Marathoning with Molly: Training Update

Molly Caughlan, PT DPT

Hello blog readers! I am writing this blog a good three or so months into my marathon training and wanted to give an update on how it has been going. Things started off rough: when just two weeks in, I rolled my ankle. Unfortunately, this story is not one of cool athletic prowess where I rolled it sprinting to save a child from a burning building. Rather, I was doing an silly move of “texting while walking the dog” maneuver that lead to a mis-step off the curb. I did a full tuck-and-roll, landed on the ground covered in dirt, and very much freaked out my doggo. I wish someone had caught this trip on camera, because I’m sure it was amazing. I took a minute to sit on a bench and assess the damage. Luckily, the grand theatrics of my trip did not equate to the severity of my injury and I was still able to put weight on it enough to walk home.

Two days later, I had a PT session with Tina Cardenia, where she worked to reduce the swelling and improve the mobility in my ankle. This helped tremendously to accelerate my healing and allowed me to return quickly to my running program. I was back on the pavement in under two weeks! Even though the sprain itself has fully healed, it continues to occasionally feel stiff during and after runs along with a little bit of swelling. Tina continues to focus on my right ankle mobility and stability to prevent future sprains. Pictured in this video below, Tina is performing what’s called a “thrust manipulation” that gives a quick stretch to my ankle joint to help it move more freely.

Disclaimer: This technique should be performed by a licensed professional and is not intended to be reproduced at home.

In addition to my right ankle, I will occasionally have left sided hip crease/groin pain and discomfort. This has come and gone even before marathon training. Based on Tina’s assessment, my left pelvic bone does not move well into extension and this causes some pinching in that area. Treatments have focused on releasing tight muscles and connective tissue in the front of my hip as well as building stability by strengthening my glutes and core.

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Another challenge with training is trying to beat out this summer heat! Compared to Atlanta’s summers (where I trained for my first marathon), this season started out pretty mild. I had been doing well and progressing mileage, but once the end of June hit I knew things needed to change. I remember the tipping point when I set out on a 12 mile run and my poor little leggies could only carry me 10. I recognized afterward my mistakes in that I woke up too late, chose a trail with little shade, and that I wasn’t properly supplementing myself in restoring electrolytes. Since this weekend, I’ve added SaltStick Chews to my regimen and they have really made a big difference. I’ve also been more diligent about really planning ahead when I can get in my long runs.

I’m sponsored by an organization called Team Tisch MS​ that performs groundbreaking research to discover the cause of Multiple Scelrosis, understand disease mechanisms, optimize therapies, and repair the damage caused by MS, as well as offering patient access to the best and most advanced treatment possible. So far I’ve raised $555 and I’m only 11% towards my $5000 goal with just 3 and a half months left to go. Support Team Tisch MS by donating to my fundraiser here.

 

Beyond Basics will be offering matching donations throughout the marathon, so keep your eyes peeled on social media to see how you can make your donation go TWICE as far!

What is Neater than your Peter? A Guide to Penile Health and Function Part 1: Premature Ejaculation

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Fiona McMahon PT, DPT

Ladies and Gentlemen, it is finally time to go for this blog and go on a deep dive to discuss at length (pun not intended), the physiology, health, and function of an amazing organ, the penis! A couple years ago we talked about testicles in our blog, All About Testicles, which remains one of our most popular blogs. Now it is time to travel north and talk about how people with penises can best care for them and how to address things that may go wrong from time to time. This blog will periodically cover different issues that can (ahem) arise with penises. Today we will go over premature ejaculation. But before we can do all that, lets review how the penis works.

As an organ, a healthy penis is an amazingly complex organ despite it’s seemingly simple exterior. It is the tail end of the urinary system, provides amazing sensation, carries sperm to the outside world, delivers a substance that can neutralize the acidity of the vagina in order to make it more hospitable to sperm, and is able to use the muscles around it to raise the blood pressure in the penis higher than that of the outside body, in order to maintain erection.

The penis is not one tissue all the way through. It has what’s called the tunica albuginea which is the wrapping for the erectile parts of the penis. This guy is really important because it closes off the vein returning blood flow from the penis to keep the penis erect during arousal. Inside the tunica albuginea is the corpus carvernosum and corpus spongiosum. No, these two tissues are not Harry Potter spells, but critical parts of penile infrastructure. The corpus cavernosum fills with blood during erection and helps make the penis hard. The corpus spongiosum keeps the urethra from getting clamped shut during erection so the sperm can get out.

How Does The Penis Get Hard?

Usually, in response to sexual stimulation, the smooth muscles (the involuntary ones, not the pelvic floor) will relax allowing the small blood vessels within the penis to fill with blood, the result is the tunica albuginea ( the wrapping of the erectile parts of the penis) will compress on the veins of the penis, thus preventing the blood returning back to the body. The trapped blood in the penis will cause the penis to get hard and stand up. The lovely muscles of the pelvic floor, specifically the ischiocavernosus will contract to further increase the blood pressure within the penis and keep the penis erect.

What Happens with Ejaculation?

Ejaculation occurs with orgasm. It is possible to have an orgasm without ejaculation if you have had a procedure like a prostatectomy. For a normally functioning penis, ejaculation occurs with orgasm and is what carries the sperm and other fluids to the outside world. The contractions felt in orgasm are what propel the sperm through the penis and to the outside world. The bulbospongiosus is responsible for these contractions and is part of the pelvic floor.

Premature Ejaculation

Here is where I would normally supply you a pithy little statistic like “ 1 in 4 men will experience premature ejaculation in their lifetime”. Unfortunately, I cannot provide any such statistic for this subject because so few people talk about this problem. The clinical definition of premature ejaculation is a little wonky too, and has not consistently been used in research, therefore prevalence data are likely inaccurate. The International Society for Sexual Medicine (ISSM) , in an attempt to improve the medical definition of premature ejaculation defines it as:

  • Ejaculation that always or nearly always occurs within about 1 minute of vaginal penetration from the first sexual experience (Defined as lifelong premature ejaculation)
    • OR
  • A clinically significant reduction in latency time, often to about 3 minutes or less (defined as acquired premature ejaculation)
  • Inability to delay ejaculation on all or nearly all vaginal penetrations; and
  • Negative personal consequences, such as distress, bother, frustration, and/or avoidance of sexual intimacy (Althof 2014)

If you are a gay or bi-man, or a man who does not have vaginal intercourse you are probably well aware how problematic this definition is. Currently, it is the ISSM’s stance that there is insufficient evidence to draw up criteria for men who have sex in ways other than vaginal intercourse.

As you can tell by the definition, premature ejaculation is divided up into 2 subgroups, lifelong and acquired. The distinction is relatively new in the research and can help patients find better ways to treat their premature ejaculation.

Potential causes of premature ejaculation include:

  • Hypersensitivity of the glans( head) of the penis
  • Issues with serotonin
  • Erectile dysfunction*
  • Either stopping or starting drugs
  • Chronic pelvic pain syndrome*
  • History of rushing early sexual encounters
  • Prostatitis*

*These are conditions treated at Beyond Basics Physical Therapy

What to do about premature ejaculation?

Don’t ignore it. Performance anxiety and premature ejaculation can often become a vicious cycle, where one will promote the other. Regardless of how your symptoms started, there is a lot that can be done to improve your sex life.

If you have prostatitis or chronic pelvic pain come to physical therapy. Did you know 90-95 percent of cases of “prostatitis”/chronic pelvic pain are musculoskeletal in nature… ahem… this is one of the most common conditions we treat at Beyond Basics. Overactive muscles, those in the abdomen, legs and pelvis can contribute to symptoms of prostatitis/chronic pelvic pain, (i.e. burning urination, painful ejaculation, sitting pain, genital pain, defecatory pain, urinary or bowel frequency, urgency, retention, incomplete emptying, etc.,.). Physical therapy can go a long way to treating and curing these symptoms by relaxing and lengthening your overactive muscles and strengthening weaker muscles. Prostatitis is a vast subject that requires its own blog. Luckily for you, I already wrote one. Check it out here.

If you are experiencing erectile dysfunction along with premature ejaculation, get thee to a doctor. I already explained to you how amazing the penis is as an organ. Its function is reliant on blood flow, thus problems with erection, especially in younger people may be an early sign that something may be up with your vascular system. Once systemic causes have been ruled out, get thee to physical therapy. We spoke earlier about how the penis requires blood flow and muscles to work properly; pelvic floor physical therapy can restore the function and improve the vascular health of the muscles vital to erection. Erectile dysfunction is yet another subject that could use its own blog. Again, luckily for you, I already wrote one. Check it out here.

If you don’t think erectile dysfunction, prostatitis, or chronic pelvic pain is causing your premature ejaculation, there is still a lot you and your urologist can do. There is new work revealing that certain medications and psychotherapy can really help reduce premature ejaculation. You are not alone in this and you deserve to start feeling better.

Thank you so much for reading our blog, if you think physical therapy can help you. Please give us a call at either our midtown location 212-354-2622 or our downtown location 212-267-0240. We are offering free phone consultations at both offices for a short period!

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Fiona McMahon PT, DPT is currently practicing from our midtown location

Check out our other Neater Than Your Peter Blog:

What’s Neater Than Your Peter (a series on male sexual dysfunction): A Bend in the Road: Peyronie’s Disease

 

 

Althof S, McMahon C, Waldinger M, et al. An Update of the International Society of Sexual Medicine’s Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med. 2014; 2(2) 60-90

Anderson R, Sawyer T, Wise D. Painful myofascial trigger points and pain site in men with chronic prostatitis/ Chronic Pelvic Pain Syndrome. J Urol. 2009;182(6): 2753-8

Anderson R, Wise D, Sawyer T. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-60

Chronic nonbacterial prostatitis (chronic pelvic pain syndrome). Harvard Health Publications. Harvard Medical School. 2007. http://www.health.harvard.edu/newsletter_article/chronic-nonbacterial-prostatitis-chronic-pelvic-pain-syndrome. Accessed December 11, 2016

Dean R, Lue T. Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction. Urpl Clin North Am. 2005; 32(4): 379-v

Herman H. “Male and Female Health Wellness and Sexual Function”. New York. 19-20 May 2018

Quinn P. A Multinational Population Survey of Intravaginal Ejaculation Latency Time. J Sex Med. 2005; 2(4) 492-497

Check out Corey’s Interview with Mongoose Bodyworks!

Below is a repost of an interview that Corey Hazama did with Moongoose Bodyworks. Corey is a physical therapist and the co-owner of our Beyond Basics Physical Therapy downtown location.

Pelvic Floor Health in NYC

COREY HAZAMA IS A PHYSICAL THERAPIST AND CO-OWNER OF “BEYOND BASICS PHYSICAL THERAPY”, A CLINIC THAT SPECIALIZES IN ALL CONDITIONS AFFECTING THE PELVIC FLOOR IN MEN, WOMEN AND CHILDREN. WE LOVE THIS AT MONGOOSE BODYWORKS, AS SO MUCH OF OUR PILATES CORE WORK IS RELATED TO THE PELVIC FLOOR.

HALLE: Tell me a bit about your practice .

COREY: We specialize in treating all conditions affecting the pelvic floor in men, women and children. We are a manually based orthopedic clinic and treat patients one-on-one for an hour.

HALLE: How did you come to focus on women’s health and pelvic floor issues ?

COREY: I had been treating orthopedic injuries for some time and was seeing more and more complex cases of back, hip and tailbone pain, etc that didn’t resolve with traditional PT. In treating these patients I started to feel that the source of their pain was coming from something else, something I didn’t understand completely, the pelvic floor. I had the opportunity in 2015 to work and train with Amy Stein who has revolutionized the pelvic floor field in New York City. I decided that I really needed to train more and understand this region of the body better so that I could help these patients.

HALLE: Who can benefit from this type of therapy?

COREY: Any individual who is having pain or discomfort in their pelvic region, which is the area from the top of your pelvis to your sit bones. This includes the Sacroiliac [low back] region as well as the groin. We can help patients who are having genital pain, or pain with intercourse. We also treat issues with bladder which can be incontinence after a vaginal delivery, or increased urgency and frequency, incomplete emptying which can affect women and men. We also see a lot of patients who are having pain with bowel movements or constipation, bloating, and pain. We also have pretty much seen it all, so we can offer insight if PT has not worked in the past, or a patient wants to know if their complaints are muscle/joint related. We treat the hard cases, the people who tried traditional PT for their hip or groin pain and the exercises either made them worse or didn’t help.

HALLE: Do you think people are ever embarrassed to contact you?

CORY\: I hope not. We are all very approachable and we offer phone consults if a person wants to know if PT can help or if they are a candidate for Pelvic Physical Therapy.

HALLE: Why do you love this work?

COREY: I feel I have a special skill set and knowledge where I can help a lot of people where their symptoms are scary and distressing and they have not been able to get the answers or treatment they need. The symptoms of pelvic floor dysfunction can be scary and these patients get bounced around from doctor to doctor without getting answers. I also feel like I have a lot of tools at this point, I have spent a lot of time taking continuing education classes to learn new ways that I can help.

HALLE: What gets you out of bed in the morning?

COREY: My brain is always going, I have always wanted to understand how things work. I used to take apart VCRs and radios when I was a kid because I wanted to see how it worked. I feel the same way about the body. I want to understand how everything works together and is related to the whole so that we are pain free and functional.

HALLE: Do you have a favorite exercise?

COREY: I really like to roll my arches on a pinky ball. I have really tight feet and calves and I am on my feet all day so it feels really good to do that at night when I get home.

HALLE: What’s your experience with Pilates? Do you have a favorite Pilates exercise?

CORY: I have been doing private pilates now for a little over a year. It has really changed how I move and my posture. I feel stronger through my core and better grounded when I am working. I don’t know if I have a favorite exercise, but I do know which one kicks my butt the most! I have never been able to do a complete curl up/roll up. Using the arc and roll down bar I can finally do it (with a little help from the bar). I also found out that my whole life I was doing the ab curl wrong and it has been very enlightening to learn how to do it correctly and also to work through my own limitations that prevented me from being able to do it correctly.

HALLE: How does Pilates relate to your work?

COREY: In doing Pilates myself, I have learned so much about the benefits of working with a skilled Pilates instructor to identify my own limitations and also learn how to correctly activate the correct muscles. In the work I do I find that eventually all my patients get to a point where I have been able to restore normal muscle tension through their pelvic floor muscles, abdomen, hips, and spine, and now they need to start to learn how to use these muscles in an optimal alignment and what better to do that than pilates! The men and women who teach Pilates are masters of observation and I trust them entirely to make sure my patients are not compensating with the exercises. It is the compensations that occur, when we don’t even realize it, that get us into trouble in the long run.

HALLE: What do you do when you are not being a PT?

COREY: I am a knitter and a foodie!

HALLE: Anything you’d like to share about home life?

COREY: I have a wonderful husband, who is also a PT, he is an amazing teacher in regards to PT, but it is more his teaching me to not be a PT all the time that has really done so much for my work life balance.

THANKS COREY!!!