The American Heritage Dictionary defines an epiphany as "a sudden manifestation of the essence or meaning of something" and also as "a comprehension or perception of reality by means of a sudden intuitive realization."1 I recall an epiphany of mine that occurred following a committee meeting when I was teaching at the University of New England. The task assigned to the committee was to decide which courses might fulfill the curriculum requirements of an interdisciplinary degree program. For me to make a decision of that kind, I kept asking for specific guidelines on which the decision could be based. If I had the guidelines, I believed that would make my decisions easier. Course outlines could be submitted and the task of the committee would be to compare the content to the specific requirements. If the requirements were met, then the course would be accepted. Students could be confident that when they signed up for a course, it would fulfill a requirement for graduation. Well.... Serving on that committee was one of the most frustrating things I have experienced in my very young life. (Mind you that was only a few years ago.) I think that my persistently asking for specifics must have been frustrating for a colleague from another department and finally she looked at me and stated, "Nancy, you are just going to have to embrace ambiguity." OMG!!.... I still get shivers up and down my spine when I think of that phrase. (I also cannot believe that I have found an appropriate time to use OMG.) I believe my (not well thought out) response was, "No, I don't, and I won't." Personally, I believe that there are times when there can be absolutely no ambiguity. In that specific circumstance, we were making decisions that not only would determine the competencies a student could claim to future employers but would also have an economic impact as students pay money to take courses. The epiphany I experienced was that I have to speak up forcefully when ludicrous statements are made.

I carried (and continue to carry) this desire for a lack of ambiguity into my daily life as a physical therapist (PT). I am bothered by some statements that I hear in clinics, at conferences, and at continuing education courses. I have heard several PTs say to patients, "I've read the x-ray and I see...." When I can, I ask PTs where they completed their years of radiology residency. I have heard PTs claim that they can move the organs of the body, and I wonder how they know if they can. Also, I wonder if it is good to move the organs. I also hear some PTs claim that they can release adhesions with gentle massage. Again, what is the proof that this can be accomplished? I have heard PTs claim that they can measure a craniosacral rhythm and that they can change the rhythm and/or change the position of skull bones by placing their fingers very lightly at the base of the skull. As I investigated this possibility, I have found that this craniosacral rhythm has not been reliably documented. Also, as an adult, it takes quite a traumatic event to reposition skull bones and that the traumatic movement usually requires a trip to an intensive care unit. I have heard an instructor teach that tapping a person on the head and shoulders (in a specific order, of course) helps to cure thoracic outlet syndrome.

I am completely mystified at why these claims are readily accepted by PTs who have studied biology, physiology, chemistry, and physics in their undergraduate and graduate curricula. As another example, I still hear PTs state that they perform ultrasound on their patients for either thermal or nonthermal effects and that the thermal effects can go as deep as 5.0 cm into tissue. Textbooks continue to state that ultrasound works via the mechanisms of cavitation and microstreaming and also that it changes membrane permeability, fibroplast proliferation, and increases cellular activity and tissue extensibility. I am mystified at the continued rationale that is outlined by PTs as they explain the use of ultrasound to their patients. I wonder why they continue those rationales because of 2 outstanding reviews of ultrasound that were published in our very own professional journal (Physical Therapy) in 2001.

As I wrote in the summer 2010 issue of the Journal of Women's Health Physical Therapy (JWHPT), to remain a profession that is relevant to our health care system, we must continually prove our relevance. It is my contention that relevance is judged based not only on effectiveness of interventions but also on the language and claims made by professionals. I believe that we must be careful what we claim, and we must ensure that our claims are based on sound science. I believe that the decisions we make as we design plans of care should not be based on ambiguities. Toward that end, I had decided, quite a while ago, that we might republish articles that may be beneficial for women's health PTs to read. I continue that in this journal with the 2 reviews on the topic of therapeutic ultrasound. After reading the 2 articles, you may see why I will perform ultrasound on a patient/client who arrives with a diagnosis of calcific tendonitis. Good research has made this decision easy for me.

In this issue of the journal, Alison Sadowy and her colleagues present their research on the development of a reliable tool for quantification of pelvic floor muscle coordination with observational assessment. Drs Beth Shelly and Laura LaPorta Krum report on their findings from a survey of PTs regarding the characteristics that are present in those who report high and low skill confidence in the examination of the pelvic floor muscles. Cynthia Neville and her colleagues report the findings of their research in comparing the assessment abilities of PTs and MDs with respect to chronic pelvic pain.

At the end of this issue, you will also find the index to the manuscripts that were published in 2010 in JWHPT. I offer my thanks to the authors for the information they provided to women's health PTs so that they can increase the quality of life experienced by the patients/clients they treat. I especially thank the peer reviewers who reviewed the manuscripts. These are individuals selected to review manuscripts based on their known expertise in specific content areas. They spend a significant amount of time providing feedback to the authors and the editorial staff to ensure that there is no ambiguity in the content. The success of this journal is, in large part, due to the volunteer hours, and the brain power, that they willingly provide to the profession. I thank them for their dedicated work. I also thank the editorial staff and the leadership of the Section on Women's Health for their support and commitment to the publication of JWHPT. I am so very proud to call them colleagues and friends. [shadowed white circle]

Nancy C. Donovan, PT, PhD

Editor-in-Chief

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