Defining Moment Elevating the Conversation A PT's journey to pelvic health advocacy By Lori Mize, PT, DPT | June 2018 Listen to this article There's nothing like having the "This is what I want to do with my life!" epiphany. I've had 2. The first came during my first year of middle school, when I witnessed my great-grandfather's rehabilitation after a major stroke. I was amazed to see how his physical therapists (PTs) helped "Pa" regain function and get his life back, given his initial severe impairment. That was my introduction to the profession of service that is physical therapy. In my young eyes, PTs worked miracles! I had found my calling. Every academic goal I set from the fifth grade on was linked to my one day becoming a PT. Growing up as an athlete contributed to my interest in and appreciation for rehabilitation. During my freshman year in college I coached competitive gymnastics. Through that experience, I learned a lot about how to teach young women difficult physical and mental concepts about prevention, maintenance, and competition that came naturally to me. I learned the value of approaching each participant as an individual—providing what that person needed to become successful. I built trust with my gymnasts. We had fun together. They taught me a lot about how to be a successful PT, although neither they nor I knew that at the time. I was elated in 2000 to be accepted into a doctor of physical therapy (DPT) program. I continued teaching and coaching gymnastics until I entered my final internships. Life lessons learned through those experiences influence my practice of physical therapy today. Because I loved athletics, particularly gymnastics, I'd determined that sports physical therapy and orthopedic rehabilitation would be my professional direction. During the final year of my DPT program, however, I unexpectedly became pregnant with our second child. This surprise brought me great joy but also major pelvic girdle pain and dysfunction. The discomfort was so intense, in fact, that I barely could complete day-to-day duties in my internships. I was completely miserable and had no idea where to go for help. My physician's only comment was, "That's what happens when you're pregnant. It's normal." Fortunately for me, however, some classmates and I had invited a women's health and pelvic floor rehab PT from a neighboring state to visit our school to teach us about this field. I was offered an opportunity to be a patient in her lab, and as a result I felt far better during the final 3 weeks of my pregnancy than I had up until that time. Several of my classmates and I subsequently attended a course that she gave at APTA's National Student Conclave. Taking that PT's course after having benefited so much from her interventions was my second defining moment. Prior to those experiences, I'd been headed toward a career in sports and orthopedics. Even after those experiences, I briefly was torn in my professional plans. The reason had nothing to do with the practice areas themselves and everything to do with my conservative upbringing in the Deep South. Where I grew up, we didn't talk about "taboo" things such as sexual dysfunction and incontinence. As a result, such subjects made me uncomfortable. But then I met the PT who eased my pain during pregnancy, and I learned when I took her course that physical therapy can make a significant difference in the lives of women who are plagued by issues that I'd always deemed indelicate. It took a little while for my mind to make the career switch. But once it did, there was no doubt where I was headed. The women's health class I'd taken as a very pregnant student awakened me to the importance of addressing issues related to the pelvic floor. It made me realize that too many women and men with incontinence, pelvic pain, and sexual dysfunction are not receiving evidence-based physical therapy to help resolve those issues. I wanted to do whatever I could to prevent other pregnant women from enduring what I had gone through. What I now understood was that while pain during pregnancy is common, it is not, in fact, "normal"! What I now knew was that much pelvic pain is utterly avoidable with the help of a women's health PT. I'd discovered my passion—to empower women and men while elevating the conversation about the pelvic floor! In the years since, I've never wavered. Since 2010, in fact, I've empowered PT colleagues to spread the word by teaching courses in pelvic health through APTA's Section on Women's Health. Doors of opportunity have continued to open for me. Four years ago, I left the clinic and moved into full-time teaching. My gymnastics coaching skills once again came in quite handy! In my current role, I'm sharing with DPT students my dedication to the therapeutic alliance, biopsychosocial care, services, and advocacy. One of my proudest moments advocating for patients, the public, and the profession came in January of this year. The Huffington Post invited me to write an opinion piece just as Larry Nassar's high-profile molestation trial was reaching its conclusion. I seized the opportunity not only to condemn Nassar on behalf of the physical therapy community, but also to draw a clear distinction between the odious acts of the disgraced former physician and the respectful, evidence-based, effective practices of pelvic floor PTs. The guest column's headline was "Nassar's Atrocities Stigmatize a Legitimate Medical Treatment."1 I hope that was a copyeditor's overstatement, and that no one has or will equate Nassar's actions with the valuable treatment that pelvic floor PTs provide. Regardless, my motivation in writing the piece was, again, to elevate the conversation about pelvic health—to remove any stigma or sense of shame that may still surround pelvic issues. That is vitally important, because shame and stigma serve only to perpetuate a cultural environment in which sexual abuse can thrive. I am so grateful for my defining moments during middle school and my DPT program, and for my subsequent career of service and advocacy. It is a privilege to be in position to empower others—patients, students, and the public—with regard to pelvic health. We, as PTs and physical therapist assistants, must speak out and teach others what we know to be true.