Foundation Alumni Advances Research in Pelvic Pain

— As a physical therapist (PT) researcher, Dr. Meryl Alappattu has long enjoyed the ability to design a scientific study and answer its questions with the hope of eventually changing how physical therapists practice and manage their patients. “For me, thinking about certain questions and developing ideas and testing them has really been what’s most fun as a researcher.”

However, she hasn’t always known that physical therapy was what she wanted to pursue.

Meryl Alappattu, PT, DPT, PhD, recipient of several Foundation scholarships including the 2009 Florence P. Kendall, 2010 & 2011 Promotion of Doctoral Studies (PODS) I, and the 2012 PODS II Scholarships, was on her way to earning a degree as a Business major at Indiana University when she realized it wasn’t something she was really interested in. After conveying this to her father, he reminded her about an athletic training internship she took part in during high school and how fulfilling it was for her. Upon suggesting she look into physical therapy, she immediately checked to see if her college credits would count towards a degree in that discipline. And with that, she set off on a new track unaware of how far it would lead her.

Upon completing her Bachelor’s in 2005, Dr. Alappattu ended up applying to the University of Florida (UF) in hopes of earning a Doctor of Physical Therapy degree. It was here that another incident shifted her focus to a more specific emphasis in PT: pelvic pain. She recalls listening to an interesting lecture from a pelvic floor physical therapist, Vicki Lukert, PT that ultimately led her to seek out an internship with Ms. Lukert at UF Health.

“I saw the work she did with people with pelvic pain and urinary incontinence and the major impact she had on their pain and quality of life,” she explains. “She literally changed their lives. Working with her and the other physical therapists was a great experience and really got me asking how some of these interventions actually worked and how manual therapy or exercise relieved something like pelvic pain?”

Upon completion of her DPT in 2006, Dr. Alappattu applied for and began her residency in Oncology Rehabilitation at UF Health. However, because it was still a non-accredited residency she was able to shape it to meet her interests and ended up seeing primarily men and women with urinary incontinence and pelvic pain due to urogenital cancers, in addition to other conditions associated with various other cancer diagnoses. During her first two months at the clinic, Dr. Alappattu worked with Ms. Lukert, her Clinical Instructor from her internship, to develop the Male Pelvic Health Rehabilitation program at UF Health, which Dr. Alappattu attributes to “a great twist of fate.” Soon after, she decided that in order to answer some of the questions she developed during her DPT training and residency, she would require more formal research training and applied to UF’s Rehabilitation Science Ph.D. Program, from which she graduated in 2014.

She explains that working at the Rehabilitation Sciences program and with some of the top PT and pain researchers in the world broadened her view of pain. “I didn’t understand how two therapists who essentially provided the same treatment to patients could have drastically different outcomes. If the treatment was the same, what else about that patient-provider relationship could affect outcomes? Talking with people like Mark Bishop, Steve George (UF Dept. of PT), and Mike Robinson (UF Dept of Clinical and Health Psychology) during my residency, I started to learn more about the psychosocial factors related to the pain experience and how they can influence patient outcomes.”

Today, Dr. Alappattu works as a Research Assistant Professor at University of Florida’s Department of Physical Therapy studying vulvodynia, a chronic pelvic pain condition affecting the vulvar area that has no identifiable cause. She is researching how vulvodynia is being managed, the types of implemented treatments, and their long-term effectiveness.

“My hope is to see the work I’m doing translated into clinical practice,” says Dr. Alappattu. “What we know today about pain is very different than what we knew even 10 years ago when I was in PT school. At that time, we didn’t have a dedicated portion of our curriculum to pain, which is crazy given how prevalent pain is in the general population! Rather, the emphasis was on biomechanical abnormalities or asymmetries as the primary contributors to why people had pain. There also wasn’t a very strong emphasis on psychosocial and contextual factors (including the patient provider relationship, patient expectations for pain relief) and how they influence outcomes. While this is definitely changing, my goal is to reframe and reshape the way we look at the pain experience in people with pelvic pain in order to optimize the best possible outcomes for them.”

As an Instructor, she wants her students to leave her classroom knowing “that the pelvis is part of the anatomy; it is the connection between our upper and lower body and contains some pretty important musculature and organs. It should be something that ALL therapists consider when treating a patient with groin, low back, sacroiliac, or hip pain.”

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