Where do YOU find value in Continuing Education?

My opinion and views have changed quite a bit over the last 10 years about Continuing Education.  I’ve always loved learning, and for years I couldn’t tell you how many CEUs were required in Illinois because I attended every course I could.  I always had more than enough, and it was never about just ticking off a box.

It was a bit fortuitous this morning as I’m working on the schedule and website for Entropy Physiotherapy and Wellness’s Continuing Education offerings that 2 pertinent tweets popped up in my Twitter feed.

The first one was from David Pulter (@orth_DavidP), sharing this piece from the PT Journal published in 2001!  The Editor’s Notes by Jules M. Rothstein laments the quality of CE offerings, comparing CE purveyors as ‘modern-day revivalists, moving from community to community with zeal and a polished act that seduces the listener’.  What is the most depressing part of that statement (other than the fact it’s true in many cases) is that after each course, 40 disciples leave that course and spread information that is enthusiastic but often poorly researched at best, and implausible or misleading as a less beneficial outcome. 

I feel confident saying that, because Sandy and I have both experienced the process of getting ‘approval’ for courses we host at Entropy Physiotherapy.  We’ve attempted to get the courses approved through ProCert.  I was at first rather excited about what appeared to be a rigorous process.  However, my hopes were dashed as we looked over the example they gave to assist in filling out the complicated forms.  The example course?  Using therapeutic ultrasound.  Yep, ultrasound. 

While there are still administrative hoops to jump through to make the CE courses at Entropy ‘count’ towards fulfilling our licensure requirements, everyone needs to be aware that the ‘stamp of approval’ is NOT an indication of quality. The processes are in place to be sure that the therapists taking the courses understand what will be offered.  These processes have nothing to do with the level of evidence or plausibility or even quality of the course.  Those determinations are up to the individual therapist to make.

This leads me to the latest blog by Adam Meakins.  ‘Who is fit to teach?’.  It’s a great question.  In my time as a Physical Therapist, I’ve certainly gone through some phases here.  I started out as a wide-eyed believer.  Obviously if someone was able to get 40 people to pay $450 for a course, they must know what they’re talking about, right?  I didn’t question much back then. 

But now I’m old, and I question everything.  So what do I look for when I’m going to be spending my money on continuing education?  I’m looking for someone who is well versed in the latest evidence (even better if they’re involved in the research!), and someone who is willing to have an honest discussion about what we know and what we don’t know.  I’m not looking for someone who is a ‘guru’….  Because those don’t actually exist unless you suspend your ability to critically think. 

So who IS fit to teach?  Adam doesn’t limit it to the people with the highest degrees, the most publications, or largest social media presence.  The best teachers have passion, personality, respect, and are able to present their material while having fun.  The best teachers inspire challenging questions and critical thinking.  The best courses do not provide rigid protocols or elaborate rituals, instead they give the clinicians skills to thoughtfully evaluate and treat a person with unique goals.


So what is the point of this post?  Mostly to say learning is good.  But not all learning experiences are created equal, and sometimes all you learn is what not to do.


Entropy Physiotherapy has solved our continuing education frustrations by collecting clever speakers from all of over the world, bringing them to centrally located Chicago, and hosting small classes in a comfortable environment.  We would love to hear your thoughts on what we're doing, and how we could do better!

Medically Induced Healthcare Issues

Healthcare can do better....

This weekend I had the good fortune to attend  a wonderful course, Comprehensive Management of Bowel Dysfunction.  As a pelvic health physio, patients with gastrointestinal, digestive, and bowel issues are always challenging.  And the fact of the matter is, if you ask your patients (even the ones coming to see you for their knees), they’d tell you about their bowels.

sitting on table

As much as I love talking about bowel issues, one of the most profound things that I experienced in this class was a completely comfortable, completely pain-free vaginal and rectal exam.  That’s right, even the rectal exam.


It got me thinking about what my patients go through on their quest for health.  The exams they experience, the things that they are told about their condition, and the testing they must endure are unfortunately unhelpful.   Many patients will come into the clinic ‘worse’ after visiting their physician for a recheck, or after undergoing ‘further testing’. Why are the examinations and tests people are put through making them worse?






In our clinic, we’ve started referring to these as ‘medically induced conditions’.

scary doctor

We unfortunately see this often.  Patients traumatized following their medical interventions or hospitalizations or physical therapy treatments.  Why does this continue to happen??  Is it necessary to ‘get worse before you get better’?  Is it necessary to endure further testing?  Here are some thoughts and questions for patients and clinicians to ponder.  I hope it makes clinicians (physios, physicians, anyone touching a patient ever) reflect and reconsider their actions/suggestions/prescriptions.  I hope it makes patients speak up if they’re being hurt.


  1. If you poke anything hard enough, it’ll probably hurt.  This goes double for poking into any orifice.
  2. Poking something hard enough to make it hurt won’t necessarily tell you what to do to help that person.  Especially if the person has already told you, ‘it hurts if this bit gets poked’.
  3. Testing should be done to help rule out red flags, or to help direct the plan of care.
  4. Patients should understand why they’re having a test, and understand how the results will impact their plan of care.cartoon
  5. Clinicians should take the time to make the healthcare experience better.  Make the patient comfortable.  Take the time to explain what you’re doing.  Take the time to answer the questions.  Pay attention to verbal and non-verbal indications that what you’re doing to them is causing pain.
  6. If a patient says ‘ouch, that hurts’, or they’re squirming on the table, stop hurting them.  Take a minute and reflect on what might be happening, and why in spite of your perfect technique this patient is not feeling better.
  7. If a patient isn’t getting better, doing whatever you’re doing harder, deeper or more often isn’t likely the answer.

I have a hopeful heart, that even when patients have negative healthcare experiences, the healthcare practitioners are basically good people with good intentions.  There are a lot of us who also fancy ourselves to be wonderfully qualified:  specializations, advanced degrees, conference and course attendance trying to acquire  new knowledge, new skills, and new evidence to educate those patients.  Professional development (heck, learning in general) should be life-long.  However that knowledge should not replace common sense and good manners.

Your Vagina is Awesome….

Even after 3 kids.  Even after menopause.  Even if you didn’t know how awesome it is.  

As a pelvic health therapist, it amazes and saddens me that in 2014, women are still ashamed, self-conscious, and confused by their lady bits.


I’d like to address a few of the myths and inaccuracies that I’ve heard, in and out of the clinic…



1)   It can be a challenge to see your vagina.  – The vagina is essentially a hallway from your uterus to the outside world.  It’s a hallway that can stretch.  A lot.  If you can see your vagina without trying, you might want to see a physician…  Vaginal prolapse can happen, and it would need to be addressed.

2)   The parts you can see vary much from person to person.  And I’ve never seen an ugly one. -  The first thing most of us run into if we’re to take a peek at our genitals is the labia majora. If we separate those, we’ll be able to see the labia minora, clitoris, as well as the vaginal opening.  These bits do change with arousal, childbearing, and age.  If you’re curious about what ‘normal’ is, I recommend the documentary The Perfect Vagina.  

3)   The vagina is not the same as your pelvic floor. – The pelvic floor muscles are a group of muscles that are located in the bottom of your pelvis, spanning from your pubic bone, to your tailbone, and out to each ‘sits bones’.  The pelvic floor has 3 openings for us ladies:  (starting from the front) An opening for our urethra to urinate, an opening for our vagina (for sex and childbirth), and finally our anus for defecation.  The pelvic floor also plays a role in respiration and core stability.  Bladder, bowel, and sexual function can all be impacted by pelvic floor muscles that are not functioning up to par, which brings us to my next point.

4)   Having a baby can greatly impact the function of your pelvic floor muscles.  There’s much to say about this…

  1. If you give birth vaginally, you’re pelvic floor muscles stretch more than any other muscle at any time in your life.  It is one of the wonders of the world that a woman can pass a child through her pelvic floor, and more often than not, regain fairly good bowel and bladder control quickly, and resume sexual activity in as little as 6 weeks.
  2. If you give birth via C-Section, you did not get the ‘easy way out’.  Studies show that pelvic floor dysfunction (bowel, bladder and/or sexual dysfunction) are just as high in women 12 months after a C-section as they are in women who have a vaginal delivery.
  3. Some women recover more quickly than others.  Some women just think they’ve recovered.  There are several common things that women experience after childbirth, such as incontinence or painful intercourse.  These are certainly common, but should not be considered ‘normal’, and therefore ignored.  There is much to be done to improve these symptoms, and I’d seek out a qualified pelvic health therapist to get an assessment as soon as possible.

5)   Even if you haven’t had a baby, it’s ok to get help for pieces that don’t seem to be working as well as you’d like. - Sometimes things aren’t as good as you’d like.  Yep.  I’m talking about sex.  Lack of enjoyment, lack of desire, lacking the ability to have orgasms…  These can be more complicated, but not impossible to address.  Identifying the different pieces that may be contributing to the situation is key.  There are physical, medical, mental and emotional issues that can contribute in various ways to sexual dysfunction.  Understanding what your bits are, and what they’re supposed to be doing can go a long way in decreasing fear and anxiety relating to sexual dysfunction/lack of enjoyment.



If you find yourself in a situation where you don’t love your vagina, get help.  Don’t assume nothing can be done, and don’t suffer in silence.  If you’ve not had a physical lately, I’d recommend you check in with your gynecologist.  If you feel like you can’t talk to them, or feel like you’re not being heard, don’t give up.  We’re happy to offer some suggestions on a starting point for you to start your journey to better sex.

You're not broken...

Pain stinks. But we will all likely have to deal with it at some time in our lives. Understanding pain, and understanding that you're not likely broken can be a very powerful pain reducer.[embed width="320" height="240"]https://www.youtube.com/watch?v=ALlNFxnO1BA&feature=youtu.be[/embed]

Learn more here:

Bronnie Thompson authors the wonderful HealthSkills blog and has a word for people who are experiencing pain:

For a visual look at what is going on with Pain, the TedX talk from Professor Lorimer Moseley is a classic.

[embed width="320" height="240"]https://www.youtube.com/watch?v=gwd-wLdIHjs&feature=youtu.be[/embed]



Understanding Pain - In less than 5 minutes

Pain is an experience most of us will have at some point in our life.  Thankfully, the scientific understanding of pain has improved drastically over the years.  Unfortunately, there are still lots of misconceptions and misunderstandings about what pain is and what to do about it.  Here's a short, fun clip that might help you think a little differently about pain. [embed width="320" height="240"]http://www.youtube.com/watch?v=4b8oB757DKc&feature=youtu.be[/embed]