news from inside the pelvic bowl…9-26-16


Musings from the Portland airport…no matter what their unique specialty, medical professionals tend to treat their own problems. I’m no different. Mostly that’s worked well over a lifetime of various musculoskeletal challenges. But last year at this time, I needed a partner in treatment: another set of skilled hands and eyes, a coach and witness. I’ve known Risa McDonald, PT about forever. We had our babies together when we worked at Sutter, did long-term orthopedic manual therapy training together, hung out a shingle for private practice the very same year in 1990. It was natural to ask her help for persistent hip pain and long term scoliosis management. Spending time with her is the reason I landed in Portland.

Over the years Risa carved out a specialty in women’s pelvic health. She is the absolute go to person in this community for issues of pelvic pain, incontinence, prolapse and sexual health. It may surprise you that one in four women have some version of aforementioned issues. Not many people are willing to talk about this fact. I would like to see this silence change. Physical therapists have emerged in this developing field as premier providers of a non-surgical approach to healing pelvic dysfunction. Surprise to me, even though I sought Risa’s expertise for an orthopedic problem, her examination included an internal pelvic exam. Now is the time to stop reading if this is just too much information for you.

What she did on the interior of my pelvic bowl was no different than what she did on the outside. A manual therapist assesses joint and soft tissue structures for tenderness, mobility, length and strength. Her internal exam revealed left obturator internus, a deep hip rotator that lines the pelvic bowl, as tender and tight. She assessed and treated much more than this of course, but the release of this impossible-to-access-from-the-outside muscle was a key component in my healing. Who knew?

I have assessed and treated about every joint, muscle and connective tissue structure from top of head to soles of feet. This past year, it has been extraordinary to discover and tiptoe my way into this vital interior region that responds to manual therapy and exercise just like the rest of the body. Over this ensuing year I have learned to self-treat my own pelvic floor and, completely intrigued, went on to complete 30 hours of online education in all things pelvis. This education delivered me to the literal threshold of internal assessment. I have been poised on this brink for months and if you’re still reading, maybe you can fire up an active imagination to conjure up my three days in Portland. Picture a hospital room full of fifty courageous practitioners learning the hands on skill to evaluate and treat inside the pelvic bowl. Yup, you got it. Over the top, awe-inspiring journey.

I am thrilled to be able to offer this adjunct treatment to individuals seeking help for persistent hip and low back pain. For now, I am limiting this internal care to my women patients only. But, in addition to the orthopedic population that comprises the bulk of my practice, this has opened a whole world of additional possibility. If you read the opening list and wonder if I may be talking to you, I want you to know that urinary incontinence affects 25% of young women, 50% of middle-aged and post menopausal women and 75% of older women. It is treatable, loves. 15% of women will have surgical repair for pelvic organ prolapse. Sometimes a conservative approach can work.   And 15-25% of women have chronic pelvic pain created by these problems as well as pain associated with menses, intercourse, pregnancy, post-partum and endometriosus. As you might guess, any general pain in the abdominal, pelvic or hip region might respond well to manual therapy, education and exercise of the pelvic floor and bowl.

If this intrigues you, please check this link  for more information. And, in utter humble acknowledgement that I am in a steep learning curve moment, I want to offer initial assessment for new women patients with primarily pelvic complaints at a reduced rate of $100 between now and year’s end. Thank you for entrusting me with your care. I know it will be an amazing journey for each and every one of us.

Love, bella