Form & Function: Redefining Rehab For Women And Athletes

It is estimated that about 73,000 births occur per day in India. Largely, women focus on their health during pregnancy with the intent of giving birth to a healthy child. Many premium maternity hospitals too walk with an expectant mother through her antenatal phase. After giving birth, her child is the primary focus for the entire family with the mother overlooking her well-being. Certain physical changes that occur in a woman's body during childbirth, which could lead to health problems, have been considered common for a very long time. Common health issues should not be normalised by women, says Dr Ravali, Founder of Form & Function, a physio rehab studio specialising in sports and women's health. She holds a Master's in Sports Physiotherapy and is internationally certified by a Canadian Institute and CAPPA, to provide rehab solutions covering overall women's health. Dr Ravali is a recipient of Dr APJ Abdul Kalam Health & Medical Excellence Award for 2022. She was recognised for her work in the women's health category

How have rehab solutions for women's health evolved over a decade?

I have been working with Srikara Hospitals for more than 11 years. I was handling majorly Orthopedic cases and a few related to women and sports injuries. During those initial years, I had discussed with other doctors for bringing the focus on physiotherapy to cover women's health. While Dr Padmavati had travelled to the US she got to know about therapy services available for women, 15 years back. Since then my journey with her started. My patients were pregnant women…preparing them for labour and patients with musculoskeletal issues. When it comes to postnatal problems, women suffer from pelvic floor weakness, abdominal weakness, non-specific back pain, pelvic organ prolapse, and sometimes urinary incontinence, after giving birth to a child. In these situations, women are not aware that there are treatments available in physiotherapy. Not only did patients lack awareness, but doctors were also not aware of the therapies available. Hence, I and a few of my friends who were into physio for women's health got together and researched about the related therapy sessions available.

How have you brought about awareness about rehab therapy especially for women?

I took up a course from an Institute in Ahmedabad. I am certified as a pelvic floor rehab specialist. After being trained, we introduced it to many other physiotherapists through an association we established in 2021, which is called as Global Women's Association for pelvic, obstetric, and gynecological physiotherapy. I along with my friend Dr Madhavi, my junior Dr Lalitha, and a gynecologist at Brundavan Hospital Dr Gitanjali, founded GWA to train physiotherapists who in turn will educate doctors and women about the available therapy. We held workshops every year individually and also in association with IIPRE. We have trained overall 400 physiotherapists under GWA's various initiatives. All the topics related to women's health are not covered in our college curriculum. Through our workshops, we have tried to cover women's health in depth. Now physios can confidently talk with doctors about the course of treatment.

How serious is the problem related to women's pelvic health?

Three in one women experience urinary incontinence issues once in their lifetime, overall pelvic health cases also include various chronic dysfunctions, and girls in their 20s with PCOS also come under pelvic health. It is a universal problem commonly seen in women. But it is not discussed openly in India as women feel uncomfortable. When spoken about…the older generation had labeled it as a common issue as there was no treatment available back then for problems that arose after giving birth. Unfortunately, today communication has been projected as normalised.

How many patients have you treated over the course?

For four years, I have treated about 50 patients in pelvic floor rehab and about 100 under various pelvic-related health issues. When I started my profession doctors were also not aware that physiotherapy could be a solution. In a few cases medications were given which used to help temporarily but if it prolapsed there used to be surgical intervention. After delivery, if a postnatal check-up is done then we can identify early and educate women to take up pelvic floor exercises which will help them strengthen their pelvic muscles and later in life they will not end up with the issues I mentioned earlier. In other cases, if the muscle is tight then it leads to constipation. One of the reasons for these conditions is lifestyle habits, which have resulted in PCOS among girls in their 20s, which has in turn resulted in non-specific back pain. So it is better to start with exercises early in our life.

What is your advice for women in their post-natal phase?

I would suggest post-natal checkups for women. We check the patient before suggesting an exercise routine. Without proper guidance, women begin hitting the gym and do heavy exercises which may further complicate the matter instead of strengthening the muscle. The exercise suggestion depends upon the patient's condition. Women who are following an exercise routine during pregnancy should continue it after delivering the child too. For these women, it will take them a minimum of four weeks to bring the tissues back to their position. But for women who are not into exercising it will take six – eight weeks period. During the course, pelvic floor rehab, back muscle, and abdomen strengthening will be taken care of.

Which are the other rehab services provided by Form & Function?

Besides physiotherapy for women's health, I also hold physiotherapy sessions for sports players. This facility is currently available in certain hospitals or renowned sports academies. At hospitals, they do not have full-fledged programs to take care of the patient until they are back on the field. Hence, many sports players are not able to perform to the level they did before surgery or injury. That is one of the reasons for setting up Form & Function. We concentrate on bringing back the performance of the sportsperson throughout the treatment. We design programs in such a way that they can get back to sports even after a post-operative ligament injury. Many sports persons from here travel to Bangalore to get treatment. Hence, I want to bring that facility to Hyderabad with Form & Function so that people do not have to travel to other cities to receive physiotherapy.

How big is the demand for sports rehab in Hyderabad?

At sports facilities that are smaller in size, a coach only takes care of the strength and conditioning session of a player, as they do not hire exclusive trainers for it. Hence, players face issues when their muscle is not conditioned properly. After taking note of these gaps at the ground level I decided to provide all these facilities here. If a sports person visits us with a requirement for a specific sports conditioning we can provide it. As each sport is different specific conditioning has to be given for preventing injuries.

How many therapists have you employed?

I have invested about Rs 50 lakh for setting up the centre, which is spread across 3,000 sft. The investment has been utilised for bringing in electro-therapy units, machines, and equipment. We have introduced Pilates reformers for exercise therapy as this has a low impact on joints, which means that tissues are not strained initially, later we load up with other exercises. I have chosen physiotherapists in such a way that they are trained in strength and conditioning. We have four therapists specifically for women's health, sports and Pilate training.

How has the response been so far?

I have got good responses from ortho patients and sports persons. I am looking forward to treating pelvic health cases too. In that process, I am meeting gynecologists practicing nearby. I have explained my model of treatment and have received a good response till now. They will send their patients who are experiencing such problems so that we can start with physiotherapy to cover the initial line of treatment.

Would you be hosting any programs to cover the awareness gap?

We will start with awareness programs at the school level first to educate teachers, parents, and children. We will cover pelvic floor health. Students hold urine when they are outside because they do not like to use the bathroom. How will this affect their health? We will start from there. During the menstrual cycle girls experience back pains. What exercise can be done rather than taking medicine? They can reduce premenstrual symptoms through exercising. The importance of physical activity from eight standards has been cut down as the focus is now on grades only. Maintaining fitness is also important during menopause through weight-bearing exercises. We are planning to conduct group sessions for elderly people as they experience problems maintaining balance.

What is your take on health influencers suggesting exercise regimes on social media platforms?

Unless and until you do not get properly diagnosed and assessed you will not get the right treatment. It is difficult to verify the background of a person suggesting exercises online. Many people suggest some exercises for certain pain, but if it does not help then it is better to know the cause of the problem instead of blindly following anything online.