Amy at the ICA Philadelphia Forum!

Will you be attending the Interstitial Cystitis Association’s Philadelphia Forum tomorrow? Beyond Basics’s own Amy Stein will be!

Amy will be discussing how physical therapy helps with painful bladder symptoms, interstitial cystitis, pelvic pain, and bowel and sexual dysfunction. She will also be giving a 10-minute breathing and gentle stretching instructional, to be used at work or on the go, for men, women, and children. Check out this interview Amy did with ICA did last year (below).

If you can’t make it, the ICA Forum tomorrow is also a live webinar! Click here to find out more information.


Scleroderma Scholarship I

By Riva Preil

June marks National Scleroderma Awareness Month. Scleroderma is a chronic autoimmune disease whose primary symptoms include fibrosis (hardening) of the skin and blood vessel changes. The underlying cause of scleroderma is unknown, however it tends to run in families, which indicates that there is a genetic component to the disease yet to be identified. Scleroderma affects the arterioles (small blood vessels) throughout the body, and it causes the endothelial and smooth muscle cells to die and be replaced by collagen. In addition, inflammatory cells (such as CD4 and helper T cells) enter the arteriole and interfere with normal arteriole functioning.  This is why there is a strong correlation between scleroderma and Raynaud’s phenomenon, a disease associated with vasoconstriction of peripheral blood vessels which results in skin discoloration, feeling cold in the hands and feet, and possibly even skin atrophy.

 The two main types of scleroderma are limited systemic scleroderma and diffuse systemic scleroderma.  The limited version is less dangerous than the diffuse version, and there is a good prognosis and normal life expectancy.  The areas mainly affected are the hands, arms, and face. Approximately one third of individuals with limited systemic scleroderma develop pulmonary arterial hypertension (elevated blood pressure), and it is therefore important for blood pressure to be monitored regularly. However, diffuse systemic scleroderma on the other hand, has a negative prognosis.  It is a rapidly progressive degenerative disease which affects not only the skin, but also one (or more) internal organs such as the heart, kidneys, lungs, or esophagus.  Five year survival after diagnosis of diffuse scleroderma is 70%, and ten year survival is 55%.

Sun-Sational Summer!

By Riva Preil

It’s official- the sun is out and summer is in!  Whether you are spending long lazy weekends by the beach or simply enjoying lunch breaks outdoors, now is as good a time as ever to review sun protection facts.

  • Ultraviolet (UV) A and B rays can damage skin IN AS LITTLE AS 15 MINUTES, even on cloudy days. From the perspective of your epidermis, the worst hours of the day are from 10:00 AM to 4:00 PM.  Therefore, the Centers for Disease Control and Prevention (CDC) recommend using sunscreen with sun protection factor (SPF) of 15 or higher. Sunscreen, which absorbs or reflects sunlight, should be reapplied every two hours (or sooner, if you have gone swimming or engaged in activities that produce sweat).  Make sure your sunscreen is not outdated- three years is the maximum shelf life!
  • Use an umbrella or pop indoors every so often for shade breaks.
  • Wear loose fitting shirts with long sleeves and long pants made from tightly woven fabric when possible. Regular T-shirts do not provide the suggested SPF 15 amount. These garments provide better protection from the sun’s harmful rays.  Also, dry clothes provide better protection than wet clothes.  As far as head gear, canvas material protects better than straw hats or other products with holes (ex. visor).
  • For those who opt for indoor tanning thinking that it is safer than the sun…you may want to reconsider.  Indoor tanning has been linked with certain cancers (ex. melanoma, squamous cell carcinomas, and ocular melanoma), and it should be avoided if possible.

Now, go ahead, apply that lotion, and go enjoy some summer fun in the sun!

Pilates: Hip Abduction

By Denise Vidal

The relationship between the thigh bone and the hip socket is known as a ball and socket joint. A ball and socket joint is different than other joints in the body in that it allows movement in all different directions. For example, unlike the hinge joint of the knee, which moves predominantly forward and backward, the ball and socket joint allows the thigh bone to move forward, backward, sideways, and around in rotation.

In the last few blogs we have discussed, among other things, the thigh bone’s ability to roll in the hip socket. Specifically, in the downward dog movement (or Pilates’ knee stretch), we focused on the thigh bone’s ability to roll forward and backward. However, as I have mentioned before, the healthiest joints are those that experience their full range of motion. Therefore, in today’s blog we will explore movement of the thigh bone in a different direction.

To begin, lie on your left side. Your bottom (left) leg will be bent, while your top (right) leg will be straight. In this position, your head, tail, and right foot should be in alignment and your pelvis should be stable. If necessary, you can put a pillow under your head.

Next, inhale through your nose and feel your abdomen expand. In your mind’s eye see your breath swirling down to the base of your pelvis. As you exhale, see your breath swirling up into your ribcage as your abdominals contract. Use this abdominal tone to keep your pelvis stable during the exercise.

On your next exhale, lift your right leg. As you do this, the top of your thigh bone, the “ball,” will move in opposition to the foot. In other words, the top of your thigh bone will roll inward in the hip socket as the foot floats off the floor. As you place the foot back down the thigh bone will roll outward in the hip joint. Continue to lower and lift the leg eight times. When you have finished, lie on your back with your legs straight and feel the difference between your two legs. When you are ready, roll onto your left side and repeat the exercise with your left leg.

Just a reminder, if you experience any pain during this exercise, do not continue. If your pain persists, contact your Doctor or PT before resuming any exercise routine.

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Prolapse Particulars, Part II

By Riva Preil

Mild prolapse may be asymptomatic, and POP may only first become noticeable at later stages of the dysfunction.  The signs and symptoms of bladder or urethral prolapse include urinary incontinence, urgency (sudden strong urge to urinate), urinary frequency (voiding more frequently than normal, generally assumed to be more than 8x/day).  It may also be associated with difficulty initiating the flow of urine (hesitancy). Signs of rectal prolapse include difficulty with passing bowel movements and/or constipation. Signs of uterine prolapse include a feeling of heaviness in the pelvic floor, and women often describe it as if they feel their “insides are falling out.”  They may even feel or see a pinkish colored lump at the vagina, especially at the end of the day or after hours of prolonged standing or walking.  There may also be pain with intercourse.

The first line of treatment for POP is pelvic floor physical therapy.  By strengthening the pelvic floor muscles, additional support can be provided to the organs from below. If that alone is insufficient, some women find a pessary helpful. This is a device which is inserted vaginally to support one or multiple pelvic floor organs.  When physical therapy and pessary are not enough, some women may decide to undergo surgery to bolster the lax pelvic floor.  One of the most common surgical techniques is transvaginal placement of synthetic mesh for POP. Research about the mesh materials are mixed, and it is important to discuss further details with one’s physician regarding what the best options are for them.

Prolapse Particulars, Part I

A few more words about Pelvic Organ Prolapse, from Riva Preil.

June is Pelvic Organ Prolapse Awareness Month. Pelvic organ prolapse (POP), descent of any of the pelvic floor organs, is one of the most common indications for gynecological surgery.  Usually, the organs in the pelvic floor (bladder, uterus, and rectum) are held in their proper position by a series of ligaments.  In addition, the pelvic floor muscles serve as a “backup support” the ligaments and support the organs from below.  As women age, the ligaments and muscles have a harder time holding the organs in their upright proper position against gravity, and each previous pregnancy and delivery further contributes to increased likelihood of developing weakened structures over time. In fact, the physical weight of the developing fetus along with the physical trauma of labor and delivery add further stress to the pelvic floor muscles and ligaments, and some of these damaged structures may never fully return to their previous strength and level of structural support.  In addition, certain birthing related complications (ex. prolonged labor, large birthweight of the baby, and vaginal delivery which requires forceps extraction) increases a woman’s risk of developing prolapse. It is unclear whether or not an episiotomy affects POP development.  In women above age 50, it is reported as the most common reason for hysterectomy (removal of the uterus).  It is estimated that in the United States, almost double the amount of surgeries are performed to treat prolapse compared to treating urinary incontinence.  The reason for this is that it is often not diagnosed until later stages of the dysfunction at which point conservative, non-surgical interventions would not suffice in treating the POP.

Naturally occurring age-related changes, mainly due to decreased estrogen levels in the bloodstream, increase the likelihood of developing prolapse. Furthermore, women who are overweight are more likely to develop POP due to increased abdominal and pelvic floor pressure.  Furthermore, chronic coughing (due to bronchitis, asthma, or smoking) as well as chronic constipation and straining predispose an individual to developing POP due to prolonged history of added stress and pressure to the pelvic floor structures. Furthermore, women who have worked for many years at a job that involves heavy lifting (ex. flight attendants) are at greater risk of developing POP for the same reason. The pelvic floor structures contain collagen, a connective tissue that provides support and elasticity. Therefore, any systemic disease such as Marfans or Ehlers-Danlos, which are associated with impaired collagen production, predisposes an individual to developing POP.  Research has shown that prolapse is most prevalent amongst white and Hispanic women.

To be continued…

For Professionals: Understanding Sexual Pain and Anxiety

Check below for a press release from our friends Talli Y. Rosenbaum, M.Sc., PT, IF and Tammy Nelson, PhD, LPC who are offering a virtual seminar on Understanding Sexual Pain and Anxiety for those in health professions!

Just Relax! Understanding Sexual Pain & Anxiety

A two-hour teleseminar by Talli Rosenbaum & Dr. Tammy Nelson

Available June 11, 2013, as MP3 files: LISTEN ANYTIME

$99 (approved for 2 AASECT CEs)

To Register:

Sad couple having an argument

This two-hour course for therapists and health professionals will address sexual health and function, the pelvic floor, and the roles that pain, anxiety and cultural factors play in the dynamics of relationships. This course will focus on the problems and solutions for pain and anxiety during sex and the ways that these issues impact relationships. We will cover vestibulodynia, vaginismus, unconsummated relationships, and couples who report, “we can’t have sex” for a variety of reasons related to complaints about sexual discomfort.

Part One: Understanding and treating sexual pain disorders

Objective: Participants will be introduced to the multi-factorial nature of sexual pain and to mindfulness based treatment protocol to address anxiety and aversion in women with sexual pain disorders

Part Two: Exploring the dynamics of anxiety and pain – Unconsummated Relationships and Sexual Aversion

Objective: Participants will be introduced to a biopsychosocial approach to the phenomena of unconsummated marriage.

 Talli Yehuda Rosenbaum, M.Sc., PT, IF, is both a physical therapist and an AASECT certified sex therapist, who is an internationally recognized expert on the integrated roles of physiotherapy, sex therapy, and couples therapy, in the treatment of sexual pain disorders and unconsummated relationships.

Tammy Nelson, PhD, LPC, is a Certified Sexologist and a Certified Imago Therapist. She is the author of Getting the Sex You Want: Shed Your Inhibitions and Reach New Heights of Passion Together, and The New Monogamy; Redefining Relationships After Infidelity.


By Riva Preil

Prolotherapy, also known as proliferation therapy, is an alternative approach to alleviating musculoskeletal and connective tissue pain. The treatment involves injecting an irritant solution (such as hyperosmolar dextrose sugar) into a joint, a lax ligament, or a strained tendon. Other agents commonly used are glycerine, lidocaine, phenol, and sodium morrhuate. The rationale behind prolotherapy is that injection of a non-irritating substance will trigger the body’s inflammatory process which creates new fibers in the muscles.  This allows for healing and repair of damaged or weak tendons and ligaments.  This in turn decreases pain because the previously weakened areas no longer transmit pain signals to the brain.  Frequency of treatment is every two to six weeks for several months or until pain subsides. Prolotherapy is most commonly used to treat low back pain, knee osteoarthritis, neck strain, costochondritis, Achilles tendinopathy, lateral epicondylitis, and fibromyalgia.

Historically, prolotherapy was first used in the 1930s to treat ligament laxity. In the 1950s, Dr. George S. Hackett, a general surgeon in the United States, used the technique to treat hernias and joint pain, and his work was continued by Dr. Gustav Anders Hemwall shortly thereafter. A literature review in 2006 revealed that prolotherapy is more beneficial when used in conjunction with physical therapy, spinal mobilization, and costicosteroid injections to treat low back pain compared to prolotherapy alone.  Some of the side effects may include local pain and/or numbness at the injection site, or mild bleeding.  Unfortunately, most insurance companies, including Medicare, do not cover this type of treatment.

Pelvic Organ Prolapse Awareness Month

Pelvic organ prolapse in women is when a pelvic organ drops from its regular placement in the body and pushes against the walls of the vagina. This is not uncommon in women nor is it necessarily untreatable or progressive. The most common type of pelvic organ prolapse occurs with the bladder, though it can also happen with the urethra, uterus, vagina, small bowel, and rectum.

Often pelvic organ prolapse happens because of a strain put on the organs in that region, as in childbirth or hysterectomy. As listed on WebMD, here are some typical symptoms of pelvic organ prolapse:

  • Pressure from pelvic organs against the vaginal wall.
  • Feeling full in the lower belly.
  • Feeling like something is falling out of your vagina.
  • Feeling a pulling or stretching in your groin area or pain in your lower back.
  • Incontinence, or a need to urinate frequently.
  • Vaginal pain during sex.
  • Bowel issues, including constipation.

Since June is Pelvic Organ Prolapse Awareness month, make yourself aware of the causes and symptoms of POP. It’s nothing to be ashamed of and it’s something we at BBPT can help you with! Take a look at this video from POP Advocate Sherrie Palm’s POP Awareness Month series about POP and PT, and let us know how we can help you!

Chill Out. With Lasers!

We’re proud to announce that we are now using Cold Laser Therapy here at BBPT! 

But what does that mean?

Cold Laser Therapy, also known as low-level laser therapy, is a non-invasive procedure in which low intensity lasers are used to relieve pain. ‘Cold’ refers not to the temperature but to the intensity of the laser itself. The laser works by stimulating repair of damaged tissues, ultimately moving toward pain relief. 

At BBPT, we are now using Cold Laser Therapy to decrease pelvic pain, to break up scar adhesions, and for lymphedema (swelling in the limbs and pelvis).  This is a great adjunct to manual therapy treatment. BBPT team members recently gathered to work with the new Cold Laser equipment. Take a look below!