Physical Therapy: a Primary Intervention for Pelvic Floor Dysfunction and Urinary Incontinence

By Amy Stein and Mary Hughes

Physical therapy is almost always the first line of defense with any orthopedic injury, in order to prevent possible invasive surgical procedures.  The pelvic floor musculature maybe the most overlooked group of muscles in the body.   The American Physical Therapy Association stated proper preventative measures by a physical therapist can help manage, if not alleviate, urinary incontinence.  In a study by Hung et. al they were able to improve symptoms of incontinence by “retraining diaphragmatic, deep abdominal and Pelvic floor muscle coordinated function.”

Over 25 million Americans suffer from urinary incontinence alone or involuntary loss of urine. And, it is not just a “women’s disorder;” men and children can have pelvic floor dysfunction as well. Physical therapy for pelvic floor muscle training is a great, less invasive option to help, reduce and/or stabilize pelvic organ prolapse, increase strength, improve sexual function and decrease leakage/incontinence.

American Physical Therapy Association. (2008, March 20). “Urinary Incontinence In Women Alleviated With Physical Therapy Treatment, New Study Reveals.” Medical News Today. Retrieved from, on October 29, 2012.

Hung, H. C., Hsiao, S. M., Chih, S. Y., Lin, H. H., & Tsauo, J. Y. (2010). An alternative intervention for urinary incontinence: Retraining diaphragmatic, deep abdominal and pelvic floor muscle coordinated function. Manual therapy, 15(3), 273-279.

Stein, A. (2009). Heal Pelvic Pain: A Proven Stretching, Strengthening, and Nutrition Program for Relieving Pain, Incontinence, IBS, and other Symptoms Without Surgery. New York: McGraw Hill.

Lying Prone

By Denise Vidal

In these Pilates blogs we have explored our breath and its relationship to our posture, core, and the movement in our joints.  We have explored the difference of breathing into our abdominal cavity as well as into our chest cavity. We have also explored breathing into the sides of the ribs as well as the front and back. However, the front and the sides of the ribs can be much easier to access, given that we can both see and touch those areas. In today’s blog we are going to talk about finding more breath in the back part of the rib cage. One way in which we can explore this is lying prone, or lying on your abdomen.

To start, take a pillow from your bed and lie on it lengthwise on your abdomen; that is, put the pillow under your torso from your shoulders to the top of your pelvis.

Put your hands under your forehead for support.

Feel how your front ribs sink into the pillow, allowing your back ribs to have room to spread and open. As we have done before, focus on the back part of your ribcage expanding with each inhale and softening back down with each exhale. See each section of your back ribs expanding separately, starting with the low ribs, the middle ribs, and then your upper ribs (under the shoulder girdle).

Once you feel like you have made a connection with the breath in your back ribs, try to engage your abdominals. Using to cues that we have used before, as you exhale feel your waist hug the imaginary sphere inside your belly. See if you can do this while keeping the pelvis in neutral. Remember, in neutral pelvis we are attempting to keep the pubic bone level with the hip bones. Depending on our individual structure this may not happen; however, the point is to keep the spine long and the pelvis heavy. When we engage our abdomen, there is no need to squeeze your butt or tuck your pelvis.

Practice this and let me know how it goes.

In the next few blogs we will begin to add movement of the limbs in this position.

Conquering Lymphedema

by Roseanne Cruz

According to recent studies, the incidence of breast cancer-related edema can range from 6-70%. Lymphedema, which can affect both men and women, is a persistent swelling of a body part due to a blockage in lymphatic flow when nodes or vessels are damaged or abnormal, such as post-radiation or chemotherapy treatment. Individuals who have lymphedema may complain of discomfort or pain in the affected limb, feeling of fullness in the limb, fatigue, or decreased flexibility. They may also complain of breast or pelvic pain, tight-feeling skin, difficulty fitting into clothes, or tightness when wearing rings, bracelets, watches, socks, or shoes.

Lymph drainage therapy (LDT) consists of a gentle massage technique that is said to aid in the circulation of body fluids, drain toxins from the body, stimulate the immune system and the parasympathetic system, reduce pain and/or muscle spasms, increase ROM, and decrease swelling.  LDT can be used to treat conditions such as post-surgery and scars, fibromyalgia, chronic fatigue syndrome, infertility, painful periods, constipation, and irritable bowel syndrome. In conjunction, it is important to have an exercise program of stretching and strengthening to get the maximum benefits of LDT.  After treatment, the patient may experience increased urinary frequency or increased amount of urine, increased sleep time or better quality of sleep, tension release and/or emotional release, or improved senses.

If you are seeking treatment, you need to see a licensed healthcare provider that is trained in Lymphedema Drainage Therapy.  To find a specialist in your area, go to and click on “Find a PT,” or do a search through the National Lymphedema Network.

Roseanne Cruz, PT, DPT, LLCC, is certified in lymphedema management through the Upledger Institute.  Roseanne received her B.S. and doctoral (DPT) degree from New York University.  Roseanne has been interested in working with patients with pelvic pain, pelvic floor dysfunction in adults and children, and lymphedema for many years and has spoken in the Greater New York area on these topics. Roseanne is a member of the APTA (Women’s Health and Oncology sections), National Vulvodynia Association, International Pelvic Pain Society, and the National Lymphedema Network.