There is physical therapy for that?!
Sarah Kremer, SPT ’21
I think that is a fairly common reaction when it comes to the area of women’s rehab and men’s health (WRMH) physical therapy (or women’s health for short). This area of physical therapy is one of the more unique ones, and one that I have particularly grown to have a lot of passion for. I could probably write a book on the different diagnoses that this area of PT can treat, but I am going to try and highlight the most common patient populations that WRMH physical therapists see.
Pelvic floor dysfunction is one of the most commonly seen diagnoses in this subset of physical therapy. All of the so called “taboo” subjects like urinary and fecal incontinence, urgency, constipation, prolapse, pelvic floor spasm, sexual dysfunction are issues the physical therapy can treat! The underlying cause of a lot of these conditions may be pelvic muscle dysfunction and can be resolved with pelvic floor physical therapy paired with lots of education. These patients often benefit from both hip and core strengthening, as weakness in these areas can play a significant role in pelvic floor dysfunction. Something imperative to note, is the importance of communication and establishing a very trusting patient-therapist relationship when treating pelvic floor dysfunction. It goes without saying that this is a sensitive and personal area of the body. It is crucial that the patient feels comfortable voicing any questions, concerns or discomforts they may feel during their treatment.
Breast cancer patients. Breast cancer is a diagnosis that unfortunately hits close to home for a lot of us, as it is the second most common cancer among women in the United States according to the CDC. The treatment that these patients undergo such as surgery (most commonly being lumpectomy, single/double mastectomy), radiation and chemotherapy can immensely alter these patient’s physical health. After a patient undergoes a mastectomy or lumpectomy along with radiation, the skin where the breast tissue was removed can become very tight and fibrotic. This condition will very likely be painful and limit their upper extremity range of motion (ROM). Following lymph node removal, these patients may experience a condition called axillary webbing, which will also greatly restrict their upper extremity ROM (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178020/ gives a thorough overview of this condition). The goal of physical therapy is to use techniques such as instrument assisted soft tissue massage (IASTM), passive range of motion and strengthening exercises to break down the fibrosis, axillary webbing and scar tissue to improve overall ROM.
If breast cancer spreads, the first place it typically will go to is the surrounding lymph nodes. After lymph node removal, these patients are at high risk of developing lymphedema. Teaching these patient’s preventative techniques, particularly manual lymph drainage (MLD) and having them fitted for compression garments can assist in prevention of lymphedema according to the Clinical Practice Guideline from the Academy of Oncologic Physical Therapy of APTA. If the lymphedema is unable to be prevented, these patients will benefit from complete decongestive therapy (CDT). CDT is a technique that women’s health PT’s will likely be certified in and includes bandaging, compression garments, MLD and skin care. Lymphedema patients are at much higher risk for skin infections so education about skin care on the first visit is crucial. Ensuring the skin is moisturized at all times will prevent any cracks/breaks in the skin that would allow bacteria or fungus to enter. Bandaging is an important part of lymphedema treatment and includes the use of short-stretch bandages to reduce swelling and prevent fluid accumulation.Unfortunately, supplies for bandaging can become extremely expensive for patients and they are not covered by insurance. I have seen patients in the clinic who are unable to properly manage their lymphedema due to financial restrictions. Here is a link to the Lymphedema Act, in which you can contact your local legislators about the importance of insurance (particularly Medicare) coverage of compression supplies for these patients.
Head and neck cancer patients are also a part of the population that WRMH commonly sees. These patients may also struggle with lymphedema due to damage to the lymph nodes from radiation. So in some cases, they will need CDT and MLD techniques to manage their lymphedema or reduce their risk of developing it. Another common issue that these patients come in with is extreme tightness and fibrosis from the radiation on the skin around their sternocleidomastoid (SCM), thyroid cartilage, scalenes and submandibular region. These patients greatly benefit from manual techniques such as IASTM, thyroid/hyoid mobilizations and passive stretching to decrease tightness and increase overall ROM. In many cases, the cancer and treatment will have caused issues with swallowing and/or speech, and many patients have to rely on feeding tubes as their main form of nutrition secondary to their issues with swallowing. The techniques utilized in PT can help to break down scar tissue/restrictions and hopefully assist these patients with their overall swallowing and speaking abilities. This population has a high risk of aspiration when eating/drinking so it is absolutely crucial to decrease the risk of this occurrence. These patients also greatly benefit from posture correction techniques due to the common presentation of forward head posture, due to tight anterior neck structures.
Finally, post partum patients are another very common subset of patients that come into women’s health PT. Giving birth is a wonderful miracle of life but can be extremely physically taxing for the mom and cause lasting musculoskeletal issues. A common postpartum issue that women experience is a condition called diastasis recti abdominis (DRA), which is defined as a separation of the rectus abdominis muscle of more than 2 cm at one or more points of the linea alba. Women can experience this during their pregnancy and also directly after giving birth due to delivery related trauma. The combination of hormones released during pregnancy and the stress of the growing fetus on the abdominal wall results in this separation. Luckily, physical therapy can help with this condition. Focusing on deep core strengthening (especially the transversus abdominal muscle), pelvic/sacroiliac joint alignment and posture are all key components of treating DRA. Additionally, women commonly experience pelvic floor weakness/dysfunction and prolapse after delivering. Physical therapy can focus on strengthening and coordinating the pelvic floor muscles which will consequently help to address prolapse symptoms. In May of 2018, the American College of Obstetricians and Gynecologists (ACOG) embraced the concept of the “fourth trimester. This concept addresses the importance of ongoing care for the mother and baby in the weeks following birth, especially physical therapy for the mother. Advocating that physical therapy should be a standard of care for women postpartum will greatly increase the resources women will have available to them to improve their overall health and well-being.
This specialty area of physical therapy clearly has quite a diverse patient population and can treat many musculoskeletal issues affecting one’s day to day life. Through my time in my WRMH clinical rotation thus far, I have experienced first hand how much this area of physical therapy improves patient outcomes and helps them achieve their own personal goals.
 Breast Cancer Statistics. (2020, June 08). Retrieved October 18, 2020, from https://www.cdc.gov/cancer/breast/statistics/index.htm
 Davies, C., Levenhagen, K., Ryans, K., Perdomo, M., & Gilchrist, L. (2020, July 19). Interventions for Breast Cancer-Related Lymphedema: Clinical Practice Guideline From the Academy of Oncologic Physical Therapy of APTA. Retrieved October 18, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412854/
 Why Bandage? (n.d.). Retrieved October 18, 2020, from https://www.lymphcareusa.com/patient/therapy-solutions/compression-therapy/bandages.html
 Thabet, A., & Alshehri, M. (2019, March 1). Efficacy of deep core stability exercise program in postpartum women with diastasis recti abdominis: A randomised controlled trial. Retrieved October 18, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6454249/
OB-GYN Group Embraces ‘Fourth Trimester’ Concept, Acknowledges Role of Phys… (2018, July 11). Retrieved October 18, 2020, from https://www.apta.org/news/2018/07/11/ob-gyn-group-embraces-fourth-trimester-concept-acknowledges-role-of-physical-therapy-in-postpartum-care