You’ve heard the expression “It takes a village to raise a child”? Well, it can also take a village to help us stay healthy and on top of changes in our bodies.

At genneve, we believe that everyone is ultimately the expert on their own body. However, information can come from a lot of “villagers,” and knowing when to heed the advice you’re given can save your life.

January is Cervical Health Awareness Month. Because cervical cancer often doesn’t have obvious symptoms in the early stages, and because some of us aren’t as regular as we should be about pap screenings, the first person to identify warning signs might just be your physical therapist.

Fatality rates from cervical cancer have declined significantly in the last 40 years, according to the Centers for Disease Control and Prevention, but as recently as 2014, more than 4000 women died from this disease. So we couldn’t be happier that Direct Access allows non-primary health care professionals such as our ever-fabulous DPTs, Meagan and Brianna, to identify warning signs and direct patients to further testing and care.

Here’s how it works ….

Physical therapy and Direct Access

It used to be if you twisted your ankle, you needed to see your primary care doctor and get a referral to a physical therapist. That way, in case your twisted ankle was actually an indication of a more serious health issue (say, osteoporosis), your doctor could spot the real problem and start appropriate treatment immediately.

The problem with this method is it can sometimes be costly, both for the patient and her insurance company; time-consuming, because patients had to make two separate appointments; and unnecessary, because most of the time, a sprained ankle is just a sprained ankle.

To lower costs and provide better care, Direct Access (DA) was instituted across the US in January of 2015. With DA, non-primary care health providers – in this case, physical therapists – are provided additional training so they are able to spot signs of trouble that aren’t musculoskeletal in origin.

What are they looking for?

Of course, says Meagan, PTs aren’t looking for signs of cancer when someone comes in with pelvic pain, for example. Usually pelvic pain has other causes PTs can and do treat, such as pelvic floor dysfunction. But sometimes, she says, they see what they refer to as a “cluster” of several signs, which can indicate a more serious condition:*

Pain that can’t be “provoked.” Pain in bones, muscles, tendons, and ligaments (musculoskeletal pain) can usually be replicated or made worse by poking different areas, stretching the affected area in different ways, or putting a painful joint through its full range of motion. If the pain is constant and unaffected by anything the PT is doing, that could indicate the pain isn’t from a musculoskeletal source.

Pain in the lower back that is constant and intensifies over time can be a sign of cervical cancer, says Meagan, so they’re especially alert for back pain that fits the description.

Fever, sweating, fatigue. Especially if these last a long time and don’t have an obvious cause like a cold or flu.

Unexplained weight loss. If the patient isn’t trying to lose weight and hasn’t changed her diet or exercise regimens, that can be a warning sign that something’s not right.

Unusual vaginal bleeding. This one is more specific to cervical cancer – bleeding outside a normal period, or bleeding after menopause can be indicators of cervical cancer.

What constitutes “normal” bleeding and when do you need to demand more tests?

Changes in bowel or bladder habits. If there’s a dramatic, rapid change in how a patient goes to the bathroom (long-term diarrhea or constipation, for example), especially if it isn’t caused by or relieved by changes to diet, can be a red flag.

Pain that intensifies at night. According to Meagan, when you lie down at night to sleep, your body calms and slows, metabolically. If patients describe pain that intensifies and is highly localized at night, that may be cause for concern.

Ulcers and sores that don’t heal. If a patient has the same sore for a longer time than they should, it’s a red flag for sure, says Brianna.

Lumps and changes in moles. PTs touch their patients in places others don’t; they see skin even the person inside that skin doesn’t see, so PTs may be first to notice things like lumps or changes to moles that can indicate a more serious problem.

Just one of these signs, Brianna says, isn’t generally enough to send them to the phone to call their patient’s primary care doc. “If I see one or two of the less serious signs, I’ll probably just monitor them for a couple of weeks to make sure their condition is improving as we’d expect.” Usually, the PTs agree, a cluster of several signs, especially if the patient has a history of personal or familial cancer, is necessary to start a bigger conversation.

Do I really have to…?

Yes. You really have to. Physical therapists are a great resource to help us stay healthy, but don’t expect a diagnosis of cervical cancer or other causes outside their area of expertise. What they will do is talk to you and let you know they found something they didn’t expect and would like you to follow up on.

The important takeaway here is follow up. If your PT asks you to see your primary care physician or a specialist, they have a good reason for asking.

This is not to say you should panic if your PT sends you back to your doc. There are lots of reasons they make ask you to pursue further care from a physician. And your village loves you and will err on the side of caution to keep you healthy and well.

*This blog is for informational purposes only and should never replace the expert advice of a doctor. If you have a cluster of the signs above or other health concerns, please contact your primary physician right away.

Do you see a PT? Tell us about it! We’d love to know what’s going on and how you’re handling it. Share with us in the comments or on genneve’s Facebook page or in Midlife & Menopause Solutions, our closed Facebook group.



Shannon Perry

Shannon is a celebrated author and global educator. Whether she’s interviewing a physician or producing a podcast, her appetite for research, facts, and truth culminates in credible health education and programming that women can rely on. An avid runner, cyclist, and climber, Shannon knows a thing or two about thriving in midlife and lives in Seattle with her cat, dog and boyfriend.


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