Sacroiliac Joint Dysfunction

Pelvic 3

By: Kaitlyn Parrotte, PT, DPT, OCS, CFMT

What is the sacroiliac joint?

You’ve probably heard of SI pain, but what is the SIJ and what can we do if something goes wrong?

The sacroiliac joint (SIJ) connects the sacrum, the wedge-shaped bone at the bottom of the spine, to the ilium, which is one of three bones that make up each half of the pelvis. (1) The sacroiliac joint is designated as a diarthrodial joint, which means it is a moveable joint that is surrounded by connective tissue. (2,3) Each joint is supported mainly by ligaments that lie in front and behind it, that are made up of strong, threadlike types of connective tissue. Stability is also enhanced through ligaments that connect between the spine and the sacrum (sacrospinous ligament), and the sit bone and the sacrum (sacrotuberous ligament). (2)

The SIJ helps us to walk and change positions by being stable enough to move weight from the spine to the legs, while allowing for a small amount of movement between the spine and the pelvis. This small amount of movement between the spine and the pelvis is also important as it allows for the pelvis to expand to make childbirth easier. (2,4) These functions can occur due to the unique design of the SIJ.

According to a well-known researcher named Andry Vleeming, the SIJ gains its stability in one of two ways: through form closure or force closure. Form closure refers to the stability provided by the bony surfaces of the sacrum and ilium, which fit together like a puzzle. You may use this type of stability, for instance, when you are lifting a heavy box, or pushing a very full cart of groceries; you want your SIJ to be as immobile as possible so your trunk can be stiff and rigid, allowing you to move a heavy load without overstressing any muscles in your back. Force closure describes stability occurring through the ligaments and muscles around the joint; this allows for more movement to occur. For this type of stability, think salsa dancing. In salsa dancing you need a great deal of hip and pelvic movement; however, you need those movements to be in control so you can move with precision along with the quick beat of the music. (5-7)

 

What is sacroiliac joint dysfunction?

Sacroiliac joint dysfunction (SIJD) is a common cause of low back pain, accounting for up to 40% of cases of nonspecific low back pain. (4,8) It can occur in any population: males and females; those with a sedentary lifestyle and those who are athletes. However, there seems to be a slightly greater occurrence in women, with the theory being that since the joint surface in women is smaller and less curved, the SIJ may become dislodged more easily. (2,4) SIJD can have a negative impact on quality of life, from being less active to having a financial impact. For instance, indirect health-care costs associated with low back pain range from $7-$28 billion per year, and individuals lose an estimated 5.2 hours of work time per week. (4)

The origin of SIJ pain is unknown; however, factors that may contribute include fractures, ligamentous injuries, or inflammation that occur with excessive stress to the SIJ. (8) Risk factors for developing SIJD include abnormal walking patterns, differences in leg length, scoliosis (abnormal curvature of the spine), heavy physical exertion, trauma, pregnancy, and back surgery. (8) Presentation of symptoms can vary quite a bit; however, individuals with SIJD often present with achy low back pain that can make it difficult to find a comfortable position. Pain may worsen with running, climbing stairs, or standing from a seated position. Also, if pain is truly coming from the SIJ, a person will not experience symptoms down into the leg, as is seen with sciatic nerve involvement. (4)

 

How is SIJD diagnosed?

SIJD can be very challenging to diagnose due to the complexity of the joint itself, as well as the variation in pain patterns that can be seen; thus, if you visit a healthcare provider, you may find he or she performs an array of components in an examination. Many individuals have tenderness with touch over the joint; this can help a healthcare provider rule in SIJD. (2,8). Also, various orthopedic tests can be performed that put stress on this joint, such as by putting a person’s trunk or leg in a certain position to see if it recreates symptoms. (2) Imaging can be performed in this area, but it rarely provides clear information that can help make a diagnosis; however, a doctor might recommend it if there is a concern for infection, inflammation, fracture, or other more serious conditions. (2) Injections into the SIJ itself can also be used to help diagnosis this condition, and are shown to be one of the single-most definitive diagnostic tools available. (2) Overall, effective diagnosis for dysfunction at the SIJ requires the use of multiple tools to help increase the accuracy of the condition being ruled in or out.

 

How can this impact function? Why does it matter?

It is hypothesized that SIJD can have such a significant impact on quality of life because it results in inadequate stability at the joint during movement. If the SIJ is unable to maintain an optimal level of stability, then excessive stresses will likely be placed on surrounding structures and tissues when each leg has body weight going through it. This can lead to other areas of pain, and potentially start the process of degeneration. (4) A recent research group looked at the impact of SIJD on a simple, but common functional task of rising from a chair. They found that in individuals with SIJD, there were significant differences in the amount of weight a person was putting through the leg on the painful side, as well as in the amount of bend at the hips when sitting. They also found that when individuals began to rise from a chair, muscles on the side of SIJ did not turn on right away, which means the muscles were not helping to keep the SIJ from moving too much. (4) Thus, this condition can make it challenging to use the body efficiently due to pain and weakness, which can negatively impact function throughout a given day.

 

What can physical therapy do?

Once a person is diagnosed with SIJD, what can be done? Research has shown that non-surgical treatment, such as physical therapy, can be very beneficial for someone with SIJD. If you see a physical therapist, you will likely receive some variation of joint mobilization and exercise, which is shown to help achieve significant improvements in pain, function, alignment, and muscle control. Exercise programs that emphasized pelvic stability through core, pelvic floor, and gluteus (hip and buttock) exercises, as well as increasing the strength of hip rotator muscles, decreased pain and decreased reported disability after a range of 8-12 weeks. (8,9) In other studies, an exercise program that focused mostly on gluteus maximus strengthening was utilized, since this muscle is considered one of the primary stabilizers of the SIJ. The exercises in these programs included bridging, single leg bridging, hip extension on hands and knees, fire hydrants, deadlifts, and single-leg squatting. In these studies, participants reported less pain after the course of treatment, demonstrated increased muscle strength, and returned to normal daily activities. (10,11) While there is no set exercise protocol established at this point, a strengthening program, with or without a home program, is a mainstay for treating this condition, and results in improved function.

 

Are there other treatments?

In some cases, physical therapy alone is unable to resolve the issue. In these situations, a patient may be given an injection of corticosteroids to decrease inflammation, in or around the SIJ. Prolotherapy is also sometimes used in this population to help reconstruct or regenerate damaged or weakened connective tissue. While it is helpful to know what other options are out there, it is important to note that the research in these areas is continuing to develop, and there is no consensus on dosage or who is the optimal candidate. (2)

 

Conclusion

The sacroiliac joint is a complex joint between the back and the pelvis, that allows for minimal mobility, and is required to maintain stability between the trunk and the legs. It can become painful due to direct or indirect trauma, which can have a significant impact on function and quality of life. While diagnosis can be tricky due to the wide variety of symptoms, research is finding that conservative care through physical therapy can make a significant difference by promoting optimal alignment and stability. If you or someone you know is struggling with sacroiliac joint dysfunction, make an appointment with a physical therapist today to help improve function. Feel free to contact our office at 212-354-2622, or visit our website (www.beyondbasicsphysicaltherapy.com) for more information!

 

 

Sources:

1. Ullrich, Peter F. “Sacroiliac Joint Anatomy.” Spine-Health, www.spine-health.com/conditions/spine-anatomy/sacroiliac-joint-anatomy.

2. Peebles R, Jonas CE. Sacroiliac joint dysfunction in the athlete: diagnosis and management. Current Sports Medicine Reports, vol. 16, no. 5, 2017, pp. 336-342.

3. “Diarthrodial Joint.” Biology Online, www.biology-online.org/dictionary/Diarthrodial_ joint.

4. Capobianco RA, Feeney DF, Jeffers JR, et al. Sacroiliac joint dysfunction patients exhibit altered movement strategies when performing a sit-to-stand task. The Spine Journal, 2018, DOI: https://doiorg/10.1016/j.spinee.2018.03.008.

5. Vleeming A, Stoeckart R, Volkers AC, et al. Relation between form and function in the sacroiliac joint. Part I: Clinical anatomical aspects. Spine, vol 15, 1990, pp. 130-132.

6. Vleeming A, Volkers AC, Snijders CJ, et al. Relation between form and function in the sacroiliac jt. Part II: Biomechanical aspects. Spine, vol 15, 1990, pp. 133-136.

7. Vleeming A, Schuenke MD, Masi AT, et al. The sacroiliac joint: an overview of its anatomy, function, and potential clinical implications. J Anat, vol 221, 2012, pp. 537-567.

8. Al-Subahi M, Alayat M, Alshehri MA, et al. The effectiveness of physiotherapy interventions for the sacroiliac joint dysfunction: a systematic review. J Phys Ther Sci, vol 29, 2017, pp. 1689-1694.

9. Albright J, Allman R, Bonfiglio RP, et al. Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Rehabilitation Interventions for Low Back Pain, Physical Therapy, vol 81, n 10, 2001, pp. 1641–1674.

10. Added MAN, de Freitas DG, Kasawara KT, et al. Strengthening the gluteus maximus in subjects with sacroiliac dysfunction. International Journal of Sports Phys Ther, vol 13, n 1, 2018, pp. 114-120.

11. Yoo WG. Effect of the single-leg, lateral oblique, decline squat exercise on sacroiliac joint pain with knee pain. J Phys Ther Sci, vol 28, 2016, pp. 2688-2689.

The Special Care Needs of the LGBTQ+ Community

Happy Pride Month!!!!

We are reposting an old post broadly discussing the LGBTQ+ community, with special focus on transgender individuals. Please keep checking back as we continue to discuss specific issues relating to the care of the LGBTQ+ community.  

Amy Stein PT, DPT and Fiona McMahon PT, DPT

rainbow flag

Who are LGBTQ+ individuals?

At Beyond Basics Physical Therapy, we have been meeting and studying with experts about the LGBTQ + community. LGBTQ+ refers to individuals who do not identify as heterosexual or do not identify as cis- gendered (although these two categories are not mutually exclusive). Cis-gender means you identify with the genital anatomy you were born with. People who belong to the LGBTQ+ community can be cis-gendered (meaning they identify with the genital anatomy that they were born with) and be gay/lesbian/ bisexual/ questioning etc.  They can be trans-gender and heterosexual or some combination thereof. Basically LGBTQ+ is a term that includes people who are not both cis-gender and heterosexual. LGBTQ+ is an acronym for lesbian, gay, bisexual, transgender, queer/questioning, and other individuals.  

Never Assume. Listen, Ask.

We were excited to understand and learn more about how we can help, specifically with patients experiencing pain or weakness in the pelvic floor. We met with an LGBTQ + advocate and he recommended the following when it comes to treating patients both within and outside the LGBTQ+ community.  First rule of thumb:  with all patients, don’t assume and be open to any questions or discussion. Ask if your patient would like you to stay away from certain terms regarding their anatomy, as well as their preferred gender pronoun. Use language that they want us to use.

 As with all patients, we need to use a biopsychosocial approach. With any patient, Richard Green at Bellevue hospital says that we always want to know exactly what is going on with our patient. We must subjectively understand why they are visiting us.  Has there been trauma, surgery, complications, or anything that has worsened their symptoms? What hormones and medications are they on? Don’t single anyone out. These questions are important for every patient.  

We want to get the medical and surgical history during or prior to the visit. There is no standard one surgical procedure or hormonal protocol in trans care. Hormones, either testosterone, estrogen, lupron, puberty blocking, testosterone suppressing can be used in many patients, but are also used specifically to aid in transition in transgender patients. Many hormones have consequences or side effects and our patients need be educated on the various options.  There is research on hormones and bodily changes, however there is no good research on how the hormones affect the pelvic region. Anti-estrogen hormones may result in vaginal drying and atrophy, more tissue tearing, and pain with penetration.  Endometriosis can be worsened with testosterone hormones.  Hormones can be administered via injection, pellets, patches, creams, gels, and pill form.  It’s important to realize side effects and risks of hormones for each patient. Dosage depends on body type, weight, previous surgeries, etc.  Hormone therapy can be given by a primary care provider or endocrinologist; however, many are not familiar with a specific protocol but at the same time each person may have different goals.  Progression of hormones can be monitored for each patient and according to patients wants and needs.  

For those who opt for surgical transition, it can result in pelvic pain and or weakness as organs are moved and or removed. Like we mentioned before, there is no one surgical protocol and it will vary from surgeon to surgeon, from changes in hormones from the removal of certain organs.  Knowing what tissues have been removed or moved and or where scar tissue could have been formed, is important to addressing a patient’s complaints. Also, it’s important to ask if the patient was having these symptoms or pain prior to any of the surgeries or hormonal medications. Surgical transition can take a long time with various surgeries and various symptoms that arise throughout. Some issues that  can occur are fistulas or fissures and when dealing with nerve implants there could be nerve damage and restrictions.

 

How is care for the LGBTQ+ community funded and regulated?

Medical coverage for the LGBTQ + community is non-regulated and different in each state. The Affordable Care Act, (ACA) covers some therapies and surgeries. You can try to appeal with each insurance which have their own policies on gender affirming care.

How can physical therapy help?

At Beyond Basics Physical Therapy, we specialize in abdomino-pelvic disorders, including pain, weakness, bladder, bowel and sexual dysfunction.  We also specialize in orthopedics and functional manual therapy.  We treat the LGBTQ+ community and we welcome any questions at desk@beyondbasicspt.com or call 212-354-2622. We are happy to help and look forward to hearing from you!
Resources: Center of excellence for transgender health.

WPATH center for care Endocrine Society

  • speaks on hormone therapy (however some information may be out of date).

 Adolescent Health Center

Pilates Tip: Supine Toe Taps

Kierstin Elliot, Pilates Instructor, BBPT

STT5toe tap

Exercise: Supine Toe Taps

Set up: Lying on back, imprint spine, legs in table top, arms resting by sides.

Execution: Inhale to start, exhale to hinge right leg down towards floor (about 45 degrees from hip) and then return back to table top. Repeat on left side, alternating for 8-10 reps. Start with minimal range of motion and then increase once you feel more confident with the exercise.

Focus: Lower abs. It’s imperative to go slowly with this exercise to ensure isolation of the abdomen. Focus on turning off the quads and hip flexors ( the muscles in the front of the legs) as they will want to take over. In addition, be careful that your pelvis doesn’t tip sideways or your back doesn’t arch. Initiate from the lowers abs.

Importance: One of the best exercises for lower abdominal strengthening. This exercise also enhances your ability to stabilize the pelvis and lower back, isolate lower abs, and hone in on the mind/body connection.

Modifications: For a challenge, try keeping legs together. Allow yourself to hinge downward for 4 seconds and then back up to table top for 4 seconds. To make it more accessible, try placing an inflatable cushion or disk under your sacrum. This prop will add increased awareness to lower back/pelvis region as well as adding support.

Joint Changes in Arthritis are Permanent, but Pain Does Not Have to Be

stick man

Fiona McMahon PT, DPT

May is arthritis awareness month. Arthritis can come in many different forms. It can be a result of wear and tear or it can be a response to an autoimmune condition. There are many different types of arthritis, but the fact remains that in all of these different types of arthritis, once the damage to the joint is done, it is done. Currently, we have no way of repairing the joint outside of joint replacement. You may be thinking, if the damage is done, why bother spending my precious time and money in physical therapy? The reason is that physical therapy and lifestyle management can make a huge difference towards reducing your pain, improving your function, and even preventing the progression of joint break down. Physical therapy has been proven to help reduce pain and increase function, and in many cases, avoid surgery.

Physical therapists are movement experts. It seems obvious that they should be the providers directly involved in restoring function to individuals with diseases of the joints. For both rheumatoid conditions as well as osteoarthritis, physical activity is considered the first line intervention for improving pain and function. This is not to say that exercise will replace disease modifying arthritis drugs (DMARDs) in cases of rheumatoid arthritis. It is saying treatment is not complete until you address the strength, pain, and range of motion problems that occur with arthritis.

Physical therapy will not change the conditions of joints that have been damaged by arthritis; however, physical therapy is paramount to improving the prognosis of arthritis by helping to improve the strength around the joint, range of motion, and stability of the joint to prevent further cartilage and joint break down. Physical therapy can also have a marked effect on the pain and function, and can open up your world to things that were once too painful. In a meta-analysis study conducted by Sampath and colleagues, two common physical therapy techniques, manual therapy (work on the joints) and exercise therapy were examined to assess the efficacy of these techniques on pain and function in individuals with arthritis. The study found strong evidence that exercise therapy and manual therapy were good at reducing pain and improving function in people with arthritis.

Physical therapy is so worth the investment. It is an investment in your comfort, the ability to do the things you love, and commonly helps people stave off needing a joint replacement. Full disclosure, I’m partial to our clinic, Beyond Basics Physical Therapy (understatement of the year, I know). What makes us so special is that we have the manual therapy, exercise and orthopedic experts. We all come from various orthopedic (joint and muscle PT) backgrounds including the Postural Restoration Institute (PRI) and the Institute of Physical Art (IPA) and many of us have earned advance orthopedic certifications such as the Certified Functional Manual Therapist (CFMT), Certified Orthopedic Specialist (OCS), and Postural Restoration Certification (PRC) distinctions. What this means is our therapists have the knowledge and skill set to go above and beyond the basics in our hour long treatments to treat you head to toe, improving the way your body moves and more importantly, how it feels. Click here to read more about the ins and outs of the CFMT certification and how it can take you to the a place of less pain and more function here.

Another thing to keep in mind is your weight. When it comes to management of arthritic conditions, additional pounds put additional stress on your joints and can hasten the progression of joint break down. Losing pounds can be a big task when your joints are not feeling their best. Your physical therapist can guide you through exercises that are efficient for weight loss and do not exacerbate your symptoms. We also can provide a valuable link to get you set up with proper nutritional support to help manage weight.

Once the damage is done by arthritis it is done; however, that does not mean you are condemned to pain, decrease function and continued deterioration. Get physical therapy today for pain relief and to get moving again!

We have two clinics. One in Midtown Manhattan and one Downtown. We also offer Pilates and personal training at our clinics, which can help get you back into an exercise routine.

Give us a call today to find out more:

212-354-2622 (Midtown)

212- 267-0240 (Downtown)

Heidari B, Rheumatoid Arthritis: Early diagnosis and treatment outcomes. J Capsian Internal Med. 2011: 2(1) 161-70

Hootman J, Murphy L, Omura J, et Al. Health care provider counselling for physical activity among adults with arthritis. Morbidity and Mortality Weekly Report. 2018; 66(51-52) 1398-1401

Sampath K, Mani R, Miyamori T, et al. The effect of manual therapy or exercise therapy or both in people with hip osteoarthritis: a systematic review and meta-analysis. Clinical Rehab. 2016; 3-(12) 1141-55

Wang Y, Lombard C, Hussain S, et al.Effect of a low-intensity, self-management lifestyle intervention on knee pain in community- based young to middle-aged rural women: a cluster randomised controlled trial. Arthritis Research & Therapy. 2018; 20(74)

What Pelvic Floor PT is and What it is Not

 

PelvicTrigger Warning: This piece briefly discusses sexual assault.

Fiona McMahon PT, DPT

Last summer, a reporter came to our office. This is usually not a tremendously unusual circumstance at Beyond Basics Physical Therapy. We often have reporters come to our office to research conditions like dyspareunia (painful vaginal intercourse), endometriosis, painful bladder syndrome/interstitial cystitis, prostatitis, and the many other conditions we treat. This time was different. This reporter was researching legitimate medically necessary pelvic floor physical therapy to put into context what was currently happening in USA gymnastics and the Larry Nassar story.

The Larry Nassar story rocked the pelvic floor world to our core. Larry Nassar was a USA Gymnastics Team physician who sexually abused girls for decades, under the guise of providing “pelvic floor treatment”. For those of us who have spent our lives promoting, educating, and treating both men and women with pelvic floor dysfunction, to see pelvic floor treatment perverted into a way to systematically abuse women and girls, it was truly heartbreaking.

We at Beyond Basics PT feel it is imperative to ensure that every patient knows his or her own rights and what to do if they feel uncomfortable. Although we are writing this in the context of pelvic floor physical therapy. Keep in mind, that much of what we talk about applies to interactions with other healthcare professionals.

Before we get started, let’s discuss why one might need to have their genital region examined in the course of physical therapy treatment. Pelvic floor dysfunction refers to a whole host of symptoms mainly felt in the pelvis, although they may appear in other parts of the body. These symptoms may include and are not limited to both male and female pelvic pain, urinary, bowel and sexual issues. Treatment may include external manipulation of the pelvic floor and genital region as well as manipulation of the pelvic floor muscles by inserting a gloved finger into the anus or the vagina. These techniques are used in combination with other osteopathic techniques to improve muscle length and strength, as well as reducing spasm within the pelvic floor and surrounding areas. To read more about what pelvic floor physical therapy is, click here. Pelvic floor physical therapy can be life changing when performed appropriately. It can allow an individual to go back to work or back to school, or the tolerance to sit on a plane to visit family, when doing so would have been too painful prior to physical therapy. It can allow an individual to have painless sex (male and female, same sex or opposite sex sex), and it can allow someone to regain continence who before was socially isolated. Pelvic floor physical therapy is a legitimate means of improving the health and quality of life of an individual. We will include peer reviewed articles below if you would like to read more.

Given the intimate nature of the treatment as well as the power dynamic that sometimes may exist between patient and clinician, it is important to discuss what rights you have as a patient in order to make yourself feel more comfortable. The following outlines your rights as a patient receiving any type of medical treatment.

Consent

When you step through the door of any medical office for the first time, you get handed what feels like fistfuls of paperwork. In that paperwork, there should always be a consent form. This form must be signed before you are treated, the exception being in medically emergent situations, when you become unconscious and consent is implied for life saving medical intervention.

Remember, just because you signed the form before treatment, doesn’t mean you consent to any and all treatment. You may always revoke your consent by saying you don’t want to participate in a procedure or intervention by saying so.

We want you to feel comfortable. If a treatment course makes you uncomfortable, tell us. Gritting your teeth and tolerating an uncomfortable treatment can sometimes do more harm than good. It is also appropriate to revoke consent to be treated if you are unsure why a treatment is being done or suspect it may not be necessary. Our jobs as clinicians are not only to treat but to educate. If you don’t know why we are doing a certain technique, we need to take time to educate you in order to do our job correctly. Revoking consent can be as simple as telling your practitioner you do not want to engage in a certain activity. Practitioners may take time to explain why they feel that intervention is necessary; however they should never make you feel ashamed for revoking consent. Remember, you are not in the clinic to please us. You are there for yourself. To get better. That is it.

Even if you truly need a pelvic floor treatment, often times there are other parts of the body that should be addressed to aid in certain pelvic conditions. Skilled practitioners can delay pelvic floor treatment by treating other parts of the body until you are ready. This can often be done while still maintaining forward progress.

Chaperone

Chaperones are individuals who accompany you to medical and physical therapy exams and treatments. If having a chaperone attend a visit or visits would make you more comfortable, you should be allowed to bring one. You should be able to bring a family members, or a friend into treatment. If you don’t have someone to fill this role, you can ask the facility to supply you with one, (usually asking ahead of time will ensure a staff member is available). In very few cases, such as surgery or trauma interventions, is it appropriate for a patient to be denied a chaperone if he or she requests it.

Second Opinion

What if your clinician gives you a diagnosis or suggests a treatment that doesn’t sound right? This is where a second opinion really comes in handy. Getting a second opinion is not “cheating” on your doctor, it can allow you to explore other options or be more confident in your original provider’s course of action.

Respect and Comfort

Feeling respected by your clinician is essential to healing . If you feel that you are not getting the respect you deserve or even if you are not connecting with clinician for whatever reason, you have the right to change clinicians. You don’t have to feel obligated to explain why you are changing clinicians if you don’t want to. Most healthcare providers realize that we might not have the right clinician for every person, and we are trained to not take it personally. It is okay to put yourself first.

Red Flags in Pelvic Floor Physical Therapy

  1. Feeling coerced, bullied, or shamed into a pelvic floor treatment
  2. Therapist does not wear gloves for treatment
  3. Therapist insists on not allowing chaperone
  4. Therapist fails to offer adequate reason for treating the pelvic floor
  5. Therapist is not licensed
  6. You therapist acts in a way to make you feel unsafe or uncomfortable

The truth is, there are so many wonderful physical therapists out there who treat the pelvic floor. Being a physical therapist is one of the greatest jobs in the world, because we get to help people do things that before were difficult or impossible. Pelvic floor physical therapy changes lives. We sincerely hope this article helps you feel empowered to go to physical therapy and know what your rights are and what to expect.

Further reading on pelvic pain:

Association

International Pelvic Pain Society: www.pelvicpain.org

International Society of the Study of Women’s Sexual Health: www.isswsh.org

 

Books

Heal Pelvic Pain

By: Amy Stein DPT

http://www.healpelvicpain.com/

Healing Pelvic and Abdominal Pain DVD

By: Amy Stein DPT

http://www.healpelvicpain.com/

When Sex Hurts

By: Andrew Goldstein, MD and Caroline Pukall, PhD

Healing Painful Sex

By: Deborah Coady, MD and Nancy Fish, PhD

 

Scholarly Articles

Anderson R, Wise D, Sawyer T. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-60

Anderson R, Sawyer T, Wise D, Morey A. Painful myofascial trigger points and pain sites in men with chronic prostatitis/ chronic pelvis pain syndrome. The Journal of Urology, 182;6 2753-58

Fitzgerald M, Kotarinos R. Rehabilitation of the short pelvic floor. I: Background and patient evaluation. Int Urogynecol J 2003; 14:261-8

Fitzgerald M, Kotarinos R. Rehabilitation of the short pelvic floor. II: Treatment of patient with the short pelvic floor. Int Urogynecol J 2003;14: 269-72

King H. Manual Therapy May benefit women with interstitial cystitis and pelvic floor pain. J Am Osteopath Assoc. 2013;(113)4: 350-61

Morin M. Bergeron S. Pelvic floor rehabilitation in the treatment of dyspareunia in women. Sexologies. 2009; 18:91-4

Shafik A, Shafik I. Overactive bladder inhibition in response to pelvic floor muscle exercises. World J Urol. 2003 May; 20(6):347-7. Epub. Apr 4

Wurn B, Wurn L, Patterson K. Decreasing dyspareunia and dysmenorrhea in women with endometriosis via a manual therapy: results from two independent studies. 2011;3(4)

Neutral Pelvis and Its Importance

Kierstin Elliott, Pilates Rehab Instructor at Beyond Basics Physical Therapy

Amy on Reformer

Our spines are comprised of three natural curves that resemble an “S” shape. The first curve presenting itself in the neck, the second in the middle back, and the third in the lower back.

1. Cervical spine (lordosis)

2. Thoracic spine (kyphosis)

3. Lumbar spine (lordosis)

The “S” pattern allows our spine to act as a shock absorber whenever we stand, walk, jump, or sit. It also provides our bodies with a posture that is most ideal for everyday movement and function.

The main support our spine receives to maintain this position comes from our core. Our core is comprised of various layered muscles. The deeper muscles include the Transverses Abdominis (TA), the Diaphragm, the Pelvic Floor, and the *Multifidus. The more superficial muscles include the Internal and External Obliques and the Rectus Abdominis (aka your “6 pack”). A strong core leads to good posture, stability, efficient breathe, and a proper functioning pelvic floor.

The easiest way to find neutral pelvis is to lie on your back with your knees bent, feet flat, legs hip distance apart, and arms resting my your sides. Imagine the back of the pelvis, specifically your sacrum (the broad bone in your lower back), flat on the mat. Let your tailbone drop slightly away from you. You should notice that the lumbar curve in your lower back is present and that there’s a small space between your lower back and the mat. In the front, your hip bones should be completely level creating a flat surface between your ASIS (hip bones) and pubic bone. This is neutral pelvis!

A couple key factors to note:

1. The TA should be engaged and can be felt as a slight hug wrapped around your waist.

2. You should not feel any strain in your back while in neutral spine.

Establishing a neutral pelvis allows us to lay the foundation to build core strength properly. Only with a stable base and correct alignment are we able to move from a functional position. We can go about our active daily lives and withstand minor accidents without injury simply because our spines are operating from the most optimal alignment. Similar to the structure of a house. If there’s no solid foundation, how can we expect an entire house to support its’ frame and be functional on a daily basis, let alone during a thunderstorm or an earthquake?

Feel free to navigate this position on your own. Explore how your pelvis can rock back and forth and side to side while noticing its’ effect on the curvature of your spine.

If you’d like to find your neutral pelvis and learn more about the correct alignment for a functional spine, please book a pilates session with me at Beyond Basics Physical Therapy!

*Fun fact about the Multifidus: it defies the rules most muscles follow. Usually when a muscle stretches or lengthens, it loses strength. The Multifidus, however, gets stronger as it stretches. This property allows these little intrinsic muscles to bend and move with the spine while at the same time provide strength and support.

 

 

PH101: Potty Issues with Kiddos

Fiona McMahon PT, DPT

Did you know kids can suffer from pelvic floor dysfunction too? Pelvic floor dysfunction in children can result in pain, bladder holding or constipation, embarrassing soiling accidents, frequent nighttime accidents, as well as trouble going potty. For most kids, there is an underlying physical component that needs to be addressed by an expert pediatric pelvic floor physical therapist.

It is very upsetting for a parent, guardian or caregiver to see a child suffer with pain or embarrassment, but there is so much that can be done to help out children with these issues. We use positive charts to develop short term and achievable goals to reinforce  behaviors and steps towards healthy toileting. Simple techniques like improving toilet posture, practicing deep breathing with bubbles, using a timer to assist in times voiding, educating the parent/guardian/caregiver on the colon massage, developing a core stability and stretching program, and more can go a long way towards improving bowel and bladder symptoms.

If your child is suffering from urinary or fecal accidents, bed wetting, skidmarks, or painful defecation, join me on  May 2nd at 7pm , to discuss pelvic floor dysfunction in children, common conditions affecting pottying, and practical tips you can use to make potty time easier.

This is our last Pelvic Health 101 class of the spring series. We want to thank for an awesome season! Keep your eyes on the blog for the Fall’s PH101 classes!

RSVP here

 

To Learn More Today, Check out our other blogs on the pediatric pelvic floor!

The Scoop When Kids Have Trouble with Poop

Pediatric Bowel Part II: How to Make Pooping Easier for your Kiddo

Pelvic Health 101 Spring 2018 (2)