Amy Talks at Mount Sinai Medical Center! Part 1

By Riva Preil

Recently, Beyond Basics Physical Therapy’s very own Amy Stein presented a talk to over sixty obstetrician/gynecologists, urologist/gynecologists, nurses, and physician assistants at the Mount Sinai Medical Center Grand Rounds, in the Icahn building.  The talk was approximately forty minutes followed by ten minutes of questions and answers.  The goal of the talk was to educate the health care providers on pelvic floor physical therapy and how we can help their patient population.  Please enjoy the following recap with Amy as she reflects upon the experience.

According to Amy, one of the most exciting parts of the experience was having the opportunity to answer the health care providers’ questions.  Several of the questions included:

¨      “Can you help reduce a diastasis recti with physical therapy exercises?”
My comment was yes, with specific exercises and guidance from a well trained pre-natal/post partum PT.
The follow up was- “does it help to reduce some of the pain symptoms associated with pregnancy?” And the answer was yes! And you can even start some exercises during pregnancy under the guidance of a specialized PT who will help monitor the exercises.

¨      “Does insurance pay for this?” and the answer is yes, as long as it is medically necessary and in line with medical diagnoses (refer to slide below) discussed in the grand rounds. The amount that we, or the patient gets reimbursed depends on the patients insurance plan.

Second Time’s The Charm

By Riva Preil

As a second born child as well as a pelvic floor physical therapist, I am fascinated by research involving the effects of multiple pregnancies and deliveries on the female pelvic floor. Women often sustain trauma to the pelvic floor muscles during delivery, especially with the first child. While it is commonly known that subsequent deliveries increase the risk of developing prolapse, it is unclear whether or not additional pregnancies contributed to pelvic floor trauma as first time pregnancies do. Fortunately, a recent study soon to be published in Ultrasound in Obstetrics and Gynecology entitled “Pelvic Floor Trauma: Does the Second Baby Matter?” addresses this topic. In the study, ninety-four women presented after delivering their second child, on average 2.7 years after delivering their first baby. Sixty-five of the women delivered their second baby vaginally (nine of which were vaginal births after Cesarean, or VBAC), and the remaining twenty-nine women delivered via Cesarean section (C-section). Fortunately, the study revealed that an additional pregnancy and delivery did not significantly damage the pelvic floor muscles, nor did it harm bladder support.  In addition, the method of delivery of the second child did not make a difference.  So mommies can rest assured that having a second child does not place them at any greater risk for developing pelvic floor damage than their first delivery.

We here at Beyond Basics Physical Therapy treat women postpartum, whether they have just delivered their first, second, or even tenth child! If you or someone you know can benefit from pelvic floor strengthening and rehabilitation after the stressors of pregnancy, labor, and delivery, please call us for more information.

Scrutinizing Surgery

By Riva Preil

When conservative approaches don’t achieve the desired effect, surgical interventions are at times warranted. However, it is important to understand the affect that surgery has on muscle, fascia, and connective tissue, especially in regards to the pelvic floor.  In men, a prostatectomy and bladder replacement for post-cancer treatment can aggravate pelvic floor disorder. In addition, several types of surgical procedures can result in female pelvic floor dysfunction. Cesarean section deliveries may result in abdominal weakness, low back pain, scar adhesions, poor posture, poor body mechanics, and visceral dysfunction.  Hysterectomy, either vaginal or abdominal procedure, may result in scar adhesions, and/or tensions or weakness in the pelvic floor, abdomen, or hip flexors. An episiotomy is vaginal tearing during childbirth which may result in scar adhesions, pelvic floor muscle weakness, pain, and dyspareunia (pain during vaginal penetration).  Finally, laparoscopic surgery may result in abdominal and visceral scar adhesions. In all of these cases, pelvic floor physical therapy with manual therapy and connective tissue mobilization, including scar massage, may be indicated. If you think that you may benefit from such treatment, please request a referral to pelvic floor physical therapy from your doctor.

Adapted from Amy Stein’s Heal Pelvic Pain


Discovering it A.L.L.!

By Riva Preil

The New York Times reported recently that Belgian scientists discovered the existence of a new ligament in the knee, the anterolateral ligament (A.L.L.) which stabilizes the knee joint by connecting the femur to the tibia.  The information was initially greeted with excitement by the medical community, however shortly thereafter, skepticism and doubt crept into the reaction of some.  How is it possible that medical practitioners have MISSED this for so long?  Could this simply be a conspiracy devised by doctors eager to perform ADDITIONAL surgeries and generate more profit?

ABSOLUTELY NOT- this ligament is the real deal, folks.  A careful dissection analyses in 41 cadavers confirmed that this tiny ligament, which measures approximately 1.5 inches length, is in the same location and has the same origin and insertion in all the studied knees.  The human body is sometimes expected to be a nicer and neater package than it actually is.  To quote The New York Times author, Bill Hayes, “The body is murky.  Muscles don’t neatly separate for you in order to display their various parts.  What lies beneath the chiseled beauty that is a six-pack, to cite one example, is wet and messy” (“The Secrets Inside Us,” December 3, 2013).  The natural variation amongst individuals, along with the internal changes that occur with the aging process, disease, and injury, make it easy to understand how such a small ligament could go undetected for so many years.

If this concept holds true regarding the knee, try to imagine how much moreso it translates to pelvic floor anatomy!  The pelvic floor, a region of the body which often gets considerable less attention during anatomy lab dissections, is a big question mark to many. Fortunately, we live in a day and age when technology affords us the opportunity to learn, discover, and analyze the many structures that are hidden within the private recesses of our bodies. The pelvic region, an inner sanctuary housed deep within our bodies, is actually a highly congested area filled with muscles, tendons, ligaments, nerves, arteries, veins, and connective tissue.  It is truly a miracle when everything works well and our bodies function smoothly.  However, when that is NOT the case, it can manifest as pain, bladder and /or bowel dysfunction, or sexual dysfunction.  Fortunately, treatment is available, and pelvic floor physical therapy can help address the musculoskeletal and neurologic components of this region. If you or someone you know has questions regarding whether or not this type of intervention is appropriate for you, please contact us at Beyond Basics Physical Therapy- we are happy to help!

Ob/Gyns Can Treat Men Again!

By Riva Preil

Recently, the American Board of Obstetrics and Gynecology overturned a previous decision which forbade obstetrician-gynecologists from treating male patients for sexually transmitted infections and to screen them for anal cancer.  The previous decision which was made in September put any physicians who did not follow the rule at risk of losing their license. This interfered with their ability to continue treating current patients and to conduct research that was currently underway.  Therefore, experts in anal cancer requested that the board change their original decision.  Fortunately, Dr. Kenneth L. Noller, the board’s director of evaluation, recognized that ob-gyns are trained to treat sexually transmitted infections in both males and females.  This includes human papillomavirus (HPV), a sexually transmitted virus that is associated with both cervical and anal cancer (which is more common amongst individuals with HIV).  Now that ob-gyns are permitted to resume treatment of their male patients, men can continue receiving the medical care that they too deserve.  Hopefully, improved screening techniques will result from the continued research in this area.

Pediatric Pelvic Floor Therapy

By Riva Preil

Great news! Pelvic floor physical therapy benefits adults and children alike…and research is proving it!  The European Journal of Physical and Rehabilitation Medicine reports a recent study which supports pelvic floor physical therapy for children with dysfunctional voiding (DV).  DV is involuntary contractions of the pelvic floor muscles and/or the external urethral sphincter during urination in children with intact neurological systems.  DV is strongly correlated with urinary incontinence both during the day and at night (called nocturnal enuresis), urinary tract infections (UTIs), constipation, difficulties with urination, pelvic holding patterns, and vesicoureteral reflux.

The aforementioned controlled study was performed in an outpatient clinical facility and it included forty three children aged 5-13 with DV.  Treatment consisted of education about proper fluid intake, toileting posture, timed voiding schedule, hygiene issues, and constipation reduction education.  In addition, children were educated on the proper performance of diaphragmatic breathing exercises (for abdominal muscle relaxation) and pelvic floor muscle strengthening exercises (three second hold followed by thirty second release).  After one year of treatment, daytime urinary incontinence was cured in 83% of participants, nocturnal enuresis was cured in 63% of participants, and constipation was cured in 100% of participants.  In other words, PELVIC FLOOR PHYSICAL THERAPY IS APPROPRIATE AND INDICATED FOR CHILDREN in certain instances.  If your child or someone that you know may benefit from these services, Beyond Basics Physical Therapy has a wonderful pediatric program.  Please ask your child’s pediatrician for a prescription for pelvic floor physical therapy, and we look forward to helping!