Pelvic Health for the Non-Pelvic Health PT

PELVIC HEALTH FOR THE

NON-PELVIC HEALTH PT

Presented by Dan Kirages, EileenJohnson, and KelsieKaiser

OCTOBER 9-10, 2021

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KAISER, JOHNSON, KIRAGES 1

Pelvic Health for the Non-Pelvic Health PT

Kelsie Kaiser, PT, DPTEileen Johnson, PT, DPTDaniel Kirages, PT, DPT

1

Objectives• Be aware of patient history, signs and symptoms (past surgical histories,

bowel/bladder dysfunction, oncological history) that may warrant further examination for pelvic floor dysfunction.

• Be able to perform pelvic health related subjective interview regarding bowel, bladder and sexual health to gain further understanding of the pelvic floor dysfunction.

• Understand the pelvic floor and surrounding joints (lumbar spine, SI joint, coccyx) anatomy and function.

• Be aware of non-internal interventions and patient education to help various populations: peripartum, coccydynia, bowel and bladder dysfunction.

• Understand when to refer out to a specialist for further assessment and treatment.

2

AnatomyBone & Ligamentous Structures

3



AnatomyMusculoskeletal

4

AnatomyMusculoskeletal

5

• Lumbar Plexus (L1-4)• Sacral Plexus (L4-S3)

• Sciatic Nerve (L4-S3)• Pelvic Nerves

• Pudendal Nerve (S2-4)• Peripheral nerves from

lumbar & sacral plexus

Neuroanatomy

6



Function – SI Joint• Transfers loads• Transfers weight in opposite

direction• Ambulation

– Shock absorber– Stability– Mobility

DeRose & Porterfield 2007

Schamberger W, et al. The Malalignment Syndrome : Implications for Medicine and Sport. Churchill Livingstone; 2002

7

Mechanics – SI Joint• Controlled Mobility

Schamberger W, et al. The Malalignment Syndrome : Implications for Medicine and Sport. Churchill Livingstone; 2002

8

Function – Pelvic Floor

• Supportive• Supports pelvic organs• Reduces force of gravity• Reduces force of intra-

abdominal pressure• Assists in pelvic and

lumbar support• Sphincteric

• Bladder• Bowel

• Sexual

9



So what?

10

So what?

11

SubjectiveCommonly Asked• Chief Complaint• History of chief complaint• SINS• Aggravating/Alleviating Factors• Occupation• Hobbies• Activity Level• PMHx (surgeries, injuries etc.)• Sleep quality• Goals

12



SubjectiveRed Flags

• Trauma• Age• History of Cancer• Fever/chills/night sweats• Weight loss• Recent infection• Immunosuppression• Rest/night pain• Saddle anesthesia• Bladder dysfunction• Progressive/severe neurological

deficits

Leerar P, et al. Documentation of Red Flags by Physical Therapists for Patients with Low Back Pain. Journal of Manual and Manipulative Therapy (2007)

This Photo by Unknown Author is licensed under CC BY-NC13

SubjectiveUrinary System

• Frequency • 2-4 hrs

• Nocturia• 65 y.o. 1x/night, increase by 1 per

decade• Incontinence

• Stress• Urge

• Urination quality• Retention• Hesitancy• Urgency

• Symptoms with voiding

• Urine odor• Foul• Sweet

• Hematuria• Burning sensation before, during

or after urination• New/worsening urinary retention

with fecal incontinence, saddle paresthesia, LE neurologic deficits

• Frequent urination with pain in back, side, or groin

14

SubjectiveGastrointestinal System

• Frequency• Stool type

• Bristol Stool Chart• Constipation/diarrhea• GI history• Straining• Difficulty with evacuation or

sense of incomplete emptying• Relief of back or pelvic pain post-

evacuation• Blood in stool• Blood on toilet paper• New/worsening fecal incontinence with

urinary retention, saddle paresthesia, LE neurologic deficits

15

https://pngimg.com/download/14697

https://creativecommons.org/licenses/by-nc/3.0/



SubjectiveFemale SpecificMenstruation

• Frequency• 21-35 days• Average 28 days

• Duration• 2-7 days

• Flow• Abnormal changing pad/tampon

every hour• Symptoms during/around cycle

• Correlation to chief complaint• Spotting• Birth control pill or contraceptive• Pain with insertion of tampon

• Irregular cycles with abnormal bleeding

• Heavy menstruation for prolonged period with pain in abdomen, low back, or pelvis

• Vaginal discharge with odor

Peri-menopause/Menopause• Age

• Average = 51 y.o.• Premature menopause = <40 y.o.

• Symptoms• hot flashes, sweats, changes in the

membranes lining the vagina, sleep disturbance, mood swing, weight gain

• Hormonal replacement therapy

16

SubjectiveFemale SpecificSexual Function

• Dysparuenia• Superficial• Deep

• Orgasm• Dysorgasmia

• Positioning

• Post-coital bleeding

Pregnancy• Number of pregnancies, number of

births• Delivery (C-section, Vaginal,

Instrumentation)Episiotomy or tearing?

• Length of labor• Weight of baby• Complications• Low back, pelvic, pub bone, or other

pain during your pregnancy or after?

17

SubjectiveFemale Specific - Pregnancy Exercise Contraindications & Precautions

• Avoid laying supine for prolonged periods of time (2nd & 3rd trimester)• Avoid sit-ups/crunches

STOP EXERCISE IF:• Vaginal bleeding• Dizziness or feeling faint• Increased shortness of breath• Chest pain• Headache• Muscle weakness• Calf pain or swelling• Uterine contractions• Decreased fetal movement• Fluid leaking from the vagina

18



SubjectiveMale Specific

• “Groin” pain• Scrotal pain• Reproduction of pain with exertion

• Pain with erection, ejaculation, or post-coital

• Odor and/or color change in ejaculate

orthobullets.com

19

Past Medical History• Surgeries

• Abdominal surgeries• Hysterectomy• Prostatectomy• Neobladder surgery• Gender affirming surgeries

–Female-to-male: Metoidioplasty Phalloplasty,scrotoplasty

–Male-to-female: Orchiectomy, Vulvoplasty, Vaginoplasty

• Prolapse• Cystocele• Enterocele• Rectocele• Uterine prolapse• Vaginal vault prolapse

Subjective

20

Incorporating New Process

Subjective

Red flags

Refer out & treat Refer out

Pelvic health questions

Urinary system GI system

Prolapse Surgical history

Female specific

Male Specific

https://aptapelvichealth.org/ptlocator/

21

https://aptapelvichealth.org/ptlocator/



Timeline of Pregnancy

Full term = 40 weeks

1st trimester: Weeks 1-12

2nd trimester: Weeks 13-28

3rd trimester: Weeks 29-40

4th trimester: post-partum

care

22

Musculoskeletal changes

• Increased joint laxity– Hormonal increase in relaxin

• Peaks during 1st

trimester and delivery

• Weight gain and increased load on pelvis and joints

• Change in COG, balance and neuromuscular control

23

Physiological changes

• Increase in resting heart rate– Increased 10-20 bpm from

pre-pregnancy resting HR• Increased stroke volume• Decreased vascular resistance

– BP can decrease in 1st and 2nd trimesters

– 3rd trimester watch for pre-eclampsia

24



Patient Case

• 34 year-old female, 18 weeks gestation • Chief complaints:

– R sided low back pain– R sided lower pelvic/pubic pain– Lower pelvic pressure/heaviness– Stress urinary incontinence

• Insidious onset 15/16 weeks gestation, began noticing R sided pelvic pain with transitioning out of bed (2 times/night)

• *Conceived 6 months postpartum 1st vaginal delivery

25

Pain Pattern

• Low back and pelvic pain• Pain level at rest: 2/10• At worst: 5/10

– R sided lower pubic sharp, burning pain and pulling sensation with pull to the anterior R hip.

– Central lower back ache, no radiating symptoms

– Pubic and R sided low back pain with getting up

26

Pain Pattern (Cont.)

• Aggravated by: prolonged standing and walking >15 min, playing with 10-month old (17 lbs) – getting up and down from floor,

bending, lifting into car seat/stroller, carrying.

– transitioning from side to side in bed, getting into and out of car, donning/doffing pants and shoes

• Alleviated by: Resting, laying down, prenatal yoga stretches

27



Pelvic Health Considerations

• Pelvic Floor Symptoms: • Vaginal heaviness 4/10 at worst

– Worse as the day progresses or with increased activity.

– Worse with prolonged carrying of daughter

• Stress UI– Coughing and sneezing, esp.

depends on fullness of bladder

28

Common musculoskeletal dysfunctions in pregnancy

• Sacroiliac joint dysfunction• Pelvic girdle pain (PGP)/low back

pain instability• Symphysis pubis dysfunction• Round Ligament Pain• Coccydynia• Back pain• PFD

• Changes in gait mechanics “Waddle”

• Diastasis recti• Pelvic Floor Dysfunction• Nerve entrapment- TOS, CTS,

sciatica

29

Social History and Patient Goals

• Lives with spouse and 10-month daughter (~17 lb)• Stay at home mom• 15 steps to go into home• Getting up every 2-2.5 hrs at night to void

Patient goals:• To learn ways to improve pain symptoms, reduce pain and

manage symptoms through pregnancy.• To be able to continue safely caring for her daughter.

30



Postural changes

• Cervical Lordosis• Thoracic Kyphosis• Lumbar Lordosis• Scapular Protraction• Rounded shoulders with

humeral internal rotation• Anterior pelvic rotation• Wider BOS with hip ER• Genu recurvatum

31

Musculoskeletal Exam

• Postural assessment– Standing, seated

• Range of motion• Strength (hip and abdominals)• Neural screen (reflexes,

sensation, LE myotomes)• Palpation

– Joint, surrounding fascial mobility and ligament

32

Round Ligament

• Fibro-muscular connective tissue

• Attaches to the uterine horns (where uterine tubes enter) to labia majora.

• Passes through inguinal canal

33



Round ligament

34

Movement Analysis

• Gait Analysis– Symmetry of pelvis in seated

posture– Quality of transition (rely on UE’s

for assistance)

• Step negotiation• Single leg squat

– Active SLR test

• Use VAS pain rating scale for objective findings

35

SI Joint Provocation Tests

• Distraction• Thigh thrust• Compression • Sacral Thrust

2/4 tests positive = SI joint dysfunction (Laslett) – 91% Sensitivity, 78% Specificity

36



Laslett Cluster

Distraction Thigh Thrust Compression

37

Modifications for Pregnancy

38

Guidelines for safe exercise

Avoid supine position >3 min after 1st trimester• 30 degree angle incline recommended if supine

L side lying preferred position• Offload the inferior vena cava

Avoid prone position

Avoid strong abdominal compression/strain during 2nd and 3rd

trimester

Avoid rapid bouncing or swinging

Avoid overheating- stay hydrated

39



Evidence says:

• 20-90% of pregnant women experience low back or pelvic girdle pain– PT during the antepartum and post-partum phase can

significantly reduce low back and pelvic girdle pain• Exercise during pregnancy can:• Significantly lower incidence of gestational diabetes

during pregnancy • Significantly shorter 1st stage of labor• Influence Neonatal outcomes in exercise group showed

significant difference in APGAR scores at 1 min mark.• Help with faster recovery post-vaginal and cesarean

delivery

40

Exercise intensity guidelines

• Borg Rate of Perceived Exertion (RPE) scale

–Moderate intense activities

–13—14 “Somewhat hard”

• “Talk test”

• 150 minutes/week• 30 min, 5 days/week

41

Foundational Neuromuscular Re-education

• Core muscle and breathing coordination and integration into mobility and function

• Incorporation of diaphragmatic breathing with PFM and TrA activation– Avoid sit ups

• Reduced interrecti distance (IRD) above and below umbilicus with headlift with twisted curl up

• Maximum PFM contraction and in-drawing increased IRD below umbilicus – Sub-max training

42



To crunch or not to crunch?

• Before • After

http://www.deliciouslyfitnhealthy.com/

43

TrA with Diaphragmatic breathing

44

“Core” Deep abdominal exercises

• Provides support to the low back and pelvis• Imagine you are gently hugging and

lifting/cradling your baby with your abdominal muscles

• Gentle exhale as you engage your muscles to avoid holding your breath

• Integrate this small action into transitional movements– Sit to stand– Rolling side to side in bed – Getting out of bed, car, off couch

45



Spine Mobility and stability exercises

Gentle abdominal brace

Move within comfortable range

of motion

Avoid excessive arching of the

back/stretching of abdomen

46

Postural exercises and Hip Flexibility

Pregactive.comhep2go.com

Thechampatree.com

47

Type to enter a caption.¡Focus on Function

¡Pelvic floor strength to meet the demands of daily activities

¡Not a strenuous exercise

48



Preparing for labor and delivery

• Mindfulness practice

• Deep breathing• Pelvic floor

muscle coordination for relaxation

Onestrongmama.com

Babycenter.com

Babycenter.co.uk

49

Postpartum recovery

• Physical Therapy with a Pelvic Health Specialist

• Pelvic Floor Rehabilitation– Pelvic pain (pain with intercourse, pelvic heaviness)

– Urinary incontinence– Diastasis recti/abdominal weakness

• Postural strengthening – Wrist, neck, back

• Baby care ergonomics– Lifting, bending, changing– Feeding considerations

Geisinger.org

50

Patient ScenarioDate: 10/10/21

Profile: 46 y/o male

Occupation: Attorney for City of Los Angeles

MD Diagnosis: Tailbone Pain

51



52

Joint Complex• L2-L5 facet• SIJ• Hip • Sacro-coccygeal

Nerve• L2-L5 dorsal rami• L2-L5 Spinal nerves

Muscle• Quadratus Lumb.• Paraspinals• Piriformis• Gluteals

Ligaments• Posterior SIJ (S/L)• Sacrotuberous• Sacrospinous

Other• L1-L5 disc

Non-musculoskeletal• Kidney• Ureter• Urinary bladder• Prostate gland• Testes• Rectum

53

Subjective Exam Summary

• Main complaint / Problem list • pain over coccyx during sitting (1º)

• Left sided low back pain (2º)

• See Body Chart details

54



Body Chart

55

History of Condition• 6 months ago

• walking briskly outside courthouse

• rainy day

• slipped on wet painted concrete and fell directly on coccyx

• immediate pain (8/10) local at coccyx region

• still went to court sitting for 6 hours (shifted onto L buttock)

56

History of Condition• lower Left lumbar region started hurting later in day

• worked next couple days from home in R side lying• heating pad on L lumbar region• avoiding sitting evenly (“flat”)

• went to primary care MD on Day 4• prescribed NSAIDs• (-) lumbosacral radiograph taken (posterior view only)

57



History of Condition• over next 2 months

• lumbar pain improved 80%

• coccyx pain improved 20%

• MD spine specialist• (+) MRI

• Left L4-L5 disc protrusion posterolateral (3mm)• anterior displacement of coccyx (<25°)

58

History of ConditionWhat happened over the next 4 months?

• Started yoga classes (needs to sit on folded blanket)

• Sitting for brief periods of time

• 2 cortisone injections to sacro-coccygeal joint (not helpful)

• Stopped taking NSAIDs (no difference)

• Physical therapy referral to you

59

Behavior of Symptoms• Aggravating Factors:

• “A”• sitting x 15 minutes

• “flat” on chair (cushion better than hard surface)• Slouched (post pelvic tilt) is most painful

• direct pressure with hands or object on coccyx

• bowel movements 2-3 times per week

60



Behavior of Symptoms• Easing Factors:

• “A”• standing up from sitting x 2 minutes

• removing direct pressure x immediate relief

• adjusted sitting positions• anterior tilt into neutral position • cushion (blankets during yoga)• toilet seat• unilateral buttock weight bearing

61

Behavior of Symptoms• Aggravating Factors:

• “B”• sitting on L buttock x 20 minutes • sitting in extreme anterior tilt x 15 minutes• occasionally after running x 30 minutes on treadmill

• Easing Factors:• lumbar flexion positions

• stretching in child’s pose• general movement (walking)

62

Behavior of Symptoms

• 24 hour pattern

• AM – “B” stiffness x 20 minutes

• PM – “A” and “B” position/activity dependent

• Night – unremarkable for pain

63



Other Key Subjective Data• (-) constitutional signs and symptoms

• fever, night pain, dizzy, weak, weight loss, numb/tingle

• (+) urogenital and anorectal symptoms• Frequent urination: 1.5 hour intervals

• Nocturia: 2x/night

• Difficult and painful “A” bowel movements

• Occasional ejaculatory pain “A” (latent by 20 minutes)

64

Biopsychosocial

• High anxiety levels (yoga is helping)

• Stressed out due to work and condition

• Negative attitude about prognosis• “For the rest of my life?”

65

Differential Diagnosis List

66



Joint Complex• L2-L5 facet• SIJ• Hip • Sacro-coccygeal

Muscle• Quadratus Lumb.• Paraspinals• Piriformis• Gluteals

Ligaments• Posterior SIJ (S/L)• Sacrotuberous• Sacrospinous

Nerve• L2-L5 dorsal rami• L2-L5 Spinal nerves

Other• L1-L5 disc

Non-musculoskeletal• Kidney• Ureter• Urinary bladder• Prostate gland• Testes• Rectum

Obturator InternusPuborectalis

IliococcygeousPubococcygeous

CoccygeousExt. Anal Sphincter

67

Differential DiagnosisBased on subjective exam data:

• Coccyx

• Pelvic Girdle

• Lumbar Spine

• Pelvic Floor Muscle

68

Manual Therapy• Soft tissue mobilization for soft tissue restrictions in

associated muscle groups:

• External and/or internal regions treated• Multiple techniques used:

• Contract / Relax • Dragging • Strumming• Static hold

69



Manual Therapy• Desensitization of local tissue for restoring tolerance to

pressure and touch.

GoalsRestore pliability

Restore circulationIncrease tolerance to pressure

Restore neural mobilityReduce referred symptoms

• Sacrum

• Coccyx• Perianal

• Perineum• Gluteals

70

Neural Mobility• Pudendal nerve branches:

• dorsal

• perineal

• inferior rectal

• Continuous nervous system (Slump)

71

Pelvic Floor Muscle Training• Re-educate phases of contraction/relaxation

• 10-20% contraction intensity concentrically

• Eccentric lengthening also very important

• Rhythmic contract/relax method (full ROM)

72



Nervous System Quieting• Elevated anxiety Sympathetic nervous system overdrive

(storage)

• Relaxation techniques

• diaphragmatic breathing

• relaxation audio

• coping mechanism changes

• stress avoidance

73

Interventions

Correction of pelvic obliquities Postural re-education

and strengthening

74

Please Don’t Be Afraid of Pelvic Health,

The World Needs You!

75



References • Schamberger W, et al. The Malalignment Syndrome : Implications for Medicine and Sport. Churchill

Livingstone; 2002• Leerar P, et al. Documentation of Red Flags by Physical Therapists for Patients with Low Back Pain.

Journal of Manual and Manipulative Therapy (2007)• Subak, Brown, Kraus, et al (2006). The "Costs" of Urinary Incontinence in Women• Abrams (2013) Incontinence: 5th International Consultation on Incontinence, Paris, 2012• Aoki, Yoshitaka et al. “Urinary incontinence in women.” Nature reviews. Disease primers vol. 3

17042. 6 Jul. 2017• Airaksinen O, Brox JI, Cedraschi C, for the COST B13 Working Group on Guidelines for Chronic Low

Back Pain Chapter 4: European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(suppl 2):S192–300.

• Ng K-S, Sivakumaran Y, Nassar N, et al. Fecal incontinence: community prevalence and associated factors–a systematic review. Dis Colon Rectum 2015;58:1194–1209

• Skardoon, G. R., Khera, A. J., Emmanuel, A. V., & Burgell, R. E. (2017). dyssynergic defaecation and biofeedback therapy in the pathophysiology and management of functional constipation. Alimentary Pharmacology & Therapeutics, 46(4), 410-423.

• Thom DH, Van Den Eeden SK, Ragins AI, et al. Differences in prevalence of urinary incontinence by race/ ethnicity. Journal of Urology. 2006;175(1):259–264.

• Whitcomb EL, Rortveit G, Brown JS, et al. Racial differences in pelvic organ prolapse. Obstet Gynecol. 2009;114(6):1271-1277. doi:10.1097/AOG.0b013e3181bf9cc8

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References • Eliasson K, Elfving B, Nordgren B, Mattsson E. Urinary incontinence in women with low back pain.

Man Ther. 2008;13(3):206–212

• Dufour S, Vandyken B, Forget MJ, Vandyken C. Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskelet Sci Pract. 2018;24:47-53. doi:10.1016/j.msksp.2017.12.001

• Spitznagle, Theresa & Leong, Fah & van Dillen, Linda. (2007). Prevalence of diastasis recti abdominis in a urogynecological patient population. International urogynecology journal and pelvic floor dysfunction. 18. 321-8. 10.1007/s00192-006-0143-5.

• Zeynep Dasikan, Rusen Ozturk & Aslihan Ozturk (2020) Pelvic floor dysfunction symptoms and risk factors at the first year of postpartum women: a cross-sectional study, Contemporary Nurse, DOI: 10.1080/10376178.2020.1749099

• William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 9. Danforth/s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 4.

• Laslett M, Aprill CN, McDonald B, Young SB. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Man Ther 2005;10:207-218

• Ying Yu, Rongrong Xie & Cainuo Shen (2017): Effect of exercise during pregnancy to prevent gestational diabetes mellitus: a systematic review and meta-analysis, The Journal of Maternal-Fetal & Neonatal Medicine, DOI: 10.1080/14767058.2017.1319929

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References

• Regular Exercise Throughout Pregnancy Is Associated With a Shorter First Stage of Labor. American Journal of Health Promotion, 30(3), 149-154. doi:10.4278/ajhp.140221-quan-79

• Wesnes SL, Rortveit G, Bo K, Hunskaar S. Urinary incontinence during pregnancy. Obstet Gynecol 2007; 109: 922–8.Maternal Cardiac Adaptations to a Physical Exercise Program during Pregnancy. Medicine & Science in Sports & Exercise,48(5), 896-906. doi:10.1249/mss.0000000000000837

• Sanabria-Martínez, G., García-Hermoso, A., Poyatos-León, R., González-García, A., Sánchez-López, M., & Martínez-Vizcaíno, V. (2016). Effects of Exercise-Based Interventions on Neonatal Outcomes. American Journal of Health Promotion,30(4), 214-223. doi:10.1177/0890117116639569

• Zumwalt, M., & Dowling, B. (2014). Prevention and Management of Common Exercise-Related Musculoskeletal Injuries During Pregnancy. In The Active Female (pp. 249-260). Springer New York.

• Casagrande, D., Gugala, Z., Clark, S. M., & Lindsey, R. W. (2015). Low back pain and pelvic girdle pain in Pregnancy. Journal of the American Academy of Orthopaedic Surgeons, 23(9), 539-549.

• Hilde, G., Gutke, A., Slade, S. C., & Stuge, B. (2016). Physical therapy interventions for pelvic girdle pain (PGP) after pregnancy. The Cochrane Library.

• Mørkved, S., & Bø, K. (2014). Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. British journal of sports medicine, 48(4), 299-310.

• Beyar N, Groutz A. Pelvic floor muscle training for female stress urinary incontinence: Five years outcomes. Neurourology and urodynamics. 2017;36(1):132-5.

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• Review of payer contracts;

• Review of charging methodologies and fee schedules and

• A clinic/facility on-site assessment of how effectively the practice engages in practice excellence, practice metrics, legal compliance and current business protocols.

California Physical Therapy Association | 1990 Del Paso Road | Sacramento, CA 95834 | (916) 929-2782 | www.ccapta.org

CPTA PROFESSIONAL CONSULTING SERVICES

Providing You with the Tools You Need for an Effective PracticePractice and payment issues are often time consuming and difficult to resolve. The California Physical Therapy Association (CPTA) Professional Consulting Services (PCS) can help!

The CPTA PCS Program provides members with flexibly designed, cost-effective services for those who experience practice and payment issues daily. We also collaborate with CPTA members to ensure their clinic/facility effectively engages in practice excellence, legal compliance and current business protocols.

THE FEES

The PCS fee includes:

• Initial two-hour phone/email expert consultation$300 (2 or more hours, additional $100 per hour)

• On-site Quality Assurance Consultation services$750 for up to 4 hours, excludes travel expenses

• On-site Quality Assurance Consultation services$1500 for 5-8 hours, excludes travel expenses

• Web-based Education – $250 per hour

THE PROCESS

Place a call to CPTA to assess your needs. If it’s determined you will require more than one hour of time, CPTA’s PCS Program is the resource for you.

After signing a non-disclosure and liability agreement, you will:

• Pay consultation fee(s)• Be referred to a content expert/schedule on-

site assessment consultation• Have the option to retain extended services at

the fee level described above

Note: PCS services are offered to CPTA members only and do not include legal consultations.

CPTA Resource Manual

California Physical Therapy Association | 1990 Del Paso Road | Sacramento, CA 95834 | (916) 929-2782 | www.ccapta.org

The CPTA Resource Manual offers comprehensive resources designed to meet the needs of all physical therapists in every practice setting. The manual subscription includes a variety of practice resources, updated annually.

BENEFITS OVERVIEW

Provider Payment ResourcesEthics and Professionalism ResourcesAdministrative/Operation ResourcesStandards for Practice ExcellenceCalifornia Physical Therapy Practice Act

HIPAA ResourcesFunctional Outcome Resources

Sample Policy and Procedure Manual

CPTA’s Resource Manual was designed to guide in the process of starting a private practice while enhancing and promoting quality physical therapy practice.

By establishing a set of quality practice indicators embedded within the manual, physical therapy clinics are provided standards of excellence for measuring performance. In addition, the manual provides clinics with the necessary resources to become quality providers of physical therapy services.

EXCELLENCE STARTS HERE

THREE SIMPLE WAYS TO PURCHASE

Call CPTA at (800) 743-2782, or

Fax the completed form below to (916) 646-5960, or

Mail completed form to California Physical Therapy Association (CPTA), 1990 Del Paso Road, Sacramento, CA 95834

CPTA Resource Manual

Name (Required) Member Number (If Applicable)

Address

City/State Zip Code

Phone ( ) Fax ( )

Email (Required)

PURCHASE FEE

This fee includes one: ALL FOR ONE LOW PRICE!¡ Hard Copy Manual .. . . . . . . . . . . . . . . . . . $299 for CPTA Members (Includes Tax/S&H)¡ USB Only . . . . . . . . . . . . . . . . . . . . . . . . . . . $149 for CPTA Members (Includes Tax/S&H)

¡ Both of the Above Items . . . . . . . . . . . . . $325 for CPTA Members (Includes Tax/S&H)

¡ *Renewal* Hard Copy Manual . . . . . . . . . . . . $100 for Subscription Renewal (Includes Tax/S&H)

¡ *Renewal* USB Only . . . . . . . . . . . . . . . . . . . $60 for Subscription Renewal (Includes Tax/S&H)

¡ Both of the Above Items . . . . . . . . . . . . . $130 for Subscription Renewal (Includes Tax/S&H)

¡ Student Manual - USB Only . . . . $100 for CPTA Student Members (Includes Tax/S&H)

No refunds provided

¡ Check (payable to California Physical Therapy Association)

¡ VISA ¡ MasterCard ¡ American Express ¡ Discover

Cardholder’s name (print)

Card Number / / /

Exp. Date CVV#

Signature

FOR CPTA USE

Received R1

Paid $ Due $

Ck#/CC Auth

Confirm Sent

BE SURE TO INCLUDE ALL INFORMATION REQUESTED BELOW:

Please type or print legibly all information below.Download the form at: www.ccapta.org

EXCELLENCE STARTS HERE

BROUGHT TO YOU BY:

101Physical Therapy Malpractice

WHAT IS MALPRACTICE?Malpractice is a type of negligence that pertains to professionals. It is the failure to provide the degree of care required of a professional under the scope of license resulting in injury, death or damage.

HOW COURTS DEFINE MALPRACTICE VS. HOW PATIENTS DEFINE MALPRACTICE

Courts

Four elements must exist for an incident to be considered malpractice:

• Duty: a physical therapist-client/patient relationship must exist

• Breach: standard of care was not met

• Cause: injury was caused by the PT’s error or omission

• Harm: injury resulted in damages

Patients

To patients, it is the perception of wrongdoing:

• Even excellent PTs can fail to connect with all of their patients.

• If a patient perceives he or she has been injured as a result of the care you provided, or failed to provide, that patient could sue.

Alleged Injury Top 5 by Distribution*

*HPSO and CNA. Physical Therapy Professional Liability Exposure Claim Report: 4th Edition. 2021. www.hpso.com/ptclaimreport.

Distribution of Malpractice Claims by Alleged Errors*

Common Physical Therapy Malpractice Allegations:*

- Improper management of surgical patient

- Failure to follow practitioner orders

- Injury during manual therapy- Improper technique - Failure to complete proper

patient assessment

- Failure to monitor patient during treatment

- Injury during passive range of motion

- Failure to cease treatment with excessive/unexpected pain

- Injury during electrotherapy, heat therapy, or using hot packs

28.4% Fractures19.0% Increase or exacerbation

of injury/symptoms16.4% Burns5.1% Muscle/ligament damage3.8% Herniated disc

27.6% Improper management over the course of treatment

16.1% Improper performance using a biophysical agent

13.4% Improper performance using therapeutic exercise

7.0% Improper performance of manual therapy

10.2% Other (see report for additional details)

25.7% Failure to supervise or monitor

27.6% Improper management over the course of treatment

25.7% Failure to supervise or monitor

16.1% Improper performance using a biophysical agent

13.4% Improper performance using therapeutic exercise

7.0% Improper performance of manual therapy

10.2% Other (see report for additional details)

10.2%

16.1%

13.4%

27.6%

25.7% 7.0%

Types of recoverable damages:

| Medical expenses | Lost income |

| Funeral expenses |

| Mental anguish | Pain and suffering |

| Loss of consortium |

Malpractice lawsuits serve two goals

COMPENSATE PATIENTS WHO ASSERT DAMAGE DUE TO PROFESSIONAL NEGLIGENCE1one

ENCOURAGE SAFE AND RESPONSIBLE PHYSICAL THERAPY PRACTICE

two2

A0747495

Text Box

Healthcare Providers Service Organization is a registered trade name of Affinity Insurance Services, Inc. (TX 13695); (AR 100106022); in CA & MN, AIS Affinity Insurance Agency, Inc. (CA 0795465); in OK, AIS Affinity Insurance Services Inc.; in CA, Aon Affinity Insurance Services, Inc. (CA 0G94493); Aon Direct Insurance Administrators and Berkely Insurance Agency and in NY, AIS Affinity Insurance Agency.© 2021 Affinity Insurance Services, Inc. I-13892-0521

| Professional liability insurance is coverage purchased by physical therapists to safeguard against malpractice allegations by |

Providing personal protection Paying indemnity for economic and non-economic damages

Professional Liability INSURANCE

Covering costs associated with hiring legal representation

*HPSO and CNA. Physical Therapy Professional Liability Exposure Claim Report: 4th Edition. 2021. www.hpso.com/ptclaimreport.

Severe burn, requiring surgery$280,688

Traumatic brain injury$254,608

Fracture$155,403

Increase of exacerbation of injury/symptoms$145,767

Loss of use of limb$137,046

Fall resulting in abrasion/irritation/laceration$97,745

Death$236,713

Muscle/ligament damage$169,740

REQUEST A FREE QUOTE

| HPSO.com | 800.982.9491 |

What to do if you have been named in a malpractice lawsuit?

If you become aware of a filed or potential professional liability claim against you, receive a subpoena to testify in a deposition or trial, or have any reason to believe that there may be a potential threat to your license to practice, you should immediately contact your personal insurance carrier.

Report claims or potential claims to your insurance carrier, even if your employer advises you that it will provide you with an attorney and/or cover you for a professional liability settlement

or verdict amount.

Never testify in a deposition without first consulting your insurance carrier or, if you do not carry individual liability insurance, the organization’s risk manager or legal counsel.

Refrain from discussing the matter with anyone other than your defense attorney or the claim professionals managing your claim.

Copy and retain all legal documents for your records, including summons and complaints, subpoenas, and attorney letters.

Selected Average Total Incurred by Alleged Injury*

Reports shouldn’t take up half your day!Our auto-report generator saves your clinic time and money!Customize and print your report in less than 15 minutes!

Carlsbad, California | 800.333.3539 | [email protected]

Return from Family and Medical Leave Healthy Worker AuditFunconal ReviewReturn-to-WorkPrior-to-Hire

FCA/FCE/Pre-Hire/HWA/FMLA

Funconal Capacity Assessments

Your all-in-one, cloud-based outpatient EHR and billing therapy solution.Net Health Therapy for Private Practice gives you everything you need—practice management, scheduling, documentation, billing, productivity tools, MIPS reporting and more—in one software solution to keep your outpatient clinic running smoothly so you can focus on your patients.

All the functionality you need in one modern, cloud-based system.

Scheduling

Documentation

Quickly access billing, productivity and operations reports

View schedule by day, week or month

Practice Management

Billing

Monitor all required authorizations

Easily track Plan of Care (POC) signatures

Analyze trends with patient attendance metrics and visit management reports

Access and analyze corporate and multi-clinic performance data at-a-glance using dashboards

Create filters to view schedule by therapist, clinical team, discipline, or visit type

Easily identify visit specifics with customizable color-coding

Keep on top of changes with easy drag-and-drop capability

Visualize provider availability based on therapists’ scheduling templates

Reduce no shows and cancellations with automated appointment reminder calls, texts or emails (optional)

Efficiently document treatment from all therapy disciplines – physical therapy (PT), occupational therapy (OT) and speech-language pathology (SLP)

Stay compliant through alerts (i.e. Medicare Therapy Threshold Estimates, Progress Reports and more)

Take advantage of industry leading functional assessments

Meet documentation needs for both adult and pediatric populations

Start documenting immediately with built-in templates and organize by body part or skill area

Customize workflow, questions and forms to meet your practice’s specific needs

Adapt easily with an intuitive, familiar SOAP note format designed with therapists’ input

NET HEALTH THERAPY FOR PRIVATE PRACTICE

Interact with patients in real-time using secure Videoconferencing for Telehealth

Maximize patient engagement with the Patient Portal

Prevent eligibility denials with embedded electronic insurance verification

Streamline your billing process with coding, billing and patient demographics all in one system

Improve claims accuracy and reduce denials with validation prior to electronic submission to the clearinghouse

Easily post payments with Auto-Import ERAs

Process Patient Statements through our clearinghouse service or print in-house with our customizable statement options

Keep on top of Accounts Receivable with comprehensive financial reports

Not sure exactly what your practice needs for success?Don’t worry, we have several plans for you to choose from to fit your needs, your size and your budget. For more information contact us at [email protected], 800.411.6281, or visit nethealth.com.

Consider these optional integrations to enhance your practice:

Appointment RemindersReduce no shows and cancellations with automated appointment reminder calls, texts or emails.

E-faxing SolutionEliminate paper and save time with built-in e-faxing.

Home Exercise Program (HEP)Improve patient engagement with easy online personalized home exercise plans.

Eligibility VerificationSave time verifying patients’ eligibility for services from within the system.

Single Sign-On (SSO)Improve security and streamline user management by accessing Net Health Therapy using your facility’s existing authentication policies and login procedures.

Reputation Management

Generate more timely, positive patient reviews with the click of a button to improve your online ratings and boost clinic growth.

FOTO Patient OutcomesBoost patient satisfaction and promote outcomes to referral sources with access to benchmarks, analysis, compliance and reporting tools.

Merit-based Incentive Payment System (MIPS) / Qualified Clinical Data Registry (QCDR)Streamline collection and reporting with MIPS / QCDR integration.

Digital Marketing Services (DMS)Grow your practice with improved online presence and reputation.

Patient Statement ServicesSave money by eliminating supplies and labor costs for manually printing and mailing patient statements.

Videoconferencing for TelehealthIncrease access to care for patients with travel limitations - interact with patients in real-time over a secure audio/video connection.

Ensure your success and fully utilize Net Health Therapy for Private Practice through access to training and support from implementation through on-boarding any new staff:

• Dedicated project manager during implementation

• US-based phone and email support

• 24/7 access to online training at Net Health University, including role-based training, functionality reviews of new releases and best practices for compliant documentation.

West Coast University’s

committed to delivering transformational education within a culture of integrity and personal accountability.

MISSION BASED ON A KEEN VISION To remain at the forefront of healthcare education.

STUDENT CENTRIC EDUCATIONAL ENVIRONMENT By challenging ourselves to be the best we can be, we help our students become the best they can be— equipped with the knowledge and skills required for a successful and rewarding career.

WE ARE SEEKING CANDIDATES THAT ARE • Passionate about teaching and service

• Enthusiastic about a creative environment

• Excited about sharing scholarly endeavors

• Interested in lifelong learning

For more information on open positions, please visit:

westcoastuniversity.edu/about/jobs

For questions about employment, please contact:

Advance your career in Sunny Southern California

WCU-HR-Flyer-CGS-PT-022020-V1

Documents

Pelvic Health for the Non-Pelvic Health PT