Take a Stand!

By Riva Preil

Prolonged sitting has been linked with obesity as well as elevated blood pressure, sugar levels, and cholesterol. Contrary to what some may believe routine exercise does NOT counteract the detrimental health effects of prolonged sitting.

In fact, according to a study published in the British Journal of Sports Medicine, “Even if people meet the current recommendation of 30 minutes of physical activity on most days each week, there may be significant adverse metabolic and health effects from prolonged sitting — the activity that dominates most people’s remaining ‘non-exercise’ waking hours.”  This means that routine exercise alone is not enough to combat the adverse effects of prolonged sitting.

Furthermore, prolonged sitting negatively impacts the pelvic floor.  Not only does it contribute to tightening of the pelvic floor muscles, but it can also contribute to pudendal nerve compression.

So what are those of us who have desk jobs, who are students sitting through class all day, or who have to endure long conference meetings supposed to do?  As I sit here at my own computer typing this blog, I must admit that even I, a physical therapist who spends majority of my time with patients, am also susceptible to extended periods of sitting at work.

The best way to combat the sitting conundrum is to incorporate as many standing and/or walking breaks into your daily routine.  For example:

  • Take that Keurig or water cooler break that you were considering.

  • Get in the habit of standing while talking on the phone.

  • Take a stroll around the office to discuss matters with your colleague whenever possible rather than meeting in an office.

  • With spring right around the corner, consider standing up and moving around outdoors during your lunch break.

  • Encourage your employer to try using a standing desk or workstation – chances are that they will be more likely to order one for you if they themselves experience the benefits.

What IS Myofascial Release?

By Mary Hughes PT, DPT

Understanding Myofascial Release (MFR)
Myofascial Release (MFR) is a holistic, therapeutic approach to manual therapy, John Barnes PT, LMT, NCTMB, is credited to the development of Myofascial Release (1). MFR offers a comprehensive approach for the evaluation and treatment of the myofascial system, the system of tissues and muscles in the body.

This technique is designed to release restrictions such as trigger points, muscle tightness, and dysfunctions in soft tissue that may cause pain and limit motion in all parts of the body. It has shown success in decreasing pain and increasing mobility (1).

The main tissue that MFR focuses on for release in the myofascial system is the fascia. Fascia is a fine tissue that surrounds all structures in the body including muscles, nerves, vessels, organs and bones. MFR allows the therapist to evaluate, identify, and treat fascial restrictions. These restrictions can be caused by numerous factors, such as trauma, musculoskeletal conditions, repetitive stress syndrome, and poor posture.

By applying gentle, hands-on techniques to the whole body, positive structural changes may occur, such as increased range of motion, decreased pain, and, most importantly, increased fascial mobility (2). In combination with traditional physical therapy, MFR can help patients return to their daily and recreational activities.

Who Might Benefit from MFR
MFR can be used to treat pain and increase mobility in patients with a wide range of conditions, including back, neck, shoulder, hip and pelvic pain, and fibromyalgia.

Athletes can also benefit. A number of sports injuries can be treated with MFR, including:

  • Repetitive strain injuries, often seen in long distance runners

  • Muscular imbalances, which lead to overuse in isolated joints and faulty movement patterns (3)

There are also increasing numbers of athletes who have found MFR to be helpful in regaining proper pelvic alignment, which in turn leads to optimal competitive performance (4).

Contraindications
MFR may not be appropriate for all patients. Contraindications for MFR include – but are not limited to – those with malignancy, aneurysm, acute rheumatoid arthritis, advanced diabetes, severe osteoporosis, and healing fractures (2). Your physician and physical therapist can help determine whether or not MFR is an appropriate course of treatment for you.

What to Expect
During your first appointment the therapist will perform an initial evaluation, a comprehensive systems review, and musculoskeletal physical exam to ensure that MFR is appropriate for you. Evaluations include a postural assessment and strength and range of motion testing.

During your first MFR treatment, it is common for the therapist to position you on your back on a treatment table to allow your body and mind to relax. The majority of MFR work consists of gentle pressure. Sometimes the motion is very fluid, and at other times your limbs may be held in a light stretch. The therapist may begin on the area in which you are currently experiencing pain. However, that is not always the case, as pain can often be referred from different parts of the body.

You may experience some slight discomfort as your tissues release tension. While many patients leave a MFR session feeling very relaxed, it’s not uncommon for there to be some residual muscle soreness. The soreness is “thought to result from postural and alignment changes or from the techniques themselves.”1

Over time, your therapist will show you how to practice MFR techniques yourself at home, using foam rollers, a tennis or Myo-Release Ball™, and/or massage sticks.

For more information on MFR you can access John Barnes’ Website at: http://myofascialrelease.com/

References

1. Dutton, Mark. Orthopaedic examination, evaluation, & intervention. New York : McGraw-Hill, c2004 pages 331-332, 1218

2. John Barnes’ Courses completed MFR I, MFR 2, Myofascial Unwinding, Myofascial Soft Tissue Mobilization workshop.

3. Taylor, D. Dealing with Muscular Imbalances around the Lumbo-Pelvic-Hip-Joint Retrieved January 22, 2012 from Athlete Acceleration.com URL:http://www.athletesacceleration.com/hipmuscularimabalances.html

4. Leigh, J. How Myofascial Release can help athletes achieve optimum performance Retrieved January 22, 2012 for source website URL:

http://www.memphismfr.com/MemphisMFR/_pdf/How%20MFR%20Can%20Help%20Improve%20Athletic%20Performance.pdf

 

 

Amy Attacks Nerve Pain!

By Riva Preil

Pudendal neuralgia is a pain disorder associated with compression or entrapment of the pudendal nerve, an important and sensitive structure in the pelvic floor.  Oftentimes, proper diagnosis of this condition is delayed because symptoms mimic other various pelvic floor musculoskeletal dysfunctions.  Patients often complain of burning or itching pain, especially with prolonged sitting.  

Individuals who suffer from pudendal neuralgia are not alone!  The Pudendal Neuralgia Association, Inc. was created in 2013 in Massachusetts as a non-profit organization to provide information, resources, and assistance to people who suffer from pudendal neuralgia, to their family members, and to health care providers.  Several of their goals include establishing a telephone hotline to provide emotional support, providing counseling services, and finding conveniently located and accessible resources to sufferers.  

Beyond Basics’ very own Amy Stein will be presenting a webinar for the Pudendal Neuralgia Association entitled “Pudendal Neuralgia and Pelvic Pain” on March 26, 2014 (5:00- 6:30 PM EST).  In her talk, Amy will discuss the anatomy and functions of the pelvic floor, musculoskeletal and neurologic pelvic floor dysfunction, and the effectiveness of physical therapy as a treatment approach.

Be sure to tune in on Wednesday for Amy’s enlightening and informative presentation!  It is guaranteed to be a wonderful learning opportunity that you don’t want to miss.

Shout Out About…IPPS Silent Auction

By Riva Preil

The International Pelvic Pain Society (IPPS) was established in 1996 with two primary objectives: 1) To educate health care professionals on how to diagnosis and manage chronic pelvic pain and  2) To bring hope to men and women who suffer from chronic pelvic pain by significantly raising public awareness and impacting individual lives.

IPPS’s mission is focused on optimizing the diagnosis and treatment of patients suffering from chronic pelvic pain and serving as an educational resource for health care professionals. As a not-for-profit organization, IPPS is broadly funded by donations and memberships from individuals, patients, and healthcare professionals alike. Your support of IPPS allows valuable educational programs that work the betterment of the diagnosis and treatment of patients suffering from chronic pelvic pain.

On that note, the IPPS is currently conducting an on-line silent auction to fundraise on behalf of their incredible work.  There are three categories of auctioned items:

  1. Pelvic pain products and education: examples include Amy Stein’s Heal Pelvic Pain book, Apex Automatic Pelvic Exerciser, an App for pelvic pain to help both the patient and the practitioner, perceptorship with Rhonda Kotarinos in Chicago, acupuncture perceptorship with Paula Haberman in NYC, De-mystifying Pudendal Neuralgia Course (for a practitioner, in Las Vegas September 2014), and a crystal wand.

  2. Travel and Leisure– examples include a week-long vacation to St. James’s Club, Antigua, a vacation in Dardanelle and Istanbul, Turkey, a 5 day/4 night Mexican Vacation at the Hacienda Tres Rios (Riviera Maya), 2 seasons tickets for the Chicago Blackhawks 2014 season, and 2 tickets to the Chicago Shakespeare Theater.

  3. Other miscellaneous products include NBC’S TODAY SHOW: VIP Behind-The Scenes Tour  for Two, $50 Gift Card Lettuce Entertain You Restaurants, jewelry, Starbucks and Apple Product Gift Cards, and a 16-Bottle Countertop stainless steel wine cellar.

As you can clearly see, there is something for everybody!  This is an incredible opportunity to win great prizes while supporting an extremely worthwhile cause.  Stay tuned for an interview with Amy Stein, Secretary of IPPS Board of Directors and Chairperson of the 2014 silent auction and for more details!

Riva Speaks at Plaza College!

By Riva Preil

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Riva, right, with Dean Marie Dolla, left.

Thanks to the help of Dean Marie Dolla, I had the pleasure of presenting a talk about pelvic floor physical therapy at Plaza College yesterday.  The goal of the presentation was to educate young women about the prevalence, signs, symptoms, and treatment of pelvic floor dysfunction.

Unfortunately, many women are unaware of the existence of pelvic floor physical therapy (or even of their pelvic floors altogether)!  When asked about my job, I respond that I am a pelvic floor physical therapist.  The follow up question I expect to receive (and almost always do) is “What is that?”

Many of us function on autopilot- when our bodies function as we expect them to, we don’t think twice.  We go about our business and don’t give too much thought to our bowel and bladder function. However, if, for whatever reason, the pelvic floor muscles cease to operate in the smooth manner that we often take for granted, symptoms such as urinary frequency, urgency, incontinence, constipation, and/or pelvic pain may develop.

Very often, these symptoms are associated with MUSCULOSKELETAL dysfunction in the pelvic floor.  When this is the case, pelvic floor physical therapy can help alleviate the aforementioned symptoms.  That was the goal of my talk–to raise awareness amongst a population of individuals who may be suffering in silence.  I am passionate about my job and strongly believe that is important to EDUCATE women about their bodies and their health so that they can pursue avenues directed towards improvement.  I long for the day when I will not have to explain my job to new people that I meet, because they will already know what pelvic floor physical therapy is.  By educating the 25 of women at Plaza College, I have taken another step along that journey.

Gut Feelings

By Riva Preil

Individuals who have endured a spinal cord injury (SCI) often experience colorectal and anal sphincter dysfunction generally referred to as neurogenic bowel dysfunction (NBD).  NBD includes constipation (in up to 80% of individuals), fecal incontinence (in up to 75% of individuals), and abdominal pain.  In fact, approximately one-third of individuals who have sustained a SCI develop abdominal pain ten years or more post injury.

Approximately 50% of individuals who suffer SCI experience neuropathic pain, pain caused by damage or disease that affects the nervous system (refer to picture below regarding nervous system connections to the stomach).  The nature of this delayed onset abdominal pain is not fully understood.  Is the abdominal pain experienced by individuals with SCI neuropathic in nature or is it visceral (organ related) in nature similar to classic constipation and abdominal pain?  Practically speaking, if the abdominal pain experienced by patients post-SCI is similar to visceral chronic idiopathic constipation (CIC) experienced by able-bodied individuals, then the same treatment that benefits those with CIC can also benefit patients with SCI.


Researchers at the Aarhus University Hospital in Denmark recently explored this topic.  The study included 21 individuals who had sustained SCI and 15 individuals with CIC.  They used radiopaque markers to assess the gastrointestinal transit time (GITT) over the course of a week.  GITT reflects the colorectal transit time, also known as the amount of time it takes for food to pass from one end of the gastrointestinal system to the other end.

Although participants with SCI generally had longer GITT scores, there appeared to be very little association between GITT scores and pain levels.  Participants also rated their pain levels with an assessment tool called the Cleveland Constipation Score.  81% of patients with SCI and 93% of patients with CIC reported abdominal pain within the past month.  Approximately 50% of participants in both groups experienced increased postprandial (post-eating) abdominal pain.  This supports the theory that abdominal pain is of visceral origin.

Therefore, even though there is probably a neuropathic component to abdominal pain amongst individuals with SCI, it is likely that there is an even stronger visceral component.  This means that the same interventions that benefit individuals with CIC can also benefit patients with SCI who experience abdominal pain.

Fortunately, pelvic floor physical therapists are trained to treat bowel dysfunction.  Treatment includes ILU colon massage, diaphragmatic breathing, proper toileting position, and education on proper usage of pelvic floor muscles.  If your or someone you know experiences CIC or SCI related abdominal pain, please share the good news with them–physical therapy can help! We here at Beyond Basics Physical Therapy would be privileged to facilitate you along your road to recovery. Please contact us if you have any questions- we would love to have the opportunity to help.

C-Section Connection?

By Riva Preil

On Monday, March 3, 2014,  New York Times writer Nicholas Bakalar suggested an interesting and somewhat shocking connection in an article– that babies delivered via cesarean section were more likely to develop obesity as adults. Bakalar reviewed data from 15 previous observational studies and discovered that C-section babies were 26% more likely to develop into overweight adults and 22% more likely to develop into obese adults.  The definition of “overweight” is body mass index/BMI of 25 or more, and the definition of “obese” is BMI of 30 or more.

It was irrelevant whether the vaginal delivery was natural, with forceps, or with vaccum extraction, and it also didn’t make a difference whether the C-section delivery was pre-labor or during labor.  The only factor that was clinically significant in the research was the general method of delivery- C-section vs. vaginal.

But don’t stress just yet!  This obviously does not mean that an obesity weight fate is sealed if you were delivered via C-section, nor does it necessarily mean that you can eat all the chocolate your heart desires if you were born vaginally.  To date, there have been no studies conducted that confirm a causal connection between adult BMI and method of delivery.

That being said, further research is warranted in order to establish clearer connections, which will provide women with more information to assist their decision making process.  Many factors must be considered in the process of making birth method decisions, including maternal and fetal health, and it is important to include one’s obstetrician in this important conversation.

Unfortunately, Bakalar did not present a hypothesis regarding WHY c-section deliveries are correlated with high adult BMI.  At first glance, the two factors seem highly unconnected.  Therefore, I invite you, dear reader, to share your thoughts.  Why do you think there is a connection between birth method and adult BMI?  The response that generates the most likes on Facebook will be entered into a raffle to win a free massage stick!