Part 1 - Women’s Health Physical Therapy Eduction: Interview with Aika Sasaoka

Aika Sasaoka is a physical therapist based in Tokyo, Japan, who has been treating post-partum women in their 20s-40s. Aika has taken perineal rehabilitation courses in France and has been interested in pursuing more education on urinary incontinence. Aika hopes to treat menopausal and elder women in the near future. Aika has recently taken the Pelvic Health Physical Therapy Level 1 and the Fundamental Topics of Pregnancy & Postpartum Physical Therapy courses that the Section on Women’s Health offered in Tokyo, Japan in May 2017. Section on Women’s Health sent four instructors to Tokyo to instruct a class of forty Japanese physical therapists in pelvic and obstetric health physical therapy. In the interview below, we have asked Aika to recount her educational experience,  tell us about the state of women’s health physical therapy in Japan, and share her thoughts about the future of physical therapy in Japan.

Please describe you reception/experience of the two Japan courses?

I was so happy to take the courses!  Before taking these courses, it was difficult to learn about pelvic floor muscle training except through English books and papers. This time, we could learn it from the experts! I especially wanted to know the anatomy of pelvic floor because it was difficult to learn it only through anatomy books. We could study it from not only the documents but also lab practices at the course. It was impressive.

What is women’s health physical therapy like in Japan currently?

Recently, a few books about women’s health physical therapy were published in Japanese and therapists in Japan are just now getting to recognize this area. If there is a teacher who is interested in women’s health physical therapy in a school, she/he can teach or speak about it to students. But normally, we can’t take medical fee for pelvic floor muscles disorder. That’s why the curriculum of it isn’t set up to get a PT license. Some of therapists learn women’s health from foreign countries such as the United States, Australia, and France.

How will you apply your newly learned knowledge and skills to your practice/work place?

I currently work at school and can now let my students recognize this new physical therapy area. I give exercises to postpartum women as disorder prevention sometimes, so that I can use this knowledge. Although there is exception, we can’t do vaginal palpation in physical therapy treatment now in Japan. In the future, if the pelvic floor muscle  approach was included under the medical fee, I want to work in a hospital.

What was the most impressive or useful part of your course experience?

I learned so many things so it’s hard for me to choose.

The impressive part is palpation because we couldn’t learn it in Japan. And it was nice to learn about Differential Diagnosis: Screening for Referral. I think this part was one of the most important piece of knowledge I learned. The most useful topics I learned about are pelvic floor anatomy, physiology of miction and physical therapy treatment of underactive pelvic floor muscles and prolapse.

What do you see in the future of Japan concerning women’s and men’s health pelvic and obstetrics physical therapy?

We, physical therapists, can’t take medical fee for treating pelvic floor muscle disorder. But when the obstetricians-gynecologists prescribe rehabilitation as musculoskeletal disorder, it is possible to treat as medical treatment of physical therapy.

Nowadays, obstetricians-gynecologists are getting to recognize that physical therapists can treat pelvic floor muscle disease and related symptoms so it is difficult for physical therapists to treat patients in Japan. As physical therapists, we can take part in the team consisting of doctors, midwifes and nurses. We then give exercise recommendations in the pre-mother’s/mother’s class.

In urology, we are in the team to treat patients who remove a urinary catheter. This system has started since last year. Although the cost isn’t high, many hospitals don’t adopt it.

I think that it will take a long time for physical therapists in Japan to treat these patients because it is difficult and it take time to change the medical standards of care. Slowly but certainly women’s physical therapy will spread in Japan. I believe that hospitals including the department of obstetrics, gynecology and urology will soon start hiring physical therapists.

Japanese women are often ashamed of talking about their symptoms or some think it is normal to have prolapse and incontinence. As physical therapists in Japan, we need not only to treat patients but also to educate women.