The question all new pelvic floor physios ask...
What All New Pelvic Floor Physios Want to Know: Identifying and Grading Prolapse
I had the joy of spending a couple of mornings last week chatting to new PPPM members during their onboarding calls. These calls are a chance to get to know our new physios and understand their current level of practice and discuss goals they have for mentoring within the program. A few of the latest cohort are fresh to pelvic health practice off the back of the APA level 2 pathway course where they have learned to perform internal vaginal examination for the first time. This is a huge step in a physio’s career journey into pelvic health and not surprisingly a time when they might feel like a new grad again with a host of questions and the need for reassurance arising when they put their newly learned skills into practice.
The physios i spoke to last week all asked me the same question that had been on their minds since returning to work from their courses:
How do I know If It’s a Prolapse?
How do I know if It’s a Grade 3 or Grade 4 (Muscle grading)?
It is normal for new physios often grapple with these questions because of the limited number of examinations or limited array of different bodies they’ve had access to in order to practice their skills on a course. Transitioning from theoretical knowledge to practical application can be daunting, especially when it comes to something as nuanced as prolapse staging and muscle grading.
What i tell these clinicians is to start by trusting the clinical reasoning skills you've developed during your training as physios. Many come to pelvic health with years of msk experience under their belt, and they will have more awareness of what is happening than they think. I always tell these new pelvic floor physios to use their observations, combined with the theoretical knowledge, and the principles you've learned to make the best-informed projection of the findings. This is the best thing they can do. Nobody can expect to be an expert from day 1.
Pelvic Floor Grade and POP-Q Staging are inherently open to interpretation and can vary based on the skill and experience of the examiner. It's important to remember that grading a prolapse is not always a clear-cut process, and can vary depending on the position of the patient, time of day and many other factors.
As with all clinical observations the key is to make an informed judgment based on the information at hand. If new information emerges that challenges your initial decision then it’s perfectly acceptable to adjust your findings. This ability to reflect and critically review a case is part of becoming a skilled and confident practitioner.
Remember, every experienced pelvic floor physio was once in your shoes. By combining your clinical reasoning with continuous learning and practice, you'll develop the confidence to make these decisions with greater certainty. And as you gain more experience, your ability to identify muscle grade and prolapse will become more intuitive.
However if you just aren’t sure and feel that the case goes beyond your capabilitites, then we are privilged in Australia to have a network of amazing pelvic health professionals who can help you with a second opinion or onward management of your client -either within your own clinic or outside of it. Don’t hesitate to ask for help!