Pelvic Floor Treatment vs. Abuse
photo from CBS news
As a former high level gymnast I was saddened to see the news this week that 3 women who at one time held places on the US National Gymnastics Team have come forward with reports of being sexually abused by a national coach using internal “treatment”. For those of you who missed it, there was a ‘60 Minutes’ featuring an interview with three former gymnasts, Jamie Dantzscher, Jessica Howard and Jeanette Antolin, who have now publicly accused their former doctor, Dr. Lawrence Nassar, of repeated instances of sexual abuse. The full report can be found on the CBS website.
This news was upsetting to me in many ways.
First on a personal level, my hurt hearts for these women. I have such empathy for the athletes who experienced the abuse. As a young gymnast, these girls were my idols. I had pictures of Jamie Dantzscher and Jeanette Antolin plastered all over my bedroom doors. They and many US National Team members were who I strived to be. Jamie sometimes came to my gym to coach our team and my heart fills with sadness to know that she was experiencing this abuse when I knew her. I can only imagine the deep hurt these young girls must have gone through at the time and the amount of processing they have done as grown women.
Second as a woman and former gymnast, I’m pissed. This doctor has not only inflicted pain upon 3 women, there are 60 total who have now filed complaints against Dr. Nassar. Per the reports, this man severely abused his power as a male physician by befriending the girls and then taking advantage of his position by touching them inappropriately and calling it “treatment”. These girls were as young as nine years old and the incidences were many. There is no excuse and it disgusts me that this happened under the watch of USA Gymnastics, an organization which I was part of for 10 years.
Lastly on a professional level, as a Doctor of Physical Therapy who has taken over 300 hours of pelvic floor- specific post-graduate work, I’m enraged! This physician is a disgrace to healthcare professionals who actually do internal work in an ethical, informed, and appropriate way. From Jamie’s report on ‘60 Minutes’, Dr. Lassar, “would put his fingers inside of me and move my leg around. He would tell me I was going to feel a pop. And that would put my hips back and help my back pain”.
None of the girls mention informed consent, none of their coaches or parents were notified of the type of “treatment” they were receiving, the “treatments” were usually performed in a bed without a chaperone in the girls’ private rooms without gloves on. As a pelvic floor professional these details make my hair stand on end. In no way is this ok, ever.
I want to take this opportunity to educate the public about internal pelvic floor assessment and treatment, because in the conversations I’ve been having with my patients and the public about this there seems to be a misconception that internal work is inherently on the line of abuse. The media doesn’t seem to be explaining that there are indeed times when this type of “rare intravaginal treatment” is actually indicated. In fact, it’s not rare, it can be totally legitimate, and it’s the basis of what my colleagues and I do all day and how we help hundreds of people every year.
I’ve had chronic back pain and many pelvic floor issues (which were not diagnosed until I was in grad school) over the years. I may have certainly benefitted from pelvic floor physical therapy and internal work as a teenager and the women’s complaints may have indicated involvement of the pelvic floor too. There are a variety of musculoskeletal complaints that can involve the pelvic floor. Trigger points (or knots) in the pelvic floor muscles can often refer to the back and hip areas, however an internal exam would never be indicated as first line treatment for a minor with hip or back pain, much less performed on someone who has never seen a gynecologist or been sexually active, and much much less done so without the consent of the patient and the patient’s parent. Informed consent includes a full explanation of the treatment, the risks and benefits, and all parties (including parents for minors) agreeing to said treatment. Dr. Nassar did no such informing leaving the window way too open to be considered legitimate treatment practices and in fact constituting abuse.
If all external structures had been ruled out and internal treatment was indicated, it should have been performed with consent by a trained pelvic floor specialist who would no doubt educate the parents and patient on what the pelvic floor is, what the muscles do, why it’s an important part of the core. That therapist would explain what she or he was doing at every moment of the physical exam which would be performed on an exam table, she or he would have a chaperone in the room, and she or he would be wearing gloves for the duration of the treatment. The therapist would do pre and post- treatment objective measurements to assess effectiveness of treatment and would then develop a plan of care with specific diagnoses and prognosis. All of this information would be communicated to the patient and her parent in a clear and open line of communication.
The fact that none of this happened is disgusting. It makes my stomach turn and I’m so sorry for these women who may have really benefitted from pelvic floor work, but will likely never get to or want to experience the healing a skilled pelvic floor PT can offer. If you or anyone you know has questions about what pelvic floor physical therapy is or should look like, please contact me at casiedpt@gmail.com.