OTs In Pelvic Health

OTs + Certifications: Do We Need One In Pelvic Health? with Tiffany Lee

• Season 1 • Episode 24

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Lindsey Vestal New and seasoned OTs are finding their calling in Pelvic health after all. What's more ADL than sex, peeing and poop? But here's the question What does it take to become a successful, fulfilled and thriving OT in Pelvic health? How do you go from beginner to seasons and everything in between? Those are the questions and this podcast will give you the answers. We are inspired OTs, we are out of the box OTs, we are Pelvic health OTs. I'm your host Lindsey Vestal and welcome to the OTs and Pelvic health Podcast. 


Lindsey Vestal Tiffany, I am so thrilled to have you on the podcast. This has been a long time coming and I cannot wait to have this conversation with you about certifications, which I don't know about you I feel like is the hottest question is probably the question I get asked. Second most you cannot actually do this. 


Tiffany Lee I hear that question all the time. And yes, yes, yes, we can do this. And I've been doing it for a very long time. So I'm a big advocate for what's being recognized. Whether we have a certification or not. I think it's important that we are in this space. 


Lindsey Vestal I agree with you, and I will forever be indebted to you because when I first started studying Pelvic health, you were the very first course I ever took that made me feel welcome, made me actually know I could do this. So it is a real privilege to have you on here today talking about a question that I think is kind of controversial. There's a lot of opinions out there, and I'm hoping that today's conversation will peak curiosity and perhaps help people kind of consider it from all of the angles. Because I have to admit, I don't think this is a black or white answer or question. 


Tiffany Lee Correct? I totally agree. 


Lindsey Vestal Okay. Let's start with a little bit of background for your certifications. As I recall, you have three certifications related to Pelvic health. Can you give us just a quick overview of them and how you use them in your work? 


Tiffany Lee I will try to be quick. There's a lot, a lot to this. So the very first one that I started with was the biofeedback board certification. And the reason why I did that was I was already using biofeedback and I had a biofeedback lab with and I was treating more of these stroke head injuries, spinal cord, facial paralysis, pretty much everything other than pelvic health. And when I decided to go into Pelvic health, I was able to find a mentor that could talk to me about how to use biofeedback and behavioral therapy to treat patients. So I found this certification. I went to a course and it was so exciting because it was an OT named Louise Marks. And I remember I was in Colorado, there was 20 of us and just a few boaties, primarily Petey's. And I just was so excited. I already knew biofeedback. So it was pretty easy for me to jump in because I was going to be recording another set of muscles, which of course there's a lot involved in that. But that part was a little easier for me to jump into. But just knowing that there was an O.T. teaching and that there was a mentoring process to it was awesome. So that was my first certification and I was able to treat patients for four years before doing anything else. That certification really helped me start a program treating incontinence, pelvic pain, prolapse, all of those types of patients. But when I got to the point where I was seeing more pain patients, I knew I needed more education at that point or more certifications or, you know, get on that track, basically. So that was how I started my whole journey was through that biofeedback one. And then I started I discovered the Herman and Wallace courses. You know, we know that Apta, unfortunately, does not allow coaches to come to any of their courses. And so the only other track that I could find at the time was Herman Wallace. So I started going to their courses and started with the one that very first time I sat in that class, there was 50 teams and I was the only O.T. and that was a little bit unnerving. And I thought, my gosh, should I be here? And I think I had already some confidence because I already had a program. I was loaded with patients, My patients were getting better. So I felt like, yes, I should be there. But when someone said, Why are you here? I didn't feel like I had a great answer for that. You know, we get asked that quite a bit. So I started working through those courses with Herman Wallace, and then they have a certification called the PR, PC Pelvic Rehab Practitioner Certified. So that is the second one that I received. And that really I don't know if you want to talk about the differences now, but I'll just kind of briefly say which ones I have and then we can go into that. But I know that when you do, you don't have mentoring and it's just an exam. And so it's a little bit different than the biofeedback one. And then about four years ago, I because I see so many prolapse patients, there is a new certification called Low Pressure Fitness. And so I wanted to go to that course because I wanted something new and different to offer my patients. And so Tamara Reale, who was one of the. Creators. She actually was coming to the United States to teach for the first time. And so Herman and Wallace put on the course at Princeton. And it was very expensive at the time. And there was only one other o.t there, Carol Harmon, who also is still using low pressure fitness. And then the rest of her Petey's there was, I believe, 21 of us there. And so I got my certification probably about a year ago. So started with the biofeedback, went to PRPC, and now the low pressure one is that are those are the three that I have. 


Lindsey Vestal Amazing. Well, I have to say I can relate to something very specifically that you said, which is being one of 50 odd one of 50 potties in a room full of pets. And I think we have all been there if we've taken a Herman and Wallace. Course, this pelvic health is a pet dominated field for sure. And I think that we are, I would say in the last ten years. Tiffany, wouldn't you agree? We have seen that shift tremendously. Tremendously. And yes, I hope more and more people are not having that experience of saying I was one of 50. It still happens. And it was one of the major reasons why I decided to start pioneers was to have a place where we could thrive exclusively for two years. Now I do have pets that that attend the course, but a place where you weren't one, you were one of many. And and to be able to hold space for that bio psychosocial approach and the unique lens that Oats have, I think makes such a difference. That being said, you know, your experiences of the three certifications that you just shared with us, I'm imagining, are also three arenas where physical therapists are primarily, you know, the most common attended is would you would you think that's the case. 


Tiffany Lee For two out of three? Yes. But I'm excited to say that the biofeedback one, I think because with your group and be able to reach so many more of these now this in two weeks I'll be teaching in Vermont. And the good news is out of the 16 that are registered so far, ten are proteins. So I'm noticing I know I'm noticing a trend of there are the last three times I've offered the course. There are more OTs than Petey's. There's a handful of our NS nurse practitioners and occasionally a surgeon that will come. But for the most part, they're OTs. And it's so fun because this is such a perfect tool for OTs to pick up and just have in their toolbox. And so with the puppy, see for sure, if you look at, you know, the amount of Petey's that have that, I think there's only 4 or 5 of us that have the PRP C that are OTs in the country. One thing I will say though, with the BCA, the biofeedback certification 112, Petey's and OTs are certified in the country, 86 are Petey's and only 26 are OTs. So I would love to see that number flipped because I really think it is a type of tool that really resonates well with what we are trying to do with our patients and just giving that control back to those patients. And so although there's more coming to the courses, a lot of people don't stick it out and go through the whole certification process. So maybe, you know, 20% that come to the course because you don't have to get certified. And I guess one thing I do want to say is you don't have to have any certifications to treat the public health population at all. I have specific reasons for each of the ones that I have, but I don't want people to think, I need to spend all this money and start taking all these certifications. I don't agree with that at all. I really just want people to understand, you know, we're going to learn through all these continued education courses and being able to network and learning through OTs for public health. And, you know, all of these podcasts are so many resources we have, but I don't want people to feel like, I think you should get these three certifications because I, I don't believe that at all. 


Lindsey Vestal I am so glad you went there. I want to go there now. And I do want to just briefly mention because you had had said that you feel like, you know, my Facebook group is is one of the ways a lot of this information is getting out there. So if you're listening to this podcast and you're not a member of our Facebook group, it's called OTs for Pelvic health, join us. We're over 4000 now and we have some such amazing conversations over there. So let's go there, Tiffany, because I think this is such an important question. I wanted to give the background that you have three certifications and I wanted to to kind of set the stage there. And I want to set the stage also and share with the community the community that I have no certifications. So you are speaking to to OTs right now, are you Excuse me? You were listening to two shots right now, one of which has three and one of which has none. And I want to ask you very directly, you mentioned it now, but I want to kind of make it even more crystal clear, because I'm sure the people joining us on today's podcast are wrestling with this or thinking about this are trying to figure out their stance on it. Do you think we need a certification to be able to treat our clients in public health? 


Tiffany Lee I do not. And I think it depends on each person's situation. But I'll just answer, you know, the easy way. No, we don't need to be certified. I will say, to give an example, the one reason why I decided to get the PRP certification through Herman Wallace is because I'm on faculty and I am teaching primarily. Sometimes in my courses I teach the biofeedback sections for Herman Wallace. It's all parties. And I, I think when I was not too sure of myself, of can I do this, can I be on this faculty because I didn't want a party questioning me, you know, why are you teaching this? And, you know, what kind of knowledge do you have? And so for me, I decided to take that so that I could give myself some recognition. And I know that's not the best way to you know, I, I probably should have been confident and said, okay, I can do this. But I felt like if I had the PR PC behind my name, that they would, you know, they would think, okay, this girl knows what she's talking about. I guess that's one thing. And it used to you didn't have to have the PR B.S. to be on faculty. And I think now they're wanting you to have that designation because it's their certification. I will tell you that you do have to have 2000 hours of direct patient care and the past eight years to even be able to sit for the exam. And 500 of those hours must be within the last two years. It is an expensive test. Has it gotten me more patients? No. Do any of the physicians that refer to me know what PRP stands for? No. So it hasn't helped me get to more patients. It's more for me to be recognized as someone that can teach on the faculty level for a, you know, a national pelvic health content education company. So that is the reason why I got the PRP. C If I was not on faculty, I would not have gotten it. It's a very hard test. It is written, it's very difficult and it is $1,200. If you have attended a Herman Wallace course. If not, it cost $2,250. And in ten years you have to retake the exam. I will not be retaining it because it was so hard in my I thought my brain was going to explode when I took it and to retake it at $650. If you've attended a course before and 1050 if you haven't. So they're really you know, they're giving you a discount if you've gone to their courses before. But there aren't a lot of OTs that have it at this point. And I don't know their reasonings for taking that exam. But I think in the community, maybe you would gain more respect if that's important. It's not important to everybody by any means, but that is one that I got because of the teaching aspect. 


Lindsey Vestal I really appreciate you sharing your vulnerability with us. I think that for for me in particular, you're someone I really respect. And I knew I belonged in O.T. in Pelvic health when I met you. And so to hear you share your vulnerability and your experiences and sort of your motivations behind getting that is really helpful because I think at the end of the day, for those listeners considering wondering if a certification is right for them, I really encourage them to dig deep as to what's motivating them and it could be a motivation very similar yours, which is extremely valid. It could be a different motivation entirely. But just to be clear on the why and I, I also really appreciate you bringing up the financial as well as the temporal requirements that the PRP has, because that is a huge issue. And so for for the students that I mentor and those that have taken my courses, I'm often asked, So Lyndsay, do you think you know that you need you need some sort of a certification? And the thing is, our clients are our best teachers. They are innately who is going to teach us and motivate us. That combined with some coursework, maybe some mentorship, formal or informal. And and that is what anyone who's on the fence who isn't starting. That is my biggest piece of advice to you is get out there, start serving your people, because let's say you do have aspirations to potentially get the PRP. Well, you need 2000 hours anyway just to be able to sit. So So it serves it serves us to get out there and start seeing our people and learning along the way. So I'm really glad you brought all that up. I think it's really important for those who've been following me for a while, they may know that I've been talking about producing my own certification for OTs, and that is still something I'm very interested in doing and I feel like it's important to just briefly mention sort of like my reasonings and why because I'm someone who doesn't. Have a certification. And I really do stand by the fact that there's a myriad of ways we can get into Pelvic health. And just to be clear on what our motivation is, is the most important. But all of the things that you outlined, the high expense, the very p t written exam that focuses on dysfunction and doesn't really speak to the T lens are are two reasons. Another reason that I'm really motivated to create our own certification is the fact that I think a certification is not just a test that you sit for and then walk away. To me, a certification is a community that you then go on to create and flourish. It's very similar to what we have a not for pelvic floor Facebook group where we're constantly leaning on each other for help getting jobs, for finding the navigating the wide world of use and all of the things that, you know, a community that has your back would provide. So I do have aspirations to do that. And again, kind of kind of I don't want to say fixing, but certainly improving some of the experiences that many of us have had who have taken certifications in the past that potentially are not serving us to our fullest. 


Tiffany Lee I agree. And I think I was so used to my very first certification was the biofeedback one, and it did require mentoring and it was such a great process that I had to go through having, you know, 12 Zoom well at the time we have Zoom meetings and even now you can mentor people from all over the country, but having the ability to talk to someone, especially if you're new, because the two certifications you can get without having all those hours would be the biofeedback one and the low pressure fitness. You basically start by taking the courses. But what I loved about and the low pressure fitness, you don't have a mentor, but the biofeedback when you would have a mentor. 



Tiffany Lee And so I was so used to that thinking certifications. You have someone that's holding your hand and you're learning with that. That was what I was used to. And then when I went to do the p, r, p, c, and it was like, here is, you know, five page document on what you need to study. And a lot of it I didn't even understand the types of testing that pets do. And it was just it was partly a foreign language, you know, so it was a little bit different. And I thought, well, there's I could just sit down and take this. And I felt almost guilty walking away with having p r, p, c behind my name because I didn't have anyone that I could talk to or learn from. Now, you you can always reach out to people, but it's not required. And so I think the mentor aspect is wonderful. And again, you can have one without ever getting sort of an idea mentor people who aren't going through certification, they just want to learn more and and, you know, figure out what they want to do with their business or if they are just even using the biofeedback and want to learn how to use it better. You know, we can do that as well. 


Lindsey Vestal So if you were speaking with an o-t who felt felt compelled for their own reasons to get a certification. What would you recommend if if you know of the through we've talked about you know if and this is a bit I'm sure this is a very challenging question to answer because they all have their different there are different reasons for taking them. And you've outlined yours, which was beautiful. But if you if you had a note listening in on our chat today, who was just thinking, gosh, I really I really feel compelled to get that certification, what advice would you give them? 


Tiffany Lee Well, first, letting them know really sitting down and saying, why do you want one? And is it going to bring you more business? Is it going to, you know, elevate you in the community that you're in or just kind of get that reason? I think that one and I'm the most passionate, as you know, with the biofeedback because I was doing it prior to public health and I saw such amazing results. And so that one to me is is very special. And it's not just because it's that tool. You know, probably 70% of the course that we teach is behavioral. And it's, you know, a good foundational course all about the bladder, all about the bowel, all about pelvic pain, about prolapse. And it's not just teaching one tool, but it's learning through. You know, Jane and I, she's the teach with we have over 50 years experience teaching in using the tool and also doing behavioral health that when for a newbie my favorite person that comes to the course is an a newbie because they just get it they get the behavioral piece of it, the bio psychosocial piece of it. That one's my favorite because then we can mentor together. And so but again, you don't need that certification. But if I had to pick out of the three, okay, I'm just starting out. I want to learn more about Pelvic health. I want to, you know, maybe open up a practice or I want to start a program in my hospital. Which one? What I start with. And out of these three, I would say the biofeedback one, because you have a tool that can set you apart. If there's only 26 coaches board certified in the country and you go to a clinic that's peat run, you can offer something that maybe they don't use or are not using it correctly. You know, that's another reason. But that's my favorite only because there's the mentor piece and it's it's so O.T. like when you really learn all of it, it's so O.T. So that's my favorite one. But again that's a good you have the old pioneers back when I was teaching you that that did not exist. And so, you know, now we also have Laura Rowan, and she's doing a lot of the almost Herman Wallace type course. You know, the hands on work that we need to know is OTs and I would have loved to been in a room of, you know, 12 OTs rather than 50 Petey's and just myself. And so we have choices now. OTs have choices that they did not have when I was starting out. And so I do recommend your course, and I love when people come to my courses. Well, I think the three is kind of such a nice it all ties in together because we support each other so much. But that certification has brought me the most business. So if out of the three, honestly people seek me out for the biofeedback, a GI Docs love it, so they're always seeking me out. Your gynecologist and functional medicine doctors really like the biofeedback piece, so I do get more business for that actual tool than the others. So that's one thing I wanted to mention too. 


Lindsey Vestal I love that. And you know, when I took your biofeedback course, I did not pursue the certification, but I do use biofeedback when it's appropriate and I love the behavioral science in your course. It is. So I felt so at home compared to, let's say, a Herman and Wallace course, which again, is very pathology focused. It's very dysfunction focused. And I learned a lot. But then I felt I was like, I was at home when I attended your course because it was to read Oatlands and it was taught by an OTP team. You and Jane together just really help us to see the full range. And again, the the courses I've taken through Herman also have only been taught by Petey's. So there's so much value. And I would say a question I get a lot in regards to this from from OTs is like, well, if I have an opportunity to mentor with a T, should I take it? And I feel like and I'd love to hear your answer on this, but my answer is absolutely yes, because very often we can learn as much about being an o.T from a petty number one. Of course, there's there's so much to learn there. There's so much overlap. But often it gives us a chance to kind of come home and do a deep dive around. Okay, how could I do this from an o t perspective? How can I really sit back and say, when this person came to me and said that they were a bus driver and that they're having issues in their pelvic floor, perhaps I would bring up the ergonomics of the chair. Perhaps I would talk about the rotation every time the door opens. Are they withholding fluids? Are, you know, are they actually having a chance to go to the bathroom during the day? And maybe I would start to think about some of the questions in the conversation and the education that I didn't hear when I was chatting with the PTA. So it's a chance to expand your thought process on what would distinguish you as well as an opportunity to sit there and learn and be exposed to, you know, thinking that can be very similar as well. What are your thoughts, Tiffany, on that? On being able to shadow with a if that's an option for us as an note. 


Tiffany Lee I would say ditto to every single thing you just said that was perfect. Sometimes that's the only option we have. But I think it's a fantastic I learned from many puts as well. And so I think it's a fantastic way to learn more. So I agree with you. Definitely. 


Lindsey Vestal Fantastic. Fantastic. Tiffany, is there anything else that you want to mention today? We've woven a net of certifications, a little bit of mentorship, which are two of the topics I love to discuss very often with you. Is there anything else that you'd love for people to listen to hear from you today? 


Tiffany Lee The one thing that we didn't touch on too much was the low pressure fitness. I just wanted to throw out that one. You can take all three levels that I really think it's important. If you're working with prolapse patients and you're with a younger clients. It does cost $650 for the three levels. And the reason why I got that certification is because I do it personally, and it's helped me a lot with, you know, low back pain. And it's great core work. But it was only $100 to take the test and I'd already gone through the coursework. So I thought, why not? And so I passed the test and so I became certified in low pressure fitness. But there is a great resource if anybody is interested, and they want to even take just a two hour introductory level course. So there's a guy named Becky Keller. She's very friendly and she's out of New Jersey and she teaches one on one online. But I take her classes on Zoom every week, and she's also the instructor for Low Pressure Fitness USA. So she's great resource. So her she's got Instagram and also her website is elevate core health.com and she's also on Instagram but that's a great certification that if anybody's interested they can look into. But again I got that because they make it very affordable to take the test once you've gone through the different levels. So I wanted to throw that out there. 


Lindsey Vestal Amazing. Tiffany, thank you so much for your time and your wisdom and your enthusiasm for our profession, and I really appreciate your joining us today. 


Tiffany Lee I had a great time and I love always getting to talk to you. So thank you for having me. 


Lindsey Vestal Thanks, Tiffany. 


Outro Thanks for listening to another episode of OTs and Pelvic health. If you haven't already, hop on to Facebook and join my group OTs for Pelvic health, where we have thousands of OTs at all stages of their pelvic health career journey. This is such an incredibly supportive community where I go live each and every week. If you love this episode, please take a screenshot of this episode on your phone and posted to IG Facebook or wherever you post your stuff and be sure to tag me and let me know why you like this episode. This will help me to create in the future what you want to hear more of. Thanks again for listening to the OTs and Pelvic health podcast. 



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