Setting the Standard: Novel Intervention for Female Service Members Suffering from Debilitating Chronic Pelvic Pain
For 250 years, women have been serving the United States military in various ways. During the Revolutionary War, many traveled with units to cook, mend clothes, and tend to battle wounds. Today, their service looks quite different—with a rising number of women deployed to direct ground combat zones. As a result, there is a growing need to understand the unique, and often invisible, health needs women face while serving.
While musculoskeletal injuries are reported by all service members, chronic pelvic pain disproportionately affects women. According to the National Institutes of Health, one in seven civilian women and one in four female service members experience chronic pelvic pain—making it as prevalent as asthma, chronic back pain, and migraine headaches. Often, it is associated with post-traumatic stress disorder and sexual trauma.
Despite its prevalence, chronic pelvic pain is still an astoundingly understudied condition. It is a complex health problem that varies for each woman and is difficult to diagnose—many doctors tend to rely on an individual’s oral history of symptoms because current laboratory tests are often inconclusive—making an evidence-based intervention strategy difficult to establish.
But two researchers in Baylor University’s Robbins College of Health and Human Sciences are out to change the narrative.
In 2024, Department of Physical Therapy faculty Shane Koppenhaver, PT, PhD, Clinical Professor and Associate Chair, and Laurel Proulx, PT, DPT, PhD, Clinical Assistant Professor, received a four-year $2.5 million grant award from the Department of Defense (DoD) to test a novel intervention for female service members suffering from debilitating chronic pelvic pain. The potential outcomes of this research could include better access to care and rapid yet effective treatment, expediting service members’ return to duty.
“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.”
Shane Koppenhaver, PT, PhD
When addressing chronic pelvic pain, most women receive “usual care,” which typically consists of non-specific exercise interventions due to a lack of knowledge of this condition. In contrast, the “gold standard” care requires a specialized pelvic physical therapist and includes treating vaginal and rectal muscles. This specialized care is often difficult to access or is limited in availability for service members, resulting in long wait lists. In turn, critical treatment can be delayed for months, leaving women suffering during deployment or military training.
“We want to compare that usual care to the specialist-level care that we’d love for everybody to get, but that our service members certainly aren’t usually getting,” Koppenhaver explained.
In addition to usual care and gold standard care, the team is also evaluating a third intervention that is more specific to chronic pelvic pain but does not require specialization to perform.
“It’s care that all military and civilian physical therapists either are or can be trained to do,” Koppenhaver said. “We want to see if that sort of intervention can be just as good as gold standard specialist care, and hopefully, better than usual care.”
The large randomized, controlled trial will compare the clinical effectiveness and physiologic efficacy of these three treatment strategies. Following their assessment, Koppenhaver and Proulx will then develop a clinical decision tool that will help providers assess who is most likely to benefit from non-vaginal conservative care. The trial’s funding allows the team to follow up with service members up to a year post-intervention. They already know exercise interventions can be effective in the short term, if started when pain begins. However, because the team is focused on long-term alleviation of pain, they aim to learn if these women have positive outcomes from the novel field-extended 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,” Koppenhaver shared. “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.”
Koppenhaver, Proulx, and their collaborators hypothesize that there are methods of care that are effective to treat chronic pelvic pain that most military physical therapists are certified in, like dry needling and manual therapy. If so, this could broaden healthcare access in both deployed and military training environments, because any physical therapist could perform these interventions, not just a specialized pelvic health physical therapist.
“That means female service members would not need to leave a deployed environment—they can be treated where they are,” Proulx explained. “And they wouldn’t have to wait for six months on a military base for their therapy to begin.”
Collaborative Expertise
Koppenhaver, the principal investigator, and Proulx, a co-investigator, both bring impressive backgrounds of expertise to the project. Before joining Baylor Physical Therapy, Koppenhaver served two decades of active-duty service in the U.S. Army, practiced as a physical therapist, and taught Army-Baylor Doctor of Physical Therapy (DPT) courses. Proulx worked as a research physical therapist for Army-Baylor, where she met Koppenhaver. She is a specialized pelvic physical therapist and founder of an inclusive pelvic health provider and online learning platform.
“I think that this project is a perfect blend of our experience and interests,” Koppenhaver said. “I come from a military background, focusing on musculoskeletal injuries, measuring muscle function, and things like that. I definitely didn’t have experience with pelvic health specialist care, at all. That’s what Laurel brings—her passion and her expertise in developing the optimal interventions for women with debilitating chronic pelvic pain.”
The award, funded through the DoD’s Congressionally Directed Medical Research Program Peer Reviewed Orthopaedic Research Program, values collaborations with civilian and military entities. To pursue the project, the team has established two research spaces, utilizing Baylor Physical Therapy in Waco and Fort Sam Houston in San Antonio as data collection locations. This highlights another collaborative piece of the project—a partnership with the Army-Baylor DPT program.
“I was faculty for Army-Baylor DPT for seven years before retiring from the Army in 2016, and I have worked to keep valuable relationships and collaborations with my active-duty colleagues,” Koppenhaver shared. “The project is a great way to collaborate with my colleagues at Army-Baylor DPT—and doing so was likely instrumental in our selection for funding.”
The Army-Baylor DPT program is housed within the U.S. Army Medical Center of Excellence, and Koppenhaver says both entities have been supportive at the highest level. Army Lt. Col. Jen Mullins, PT, DPT, PhD, OCS, Associate Professor for Army-Baylor DPT, is a co-investigator on the project. She serves as site primary investigator at Fort Sam Houston and was instrumental in obtaining local research space and ethics approval. Air Force Maj. Matthew Williams, BSC, PT, DPT, PhD, Assistant Professor for Army-Baylor DPT, provides his expertise with digital survey tools, while Melissa Hemphill, PT, DPT, is employed full-time as the project’s research physical therapist.
“I am very hopeful that this collaboration between faculty in the Department of Physical Therapy and faculty from the Army-Baylor DPT program sets a precedent for many more successful research collaborations in the future,” Koppenhaver said.
Global Impact
In addition to valuable collaborations, Koppenhaver and Proulx’s project is also utilizing innovative and advanced equipment, including cutting-edge ultrasound imaging technology found in only a few labs in the world and used to measure the pelvic floor muscles. The machine’s shear wave elastography high-quality imaging measures the stiffness of tissues, which should provide more comprehensive information on potential physiologic effects of treatment. In Waco, Hope Padgett, PT, DPT, a PhD student research assistant, is collecting the initial physiologic data for the team.
“What that will allow us to do is to look at not just clinical outcomes, like questionnaires about patientsʼ pain and disabilities, but also physiologic outcomes like muscle function and pain sensitivity. These unique technologies will allow us not just to tell if interventions are effective, but possibly how they’re effective,” Koppenhaver said.
Koppenhaver and Proulx are excited about the potential to develop a life-changing methodology to treat female service members. The novel intervention they are assessing could ultimately change how the military provides treatment for pelvic pain, and it could also mean the difference between soldiers remaining in deployed and training environments or being sent home or to a hospital for specialized care.
“If we are successful in designing an intervention approach that is effective in helping women and that anybody can be trained to do, that could have a remarkable effect on the field,” Koppenhaver stated.
Both Koppenhaver and Proulx are honored and excited to lead a potentially practice-changing research project funded by the DoD.
“It means a lot to me that we’re improving access and serving an underserved medical population. To me, that’s how we live out the Christian values of our university—it’s really the ‘why’ behind our research,” Proulx shared. “Baylor’s status as a R1 institution allows us to do this important research that needs to be done on a global scale. For example, the number of people that we need to enroll in this study, the support, and the instrumentation. It takes infrastructure and grant dollars and support from the University to have impactful research—so the combination is what makes it possible for our research to make a global impact.”
ABOUT ROBBINS COLLEGE OF HEALTH AND HUMAN SCIENCES AT BAYLOR UNIVERSITY
Established in 2014, Robbins College of Health and Human Sciences seeks to enhance health, quality of life, and human flourishing for all individuals and communities through education, research, and innovation. It includes six academic departments—Communication Sciences and Disorders; Health, Human Performance, and Recreation; Human Sciences and Design; Occupational Therapy; Physical Therapy; and Public Health—along with the Division of Health Professions, which houses the Master of Physician Assistant Studies program. Robbins College offers 13 bachelor’s degrees, eight master’s degrees, and six doctoral degrees, as well as nine graduate programs in partnership with the U.S. Army. Graduate programs in Robbins College are offered in a variety of modalities, including on campus, online, and hybrid.