Physical Therapy Researchers Receive $2.5 Million Department of Defense Grant Award to Improve Pelvic Care for Women Service Members

Novel intervention to be tested by Robbins College faculty could have a “substantial impact on the health and wellbeing of countless women service members”

June 27, 2024
Baylor physical therapy researchers Shane Koppenhaver and Laurel E. Proulx

Baylor University physical therapy researchers Laurel E. Proulx, PT, DPT, Ph.D., and Shane Koppenhaver, PT, Ph.D.

Contact: Kelly Craine, Baylor University Media & Public Relations, 254-297-9065
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WACO, Texas (June 27, 2024) – Baylor University physical therapy researchers Shane Koppenhaver, PT, Ph.D., and Laurel E. Proulx, PT, DPT, Ph.D., in Baylor’s Robbins College of Health and Human Sciences, have received a four-year $2.5 million grant award from the Department of Defense (DoD) to test a novel intervention for women service members suffering from debilitating chronic pelvic pain that could provide better access to care and rapid, effective treatment, expediting their return to duty.

Their project, “Conservative Care for Pelvic Pain in Women Service Members: A Multisite, Multigroup Noninferiority Randomized Clinical Trial with Development of Clinical Decision Tools,” also includes measuring the pelvic floor muscles by using advanced ultrasound imaging technology found in only a few labs in the world.

“We are thrilled for Dr. Koppenhaver and Dr. Proulx on this momentous award from the Department of Defense,” said Jason R. Carter, Ph.D., dean of Baylor’s Robbins College of Health and Human Sciences. “Through their research, they have the opportunity to make a substantial impact on the health and wellbeing of countless women service members. This is a great example of Research 1, mission-oriented research we strive for within Robbins College.”   

Improving access to care, effective treatment

Musculoskeletal injuries reported by women service members differ from their male counterparts, with chronic pelvic pain disproportionately affecting women in particular. The National Institutes of Health reports that one in seven women experience chronic pain, but in the Armed Forces, one in four women service members experience chronic pelvic pain, making it more common than asthma and knee and low back injuries. In addition, chronic pelvic pain is often associated with PTSD and trauma.

Generally, care for chronic pelvic pain focuses on treating vaginal or rectal muscles and is provided by pelvic health specialists. This specialized care is often difficult to access or limited in availability for women service members, and treatment can be delayed for weeks to months for individuals suffering from this debilitating condition during deployment or military training.

“Pelvic pain is one of the most common physical ailments experienced by women and, sadly, one of the most understudied. ‘Pelvic pain’ is an umbrella term for a multitude of heterogenous physiologic impairments, making an evidence-based intervention strategy difficult to establish,” said Proulx, who serves as co-investigator for the project. "We are not only hoping to test a novel intervention that could improve access to care but also gain information about the mechanism of action of our intervention. This grant allows us to do that with technology to measure the pelvic floor muscles – something only a few labs in the world are doing.”

Koppenhaver and Proulx hypothesize that there may be other methods of care – outside of intravaginal specialization – that are effective in treating chronic pelvic pain. Most military physical therapists are trained and credentialled to perform treatments like manual therapy and dry needling, which can be applied rapidly across the continuum of care. If these types of interventions are proven successful at treating chronic pelvic pain, they can be used broadly in both deployed and military training environments to assist women service members closer to the point of injury and to expedite their return to duty.

Developing best-practice treatment strategies 

In their research, Koppenhaver and Proulx will compare the clinical effectiveness and physiologic efficacy of usual care, emerging field-expedient care and gold-standard intravaginal specialist care in women with chronic pelvic pain. Then, they will develop a clinical decision tool that will help providers assess which women with chronic pelvic pain are most likely to benefit from non-vaginal conservative care.

“I took care of numerous women with chronic pelvic pain during my 20 years as an Army physical therapist. Unfortunately, I didn’t have much guidance on how to treat them and, therefore, treated them as I would any other patient with low back and pelvic pain,” said Koppenhaver, the project’s principal investigator. “We hope that the results of this project will give physical therapists valuable evidence-based guidance on best-practice treatment strategies to treat women with chronic pelvic pain both in the military and general civilian practice. Additionally, because we are including advanced ultrasound imaging technology measurements – shear wave elastography – of the pelvic floor muscles, we should be able to explain some of the potential physiologic mechanisms of treatment benefit as well."

Shear wave elastography creates a higher-quality image while checking tissue stiffness, including ultrasounds of the musculoskeletal system.

Uniquely positioned for this particular study, Koppenhaver and Proulx bring an impressive portfolio of experience and expertise to the table. Koppenhaver completed two decades of active-duty service in the U.S. Army, and both he and Proulx have held positions in the U.S. Army-Baylor Doctor of Physical Therapy program. Proulx’s clinical practice and research focuses on pelvic health, and she is founder of an inclusive pelvic health provider and online learning platform. Koppenhaver’s research interests relate to dry needling and the mechanisms of manual therapy. 

“The collaboration cultivated by Dr. Koppenhaver and Dr. Proulx has the potential to make an extraordinary difference in the lives of women service members suffering from pelvic pain. They each offer extensive knowledge and distinct familiarity with the various aspects of this project, which, brought together, make them the ideal partners to pursue this research,” said Brian A. Young, PT, D.Sc., chair and clinical professor in the Department of Physical Therapy at Baylor. “Through cutting-edge technology and mission-driven focus, Dr. Koppenhaver and Dr. Proulx are worthy recipients of this award from the Department of the Defense, and we look forward to seeing their work ensue over the next several years.”

ABOUT BAYLOR UNIVERSITY

Baylor University is a private Christian University and a nationally ranked Research 1 institution. The University provides a vibrant campus community for more than 20,000 students by blending interdisciplinary research with an international reputation for educational excellence and a faculty commitment to teaching and scholarship. Chartered in 1845 by the Republic of Texas through the efforts of Baptist pioneers, Baylor is the oldest continually operating University in Texas. Located in Waco, Baylor welcomes students from all 50 states and more than 100 countries to study a broad range of degrees among its 12 nationally recognized academic divisions.

ABOUT ROBBINS COLLEGE OF HEALTH AND HUMAN SCIENCES AT BAYLOR UNIVERSITY

The Robbins College of Health and Human Sciences at Baylor University seeks to prepare leaders in health and quality of life through science, scholarship and innovation. Together, the departments housed within the Robbins College – Communication Sciences and Disorders; Health, Human Performance and Recreation; Human Sciences and Design; Occupational Therapy; Physical Therapy; Public Health; and a number of Army-Baylor graduate programs – promote a team-based approach to transformational education and research, establishing interdisciplinary research collaborations to advance solutions for improving quality of life for individuals, families and communities. For more information, visit the Robbins College website.