Using Words And Images To Grow Your Pelvic PT Practice With Beth Shelly

 

There is a certain resistance in the physical therapy space to treat women, especially pregnant women who are going through a lot of physical changes in their bodies. Contributing to half of the population PTs are seeing in their clinic, it has become a wonder why women’s health as a whole is perceived as uncomfortable for some. Beth Shelly, one of the pioneers in pelvic health physical therapy, found her calling in this area. She joins host, Aaron LeBauer, to help us have a deeper understanding of women’s and pelvic health and the changes she has seen around it in the last couple of years since she’s been practicing. Helping PTs overcome sensitive topics that are part of the pelvic PT practice, Beth shows some exercise on using words and images to explain sexual health to patients properly. She also talks about differential diagnosis, strength training, women’s health education, social media, and more. To date, the field of women’s health and pelvic therapy is a wonderfully growing field. Tune into this conversation to find more opportunities to succeed in this area.

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Using Words And Images To Grow Your Pelvic PT Practice With Beth Shelly

My special guest is Beth Shelly. Beth is one of the pioneers in pelvic health physical therapy, and believe it or not, I’ve been following her in her Pelvic Journal Club since 2012. I’ve looked it up. I looked way back and I was like, “It was 2012.” A few years out of PT school, our mutual friend Jane O’Brien, met her at the NFR course and she said, “You got to look up Beth Shelly,” and I did. I’ve got a ton of stuff from your pelvic health resources. Even though we’re not a specialty practice, I’ve been able to use that to help so many people and many women. Thank you and thank you for being here. I appreciate you taking the time out of your day, Beth.

I’m glad to be here.

A lot of people may not have heard of you or known who you are. Some of the pelvic PTs reading will be like, “I know Beth.” Can you share a little history like how’d you get into PT and decided physical therapy is the thing for you? We’ll start there.

I was thinking originally, I wanted to be a gym teacher. That was my original thought. My dad was a teacher. He taught woodshop and he said to me, “No child of mine is going to be a teacher.” He did not think very highly in particular of the public school system. I’m a teacher through and through. I just don’t teach in the public school system. At the time, my mom was going through some medical diagnoses and she was asking everyone in the hospital, “What do you do? Do you like it? How’s the job market?” She said, “This is like a gym teacher. Go do this.” That’s how I fell into physical therapy.

My mom used to say, “You should be a teacher.” I was like, “I don’t want to teach people that don’t want to learn from me,” because I was in high school. I was like, “People don’t want to learn this stuff.” That’s cool. You went from being told not to be a teacher to a teacher. How many years did that take?

I graduated in 1985 and I began teaching prenatal and postpartum exercise right out of school. I went to my first job and I said, “This is what I want to do.” I had already taken the landmark course from Elizabeth Noble at the time, and I wanted to treat pregnant and postpartum women. I began as an aerobics instructor right out of school there. I started to teach physical therapists about pelvic therapy and obstetrics in 1993 when I worked at Elizabeth’s clinic, Cambridge Physical Therapy, at the time was owned by Holly Herman and Trisha Jenkins. That was my start of professional teaching.

What was it that occurred or what’d you learn or what did you experience that you were like, “Pelvic floor physical therapy is my thing or working with women or expectant mothers versus people getting knee replacements?” What was there something that sparked your interest or hit you pretty hard and you’re like, “This is my life’s work.”

That is a typical story. What I hear at least is that women, as they’re having babies, are thinking, “There’s a lot of physical changes that are going on.” There’s got to be something we can do to help these people. That’s where I came to recognizing in college that there wasn’t anything. In fact, at that point, what they were saying is, “You can do this and this but not during pregnancy. You can do that but not with pregnant girls.” All over the board, it was, “Don’t do anything with these women.” I had already had one child. I knew that there were a lot of physical changes and I felt like we had things to offer. I was drawn mostly from my own experience. That was again into that prenatal, postpartum side of things, from there, people started to tell me, “When I go to exercise class, I’m leaking.” That opened up the door to the pelvic dysfunctions, eventually working into pain, men, then we add the pediatrics, the geriatrics and the neurology. It’s been a wonderful ride.

Half of the population that you're seeing in your clinic is women. You're treating them whether you think you are or not. Click To Tweet

For me, I came from massage therapy and people tell me all the weirdest things. In PT school people learn about pelvic health, pelvic floor and they’re like, “I would never do that.” I’m like, “What do you mean you would never do that?” To me, it’s not an aversion. To me, it was more of, “I’m a man. I’m not 100% comfortable going into a room with a woman to doing any internal stuff.”

There are men in the US that are treating men, so that’s quite helpful. I agree with you. I don’t understand how women’s health as a whole or even pelvic health, the smaller specialty working with the pelvic floor dysfunction, I’m not sure how they are listed as alternatives. In Europe, in the 1970s, it was an undergraduate skill. It has been for many years in European countries like anything else, like geriatrics or orthopedics. It’s another thing you can choose to specialize in.

Is it because sex is a stigma in our country?

You wouldn’t think so. We learned originally from Jo Laycock in England and they’re a lot more conservative than we are. It’s getting better though. I hear more and more that students are coming out of school with an interest, which is healthy. We have over fifteen residencies at this point in women’s health. I do believe it’s becoming more accepted as another branch of physical therapy. Truthfully, half of the population that you’re seeing in your clinic is women. You’re treating them whether you think you are or not. With the percentage of women that we know are leaking, you are treating people who are leaking without even knowing that they are and that’s a loss. Especially when you consider in the field of orthopedics, we know so much about how the pelvic floor contributes or doesn’t to back pain and issues of stability. More and more, it’s accepted.

A friend of mine here in Greensboro, Wilda Young, you may or may not know who she is, but she owns pelvic health and women’s specialty practice here. It was years that she couldn’t find someone else who had wanted to do it with her. It’s great. I agree with you, there are younger students, is there some other reason that this is ignored or is our ignorance and marginalization of women and female bodies?

As I said, it is getting better and people are realizing there is a big role for this. I work with a lot of colleges and there is better education for the first professional students so there’s less resistance.

When I went to school years ago, there wasn’t that much. Duke has a women’s specialty practice if you want to do a rotation there. That was the extent of it. We also did two three-hour labs on soft tissue and no one wanted to be my partner because I was a massage therapist. What’s the biggest thing that you’ve seen change in terms of women’s health or pelvic health PT specifically since you’ve been doing this and teaching it?

The biggest change is the WCS. This is Women’s Health Certified Specialty. It is a specialty through AB-PTS. It started in 2008. That was the first specialty that had been added in over fifteen years. It was a big accomplishment. We worked for many years in securing what we needed to, as far as the number of people who said they were going to sit and there were funds that were raised in the DSP had to be created. Since that time, it has been a snowball. We’re over 500 now, which is more than electrotherapy, the very first certification. There’s another one that has not very many but it’s growing. This is something that I have done for many years now, is to mentor those who are working towards their WCS. It’s a big test. It costs a lot of money. There’s a lot of things to learn. Unfortunately, if you don’t study in the right way, you’re going to spend a lot of time working that doesn’t help. People have failed, sometimes even twice. It’s a thing that people sometimes find they need direction. With that change, we have come up in the understanding in other countries. There are other countries that have these certificates or certifications or board distinctions, and we never could compete with them because we didn’t have anything like that. Now internationally, we are more highly regarded because we have the board certification.

TCLHP 172 | Grow Your Pelvic PT Practice

Grow Your Pelvic PT Practice: Studying makes you a better therapist. When you are a better therapist, you have better outcomes. When you have better outcomes, then you have a better business model.

 

What does that change for our profession? What does this change for the people that are board-certified now? Is there something different or is it the education on the way to the certification that is more meaningful?

As you mentioned just studying makes you a better therapist. When you are a better therapist, you have better outcomes. When you have better outcomes, then you have a better business model. It is that as well, but there are some organizations that are providing financial incentives that you are stepping up the ladder if you are board-certified, there also is incentives if you are a teacher or a researcher because you are more highly thought of. It elevates the whole practice when we have this distinction of a specialization. One thing that’s a little bit different than for instance, orthopedics, pretty much everyone has a good basics of orthopedics. When you step into the specialty of women’s health or pelvic physical therapy, people think they are a specialist but that’s not true. It’s not the way it is. It brings that up to a higher level that now you are a specialist in a specialty and it can be used in marketing. It can be used to speak to physicians. It sets you apart. Even in my local area here, I’m still the only one who has that distinction.

While we’re on the topic, Beth, can I assume when you graduated PT school, you had a Bachelor’s or Master’s degree?

BS, yes.

This has been a thing that people struggle with or triggers people in our profession. You have a DPT degree. You’ve gone back to do your transitional DPT. Two questions, I want to know why do you feel that was important for you to do? You’re already a specialist, probably top of your game teaching other people, why was it important for you to go back and get that degree?

There’s something to clarify there because I got my DPT before the WCS was even available. I didn’t have that choice. I didn’t have the choice to be board certified. There was no distinction that set you up as a professional. I did go back for the DPT because I felt that was a way to elevate the profession to help physicians understand that we are at a higher level than people that they write prescriptions. I graduated in 1985 and when I graduated, we would get a prescription that said, “Hot pack, ultrasound and massage three times a week for twelve weeks,” and that’s what we did. It was ridiculous. Even then, I knew this is not the way I wanted to practice but it was the standard. That’s how we worked. Very quickly after that, Massachusetts was one of the first states to have a practice without referral.

When I worked at Elizabeth Noble’s clinic in the early 1990s, we did that. People would come in off the street and say, “I’m leaking urine.” I would say, “Great, let’s see what’s going on and if you need the physician, we’ll call them in.” This was the way my practice was going from the beginning whether you call it a doctor or not. We practiced that level way back in the 1990s. Differential diagnosis is one of the things that sets us apart as an entry-level practitioner and that’s what I strive for as a specialist and that’s what I focus on in that WCS training because that’s a big part of it.

What’s important to what you said is to have the degree as it’s the learning but also practicing at the level of a doctoral profession is more important and being able to do the differential diagnosis, bring people off the street and feel comfortable. It’s more important than the letters and the letters are basically the signifier that, “I’ve achieved this level.” When I post something on Instagram about how we should be proud to call ourselves doctors and people get triggered by it and you’re like, “What about me? What about this?” It’s about the level at which we practice because physicians don’t know what we do that well and the patients don’t know what we do because they still think we do the hot packs, leg lifts and ultrasound. What we have to do is be able to speak to them in a way that we’re confident that we can take care of them and we know what to do with them if we can’t. Wouldn’t you agree?

We know so much about how the pelvic floor contributes or doesn't to back pain and issues of stability. Click To Tweet

Yes, absolutely. It’s a thought process.

I’m impressed that you articulate it well and I have to repeat it because it’s important. All the other things you’ve done to me, that’s the one thing, you’re operating at the highest level of profession, regardless of the letters behind your name. I want to applaud you for that and that’s important that I don’t think people getting that now. They’re either taking it for granted or because they haven’t seen the struggle that you have.

Maybe that’s part of it. It’s a historical thing and people who haven’t had it or didn’t have the choice to have it are very grateful that we do have it.

Whether it’s women’s health pelvic floor PT or not, what else have you seen change over the years in public perception or in our profession that some of the people who are even younger than me reading might benefit from?

Another thing that has changed is the patient because when I first started the patient came and they were passively receiving a treatment and then they went home. We already know that’s not successful. That’s not as successful as when the patient and the therapist are at equal plane and both working to achieve the final goal. That patients are more involved as they rightly should be. A little upset about Dr. Google and sometimes people coming in thinking that they know and having read something that it may not have applied to them at all. If you are able to articulate well, then you can explain things, even if it involves very private parts. That’s a thing that takes a bit of skill but even an orthopedic therapist, you must be able to explain, “Why am I asking about your sexual function and why do I care that you’re leaking urine?” Those things are important to your practice as well. Patients are able to understand if you are able to explain it well, but they are more involved than they used to be.

What’s the question? Like I’m a guy I’m into lifting or maybe I’m a therapist, whether I’m a guy or not. I’m into cycling, not lifting. Why would I care? Why would I need to ask one of my patients like, “Tell me, do you have any sexual health or leaking?” The goal is what’s the exact wording that I could use so that I don’t feel weird about it and my patients don’t feel weird about it?

This is how I approach the question to my students. I teach at the local university here and I do several different facets of their women’s health program. One of them is the assessment. How do we ask questions? One of the exercises we do is to practice using the words and asking questions. I do suggest that therapists look into the mirror, hold eye contact with that person and say the word vagina and say it in a way with confidence that does not feel you’re asking the wrong thing. As far as the words, what I would suggest is that every physical therapist have on their intake form three questions. If you put it on the intake form, then it comes up a little bit more easily, and it’s a little easier to start the discussion.

The three questions are, “Do you leak urine?” The next question is for women, “Do you wear a pad for anything other than your cycle?” The third one is, “Do you have pain during intercourse?” The first two are trying to identify a person who might have weakness in the pelvic floor, which can compromise the core and can be important if that’s the area of the body that you’re working with. The other question about pain during intercourse, is more related to spasm or contracture, which is often a pelvic pain contributor. It can contribute to sacral pain because it tethers the sacrum. Those are the three questions that I would suggest everyone to ask. I don’t know if you had this book but it is a very common book being used now in the PT school. It’s called Differential Diagnosis for Physical Therapists. Did you use that book?

TCLHP 172 | Grow Your PelvicPT Practice

Differential Diagnosis for Physical Therapists: Screening for Referral, 6e

Yes.

It’s been around for a long time. I’ve been involved in two edits up to this point and giving my perspective from the women’s health pelvic therapy angle so that people are able to incorporate these things into the various locations. There is a series of thought process that would take you to, “Do you have numbness in the saddle area?” That’s an important question for a person who’s a cyclist because sitting on the saddle can compress the pudendal nerve on the inside of the initial tuberosity and then you have neuralgia, which can result in motor and sensory deficits, as well as pain. You have this technique of recognizing what might be connected using that differential diagnosis process that would lead you to asking the questions. You know the question that you’re supposed to ask at the end. “Is there anything else in any other part of your body that’s going on at this time?”

Beth, in PT school, we were taught to us how many steps they had going into their house and do they have a handrail or not.

That’s the differential?

Those were the questions I learned in PT school that stuck out the most. I was like, “Why are we asking these questions?” I get it if I’m discharging someone from the hospital maybe, but these are much more important questions. The reason I bring it up is because there are much more important questions for people’s daily life and function and I was never taught to ask these questions. I had to go learn it myself and I’m not sure we ask all three of those on our intake form.

It’s a great business thing because if you do have access to somebody who’s treating the pelvic floor, you ask that to every single patient that comes in, you are generating patients for that person with the pelvic skills.

I know it’s important and you know it’s important and you brought up the best point. Generally, this a business show but I like to bring in people who have different specialties but it is. It’s like, “Can I identify something where people need help?” No one else is going to help them with this. Most of these problems are mismanaged, in my experience. Do you see that too?

Yes. They have pads, loads of them, and then they’re given medication. We have multiple guidelines from organizations that are telling us that, “Medication is not first.” That’s the second line. The first line is behavioral training and behavioral training is what we do that is for incontinence, bladder training and pelvic muscle exercise. I feel it is absolutely within the scope of every physical therapist training to teach pelvic muscle exercise. I’d love to share with people what the best words are. These are words that we know based on imaging ultrasound. We can see the recruitment, we can see the movement of the pelvic floor muscle. We know that when you say these words, you have the best chance of getting that. Here are the words. For women, the best description is, “Hold back gas.”

If older people are getting up three or more times, they are more likely to fall and break their hip. Click To Tweet

I would add to that in church. The reason I say in church is because I don’t want anyone else to know you’re doing this. It is not squeezing the butt. It’s not moving the legs. It’s not pulling in the belly. It’s not holding the breath. It’s not squinching the face. Nobody should know that you’re doing this on the outside, but you can recognize that squeeze because in particular, women have a very large portion of their pelvic floor posterior, and it’s usually preserved from trauma of childbirth. Hold back gas for the ladies gets the elevation. The instruction stop your pee is what we started with many years ago but we have some data now that tells us if people do practice stopping their urine flow, they are creating dysfunction. They’re creating a scenario where the bladder only squeezes part way and does not fully empty.

It’s not a good plan. The bad thing is if somebody is having trouble with leakage, they can’t stop their pee. Telling them to stop their pee is frustrating. It’s not helpful in any way. “Hold back gas.” For the men, we have two instructions because for men, the front portion of the pelvic floor is much more influential in the bladder. It is very different from the ladies. Men will also benefit from the instruction hold back gas but simultaneously we’re asking them if it’s possible to pay attention to two areas, the best instruction for the men is shorten the penis. That motion of pulling back in the front is the one that causes the compression of the urethral sphincter. It’s best. We have to develop other little tricks for people who are having more difficulty but at least 40% of people can understand those instructions without a vaginal or rectal exam, without biofeedback equipment, with only verbal instruction. You can have a pretty good shot at instructing your orthopedic patient how to do this with those words.

Hold that gas like you’re in church and shorten the penis. What about those people that have overactive pelvic floor muscles?

This is a bit of a challenge but as you can understand, if you do strength training on a person that has a muscle spasm, it’s going to make it worse. The recommendation, as you learned, is to proceed for one month. If they’re not better or if they’re worse, then you got to get more input. That’s my first suggestion. I would ask more questions if there was a pain scenario. We’ve got the pain with intercourse, pain with sitting in the perinatal area or tailbone pain and pain from sit to stand in the tailbone is the hallmark of that area. The occurrence of urgency frequency, where you have to go to the bathroom very badly, that can be a weakness condition but you have to be careful that they know how to relax as well. Constipation is another thing that can be related to that constriction and that holding situation.

In these conditions, what I do, and this is the world according to Beth but you’re welcome to use it, and that is an anti-Kegel. Dr. Arnold Kegel was a guy in the 1940s, ‘50s and ‘60s, a gynecologist that used a pressure biofeedback device inside the vagina to teach women how to squeeze the muscle so that they would have less leakage and better sexual appreciation. Kegel exercise technically is strength training. The anti-Kegel, therefore, is not for the purpose of strengthening or squeezing better but for the purpose of relaxing better. We have both pressure and EMG data that tell us if you do a small squeeze and then a big relax, contract, relax is basically what we’re using but we do know that this is helpful in being able to relax better.

I’ll teach them to do that small squeeze and big relax, and only have them do ten. Short, not small number, in a relaxed position, focus on the relax. If you use this, please make sure when they come back the next time, you ask them how they did it and you make sure they understand. I always say to them, “This is a test. Why did I ask you to do that exercise?” I would say still about half the time people say, “To contract better. To squeeze better, so that I don’t leak,” or something like that, which is exactly wrong. Somehow, they all feel the squeeze part is the important thing. You have to check to make sure they understand the relaxed part is key. Of course, I have EMG and imaging ultrasound that we can see it then.

Is there a visualization that helps with that or is that confusing for some people?

No, it’s not necessarily confusing. The pelvic floor is like a bowl. We had this bowl going this way in the body and when it squeezes, it goes up and I would want to make sure that they can recognize, “I feel when I squeeze, it goes up.” Even more importantly, when you relax, it goes down. I encourage them to think about down towards the feet. There have been some in particular in the alternative realm who have used visualizations like, “Imagine the sit bones are separated.” They don’t separate obviously. If you have a good ability to imagine, to visualize, to use your mind to affect things, that separation is part of the lowering but it is a lowering towards the feet that is most helpful. You have people remember, what does it feel when you release gas? What does it feel when you move your bowels If you can do that well? That’s the signal of relaxing.

TCLHP 172 | Grow Your Pelvic PT Practice

Grow Your Pelvic PT Practice: Kegel exercise technically is strength training. The anti-Kegel, therefore, is not for the purpose of strengthening or squeezing better but for the purpose of relaxing better.

 

Is there a difference with the cues for men and women? Is that more of a visual thing or is it there’s an anatomy contributor? Is it like the way our pelvis sits or stands or is it mostly a pregnancy contributor that you think might be different?

There’s a lot of ways we can go with that question. Let’s talk about guys. The majority of men pee standing, and the amazing thing is I don’t have this structure because it’s not what I do but I ask a lot of questions to a lot of guys. I must think that in the public male bathroom, there’s this whole thing going on. Women have no idea that you do this, you don’t do this. You got to look this way and don’t look this way. It’s a whole thing. Ladies, you have no idea.

We have rules. You guys have a lounge area or something like that.

Shut the door and do what you do. Think about this, you’re in the standing position, a man has to get a little bit of hip extension in order to shut off some of the hip muscles. When you are contracting the glutes and the adductors, you’re facilitating the pelvic floor and you can’t relax completely, and you’re not going to empty completely. You got to get a little bit of hip extension to shut off those muscles. Think about the Parkinson’s patient who can’t get to neutral, never mind into hip extension. We have that scenario as far as position going on. We then have the amazing ability to relax the front but keep the back. I understand that sometimes it doesn’t help and you have a release of gas when you’re peeing but oftentimes there is that ability to differentiate between these muscle groups, where in women, that isn’t the case.

It’s relaxing completely all front and back. Positional issues are quite interesting. We know that when you’re in an anterior tilt, you have better support in the pelvic floor so that people who have a flat back tend to have more prolapse. People who have a lot of an arch the African American community, they tend to have less prolapse. It activates better or best in the neutral position. It works with the diaphragm. Here’s another very good caveat for that pain person. The respiratory diaphragm going this way and the pelvic diaphragm going this way, they are buddies. When you breathe with the respiratory diaphragm, it dissents.

In order to keep the pressure in the abdominal and pelvic cavity stable, the belly is going to pooch out. That’s how we know. The pelvic floor relaxes down. Inhale should have pelvic muscle relax. In Telehealth what, I’ll do is have people on a relatively firm chair where they can feel the sit bones and pay attention to the perineum the space in between. We practice the diaphragm breath and notice that the pelvic floor is coming towards the chair during the inhale. That can help in the process of getting that muscle to release.

That’s such a great little tidbit. I’m sure that’s helpful for a lot of people right now. Are there any other little tricks or signs? We’ve got these three questions on the questionnaire but say my patient with back pain or hip pain or whatever, is there a question or like a pattern recognition? When the patient says this, you better ask this other question, whether you’re a pelvic floor therapist or not.

One of the things that I would like to challenge everyone to consider, especially in the older population. We’re talking about people who maybe have a little bit of a balance difficulty. We’re trying to do some strength training it’s certainly applicable to the home-bound elderly. That is, “How many times do you get up at night to go to the bathroom?” What I’m talking about is not the pee before you go to bed and not the pee that you get up to stay up for the day but what is going on in between that, where you sleep before and after? This is called nocturia. We know that if older people are getting up three or more times, they are more likely to fall and break their hip. Now we have a big impact. We can have a very big impact in this person’s ability and going forward in life, whether they’re going to be in a nursing home or not, by helping them to be able to do better at night.

“How many times do you get up to go at night?” If they get up three or more times, now we have to get into, “What do you do? What kind of things could be helpful?” Not only do you want to make sure that the track to the bathroom is clear, you want the usual things you would think of like a nightlight, no obstacles in the way, no throw rugs, make sure the walker is closed. All of these things that we would do already but also, “What are you drinking before bed?” Sometimes people get this idea, “If I stopped drinking before bed, then I won’t get up at night.” They stop at 3:00 or 5:00 PM. That’s way too early. It takes about 45 minutes.

Our kidneys make less pee per minute if we're sleeping deeply. Click To Tweet

To give a space for the bladder and the kidneys to create, I ask people to stop drinking two hours before bed. If they go to bed at 9:00, they’re going to stop at 7:00. That allows them to pee, whatever they have had out before they go to bed. This is very interesting. Our kidneys make less pee per minute if we’re sleeping deeply. Sometimes it’s a sleep problem that’s making them make more pee, but oftentimes they’re getting up because their shoulder hurts or their hip hurts and they figure, “I might as well go to the bathroom.” Don’t do that. It’s not good. Roll over and go back to sleep.

I want to bring why this is so important because I had a family member who fell and fractured the femoral neck and had the screws or ORIF but I’m like, “This is a problem. She needs physical therapy.” I looked up the stats, there’s a 25% mortality rate within the first year for someone over 75. That’s a huge and massive number. Fifty percent of people are discharged to skilled nursing.

Potentially, you can influence that by asking that one question, “How many times do you get up to go to the bathroom at night?” Work towards helping them to understand they shouldn’t if they don’t need to go or getting them to somebody who can get a little bit more clearly why and what should be done.

That’s such a good clinical pearl and this underserved area that we as physical therapists do that people don’t appreciate because patients say, “It’s never going to happen to me.” When it does, they don’t have the opportunity to come see us because they’re in the emergency room in surgery. A big part of my question and I’d love to know this from your experience. I feel like physical therapy is missing in the conversation around opioid crisis. In the hospital when we had our kids, there was no physical therapy. I’ve got so many things I could say about that but like, “What do we have to do as physical therapists to be part of this conversation in people’s normal daily lives and around these big issues and big areas?” Half the population has babies and 25%, if you fall, you’re going to die over 75, 25% chance. Fifty-five percent of people who reported back pain were being prescribed opioids in the past decade. How do we become part of this conversation?

Whether we like it or not, physical therapists are educators. One of the groups we are educating is patients. Especially with social media and the ease of accessing information, it’s important that physical therapists produce educational materials. Even little snippets that go out over and over again to patients to be able to start these conversations and help them to understand. This is one of the things that women’s health, physical therapists do in great fervor, and that is the obstetrics and the postpartum moms to help them to understand that there are things that can be offered. I think they are searching for something but they’re not sure what they’re searching for and they don’t know where to get it. The original way that we tried to make this happen was to go to the physicians and educate the physicians.

Midwives may be a little bit more interested in learning some of these things but physicians have so much on their plate and for them to have all of that recognition, maybe it’s not realistic but I have banged on a lot of doors and brought a lot of donuts and it didn’t help. That’s the way it is. The other angle that is occurring, that I am very pleased with is what is happening with our national organizations. The APTA I was reading is working on the opioid issue. They’re working towards increasing the awareness, not only to the patients with their branding and who they have access to but also to legislators and to insurance companies and they are our voice.

They have been doing a good job. The Pelvic Academy, of course, is for women’s health or pelvic therapy. They have a whole postpartum thing going on right now. Those groups are very useful. I saw a post on Facebook, “Are you a member of The Pelvic Academy? Why or why not?” I can tell you with a great deal of certainty since I graduated from school, I am a member of APTA. I have always been, I will always be a member of The Pelvic Academy and that is because they support us in so many ways.

TCLHP 172 | Grow Your Pelvic PT Practice

Grow Your Pelvic PT Practice: If you’re looking for a place to expand your business, that you’re probably not going to have very much competition, pelvic therapy is the place to do it.

 

Here’s my contracting question is going to be. Beth, you graduated in ’85, I want you to help the people that are between the ages of me and you, which is like you’re five months older than me, I’m sure. What you said was so important. How do you overcome this technology like Facebook and Instagram, which I didn’t grow up with, I’m not that great with? I grew up in Atari and I only had it five years after all my friends did. I want you to share like the other physical therapists in your generation, how can they understand or easily understand how to get their message out to people in the same way as you have in public, through social media like there’s some block. Maybe you’ve had this or not, but you don’t have it right now.

I have had the block.

How did you get by it?

I have had situations where I stuck my heels in and I said, “I am not going to learn this. I’m not going to go this way.” Now, I’m working through Google Docs and Google Drive and storage issues. With all of these things that I’ve created, I’ve got to store them somewhere and easily access them. What I would say is surround yourself with people who are able to understand and help. the Journal Club is a good example of this. I started the Journal Club in 2010, and I started with the people that I knew were teachers, inviting them personally to take a month and to be able to provide this service of reviewing articles. As time went on, I would send out through the Journal Club email and say, “I need somebody to help with a blog because we got to be able to load these things somewhere.”

I have this girl now who’s a helpful blogger and I send her my stuff and she puts it where it needs to be, changes the color or whatever. I have work to surround myself with people who have different skills. There’s one girl who helps me with Mailchimp. I have another girl that’s working on some of the things related to Instagram. I have an Instagram account I don’t know if you’ve seen that. The Journal Club is over 1,000 followers. I never get on it because I don’t know how to. I left the other girl to it. For me, I am the kind of person not worried about technology. When EMG first came out, I didn’t look at the book. I got on the machine and I clicked around and I was like, “What does this do and what does that do?” Maybe that’s different from some of the people of my generation, but that’s how I got into Facebook. I started clicking around and trying different things and connecting in different groups and posting things. When the quarantine hit and I started to put things in about Telehealth, I could not believe the response. I was like, “This is how it works. Now I’m in there. I get it.” It was quite and a learning experience.

Thank you for sharing that. My dad, I’ve had to tell him twice to delete the video of his Facebook Live of this forehead. My uncle has done the same thing and they’re 85 I’m like, “You guys delete that.” They’re like, “I don’t know how we did that.” They had to press three buttons to get there. It’s important because what you said is it’s our duty to get this information in front of people and create content. If I can’t figure it out, it’s not like, “How do I do it?” It’s, who do I find that can help me do it? That’s what I’m hearing from you. Thank you very much. Beth, there are probably twenty other questions I have but can you share a little bit about if someone’s interested in the Journal Club, where do they find the information about that or how do they go about getting on the notification list? I’m not sure if it’s an email thing anymore or if the membership site or something different but I’d love you to share how to find that out.

My website is my name, BethShelly.com. I am in the process of redoing that as well, my more techie things but right on the homepage, there is a button that says Journal Club. When you open up that page, you will see information about the Journal Club. It’s completely free. We usually hold it on Wednesday night at 7:30 Central Time, the first Wednesday of every month. All that information there, you’ll see the schedule. It’s done up for one year and there is a signup link and it’s a Mailchimp situation. You put your email in there, you’re automatically into the email. Whenever the articles go out, two articles every month.

The field of women's health and pelvic therapy is a wonderfully growing field. Click To Tweet

There’s a full article, unless we have issues with copyright and we have to post in the link to where you would find it or download it. Most of the time, there are PDFs and then the recordings are done so that you can go back and listen to the recordings that will come out again in an email and going to the blog will take you there. That’s where you can find other information about other educational products that I have, the WCS Mentoring. I have a page that says Free Stuff. I’ve listed links to AUA guidelines and things that would be of interest to people in the field there as well.

Thank you very much. I know this stuff that was helpful for me when I was getting started and I had to go out and find do the right information and I found your stuff back in 2012, which seems a long time ago. Thank you very much. Beth, if there’s one more thing you have to share or maybe a question I didn’t answer, is there something that you think would be important before we finish up?

I would say that the field of women’s health and pelvic therapy is a wonderfully growing field. If you’re looking for a place to expand your business, that you’re probably not going to have very much competition in, this is the place to do it. It’s a very quickly growing field. I think people can have a great deal of success in business adding that to their model.

I agree that some of the people I work with whose businesses grow the fastest or expand the quickest or specializing in pelvic health or adding it to their services and educating people about it. Thank you for that. You’re absolutely right. Beth, thank you so much for being here. I appreciate your time. I’ve learned a ton and I’m sure if I learned something that people reading have learned a lot too. This was a pleasure. I look forward to meeting you in person one day when travel resumes and all those things. Until then, thank you so much. I appreciate you, Beth and we’ll see you on the next show. Keep going in making content and let us know about it. Thanks.

What’s up? Real quick, if you’re starting a cash-based physical therapy practice or you already have one and you want to learn how to grow it and scale it, this is for you. I released my brand-new book, the CashPT Blueprint, because I want to get this book in the hands of every physical therapist out there. I want to give it away to you for free. All I ask is you pay a little bit of shipping and handling and you’ll not only get the steps to create your own cash practice, but the tools to grow it and scale it beyond what everyone thinks is possible. To snag your copy right now, go to CashPTBlueprintBook.com. When you get your copy, give me a shout-out somewhere on social media. We’ll talk to you soon.

Important Links:

About Beth Shelly

TCLHP 172 | Grow Your PelvicPT Practice

Beth owns a private PT practice in Moline, IL where she treats outpatients with all forms of pelvic floor dysfunctions.

She is also an international speaker in the field of Pelvic PT and has authored many chapters and articles on the topic.

She coordinates the Pelvic PT Distance journal club and mentors those preparing for the WCS exam.

About The Author

Aaron LeBauer

Aaron LeBauer PT, DPT, LMBT started a 100% cash based physical therapy practice right after graduation. He's on a mission to save 100 million people from unnecessary surgery & enjoys helping passionate therapists build successful businesses without relying on insurance.

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