learned that there are muscles of the pelvic floor and that issues can often arise during and after pregnancy. Most students will cringe at the idea of assessing and treating internal muscles, and clinical placements in the field of pelvic health physio are virtually non-existent.
So, how do physiotherapists become pelvic floor physiotherapists? Generally, physiotherapists will work in orthopedics, often in a private practice setting. Somewhere along our careers, we develop an interest in pelvic floor physiotherapy. Perhaps it is after developing an issue ourselves or perhaps it is seeing a loved one deal with an issue that we know pelvic floor PT can help with. You will have to ask your specific physiotherapist what sparked their interest in the pelvic health world.
In Ontario, the act of “inserting a finger, hand, or instrument beyond the labia majora, or beyond the anal verge, for the purpose of assessing or rehabilitating pelvic musculature” is called a controlled or authorized Act. Physios who perform controlled acts must be able to prove that they have successfully completed training for the act that they perform. This can be formal education or training delivered on the job, as long as they are competent and safe performing the act, and as long as they have been evaluated on it. If a physiotherapist feels that they are competent in performing the skill, he or she declares this skill with the College of Physiotherapists of Ontario, called rostering.
Among the formal pelvic health education we can take to become proficient, a vast number of courses exist. Courses are mostly offered through private companies who develop and provide education to physios. Although the specific content within each course varies, courses are typically divided into a number of levels, each focusing on different aspects of pelvic health. Intuitively, Level 1 is the most basic, generally focusing on general anatomy, safety and the assessment and treatment of urinary and fecal incontinence. The majority of physiotherapists will roster with the college after only completing a Level 1 course or equivalent.
In Ontario, the College of Physiotherapists does not set guidelines on specific courses physiotherapists should take to become proficient at their rostered skill or how physios should remain up to date with their education. Many of our healthcare colleagues, including RMTs and physicians, are required to fulfill Continuing Education Units (CEUs), however as physiotherapists there is much more freedom to determine which courses to take. The highest designation for a Pelvic Health Physiotherapist in Canada is a special designation of Women’s Health Clinical Specialist. These therapists have been certified by the Physiotherapy Specialty Certification Board of Canada and only then can a therapist consider themselves a true “specialist”. This program is similar to the program in the United States (see below). It is fairly new and only four, yes, four therapists hold this title in all of Canada (zero in Ontario or the rest of Eastern Canada).
Given that there are no specific courses we take to become proficient at what we do, how can you tell one pelvic physio from another? Let’s jump back to the most common pelvic floor courses offered. Level 2 generally focuses on basic pelvic pain. From there, courses range anywhere from treating more advanced pain conditions, to athletes with pelvic floor issues, to cancer survivors, to menopause, to pre or post natal populations, and to kids, just to name a few.
Just as formal education can vary greatly from quality and types of courses offered, the method of education can also vary- from online course to medical conference to in person, hands-on courses.
Looking across the border, our colleagues in the United States will often have a Masters of Doctoral degree in PT. Courses are typically taken through two main routes: Herman and Wallace Pelvic Rehabilitation Institute or the American Physical Therapy Association’s Section on Women’s Health. With the former, therapists receive a “Pelvic Rehabilitation Practitioner Certification”. And with the latter a successful PT will obtain a Certification of Achievement in Pelvic Physical Therapy or a Certification of Achievement in Pregnancy/Post-partum Physical Therapy. Women’s Health Clinical Specialists (WCS) are board certified and have knowledge, skill, and experience exceeding that an entry-level PT is Women’s Health.
Many people, physiotherapists included, assume that the quality of their therapist is a reflection of the quality and quantity of education they receive. Although it is important to stay up to date with current research, practice protocols, and treatment options, there is much more to becoming an effective physiotherapist. Shadowing other pelvic health PTs, having a mentor in the profession, and working with others in the field are all excellent forms of informal education and should not be disregarded education. And lastly, the simple power of a positive therapeutic relationship is instrumental in a person’s journey to recovery.
The most comprehensive way to find a rostered physiotherapist in Ontario is to search the College of Physiotherapists Public Roster here (http://publicregister.collegept.org/PublicServices/Start.aspx).
Given the vast array of formal and information education among pelvic health physiotherapists, and each practitioner’s interests in the field of pelvic health, it can be overwhelming looking for a pelvic physio. You may want to consider the following questions when choosing a pelvic health PT that is right for you (and one size does not fit all!):
How important is formal education to you in consideration of your care?
What type of education has your physiotherapist taken?
How else does your physiotherapist keep up to date with research and advances in the pelvic health field?
How often does your physiotherapist treat your specific condition or symptoms?
How does your physiotherapist make you feel when you are with them?
Do you trust your physiotherapist?
How safe do you feel under the care of your physiotherapist?
At Proactive Pelvic Health Centre our team of pelvic floor physiotherapists are trained in all of the following: urinary and fecal incontinence, prolapse, pelvic pain, complex pain, pregnancy and postpartum. Many members of our team are also trained to treat the following populations: pediatric and athletic pelvic health concerns, genito-urinary syndrome of menopause (GSM), gastro-intestinal disorders, pessary care, post urologic (eg. post-prostatectomy surgery) and gynecologic cancer. We pride ourselves on life long learning so rest assured that one of our physiotherapists will be a great fit for all your pelvic health needs.
For more information about the programs listed in this blog, please visit:
Physiotherapy Act, 1991 found at: https://www.ontario.ca/laws/statute/91p37
http://publicregister.collegept.org/PublicServices/Start.aspx
https://www.womenshealthapta.org
https://physiotherapy.ca/clinical-specialist-program