By: Fiona McMahon, DPT
Hey Ladies!!! In the next installment of our Pelvic Health 101 course, we are hosting a women’s only session to allow for a safe and non-threatening place to discuss many issues that can affect the health of your pelvic floor. This class one of Stephanie Stamas’s (the founder of PH101’s ) favorites and is definitely not to be missed. Hear more about it in her video below! Join us at 7pm on October 25th, 2018. Please register at pelvichealth101.eventbrite.com
Have you noticed an increase in the amount of pink on just about everything the last couple of days? The increase of pink everything is because October is Breast Cancer Awareness Month. Breast Cancer is an extremely common cancer. According to the Nation Breast Cancer Foundation, 1 in 8 women will be diagnosed with breast cancer in their lifetime. Men can also get breast cancer, however, it is much rarer for men to develop breast cancer. Luckily with early detection and treatment of early stage and localized cancer, the 5-year relative survival rate is 100%. That being said, early detection is crucial and it is important to catch breast cancer early to ensure the best possible outcome. Let’s take some time to review the signs of breast cancer and recommended screening protocols.
Signs and Symptoms of Breast Cancer
Change of Sensation/ texture of the Breast or Nipples
Lumps, change in texture in the breast, nipple, or underarm area
Change in appearance of Breast or Nipple
Change of nipple orientation
Discharge from nipple
Recommended every 1-2 years for women who are 40 years old or older.
May be recommended for women who are under 40, but have increased risk of breast cancer.
For some types of breast cancer, there is a very specific link to a person’s genes and her or his risk of developing breast cancer. BRCA1 and BRCA2 are genes that are responsible for the production of certain tumor-suppressing proteins. In some populations, there are mutations in these genes that disable their tumor-fighting properties. These gene mutations are relatively rare and currently, screening is recommended just for individuals with increased risk of harboring these mutations. According to the National Cancer Institute, individuals who are at higher risk and should consider genetic testing are:
Individuals who have a male relative who has developed breast cancer
History of BRCA related cancers within family history
People of Ashkenazi (Eastern European) Jewish ancestry
Breast Cancer diagnosed before age 50 in family
Multiple cases of breast cancer in family
Individuals that test positive for BRCA mutations may consider increased screening, prophylactic surgery or chemoprevention.
Mastectomy and Physical Therapy
Mastectomy, removal of the breast is currently the most common treatment for breast cancer. Some women chose to have their breasts reconstructed after their mastectomy and others do not. It is obviously a very personal choice. Like any surgery, mastectomies require close postoperative care to ensure maximal function and recovery.
You may have read the last sentence, and thought, “What is the function of the breast, besides breastfeeding and for sexual pleasure?” The breast lies in an important intersection in the body. The armpit (axilla) contains bundles of nerves, blood vessels, and lymph vessels that course through it, serving the arm down to the fingers. After a mastectomy, their course can be interrupted by scar tissue, radiation damage (if your treatment included radiation), causing painful conditions such as nerve entrapments, frozen shoulder, and lymphedema, ( a backup of lymph fluid, if left unchecked can cause permanent damage and deformation of the arm).
Victoria LaManna, DPT, CLT, is our lymphedema expert. If you have had a mastectomy and are unsure about lymphedema care, she is an excellent resource. She will be able to instruct you in self- care and lymphedema prevention measures. Physical therapy can also help to release scar tissue in the breast and upper arm area, regain strength in the arm, and ultimately improve your function. Visit us, and read up on Victoria’s bio here, as well ask on our website at: www.beyondbasicspt.com/lymphedema
Sex should feel good… really, really good. But when it doesn’t, you may start to wonder, what’s wrong with me? Am I broken? Am I a prude? Am I frigid? Painful sex isn’t something we talk about. No one would look at you twice if were complaining of pain in your elbow, but in your genitals is a different story.
On October 18th, we at Beyond Basics are breaking down those taboos and having an educational seminar, followed by an optional question and answer session at the end. We will discuss the many causes of sexual pain and how physical therapy can help. The event will be hosted by one of our expert therapists, Stephanie Stamas. Stephanie will give a detailed seminar about pelvic health and take time to clear up some common misconceptions many people have concerning their bodies and sexual function.
In this blog, our guest writer is talking about pelvic girdle pain (PGP), which can often get confused with pelvic floor dysfunction (PFD), although they are related, they are different conditions. For pelvic floor dysfunction, we often caution against just strengthening the pelvic floor. Often times the pelvic floor muscles are over tightened and tense and strengthening often can worsen the situation. Pelvic girdle pain refers to issues around the pelvic bones and sacrum. Both can occur during pregnancy but often require different treatment approaches. If you have pain, come see us at BBPT.
Exclusively written for BeyondBasicsPTBlog.com
Back in college, I used to be an avid tennis player and even had the chance of representing my school in intercollegiate tournaments. I would wake up at 5 am for three-hour training sessions all the while trying to balance my studies. But after college, the corporate life sucked me in, and I was lucky if I got to play for an hour every other week.
Then after childbirth, my life consisted of trying to raise a beautiful baby boy. I haven’t picked up my racket in months. It’s not because I don’t have time for things other than raising my child – I’ve been blessed with a husband who assumes his fair share of the responsibility. What’s holding me back is my physical state. The pelvic girdle pain (PGP) I experienced during pregnancy never really went away postpartum. In truth though, it is not uncommon. The American Physical Therapy Association notes that many women continue to have the symptoms of PGP after birth.
It’s a scary thought not to be able to do something you used to love so much. Compared to other stories I’ve heard, my case can be considered mild, but I had to seek help if I wanted to play again. Beyond Basics Physical Therapy led me to Pilates and I learned to channel my breathing in a way that it gently engages my pelvic floor [ remember this may be appropriate for PGP but not necessarily PFD]. It has been a great way to reintroduce strength to my core, considering that pregnancy has changed my body in more ways than one. When I get nostalgic and look at pictures from my glory days, I barely recognize myself. Where are the muscular legs, rock hard abs, and enviable arms? Not in this 34-year-old body of mine, that’s for sure. But I’m committed to gaining control over my body and getting back to the court.
But in the five months that I’ve been doing painstaking therapy, my sacroiliac joint feels a lot better, and I no longer feel stiff. During my recovery, Serena Williams was a great inspiration to me. For one, she’s a fantastic player, and Coral identified her as the highest paid female tennis player. More importantly, though, she’s a mom who never used her pregnancy as an excuse not to get a hold of her life. She probably even went through the same pain many other women, and I did. When I was bed-bound during my pregnancy, my idol was playing in the Australian Open while she was 8 weeks pregnant and even won the final.
Not all women’s bodies are the same or even experience pain similar to mine, but Williams continues to be my inspiration on and off the court. I have been playing tennis with my trainer—sometimes with my husband—and we sometimes play for as long as my stamina allows it. Torquing my hips doesn’t worry me anymore, in fear of a sudden crack of my bones anymore. On excellent days, I think that my backhand is even returning. Although I suspect that it will be a long time before I regain the level, I was playing at during college
Note from Fiona McMahon, PT, DPT at Beyond Basics Physical Therapy
We are so grateful to have AvaFreya share her experience of returning to tear up the court post baby! Everyone’s story evolves so differently with pregnancy and childbirth, which is what makes it both terrifying, exciting, and momentous, all the same time. The truth is some women bounce back on their own, (lucky duckies), others find it to be much more complicated. We recommend coming to visit a Pelvic Floor Physical Therapist during pregnancy and after you give birth to guide you to a program that is right for you. We often run into women, who with the very best of intentions, started down a path that actually made them worse! Often times we see this with women doing excessive Kegels when their pelvic floor is already too active secondary to weakness somewhere else in the body. Frankly, it’s a total bummer and delays getting back to the things you love. If you have recently had a baby or are currently preggers, you owe it to yourself to see a pelvic floor physical therapist who can advise you on exercises to do on your own or treat you more intensively if you need it. Your time and your health are way too precious.
For more reading on pregnancy and pregnancy-related conditions, please check out these blogs:
The number of Americans who deal with constipation issues is massive (4 million)! It seems like every time I mention that I’m a pelvic floor physical therapist, another friend of a friend pulls me aside with bowel movement concerns. Why is it that so many people have issues? And more importantly – what can we do about it? This is the topic of our next Pelvic Health 101 seminar on October 11th at 7pm.
Not only will constipation be discussed but other bowel conditions, such as irritable bowel syndrome, fecal incontinence, bloating, and hemorrhoids will be addressed. The lecture will also go in depth on the role of fiber, water intake, toilet posture and pelvic floor muscles in having a successful bowel movement. You will even go home with easy techniques that you can implement immediately to help you get that smooth move! Don’t miss out on this FREE event – it’s a MUST for anyone who struggles on the porcelain throne. Seats are going fast! Light snacks and refreshments will be served.
Okay, you’ve got the referral in your hand. You have found the clinic that seems perfect for you. You are ready to improve your health and go to physical therapy (GO YOU!). But what if it doesn’t work? Your Aunt Gladys did great after her treatment and is back to hiking after a hip replacement, but your brother Dale is still struggling with his knee pain. Why? Will you be like your dear auntie or will you be like Dale? Is there anything you can do to improve your chances of absolutely rocking physical therapy (PT)? The answer is yes. There is a lot you can do to help speed your progress in PT.
One of the most common questions I get as a physical therapist, second only to “why did this happen to me?” is “how long will it take to get better?”. The answer is variable and to explain my answer, I hop in the way-back machine and bring back a picture of a standard distribution from high school.
I explain that most of my patients fall in the middle of the bell curve, and are seen for 7-10 visits. These patients tend to be pretty regular with appointments and more or less do there home exercise program regularly, with room for lapses due to normal life events. The middle is a really good stable place to be.
Now, there are always people far from the middle on the right side who just blow me away with how much better they do and how quickly they improve. They tend to be folks who don’t have many other conditions going on medically, manage stress well and tend to keep pretty healthy lives. These folks also tend to be very dedicated about adhering to their home exercise plan. Also, in my clinical experience, this accelerated group tends to not have had their condition for a long time, which speeds their recovery.
What about people on the left side, who stay in PT for a long time? This is definitely a tough group to be in and you can end up in this group due to factors both inside and outside of your control. People in this group may have many conditions contributing to why PT is taking so long. They also may not be able to keep regular appointments due to outside circumstances and adhering to a home program may be difficult, or they may have other medical conditions complicating recovery. Though this group is a challenging group to be in, we can still work on speeding up PT in small ways just as we can in other groups.
We can’t always control our lives, how long we’ve had conditions, and our medical histories, but everyone has the ability to make the most out of PT. In this blog, we will discuss the factors that are in your and your physical therapist’s control to get the best out of your physical therapy experience.
Set Realistic Goals with Your Physical Therapist
When we physical therapists meet a new patient, we always make PT goals to help guide our treatment. These tend to be pretty dry and based on things like range of motion, strength, etc.,. But really, what is most important is what you want to do. Often times we think exclusively of our pain at the expense of function. Think very specifically about what you want to do or what you could do if your pain was more manageable. Do you want to dance? If so, for how long? What type of dancing? Do you want to sit at work comfortably for 1-2 hours? Do you want to get on the floor and play with your 1-year-old? Being specific about your goals serves a dual purpose. It helps us zero in on exactly how to conduct our treatment and it provides you with motivation when life gets crazy, PT gets hard or you have a setback, and the last thing you want to do is your home program.
We work a lot on constipation here at Beyond Basics, but that’s not what I’m talking about. Regular appointments can help us augment a term we call “carry over”. Carryover is one of the most important things we try and achieve as physical therapists. It’s all well and good to improve pain, range of motion, or strength but if it only lasts a day or two, what good is it? Many of the things we do are cumulative and may require a few visits relatively close together to get things to stick. A practical way to get regular appointments is to schedule way out in advance to ensure you get the appointments that best fit with your schedule. I often have my patients schedule 10-12 appointments out. With the best case scenario being they don’t end up needing them, which is fantastic but they have them if they need them. I also encourage my patients to get on our clinic’s waitlist if they can’t get appointments. Many physical therapists will experience cancellations during the week, and can often fit patients in when it appeared at first that they were completely booked. If you can’t get in, speak up. Physical therapists don’t want you to lose your progress either, they will often work with you to make sure you get seen.
The home program is one of the most important parts of physical therapy. Even if you are going to PT relatively frequently, 3 times a week or so for one full hour, you are still spending less than 2% of your time in PT, versus 98% of your time in the real world. Although I truly believe in the work of myself and my colleagues, most people really need to take PT home with them in terms of their home program. It takes a lot to change how your body moves and works. Muscles take time to grow, the nervous system takes time to learn how to use them and or calm down, and inflammation takes time to go away. It often takes a lot, either a large injury or years of repetitive microtrauma to get yourself at a point where you find yourself in need of physical therapy. It can take a lot of consistent work to get to recovery. A good home exercise program can really help shorten your time at physical therapy and ensure that the results you achieve stick around for the long haul.
Don’t Let Perfect be The Enemy of the Good
Some physical therapists can prescribe a ton of exercises. They usually do this because they see the potential for your improvement, but sometimes neglect the fact that the real world exists and spending over an hour a day on physical therapy is not always possible. Yours truly is often guilty of this. If you feel overly burdened by your home exercise program (HEP in PT lingo), don’t throw the whole thing out. Pick 1 or 2 exercises you can do consistently until you next see your PT. When you see your PT next, discuss your HEP with them. Your HEP may need a revamp, or your physical therapist may work with you to find ways for you to be more consistent with your HEP, or they may help you to prioritize your exercises into “must do”, “should do” and “nice to do” exercises. We don’t take offense to this type of frank talk, because it helps us help you get better.
Your HEP Should Evolve as Your Needs Evolve
The super buff guy or girl at the gym isn’t lifting the same amount as the day he or she started lifting weights. As he or she got stronger, they progressively increased the challenge of his or her program. The same thing should happen with PT home programs. Your program may not change week to week but the program should be regularly updated as you improve. If this isn’t happening ask your therapist why your plan has not progressed, they may have a good reason or they may welcome the nudge to push you to harder activities.
Do Your Research
Physical Therapy practices can vary a lot and some can be better suited to fit your individual needs better than others. What do you value? Would you rather have 1 on 1 time with your physical therapist, or would you thrive in a place surrounded by other patients working out together? Does your physical therapist have an interest in treating your condition? Has your physical therapist contributed to the field in ways outside of clinical practice, like getting advanced certifications, teaching new students, or contributing to the literature? The website of a prospective clinic is a good place to start. Often times, you can find information on what the general treatment approach is like, as well as the personal biographies of physical therapists you may be working with to see if they will be a good match. If you still have questions, call the clinic. Often times the front desk can set you up with someone to answer your questions.
At Beyond Basics Physical Therapy, we value 1 on 1 treatment in order to give our patients the most individualized treatment possible. We believe this treatment allows us to treat our patients as efficiently and return them to full function sooner. We are the experts on pelvic floor dysfunction in both adults and children, but also offer expert treatment for orthopedic conditions with advanced orthopedic physical therapists. We offer phone consults to our patients to help them determine if we are the best clinic for them. If you are thinking we might be a good fit for you, give us a call today at 212-354-2622 for our Midtown location and 212-267-0240 for our Downtown location.
Finding a good PT and going to physical therapy can seem like a lot, and sometimes it is. That being said, the rewards are often so spectacular. There is nothing like being able to do what was once painful or extremely difficult with the help of physical therapy or avoiding a surgery because of physical therapy. When setting out on your journey remember: do your research, do your HEP, and be open with your physical therapist about what’s not working and what is. After that, the sky’s the limit.
Fiona McMahon PT, DPT treats at our Midtown location