Let’s Put The Pelvic Floor back In The Body, and Take a Whole-Person Approach To Rehab

By Carolyn Vandyken and Nicola Robertson


I opened my inbox last week to find yet another email from a physiotherapist sharing with me how moving into pelvic floor physiotherapy saved her career. Ready to leave the profession, disenchanted with patient care and outcomes, Nicola Robertson shares her story below, to help other physiotherapists understand the importance of a whole-person centered approach. A whole-person centered approach includes two things:


  1. Putting the pelvic floor back in the body; assessing its contributions fully by completing an internal exam, acknowledging tension, weakness and coordination problems as they contribute to low back pain, hip pain, incontinence, prolapse and a host of other viscerally-oriented problems.
  2. Recognizing the pelvic floor’s pivotal role in central sensitization and upregulation of the need to protect the body for procreation, sexual function and bladder/bowel function. Pelvic floor tension is the ultimate “protective” mechanism for life and procreation. Considering the whole person- their distress, diet, exercise level, connection to self/others and their spirit- rehabilitation needs to take a broad-based, whole person approach in order to downregulate the protective outputs that the brain produces including bladder and bowel urgency, pain, spasm, muscle tension, thirst, hunger, fatigue, etc. We need to get out of a tissue-based approach and start to embrace a biopsychosocial approach. That is what every course is based upon at Pelvic Health Solutions.


At Pelvic Health Solutions, we use an evidence-based, whole person approach, putting the pelvic floor back into its place of honour, as one of the most important set of muscles that contribute to many ADL’s including lifting, carrying, pushing/pulling, control of bladder/bowel, keeping our organs inside us where they belong, and the “king” of ADL’s, great sexual function.


Here is Nicola’s story.


“This year has been a HUGE year for me and thanks to Pelvic Health Solutions it has been an amazing year. Please bear with me…


When I graduated as a physiotherapist in Scotland in 2006 and started my career in the public sector I was pretty sure where I was going and what my future held for me. I was wrong.


I had spent time in Canada in 2005 as part of my clinical practice and decided to move there. In 2008 my other half, now husband, and I made the journey to Nova Scotia. We spent 4 years there before moving to Ontario in 2012.


When I commenced my career as a physiotherapist I assumed, and envisioned working in orthopedics and ultimately progressing in the world of sports. I had volunteered with soccer teams in Scotland and planned to do the same when I moved to Canada. I continued with orthopedics in Canada, working in a large multi disciplinary clinic. I completed courses in manual therapy, exercise prescription, acupuncture and vestibular rehabilitation. I also did some work and training in pain management, which I really enjoyed as I found it could be applied to almost every patient.


Pelvic floor physiotherapy was not something I was even thinking about; despite the fact I had worked in and around it since I started work. In the UK physiotherapists are on the maternity wards and my short time in a hospital saw me spend some time there and witness several births. In outpatients, I worked alongside a pelvic floor physiotherapist, again fairly standard practice in the UK. When I came to Canada one of my colleagues qualified in pelvic floor physiotherapy; I was very impressed but really did not see it as an option for me.


Fast forward to my first pregnancy in 2014. My primary care provider was a midwife and when I asked about post natal pelvic floor physiotherapy I was met with a blank stare. I was shocked, how could this not be normal practice? I started to do some research and realised how far behind Canada was compared to Europe in this respect. My first baby was a 23.5hr labour, 3hr push; he was sunny side up, weighted 10lbs 3oz and had shoulder dystonia that resulted in a 4th degree tear for me. I realised after this experience that pelvic floor physiotherapy should be more available, should be part of the conversation and normal pre-natal and post-natal practice. However, I still did not step up and complete the training. I was still unsure about abandoning that initial dream of being a sports physiotherapist.


I took a job between the births of my children, which in hindsight was not the best choice for me. I started to feel worn down and tired of the profession. I had my second baby in 2016 after another long labour, sunny side up and 5.5hr push I had a 10lb 9oz daughter. I spent the next few months focussing on my baby and my own recovery.


I was about halfway through my second maternity leave and I suddenly realised I no longer found joy in my career; I really was lost. I considered giving it all up. However, the huge lack of women’s health and pelvic floor physiotherapy played on my mind and I spent a lot of time reading and researching what my options were; I began to see a whole new and exciting opportunity.


After researching, reading and conversation with other physiotherapists, I decided Pelvic Health Solutions was the perfect fit for me. I completed my level 1 in April, which quickly led to Level II/III in October and the pregnancy course in Nov 2017. Becoming a pelvic health physiotherapist has not only filled me with a passion for my profession, but for my life and my future. I feel empowered and curious; I read the articles and actively seek new learning opportunities. I feel that I have that missing piece, my clients leave feeling better every session. The skills that I have learned I also use with my musculoskeletal patients every day.


The instructors and TA’s who spend their time educating me and others are wonderfully patient and skilled, making it a joy to learn and as a result I have victories everyday. I have struggles too but I know there are answers and supports out there.


I have re-kindled the joy in my career, I skip to work on a daily basis. I already plan to do several courses over the next year. Thank you PHS!”


Thank you, Nicola, for sharing your story. We wish you every success in your career as a physiotherapist. We join the ranks of our fellow orthopaedic therapists in retraining ADL’s and function from a whole-person centered approach, guided by biopsychosocial principles. We acknowledge the pelvic floor’s contributions to almost every ADL, and recognize that the time has come where the dotted line between the pubic symphysis, tailbone and ischial tuberosity needs to be erased, and that ALL orthopaedic therapists NEED to integrate the pelvic floor into their rehabilitation programs.