Postcard from the Beyond Basics Holiday Party

Ho! Ho! Ho! Last weekend the Beyond Basics crew put on their best duds and dancing shoes to celebrate the holiday season at Tiny’s NYC. Tiny’s is a rustic looking little bar/restaurant that has large plank pine wood floors and handsome wood beam rafters decorated with white Christmas lights and evergreen garlands. It definitely felt calm and cozy on the inside, despite the cold December night outside.  

We also held our first ever “Beyondies.” The Beyondies are awards based loosely off of the Dundies from the show The Office. Superlatives were sent out to the staff and collectively, we voted on the woman from our practice most likely to be hiding candy in her desk, the woman most likely to become a crazy cat lady, and many more. Below are pictures from our Holiday Party as well as some of the results from our first ever annual Beyondies Awards.

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Fiona presenting Alexa with “The Most Likely to Never Kayak Again Award”

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Jaquie receiving the “Clinic Mom” award

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Anne Taylor winning the award for “Most Likely to Become a Crazy Cat Lady”

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Corey wins the award for “Most Gluten-Free”

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Ryanne gets the award for being the most likely to start a dance off

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Melissa receives the award for Clinic Clown

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Amy wins the award for Most Competitive

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Stephanie wins the award for most “Martha Stewart”

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Victoria wins the awards for “Best Brown Bag Luncher”

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Yarisa winning the award for most Disney Princess

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The whole crew (minus Rose and Yarisa) at the Beyond Basics Holiday Party

Postcard From: Boston

By Fiona McMahon, DPT

Last weekend, a small group of physical therapists from Beyond Basics Physical Therapy travelled north to Boston to review the latest and greatest in colorectal and male pelvic health.

Corey Silbert, Victoria LaManna, Stephanie Stamas, and Fiona McMahon, physical therapists and experts in pelvic floor dysfunction, traveled to Norwood, Massachusetts, just outside of Boston, to Herman and Wallace’s Pelvic Floor 2B Course. The course highlighted techniques such as the evaluation and treatment of fecal incontinence, treatment of coccyx (tail bone) dysfunction, treatment of constipation, male pelvic pain, pudendal nerve syndromes, and how physical therapy can help treat conditions like ulcerative colitis, crohns, irritable bowel syndrome, prostatitis, post prostatectomy incontinence, and many other conditions

The physical therapists at Beyond Basics Physical Therapy pride themselves on striving to bring the most current and up to date clinical techniques into their clinical practice. We have extensive experience in the treatment of disorders of the pelvic floor.

We encourage you to schedule an appointment if you feel you could benefit from our services.

Check out some of the pictures from our trip!

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Above: Corey Silbert and Holly Herman (co-founder of the Herman & Wallace Institute)

Below (left to right): Corey Silbert, Stephanie Stamas, Victoria LaManna, and Fiona McMahon

Postcard from Melissa Stendahl’s Visceral Mobilization Inservice

By Fiona McMahon, DPT

Here at Beyond Basics Physical Therapy, we are fortunate to be able to carve out time in our busy schedules to build our skills. Our staff is composed of physical therapists who are experts on both pelvic floor and orthopedic rehabilitation; however, our diverse staff has expertise that goes beyond traditional pelvic and ortho physical therapy. We take time a couple of days per month to share our knowledge in subspecialties of interest with our coworkers.

Last Wednesday, Melissa Stendahl taught an inservice on visceral techniques to aid in conditions like constipation, dysmenorrhea, infertility, reflux, and more. In her inservice, Melissa explained how the musculoskeletal system can affect the body’s organ systems (viscera) and vice versa. Melissa demonstrated techniques to mobilize organs like the esophagus to help with ulcers, and reflux, the small intestine to treat women’s health issues, low back pain, and lower extremity joint pain, ileocecal valve for bowel disturbances, as well as many other organs.

The symptoms visceral mobilization can be helpful in treating include:

  • esophageal and gastric ulcers
  • headache
  • sacroiliac joint dysfunction
  • low back pain
  • weakness
  • women’s health issues
  • nausea
  • bowel disturbances
  • incontinence
  • bladder prolapse
  • testicular pain
  • groin pain
  • erectile dysfunction
  • pelvic congestion
  • mechanical infertility issues

Check out photos from Melissa’s inservice below. If you are interested in the benefits of visceral mobilization, please call us at  212.354.2622 to schedule an appointment!

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Melissa and CoreyMelissa

Postcard From: Expert Panel

Compiled By Fiona McMahon DPT

Experts

Beyond Basics Physical Therapy recently held its first ever Expert Panel and it was a massive success. We invited some of the City’s/Country’s/ World’s leading clinicians in pelvic health/pain and opened the floor up to our guests to ask questions regarding pelvic pain and its treatment.

Let us first introduce you to the guests on our panel. First up is Dr. David Kaufman (DK), urologist and leading expert on interstitial cystitis, a condition affecting the bladder, which can cause severe pain, urinary urgency, retention and frequency. Our next expert speaker is Dr. Dena Harris (DH), a gynecologist and expert in chronic sexual, vulvar, and pelvic pain. Dr. Allyson Shirkhande (ASMD) is a physiatrist specializing in male and female pelvic pain. Dr. Amy Stein (ASPT) is a physical therapist specializing in pelvic floor dysfunction, the author of Heal Pelvic Pain, and founder of Beyond Basics Physical Therapy.

The floor was opened to our guests to ask our expert panel whatever questions they wanted. Here is a brief synopsis of the questions asked and our experts’ answers.

Question: How can a labral tear [a tear in the the covering of the hip joint] effect pelvic pain and vulvodynia?

Answer:

DH: A labral tear can be related to pelvic floor dysfunction and starting off with a conservative approach is recommended: PT, injections and anti-inflammatory medication if needed. Earlier detection is better and repair of labral tear can help, especially with generalized vulvodynia  (non-provoked). [Non-provoked vulvodynia means that there are vulvar symptoms without a specific irritant. Provoked vulvodynia means that vulvar pain occurs in response to a specific stimulus].

ASPT: Typically we like to see if PT or a more conservative approach can help and in most cases it does! We do a combination of manual [hands-on] work and exercise to take the pressure off of the labrum and to help with proper alignment and body mechanics.

ASMD: There is a relationship with obturator, piriformis and other external rotators of hip and vulvuodynia. Typically we do a course of physical therapy first. We very rarely do surgery right away.

Follow up question: Can you treat it with physical therapy here [Beyond Basics Physical Therapy], if we are already seeing you for another issue?

ASPT: Yes, we are all well trained in treating hip issues, including labral tears. We find that people with premorbid pelvic floor dysfunction present differently than those with just hip pain. Because we have knowledge of the pelvic floor, we can treat your hip without worsening your pelvic floor, which can happen with clinicians who are not well educated in pelvic floor dysfunction. We also treat hip dysfunction with patients that do not have a pelvic floor condition.

Question: I have a lot of pulling in my pelvic floor. I do pilates and yoga and I know the importance of strengthening. I have vulvodynia and neuropathy. I sometimes feel like I’m hurting myself. I sometimes get stabbing pain throughout my leg. I’m tight but not too flexible. What should I do?

DH:  Have you been to physical therapy?

ASPT: It sounds like you have tightness in your pelvic floor muscles and other areas of the body and possibly some nerve irritation.

ASMD: It sounds like you are spasming because you are unstable.

ASPT: We see a lot of foot pain secondary to fascial pulling and nerve irritation. In the brain, [the homunculus: the area that senses what is going on in the body], the feet and the genitals are very close together and the nerves get overflow onto the other nerves. I would tell you to stop Pilates if I saw you and then I think you’d need a very specific type of yoga. I have my patients start from 0 and then slowly work up. I then monitor very careful to detect what is aggravating their symptoms.

Follow up comment: I have neuropathy too.

DH: It may be worth checking it out if you haven’t been to physical therapy in a while. A lot can change [in one’s body over time] and there are constantly advances in medicine and physical therapy.

ASPT: Have you had a nerve block?

Follow up Question: What type of nerve block?

ASMD: That would require an assessment to determine which nerve(s) are irritated. There are a lot of medications to calm it down, injections, medications as well.

DK: I find that if you do things piecemeal it doesn’t work as well. You can do all these individual pieces, but the magic is when you do it all together

Follow up Question: I see a lot of different doctors, it’s so hard to navigate.

DK: That’s why we’re all here, I certainly understand it.

ASPT: A fresh set of eyes may be helpful to see what’s changed in the past five years. I am a huge proponent of home exercise programs and so are the physical therapists here. For your situation I’d have you do more relaxation and breathing exercises. You probably need a lot of soft tissue work and sympathetic nervous system down training.

DH: A lot of doctors are into meditation in ways to desensitize the pain, acupuncture

ASMD: Accupressure as well.

Question: Is there ever a time where it stops? Are you in therapy and the doctor’s office forever? Do you always have to maintain or do a home program?

DH: It depends what’s wrong. Some people get completely better

ASMD: With our physical therapists, we try to instill lifestyle changes. When you’re done with PT you may want to do something like yoga.

DK: You need to find the instigator to find out what’s making the fire that’s making the muscles go nuts. You need to get the fire down. Medicine and physical therapy can help.

Follow Up Question: Say you got a massage and then you feel better, but a few days later your back hurts again, is it like that?

DK: If you haven’t figured out why your back hurt in the first place your back will cramp again.

ASPT: When people are getting ready to be discharged,  I warn them to come back  if they feel their symptoms coming back even the slightest or to increase their home program. Your home program should work for you. It should help to reduce your symptoms and reset the pain cycle. If not, you need to meet with your PT and adjust it accordingly. I have patients that come in for “check ups” but the majority of our patients we do not see again in our office because they get better. We give them the tools to be independent, monitor their symptoms, make adjustments in their daily routine, etc.

Question: What’s the relationship between the gastrointestinal system and vulvodynia?

DH: Sometimes the trigger is gluten, constipation, ulcerative colitis, Crohn’s, IBS [irritable bowel syndrome]. Sometimes the treatment for IBS helps with vulvodynia.

DK: Sometimes a spastic pelvic floor and abdominal wall can cause constipation and IBS-type symptoms.

Follow up Question: What about food?

DK: It’s interesting with people that think they have bladder problems because their symptoms are flared with certain types of food. I look at the bladder it’s fine. Sometimes the food is actually exacerbating pelvic floor muscles.

Question: If you have pelvic floor dysfunction and nothing else, [no other diagnosis], is there anything else that  could cause it?

DK: If you go back in time there is usually something. Like history of infection, a fall on the tailbone or sacrum as a kid.

ASPT: Lots of things, alignment.

Follow up question: What about scoliosis?

All: Definitely.

Follow up question: How often is the cause emotional?

DK: There is always a component of emotion. It’s devastating. I never think emotions cause the problem. Anxiety can make it worse but not the cause.

ASPT: There’s usually trigger like a urinary tract infection but you have to address the emotional component to bring down the activity of the pelvic floor muscles.

There are some great mindfulness/mediation options on iTunes. It’s not for everyone. Sometimes people respond better to yoga.

Q: I have interstitial cystitis which is well managed, however the interstitial cystitis keeps coming back secondary to bacterial vaginosis. I’m  taking meds and suppositories why does it keep coming back?

DH: Ureaplasma, it can cause recurrent pain. There may be some underlying infections that aren’t being detected. You need a really good lab to pick up some of the other types of yeast. There’s certain candidiasis [yeast] that doesn’t respond to typical drugs.

DK: I think it’s great that she’s figuring out what the fire is. Just a little bit of bacteria can send someone to the moon. Sex can move a lot of bacteria to the urethra and set off interstitial cystitis. These are the things I recommend that my patients do:

1.) Pee after sex- a little tinkle after sex isn’t going to cut it. If you pee before sex you don’t have enough urine to really flush out the bacteria from the urethra. It needs to be like a water hose!

2.) Bidet- really wash out the vulva- you really need to irrigate it with water before sex: put it on strong. Get a moveable shower head, spread apart the lips of the vulva to get it really clean.

Q: What percentage of you patients are male?

DK: There is a whole category of men that no one thinks of as pelvic floor dysfunction. It actually is the most common diagnosis in my office. It’s common knowledge that pelvic floor dysfunction can come from untreated prostatitis. 95% of prostatitis is nonbacterial, and the cause, pelvic floor myalgia/spasm.

Pelvic Health 101: Restorative Yoga and Calming Down Your Pelvic Floor

By Fiona McMahon, DPT

Hello all!

We have really enjoyed hosting our Pelvic Health Seminars and were thrilled to discuss a multitude of different pelvic health topics with both familiar and new faces. We will be winding down this series of PH101 classes with an exciting lecture on the merits of yoga practice for relieving pain conditions, including pelvic floor, back and hip dysfunction, as well as hosting a yoga class for all lecture guests.

This Tuesday, December 8th, 2015, at 7pm  Anne Taylor, who has worked with Beyond Basics Physical Therapy for over 9 years instructing group and individual classes for patients with different types of pain conditions, as well as those seeking compassionate and personalized guidance through their practice of yoga, will guide class participants through the science and philosophy of yoga. Anne will also lead a complimentary yoga class at the end of the lecture.

Join us for this extraordinary finale to our PH101 classes. Register at pelvichealth101.eventbrite.com.

See you soon!

Enlightenment in nature