Denise Jagroo earned her Doctor of Physical Therapy degree from NYU Steinhardt in 2002. She is a specialist in manual therapy and is certified in pelvic physical therapy through the American Physical Therapy Association’s Women’s Health Section.
Jagroo is one of 300 board-certified clinical specialist in women’s health physical therapy in the country. Her seminars on pelvic health and rehabilitation have been attended by thousands of clinicians, including obstetricians, nurse practitioners, physician’s assistants, midwives, physical therapists, occupational therapists, athletic trainers, and dieticians. We sat down with her to discuss her career and PT philosophy.
You are a certified pelvic physical therapist. What got you interested in the women’s health field?
I became interested in women’s health because I have suffered with pelvic pain for much of my life. Pelvic pain can be incredibly complicated; as a patient, this issue took me down a frustrating medical path. Today, I am pain-free and have learned the importance of the mind-body connection as it relates to chronic pain.
When I was a student at NYU, I took Evelyn Hecht’s women’s health class. She inspired me to branch out into this specialty. The anatomy and the kinesiology of the pelvic floor just made sense to me. It was different – a different skillset; a different entity to understand. But I knew then that I wasn’t quite ready to delve into the world of pelvic PT. It took me six years of practice before I took my first post-graduate course.
In 2008, when I took my first postgraduate course in women’s health, I felt that the ‘cosmos aligned.’ I knew the rest of my career would move down this path. Everything I had learned – I was already a certified manual therapist – was coming together and making complete sense. I took many more courses and filled in the missing pieces of my education to create the best comprehensive understanding of the pelvis and its complications. I feel truly blessed to have found my calling.
You created a pelvic rehabilitation clinic at Manhattan Veterans Hospital. Can you talk about your work with male and female soldiers?
My work at the VA Hospital is complicated. My patient caseload is very specific and has very different issues compared with my private practice patient population caseload.
Very often men and women return from deployment with increased anxiety and depression, which leads to increased pain. Understanding the ‘whole picture’ of the patient is extremely important to developing a unique treatment program for each individual.
Many of my female veterans at the VA Hospital have suffered sexual assault in the military. Dealing with military sexual trauma (or any sexual trauma) requires delicacy and a special sensitivity from me as a clinician. I used to keep my head down and check off a checklist of questions until I realized that I paused when I approached the sexual trauma questions in my evaluation questionnaire. I also noticed my lack of eye contact and a change in my body language. To stay connected, I have learned to monitor my reactions and always look at my patient and engage when I am asking about their history. I also make sure to always ask permission before making any contact to make sure they feel safe in the environment.
Sometimes sessions are just spent learning relaxation and breathing techniques, and that’s okay. I’ve learned that in treatment, ‘less is more’ sometimes. And it’s not always about using every ‘tool in your toolbox.’ Sometimes just being a compassionate ear is all the patient needs to start healing.
As for the male veterans, many of them suffer from prostate-related issues (prostate cancer, prostatitis). I have special equipment such as a biofeedback unit to help them visualize what state of tension their pelvic floor muscles are resting in. I also use mind body calming and awareness techniques with the men.
You are the author of Your Best Pregnancy: The Ultimate Guide to Easing the Aches, Pains and Uncomfortable Side Effects During Each State of Your Pregnancy. Did this book also grow out of your clinical practice?
My co-author and I sat down in 2010 and discussed how so many postpartum women in our private practices suffer from pain and dysfunction.
Together we imagined how much relief pregnant women would feel if we gave them tools to help prevent and treat their pain and dysfunction during and after pregnancy. We spent four years researching and writing a book teaching pregnant women to recognize, prevent, and treat different conditions on their own to have a healthy and safe pregnancy. It was a fun journey!
You have a lot to say about our mind-body connection in your web series. What is your advice for someone with chronic pain who finds that medication is not alleviating symptoms?
This is such a great question.
I believe that in our society, the medical model has always leaned towards the use of pills, ointments, drugs, and cream to treat symptoms. I used so much of that to treat my own pelvic pain! Then I noticed that a lot of my patients, like me, didn’t have just one inflammatory condition, but had many inflammatory conditions throughout many systems in their bodies. It could start with something simple – a urinary tract infection, or a fall, or some kind of trauma. I thought there had to be some connection between these conditions.
I started to research chronic pain and realized that the central nervous system in people who suffered chronic pain was hypersensitive. I surmised that we all need to calm our central nervous systems. One way to do this is to reset the autonomic signal to the pelvis, the bladder, the prostate (all the muscles and organs and tissues that you cannot voluntarily control). To reset that signal you must try to regulate breathing, control your heart rate, and blood pressure.
So, I started incorporating diaphragmatic breathing into my patients’ sessions. I added meditations, visualizations, yoga, and mindfulness. I became diligent in adding this all into my own personal daily routine, as well, and my pain levels started to decrease, my inflammatory conditions started to resolve. I see a great change in my patient’s conditions since I started incorporating breathing into PT sessions. Any exercise to decrease stress and increase mindfulness always helps.
My advice for people who are suffering chronic pain is to slow down and breathe. Be mindful of your movements. Download free meditation apps; try yoga.
How did your doctoral education at NYU Steinhardt prepare you for the real world?
My NYU education gave me the tools to be a compassionate educator and clinician.
I absorbed all that I could from the amazing faculty. I have been blessed to be given the opportunity to come full circle and teach at NYU as well. My doctoral education was so comprehensive. It helped me build the foundation for the incredible career I’ve been privileged to have.