Interview: Mary Ellen Kramp, DPT, CLT-LANA

Mary Ellen Kramp, DPT, CLT-LANA is a Physical Therapy Specialist in Seminole, Florida. Her professional experience includes 25 years providing care in a variety of inpatient rehab and outpatient settings. She is the owner of Relief at Hand, LLC, a small manual therapy clinic that maintains an integrative practice of physical therapy, massage therapy and acupuncture. In the past ten years she has become more specialized in women’s health areas including post-breast cancer lymphedema and infertility. Currently, she is leading a multi-site pilot study focused on manual therapy for women’s infertility.   

Please read more about Dr. Kramp, and her work and her study at:
www.mechanicalinfertilitystudy.com
www.pelvichealthresearch.org
www.reliefathand.com
 
What motivated you to focus your career on women's health and infertility?
 
I had worked in Michigan several years ago, and had the reputation for being able to treat any weird kind of thing. If you had a patient with weird issues, send them to me. My best friend was trying to get pregnant, and at one point (after I had moved to Florida) called me and asked for my help. Using the same principles that we would use for the shoulder joint, I applied it to the reproductive system. She went home, and got pregnant. A couple years later, she had gotten pregnant and miscarried, and then couldn't get pregnant again. I treated her again and she got pregnant immediately. I knew then that we needed to do the scientific research and show that this is a viable option for people struggling with infertility.
 
You are currently working on a research study entitled: Physical Therapy For The Treatment Of Infertility. Can you tell me more about it?
 
We are recruiting 30 women at this point in time. It's a pilot study. We want to work out all the kinks before we go into the large study that we’ll be doing. In the large study, we're going to have about 25 to 30 sites nationwide, and right now we have five sites. Currently, it's a randomized control trial. The participants are blinded as to which group they're in. Since no physical therapy type treatments have been studied, as far as efficacy of physical therapy for infertility, we chose one other type of treatment and we're comparing the two treatments, as far as effectiveness. We have the main treatments and then we have another set of treatments
that are being done in the control group. The women are seen weekly for the first four weeks, and then after their next period, we see them between their period and ovulation for that cycle. Then if they get their period again, after that period and between ovulation, for the sixth treatment. We follow them up for three cycles to see if and when they do become pregnant after they finish the six treatments. Those are the main things. Women that were in the control group (because we're hypothesizing that in the control group they won't be quite as successful as the treatment group) will be offered the treatments at the end of the study. There's no charge for any of the treatments.
 
Who would be a good candidate?
 
We do not know for sure yet who would be the optimal candidate, because we are just starting the research.  We are planning to assess all women struggling with fertility, because we may be surprised that some diagnoses may be responsive to our treatments that we did not think would be.  For our research, the only women we are not accepting are those who do not have a normal reproductive tract, who have had prior tubal ligations and reversals, and who have cancer. We are hypothesizing that the optimal candidate would be those who has been through all of the testing. Doctors have checked hormone levels and their cause is still unknown. Hormone levels are okay and the tubes are open and everything seems to be fine. They would be optimal, because it’s possible they have physical restrictions that might be preventing pregnancy. 
 
Can you tell me a little bit about how physical therapy treats infertility?
 
Looking at the reproductive system, if we compare it to a shoulder, you have the bones of the pelvis, just like you would have the bones of the shoulder. You have ligaments holding the pelvis together. You also have the uterus in there, and the fallopian tubes, and the ovaries and bladder, et cetera, et cetera. Well, you have ligaments holding that uterus to the front of the pelvis, you have ligaments holding it to the back of the pelvis, to the sides. The blood vessels travel through all that connective tissue that is surrounding and supporting the uterus and the tubes and the ovaries. If there is tension in those ligaments, there is going to be probably some compromise in the blood getting to and from the uterus itself. So, can the uterus get what it needs? Can the ovaries get what they need if there is compromised circulation in there? Looking at it from a physical standpoint, sometimes you can have a pretty harsh environment for the reproductive system. What we're trying to do is optimize and normalize everything so you have
this nice, friendly environment, an optimal environment for the ovary to be able to produce its eggs, for the tubes to be wide open, for the uterus to create the endometrial lining, and be a hospitable environment for implantation and to support a pregnancy.
 
What should one expect in a visit to your office?
 
When a woman comes in, I assess her pelvis, just like if she was coming in to me for low-back pain. I check to see if her pelvis is even. I assess her lymphatic system, to make sure that is open. I check for trigger points in the muscles around the pelvis and then I check the ligament mobility around the uterus to see how mobile that is. Then I will do a vaginal exam and check and see how the pelvic floor is. I will also check the mobility of the cervix, because studies have also shown that mobility of the cervix is important, as well. That's the typical evaluation.
 
What can someone expect to feel in general during treatments or afterward?
 
For the most part, it's very, very gentle. The techniques are much lighter than you think they would be because I'm just basically acting as a catalyst to get the body to react. I am putting some tension on those ligaments, just enough so I am engaging them, and then putting them in  a position where the body must respond. People usually don't feel a whole lot during the treatment. They'll feel it when I hit a trigger point, but I bring the body to a position around the trigger point where I'm basically hugging the trigger point, and allowing the body to neurologically shut off the spasm that's happening in that section of muscle. It's a similar type of technique for the connective tissue and ligaments. The lymphatic drainage feels more like a massage, so it's a pretty comfortable treatment. Afterward, some women can have some spotting, there might be a little bit of cramping, there might be some low-back discomfort, the muscles might be a little sore, because when tissues are really tight for a long time, the blood flow isn't quite as good through the area as it should be, and the waste process from the normal cell  metabolisms build up. So, it allows the body to release all of that back into the blood stream. The body picks that up, and so there's a general achy, soreness, it feels like you worked out too much type thing. Then within 24 to 48 hours, the body has cleared all that out and the person feels fine.  In general, most women feel just more comfortable.
 
At what point in their infertility journey would you say they should start seeking treatment in the physical therapy form?
 
I would like to see them when they notice that they're struggling. I would like to see physical therapy as a first-line treatment. Before somebody spends over $10,000 in treatments, I would prefer they spend a tiny little amount (1% of that $10,000) in physical therapy to see if it makes a difference for them. Even if it doesn't, there could be other combined factors that PT can address. I would like to treat these women prior to IVF, and see if we can up the success rates of IVF, too.
 
Do you do physical therapy in conjunction with other medical treatments, or is it one or the other?
 
I’ve worked with some women while they've been on Clomid or I've treated them and they're going for an IUI, or I've had a couple that have asked me if I could treat them before they go for an IVF treatment. I also have an acupuncturist in my office and we'll often co-treat during a session.
 
In general, what kind of success have you seen with your infertility patients?
 
About 60%. I see women typically between one and six visits and within three months after finishing the last visit, it's about a 60% success rate, which the average couple trying. When the average couple begins to try to conceive, within three months, 57% of them will become pregnant, at six months 75% will become pregnant, and at a year 85%. We're bringing it up to normal rates of fertility.
 
What is your favorite thing about working with your patients?
                               
I love seeing the changes that happen, even in the cases where someone wasn't able to become pregnant. They tend to have more comfortable periods, they tend to have more regular periods. I have had several patients tell me, "Oh my gosh, I didn't realize I was having pain with intercourse until after you treated me. I didn't realize how good sex could feel." There are a lot of benefits on top of the fertility that these women achieve during the sessions. I just love seeing people being able to function better. Even if a pregnancy is not achieved (which is the coolest thing in the world when it does happen), I just love being able to impact parts of their lives that are so private, that they don't talk to their friends about. I love being able to give somebody a better sex life, I love being able to take their pain away with periods, that they didn't know could ever be done. I can't express how rewarding that is.
 
Is treating infertility with physical therapy a new concept?
 
Yes, it’s new. We are just starting to do the research on this. My thought is, I want to show that this is something that is viable and I want to teach it to any therapist who wants to learn it, because I think it should be out there for everybody.
 
How can somebody seek you out to join your research study?
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They can visit us at www.mechanicalinfertilitystudy.com and www.pelvichealthresearch.org.