Help Across The Pond

As difficult as it is here in the states to find qualified professionals to treat pelvic floor dysfunction (PFD), Europeans have an even worse time.  For this reason, I was very excited to stumble across: Pelvic Physiotherapy for Pelvic Pain.  This site is in its infancy, the plan is to grow; the are adding video instruction, building a larger database of therapists and resources.   

I am usually wary of sites that give information on pelvic pain and give instruction on strengthening the pelvic floor.  The site is VERY clear about learning to relax completely before jumping into strengthening, and I LOVE the descriptions of the relaxation sequences.  Sniff, Flop, Drop.  Even I can remember that. 

Thanks, Maeve Whelan, for coming up with this wonderful resources, for women all over the world!

 

Book Review

Ending Female Pain
    - A Woman's Manual
By: Isa Herrara, MSPT, CSCS

This is a comprehensive manual for women who suffer pelvic pain and are seeking control of their condition and their lives.  Ms Herrera has tackled a daunting task, filling her book with information, resources and techniques to benefit women with a wide range of pelvic pain conditions.   This is the book that I felt needed to be written, and if someone else hadn't step up I would have eventually made a feeble attempt to do it.  Thank Isa, for saving me, and the world from my trying to write this.  She gives detailed explanations of the anatomy involved, how pelvic pain coincides and contributes to pain in other regions of the body, and how postural habits and activity influence pelvic pain.  She then goes into very detailed explanations of self-examination and self treatment.  Her program includes exercise, stretching, self-massage, diet, posture, heat and cold therapies and stress control.  I am especially impressed with the description of internal massage and stretching for the pelvic floor, a very difficult activity to teach in this format.  I have always felt more comfortable with the results of direct, individual demonstration and training, whether teaching self-massage or teaching a partner.  Whenever I have tried to create a written instruction tool, the performance by the reader has been variable.  Isa's instructions seem sound.  It is difficult to assess, if you already know how to do a technique, reading it is a reminder, and of course it makes sense.  I would like to see how the application from an untrained reader would be.  My guess is that most people with a little trial and error will figure it out quickly enough.

It is suggested at the beginning of the book that the reader go through the entire text before implementing any of the techniques.  I highly recommend this, as it is a lot to absorb, and some of the important elements, such as moving slowly, listening to your body, achieving relaxation before strengthening, etc. are reinforced throughout the text, and may be missed with a hurried, "jump in with both feet" approach.  The beginning chapters of the book, where she discusses anatomy and conditions are a little top-heavy academically.  The use of technical terms in language and description may be difficult for the general population, but there is a comprehensive glossary, and anatomical terms have illustrations that go along with them.  In my experience, women that suffer with pelvic pain are the amongst the most knowledgeable population seeking health care.  They often have to do their own research, and familiarize themselves with the lingo.  This book is a little heavy, but worth the effort.

I feel that this is a "must" read for health care professionals working in this field, especially those that have patients that are isolated from access to caregivers and must perform a large portion of their treatment themselves.  It is a manual that I wish had been available when I was actively treating patients, especially when I would get people that were coming into town for a couple of days and wanted a "training" session, because there was no one in their area.  On that note - the author consistently mentions the need for a "team approach" to care.  This book will best serve those that have access to knowledgeable health care professionals, who can help them tailor the activities in the book to their specific needs.  I would love to see this book presented as a work book, with the goals, self assessments and a companion DVD.     

And now, because it can't all be glowing, there are a few things that I would have liked to see a little different.  Ms. Herrera tells how she uses a "mind-body-spirit" approach in treatment.  Early in the book she mentions the 1st chakra and its relation to the pelvic floor.  It was mentioned in passing which can be slightly problematic.  Those familiar and comfortable with energy healing techniques may be disappointed in having a mention without substance to follow up.  Those that consider "Eastern" concepts to be snake-oil, or worse, EViel, will be put off, for no reason. Lastly, as detailed as the book is about everything else - there is not an in-depth explanation, so the curious and uneducated are left hanging.

Ms. Herrera gives resources to follow-up on many conditions, and she hit most of the major ones, but were some that were missed, and the miss was obvious enough that there almost has to be some underlying motivation.  The ICN was mentioned no fewer than 3 times.  The ICA was not mentioned at all.  For those unfamiliar with these two groups, the ICN is a public, for profit site, full of information about interstitial cystitis.  It is an amazing site, with chat forums, information, resources, I recommend it to people all the time, and the founder, Jill Osbourne, has done so much to help advance the cause of pelvic pain research and help that she is one of my heros.  The ICA is a non-profit site, covering much the same mission, they have individual patient advocates available to help you walk through the incomprehensible maze of early diagnosis, they put out a beautiful patient oriented magazine 4 times a year,and they work very hard at bringing information to the medical community, and to patients.  I am not involved in the politics surrounding these organizations, I do know that there are some differences in style and delivery of information between the two.  I am a little disappointed that a book designed to help women, a book that outlines almost every possible treatment option with a "pick and choose what works for you" premise, would not mention another option in resource information.


All in all, a good read.  Just be prepared to learn something.  Don't think of this as a "book" to "read" but a manual to guide.  And don't give up on finding a health-care specialist to help.

addendum - Isa just sent me this link - it is an online resource kit companion for the book.  All of the forms in the book for tracking and managing your pelvic health can be found in pdf format here. 
http://www.renew-pt.com/self-help-EFP-resource-kit.cfm