OptimisPT Practice Spotlight: Roaring Fork Physical Therapy Featuring Caitlyn C. Tivy, PT, DPT, OCS

By: Cheryl “Chae” Dimapasoc Canon, PT, DPT;  OptimisPT Director of Implementation and Compliance

We are proud to spotlight an amazing therapist that is making a difference in the lives of so many of her patients.  Caitlyn Tivy has been a therapist for four years and focuses her interventions on patients with orthopedic and pelvic health conditions.  Caitlyn completed an Orthopedic Manual Physical Therapy residency with Evidence in Motion in Austin, TX, and achieved her OCS in 2018.  During the residency she had the opportunity to also interact and treat patients with pelvic health conditions which increased her desire to explore additional education to focus on that population.  She currently works at Roaring Fork Physical Therapy in Colorado. We caught up with Caitlyn to learn more about her successes, biggest challenges and insights into this underserved community that physical therapists could have such a huge impact on.

Chae: You’ve now been focusing on both orthopedic and pelvic health patients in your outpatient practice.  What have been some of the biggest rewards as well as the biggest challenges that you’ve faced?

Caitlyn: The biggest reward is that pelvic health treatment in the realm of physical therapy is becoming slightly more well known. It has been a challenge where 1) the patients don’t always know it’s a problem that has a solution; they think it’s just part of normal life and they have to live with it, and 2) patients don’t know it’s a problem that physical therapy can address. Reaching more people and seeing the improvement in their quality of life has been so rewarding.  

Similar to the biggest reward, the biggest challenge has been getting the word out that physical therapists can have a huge impact on a person’s pelvic health challenges.  Often, marketing to obstetricians and gynecologists has “hit a brick wall”.  It’s hard to often get past the front office to have a conversation with the physicians, and sometimes even talking to the physicians doesn’t get you anywhere.  The other biggest challenge has been figuring out how to streamline scheduling pelvic health patients in a primarily outpatient orthopedic clinic with three other therapists that focus on orthopedic physical therapy.

Chae: For those brick walls that you’ve hit, how have you overcome those obstacles to keep growing your pelvic health population in your clinic?

Caitlyn: At some of the OB-GYN practices, going through the midwife has proven to be successful.  The midwife in our local referral offices has been more open to treatment collaboration and passing on the specific detail of how physical therapy can complement other approaches to helping the patient and the physician(s) have become more receptive.  I’ve tried to get in to observe surgeries related to pelvic health, but that has not been successful so far.  Many times when we’ve approached Uro/Gyn practices we haven’t been able to get past the front desk. Older physicians in our area have been more “traditional” and unaware of their ability to refer any patients beyond the diagnosis of incontinence.  

In terms of scheduling, with orthopedic patients we can usually dovetail multiple patients, but with pelvic health it becomes more challenging because the topic and discussion is very personal, and a private room is necessary.  Much of the time ortho patients can be scheduled for 30 minutes and pelvic health patients are scheduled for 60 minutes so at least 25 minutes can be in a private room; the challenge is we don’t get reimbursed more for pelvic health patients.  The great thing about our cohesive practice, is that many of my pelvic health referrals have been from my colleagues in the practice that discover incidental problems with their patients that they didn’t necessarily come in for, and they refer the patient to me to focus on the pelvic health concerns.  It has been great to have a subspecialty within an orthopedic practice when the entire team is on the same page and works together to address the patient’s overall health and quality of life.

Chae: What message do you have to therapists that may be interested in getting into pelvic health intervention for their patients?

Caitlyn: Don’t be afraid, pitch the idea of specializing to your administrative staff/clinic owner.  The response I received: “I have been having docs who have wanted to refer for 20 years and have had no one to do it, so awesome!”, If you’re looking to diversify your resume, specializing is a great way.  Don’t be afraid to advocate for yourself for continuing education.  If you’re looking at just Level 1 Herman and Wallace or Level 1 APTA courses, you’re learning just enough to be dangerous.  To really get to a level where you feel a basic level of competence to treat pelvic health patients and not do them a disservice, you really need to take the full series of courses.

Chae: Which courses would you recommend to get started into marketing to treat pelvic health patients?

Caitlyn: The Pelvic Floor Series from Herman and Wallace (similar to what APTA offers) is a great foundation.  All levels are so helpful as the “jumping off point”.  You can begin treating basic level patients after taking this series of courses. Lately, I’ve started branching out to take more in depth courses, the next one coming up at CSM: Treatment of Pelvic Health in Oncological Patients.  

Chae: Has there been any other education or courses you’ve taken that can attribute to your success with your patients?

Caitlyn: Taking the residency in orthopedics provided the fundamental principles for treating pelvic health patients.  A colleague of mine once said, “Pelvic PT is just ortho PT in a warm dark place”.  This resonates so significantly; the stronger your ortho background, the stronger your clinical reasoning and intervention related to assessing pelvic health.  

Chae: What have you found to be one of the biggest surprises in your treatment of pelvic health?

Caitlyn: I was surprised to find a few lesser known conditions that pelvic health therapists can treat or assist in the improvement of: one being the number of patients with orthopedic hip problems that also have pelvic floor dysfunction.  I have been fortunate enough to have colleagues that ask the right questions and brainstorming with these ortho colleagues on how you can juxtapose care by referring the “hip patient” and adding in pelvic PT, which ends up helping their “hip conditions”!  The two presentations can be very interrelated.  Another realization is that bowel dysfunction is not always as well known of a classification that physical therapists can treat; the same with male pelvic floor dysfunction.  It is essential to advocate for patients and let them know, as well as their referral sources, the diversity of all we can treat and have a significant impact on.

Chae: Have you noticed any limitations being in a rural area and treating pelvic health patients, and if so, how have you overcome the challenge?

Caitlyn: If you’re the only one in the area that is available to treat specialty conditions, it is not only important to advocate for con-ed, but linking up with other therapists to reduce that feeling of imposter syndrome because you feel you “don’t know enough”, it’s all extremely helpful and important.  I just became a member of the Academy of Pelvic Health.  I use the connections through the academy as well as through APTA to find out other research and con-ed opportunities. 

Chae: Final question.  You indicated that you have used telehealth in the treatment of your patients during the COVID pandemic.  How has that been with pelvic health patients?

Caitlyn: We actually didn’t close our clinic during the COVID outbreak because we are in a rural area and we remained open as essential workers.  I actually treated more orthopedic patients via telehealth than pelvic health patients. As I pride myself on my manual therapy skills, it became even more evident through telehealth visits that manual therapy is important, but it’s not the only mechanism to achieve exceptional results.  Surprisingly (or not), treating pelvic health is very amenable to telehealth. Much of the intervention is discussion and education, and the patients have commented that they enjoyed great and tangible benefits from the session.  Since we didn’t close, however, most patients continued to come into the clinic and we didn’t have the need to “resort” to telehealth; it remains, however, a great method to interact and achieve great results with pelvic health patients.

Caitlyn is very excited to see where the field of urogenital therapy for men and women grows in the future.  We are confident Caitlyn will remain a great advocate and difference maker in the area of pelvic health physical therapy. We are proud to have her as an OptimisPT user and colleague and thank her for her contribution to growing the OptimisPT platform as well as the profession of physical therapy.