Opinions from Orlando

By Riva Preil

The IPPS hosted its Annual Fall Meeting on Pelvic Pain October 17-19, and I promised that I would update you on the conference.  Today, I am excited to share with you the thoughts of two of our physical therapists, Dania Kafka and Mary Hughes, both of who were present at the conference.


Overall the IPPS conference was the 3 I’s – interesting, informative, and insightful. The interesting topics discussed included medical/surgical, physical therapy/musculoskeletal, and psychological/mental health. One lecture was about the multi-disciplinary approach in the treatment of pelvic pain.  Another lecture provided an overview on the Vulvodynia Registry, a study that involves collecting data from various clinical sites across the United States. Other topics covered were bladder, bowel, and sexual dysfunction, as well as pelvic pain syndromes. The highlight for me was the post-conference course on the Movement Impairment Syndromes approach for pelvic pain/pelvic floor dysfunction given by Theresa (Tracy) Spitznagle, PT, DPT, WCS. She was awesome! Tracy introduced the theory behind Shirley Sahrmann’s movement approach.  Shirley Sahrmann, PT, PhD, developed this approach for the entire body with her colleagues at Washington University Program in Physical Therapy. These syndromes are described in Dr. Sahrmann’s books, Diagnosis and Treatment of Movement Impairment Syndromes and Movement System Impairment Syndromes of the Extremities, Cervical and Thoracic Spine. A Movement Impairment Syndrome can be localized painful conditions or other types of symptoms arising from irritation of myofascial, periarticular, or articular tissues, as a result of mechanical trauma, most often microtrauma. Tracy discussed the theory and gave us an introduction to evaluation and treatment of pelvic pain related Movement Impairment Syndromes (i.e., hip, low back, and sacroiliac joint).  It was excellent!

IPPS was a great opportunity for me to meet physicians and other pelvic floor physical therapists. I work with many of the other health care providers on a regular basis, and it was nice to finally “put a face to the names” of my colleagues. Furthermore, as physical therapists, we were taught in school the importance of an interdisciplinary team approach.  It is great to see so many physicians open to the same idea, because it will enable us to provide the best plan of care for our shared patients.

Tis the Season to be Sneezin’

By Riva Preil

As those of you with seasonal allergies already know, airborn allergies (such as pollen, dander, and dust) often continue to pester those with hypersensitive immune systems through late fall.  These as well as other allergens trigger the nasal mast cells to release histamine, which creates an inflammatory response characterized by itching, sneezing, swelling, and production of mucus.  Individuals with extremely hypersensitized immune systems may even develop hives or a rash.  According to the American Academy of Allergy, Asthma, and Immunology, the approximate 35 million allergy (or rhinitis) sufferers will be joined by many more in the near future due to climate changes.

So how to fight back when the allergies attack?  Fortunately, this question has been addressed by many.  Several tried and true methods include oral anti-histamines, nasal sprays, and eyedrops, and one should consult with their medical care provider regarding which choice is best for their needs.  Other solutions have been proposed, including natural remedies such as Quercetrin, a natural anti-inflammatory chemical found in tea, onions, grapes, and tomatoes, which blocks the effect of histamine.  It is recommended to take 500 mg of Quercetrin 2x/day along with Vitamin C supplementation for best results.  And of course, try to avoid environments where allergens abound.  In general, trees pollinate in the morning, so wait until the afternoon or evening for your jog in Central Park.  But can self-hypnosis help to alleviate symptoms of seasonal allergies?  To check out more information about this proposed solution as well as other interesting suggestions, please refer to this article from Prevention magazine.

Let us know your thoughts here at Beyond Basics Physical Therapy, and please share with us which method works for YOU!

Node Knowledge

By Riva Preil

Breast cancer awareness is sweeping the nation this October!  In honor of the many inspirational survivors who have undergone mastectomies, I have decided to blog about rehabilitation post mastectomy.  In western societies, breast cancer is the most commonly diagnosed tumor amongst women.  In fact, 27% of tumors diagnosed amongst females are breast tumors.  Fortunately, recent research has helped develop minimally invasive surgeries (including sentinel or axillary lymph node dissection) that allow for faster healing.  However, as with any surgical procedure, internal scarring may occur after the surgery which may affect upper extremity joint and muscle function.  Furthermore, removal of lymph nodes may result in dysfunctional drainage of the lymphatic system into the venous system, a condition called upper extremity lymphedema (associated with swelling and heaviness in the affected limb).  This may lead to impairments in functional abilities, including carrying heavy objects and overhead reaching.

A recent study in “European Journal of Physical and Rehabilitation Medicine” (2012, vol 8, No. 4) explored the benefits of early rehabilitation following surgery.  Of the 83 participants in the study, 25 were in the control group (no physical therapy until after discharge from the hospital) and 58 were in the experimental group (physical therapy beginning the day after surgery until discharge from the hospital).  The physical therapy interventions including exercises to maintain shoulder muscle flexibility, decrease pain, improve lymphatic circulation through the affected upper extremity, and breathing exercises to maintain proper pulmonary function.  Each P.T. session was 30-40 minutes during hospitalization, and they were educated on appropriate home exercises for post discharge.

Follow up was performed with both groups 6 months after surgery.  There was a statistically significant difference between the groups regarding the presence of lymphedema- those who had participated in early post-op intervention were less affected than those who had not.  Furthermore, those who had participated in physical therapy earlier on were more flexible and capable of greater function.  Once again, research has proven that physical therapy, including lymphedema treatment, is very beneficial post-surgery, and women are encouraged to use their arms freely post-surgery rather than “taking it easy” in attempt to heal.  Fortunately, we here at Beyond Basics Physical Therapy offer lymphedema treatment!  Our skilled physical therapist, Roseanne Cruz Schoen, is a Certified Lymphedema Therapist.  If you or someone you know may benefit from lymphedema treatment, please contact us- we would love to help!

The Postnatal Pelvis

By Riva Preil

Young mothers face a myriad of new challenges they did not encounter prior to mother-hood.  They often experience hormone related changes, sleep deprivation, and possible nursing complications, should they decide to breast feed.  This is all on top of trying to lose the baby weight and return to their pre-pregnancy size.  In addition, new mothers face the challenge of adjusting to the new reality of having a child and being responsible for their child’s wellbeing.  Therefore, it is no surprise that many mothers inadvertently neglect the musculoskeletal related aftermath of pregnancy and delivery.  Some of these changes are very significant, and may manifest later on in life if left untreated.

The Wall Street Journal recently published an article by Sarah Nassauer addressing post-partum pelvic floor dysfunction (October 14, 2013).  According to Dr. Linda Brubaker, an urogynecologist and dean of the Stritch School of Medicine at Loyola University Chicago, the pelvic floor “is the center of the universe” because it provides much structural support.  In fact, she recommends that ALL WOMEN REQUEST PELVIC FLOOR MUSCLE STRENGTH TESTING from their doctor 4-6 weeks postpartum to make sure the muscles are functioning properly. The article also discusses that nowadays, a popular trend is to have multiple babies in close proximity and at a more advanced age.  This gives the body less time to recuperate compared to spaced out pregnancies.  Furthermore, more women are using in vitro fertilization treatment which increases the likelihood of twin and triplet pregnancies.  Pregnancies of this nature put more stress on the pelvic floor muscles than single pregnancies.  Some of the physical changes women encounter include exaggeration of the spinal curves, overstretching of the abdominal muscles (which may even lead to separation of the two halves of rectus abdominus muscle, a condition referred to as diastasis recti), internal scar tissue (after caesarean section deliveries), and overstretched pelvic floor muscles and weakness (resulting in incontinence and/or prolapse, organ descent).  Fortunately, pelvic floor physical therapy can help address all of the aforementioned changes.  Kudos to The Wall Street Journal for acknowledging and publicizing the benefits of pelvic floor physical therapy!

Say YES to IPPS!

By Riva Preil

The International Pelvic Pain Society (IPPS), established in 1996, was created with two primary objectives: “To educate health care professionals how to diagnosis and manage chronic pelvic pain, thereby changing the lives of patients worldwide [and] to bring hope to men and women who suffer from chronic pelvic pain by significantly raising public awareness and impacting individual lives.”

Every year, IPPS hosts their Annual Fall Meeting on Pelvic Pain, and this year, the conference will take place this coming weekend, October 17- 19, in Orlando, Florida. There will also be a post conference course on October 20.  The conference is geared towards educating gynecologists, physical therapists, nurses, and residents on the latest research in treatment and diagnosis of pelvic pain related disorders.  Lecture titles include “A Multidisciplinary Approach to Caring for Women with Chronic Pelvic Pain” (by Donna Carrico, WHNP, MS), “Introduction to the Physiology of Chronic Pain,” and “Evaluation and Treatment of Musculoskeletal Causes of Chronic Pelvic Pain.”  Other topics that will be addressed include painful bladder syndrome, postsurgical pain, abdominal pain, pelvic musculoskeletal health, endometriosis surgical management, and vulvar disease management.

Our very own Amy Stein is very involved with the IPPS- she has been on the Board of directors since 2007 and has been Chairperson of the Fundraising and Marketing committee since 2012.  STAY TUNED for more details from Orlando as the conference unfolds… it is sure to be an educational and exciting convention, and we look forward to keeping you abreast of the information that will be shared!


Endo Warriors! Part II

By Riva Preil

Here is some more insight from our PTs about our most recent Endo Warriors session! Read below to learn more about physical therapy for endometriosis treatment.

Can PT change or stop the disease process of Endometriosis?
A: No, but by working on releasing restrictions the result can be decrease pain.

-How can PT help with my pain?
A: By addressing posture, alignment and connective tissue / organ mobility the pain is often decreased.

-PT vs. Surgery
A: Surgery is sometime necessary, but with pre-op PT and PT after surgery, recovery time is often reduced.

-Is all PT the same?
A: No, not only do you want a therapist that specializes in the pelvic floor you want one  who treats with an holistic approach.  i.e., visceral, myofascial, cranio-sacral.

1.    What did you impart to the group?
We provided education about the importance of symmetrical pelvic alignment, pelvic floor muscle anatomy and function, and the anatomy of the uterus.  We also informed the group on how adhesions associated with endometriosis can contribute to their pain and sexual, bladder or bowel dysfunction and how myofascial release, visceral manipulation and trigger point release techniques can facilitate symptom relief. We finished with a demonstration on visceral manipulation, and Amy Stein showed the group diaphragmatic breathing techniques along with self-pelvic floor stretches (ex. double knee to chest, squatting- refer to Heal Pelvic Pain for more details). Overall I feel we helped with providing encouragement and hope that physical therapy is a holistic treatment for endometriosis.

2.    Did you have any specific recommendations or advice for women who suffer from endometriosis?
To seek pelvic floor physical therapy and if possible find a therapist who practices myofascial release or visceral mobilization before and after laparoscopic surgery.

New Bid-ness: A Silent Auction at IPPS

The mission of the International Pelvic Pain Society (IPPS) is to educate healthcare professionals serving patients with pelvic pain, raise public awareness and offer hope to the 200 million men and women worldwide who suffer from chronic pelvic pain conditions. IPPS strives to optimize diagnosis, evaluation and management of patients suffering from chronic pelvic pain.
We encourage you to support this not-for-profit organization. IPPS is having an on-line auction from October 11-25th. Please mark your calendars and visit www.biddingforgood.com/IPPS. Please note: the site will not be active until the actual start date on the 11th.

There are several educational opportunities and fun items (jewelry, gift cards, Apple, Starbucks…, 2nd row tickets to Stanley Cup Champions Chicago Blackhawks game, travel).

Your support of the IPPS allows invaluable educational programs that work for the betterment of the diagnosis and treatment of those with chronic pelvic pain. Contributions to the IPPS are tax-deductible by donors as provided in section 170 of the IRS code.

To learn more about chronic pelvic pain, IPPS and their annual conference, go to www.pelvicpain.org. This years meeting is being held October 17-20th in Orlando, Florida. Thank you so much for your support!

Amy Stein is a Board Member of IPPS. Here is a photo of her with colleagues Stephanie Prendergast and Lorimer Mosley at last year’s conference!


International Pelvic Pain Society

2013 IPPS Online Auction

October 11, 2013

8:00 A.M. ET

 The IPPS2013 Auction opens for bidding on October 11, 2013 at 8:00 A.M. ET. Our goal this year is to raise $15K to support IPPS. We need your support! This is an exciting and fun way to help us, and at the same time have a chance to win several great items!

Bid on several pelvic pain items, instructional tools, and

other exciting auction items, including:

Vaginismus.com Treatment Combo  (“tool kit”)

How about a Vacation in Dardanelle and Istanbul Turkey?

Perhaps a boating trip on the Chesapeake?

Maybe you prefer an autographed football from the University of Alabama?

Take a look at the items to preview as the auction date approaches. Check back often to see what’s new. Place a ‘Watch’ on your favorites to know as soon as bidding begins!

To register and bid:

www.biddingforgood.com. Click the “Register” link in the upper right corner of any auction page. You will need to give a credit card to hold the bidding items. Your card will be charged if you are the highest bidder and the item will be sent to you. Once you have completed the registration, enter your username and password in the upper right corner and click the “sign in” button. Bidding is available October 11-25th at www.biddingforgood.com/IPPS. All funds will be donated to IPPS, which is a not for profit organization (minus Bidding for Good’s 10% operational fees).

Endo Warriors! Part I

By Riva Preil

Beyond Basics Physical Therapy had the opportunity to host an Endo Warriors meeting on Sunday, September 29.  According to their mission statement, “Endo Warriors is a support organization for women who are focused on helping each other to fight against the devastating effects of endometriosis, the leading cause of pelvic pain and infertility in women. Through this group we exchange ideas, current research, and give support to those in need-we could all use someone who understands what we’re going through and how we feel.”  We here at BBPT support the Endo Warriors, and are always looking to help those suffering from endometriosis. Our own Amy Stein, Michele McGurk, and Mary Hughes participated in Sunday’s session.  Please enjoy the following interview I conducted with Michele, physical therapist at BBPT, regarding the session (paraphrased responses).

1.    What questions were asked at the session and how did you respond?

-What are dilators and what is their purpose?
A: Dilators are used to help increase one’s comfort with inserting something into the vagina, to help stretch the pelvic floor muscles, to monitor their personal progress with physical therapy, and to prepare for intercourse and/or use of sexual toys.

-What is the expected course of physical therapy?
A: Approximately 8 weeks is a good timeframe within which to expect to see progress from treatment.

-Are pelvic floor exercises found through Google or YouTube any good, or is it better to speak to a doctor/physio etc? Can those exercises help with pain?
A: It’s better to speak to physician or pelvic floor PT, and yes they can help with pain!

October is National Physical Therapy Month!

Now that we’ve started October, we thought we’d share with you some important information: it’s National Physical Therapy Month!

As PTs, we treat the body without medication, easing it through a variety of common health problems and recovery processes. We love the work we do, and we love helping you!

National Physical Therapy Month was created to create an official space for PTs to continue to educate the public about the benefits of physical therapy and the motion improvements it makes in people’s lives. We encourage you to visit the American Physical Therapy Association here or ask us to learn more!


Promote Pink!

By Riva Preil

October marks National Breast Cancer Awareness Month (NBCAM).  NBCAM was established in 1985 as a partnership between the American Cancer Society and a sub-division of Imperial Chemical Industries with the goal of promoting routine mammographies as the best tool to detect and combat the disease.  In 1993, Evelyn Lauder, Senior Corporate Vice President of the Estee Lauder cosmetics company established The Breast Cancer Research Foundation and the popular pink ribbon as its symbol.  The National Race for the Cure was established in October 1983 to raise funds for breast cancer research.  The first race was held in Dallas, Texas, and there were 800 participants.  By 2002, within a mere decade, the event had exploded into 1.3 million participants in over one hundred U.S. cities!

Fortunately, breast cancer awareness and research has helped with earlier detection and treatment than ever before.  Furthermore, prophylactic measures have become a viable option for women with increased risk of developing the disease.  October is a great time to review the proper way to perform a breast self-examination.  Please refer to the link here to ensure that you are properly performing a BSE monthly.