Yoga with Anne Taylor on July 20th

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Fiona McMahon PT, DPT

Join us on Thursday, July 20th at 7pm for a really special treat: Yoga with Anne Taylor. Anne Taylor’s approach to yoga, which integrates movement, breath awareness, opening, and grounding to recalibrate the neuromuscular system, to help decrease pain and increase function has been a mainstay of Beyond Basics’ multi-disciplinary approach to improving the health and well being of our patients for nearly a decade.

Join us for a chance to explore the practice of yoga, without the pressure of trying to learn in an overcrowded class in a trendy yoga studio. Learn poses and breathing techniques you can take with you anywhere to help improve your quality of life. Sign up here today.

Summer Movement Class

Pilates Blog: Centering

Denise Small, PT, DPT

In today’s Pilates blog, we are going to discuss the basic principle of Centering.  Pilates used the word centering to refer to the “core” musculature.  He believed that all movements should radiate out of the core for maximum stability.  There is a lot of use of the word “core” in exercise literature. However, no one ever discusses what that actual means. In the Pilates method, the “core” refers to the diaphragm, the pelvic floor, the deep spinal muscles, and the transverse abdominus.  The transverse abdominus is a deep abdominal muscle that is attached to our pelvic bones in a horizontal fashion, from one hip bone to the other. One way to find these muscles is by breathing, as all the core muscles are attached to the diaphragm and ribs via fascial connections.

Try this exercise to find your “core.”  Lie on your back with your knees bent. If you need, you can have a small pillow under your head for support.  Now, imagine that you have a small, helium filled balloon in your abdomen behind your navel.  As you inhale see the balloon expand. As you exhale, imagine the balloon being hugged by your navel and your spine, simultaneously.  On your next exhale keep that image of hugging the balloon as it floats up into your ribcage.   This image incorporates the three dimensions of our torso, aka the “core” of our body.

ballon

There is no need to think of contracting individual muscles. Just keep this vision in mind and you will have a wonderfully functional core.  Go over this exercise with your PT in your next session, or come see me for a private session at Beyond Basics. Your body, and your core, will thank you!

Join Denise Small PT, DPT on July 6th for a Free Pilates Class

denise

Fiona McMahon, PT, DPT

Denise has not 1 but 2 hats here at Beyond Basics Physical Therapy. Not only is she a Doctor of Physical Therapy, specializing in functional manual therapy, orthopedics and pelvic floor conditions, she is also a certified Pilates instructor. Through the years she has worked to combine her passions to produce an outstanding Pilates program tailor made for individuals suffering from any pain condition and to help them become more functional and back to their exercise routine.

On July 6th at 7pm, Denise will be sharing her expertise with the public by offering a FREE gentle pilates class here at Beyond Basics. In this class participants will “ examine the interconnectedness of [their] own functional anatomy to move through and around [their] current fitness barriers”

To get a flavor of what Denise has to offer check out her blog posts bellow. If you are interested in attending the class, please RSVP here. Learn more about the Pilates program and the physical therapy program by clicking here.

Check Out Denise’s Blogs Here:

Pilates Blog- Rhythm- Coordination of Breath and Movement

The use of Breath in the Pilates Method 

Benefits of Pilates with Pain Conditions

Summer Movement Class

Beyond Basics Physical Therapy: Free Movement Classes are Here

Summer Movement ClassFiona McMahon PT, DPT

It’s summer in the city and maybe the air isn’t the only thing that’s a little stagnant? Could your workout routine use some updating? Are you itching to try something new like yoga, pilates, meditation, or tai chi? Have you been hesitant to try something new because you are nervous because of a past injury or pain condition? It’s time to take the leap and broaden your workout horizons with classes taught by practitioners with decades of combined experience in working with patients with acute and chronic pain conditions and sports and dance injuries. Take some time to read a little bit about this summer’s offerings and see if there is a right fit for you!

On July 6th at 7pm we will be offering gentle Pilates with Denise Small PT, DPT. Denise is a physical therapist at Beyond Basics Physical Therapy, who specializes in the treatment of orthopedic conditions and pelvic pain. She also is a certified Pilates instructor and combines both physical therapy and Pilates to help patients move throughout their world with increased strength and endurance, and with less pain. Denise is also a frequent contributor to the blog. Take some time to check out her recent articles,  on the Coordination of Breath and Movement, the use of Breath in in the Pilates MethodThe Benefits of Pilates with Pain Conditions, and check out our Pilates program here.

On July 13th at 7pm, Dr. Deborah Coady MD will be leading a gentle Tai Chi class designed to reduce stress, improve balance, and improve many other health conditions. Dr. Coady is a pioneer in the treatment of chronic pelvic pain and has a keen interest in the power of movement in aiding healing.

On July 20th at 7pm join Anne Taylor for Yoga. Anne teaches all over New York City and has worked with Beyond Basics Physical Therapy for years to offer private and group restorative classes for men and women with pelvic floor dysfunction.

Our last class is on July 27th at 7pm and will be lead by Ryanne Glasper PT, DPT. Ryanne will be offering a medication class to help you learn how to focus and calm the mind. Ryanne works at Beyond Basics specializing in orthopedics, dance medicine, and pelvic floor dysfunction. Ryanne is also a certified yoga instructor and has studied the Franklin Method through the Feldenkrais Institute.

If any of these classes interest you, click here to register today!

Pilates Blog- Rhythm- Coordination of Breath and Movement

PilatesDenise Small, PT, DPT

Today’s Pilates blog will focus on another basic movement principle of the Pilates method, Whole Body Movement.

In the last blog, I wrote about the importance of breathing three dimensionally, both expanding and contracting your abdomen and ribcage when breathing. Joseph Pilates wanted to help exaggerate these physiologic functions with movement, to help bring better awareness of these functions to one’s consciousness. He did that by coordinating both whole body movement and breathing. For example, when one inhales, the ribs and sternum move up and out, like a water pump or the handle on a bucket. You can feel this action by placing your hands on the outside of your ribcage, or on your sternum, as you inhale. When the ribs move up and out or the sternum lifts, the spine also extends because of the physical connection of the ribs into the spine. So, when Pilates gave a movement that involved spinal extension, like cow pose, he encouraged his students to inhale.

Conversely, when one exhales the opposite happens, and the ribs move in and down. When the ribs move in and down, this helps facilitate spinal flexion, because of the ribs physical connection to the spine. So, when Pilates gave a movement involving spinal flexion, he encouraged his students to exhale.

The result is inhalation with ribcage expansion and spinal extension, and exhalation with ribcage compression and spinal flexion. By coordinating the ribcage and spinal movement with the breath, you can maximize your air intake and expulsion. In addition, by coordinating your breath and movement, your body can more easily access its natural rhythms, calming the nervous system and promoting relaxation and healing.

Give it a try in your seat at work. Or come to Beyond Basics and visit me for a Pilates private!

What is Pelvic Floor Physical Therapy

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

May is Pelvic Pain Awareness Month (#PelvicPainAware), supported by the International Pelvic Pain Society (www.pelvicpain.org). 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. We are promoting Pelvic Pain Awareness Month because it is our mission to ensure that people know that help exists so they can start living richer and fuller lives. In honor of Pelvic Pain Awareness Month we want to take some time to explain what we do and how it can help with the symptoms of pelvic pain. 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

PH101: Ladies Only Session

By: Fiona McMahon, DPT
Hey Ladies!!! In our next installment of our Pelvic Health 101 course, we are hosting a women’s only session to allow for a safe and non-threatening place to discuss many issues that can affect the health of your pelvic floor. This class one of Stephanie Stamas’s (the founder of PH101’s ) favorites and is definitely not to be missed. Join us at 7pm on April 20th, 2017  Please register at pelvichealth-101.eventbrite.com.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

pelvic-health-101-spring-2017