In this episode of the Pelvic Biz Podcast, Dr. Kelly Alhooie explains how a wide range of health providers—chiropractors, OB‑GYNs, physical/occupational therapists, nurse practitioners, midwives, naturopaths, acupuncturists, psychologists, physicians, and others—can incorporate pelvic floor therapy into their practices. She begins with a personal cautionary story about the EMSELLA chair, noting that it tightens rather than lengthens the pelvic floor and caused her own tailbone pain. Dr. Alhooie then introduces her proprietary LSR method (Lengthening, Strengthening, Return), emphasizing that many patients miss the essential lengthening phase, leading to leakage and other dysfunctions. She advocates for multidisciplinary collaboration, outlining concrete ways each provider type can partner with pelvic floor therapists—whether through referral pathways, shared treatment protocols, or complementary modalities such as nutrition, hormone testing, blood work, peptides, red‑light therapy, and functional movement training. Throughout, she stresses a holistic, systems‑based approach that integrates breathwork, pressure control, and coordination of the entire kinetic chain (feet, knees, hips) rather than isolated pelvic floor exercises. The episode serves as a call to action for providers to expand their service offerings, improve patient outcomes, and address the shortage of pelvic floor specialists.
Chapters
What's up guys? Welcome to Pelvic Biz Podcast. I'm your host, Dr. Kelly Alhooie. Today I wanna talk about how different providers can actually incorporate pelvic floor therapy into their practice and what that actually looks like. So whether or not you are a chiropractor, OT, PT, um, OB-GYN, functional medicine, nurse practitioner, certified nurse midwife, physician's assistant, who else? Speech, neuropathic doctor, okay? Or naturopath doctor, an acupuncturist, like whoever, you know, you are. I basically want to talk about how you can add pelvic floor therapy. So I'm gonna start with chiropractic first. I have had many chiropractors reach out and they're like, how do we actually have pelvic floor therapy without you know, me having a lot of my hands in. I've had OB-GYNs reach out and be like, how do I provide pelvic floor therapy without, you know, having an actual therapist on board? And here's my answer to this. Many of you guys are saying, well, Kelly, I'm going to go get that Encella chair. The Encella chair does not actually test if people need to lengthen their pelvic floor. It only tightens their pelvic floor. And I actually have actually sat on it and used it from a urologist. He was like, yeah, sit down, let's try it. I'm like, okay. I was on it literally for like 15 seconds. And ever since then I have tailbone pain because it tightened my pelvic floor so much. I'm not kidding. Um, and, and I'm not saying that to like bash the thing. I'm saying it because it's actually like true. And that's what I experienced. And the process of it, they, you didn't look at my pelvic floor beforehand. There was nothing that said, "Oh, okay, this is how your muscles are firing," not filing, firing. It was just like, sit on this machine, it's just gonna basically shock you 20,000 times and then tighten the muscles. Well, that's actually what I did not need. I needed the opposite. I needed actually lengthening of my pelvic floor. Still to this day, I probably still do. "Because I feel tension and pulling." So if you're a chiropractor that adjusts tailbones, this is what we do as pelvic floor therapists. This is something to consider, not the EMSELLA chair, but something to lengthen the pelvic floor. And so I just wanna start by that, by saying be very mindful of the EMSELLA chair, just putting people on that thinking that, you know, this chair set claims that it's going to do this, thinking that you're helping people with their pelvic floor. A lot of times it's the opposite. They need a— I call it a 3-phase. This is my method that I've come up with. It's called the LSR method, the lengthening phase, the strengthening phase, and return. A lot of times people miss the lengthening phase where you need to actually lengthen the muscle because it's holding on because it doesn't know how to react, which is why typically people have leakage. Now, not always, but this is why you need the experts to evaluate and understand truly why they have leakage. Is there a prolapse? A urogynecologist is really good to help diagnose that, some OB-GYNs. But anyways, we— pelvic floor therapist is really good as well to diagnose that. And so my point is, there's many things of what could be causing the issues that women are having, aka leakage. So we have to be very mindful. And I actually promote working with different providers to put all the pieces of the puzzle together. Yeah. Together. It, it— and so when it comes to cross-collaborations and how to incorporate it into your actual practice, I think this is key. So if I'm a chiropractor, well, what are programs, or who can I hook on with to actually create a routine to help lengthen the pelvic floor? Especially if you're a rehab chiropractic— okay, or chiropractor, I should say. Um, if I'm an OB-GYN, I'm looking at, could I partner with a pelvic floor therapist to be able to bring those people into my office so that I can cross-refer very easily? Um, if I'm a naturopath doctor, I'm looking to partner because I am looking to see, like, is there food issues that are happening that's causing inflammation that's maybe contributing to X? Pelvic floor issue, right? Is there ways that we can overall bring down, you know, inflammation naturally? If I'm a, let me think, if I'm a psychologist, maybe I'm partnering with a pelvic floor therapist because I know a lot of their patients have trauma, especially if they work with like chronic pain or trauma-informed care. That I could be a part in helping with getting people to have less pain with sex, getting people to feel that their nervous system can come down and regulate, right? So maybe that's how I'm collaborating in bringing in pelvic floor therapy. I think, I think it's such an underutilized world. And I think there's actually a big opportunity for, you know, every provider out there to cross collab. Yeah. With pelvic floor therapy. If I'm an OB-GYN— why I said OB-GYN— if I'm a nurse practitioner, okay, well, could we talk about peptides? Could we talk about, um, different things to help again calm inflammation? Maybe we could do blood work on these people and help with understanding hormones, you know, depending what nurse practitioner they are, but help understand hormones so that we can actually Maybe that's why they have pain with sex, because they have a lack of estrogen and lack of progesterone. And maybe that's what we need to do. Or maybe even testosterone as well could be low. So I'm incorporating that into actual treatment with a collab with a therapist and/or, you know, offering some kind of blood work from home, which now there's options for that. Um, if I'm a certified nurse midwife, well, of course I'm gonna collab with pelvic floor therapists because I am going to, um, help people before and after their birth. Um, and so, and making sure, and during their birth, and making sure that all goes well and that they are informed on what to do, how to do things, and making sure that they feel taken care of and supported during the birth process. Um, so, you know, That's huge. If I'm an acupuncturist, well, maybe they're trying to conceive and my— the patients are trying to conceive and they need acupuncture to help bring more blood flow to the uterus and the pelvic floor area so that they're more likely to be able to conceive and have a baby. So maybe I'm doing some kind of partnership there. If I'm a physician, I am again trying to see if I can partner somehow, some way, because I feel like a lot of people just look at medicine like it's either medicine or like an X-ray or an image or whatever. And that's not how pelvic floor works. And so it's the whole system, which is why we need everyone on board. And what I think I do very well is I get the people on the team to create the team. Not, don't put everyone, but like create the team specifically for that patient, and then do a collab. So my whole point is, is there's a lot of collaboration and crossover between pelvic floor and currently what you guys are doing. And I just want you to think about maybe you add another avenue. So maybe is that where you have pelvic floor stretches that clients can first start out with? Maybe you have a strengthening phase but maybe it doesn't have to be on the EMSELLA chair. We really promote functional movement because we look at what they do and that's typically where the symptoms occur, whether or not they're running, sprinting, jumping. Again, I'm just talking about leakage in this incident, but there's like so many other things that we do. Um, and so I look at all that and say, okay, how could we incorporate this? Is there certain things that would help? Their pelvic floor, like red light therapy. If you guys are trying to incorporate wellness, okay, well, there's Red Light Therapy Wand. So could you get that and help increase blood flow transvaginally, right? Um, could you do that red light therapy on their belly? Yes, to help take down their chronic pelvic pain, 100%. Um, could you again have something that maybe Helps with muscle coordination. Yes. So again, there's all these things that you could cross collab or put in the office to help get people to know how to actually work their abdominals, how to actually work their pelvic floor, and how to actually breathe properly, because that is the foundation of pelvic floor therapy is that You are actually trying to get the whole system to coordinate, and it's not just let me focus on the pelvic floor muscles because there's so much impact and load, and all that comes from the feet, the knees, the hips, and breathwork and pressure control. And so it's not just in abs, so it's not just like one way. Um, and so I think really understanding and having a good person that you could bounce ideas off of or collaborate with, like a pelvic floor therapist, um, is actually a really good resource and things that you could do to help further along your practice because so many women and men want these services, um, and there's not enough of us. So just some thought of how to actually incorporate this into your actual practice.
