Yoga for Chronic Pelvic Pain

crop faceless lady sitting in zen pose on yoga mat
Photo by Karolina Grabowska on Pexels.com

Kathryn Ahuja PT, DPT RYT200

Patients with chronic pelvic pain (CPP) often ask, “Is there anything else I can do?” They have often been living with pain for a long time and are eager to feel better as quickly as possible. The truth is that there is no fast lane to healing CPP. Healing should integrate the biomechanical, psychological, and social factors, which can all play a part in your symptoms. Yoga can be a very effective way to address each of these players and move you towards increased freedom and function.

Biomechanical factors: How can yoga help?

Previous blog posts,Pelvic Pain Awareness Month Part 1: What is Pelvic Pain  and Pelvic Pain Awareness Month: Part 2: Hope for Chronic Pelvic Pain  have discussed how the muscles of your pelvic floor can lead to CPP. If you have lived with pain in the pelvis, genitals, reproductive and urinary organs, coccyx, or pubic bones for a long time, the pain can alter the way you move in everyday life. People with CPP tend to be less active than their peers, have altered postures, (usually with a more posteriorly tilted pelvis (a tucked tail bone) and an increased thoracic kyphosis (hunch in upper spine), and they tend to adopt ways of sitting or standing that is protective of their painful spots (Zhang 2015). It makes sense! Pain in this area of the body makes us just want to curl up in a ball and stay there!

Being curled up like a cashew all day has a real influence on your pain. Our bodies are designed to move and when we stay in one place for a long time our joints get stiff, blood flow to and from our tissues is impaired, and the muscles that should help us stand tall become weak and tight. It can become difficult to actually differentiate the pain that is coming from your pelvic floor and the discomfort you may feel because of the adaptations you have made because of this pain.

Practicing yoga poses called asanas is an effective, safe way to get you moving again. Standing poses like warrior II (Virabhadrasana II) and crescent lunge (Anjaneyasana) simultaneously lengthen and strengthen the muscles of your legs and hips. When these muscles regain their function, it can help your pelvic floor muscles to back off any chronic holding patterns. Backward bends like cobra (Bhujangasana) or camel pose (Ustrasana) help restore the natural curves of your spine while lengthening any tension in the abdominal muscles. This may make it a little easier to keep your body in an upright posture throughout your day. Supine stretches like butterfly (Baddha Konasana) or happy baby (Ananda Balasana) can help ease tension in the muscles of the inner thighs (adductors) while you are supported by the floor. When these muscles relax, there can be a noticeable reduction in pain since trigger points in the adductors can refer to the genitals and pubic bone.

In a study performed in India, 30 women who attended a 1-hour yoga class five times weekly for eight weeks saw significant reduction in their pelvic pain ratings compared to the start of the intervention. These women also showed a significant reduction in pain scores compared to women who only took NSAIDS for pain relief over the same time. The researchers theorized that the intervention was effective not only due to the effects of the stretching and strengthening, but also because of the relaxation exercises which “modify neurological pain perception which could be the mechanism for pain reduction” (Saxena, 2017). This research suggests that yoga is doing something more than addressing the muscles. It may actually change the brains of those who practice.

Psychological factors: How can yoga help?

Ask any regular yogi and they will tell you that there is much more to the practice than just the asanas. It turns out, there is some really interesting science behind the feel good vibes you might experience after a yoga class.

Yoga is different from many other forms of exercise because there is an intentional focus on your breath. In Hindu philosophy, prana means not only breath, but “life force.” It is believed that one’s breath has tremendous power and in performing pranayama (breathing exercises) we can strengthen and harness that energy. Today, we understand that breathing does more for our bodies than move air in and out and we have even greater appreciation for this ancient philosophy.

You are probably familiar with the idea that slow, deep breathing can help to calm you down. The mechanism that drives this response is called the parasympathetic nervous system (PNS). Deep, slow breathing sends a message to your brain that you are not under a direct threat. The PNS then works to shift you out of “fight or flight” mode and into a calmer, more peaceful state. If you have CPP, your body might live in a constant state of fight or flight. Pranayama exercises have been shown to help quiet those signals and strengthen the signals from your PNS. With a consistent practice of slow, deep breathing you can actually shift your whole body towards a parasympathetic dominant state (Gerritsen, 2018).

Depression and anxiety are common comorbidities for people with CPP. Yoga can help to shift your mood which may also have an effect on your perceived pain. A randomized control trial evaluated the levels of a neurotransmitter called GABA in people with Major Depressive Disorder (MDD) and in a healthy control group. GABA is an inhibitory neurotransmitter that helps to regulate important cortical functions including mood. When compared to the control group, those with MDD had significantly lower levels of brain GABA. After completing a 12-week yoga program however, there was no difference in these levels between groups. Even more importantly depressive symptoms decreased significantly in the MDD group and anxiety levels improved for both groups (Streeter, 2018).

These stunning changes do not seem to be attributable to all forms of exercise. In comparison to people who walked for one hour, those who did yoga for the same amount of time had greater increases in GABA as well as improvements in mood scores (Streeter, 2010). While this study was small, it makes a great case for future research to determine if yoga may be a suitable alternative to medication for those with serious anxiety or depression.

Social factors: how can yoga help?

Persistent pain can have a profound effect on how you interact with the world. Symptoms of CPP are not visible to others and we tend to not talk about them with most friends and colleagues. Throbbing, aching, and stinging sensations can make you more irritable, less willing to put on certain clothing, or cause you to avoid aggravating activities. This can put a real strain on all your relationships. Emotional distress from fraying relationships can be difficult to manage when you are trying to heal and could even stress you to the point of making your symptoms worse.

If you are limited in your daily functions or feel that your quality of life suffers due to CPP symptoms, there is evidence to support using yoga to intervene. Women with pelvic pain had improved emotional well being and sexual function scores after a 6-week yoga course consisting of about 3 hours of yoga per week. At the end of the program, 75% of the participants indicated they felt the yoga program was something they could continue to do without guidance (Huang, 2017). It can be quite empowering to feel like you have control of your symptoms and are not reliant on a doctor or PT to “fix” you. Additionally, a yoga class can be a nice way to socialize while doing something positive for your body.

Yoga may not totally eliminate the pain you feel, but it may help you to manage your symptoms more elegantly. Breathing techniques can assist when symptoms strike at work. Mindfulness about your body can help you determine when it is appropriate to push yourself and when you need to rest. Mastering a tricky posture is very rewarding and may encourage you to open up to other novel challenges.

Ready to give it a try?

As with all new forms of exercise, if you are looking to try yoga for CPP you should seek out a class with a knowledgeable instructor who can offer modifications and cue your alignment appropriately. Start slow and never be afraid to ask your teacher a question if something does not feel right in your body. At first, the hardest part might just be learning to be still and breathe deeply: that’s ok, and it will get easier!

Please consider joining me for our virtual yoga class every Tuesday at 7pm. Click here

for more details.

References

Gerritsen RJS, Band GPH. Breath of Life: The Respiratory Vagal Stimulation Model of Contemplative Activity. Front Hum Neurosci. 2018;12:397. Published 2018 Oct 9. doi:10.3389/fnhum.2018.00397

Huang AJ, Rowen TS, Abercrombie P, et al. Development and Feasibility of a Group-Based Therapeutic Yoga Program for Women with Chronic Pelvic Pain. Pain Med. 2017;18(10):1864‐1872. doi:10.1093/pm/pnw306

Saxena R, Gupta M, Shankar N, Jain S, Saxena A. Effects of yogic intervention on pain scores and quality of life in females with chronic pelvic pain. Int J Yoga 2017;10:9-15

Streeter C, Gerbag P, Nielsen G, Brown R, Jensen JE and Marisa Silveri. The Effects of Yoga on Thalamic Gamma-Aminobutyric Acid, Mood and Depression: Analysis of Two Randomized Controlled Trials. Neuropsychiatry Journ. 2018;8(6).

Streeter CC, Whitfield TH, Owen L, et al. Effects of yoga versus walking on mood, anxiety, and brain GABA levels: a randomized controlled MRS study. J Altern Complement Med. 2010;16(11):1145‐1152. doi:10.1089/acm.2010.000

Zhang R, Chomistek AK, Dimitrakoff JD, et al. Physical activity and chronic prostatitis/chronic pelvic pain syndrome. Med Sci Sports Exerc. 2015;47(4):757‐764. doi:10.1249/MSS.0000000000000472

Pelvic Floor Physical Therapy for the Transgender and Gender Diverse Population

Photo by Steve Johnson on Pexels.com

By Molly Caughlan, PT, DPT (pronouns: she/her/hers)

Healthcare equality for the LGBTQ+ community is one area we as a society are significantly behind on and continues to require research, education, and training. For many, access to compassionate healthcare can be challenging, especially to those within the transgender/gender diverse population. According to a survey done by Lambda Legal, 52% of transgender respondents reported that they believed they would be completely denied medical services because of their gender status. They also found that 56% of lesbian, gay, or bisexual persons surveyed have experienced some type of discrimination in healthcare leaving many to avoid seeking treatment altogether.

As healthcare providers, we, at Beyond Basics Physical Therapy, understand the importance of cultural competence and strive to live up to the standards that the LGBTQ+ community deserves. Our goal is to ensure that every patient is provided with the highest quality of care, dignity, and respect. We strive to create a safe environment for patients and aim to deliver health care services with the specific needs of the patient in mind.

What Does a Physical Therapist Do?

At our core, physical therapists are MOVEMENT SPECIALISTS. We use a wide range of evaluative tools to assess how the systems of the body work together. We provide treatment to prevent, minimize, or eliminate impairments in order to optimize physical function. This includes restoration after injury, pain relief, maintenance of current function, and promotion of health.

Components of a Physical Therapy Evaluation

•        Self-report questionnaires

•        Posture and alignment in various positions

•        Breathing patterns

•        Range of motion and strength in relevant parts of the body

•        Functional movements – walking, getting in and out of chairs, in and out of bed and with any type of exercise 

•        Palpation of muscles in back, abdomen, pelvis, and lower extremity

(palpation is a fancy word for feeling parts of the body to assess for restrictions and tightness)

•        Goal setting – determine personal goals for coming to physical therapy

(How can we use the information from the evaluation to best help you meet your goals?)

What is Pelvic Floor Physical Therapy?

Pelvic Floor Physical Therapists receive special training to assess the pelvic floor muscles and abdominal organ mobility in conjunction with the other components of a standard physical therapy evaluation. This enables them to treat a variety of diagnoses including bowel, bladder, sexual problems, as well as prolapse, abdominal pain, back pain/pelvic pain, genital pain and more. We are experts in the areas associated with the pelvis, including vulvar and vaginal, penile and scrotal, and colorectal regions.

Pelvic Floor Muscle Anatomy

The pelvic floor is a sling of muscles that connect from the pubic bone to the tailbone and lives in the pelvis. They are responsible for providing the following 5 major functions:

  1. Stability: they work with the hip and core muscles to control movement in the pelvis
  2. Support: the “hammock” like muscle group holds and supports the abdominal organs (i.e. reproductive organs, bladder, bowel)
  3. Sphincteric: this function gives control to “open” (i.e. urinate or have a bowel movement) and stay “closed” (i.e. avoiding pee/poo accidents)
  4. Sexual: the muscles stretch to allow for receptive vaginal or anal intercourse; they also are what contract with orgasm
  5. Sump Pump: the muscle contract to move blood from the pelvis on its way to the heart

How can Pelvic Floor Physical Therapy help me?

If you have a pelvis, you may encounter issues with bowel, bladder, or sexual function. Although we specialize in pelvic floor treatment, it’s important to note that we treat the person as a whole and strive to understand the complexity of the many systems of the body work together.

There are also a number of common complications that accompany gender affirmation practices and surgeries that can be relieved through physical therapy. Since bottom surgeries drastically change the anatomy, there is an impact on the ability of the pelvic floor muscles to work properly. There are also many other post-operative considerations such as dilation (for neo-vaginoplasties), wound care/scar tissue management, and relearning toileting behavior with new anatomy. All of these considerations can be addressed and aided through pelvic floor physical therapy. Other procedures such as mastectomy or breast augmentation also create changes to the muscles of the chest as well as lymph vessels  and require the help of a physical therapist to ensure your body is able to function properly with that change. Practices such as binding or tucking come with their own set of complications, which can be minimized with a skilled physical therapist.  We understand how important these activities are and don’t want to make you stop, rather we want to help encourage good habits and help minimize any negative side-effects you may experience as a result.

Still unsure if we can help your specific needs after reading this article? At Beyond Basics, we offer free 15-minute phone consultations to ask us more specific questions. Give us a call to see how best we can help you today!


[1] https://www.lambdalegal.org/sites/default/files/publications/downloads/whcic-report_when-health-care-isnt-caring_1.pd

Do I have Pelvic Congestion Syndrome?

 

aerial photo of vehicles in the city
Photo by VisionPic .net on Pexels.com

Eliza Etter PT, DPT, CLT

Do you ever notice at the end of the day your feet or ankles seem swollen? If you were on your feet for a long portion of the day, your feet, ankles, and legs may feel achy or heavy. This is not an uncommon experience and most of us have probably felt this at some point in our lives. But have you ever felt a similar sensation in your pelvis? If so, it could be related to something called Pelvic Congestion Syndrome.

What is Pelvic Congestion Syndrome?

Pelvic Congestion Syndrome (PCS) is essentially varicose veins in the pelvic region. There are several large veins coursing through the pelvis and around the pelvic organs. These veins can become “incompetent” meaning that they are no longer pumping blood back up towards the heart as effectively as they should. As a result, the blood begins to pool in these veins of the pelvis, termed “pelvic congestion.”

Symptoms of PCS often include chronic pelvic pain not associated with menstruation or a heaviness feeling in the pelvis which may frequently worsen with prolonged standing. PCS also has been found to have associations with painful periods, pain with sex, urinary urgency, and varicosities in the genitals or legs. A systematic study conducted in 2018 found that PCS was associated with pelvic pain in 30-40% of individuals with chronic pelvic pain diagnoses. The majority of the current literature describes PCS in women, with the prevalence increased in women compared to men, at least in part, due to hormonal changes and pregnancy.

What causes Pelvic Congestion Syndrome?

Similarly, to varicose veins of the legs, there are a number of factors that contribute to PCS.

These include:

· Dysfunction in the valves of the veins – These valves inside the veins are supposed to allow blood to travel only in the direction back to the heart, but can become weak and allow some of the blood to flow backwards.

· Anatomy differences in the veins themselves

· Pressure or kinking on the veins – One of the ways this can occur is from the position of the uterus.

· Structural and hormonal changes – These types of changes are often associated with pregnancy.

It is possible that pelvic varicosities may be present for a period of time without any pain or symptoms at all. Slower flow of blood return, inflammation, blood clots and insufficiency can be the result of pelvic varicosities that were possibly already present, but are just now starting to cause pain or symptoms.

How do I know if I have Pelvic Congestion Syndrome?

To be diagnosed with PCS requires medical imaging, such as pelvic venography, ultrasound, or MRI. However, based on your symptoms alone there are things that you can do that may give you some relief from your symptoms.

Tips to Help Relieve Symptoms of Pelvic Congestion Syndrome:

· Stay moving! Sitting or standing in one position for too long can increase the pooling of blood in the veins. When you move, the movement of your muscles assists the veins in pumping blood upward and towards the heart.

· Stay hydrated and eat a low-sodium diet. This can help with decreasing swelling and inflammation throughout your body which can overload your venous system.

· Elevate your pelvis. Just as you would elevate your feet if they were swollen, elevating your pelvis will use gravity as your friend to assist the veins with returning the blood from your pelvis back towards your heart.

· Pelvic floor exercises. Pumping the muscles in your calves can help decrease swelling in the feet and legs, and similarly contracting and relaxing the pelvic floor muscles can help pump the blood out of the pelvis. Not sure how to do this? Contact your pelvic health PT.

· Manual Lymphatic Drainage Massage. This is a particular type of skilled manual therapy that helps to stimulate the lymph vessels, which run along with and help the veins, that further assists and decreases the load on the veins, with moving the excess blood out of the pelvis and returning it towards the heart. Contact your Certified Lymphedema Therapist for this treatment.

For further information and non-invasive treatment options contact a Pelvic Health or Lymphedema therapist who has experience with Pelvic Congestion.

Brown et al. “Pelvic Congestion Syndrome: Systematic Review of Treatment Success.” Seminars in Interventional Radiology, 35.1 (2018): 35–40.

Jurga-Karwacka et al. “A forgotten disease: Pelvic congestion syndrome as a cause of chronic lower abdominal pain.” PLOS One, 14.4 (2019): e0213834.

Telehealth: Physical Therapy from Home

man having a video call on his phone
Photo by Edward Jenner on Pexels.com

Rachel Clausen PT, DPT

Pelvic pain doesn’t stop because of a pandemic. Beyond Basics Physical Therapy wants to make sure you have access to the care you need to stay healthy and feeling good in your body. If you are unable to leave your home because of coronavirus, we want you to know we are currently offering telehealth to new and existing patients who are in need of care.

So what is telehealth you may ask?

Telehealth is the use of telecommunication technologies to provide remote healthcare services. Both audio and video technologies are used to evaluate and treat patients who are unable to attend an in-person appointment, like a video chat or facetime. After extensive research, Beyond Basics has decided to use Doxy.me as our telehealth platform. This platform is easy to use, does not require downloads, and is HIPPA compliant, meaning the sessions are fully protected and encrypted. Telehealth is also now accepted by a wide range of insurance companies, including Medicare.

You may be thinking, what can a PT do without being able to touch me?

The answer is a lot! We can assess posture, mobility, movement strategies, coordination, prescribe and progress exercises, assess work from home set-ups, provide pain relief strategies, discuss behavioral modifications, work on breathing and system down-training, and the list goes on. Even if you feel that eventually you may need hands on treatment in clinic, telehealth can go a long way towards providing a sturdy foundation of strength, mobility, and good postural habits and strategies to allow hands on treatment to take hold more rapidly when you can come in.

As a PT I have found it especially helpful to be able to work with patients in their home environment. We are able to recreate positions in which you experience pain and work through modifications to decrease that pain. We can work on sitting posture and workstation ergonomics using the desk and chair you spend hours each day using. We can work on movement strategies in your environment, such as emptying the dishwasher or picking up a child in order to optimize core activation and decrease symptoms with functional activities. It is exciting to see patients continue to make progress towards reaching their goals despite being home without physical PT contact.

Are you interested in telehealth, but not sure you have the necessary equipment?

All you need for a telehealth session is a computer or phone, internet connection, and enough room to move around and lay down on the floor. Other helpful (but not necessary) items may include TheraBand, foam roller, balls, weights and yoga blocks. Don’t have any of these items? Don’t worry, PTs are great at being creative and using household items as props. Don’t have a foam roller? We can use a rolling pin or a bottle of wine to roll out tight muscles. Don’t have a yoga block? We can use books or pillows as props. Don’t have any weights? We can use soup cans or a bag of rice. Getting creative is part of the fun!

How does billing work?

Most likely, your current billing will not change, as many insurances are covering telehealth physical therapy sessions. However, for some plans, reimbursement rates may be different for telehealth services. All billing will be continued to be submitted by our staff. We are currently offering discounted rates and packages in order to serve our community at this time.

Please contact billing@beyondbasicspt.com for further billing information and clarification.

If you are interested in a telehealth PT session please contact our midtown office at (212) 354-2622 or downtown office at (212) 267-0240 to make an appointment or if you are uncertain if telehealth will work for you, we are offering a free 15 minute consult for a limited period of time. We are also continuing to offer in office appointments for those who would prefer them.

 

We look forward to helping you reach your goals and returning to the activities you love, symptom free!

Pelvic Pain Awareness Month: Part 2: Hope for Chronic Pelvic Pain

Mayis PelvicPainAwarenessmonth

Welcome back! In part 1 of this blog we discussed how pelvic pain can affect anyone, regardless of their age or gender. We also discussed that pelvic pain can feel many different ways and may occur in different body locations and be triggered by different activities. Now that we have the basics under our belt, we can march forward and start to explore different ways to manage and treat pelvic pain.

First steps

Now that you have a name for what you are experiencing, it is important to get a handle on the various characteristics of the pain you are experiencing. This information will provide valuable insights to the clinicians who are treating you. Some questions to think about include:

  • How long has this pain been going on?
    • Chronic pelvic pain is classified as pain that has gone on for 3 or more months, this type of pain likely has musculoskeletal involvement and will likely require the help of a pelvic floor physical therapist in addition to medical intervention
    • Also try and think if there were any significant events around the time of your symptoms onset; these events may be physical like spraining an ankle or emotional, like moving or starting a new job
  • What makes it worse and what makes it better?
    • Sometimes you won’t know and that’s ok too.
  • Where is the pain?
  • What does the pain feel like?
    • Describing the character of pain can be really tricky. Here are some words we hear a lot
      • Burning
      • Itching
      • Stabbing
      • Buzzingwork
      • Aching
      • Gnawing
      • Sharp, Shooting
      • Dull
      • Tingling/numbness

Now that you have this information, it’s time to make an appointment with a doctor, who ideally has experience in treating pelvic pain. Your doctor will work to determine if there are any immediate medical concerns that require treatment. It is important to be patient when starting this step. Usually it is not immediately clear on exactly what is causing your pain, especially if it has been going on for some time. Usually chronic pelvic pain is caused by more than one system (i.e it could be a bit digestive and also a bit musculoskeletal). That is why your first visit with a clinician is typically just a jumping off point.

Next Steps

After your initial appointment you may have a referral in hand to see a specialist. Specialities that treat pelvic pain include:

  • Colorectal
  • Gastroenterology
  • Gynecology
  • Physical therapy
  • Physiatry
  • Psychiatry
  • Psychology
  • Neurology
  • Urology
  • Urogynecology

It is important to visit a clinician who specializes in pelvic pain, considering it is a very specialized topic, and unless a clinician has an interest in it, their exposure to pelvic pain may be limited.

The next two pieces of advice I am about to give may seem mutually exclusive, but hear me out. Trust your gut, but also be patient with the process. For chronic pelvic pain, it takes some time to see improvement. Think about it, you’ve had this pain for a very long time, it will take a while to improve. In physical therapy, we expect our patients to see some improvement in 4-6 weeks, and similar timeframes can be expected for other types of interventions. That said, if you feel like the clinician you are seeing is dismissing you or not taking your complaints seriously, that is important. A colleague of mine, who I adore, tells her patients “who knows your body better than you?”. The answer is no one. If you think something is wrong, it is your right to be taken seriously.

First Steps in Treatment

There are steps you can take to start addressing your pain almost immediately. I discuss some of them in this blog. Getting a handle on your stress is really important when dealing with chronic pelvic pain ( I am currently writing this during a global pandemic, so I do recognize this is much easier said than done). This is important because chronic stress can cause the pelvic floor to tighten which can exacerbate pain issues. It is important also to recognize that despite anxiety and stress being strong contributors, pelvic pain is not in your head and your symptoms are real.

It also may be worth your while to experiment with gentle heat or cold. A warm bath or hot pack or cold pack can be helpful. Just make sure to put plenty of layers between you and the cold/ hot pack.

Professional Interventions

Address your muscles. Yes, we are a PT clinic and we will always say muscles are important, but the truth is, with chronic pelvic pain, muscles spasm/tightness is involved in most cases of pain. For those of us on lockdown, physical therapy is still accessible and considered essential. Beyond Basics offers both in person and telehealth appointments to guide you on your way.

A trained pelvic floor physical therapist can help to teach you exercises to do on your own to manage pain, release muscle tightness, and correct poor postures and overuse patterns that may have contributed to your pain in the first place.

Depending on your diagnosis you may see other medical specialities who will prescribe medicine, injections, or surgery in some cases, like endometriosis. You may also be referred to a nutritionist, acupuncturist, or mental health therapist as well. Like I mentioned earlier, typically pelvic pain can have many different contributing factors so it is really important to have a team and to make sure your team is communicating well together.

Although pelvic pain can be massively disruptive and upsetting, that fact is people can get better. Have hope, trust your gut, and reach out if you need us.

Beyond Basics Physical Therapy

212-354-2622

How to find a physician familiar with pelvic pain:

International Pelvic Pain Society, Interstitial Cystitis Association

Bonder J, Chi M, Rispoli L. Myofascial pelvic pain disorders. Phys Med Rehabil Clin N Am

. 2017 28(3), 501-15

Speer L, Mushkbar S, Erbele T. Chronic pain in women. Am Fam Physician. 2016 1;93(5):380-7

Van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion- inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12 (5) 328-31

Hope with Pelvic Pain: A Patient’s Story

The writer of this blog and patient and wishes to remain anonymous.

flower
I am a 65-year-old married professional male who resides in NYC. About a year ago, I woke up with pelvic pain and I assumed it was a urinary infection. Immediately I went to my urologist, who gave me a urine test which showed a slightly elevated white blood cell count and was given antibiotics for two weeks. Despite this treatment, the pain continued and I went for another test, which was negative.  I was told I had an inflamed prostate and to avoid spices and caffeine. This pain was so severe and constant that it affected all my daily life activities. Even painkillers, which I took for a short duration, could not relieve the pain.
Having performed my own internet research, for the better or worse, I came across several blogs on how pain sufferers had these similar symptoms that remained unresolved for years. The majority of these blogs focused on the perineal nerve, which I thought could be my issue. Therefore, I then went to a neurologist who claimed this was not the problem and then had other nerve blocks without any relief. Neither the urologist, neurologist, or general practitioners could offer any explanation.
Then, going back to the internet I found the keyword “pelvic pain”, which unlocked this pain mystery with services offered by only a handful of providers. The explanation was that rather than having headaches or backaches from stress, I was tightening my pelvic floor muscles thus creating pain.
After reviewing the few physical therapy sites I decided to try Beyond Basics for a discussion, evaluation, and treatment. I was able to schedule an appointment right away without needing a prescription from a physician. At my first session, I explained that I lacked the hope that this problem would ever be resolved, but that I would be committed to their program.
Now after almost two months of weekly sessions, my Physical Therapist has led me on a road to holistic recovery guided by exercises, massage, education, and emotional support.  I understand that the scale of pain relief will be a roller coaster, but now for the first time, I can relax when there are dips in pain.
I want to conclude my first blog by saying that my Beyond Basics PT has given me “hope” by defining the problem and offering a solution with life lessons on how to deal with this issue that is unknown to so many people.
It has been a few weeks in which I have no pain, feel fully recovered and I am back to appreciating life.

Anonymous

 

If you have questions about orthopedic, pelvic, or sports physical therapy, BBPT is offering free phone consults to those living in the greater NYC area for a limited amount of time!

Beyond Basics Physical Therapy

212-354-2622 (42nd Street Location)

212-267-0240 (William Street Location)

 

 

Pelvic Pain Awareness Month Part 1: What is Pelvic Pain

Beyond Basics remains open and is offering both in person and telehealth appointments. Call 212-354-2622 for our midtown office and 212-267-0240 for our downtown office to learn more

Mayis PelvicPainAwarenessmonth

Fiona McMahon PT, DPT

I don’t need to write it out. You’ve already heard it. But I will write it anyway. These are uncertain times. This May, much like March and April, is shaping up to be a May that is very different than ones we’ve ever experienced before. That said, life still marches on. May is Pelvic Pain Awareness month and it seems appropriate to take some time to recognize those who are dealing with pelvic pain as well as spread awareness to what it is and how we can make it better… even in these uncertain times.

What is Pelvic Pain?

Pelvic pain can sound really simple, it’s pain in your pelvis, but let’s explore what that really means. The pelvis is a bowl shaped set of bones, the innominate (literally meaning no name), the sacrum, and the ischium, that connect your abdomen to your legs. Within this bowl lives your reproductive organs, your bladder, and rectum. Surrounding these bones and organs you have this nifty stuff called fascia. Fascia is the organ of shape and helps to both give structures within our body form as well as help them to slide and glide past each other. Like I said, nifty. Also within the pelvis we have muscles, nerves, and blood vessels! It gets really busy down there!

Because there is so much going on in the pelvis, pelvic pain can feel a lot of different ways depending on what structures are involved and even individual differences in how the body feels pain. Pelvic pain can have the feel of a dull ache, which you can feel in your pelvic bones, genitals, and or abdomen. It could also feel sharp and “stabby”, hot and burning, itching,and/or like a bunch of pressure. It can come and go or be a constant sensation. It can be what we call provoked, meaning certain triggers elicit it, or it could come and go seemingly without any obvious cause.

Pelvic pain can come in a lot of different varieties and it can affect everyone, regardless of gender or age. Many people who hear that I am a pelvic floor physical therapist, assume that I only treat postpartum women. The truth is postpartum women are not the only ones who can experience pelvic pain.

People with male anatomy can experience pelvic pain. They may feel burning with urination or climax, pain in the tip of the penis, in the testicles, or in their rectum. Sometimes this pain limits the ability of its sufferer to sit, wear tight clothing, or have pain free sexual experiences Often these symptoms get confused as a bladder, prostate or yeast infection. Although infections can certainly cause these symptoms, many times tight and spasmed muscles within the pelvis can be the culprit. We will discuss this further in part two of this blog.

People with female genitalia can experience many of the same symptoms listed above with obvious anatomical differences. Instead of the tip of the penis, a person with female anatomy may feel pain in their clitoris, or labia. They also may have pain with sexual penetration or arousal. Patients may also experience burning urination similar to the sensation of having a bladder infection. For people who menstruate, the cramps may be so debilitating that they are unable to work or go to school through the pain. All of these different presentations fall into the category of pelvic pain.

Children can also experience pelvic pain. Oftentimes this is caused because of prolonged constipation, but it can also be caused by muscle tightness, and gynecological conditions like endometriosis or lichens planus/ sclerosis.

People with pelvic pain, regardless of age or gender may also experience pain with voiding, either urine or feces, abdominal bloating, and or difficulty sitting.

What Causes Pelvic Pain?

So now that you know what pelvic pain is, what causes it? Many, many, many different things can cause pelvic pain. As we spoke about earlier in the blog, infections can cause pelvic pain. That is why it is important to get yourself in to see a doctor if you are experiencing this type of pain. She will be able to rule out or rule in infections or other medical causes for your pain. Often the problem causing your pain may be musculoskeletal. People with this cause of pelvic pain may not feel relief with traditional medical intervention. The muscles of your pelvis include the muscles of your abdominal wall, your bottom, and the muscles that live between your pubic bone in front and your tail bone in the back, also known as your pelvic floor. These muscles may be in spasm causing the types of pain I described earlier, (yes even the burning urination pain). It may also be that a muscle group in the pelvis itself or supporting the pelvis may be too weak to do its job properly. When this is the case, it is important to get yourself in to see a pelvic floor physical therapist, who can figure out exactly why your muscles are causing your pain.

Although pelvic pain can seem really bleak, there is a lot that can be done to treat it. It’s all about finding the right qualified professional to treat it. At Beyond Basics Physical Therapy we are the experts in pelvic pain and we treat patients from all over the world. We not only treat musculoskeletal causes of pelvic pain, but also work to connect our patients with other professionals who can help to holistically treat pelvic pain. If you have pelvic pain, please remember that there is hope for you.

Alright readers, that’s the basics on what pelvic pain is and what it looks like in different people. Next week we will go Beyond the Basics (see what I did there?) and discuss how to treat pelvic pain, especially pelvic pain caused by muscle dysfunction, in the clinic and even at home.

For more reading on pelvic floor dysfunction please check out these blogs as well as Amy’s books books on pelvic pain

Treatment

How to Deal with Pelvic Floor Pain From Home

What is Pelvic Floor Physical Therapy

What is Myofascial Release and Why do We Always Talk About it So Much?!

For People with Female Anatomy

Endo Awareness Month: How Endo can Affect your Tummy

Endo Awareness Month: Understanding Endo

Endo Awareness Month ( Part 2 of 4) : How Endo can Affect your Bladder

When it Feels Impossible to Have Sex

For people with male anatomy

All About Testicles

What’s Neater Than Your Peter? Burning Urination

Prostatitis What it is and What to do About it

Bladder Health

Pelvic Floor MythBusters! Don’t eat lemon to avoid bladder pain, true or false?

How to Improve Bladder Health

Books By Dr. Amy Stein PT DPT

Heal Pelvic Pain : available here

Beating Endo: available here

The International Pelvic Pain Society (IPPS) is a multidisciplinary group working to promote awareness and education of pelvic pain, if you care to donate, click here

Running During a Pandemic

 

Fiona McMahon PT, DPT

running picture

Hello all!

We in NYC are closing in on completing our very first six weeks and counting, of social distancing. It has been tough. Many of us have had to drastically uproot our lives and routine to help keep our communities as safe as possible. For many of us, our daily escape of a yoga class in a studio or a lifting session at the gym is on pause. As a result, we are turning en masse to running, many for the very first time. As with any time you add a new exercise, one must proceed with caution as your body begins to adjust to the new exercise, throw in a global pandemic, and things get a lot more complicated. To guide you through this transition, we have compiled practical tips to start your running journey.

Socially Distant (and Responsible) Running

You want to protect yourself while running, but if you are feeling laissez faire about your own health, (maybe you’re young and healthy), you must remember that as a runner, you are a much larger threat to other people than they are to you. Anytime you are working out, you are exhaling more breath in volume, than someone walking at a moderate pace. That increase in breath volume, and thus respiratory droplets makes you far more likely to pass anything on if you are carrying a covid infection. You must do what is in your power to avoid getting others sick. No exercise is worth harming others.

In NYC, you are required to wear a face mask if you cannot avoid being within 6 feet of another person. For most running areas in NYC, it is nearly impossible to maintain 6 feet, so opt for a moisture wicking gaiter, to prevent any chapping of your lips. Keep in mind that running with a face mask can be more difficult, so go easy on yourself. You are running to get your ya-ya’s out, not to break a world record, so take plenty of walk breaks if you need them.

For those of you who do not live in a densely populated area, continue to try and maintain 6 feet. Take back roads, rather than main drags and run on off hours to avoid large crowds. Run against the flow of vehicular traffic so you can easily determine if it is safe to dart into the road safely (maintaining 6 feet) to overtake a fellow runner or walker. When it is not possible to avoid coming within 6 feet of someone else on your path, be prepared to stop altogether, or dart up onto someone’s lawn or driveway.

How to Start

If you aren’t a seasoned runner a run/walk program can be a really nice place to start. Starting by alternating walking 2 minutes and running for 30 seconds for 20 minutes is a good way to dip your running toes into the water. Also there are scads of really lovely couch to 5k programs out there to build you up from a novice jogger to a confident runner.

Volume of Training

With all this time on our hands, it can be really easy to up your weekly mileage. Your agenda is practically clear, why not bust out a 16 miler everyday? In general, bumping up your mileage by more than 10% a week is a fast-track way to invite injury. So if you are typically running 20 miles a week, bumping up to 22 miles a week is fine, but more than that can invite injury.

 

Stretch and Strengthen

Most runners will happily trade 10 minutes of stretching for an extra mile on the road. Don’t do it. Stretching after a run, when your muscles are still nice and warm can help prevent injury and keep you up and running. Stretching through your quads, hamstrings, inner thighs, and calves are all great places to start.

To run well, our bodies require lots of strength to stabilize our joints and provide us the power to gain speed. Core strength is essential as well as learning to perform core strength exercises properly. Did you know that your pelvic floor is part of the core too? Amy Stein, founder of Beyond Basics Physical Therapy, writes about it here.  Even on lock down, virtually meeting with your physical therapist will help you to review stretches and stability exercises specific to your body.

Beyond Basics is still open and taking patients, as well as providing virtual appointments. If you require treatment at this time, please call 212-354-2622

Saggy Jeans and Tailfeathers: How Your Pelvic Positioning Affects Your Body

animal bird blue bright
Photo by Pixabay on Pexels.com

Joanna Hess PT, DPT, PRC, WCS

Wait! Marie Kondo has you throwing out your favorite jeans because the joyless saggy bottoms that your tushy cannot manage to fill out? We are seeing an epidemic flat butt among mamas, plumbers, barre fanatics, and office workers—all with strangely similar symptoms—pelvic floor dysfunction, low back and sacroiliac pain, and a tucked under pelvis. In this blog we will explore why the position of the pelvis, the maker of flat butts and the maker of less flat booties, is important and how to more easily move out of this position for benefit beyond your behind.

Besides needing a new wardrobe, why should I care about my flat bum?

The flat bum or preference towards posterior pelvic tilting shrinks the distance between the front and back of pelvic outlet which changes pelvic floor muscle tension. The body needs access to the full range of the pelvis and pelvic floor muscles. Over time, this position could cause excessive pelvic floor activity to compensate for the loss of resting tension. Think of the pelvic floor muscles simplified as a rubber band between two points, the pubic bone and tailbone. When the distance between the two points decreases, the rubber band loses its stability from resting tension. Changes in pelvic position alters stability from the pelvic floor muscles. This posterior pelvic tilt position also decreases the accessibility for hip extension and therefore the upper glute muscles get sleepy. As the top of the pelvis moves back, the sacroiliac joint in the low back opens and decreases its bony stability. Translated into everyday life, the flat butt position increases the potential for incontinence, pelvic floor muscle tension, sacroiliac pain, and decreased efficiency in movement.

The Flat Bottom. Only in the eye of the beholder?

Pelvic floor and tilt

The disagreement of the “neutral pelvis” or zero-point causes confusion when describing pelvic tilt—anterior pelvic tilt, posterior pelvic tilt, and neutral pelvis. Some argue that the neutral pelvis is when the ASIS’s (front hip bones) are level to the PSIS (back butt dimples). Others say that the pelvis is neutral when ASIS’s are in the same plane as the pubic bone. Or for those with X-ray vision, pelvic tilt is the vector of the sacral angle at S2 in relation to the vertical axis. But often, neutral pelvic position is subjective to the observer and relative to other parts of the body—namely the spine/rib cage and thigh bone. Clinically, this “neutral pelvis” is hard to find because 1) pelvis’ are shaped very differently, 2) left and right pelvis on the same person can also be quite different, 3) feeling these bony landmarks have been shown to be remarkably unreliable, 4) the neutral pelvis should be on top of vertical thigh bones. See how the eyes can be tricked confusing spinal curve focusing on pelvic tilt without also including rib position.

Rib pelvic alignmentThe inability to move in and out of posterior pelvic tilt and anterior pelvic tilt decreases efficiency and possibly results in pain and instability. Anterior pelvic tilt is when the front part of the pelvis moves forward/down. Posterior pelvic tilt is when the front part of the pelvis moves back/up. A neutral pelvis on top of vertical femurs and happy rib cage should correlate with better muscle performance.

Do I have a flat butt?

Aside from the saggy jeans, the flat butts of the world have a few other correlations.

1. The Tailfeather Test: Stand comfortably and squeeze the gluts.

a. Neutral pelvis: Thigh bones rotate.

b. Posterior tilt-ing pelvis: The butt will further tuck under and mainly access the lower glutes.

c. Anterior tilt-ing pelvis: The pelvic floor muscles will do most of the work.

2. You bear weight more in the heels

3. Back of your rib cage is behind your pelvis

4. Your Thigh bones are angled so that your pelvis is front of your knees

5. Your lower belly pooch

6. You Sit with pressure more on the sacrum/tailbone vs. sit bone

7. You have Overactive and possibly overworking pelvic floor muscles—the front to back pelvic distance decreases with your posterior tilted pelvis and loses the resting tension from length. As described earlier, this is similar to tensile strength of a slightly stretched rubber band vs. rubber band without pull/tension. Therefore, your pelvic floor muscles have to work harder to keep some type of tension for purposes like continence, stability, etc. The inability for the pelvic floor muscles to work optimally can lead to incontinence, pain, and constipation.

9. You have Breathing and abdominal pressure problems

10. You have Sacroiliac joint pain. As the pelvis tips back, the sacrum moves away from the ilium decreasing the bony stability. The hip muscles have to work harder, but as felt in the Tailfeather Test, the glut muscles aren’t in a good place to work.

Is there a better fix than butt implants?

Bodies have and love variability for posterior, anterior and “neutral” pelvic positioning. The brain likes positions where muscles and nerves work with ease and stability—life shouldn’t be so difficult—but it needs the chance to choose and learn it. Folks working with bodies have traditionally “corrected” spinal curves by changing pelvic position. From what has already been discussed, spinal and pelvic position can be altered many different ways—from the changing weight-bearing area in the feet, to position of ribs and range of breath, and even head angles with visual and vestibular input. Consider these hacks into pelvic stability until the brain learns how to access this stability in many situations and positions.

1. Standing. Bring your chin down to your neck and keep looking down until you see the front of your ankles. You’ve just untucked your pelvis and brought your ribs over your pelvis. This one is courtesy of my colleague, Stephanie Stamas. Or check in to feel where the weight is going through your feet. The front to middle of the foot is a good place to start and then do the Tailfeather Test. You might have to toggle other parts of the body because of how the body will compensate in the chain.

2. Sitting. Get your hips as far back as possible. Or put a pillow in the back of the chair so that your hips can find the pillow and you are sitting on top of your sit bones. Then, relax the trunk into the seat back/pillow. Again, you’ve untucked your pelvis and brought your ribs over the pelvis.

3. Better squats/lunges/burpees/stairs/ab work. You can do 5 sets of 20 squats, but still no junk? Take care to see if your pelvis is tucking under in the movement. If so, use an inhale to keep the pelvic floor lengthening as your hips bend in movement. Later, the movement should be dissociated with breath pattern (as long as you are breathing.)

4. See a physical therapist. Often times, the habits of pelvic tucking are a little more complicated because it is a protective and compensatory mechanism for stability. A physical therapist can help with seeing the bigger picture and how different parts of the body relate to each other. They can also help facilitate better movement through manual therapy and specialized movement.

Good luck with the joy sparking!

How to Deal with Pelvic Floor Pain From Home

woman-in-grey-jacket-sits-on-bed-uses-grey-laptop-935743

Dear reader, 

As I sit down to write this, New York City is on PAUSE, many other cities around the world are on various forms of lock-down. As a planet, we are working to slow the spread of COVID-19, the condition caused by the novel coronavirus. Those of you who are working from and staying at home, your efforts are noble and life saving. We thank you. For those of you in pain, we see you and feel for how tough it can be to feel like you have to wait to get help. Hopefully in a short period of time this virus will have passed . Follow these simple tricks to get started on tackling your pelvic pain. 

 

Check In With Your Seat

Work from home setups can leave a lot to be desired. Designed for portability, but not ergonomics, our laptop computers can leave us curled up like little cashews or “c’s”. This position tucks our pelvis underneath us and can cause us to put extra pressure and compression through our pelvic floors, not to mention putting extra pressure on our spinal discs. Even if you only have a laptop, you can remedy this c position by imagining you are a puppy dog with a tail. You want to sit so you could wag your tail like a happy puppy. Now for some people this may actually feel a little worse, if it does, this is not the trick for you. Don’t worry I have more. 

If you can, use a portable mouse and keyboard to discourage your cashew sitting tendencies. Arrange your setup so your eye line falls just about in the middle of the monitor by elevating it on some books.  You should be able to access your keyboard with your elbows bent at 90 degrees.

Now it’s time to think about what you are sitting on. I recognize that those of us living in teeny tiny NYC apartments may not have a lot of options to think about. But keep in mind that pelvic floor pain can be counterintuitive and an overstuffed couch, may not be the best thing if your pelvic floor is overworking to stabilize your body while you are sitting. Likewise, your kitchen chair may be too firm. Play around, how does the couch cushion feel on the chair? Is a firmer seat better or worse? You may have to trial and error your way into a solution.

Move

This one is so important. Depending on where you are geographically, you may be allowed different degrees of movement. If you are currently allowed to leave your home for exercise, go for a walk. Besides breaking up the day, walking can decrease the pressure from all the sitting you have been doing, as well as increase blood flow to the pelvic floor. While the requirements for social distancing remain, ensure that you maintain a distance of 6 feet (about 2 meters) between yourself and other people and wear a homemade mask.

If you cannot walk outside, and even if you can, get up periodically throughout the day. Stretch out, do some gentle air squats if they feel good. Look for some free restorative virtual yoga classes. Movement is medicine. 

Just be Happy… Like a Happy Baby

I love this pose so much that I could write a love song to it. Honestly. It works to stretch not only your pelvic floor, but your entire posterior chain  (back of the body). 

The most traditional way to do it, is to lie on your back, bend at your hips and knees, so that your feet are in the air, and grab the outside of your feet. As you stretch bring your knees towards your armpits. Hold this pose for 10 deep, beautiful breaths.

Feel free to modify this pose. Grab on the back of your calves or behind your knees if you have tight hammies. Put a pillow between your abdomen and thighs to prevent any pinching in your hip. It’s honestly all good.

Breathe

Another super important tool in your toolbox. Deep slow breathing can calm your nervous system, which can help to decrease pelvic floor spasm and guarding. In fact, in a study by Van der Velde, it was found that stressful stimuli do cause an increase in pelvic floor tightening. Try 10 deep slow breaths throughout the day and note how you feel from both a pain and stress perspective.

We are OPEN and also offering Telehealth

For those of you who are ready to get started NOW. You can. We are currently offering office evaluations and treatments, and telehealth services. Both Corey Hazama PT, DPT and Amy Stein PT, DPT are doing in person visits and telehealth visits are available with Sarah Paplanus PT, DPT.  For more information contact Beyond Basics Physical Therapy at 212- 354-2622 or check out our website: http://www.beyondbasicspt.com

 

Van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion- inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12 (5) 328-31