Pelvic Pain Awareness Month: Part 2: Hope for Chronic Pelvic Pain

Mayis PelvicPainAwarenessmonth

Welcome back! In part 1 of this blog we discussed how pelvic pain can affect anyone, regardless of their age or gender. We also discussed that pelvic pain can feel many different ways and may occur in different body locations and be triggered by different activities. Now that we have the basics under our belt, we can march forward and start to explore different ways to manage and treat pelvic pain.

First steps

Now that you have a name for what you are experiencing, it is important to get a handle on the various characteristics of the pain you are experiencing. This information will provide valuable insights to the clinicians who are treating you. Some questions to think about include:

  • How long has this pain been going on?
    • Chronic pelvic pain is classified as pain that has gone on for 3 or more months, this type of pain likely has musculoskeletal involvement and will likely require the help of a pelvic floor physical therapist in addition to medical intervention
    • Also try and think if there were any significant events around the time of your symptoms onset; these events may be physical like spraining an ankle or emotional, like moving or starting a new job
  • What makes it worse and what makes it better?
    • Sometimes you won’t know and that’s ok too.
  • Where is the pain?
  • What does the pain feel like?
    • Describing the character of pain can be really tricky. Here are some words we hear a lot
      • Burning
      • Itching
      • Stabbing
      • Buzzingwork
      • Aching
      • Gnawing
      • Sharp, Shooting
      • Dull
      • Tingling/numbness

Now that you have this information, it’s time to make an appointment with a doctor, who ideally has experience in treating pelvic pain. Your doctor will work to determine if there are any immediate medical concerns that require treatment. It is important to be patient when starting this step. Usually it is not immediately clear on exactly what is causing your pain, especially if it has been going on for some time. Usually chronic pelvic pain is caused by more than one system (i.e it could be a bit digestive and also a bit musculoskeletal). That is why your first visit with a clinician is typically just a jumping off point.

Next Steps

After your initial appointment you may have a referral in hand to see a specialist. Specialities that treat pelvic pain include:

  • Colorectal
  • Gastroenterology
  • Gynecology
  • Physical therapy
  • Physiatry
  • Psychiatry
  • Psychology
  • Neurology
  • Urology
  • Urogynecology

It is important to visit a clinician who specializes in pelvic pain, considering it is a very specialized topic, and unless a clinician has an interest in it, their exposure to pelvic pain may be limited.

The next two pieces of advice I am about to give may seem mutually exclusive, but hear me out. Trust your gut, but also be patient with the process. For chronic pelvic pain, it takes some time to see improvement. Think about it, you’ve had this pain for a very long time, it will take a while to improve. In physical therapy, we expect our patients to see some improvement in 4-6 weeks, and similar timeframes can be expected for other types of interventions. That said, if you feel like the clinician you are seeing is dismissing you or not taking your complaints seriously, that is important. A colleague of mine, who I adore, tells her patients “who knows your body better than you?”. The answer is no one. If you think something is wrong, it is your right to be taken seriously.

First Steps in Treatment

There are steps you can take to start addressing your pain almost immediately. I discuss some of them in this blog. Getting a handle on your stress is really important when dealing with chronic pelvic pain ( I am currently writing this during a global pandemic, so I do recognize this is much easier said than done). This is important because chronic stress can cause the pelvic floor to tighten which can exacerbate pain issues. It is important also to recognize that despite anxiety and stress being strong contributors, pelvic pain is not in your head and your symptoms are real.

It also may be worth your while to experiment with gentle heat or cold. A warm bath or hot pack or cold pack can be helpful. Just make sure to put plenty of layers between you and the cold/ hot pack.

Professional Interventions

Address your muscles. Yes, we are a PT clinic and we will always say muscles are important, but the truth is, with chronic pelvic pain, muscles spasm/tightness is involved in most cases of pain. For those of us on lockdown, physical therapy is still accessible and considered essential. Beyond Basics offers both in person and telehealth appointments to guide you on your way.

A trained pelvic floor physical therapist can help to teach you exercises to do on your own to manage pain, release muscle tightness, and correct poor postures and overuse patterns that may have contributed to your pain in the first place.

Depending on your diagnosis you may see other medical specialities who will prescribe medicine, injections, or surgery in some cases, like endometriosis. You may also be referred to a nutritionist, acupuncturist, or mental health therapist as well. Like I mentioned earlier, typically pelvic pain can have many different contributing factors so it is really important to have a team and to make sure your team is communicating well together.

Although pelvic pain can be massively disruptive and upsetting, that fact is people can get better. Have hope, trust your gut, and reach out if you need us.

Beyond Basics Physical Therapy

212-354-2622

How to find a physician familiar with pelvic pain:

International Pelvic Pain Society, Interstitial Cystitis Association

Bonder J, Chi M, Rispoli L. Myofascial pelvic pain disorders. Phys Med Rehabil Clin N Am

. 2017 28(3), 501-15

Speer L, Mushkbar S, Erbele T. Chronic pain in women. Am Fam Physician. 2016 1;93(5):380-7

Van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion- inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12 (5) 328-31

Pelvic Health 101 is back!

Pelvis Drawing

***In light of current events, and in an effort to keep our community as healthy as possible, we have moved our Pelvic Health 101 (PH 101) seminars from in person to online.  Although we regret not being able to meet everyone in person, we are excited for the opportunity to broadcast information about pelvic floor disorders and how to treat them fair and wide. Please keep an eye on our social media as well as the blog to find out how you can learn more about the pelvic floor.****

Warmly,

The Team at Beyond Basics

 

On March 19th, at 7pm we will be kicking off our spring semester of pelvic health education class, we call Pelvic Health 101 (PH101). In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health and function of your bowel, bladder, and sexual functioning. We will also be covering how things such as alignment, posture, muscle tone and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.

 

New York, NY 10017
Register at: pelvichealth101.eventbrite.com

Here is our line up of this and future classes

ph101 sp 20

 

 

Endo Awareness Month: Understanding Endo

Amy Stein and Fiona McMahon

Beating Endo Cover

March Is Endometriosis Awareness Month. Treating endometriosis and improving the lives of people with endometriosis, has long been a passion of Dr. Amy Stein, founder of Beyond Basics Physical Therapy, so much so, that she teamed up with Dr. Iris Orbuch and wrote a book about it! This month we are reviewing some of the major talking points in their book, Beating Endo. Available here.  For more on endometriosis, check out our past blogs as well as Beating Endo.

Endometriosis is a condition that affects people born with female anatomy. It occurs when a tissue similar to that of lining of the uterus (known as the endometrium) grows outside of the uterus. Seems like a pretty simple definition, but it can cause a whole host of symptoms.

When something that doesn’t “belong” in the body is detected by the body, inflammation will occur. It is this inflammation that is believed to cause the myriad symptoms someone with endometriosis may experience. These symptoms can include

  • Irritable bowel syndrome (IBS)
  • Painful bladder syndrome
  • Pelvic floor dysfunction

One of the confusing things is, you don’t have to have all of these symptoms to have endo and the severity can range. This is Fiona writing, and I’m sure Amy would agree, no two endo patients are alike, and your pain is valid even if your symptoms do not necessarily look like someone else’s’ who is suffering with endo. It is this variability in presentation along with poor awareness within the medical field and public, leading to an average of 7 to 12 years to get a diagnosis.

Endometriosis can only be diagnosed by analyzing the suspected endometrial lesions removed during an excision surgery. There is no other test to confirm it, which can make diagnosis obviously, very difficult.

There is another condition that is called Adenomyosis. Similar to endo, adeno occurs when cells similar to the lining of the uterus occur within the muscular wall of the uterus. Most people with adeno have endo, but it is not always true that most people with endo have adeno. Adeno can show up as heavy periods, low back pain, and pelvic pressure.

Endometriosis is a chronic illness that affects millions of people. There is still a lot to figure out about endo and because of that fact there are many truths, half-truths, and myths floating around out there about endo. Check out some of the myths Amy and Iris busted together in Beating Endo.

Common Endo Myths

The abdominal and pelvic floor muscles are rarely affected by endometriosis.

False: Constipation, frequent urination or retention, pain with vaginal penetration from endometriosis causes tightening of the abdominal and pelvic floor muscles; So too does assuming the fetal position which is our go to pose when we are in pain. Both contribute to tight abdominal and pelvic floor muscles which causes pain.

The pelvic floor and abdominal muscles do not cause bladder, bowel, sexual dysfunction or abdominal-pelvic pain in patients with endometriosis.

False: Tight pelvic floor muscles caused by years of straining or reflexive tightening due to pain, often cause a severe amount of pain which results in further tightening and shortening of the pelvic floor muscles. Good news is that pelvic floor physical therapy benefits most people who have been experiencing abdomino-pelvic or sexual pain and/or are straining due to ongoing bladder and bowel symptoms.

Hysterectomy is a cure for endometriosis.

False: Hysterectomy is neither a treatment nor a cure. By definition endometriosis consists of cells similar to those in the lining of the uterus but found outside the uterus. Only surgical ‘excision’ removes endometriosis cells.

Medical menopause is a cure for endometriosis.

False: Just because your medicines give you hot flashes doesn’t mean your endometriosis is going away. The best treatment approach is to meet with an endo specialist to discuss options, and in most cases PT management. As well surgical excision has much better results than ablation of Endometriosis.

There is no correlation between quantity of endometriosis and severity of disease.

Truth: Even if you have a minimal amount of endometriosis, you can be in debilitating pain with lots of symptoms and in most cases dietary changes, physical therapy and mindfulness practices can help manage a lot of your symptoms.

Teenagers are too young to have endometriosis.

False: Teenagers can have endometriosis and their endometriosis can cause debilitating symptoms.

Pregnancy is a cure for endometriosis.

False: Just plain no. Pregnancy does not cure endometriosis.

Ablation surgery is the same as excision surgery.

False: Not even close. Excision surgery is the proper treatment for endometriosis. Ablation surgery, burns the surface of the endometriosis lesion but leaves the bulk of endometrial implants behind.

Surprising Endo Facts:

Fact: Physical therapy (pelvic PT) can help many suffering from the many pains and symptoms of Endo, including back, abdominal and pelvic pain, bladder, bowel and sexual function.

Fact: The majority of patients with Endometriosis require pelvic floor physical therapy. Pelvic floor PT can be instrumental in the healing process and can help abdominal-pelvic pain, bladder and bowel urgency, frequency, retention, incomplete emptying, and any sexual pain related to the musculoskeletal system.

Truth: Painful bowel movements, constipation, diarrhea and bloating are symptoms of endometriosis as well as symptoms of pelvic floor dysfunction .

Truth: Painful sex is a symptom of endometriosis as well as a symptom of pelvic floor dysfunction.

Truth: 40 to 50% of women with unexplained infertility is caused by Endometriosis.

Truth: Teens with endometriosis often have acyclic pain, that is, pain at other times of the month rather than only during their period, in addition to cyclic pain.

Truth: Back pain is a symptom of endometriosis.

Truth: If your ultrasound is normal you can still have endometriosis.

Truth: roughly 10% of women have endometriosis. That’s close to 200 million women worldwide. Endometriosis is much more than just bad period pain. 1 in 4 women have pelvic floor dysfunction.

Truth: Endometriosis commonly affects the musculoskeletal system, and in many cases can be a primary contributor to one’s pain and symptoms.

 

Orbuch I, Stein A. Beating Endo. New York. Harper Collins. 2019

How to Stay Whole During the Holdiays

assorted color gift boxes
Photo by Giftpundits.com on Pexels.com

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!

 

 

How to Start a New Exercise Program When You’re Feeling Intimidated

How to Start a New Exercise Program When You’re Feeling Intimidated

woman stretching on ground
Photo by Jonathan Borba on Pexels.com

Kierstin Elliott

Maybe you were an avid gym-goer, cross fitter, or yogi and then you got injured. Or maybe fitness has never been a part of your life, but now your doctor or PT has told you that a fitness regimen is necessary in order to help you feel like yourself again. Whatever the case may be, you just don’t know where to start, or you feel intimidated to return to what you were doing in the past because that is how you got injured in the first place. My advice is to start slowly. Educate yourself on how and why you got injured and what the next steps are on your road to recovery. Set goals on what you need to accomplish and build a plan to achieve them. Last but not least, train smartly. If you follow this check list, then you should definitely feel more confident moving forward!

It is imperative when you are transitioning from injury rehab to the fitness world, or starting a new exercise program for the first time, that you build a foundation. It is so crucial you stay true to your journey and not compare yourself to others. Trust that progress takes time. Resist the urge to jump right into something new if you’re unsure about form, alignment, and technique.

The first step would be to invest in private sessions. Educate yourself on what you’re getting into and find an expert in what you want to master. Having a coach who devotes the entire hour to your body and your needs will help you garner a deeper understanding of how your breath, body, and mind connect. Learning the proper form with a watchful eye on alignment, will ensure you have a strong foundation to move forward or join group classes.

Once you’ve gained confidence with your new (or old) exercise program, set some fitness goals. You’ve laid a strong foundation and now it’s time to build a skyscraper! Do you want to improve strength, flexibility, endurance? Once you have clear goals set, create a timeline. Establishing a realistic timeline will hold you accountable to sticking with your exercise program and crushing your goals!

The point I’ll end with is to train smartly. No matter what discipline you train in, if you are not focused on form, alignment, and breath control, you are only setting yourself up for future injuries. If you are in a group class, don’t be afraid to ask questions if something is unclear, doesn’t feel quite right, or if you know you need a modification. If you are doing an at home workout on your own, try to do it in front of a mirror to check out your form. If there’s no mirror accessible, simply take it slow and use the knowledge you’ve acquired from a trainer, coach, or PT. Take notes. Practice. Your exercises won’t be perfect the first time you attempt them. Be patient and mindful. It’s all about the journey 🙂

How Exercise Can Help Your Recovery From Breast Cancer

awareness cancer design pink
Photo by Miguel Á. Padriñán on Pexels.com

Fiona McMahon PT, DPT

Have you noticed it yet? Everything is pink. Pink cups, pink pens, pink stickers, pink ribbons, pink everything. The flood of pink that happens every October and reminds us it is Breast Cancer Awareness Month. If you are someone you love has or has had breast cancer, chances are you don’t need any reminding. At Beyond Basics Physical Therapy we have spent a good deal of our blogs discussing the ins and outs of how PT can help with the symptoms following treatment for breast cancer. But what can you do right now to help your health? Emerging research is pointing to the profound importance of exercise on so many facets of well being for individuals with breast cancer. In this blog we will discuss some of the newest findings as well as practical ways to apply these findings in your own life. I hope you choose to read on and please share this with family and friends.

What the researchers are finding:

We know that to say breast cancer treatment can be hard is an understatement. The risk of symptoms like fatigue, sarcopenia (muscle loss), osteoporosis, cardiovascular disease, and cognitive impairments are all elevated in individuals who are undergoing or have undergone treatment for breast cancer. These symptoms can have a profound impact on quality of life, which breast cancer survivors should not have to accept. Luckily in researching this blog, I found so many studies examining how to improve the quality of life of people going through breast cancer treatment. As a physical therapist, the studies on activity naturally piqued my interest.

Three of the studies I looked at examined how structured and monitored physical activity helped out people undergoing breast cancer treatment and those who had already undergone it. The studies included workout programs consisting of cardio, resistance training, or a combination of both. The studies showed improvements in fatigue, depression, physical fitness, and quality of life immediately following the exercise program. In one of the studies that look at how long these effects lasted, the positive benefits were lost 36 weeks after completing the exercise program.

How to use these findings:

It’s probably not groundbreaking journalism on my part to tell you that exercise is good for you. But what I do find compelling is the amount that good exercise can do, even during treatment. So the question is how to make exercise work for you. First get your doctor’s clearance for exercise, because there may be some exercises to avoid, especially if you have had a mastectomy. Most of the studies I looked at examined structured and monitored programs run by a physical therapist or other healthcare professional, which I would highly recommend especially if you are not used to exercising. A skilled physical fitness professional, like a physical therapist or Pilates instructor can not only help you progress safely through different exercises, but they can also introduce you to fun exercises you may have never thought of. That said, the best exercise is the one you will actually do. Remember, the benefits of exercise will be lost if you aren’t consistent. Cancer treatment can often feel like a full time job and adding another appointment into the mix is often not very practical. The good news is that in the study by Gokal and colleagues, walking independently for 30 minutes 5 times a week reduced self reported cognitive failures in participants. So even if you can’t make it out to see someone, there still is a lot of good you can do for yourself on your own.

Practical tips:

  1. Start slow: be kind to you body and ease yourself back into exercise. “Chunking” or breaking exercise into smaller sessions is a great way to start
  2. Spark Joy: (Shout out to Marie Kondo) but exercise should not be something you dread the thought of. If yoga, or walking makes you wanna crawl under a rock and hide, it’s not for you and that’s okay. Approach exercise curiously and you will find one you love, or at the very least, don’t hate.
  3. Buddy up: in the spirit of sparking joy, having an exercise buddy will not only help you remain accountable, it will probably make the experience a heck of a lot more fun.
  4. Get help when you need it: If you are a brand new exerciser, are in pain, or just feel like your routine is getting stale, see a fitness professional. It’s a short term investment that will pay dividends in the future by making exercise more comfortable and fun.

Keep positive, keep moving and if you have any questions, give us a call!

Dieli- Conwright C, Courneya K, Demark-Wahnefried W, et al. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Research. 2018; 20 1:24

Gokal K, Munir F, Ahmed S, et al. Does walking protect against decline in cognitive function among breast cancer patients undergoing chemotherapy? Results from a small randomised controlled trial. PLOS ONE. 2018

Penttinen H, Utriainen M, Kellokumpu-Lehtinen P, et al. Effectiveness of a 12 – month Exercise Intervention on Physical Activity and Quality of Life of Breast Cancer Survivors; Five- year Results of the Brex- study. In Vivo. 2019. 33:881-888

Witlox L, Hiensch A, Velthuis M, et al. Four -year effects of exercise on fatigue and physical activity in patients with cancer. BMC Medicine. 2018; 16:86

PH101: Running to the Bathroom Again?!

Fiona McMahon PT, DPT

hd-wallpaper-macro-splash-67843 (1)
via Pexels

Bladder problems can be vexing, it may hurt for you to pee even though every test for infection you’ve taken has come back negative. You may find yourself incontinent after surgery or childbirth, or for no reason at all. You may find yourself waking up countless times to go, or needing to memorize every bathrooms’ location in the city because you go too often.

The bladder and the pelvic floor are intimately related and often times problems with the pelvic floor can cause real trouble with the bladder. Pelvic floor dysfunction can cause you to suffer from bladder frequency, urgency, incomplete emptying, slow stream, stream that stops and starts, bladder or urethral pain, or leaking.  By the way, it’s not just a female issue. Men and children can also have these symptoms. Learn from one of our experts about how exactly the pelvic floor is related to bladder function and dysfunction, what you can do about it, and about common medical conditions affecting the bladder. Join us for this great seminar on September 25th at 7pm . Register here: pelvichealth101.eventbrite.com

And for those who can’t wait to learn about the bladder, check out our blog on bladder health here!

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Flyer-jpeg

How to Travel with Pelvic Floor Dysfunction

Fiona McMahon PT, DPT (She, her, hers)

airplane-backlit-clouds-1262304

It’s that magical time of year in New York City, that I call “Goldie Locks Time”. It is that brief stretch of one to two weeks right after the cold of winter has left us and right before the sweltering hot gritty city summer descends upon us. It is the time of year that the weather is so supremely pleasant, that the hustle and bustle of the city slows and usually frenetic New Yorkers actually take time to stop and smell the roses, literally. My pediatric patients begin to grow giddy as school is wrapping up in a couple weeks. It is a time when many New Yorkers start looking forward to their summer escapes back to their home towns across the country or vacations to new and familiar locales alike. Having the time and resources to travel is a luxury, but for those with chronic pelvic pain, it can seem like a really daunting task. People often wonder, “how can I fly across the country if sitting for more than 20 minutes causes my pain?”, “how will I keep from flaring?”, “How do I negotiate the demands of travel so I can actually enjoy my time away?”. Although travel can be really daunting, there are steps that you can take to ease your journey and help you enjoy your time at your destination. Below are some considerations for travel I hope that you will find helpful.

Hydrate- Even if You Have Bladder Problems

Recirculated air is the worst and is inevitable when flying, but is also something you should consider with bus, car, and train trips. Long and even short haul flights can leave you feeling parched and dry which can cause issues with many pelvic floor symptoms. It is really important to not get on the plane dehydrated. In the week or so preceding your trip, be extra mindful of trying to get enough water. A popular guideline we use at BBPT with to try and consume at least one half your body weight in water in ounces. For example, if you weigh 150 pounds, drink 75 ounces of water. Being properly hydrated will decrease irritation within the bladder and can even reduce frequency, reduce your chances of constipation, and ensure the tissues of your body have good mobility. Also be sure to hydrate on the plane and in the airport. Water sold at airports is usually overpriced and has the downside of being packaged in environmentally unfriendly plastic. To save money and the planet, I suggest bringing an empty reusable water bottle through security. Once you are through security you can fill it up and keep on your hydration game. One thing to remember is to take your water bottle out of your bag and place it in the screening bin, so you won’t lose time having security check inside your bag to verify that your bottle is indeed empty.

Prioritize Pooping

In my world, it’s all about poop. Traveling can lead to some gnarly cases of constipation, which makes virtually every pelvic floor complaint worse. We talked about keeping up with your hydration, which is a really good first step. Making sure that you have a enough time to eat, chill, and have a solid BM before rushing off to the airport is really important. So when possible, Try and carve out at least an hour of pre-travel chill time before heading out the door.

Food

Eating well is so important. Many of our patients have diets that make them feel better. When travelling, food can be a wild card. With the change in routine associated with travel, it can be all too easy to throw a diet that is working to the wind. A huge change in dietary routines is one of the top reasons I see people flare. Although indulging in margaritas and other treats can be so much fun, be aware of how it will affect your symptoms and overall enjoyment of your trip. It is good to come prepared if possible. Packing snacks that you know don’t make you feel like garbage if you are going to place where you are unsure of what the food situation will be like, will help.

Choose your Seat

The idea of sitting on a long haul flight is daunting especially for those who have pelvic and or sitting pain or bladder issues. There are travel cushions you can bring with you to ease your symptoms. If you don’t typically use a travel cushion, check out my cushion hack bellow using a jacket.

seat.jpg
The cushion hack: If you find you have sitting pain but no cushion, use your coat or sweatshirt to fashion a cushion

Choosing seats next to the bathroom when possible can go a long way towards reducing stress for folks with bladder issues. Additionally ,opting for an aisle seat can also be helpful. To the extent possible, try to get up and move to reduce the pressure on your pelvic area.

Manage Travel Stress

Travel is a stressful thing for most of us. There is so much out of our control and there’s no amount meditation or mindfulness that can change that. That being said, meditation and mindfulness practice can help how you deal with how you react to  cancelled flights, lost baggage, the works. Allowing yourself a quiet moment to breathe before and during your travels can help you re center and get back to enjoying the journey. Both Calm and Headspace make really awesome guided meditation apps that you can use while waiting for your flights.

 

Get out There!

This world is so big and beautiful. It can be really hard if pelvic pain is holding you back. Try these tips out on smaller trips to see if they help you! If you find that you are still having pain that holds you back, see a pelvic floor physical therapist who can help you get out there!

Beyond Basics Physical Therapy offers intensive week or weeks long treatment to those who live out of town and do not have regular access to pelvic floor physical therapy. If you are feeling like taking a trip to the Big Apple, NYC, check out more about our out of town services here.

 

The Benefits of Pilates While Healing Diastasis Recti

Ta facilitation pic

Kierstin Elliot

Almost all postpartum women experience some degree of diastasis recti, or separation of the rectus abdominis or 6 pack muscles. Think about it, your abdomen is stretching continuously for a solid nine months! Something’s got to give. The linea alba (line of connective tissue that splits your rectus abdominus right down the middle) separates as a result of a growing baby. On some women, this separation naturally heals itself within the first year postpartum. In other women, the separation is so severe that they need a little extra attention and care to fuse their rectus abdominis back together again.

Once you’ve given yourself enough time to heal the inflamed tissues from giving birth, usually about 6-8 weeks, then you can start implementing some basic Pilates principles into your routine. Drawing attention to the breath, the transversus abdominus (TA), and the pelvic floor without creating excess pressure throughout your system, will be essential while moving towards healing your diastasis.

Connecting to your breath and your TA should be the first step. Deep three-dimensional inhalation to the back of the ribs and mindful exhalation, tapping into the TA will be crucial. During the exhale you should feel as if your abdomen is hugging or wrapping around your waist like a belt. This is TA activation. Once you’ve established the TA activation, focus on drawing your bottom ribs towards your naval and narrowing your ASIS (hip bones) towards each other. Imagine a drawstring; when you pull the drawstring, the opening of whatever object you’re trying to close, draws together from all sides evenly. That is the effect we are trying to create with the abdomen. Visualize your naval as the center of the opening and your exhalation pulling the drawstring closed.

Once you’ve mastered connecting breath to the TA, shift your focus to the pelvic floor. The easiest way to achieve this is by lying on your back with a neutral pelvis with knees bent and feet flat on the floor. Visualize the tailbone unfurling and your sits bones widening as you inhale allowing the pelvic floor to gently stretch and relax. On the exhale, as you engage the TA and obliques, feel the pelvic floor tighten slightly and if appropriate (after a pelvic floor check from your PT) find a kegel. The ultimate goal is to be able to contract and release your pelvic floor without any problems. After practicing this breathing exercise every day for about 8-10 reps, you should start to feel stronger throughout your core and find some closure or firmness in the linea alba.

This first step is HUGE. After 2-3 weeks of consistent breath work and core activation, layering more extensive exercises will become safe and accessible. Keep in mind that it is not wise to go from zero to one hundred, but rather continue to build and progress slowly. It may feel tedious, but I can’t stress enough how imperative it is to lay this foundation and rebuild your core after birth. Once you feel you’ve made considerable progress with breath work, add in marches (leg lifts) targeting lower abdominal stabilizers and add in a side lying series to challenge pelvic and core stability while also strengthening glutes. Try a side plank starting on knees and then progressing to feet. Any exercise in quadruped is a safe bet that targets shoulder stability, core, glutes, and hamstrings!

One thing to note is that women with more severe cases of diastasis should avoid abdominal curls, rollups, or flexion of the rectus abdominis until there’s been a considerable amount of progress with the deeper core muscles. If you fall under this category and constantly wonder if you’ll ever close your diastasis, yes! You can! And you will if you dedicate the attention and mindfulness to connecting to your body. Think you’re doing everything right, but still feel like no progress is being made? Feel free to book a session with me at Beyond Basics Physical Therapy! I’d be more than happy to help you out on closing your diastasis and transitioning you back into the wonderful world of pilates 🙂

Questioning Childbirth Status Quo, Part One: Common Labor Positions

The following blog is a repost of Ashley Brichter’s original blog post. Ashley is a  birth educator, birth and post-partum doula, lactation counselor, and friend of the practice. She hosts many classes on childbirth, lactation, and much more. We will provide more information at the end of the post on how you can get in touch with Ashely and how you can sign up for her excellent classes. 


Ashley Brichter

Originally posted: January 22, 2019 

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Hollywood misrepresents a great deal about the childbirth process, but the fact that they show everyone delivering babies while lying on their backs in a hospital bed is accurate. As Ross clearly demonstrates above, lying down with knees apart is the most common way for someone in the United States to deliver. Here’s why you may want to question this:

A baby’s job in labor is to rotate and descend through the pelvis. If we can maximize the amount of space a baby has within the pelvis, we can not only speed this process along but minimize the stress on muscles and tissues within the pelvic bowl (and therefore minimize the risk injury).

How do you maximize the space in your pelvis to encourage the baby’s rotation and descent? The pelvis has four boney landmarks that determine the maximum circumference a baby has to fit through: the pubic bone at the front, tail bone or coccyx at the back, and two sitz bones at the bottom. Let me walk you through two very simple movements to see how you can create the most space between the pubic bone and tail bone and two sitz bones.

If you’re in a location where feeling around on your pelvis would be immodest, make a commitment to try it the next time you’re in the bathroom or back at home.

First, find the space between your pubic bone and tail bone: 

Place one hand on your pubic bone (it’s very low down under the belly, right between your legs. Isn’t it wide!?). Place your other hand on your tail bone. To find your tail bone, invite your hand to feel between the crease of your behind. It is often higher up than most people realize.  You can walk your fingers all the way down the bottom of your spine until you reach the end – and/or lean back on your fingers in order to feel it more.

Once you have fingers on the pubic bone and fingers on the tail bone, lean forward and feel the space between your fingers. Then lean back. In which direction to you have the most space between your fingers, between your pubic bone and tail bone?  When you are leaning forward or leaning back? Try this a few time before you move on.

 Then, find the space between your sitz bones: 

This is best done sitting down on the edge of a chair. Place your hands underneath your bum and your should feel your sitz bones protruding down. If you don’t feel them right away wiggle side to side a bit. You should feel boney points digging into your hands. 

Now, spread your knees out wide (like you’re having a baby!). Feel the space between your fingers. Then, bring your knees in close together (keeping your feet fairly separated). In which position do you have more space between your sitz bones? With your knees together, feet apart, or your knees and feet wide?   

Hopefully when you tried it you were able to feel that there is more space in your pelvis when you are leaning forward and that there is more space in the pelvis when your knees are closer together than your feet. 

WAIT. What? That’s right. I said it. 

Most people deliver their babies on their backs with their knees spread wide because this is the most convenient position for hospital staff. If you’re thinking about a physiological birth, looking for ways to possibly shorten your labor, or looking for ways to reduce the risk of tearing, give some serious through to positions that lend themselves to forward leaning and keeping feet wider than knees!

Let’s take one more look at the tail bone specifically: leaning backwards makes the tailbone stick in. It limits the amount of space a baby has to rotate and it asks your body to push a baby uphill!  Upright and forward leaning positions will allow the tailbone to get out of the way.   Granted, you have to deliver with a provider and in a location that is supportive of this. But that’s for another post!

You can learn more about Ashley on her website: http://overwhelmingmoments.com/

Her blogs are available here

Click here for a list of upcoming events with Ashley