Regarding Amy Stein’s recent presentation at Beth Israel Medical Center to a team of urologists:

From a Physical Therapy student’s point of view, this presentation was eye-opening.  Not so much because of the subject matter that was presented, but rather because of the questions asked by these physicians.  One assumed that the psoas muscle was out of reach and could not be palpated as a part of physical therapy treatment.  Another physician doubted how eliminating myofascial restrictions in muscles and tissue around the branches of the pudendal nerve could truly help alleviate a patient’s symptoms.  Amy addressed all questions professionally with thorough explanations, and at the end of the presentation she was sincerely thanked for enlightening the group.  The take-home message for me is that the role of the Physical Therapist as educator is just as important as our role as clinicians.     

Luisa Siepi, SPT, CSCS, LMT

Doctor of Physical Therapy Candidate

New York University

Amy Stein featured in panel discussion about painful sex

Amy Stein, MPT, was featured in the January 2012 issue of the American College of Obstetricians and Gynecologists Update entitled “Dyspareunia: Diagnosis and Treatment”.  This discussion was moderated by Dr. John F. Steege, Director of the Division of Advanced Laparoscopy and Pelvic Pain and the University of North Carolina at Chapel Hill.  Providing a psychological perspective was Dr. Irving M. Binik, Director of the Sex and Couple Therapy Service at McGill University Health Center in Montreal.

This continuing education module highlights recent advances in the treatment of vulvar pain.  The paper discusses the relationship between IBS, interstitial cystitis, endometriosis, fibromyalgia, and pelvic pain. The doctors report positive results with the use of topical agents as an effective treatment option for vestibulodynia.  Physical therapy continues to be highly recommended as a treatment for pain with intercourse.  Debunked was the myth of pain at the vaginal opening being from a psychological origin.

The article finishes with this startling statistic: 24% of women have pain with sex at the vaginal opening 6 months postpartum.  These women don’t have to suffer or assume that “this is the way things are now”.  Pelvic floor physical therapists can work with muscle spasm, scar tissue, pelvic misalignment, and muscle imbalances to restore the optimal tissue relationships.

For more information, please visit

Painful periods

Painful periods. It may not be just cramps.

Endometriosis is a disease that affects over five million women and adolescent girls in the United States.  It occurs when endometrial tissue, normally contained within the uterus, grows elsewhere in the body.  This tissue may migrate outside of the uterus and into the ovaries, vagina, bowel, bladder, rectum, and diaphragm.  During the menstrual cycle, endometrial tissue increases in blood vessels and surface area then sheds appropriately during menstruation.  For a woman with endometriosis, abnormal tissue growth outside of the uterus may also respond with the hormonal cycle.  The results of the displaced endometrial tissue is inflammation, scar tissue, and pain.  Scar tissue builds bridges between organs and the adhesions decrease the ability of the organs to slide and glide. The restricted mobility of the nerves, muscles, viscera and surrounding connective tissue can cause blockages and pain.

These abnormal growths can cause debilitating symptoms including unbearable menstrual cramps, pain with sex, pain with voiding, fatigue, diarrhea, constipation, bloating, and nausea. Some women will experience infertility.

Treatment options for endometriosis include pain medicine, hormonal treatment, surgery, and physical therapy.  Manual physical therapy has proven to be an effective treatment option for women with restrictions or decreased mobility due to endometriosis.  Visceral mobilization and soft tissue mobilization help free the restricted structures and decrease secondary muscle tightness.  Manual techniques do not prevent endometriosis, but decrease or eliminate pain by optimizing the available range of motion.

Surgical intervention is necessary for some women suffering from endometriosis.  Two common side effects of surgical intervention include constipation and urinary urgency.  Physical therapists trained in pelvic floor dysfunction are able to treat the musculoskeletal aspect of these voiding disorders.  Abdominal adhesions typically occur after surgical intervention.  Prophylactic post surgical physical therapy is beneficial to restore mobility, increase core stability, retrain posture, and advise appropriate therapeutic exercise.

March is endometriosis awareness month. Reach out to the women in your life in crisis.  End the myth “it’s just cramps that I have to deal with” and encourage them to ask their physician about their symptoms.  Sex doesn’t have to be painful.  It is important to get a proper diagnosis.  Musculoskeletal causes of pelvic and abdominal pain are very common and can be the reason for pain.

For more information please visit



by Dustienne Miller, MSPT, CYT

Our breath brings us into this world. We sigh with relief, laugh, and shout for joy. We hold our breath and hold our pain.  Maintaining freedom of breath can inspire equanimity and decrease pain.  A regular yoga practice is a mirror we can use to see our unconscious patterns and strengths.

Yoga is the union of body, mind, and spirit. Breath is the medium that weaves them together.  The practice of pranayama, or breath control, provides an awareness of your breath and carries over into your daily life. Take a minute to close your eyes and study your breathing patterns. Where does your breath initiate from? Your chest? Your belly? Are you able to breathe with ease, or do you feel constriction in your throat or diaphragm?

Deep diaphragmatic breathing is an efficient and almost instant tool to decrease tension in the body.  The heart rate decreases and breathing slows. The pelvic muscles passively elongate with each diaphragmatic inhale as a result of intraabdominal pressure.

People experiencing chronic pelvic pain, back pain, or abdominal pain often expect pain with movement because of prior memories stored in the body.  They could become fearful of movement associated with day to day life.  The nervous system can be retrained to experience movement in a pain free way.  People can reconnect and reprogram to expect pleasure and joy to be a consistent byproduct of movement.

Yoga promotes self awareness. It cultivates an understanding of what your body craves and where the limits are. As your practice deepens, you may find yourself spontaneously taking on a yoga posture because your body “needs it”.  Explore the edge of what is appropriate and fine tune a new boundary of expansion.  Breathe, move, and trust your body!

Dustienne MIller, MSPT, received her yoga teacher certification at Kripalu Center for Yoga and Health. She is the creator of the DVD Your Pace Yoga; Relieving Pelvic Pain.

 References: Why Do Yoga? by Patton Sarley Spring 2008 Kripalu Catalog

Yoga and the Quest for the True Self by Stephen Cope, Bantam Books October 1999


Now available on DVD:

Your Pace Yoga: Relieving Pelvic Pain

Created by Dustienne Miller, MSPT

This yoga program is specifically designed for people healing pelvic pain and can be ordered on

Painful sex? Try Botox injections

Painful sex? Try Botox injections

Dr. Deborah Coady states:

“The muscles that are newly released, lengthened and relaxed are surrounded by connective tissue, which may still be shortened and inelastic,” Coady said. “Physical therapy is necessary to normalize the connective tissue to accomplish long-term balance and strength.”

Botox is just one of many ways to treat sexual pain, but in order to treat the problem, women have to talk to a doctor – the right doctor – about it.

Coady said many women feel too uncomfortable discussing the topic with their doctors, and all too often, doctors can be just as uncomfortable or uninformed. This should not stop you from getting the care you need.

The Pelvic Messenger










The Pelvic Messenger

Elisabeth Oas and NFP “Freedoms Children” are partnered to produce a series of educational documentaries about Chronic Pelvic Pain, for PBS.

“THE FACE OF CHRONIC PELVIC PAIN”: focus on Interstitial Cystitis

Is currently looking for patient stories

Patients must be willing to be on camera. Names may remain anonymous

We are looking for patients who are either under 35 with severe pelvic pain that is inclusive of IC : OR patients who are over 35 but have had their symptoms since they were young.

We are currently looking for video submissions that will be used to create our 10 minute trailer/preview for the film.

This 10 min. film segment will be used at Fundraisers, inside application packages, and be put on websites for The Pelvic Messenger, and Freedoms Children for Donations.

Please consider sending in a video. This is a chance to use your pain to truly make a difference in our community, in future generations, and in our present situation. The time for change is NOW. We MUST come together, work to raise awareness nationally and push for change

Please email : or call 312-890-7100 for more details

We will give you the exact questions to answer, and where to send your video submission.

Whoopi Goldberg. Kris Jenner. You?

What do Whoopi, Kris Jenner, and 33% of women have in common? A love for Sister Act? A penchant for Jimmy Choo? Fearlessness in the face of controversy? No! Urinary incontinence. Well…maybe the shoe bit too.

Over 20 million men and women in North America suffer from incontinence. Most people are too embarrassed to talk about it, or think that it is “normal” and just deal with it. Men don’t escape the statistics, at a prevalence of up to 11%.

There are different types of incontinence. Stress incontinence is defined as urinary leaking with increased intra-abdominal pressure, from such events as coughing, sneezing, laughing, or any physical exertion. This is a result of the pelvic floor muscles (the muscles that connect from the pubic bone to the tailbone which support the abdominal organs and assist in bowel, bladder and sexual function) being too weak and/or shortened. After vaginal delivery, the pelvic floor muscles may lengthen and weaken, and many women are unaware of how to strengthen the muscles. Both cases can result in urinary or bowel leakage.

Another type of incontinence is urge incontinence, also known as key-in-lock syndrome. A woman states that as soon as she puts the key in the door, she gets this sudden and strong urge to urinate, but is unable to control it and leaks urine. This could be the result of shortened and weak pelvic floor muscles or from an increase in the normal tone of the muscles.

One can also have a combination of stress and urge incontinence, called mixed incontinence. A woman will complain of leakage with coughing, sneezing and lifting a heavy object and also state that she gets strong urges to urinate that subsequently results in small or large amounts of urinary or fecal incontinence.

So, can these problems be fixed? YES! Medication and/or surgery are not always the answer, and sometimes can worsen patients’ symptoms. If you suffer from stress incontinence and/or decreased sexual stimulation, you need to strengthen the pelvic floor muscles. Strengthening of the muscles are called kegels, named after Dr. Arnold Kegel, the gynecologist, in 1950’s. Medications and surgery are not capable of this. There are two different types of muscle fibers in the pelvic floor, therefore, you need to do two different types of kegels: endurance holds (holding for 10 seconds) and quick holds (holding for 2 seconds) and repeating each exercise 10 times. The two exercises need to be done three to four times a day. Biofeedback, directed by a trained healthcare provider (physical therapist, nurse practitioner), can assist in understanding where these muscles are and how to do the exercises properly. They can also help develop an exercise program specific to your needs. Physical therapists also address the entire musculoskeletal system, taking into account hip strength, core stability, and pelvic alignment. With specific exercises, the leakage should stop and the orgasms will improve. Keep in mind that everyone responds differently. One person may achieve their goals within 2 months, and for another person, it may take 6 months.

Urge incontinence usually requires a more “hands-on” approach by a physical therapist that is trained in the treatment of pelvic floor dysfunction. Urge incontinence is typically the result of shortened or hypertonic pelvic floor muscles and these muscles need to be lengthened through myofascial trigger point release and connective tissue mobilization. Once these muscles are lengthened and functioning at full capacity, then you can strengthen them by performing the kegel exercises and core stabilization exercises. If one strengthens the pelvic floor muscles prior to lengthening them, then they will remain in the shortened position and the problem will persist.

A prolapse (a descent) of the bladder, colon or uterus may or may not contribute to the leakage. A prolapse is typically from weak and/or lengthened muscles and fascial tissue. A prolapse can also be helped through strengthening of the pelvic floor muscles (kegels).

What caused these problems in the first place? Sometimes this is easily answered: a fall on your tailbone, a labored vaginal delivery, or chronic straining from constipation. But, usually the answer is not easily understood. The less obvious causes of incontinence may be from poor posture, a horseback riding injury 20 years ago, multiple urinary tract infections or yeast infections. Luckily, physical therapists trained in pelvic floor dysfunction have the skill set to treat these musculoskeletal dysfunctions of the pelvic floor.

We are grateful to Whoopi and Kris for bringing light to this hot topic. Urinary incontinence is much more common than we realize. Tell your friends that they don’t have to suffer in silence.

Take time to enjoy the view without taking your pad along for the ride. See a pelvic floor physical therapist today!

 Whoopi Goldberg and Kris Jenner find their “Poise”

Hello world!

Beyond Basics Physical Therapy, located conveniently in Midtown Manhattan on 46th street between 6th and 7th Avenue, has been committed to providing integrated and individualized rehabilitation since 2003.

All Beyond Basics physical therapists are licensed in the State of New York and hold a master’s degree in physical therapy with specialized training in pelvic floor dysfunction, women’s health care, and orthopedic injuries. In addition, all physical therapists have extensive training in manual therapy.