When I started The Cheerful Pelvis, one of my goals was to tackle the huge discrepancy and the lack of regulation, standardization and quality control in pelvic health.

Any physio can take a weekend course, learn how to do an internal exam, and call themselves a pelvic floor physio (I did!). Plus clinics are so eager to establish a pelvic floor service – we seem to be the new black – that they can hire a therapist with no experience just to get that box ticked (I was this physio too!). As pelvic floor physios are hard to come by, often we work alone or with little mentorship, and honestly, not really knowing what we’re doing (100% guilty).

Needless to say, this creates a low baseline standard of care with a poor safety net for our trusting clients.

In my desire to address this problem, I wasn’t interested in fighting for change in how we are regulated (I know others are working on this in BC), but in establishing a clinic where the quality and standard of care was being proactively and transparently addressed, hopefully setting a new standard for others to follow.

I opened TCP 2 years ago and have since worked with my team figuring out what physios new to pelvic health need to learn to up their game to a more integral clinical baseline.

One of the issues for eager and well intentioned physios new to pelvic health is that they don’t really know how to apply their learning. There are many courses to take, and the scope of pelvic health is so broad that the learning is often very siloed and unintegrated. We take a course here and a course there, but the physio is on their own in terms of piecing it all together, which is really hard to do.

That was certainly my path. I had no one to learn from, made so many mistakes with clients, and definitely tried to help clients that I didn’t have the skills to. I would feel overwhelmed and either frustrated or relieved when they dropped off my schedule. (The negative impact on the client in these cases goes without saying and is a huge driver for us wanting to address this gap for our profession.)

When our learning is self driven, we tend to bias towards our interests, as we don’t know what we don’t know. If we don’t enjoy something or find something hard to learn we can opt out, to the detriment of those who need us to be strong in that area, and some clients will get left behind.

I remember jumping around courses treating them more like fashion trends, something I felt I was supposed to do, and did it to tick the box, rather than a real in depth development of new skills and understanding based on the needs of the clients in front of me. I didn’t realize I was bending all clients to fit the new trend I had learned when it should be the other way around. From a learning standpoint I was adding a lot of tools without actually moving forwards.

Our learning can also be driven by personal factors (like anxiety or imposter syndrome) so we take courses to feel more confident, or to feel inspired if we’re burnt out. Unsurprisingly, they’re unlikely to improve our practice if this is the foundation of our learning, nor does it help with the anxiety as the clinical course isn’t addressing the real issue; we have some personal work to do. 

There was no complete road map for what pelvic floor physios should know or be able to treat, so trying to cover it all was working blind. And if your personal insecurities or biases are coming up, that certainly needs to be looked at as that will drive all your client interactions regardless of skill set.

So the gap is not that there aren’t good courses out there. There are fantastic courses designed to give you the knowledge and skills you need in all the varied areas of pelvic health and that’s what they do.

What they can’t do, is support you in how to integrate the new learning over time, based on your own learning needs, your own strengths and struggles, for the specific clients who come to you, and in context with all the many other things there are to learn in pelvic health.

In coaching our team at TCP we found 4 main themes that needed to be tackled for therapists to really feel confident, and be competent;

• Knowing how to integrate their new knowledge and apply it to the big picture (especially from a whole body MSK standpoint)
• Laying out a clear roadmap for pelvic health, both in general and for each ‘sub category’, so they have structure to start to integrate their skills and knowledge (and become more aware of their gaps and biases)
• Case specific support to dive into and help assimilate reasoning
• Emotional support through the ups and downs of a crazy steep learning curve with a demographic that can be super challenging

So we developed an internal mentorship program for our TCP staff that addressed these issues. Not just knowledge acquisition but building the depth of understanding and integration to use it in real client cases, that had a broad scope that would capture all the common client presentations that walk through the door and start to plug those common gaps.

We (Trish Gipson, my co-instructor and I) have been there and done it. We have muddled through it all ourselves and have years of experience, tonnes of pattern recognition and positive outcomes with complex cases to draw from. We too have taken courses and struggled to apply it. We too have googled clients’ diagnoses while they’re sitting in front of us. We too have gone cookie cutter physio rather than use our brains cause we were stuck and overwhelmed. We have done it, and we have coached many others through it too.

We know what you’re going to see, we know what you’re going to struggle with, and we know what you’re likely to miss.

Having refined our program coaching our team over the last 2 years (thanks team for being our generous guinea pigs!), we are rolling out our foundations program as an online course available to all!

We can’t know it all before we start seeing clients (we never will know it all!) and we can’t learn it all at once. We learn by doing, reflecting, and diving into critical thinking over time.

Our goal is to walk you through the ABC’s of applied pelvic floor physiotherapy. To offer a step by step process of how to tackle most common presentations, as well as clinical reasoning integration to build a solid independent foundation for each participant.

It’s what you need to be able to start and establish a practice with confidence, competence and integrity, and with the resources to tackle those complex cases with a bit more ease.