When I was 16, I dislocated my elbow in a gymnastic accident involving the uneven bars. Shortly after, I was introduced to physiotherapy.
I was intrigued by the profession and interested in sports medicine, but didn’t really think a small town gal from Kamloops would have any hope of capturing one of the University of British Columbia’s coveted acceptance letters.
I applied in 1973, but started planning to backpack through Europe when I assumed I wouldn’t be accepted. To my surprise, I got in! This began a long and intensive university journey that, at times, I wasn’t so sure I wanted to continue. In all honesty, I wasn’t that impressed with our profession when I graduated in 1976.
Back then, I found the field to be about fitting crutches, giving hot packs and ultrasound for back pain, pounding chests before and after surgery and moving toes in the ICU. It wasn’t that motivating to my brain, nor was it reflective of the many things I had learned in my training. I didn’t start doing research until 2007 with Professor Paul Hodges.
The Lower Mainland in ‘76
When I graduated, there were only three private practices in the Lower Mainland: John Oldham, Cliff Fowler (who later became my second mentor) and Jim McGregor. Employment in any of the practices required more orthopaedic knowledge than I had acquired with my undergraduate training and all of them required two to three years of general hospital practice before they would even consider hiring you.
In fact, a new physiotherapy graduate could not be employed on the Worker’s Compensation Board (WCB) without at least one year of general physiotherapy experience at a community hospital. So, I secured my first job at the Royal Columbian hospital, where I worked in the wards.
After nine months as a public hospital general physiotherapist, I contacted Myra Thomas at the WCB to request an interview for employment. I met my first mentor in physiotherapy, Marilyn Atkins, in my second job at WCB. I began postgraduate training in orthopaedic manual therapy in 1978; two years after the program began.
I left the WCB in 1980 to work and study in private practice with Cliff Fowler, my second mentor, in Surrey, B.C.
In 1981, I passed the orthopaedic examinations to become a Fellow in the Canadian Association of Manipulative Therapy. I taught and examined here for almost 20 years.
In 1982, I opened my own private practice in North Delta and witnessed the impact that orthopaedic manual therapy could have for women experiencing back and pelvic pain after pregnancy. Incidentally, some also reported improvement in their postpartum urinary incontinence, although I had no idea at the time how the two conditions were related.
Around the world
In 1992, I met my third mentor, Dr. Andry Vleeming, the chairman of the World Congress of Low Back and Pelvic Girdle Pain. Dr. Vleeming had read the first edition of my book, The Pelvic Girdle (1989) and invited me to present my clinical views on the relationship between the low back, pelvis and hip at the first World Congress in San Diego in 1992.
This introduction began a 25-year researcher/clinician collaboration that opened doors for me to teach and lecture around the world on the topic of pelvic girdle pain in postpartum women. My international speaking opportunities have come from that small book I wrote in 1989 (now in its 4th edition) and my collaboration with Dr. Vleeming.
In 1995, I met Professor Paul Hodges. His work on the abdominal wall provided so many answers to questions I had about the relationship between the thorax and pelvis in women with pelvic girdle pain, incontinence and prolapse.
From 1995 to 2007, I saw the benefits that restoring posture and function of the thorax and pelvis (and all muscles that connect the two regions) could have for women with conditions related to pregnancy.
In 2007, I had the opportunity to show Professor Hodges a selection of clinical and ultrasound video clips of the abdominal wall of a woman with diastasis rectus abdominis and explained how, in my clinical opinion, there is a subgroup of postpartum women who, in spite of rigorous abdominal wall training, cannot restore function of the trunk. These women have a wide variety of individual complaints including low back and pelvic pain, urinary incontinence and pelvic organ prolapse. This case presentation initiated the research trial (overseen by Professor Hodges and a grant from his research center in Australia) on the behaviour of the linear alba in women with and without diastasis rectus abdominis (2016 JOSPT).
The decision to specialize
In 2015, I decided to pursue the CPA Clinical Specialty Program. I really didn’t need more work on my schedule, and the program was not easy.
However, I strongly feel that Women’s Health is about more than the pelvic floor. I believe that treating the pelvic floor requires an understanding of the entire body.
I felt that I was justified in obtaining a designation as a Women’s Health Clinical Specialist from all the work I had done in the thorax, pelvis and abdominal wall and wanted to clearly show that this work was important for ‘traditional conditions’ considered to be solely related to the ‘pelvic floor’( i.e. incontinence, prolapse).
The research evidence is clear, there is a relationship between low back pain, breathing disorders and incontinence but this evidence is not translating very quickly to either the orthopaedic manual therapy clinicians or the pelvic floor clinicians.
I wondered if the examining board would broaden their perspective on what a specialist in Women’s Health ‘looked like’; fortunately they all agreed that the health of a woman includes more than her pelvic floor!
My focus was on the abdominal wall and relationship of the thorax and pelvis on lumbopelvic pain (yes it is one word), incontinence and diastasis rectus abdominis.
I plan to keep doing what I’m doing, including:
- Part-time clinical work and consultation for my team at Diane Lee & Associates
- Part-time teaching at my own studio, Akasha Studio and other international places where I have established great contacts (including Japan, Finland and England)
- Continue to research the abdominal wall together with Professor Paul Hodges. I will also continue to write clinical texts to share the journey!
If you’re interested pursuing a physiotherapy career in women’s health or you’re considering the Clinical Specialty Program, my advice is to:
- Keep learning
- Be curious
- Be open to change
- Connect to like-minded peers
- Become a good writer and communicator. You can have the best ideas on the planet but if you can’t communicate them, they stay with you.