How to Become a Pelvic Health OT

The secret is out!  

Occupational therapy professionals can pursue careers in pelvic health––and the best part is we’re ideally equipped to do so!

After all, what good is a healthy pelvic floor if not to serve you (even if “serve” means “avoid leaking urine”) during your daily activities?

We thought it was best to find out how to become a pelvic health OT by going straight to the source, Lindsey Vestal, MS, OTR/L.

Lindsey is an occupational therapist and founder of Functional Pelvis, a concierge in-home pelvic health provider in Manhattan, NY. We were lucky enough to pick her brain about how she got where she is today, and how you, too, can become a pelvic health OT!

Where did you graduate from OT school? Did you know about pelvic health as an option there at school?  

I graduated from NYU in 2011, and I’m totally one of those geeks who always knew she wanted to serve women (and men) by bridging the gap between the body and the mind. I applied to graduate school already knowing I planned to pursue pelvic floor therapy.

I knew that graduate school itself was not going to provide much exposure to the pelvic health specialty–that I was going to have to pursue it through continuing education after graduation.

Wow, so you knew that you wanted to be a pelvic health OT that early?

Well, it’s an interesting story. I always thought I would become a PT in order to pursue pelvic floor therapy studies. Before applying to grad school, when I was getting my shadowing hours under my belt, the PT I was following called in sick one day.

The rehab director placed me with an OT, and I had no idea what occupational therapy even was! In the session I observed, the OT was focusing on building long-term and short-term memory skills.

I was so intrigued by this form of rehab, where we could address the mind as well as the body.

From that day forward, I did not look back! For my graduate school foundation, I chose OT specifically because I was drawn to the holistic framework. I thought that the OT perspective would provide a great foundation before pursuing the pelvic health continuing ed studies that both PTs and OTs alike have to take.

That is indeed a unique route! So, what initially got you interested in pelvic health all those years ago? 

I discovered this amazing specialty by watching my very gregarious and outspoken father develop urinary incontinence (an inability to control leaking) when he was diagnosed with prostate cancer.  

He became a withdrawn, less socially active member of his community as result of his incontinence.  

Watching this transformation, I did as much research as I could, and I remember learning that the pelvic floor is a set of muscles. We go through rehab for our shoulders and knees when they work less optimally, so why couldn’t we do the same for our pelvic floor muscles?

Once I discovered that there was such a profession (which has been around since 1990s,) I found my father someone to work with––and at the same time, I found my life’s work.

Did you consider working for an established clinic—or did you work for one—before starting your business?

Yes, I did work for an established clinic before starting the Functional Pelvis.

I find mentorship such a valuable part of building skill sets.

This is true with most professions, but most certainly with pelvic health. Each client is so unique, and following a protocol will not serve our clients the best.  

By working with someone who has experience, you start to develop your individual clinical reasoning skills to tailor your sessions with each of your clients.

You build confidence and start to really evaluate each client uniquely.

However, I have to share something with you:

Getting a job with an OT degree within pelvic health was not an easy task, and meeting a mentor was certainly a challenge.

This is one of the biggest reasons I started my own online training course for OTs. I think OTs are uniquely suited for this incredibly rewarding field. 

(Editor’s note: Many OTs have no idea that we can become pelvic floor specialists. We OTs have so many ways to serve this very underserved and deserving population, so I am officially encouraging you to go for it! Represent us in the pelvic health world!! But I digress…)

What made you decide to venture out on your own?  

I wanted to be able to offer my clients more of a specialized experience than I was able offer them in a typical outpatient setting.

First, I wanted more time with them during each session––at the Functional Pelvis, evaluations are 90 minutes and treatments are 60 minutes.  

In order to provide the type of experience that most pelvic floor clients need, which includes hands-on work, building our relationship, and tons of education, I required this amount of time with them.

I also wanted to be able to treat them in their homes––where the most functional training occurs.

In most of my sessions with new moms, we review transferring their babies into cribs, practice optimal posture while standing at changing tables, and analyze how they are holding the car seat as they climb stairs.

I wanted to provide them with the tools they needed to see improvement in their bodies, while also helping them understand why these interventions are effective.

I wanted my clients to become detectives for their own bodies, and feel empowered in the process.

For me, this meant creating my own business.

Was there a moment when  you realized it was time to start?

It was when I thought of the home being an ideal place to treat this population, and I found that no one else was doing it here in Manhattan.

That’s when the idea of the Functional Pelvis was born.

How did you find your earliest clients? 

My first year, I visited doctors, dropped off flyers, and sometimes had the opportunity to chat with them about my work.

I did not see much growth this first year.

My second year, I started offering community workshops––that wound up being a phenomenal growth year.

Being able to be in front of my potential clients––enabling them to get a firsthand experience to my approach and my personality––really built referrals for me.

I also joined networking groups and built relationships with other referral sources such as doulas, childbirth educators, and fitness professionals.  

I even started a pelvic floor “study group” for any professionals interested in the pelvic floor; we still meet monthly.

My third year in business, I started to see more referrals come in from doctors because they started hearing about me from their clients. It came full circle.

What is your biggest referral source?

I am 100% word of mouth. I do no marketing at this point.

What are some of the biggest challenges and rewards of your role?  

I would say my biggest reward is my also biggest challenge: debunking myths around what the pelvic floor actually is. (Most people still think kegels are the one stop shop for any pelvic floor dysfunction.)   

My primary mission is making sure people get accurate, positive pelvic floor health information.

Pelvic Health is often practiced by PTs, so when I take my continuing ed coursework, I am usually the only OT present.

I have begun to connect with lots of OTs in both the US and Canada who are working in this field. I really feel like it’s a natural fit for OTs since our scope of practice encompasses both toileting and sexuality.

In addition, our background in mental health really prepares us for some of the more significant challenges that this population faces.

What are some of the ways that pelvic OT differs from pelvic PT? How do you differentiate the two to potential clients?

OTs, by nature, are holistic thinkers.

We excel at task analysis (crucial in pelvic floor therapy). OTs also address psychosocial aspects of therapy (also a MUST in pelvic floor therapy).  

While the pelvic floor muscles are just like any other group of muscles in the body, it takes a sensitivity and an ADL background to really evoke change.

If I were to just assign three sets of 10 of bridges or clam shells to someone who has weak glutes to help them with their concerns of urinary leaking, I would be missing the whole person.

Alongside exercises, we examine behavior that is contributing to their symptoms, and we address the vulnerability that their symptoms are causing.

We look at posture, stress triggers, sleep hygiene, and their food and beverage habits. We look at them as whole entities, and assess all of the contributing factors.

Of course, I have met PTs that practice this way, but not consistently.

In contrast, OTs by nature (and by training), always practice this way. It’s the considerate, deliberate, and kind approach that takes into account the entire being that makes such a difference.

Do you have any challenges associated with working in people’s homes, or is it usually a good thing?  

There really is nothing like working in someone’s home.

It’s literally meeting a client where he or she is––physically, emotionally, and psychologically.

If someone had $200, $500, and $1000 to spend, which courses would you recommend they take and why? If someone wanted to become a pelvic health OT, can you please outline what you’d consider the most essential steps to getting there? 

The answer to this question depends largely on where they are in their career.  

If I was just starting out, and not sure whether the pelvic floor specialty was for me, I would take my course, OT Pioneers: Introduction to Pelvic Floor Therapy (a shameless plug!). It’s online, so there is no travel required, nor hotel costs racking up.

If someone is within their first few years of pelvic floor therapy, I would suggest they take the mentorship track of the same course. It enables me to give them more direct feedback in a small group setting.

If I had $1000, and I was just starting out, I would take Pelvic Floor 1 through Herman and Wallace. This would give them their first hands-on experience with internal exams. (Herman and Wallace has been really gracious in their support of my work. They even gave me a 10% discount to pass along to fellow OTs, just use the promo code “OTR10.”)

There are so many other courses that I love, including Biofeedback Training and Incontinence Solutions with the OT/PT team Jane Kauffman and Tiffany Lee.

Marquette University also offers amazing courses with OT Jeanette Tries, a pioneer in the field. I tend to gravitate towards courses that have an OT staff member.

Are there any other courses you’d recommend, meaning ones that aren’t directly related to pelvic health?

There is no prescribed, linear path to pursing pelvic floor therapy, so this is actually a very challenging question to answer.

Some of the courses that I think really complement pelvic floor therapy include myofascial release work like John Barnes, Maya Abdominal Massage, visceral manipulation courses, and craniosacral studies.

From a fitness and exercises studies background, I love Restore Your Core with Lauren Ohayon (she has a teacher training track), as well as what Jenny Burrell and Julie Wiebe have to offer.

What are some of the best moves you’ve made on your journey?  

Building relationships within my community.  

People get to know you, see your passion, and then work with you. Then they make referrals, which beget referrals, which beget more referrals.

Starting a pelvic floor “study group” (comprising pelvic floor therapists, doulas, childbirth educators, midwives, fitness professionals, etc.) and participating in fundraisers for local perinatal organizations have both been very helpful in helping my business grow.

What is your favorite part of being in pelvic health?

People often become very withdrawn from participating in their ADLs and IADLs when incontinence or pelvic pain becomes a struggle for them.

It is so rewarding to be able to empower them to take control over the very basic function of bowel and bladder management.

What have you learned along the way?

I’ve learned a lot about function. The very taboo topic of pelvic floor muscle dysfunction––which includes bowel/bladder issues and pelvic pain––provides me with the opportunity to focus on some very interesting cases.

I work with both men and women (which includes post-partum women and post-menopausal women) and I find it such a privilege to enable people to talk about topics that can often be challenging to discuss. I enjoy helping them to feel more comfortable and at ease.

Once they find pelvic rehab, I am often told how comforting is it that someone finally understands some of the challenges that they have been dealing with.

The topics that I discuss and treat are often overlooked by most practitioners, either because they don’t know how to ask the questions or the patients might feel uncomfortable bringing them up.  

I have heard topics like incontinence described as the “hand on the doorknob” conversation.

If a patient actually feels comfortable bringing it up to their gynecologist or general practitioner, it may be as they are opening the door to leave. I take great pride in the fact that I broach these same topics when my patients walk in the door, not when they leave.

You mentioned your online course. Where can we find out more about it?

For anyone interested in learning more about my online course, please visit:

OT Pioneers: Introduction to Pelvic Floor for Occupational Therapists

Here’s a little snapshot of what you will learn in the course!

Conclusion

We need more OTs stepping into the incredibly fulfilling and beneficial niche of pelvic health, so keep it in mind as you grow your career! Not only does our holistic approach fit perfectly with pelvic health, there simply aren’t enough OTs practicing in this area.

If you’re interested in pursuing this path, a great first step is to build your awareness with free sources of information. You can join Lindsey’s Facebook group, OTs for Pelvic Health, and follow the Functional Pelvis on Instagram to get a better idea of whether pelvic health is right for you. Then, if you decide you want further training as a pelvic floor OT, check out Lindsey’s course! 

Finally, you can hear more from Lindsey (and about the research behind pelvic health OT) by listening to OT Potential’s podcast episode/CE course: OT and Pelvic Health.

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