A Note from Annemarie
As a lifelong “good student,” I soaked up every ounce of the education I received in my physical therapy doctorate program and committed myself to the theoretical and practical framework presented by the sources of my professional education in women’s health. In a constant striving to “do well,” I didn’t stop to question what I was being taught - while eagerly trying to follow all the rules, there wasn’t space for the mental discomfort of seeing the contradictions of physical therapy dogma, or the range of logical fallacies that could be used to explain how and why we were affecting change (or not).
I was forced to grapple with these questions when I had clients I couldn’t “fix.” When people felt better, and everything went according to plan, I could live comfortably in my bubble and feel validated that I had done the “right thing.”
The problem, however, was when that didn’t go according to plan.
I simply didn’t have a way to understand what was happening - I was doing exactly what I was supposed to, and the patient was following every instruction to the letter. Outside of the structured world of my education, where all of the patient case studies behaved exactly the way they were supposed to, I was lost trying to reconcile the real world and the theory that I had been taught was “truth.”
Since becoming a pelvic floor physical therapist, I have had to continually confront my biases and assumptions. I have been uncomfortable, confused, and unsure. I have let go of many of the beliefs I originally learned as doctrine, and have become more comfortable with admitting where I have made mistakes in the past.
I have let go of a lot of ideas in favor of new frameworks for understanding my work. Here are a few examples:
If I give my patient the right exercise or perform the right manual therapy intervention, they will get better. If they don’t, it’s because I chose the wrong one, performed it incorrectly, or the patient was non-compliant.
If a patient doesn’t follow my instructions, they won’t get better.
Exercise is good, but joints and other tissues can “wear out” in response to load.
People with pelvic floor dysfunction need to restrict their activity to be safe.
People with overactive pelvic floor muscles shouldn’t do pelvic floor exercises until their pelvic floor is a normal tone and pain has been relieved.
The goal of treating POP is to regress its anatomical grade, which will treat the associated symptoms.
Every postpartum person needs pelvic floor physical therapy.
These may be beliefs that you hold, and may still have at the end of this course. That’s completely fine with me! What I'm hoping for is a critical re-evaluation of these beliefs - keep what passes your tests, and discard what no longer has enough evidence to make the cut.
Every day, I try to question my assumptions and biases - even the ones that I feel are “correct” based on my experience and the best available evidence. I’m a firm believer that a true expert in any field is one who is continually improving. That requires self-reflection and a healthy ego check here and there - and it means that there may have to be fundamental shifts in our thinking prompted by learning and experiencing more as the years pass. Having the humility to acknowledge when our strategies need to change, and allowing ourselves the grace to do it, is the most important way to approach all things, including our work as healthcare professionals.
POP Up is born of a desire to question… everything! I sincerely hope - with the greatest respect for all of the professionals reading this - that there are parts that make you uncomfortable, and inject a healthy amount of skepticism in your daily practice. We wrote POPUp with the hope of not just mentioning but embracing the messy gray areas of humans and healthcare. I have certainly been challenged as a co-writer of this course with continued confrontation of my own assumptions, and I’m excited to challenge you as well!