How to Start an Exercise Routine When You Have Pelvic Floor Issues

woman running with white backgorund
Photo by Tim Savage on Pexels.com

Fiona McMahon PT, DPT

New Year New You! It’s all well and good, but if you are dealing with pelvic pain or dysfunction this can be an especially tough time of year when you want to get fit, but the gym can feel like it is off limits. Do you have to stay on the sidelines until you get better? Or is there a way to integrate a workout routine into your recovery from pelvic dysfunction?

The first thing I would suggest is to get a good pelvic floor physical therapist. Before we become pelvic floor physical therapists, we receive broad based education in sports physical therapy. What that means, is we have the ability to think about and treat the pelvic floor as it relates to sports and exercise. We also can take a close look at the health of the pelvic floor and assess if there are any exercises you probably shouldn’t be doing right now. If you do try something and you symptoms flare, it is an excellent opportunity for you and your physical therapist to determine why and help correct the issue so it doesn’t happen again.

The tricky thing with writing this blog, is there are no hard and fast rules, no “don’t do that” or yes “definitely do this” in terms of exercise. The literature out there is really varied. There are many studies that sing the benefits of exercise for the pelvic floor, while others caution against it. Before we get into some exercise guidelines, let’s look at what the data say.

The Research

I read a few studies about the impact of exercise on the pelvic floor and thought the data are mixed, I did come away with some important takeaways. The first of these takeaways is that pelvic floor dysfunction is exceedingly common with a prevalence of 1 in 4, which most of us in the field would feel is on the low side, given how personal the subject is and that many people may not want to talk about it. Because pelvic floor dysfunction is so common, it is something all fitness professionals should at least think about when recommending exercise programs.

The next consideration that honestly I did not need to read a study for, nor do you need to read to in this blog to learn is that exercise is overwhelmingly good for you! Exercise can improve health in a multitude of different ways from heart health, bone health, even mental health. There are huge potential benefits to be gained from starting an exercise program.

What was unclear are the risks. One hypothesis is that exercise can strengthen the pelvic floor and leave it nice and healthy well into your old age. The next hypothesis is that exercise can increase the burden on the pelvic floor which may be rough on the pelvic floor. SO WHAT DO I DO?!

Freak out. No don’t do that. Let’s just put on our critical thinking hat and dissect the second hypothesis a bit more, shall we? “Exercise may increase intra-abdominal pressure (IAP), which may be harmful to the pelvic floor.” Okay so what does that mean? There are certain but not all exercises that increase the pressure from your abdomen down on your pelvic floor. A good example is a person in the upper echelons of powerlifting holding their breath to make their core stiffer to lift up a massive weight. Can you imagine the grunt? That breath holding serves a purpose to allow the weightlifter to crush her competitors and put up the most weight, but also creates a heck of a lot of downward pressure on the pelvic floor (increased IAP). We also see increases in IAP in sports that involve jumping, think running (which is essentially a hop from one foot to the next), basketball, or trampoline training. These increases in IAP may actually worsen pre-existing pelvic conditions for a number of reasons. If you are already suffering from prolapse the pressure coming down on your pelvic organs may worsen it. If your pelvic floor is weak from being either too tight or too loose, you will likely experience as loss of urine with your workout. It may worsen pelvic floor tightness and make pain worse.

Total bummer right? Seems like it, but all is not lost. Not all exercises dramatically increase IAP and they are really lovely places to start when returning to fitness. One study found that the mean IAP increase with Pilates exercises was less than that of getting up out of a chair (seems like a safe activity to do!) I would suggest going to a 1 on 1 session (Pilates Rehab, ideally), a few times before jumping into a group class so you can explore how your body likes to work with Pilates. We offer Pilates at Beyond Basics with special focus on pelvic floor patients. Other exercises that are pretty gentle are the elliptical machine, walking (especially on a slight incline if you want to get your sweat on), and swimming.

I can hear some of you yawning in the back. For the high intensity people who do like running and crushing weights at the gym, I hear you! There are ways in physical therapy where we can train your body to both absorb more of the ground impact force and thus decrease IAP as well as improve your pelvic floor’s response to increased IAP. A good pelvic floor physical therapist can help you develop better pelvic floor mobility, length and strength to deal with IAP appropriately, as well as strengthening other muscles in your body to share more of the burden. This ultimately results in a decrease in load on your pelvic floor. The caveat being is sometimes you do have to be patient and work on some of the fundamentals before you can really let it rip with more intense exercise. But as a previously injured athlete, I can assure you the wait is worth it.

 

Start Slow

When adopting a new exercise it can be really easy to go all in. But I highly advise you to go slow. This allows for a few things. One for your body to get used to the increased activity, and two for you to develop a sustainable routine. I would strongly encourage those of you with pain and dysfunction in your pelvic floor to consult with your local pelvic floor PT to help guide you to safely returning to exercise.

Stretch

Don’t skip it! I am so guilty of this and have paid the price more than once. Stretching after a workout is so helpful. Amy, the founder of BBPT has some excellent stretches in her book, Heal Pelvic Pain.

Last Thoughts

There is a way to make exercise work for you if you are suffering with pain or dysfunction. Reach out to your PT to help guide you and have fun out there.

Sources:

Dias N, Peng Y, Khavari R. Pelvic floor dynamics during high-impact athletic activities: a computational modeling study. Clin Biomech. 2017;41: 20-27

Gephart L, Doersch K, Reyes M, et al. Intraabdominal pressure in women during Crossfit exercises and the effect of age and parity. Baylor University Medical Proceedings. 2018; 31(3) 289-93

Karmakar D, Dwyer P. High Impact exercise may cause pelvic floor dysfunction FOR: Scale, strengthen, protect. BJOG Debate.

Kruger J. Against: is high-impact exercise really bad for your pelvic floor. BJOG Debate.

What is Pelvic Floor Physical Therapy

marigold-2117436_960_720By Amy Stein, DPT and Fiona McMahon, DPT

As physical therapists who specialize in abdomino-pelvic pain disorders, one of the toughest parts of the job is meeting men and women who have suffered with pelvic pain for years, only to be told by their doctors/healthcare providers that there is no help for them. It is not uncommon to meet a patient who has suffered for 5- 10 years without help before finding us. Musculoskeletal causes of abdomino-pelvic pain are treatable conditions and often times we can start to improve a patient’s symptoms within just a few visits. Please read on to see how we can help you with your pain.

What do pelvic floor physical therapists actually do? Why do they do what they do? What can you expect from your first physical therapy visit?

Physical therapists (PTs) are experts in movement and function, which sounds like a pretty broad topic to be an expert in, and it is. After physical therapists graduate PT school (now-a-days at the doctoral level), they find their niche and specialize. You can find PTs working with high-level athletes, children, infants, people who are recovering from injuries, people with neurological conditions and many other types of clients.

Pelvic floor physical therapists specialize in the muscles, nerves and connective tissues that live between your legs, also known as the pelvic floor. They gain their expertise through a series of post-graduate continuing education classes, certifications, and training. Their training allows them to perform both internal and external pelvic exams, and broadens their knowledge of conditions which affect the pelvic floor. Sometimes, people who specialize in modalities like biofeedback or dilator therapy, advertise themselves as pelvic floor therapists, but don’t have any hands on experience treating the sensitive and often reactive muscles of the pelvic floor. If you are seeking pelvic floor physical therapy, it is important to enquire about the experience and level of training your potential physical therapist has had in this specialty.

What is the pelvic floor and what is pelvic floor dysfunction?

Who needs pelvic floor PT? The pelvis performs many important functions of the body. The muscles, nerves, connective tissues and skeletal structures of the pelvic floor help to keep us continent, aid in sexual performance and function, and assist in core stability.

When some or all of these structures of the pelvic floor are not functioning properly, they can cause a multitude of different symptoms. People who are suffering from bowel, bladder, and or sexual problems, as well as those who are suffering from pain in the pelvis, upper legs, abdomen or buttocks most likely have pelvic floor impairments contributing to their pain.

Issues with the pelvic floor can arise from a multitude of reasons. Infections, previous surgeries, childbirth, postural and lifting problems, and trips and falls can all bring on pelvic floor dysfunction. Pelvic floor pain can persist well after the cause of it has been removed. So it is entirely possible to feel the effects of an old infection, surgery or injury, days to years after they occur. Anyone who has had long standing abdomino-pelvic pain, or pain that they can’t seem to get rid of after seeking the help of medical doctors or other healthcare providers is a good candidate for a pelvic floor physical therapy evaluation and possible curative treatment.

What is Pelvic Floor Physical therapy?

Physical therapy is a practice of healing that restores function and reduces pain through the use of techniques to improve bony alignment, reduce trigger points, and improve muscle coordination and strength. Pelvic floor physical therapy is a branch of physical therapy and is built upon these same principles.

What sets pelvic floor physical therapists apart is their in depth understanding of the muscles and surrounding structures of the pelvic floor, beyond what was taught in physical therapy graduate school. What that means for a patient who is seeking the help of a pelvic floor physical therapist, is that his or her pelvic floor issues will be examined and treated comprehensively with both internal and external treatment, provide them with lifestyle modifications to help remove any triggers, and receive specific exercises and treatment to help prevent the reoccurrence of pain once he or she has been successfully treated.

What exactly do Pelvic Floor Physical Therapists Do?

The elephant in the room with pelvic floor physical therapy is the internal exam/ treatment. It can seem a little daunting, especially if you have pelvic floor pain, but pelvic floor therapists are trained to be as thorough as possible while minimizing discomfort.

During the internal exam, your physical therapist will place a gloved finger into your vagina or rectum to assess the tone, strength, and irritability of your pelvic floor muscles and tissues. Internal exams and internal treatment are invaluable tools that are taught to pelvic floor physical therapists. It can tell us if there are trigger points (painful spots, with a referral pattern or local); muscle/tissue shortening; nerve irritation and/or bony malalignment that could be causing your pain directly or inhibiting the full function of your pelvic floor muscles. We can also determine if your pelvic floor has good coordination during the exam. A pelvic floor without good coordination, may not open and close appropriately for activities such as going to the bathroom, supporting our pelvis and trunk, sexual activity, and keeping us continent.

It is essential that we, as pelvic floor physical therapists, also include other assessments when we are examining our patients for the very first time. We employ the tried and true physical therapy exam practices to determine if there is an underlying condition elsewhere in your body, such as a strength deficit or alignment issue that could be affecting your pelvic floor. It’s wild to think of it, but something as seemingly unrelated as a flat foot or a hip injury can be enough to set off pelvic and abdominal pain!

Some pelvic floor physical therapists may have the opportunity of getting a lot of time to speak one-on-one with a patient to determine possible causes of his or her symptoms, educate the patient and to guide them to other practitioners who may optimize their physical therapy results if necessary. We truly can find out so much by just listening to what our patients have to say. A fall, or infection can be significant as well as a patient’s feelings and knowledge about their current condition.

Once we determine the cause of our patient’s pelvic floor dysfunction, we design a plan tailored to the patient’s needs. At Beyond Basics, we have a diverse crew of physical therapists who bring their own training and background into each treatment. What is really beautiful about that, is that all teach and help each other grow as practitioners. It will be difficult to go over every single type of treatment in one blog post, but we will review some of the main staples of pelvic floor rehab.

Manual Techniques

As physical therapists, are our hands are amazing gifts and phenomenal diagnostic tools that we can use to assess restrictions, tender points, swelling, muscle guarding, atrophy, nerve irritation and skeletal malalignment. We also use our hands to treat out these problems, provide feedback to the muscles, and facilitate the activation of certain muscle groups. There have been a great number of manual techniques that have evolved over the course of physical therapy’s history. Let’s go over a few.

Myofascial Release

Myofascial release was developed by John Barnes to evaluate and treat the myo-fascia throughout the body. The myofascial system is the connective tissue that coats our muscles, nerves, blood vessels, and bones, and runs throughout our bodies. Any tightness or dysfunction in the myofascial system can affect the aforementioned structures and result in pain and or movement dysfunction. By treating the fascia directly, therapists can improve their patient’s range of motion, reduce pain, and improve a patient’s structure and movement patterns.

Myofascial release is a more gentle technique that can be useful in cases where a patient is already experiencing a great deal of pain. The therapist will hold gentle pressure at the barrier of the tissue (the point where resistance is felt) for a short period of time, usually less than 2 minutes until the therapist feels the tissue release on its own. The therapist does not force the barrier.

Scar Tissue Manipulation

Scars are almost always a fact of life. From surgeries, to accidents, to conditions like endometriosis, or certain STI’s, almost everybody has one. What doesn’t have to be a fact of life are the muscle, nerve and skin restrictions and overactivity that they can cause. By releasing scar tissue in physical therapy, it has been shown that the surrounding restrictions also decrease their resistance and adherence to the deeper tissues and surrounding organs.

Myofascial Trigger Point Release

Discussed extensively in Travel and Simon’s two volume series, trigger points are taut (firm) points in the muscle that have a consistent referral pattern (they transmit pain to the another part of the body). Trigger points are not only important because they cause pain, they also can affect how the muscle works. This is one of the main reasons our therapists at Beyond Basics are fastidious about ensuring all trigger points are released in the abdomen, back, legs and pelvic floor before transitioning to any core stabiltiy or strengthening exercises that can re activate a trigger point.

People with trigger points in their pelvic floor and surrounding areas can experience pain in the rectum, anus, coccyx, sacrum, abdomen, groin and back and can cause bladder, bowel, and sexual dysfunction. When physical therapists find a trigger point they work to eliminate it and lengthen it through a myriad of techniques. Recent literature has found that trigger point release alone can achieve an 83% reduction in symptoms.

Connective Tissue Manipulation

Skin rolling, ie. rolling of the skin over another layer helps to improve the movement of those two layers and reduce the tension and pulling between them. It feels like a scratch or ‘nails’, and in cases where a patient has more restrictions, the sensation may be more amplified.

One of the great benefits to skin rolling is it increases the circulation in the area to which it was applied. Often times, areas that are tight or restricted are receiving reduced blood flow and oxygen. By bringing blood flow to the area, toxins can be cleared and the healing contents of the blood are brought to the injured area. Skin rolling can also restore the mobility of surrounding joints and nerves, which can help to restore normal function. By allowing the skin to move more freely, pelvic congestion, heaviness and aching can be effectively treated.

Neural, Visceral, and Joint Mobilization

Nerves, organs, and joints can lose their natural mobility over time and cause a whole host of symptoms from pain, to loss of range of motion, and poor functioning of the bodily symptoms. Skilled and specialized therapists can use a variety of active techniques (patient assisted) and passive techniques to free up restrictions in these tissues and organs and improve overall function.

Neural mobilization as the name implies, involves the restoration of neural structures back to their normal mobility: to glide and slide. Neural structures that cannot move properly can cause pain that can radiate down an extremity or into the trunk and can give the sensation of burning, zinging, and stabbing. Some orthopedic therapists practice this type of mobilization; common examples include the sciatic nerve in the leg and the ulnar nerve in the arm. Pelvic floor PTs focus on these nerves when they cause issues, but they also pay attention to nerves that innervate the perineum and genital region (bicycle seat area), such as the pudendal, iliohypogastric, obturator, ilioinguinal, genitofemoral and the femoral cutaneous nerves. By allowing these nerves to move freely, symptoms such as vulvovaginal, penile, rectal, clitoral and testicular pain, itching and burning can be greatly improved.

Visceral mobilization restores movement to the viscera or organs. As elucidated earlier in our blog, the viscera can affect a host of things even including how well the abdominal muscles reunite following pregnancy or any abdominal surgery. Visceral mobilization aids in relieving constipation/IBS symptoms, bladder symptoms, digestive issues like reflux, as well as sexual pain. Visceral mobilization can facilitate blood supply to aid in their function, allow organs to do their job by ensuring they have the mobility to move in the way they are required to perform their function, and to allow them to reside in the correct place in their body cavity. Evidence is beginning to emerge to demonstrate how visceral mobilization can even aid in fertility problems.

Joint mobilization is a common and favorite tool of most orthopedic physical therapists. We love it so much because it can have so many different benefits depending on the type of technique used. Maitland describes types of joint mobilization on a scale between 1 and 5. Grade 1 and 2 mobilizations are applied to a joint to help to lessen pain and spasm. These types of mobilizations are typically used when a patient is in a lot of pain and to help break the pain cycle. On a non-painful joint, grade 3, 4, and 5 (grade 5 requires post graduate training) mobilizations can be used to help restore full range of motion. By restoring full range of motion within a restricted joint, it is possible to lessen the burden on that and surrounding joints, thereby alleviating pain and improving function.

Neuro-education of the Pelvic Floor and Surrounding Structures

The muscles of the pelvic floor must work together and in coordination to perform specific tasks. The pelvic floor has to contract, elongate and relax in very precise ways to perform basic functions like urination, defecation, support the pelvis and organs, and sexual function and pleasure. If your pelvic floor muscles and/or nerves fail to do what they are supposed to do at the right time, problems like painful sex, erectile dysfunction, constipation, and incontinence can occur.

Biofeedback is a modality that allows you to learn how to better control your muscles for optimal function. Biofeedback shows you what your muscles are doing in-real time. It is helpful to teach patients to lengthen and relax the pelvic floor for issues like general pelvic pain, painful sexual activity and constipation or to contract the pelvic floor in order to prevent leakage with activities like coughing, laughing, lifting, running or moving heavy objects. However, biofeedback does not demonstrate shortened muscles and tissues; therefore, in certain cases the biofeedback may seem to be within normal limits but yet the patient has 10/10 pain. In these incidences, manual palpation is more appropriate to identify restricted and shortened tissues and muscles, and myofascial trigger points.

HEP: Home Exercise Program

 

Home exercise programs are essential for each patient. In the case of weakness, a patient will require more pelvic floor, core and functional strengthening and stability exercises. For overactive and pain conditions, the HEP typically consists of relaxation techniques, self-massages (both external and internal), gentle stretching, cardiovascular fitness as tolerated, and eventually pain-free core stability exercises. Both require postural and behavioral modifications and self-care strategies. For more information and detail, check out the book: Heal Pelvic Pain, by Amy Stein or her DVD: Healing Pelvic and Abdominal Pain here.

Conclusion

As you can now see, there is so much out there that can be done for people suffering with pelvic floor dysfunction. This blog is by no means extensive, and there are even more options you and your physical therapist can explore to help manage your pain or other pelvic issues. Pelvic floor dysfunction requires a multidisciplinary approach for most of our patients. Hopefully, this blog helped to paint a picture of what you will experience with a pelvic floor physical therapist. We advise that you seek out an expert and experienced pelvic floor physical therapist in order to help better your life and improve your function.

Sources

FitzGerald M, Kotarinos R. Rehabilitation of the short pelvic floor I. Background and patient evaluation.

Padoa A, Rosenbaum T. The Overactive Pelvic Floor. Springer. 2016

Simons DG, Travell JG, Simons LS. Travell and Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Volume 1 Upper Half of Body. 2nd ed. Baltimore, MD: Williams & Wilkins; 1999.

Stein, Amy. Heal Pelvic Pain. McGraw-Hill. 2008

Stein, Amy. Healing Pelvic and Abdominal Pain. Video: www.healingpelvicandabdominalpain.com 2013

Travell, Janet G. and Simons, David G., MYOFASCIAL PAIN AND DYSFUNCTION. THE TRIGGER POINT MANUAL, Volume 2, The Lower Extremities, Williams & Wilkins, Baltimore, 1992.

Valovska A. Pelvic Pain Management. Oxford University Press. 2016

Weiss J. Chronic pelvic pain and myofascial trigger points: manual therapy for interstitial cystitis and the urgency-frequency syndrome. J Urol. 2001; 166(6) 2226-31

Pilates with Kierstin! Kneeling Side Leg Series with Stability Ball

Kierstin Elliott, Pilates Rehab Specialist

Exercise: Kneeling Side Leg Series with Stability Ball

Set Up: Kneeling on mat, place right forearm on stability ball and extend left leg out parallel creating a long diagonal line from the head to your left foot. Extend left arm overhead, knit ribs together and engage glutes.

Execution:

  1. Inhale to prep, exhale to lift left leg and lower left arm toward each other and then return to starting position. Complete 8-10 reps and hold the leg up.
  2. Place left hand on hip. Inhale to sweep left leg forward and exhale to sweep leg back. Complete 8-10 reps and hold the last rep back.
  3. With leg extended back, roll ball slightly forward and place both hands on the ball. Square off hips and shoulders to the ball and engage lats. Lift and lower back leg about 8-10 times holding the lift on the last rep.
  4. Exhale to bend both elbows pulling ball towards chest and then pressing ball away from chest. Complete 8-10 reps.

Focus: Stability! It’s imperative to keep the core, glutes, and lats engaged throughout the entire exercise in order to focus on moving the correct body part at hand while stabilizing everything else. Connect movement to breath. Exhale on the hard parts! It will help you through 🙂

Importance: Stability, strength, and coordination. There is a lot going on in this exercise. The challenge is to not only perform the exercise with correct alignment, but to make the transitions as seamless as possible.

Modifications: To add greater challenge, add an ankle weight to moving leg. To simplify, take the ball away and place your hand on the floor for steps 1 and 2. If you have wrist or shoulder sensitivities, lie on the floor and proceed with Side Lying Series.

How to Stay Whole During the Holdiays

assorted color gift boxes
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Fiona McMahon PT DPT (She, her, hers)

It feels like it started early this year, didn’t it? The day after Halloween the Bryant Park Christmas fair was up and running. Little wreaths and twinkly lights adorn the downtowns of the tri-state area. Yesterday, (I am sitting down to write this blog on November 11th) I saw an adorable little boy absolutely losing his mind with joy over a Santa statue at my local drug store. It was excessively adorable. It’s a sweet time of year, filled with beauty and love, but it can also be a super stressful time of year filled with obligations, travel, shopping, expectations, and the bittersweet longing for those who cannot celebrate with us this year. In short, the holidays are loaded. There are elements of the holiday that will never not be stressful. It is stressful to fling yourself from event to event while trying to maintain some modicum of self-care, but in this blog, we will discuss practical tips to protect your holiday and better yet your peace of mind during this time of year.

Boundaries

Oh the B-word. Boundaries. Much like a fence, boundaries can be protective and can provide your friends and family with a clear set of expectations for how you want to be treated and what they can and cannot expect from you. Sounds a tad harsh, but what’s harsher is getting upset with your loved ones when they do things that they had no idea would bother you. Boundaries should be clear cut and judgement free. A good example, for most families is discussing politics. If political discussions, especially if your family’s views vary greatly from yours, are stressful, you may want to set up some boundaries around it. You may say, “ I would prefer not to discuss politics tonight at the holiday table, if we do discuss politics, I will excuse myself to the living room”. Excusing yourself to the living room is not meant to be punitive. You are not punishing your relatives for discussing politics, you are simply excusing yourself from a potentially divisive and argument starting topic that will upset you. You cannot control the actions of others, but you can control how you react to those actions, hopefully with kindness while keeping your boundaries intact.

Another way to set boundaries is setting boundaries with your time. For most of us with the crazy schedule of the holidays there are certain rituals that fall by the wayside. It’s okay to have some elements of your routine be non negotiable, like your 30 minute jog or morning meditation session, Holding onto the activities that bring you peace can best allow you to show up and be present for all of the holiday festivities.

Planning

You don’t have to do it all. Not every party requires your attendance, not every bake sale requires your dessert, and you can allow some things to slide. At the beginning of the season decide what is really important to you. Is the “coats for kids” fundraiser really meaningful? Put it up on your list, but could you let your work friend’s party slide? Cool, buy yourself some extra time. Look at your weeks and decide what is not only realistic, but healthy for you. Maybe if there are a few parties you want to go to, you could give yourself a day or two off from your workout routine and (here’s the important part) be kind to yourself about taking a break. You can say no. I believe holiday cheer to be a finite resource so save it up for what matters to you.

Diet

Loaded, loaded, loaded topic. But the holidays are where we can fall into some really unhealthy eating habits, which can make us feel really crappy. Try to mix in some healthy food with your holiday treats. I’ve quoted this Oscar Wilde quote (which I have misattributed to Mark Twain, full disclosure), “everything in moderation, including moderation.”, which I think is an excellent mantra to take into the holidays. Sometimes you gotta have a little fun and indulge, but being mindful of how much and how often, can help us to feel our best during the holidays. Make sure along with your cookies you are getting some vegetables and lean protein to keep your blood sugar stable. Limit alcohol to the best of your abilities as it can decrease the quality of your sleep, to avoid the trap of over caffeination and requiring a nightcap to sleep.

Self care

Leave time if you can for exercise and movement and time just for yourself. It allows you time to check in with yourself and see how you are doing as well as time to sit back and reflect/appreciate the holidays.

Self Kindness

The holidays and year’s end can be a time when we look back at our year and evaluate how far we have come. It can be easy to dwell on our shortcomings, and although they can provide important direction for our future goals, it is also a brilliant time to reflect on your achievements. You have successfully gotten yourself through another year, Heck! Another decade, where you have grown and learned valuable lessons, which makes you all that more deserving of some good ol’ holiday cheer.

Happy Holidays from the Beyond Basics Family.

hollerday!

 

 

BBPT Health Tip: How Not to Mess Up Your Back this Holiday Season

Fiona McMahon DPT

low angle photography of atlas statue
Photo by Ana Paula Nardini on Pexels.com

Chances are doing some traveling over the coming months. The holidays are a time when we haul luggage through airports, Christmas trees and boxes of decorations through your house, or load massive turkeys into the oven. With all this lifting on the docket, I have a pretty good hunch you don’t want to start the new year with a heating pad and lying down in bed, so I am going to share with you, some of my favorite lifting tips.

Get close to what you are lifting:

black jurassic figurine
Photo by rawpixel.com on Pexels.com

I mean really close. Maybe hug it if you can. The reason why we should get close to what we are lifting calls back to high school physics. The force on the spine equals the weight of the object being lifted by the distance it is away from the spine. Therefore, the farther an object is away from you, the harder it is on the spine to lift. My co-workers use the term “T-Rex arms” to describe how close they want their patients to be holding what they are lifting.

 

Squat

Don’t lift with your back. You have all heard it a million times, but if you bend forward with your back to pick up what you are lifting, you will end up placing a tremendous strain on the muscles and bones of your spine. Just don’t do it. Instead, bend with your knees to get to what you want to lift, and push through your legs to stand back up.

Don’t be a Hero

Ask for help if something seems too heavy to lift. In the long run, everyone will be better off. Knowing when to ask for help is sometimes the most challenging part of safe lifting practices.  If you feel you are asking for more help than you would like or you have back pain that is not resolving, come see us at Beyond Basics to help you get back into lifting shape.  The sooner, the better.  You don’t want it to become a chronic problem.  

Fiona McMahon PT, DPT practices at our Midtown location

fiona2018

Pelvic Floor MythBusters! Don’t eat lemon to avoid bladder pain, true or false?

alcoholic beverage bubble citrus
Photo by Pixabay on Pexels.com

Fiona McMahon PT, DPT

Hey guys!  If you have bladder pain, you probably have done some reading about bladder irritants. Lemon, dairy, spicy foods have all been rumored to spike bladder pain. But is this really the case? With everyone? Before you put down your lemon water, let’s dissect the truths, and kinda truths about bladder irritants in this month’s Pelvic Floor Mythbuster’s.

Truth be told there are a lot of different ways the bladder can go sideways. You can experience an urge to urinate that is so frequent it disrupts your everyday tasks. You can experience strong urge that feels impossible to repress. You may experience leaking. You may experience pain in your bladder while it fills, while you empty it, or immediately after emptying it. Can diet cure all these ills? In some cases, maybe. But in many cases, it’s a bit more complicated than that. Read on as I run through why we consider diet with bladder issues, what else may be at play, and some practical advice on how to manage an unruly bladder.

Common Bladder Conditions

Before we go over bladder irritants, lets go over some of the most common bladder ailments we see here at Beyond Basics Physical Therapy.

Urgency: Urgency can best be described as having a sudden need to urinate which is either extremely difficult or impossible to delay

Frequency: In most people, going to the bathroom every 2-3 hours is normal going more frequently is considered frequency. But keep in mind, you may experience more frequency after drinking a lot of water all at once or after having caffeine, alcoholic and carbonated beverages.

Hesitancy: Hesitancy is difficulty starting the stream of urine.

Pain: Pain seems pretty simple, but if you visit us at BBPT we usually will ask you more questions than “do you have pain? Yes or no?” We will ask where the pain is, and if you have pain with bladder filling, emptying, or urgency which can tell us a lot about what to do about the problem. We will ask what makes the pain better or worse?

Nocturia (nighttime bathroom trips): Unless you have had a ton of water right before bed, it is generally accepted that getting up 1 or more times a night to pee if you are under 65 and more than 1 time a night to pee if you are over 65 is considered nocturia.

Stress incontinence: Stress incontinence refers to the involuntary loss of urine usually associated with activity, like running, lifting, coughing, laughing and sneezing.

Urge Incontinence: Urge incontinence is the loss of urine with a strong urge to pee.

Mixed Incontinence: As the name would imply, mixed incontinence is a combination of both urge and stress incontinence.

How Can What We Eat Affect our Bladders?

The science community isn’t really sure yet what causes certain foods to irritate certain people’s bladders, but they have some good hypotheses. In the case of pain, some scientists have proposed that people who are affected by food may have linings of the bladder that are less protective from the irritating material found in pee, especially pee that contains irritants from certain foods. Some evidence supports “cross talk” between different organs in that things that irritate the bowel, may irritate the bladder. Also it is believed in cases where the nerves are more sensitive, which can happen in cases of chronic pain, diet can more easily cause symptoms to spike.

So What to do About Irritants?

There is a saying I say a lot. Everybody is different and every body is different. This saying could not be more true when it comes to bladder irritants. Not everyone’s bladder is irritated by the same thing. You can find a list of common bladder irritants here . Did you click it? Totally overwhelming, am I right? The thing is my bladder irritant may not be your bladder irritant. The best way to find out what is your irritant, is to eliminate items you may suspect as being irritants for three to four days and add them back in to see if they bother you. If you find that you are really unsure what is bothering you or you have a history of disordered or restrictive eating. I would highly recommend doing this with the guidance of a trained nutritionist. Not only can a good nutritionist help you detect irritants more efficiently, they also can provide you alternatives, so you have plenty of yummy things to eat during your quest to determine if your diet is bothering your bladder as well as keep you safe if you have had or are currently struggling with disordered eating.

The Bladder and The Pelvic Floor

All of the conditions listed earlier in this blog can be caused entirely or in part by the pelvic floor. Hopefully experimenting with eliminating bladder irritants improved your symptoms at least somewhat. But if it hasn’t, it may be time to consider the pelvic floor. Both pelvic floors that are weak and tight and weak and loose can contribute to the symptoms outlined above. Often times combining dietary changes with pelvic floor rehab can provide the right synergy to get over the hump and to start feeling better again.

Practical Bladder Tips

  • Normal voiding frequency is once every 2-3 hours. If you find you can not make it that long and don’t have pain, try lengthening the time between “goes” 10-15 minutes at a time and practice deep diaphragmatic breathing in the interim.
  • If you experience sudden urge, DON’T PANIC! Rushing often makes it worse. Breath slowly and calmly make your way to the toilet.
  • When hesitancy strikes, breath deeply. If you have male reproductive organs, try sitting on the toilet to relax the pelvic floor and make peeing easier.
  • Avoid drinking water 2 hours before bedtime if you are experiencing nocturia.
  • If you are constipated, work on managing that problem. The bladder lives right in front of the rectum. A large backup of stool will press on the bladder, irritating it and reducing its holding capacity.

Conclusions

Are bladder irritants really a thing, yes for some people and we are still trying to figure out why. If you are having trouble tackling your bladder problems. Come give us a visit at BBPT so we can get you feeling better! Also check out Amy Stein’s book for more ways you can deal with bladder pain.

Friedlander J, Shorter B, Moldwin R. Diet and its role in interstitial cystitis/ bladder pain syndrome (IC/BPS) and comorbid conditions. BJUI. 109. 1584-91

Molly completes the NYC Marathon!

On November 3rd 2019, Molly Caughlan completed the New York City Marathon for the very first time! We at Beyond Basics are so proud and overjoyed for her! She ran to raise money for multiple sclerosis research. Read her last update before the big race, here!

I sit here writing this blog with just 6 days left to go before the big race. I’ve been tapering down milage, taking time to rest, stretch, and strengthen. The forecast, fingers crossed, is looking very ideal with highs in the mid 50s and looking like sunshine all day. I’m nervous, excited, and feeling confident that I’m going to cross that finish line.

Since my last blog, I’ve hit just a few bumps in the road with my training. In September right before a critical long run (my first 18 mile run), I had an acute onset of posterior tibialis tendonitis that made it difficult to even walk on. I was devastated and had to hold on running any distance all together. I was feeling incredibly anxious because of how close I was getting to the big day and at the thought of skipping such an important training notch. While I was healing, I did a Hot Vinyasa class that I hadn’t done in a while that help me hit a reset button and set up a strategy to manage these symptoms. I took a whole week off from running and had two sessions with Tina as well as doing some self treatment with modalities (ice/heat). I also had an acupuncture treatment with something called dry needling to my calves with a treatment for chi energy deficiency. With ALL of these treatments combined, the first run I did I was FLYING! I had so much energy and was going at such a fast pace that I shaved a few minutes off of my traditional 5 mile run. Things have been looking up since that week in September and looking back now, resting was the most important treatment I could have done.

As part of my training, I ran the New York Road Runner’s Brooklyn Half Marathon October 19 and had such an amazing time. The end of the race was in Prospect Park, which is essentially my back yard and where I’ve been doing a lot of my training. This helped me to finish strong and break my own personal record for a half marathon with a time of 2:07.

As the days wind down, I’m looking forward to having some of my family members come visit just so they can support me on Sunday. I’ll have support from my local friends on the sidelines and, with the help of modern technology, will have the spiritual support from friends across the country. I’m eager to see all of the other anonymous supporters with their signs and I’m excited to have all of this energy boost me across the finish line.

Last but not least, I must say that I am still working on my $5000 fundraising goal and I’m 71% of the way there. I’m sponsored by an organization called Team Tisch MS​ that performs groundbreaking research to discover the cause of Multiple Sclerosis, 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. Support Team Tisch MS by donating to my fundraiser!

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