PH101: Something’s Wrong with my What?

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Image via PlayBuzz

On March 16, 2017 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.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth-101.eventbrite.com

Here is our line up of this and future classes:

pelvic-health-101-spring-2017

Exercise, The Female Athlete, and the Pelvic Floor

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Fiona McMahon PT, DPT

In honor of National Women’s Health and Fitness Day ,September  28, we are exploring the benefits of regular exercise for women as well as addressing some pitfalls (pelvic floor included), that female athletes can fall into too. It is far too often that women find themselves sidelined from their favorite sports and fitness routines secondary to issues like orthopedic or sports-related pain or incontinence. Although all the issues outlined in this blog can occur to both genders, many of these conditions are more likely to happen to females, secondary to their pelvic structure and physiology.

 

Exercise and Its Benefits

heart-health

 

The benefits of exercise are too numerous to discuss every single one here and span the physical to the emotional. There are a number of conditions that have profound effects on the health of women nationwide. Let’s explore some of exercise’s specific benefits for these conditions together.

Heart Disease

According to the American Heart Association, Heart disease is the number one killer of women in the US and is responsible for 1 in 3 female deaths.  Exercise and a healthy lifestyle have been shown to reduce the risk of heart disease by 80%. The American Heart Association recommends 150 minutes of moderate activity or 75 minutes of vigorous activity to stave off heart disease.

Osteoporosis

Osteoporosis is unfortunately a common affliction among white and asian urban dwelling females.  It is characterized by reduced bone density, which causes bones to be fragile and increases the risk of fracture in individuals that have osteoporosis. Exercise has been shown to be helpful in both reducing the risk of osteoporosis as well as improving the bone mineral density of those who already have osteoporosis.

Other benefits of regular exercise include:

  • Reduced risk of diabetes
  • Reduced risk of colon cancer
  • Improved psychological well being
  • Maintenance of healthy body weight

Remember, it is important to consult with a trained healthcare professional before commencing a new fitness routine.

 

The Female Athlete Triad- Aka the Downside

All things in moderation. Although exercise is beneficial it is easy to over do it. It becomes easier to slip into an unhealthy relationship with exercise, especially in women who are training at elite levels, have eating disorders, or body dysmorphia issues.

The  female athlete triad consists of three disorders that can have severe health consequences in both the near and long term. The three disorders that compose the female athlete triad are:femaletriad

  1. Disordered Eating
  2. Ammenorrhea (absent periods or periods that are irregular)
  3. Osteoporosis

The female athlete triad is often attributed to the expectation that women keep a slender appearance. Girls and women who have body image issues may be at greater risk. The female athlete triad is dangerous and has the potential to be deadly. Osteoporosis can result  in fractures and eating disorders can seriously impact fertility, or even throw off the delicate balance of electrolytes in their system, putting them at serious risk for a cardiac event.

Warning signs of the female athlete triad include:

  • Yellowing of skin
  • Stress fractures
  • Rapid fluctuations in weight
  • Development of baby hair over skin
  • Daily vigorous exercise to an excessive level

 

The female athlete triad requires a multidisciplinary approach from medical, to psychological to nutrition.  It is important for someone who is suffering from the female athlete triad to seek help in order to safeguard their health and emotional well being.

 

Athletics and The Pelvic Floor

d14e2-tipsforahappyandhealthyvaginaLike any muscle, the pelvic floor can get fatigued, strained, or even go into a painful muscle spasm. The thing about the pelvic floor muscles, is that they have to work in almost every athletic pursuit. They work in partnership with the multifidus of the back, the transverse abdominus of the belly, and the diaphragm to stabilize and protect your spine. They also contract with every step during running activities to prevent your pelvic organs from dropping down in your pelvic cavity and to prevent urinary and or fecal leakage. Things can go wrong when the pelvic floor or other core muscles don’t function properly. Athletes’ pelvic floors can become tight and restricted, preventing closure of sphincters and support of pelvic organs. They may go into spasm from working too hard to stabilize the spine, if one of the other core muscles is failing to pull its weight.

Recently there has been more work to investigate the link between athletes and pelvic floor dysfunction. A recent study found that self identified female triathletes suffer from urinary and fecal incontinence at rates as high as 37.4% and 28.0%, respectively. Similar results were also found on a group of runners. Of the triathletes studied, nearly a quarter of them fit the criteria for female athlete triad, discussed earlier in this post.

Does this mean you have to give up your penchant for running? NO! (hellooooooo the author of this post is a runner), but if you find yourself experiencing incontinence, pain, constipation, and or painful sex, something is wrong and you must intervene in order to protect your long term health and your ability to participate in your favorite sport. At Beyond Basics Physical Therapy we combine orthopedic and pelvic expertise to help return athletes to their sports in a more functional and less painful condition. We relax tight muscles of the pelvic floor, train the core, including the pelvic floor if needed, to do its fair share, and return normal postural and structural alignment to our patients. We work one on one with you to develop a home exercise plan to help you reach your goals and prevent a reoccurrence of your pelvic floor or core disorder.

 

Please come see us so you can return to your sport in a better and more optimal condition than when you started: http://www.beyondbasicsphysicaltherapy.com/

 

 

Sources

American College of Sports Medicine. Information on … the female athlete triad. https://www.acsm.org/docs/brochures/the-female-athlete-triad.pdf. Accessed September 19, 2016

 

American Heart Association. Facts About Heart Disease in Women.  2016. https://www.goredforwomen.org/home/about-heart-disease-in-women/facts-about-heart-disease/. Accessed: September 6, 2016

 

Bø, K. Urinary incontinence, pelvic floor dysfunction, exercise and sport. Sports Medicine, 34(7), 451-464. 2004.

 

Illinois Department of Public Health: Women’s Health. Facts about  women’s wellness exercise . http://www.idph.state.il.us/about/womenshealth/factsheets/exer.htm Accessed: September 13 2016

 

Loyola University Health System. “Female triathletes at higher risk for pelvic floor disorders.” ScienceDaily. ScienceDaily, 23 August 2016. <www.sciencedaily.com/releases/2016/08/160823165743.htm>.

 

Stampfer M, Hu F, Manson J, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. The New England Journal of Medicine. 2000; 343(1). 16- 22
Todd J, Robinson R. Osteoporosis and exercise. Postgrad Med J. 2003; 79:320-23

Amy is Live with Integrated Pelvic Health!

Fiona McMahon DPT

amy2016What would you ask a pelvic floor physical therapy expert about exercise, or about the pelvic health as an athlete, if you had the chance? Don’t miss Amy Stein, founder of Beyond Basics Physical Therapy and author of Heal Pelvic Pain answer some commonly asked questions in a webinar hosted by well-renowned Jessica Drummond of Integrated Women’s Health Institute. Jessica is a nutritionist specializing in abdomino-pelvic health and dysfunction.  She will be interviewing Amy on the athlete and pelvic floor dysfunction, treatment paradigms, and practical tips for relieving the under active and the overactive pelvic floor.

Details:

Time: Friday, Sept 23, from 12-1pm EST.

Place: www.facebook.com/IntegrativePelvicHealth

Remember this interview can be replayed later if you cannot view it live.

 

 

Resources for Pelvic Pain:

Beyond Basics Physical Therapy: http://www.beyondbasicsphysicaltherapy.com/

 

Heal Pelvic Pain: http://www.healpelvicpain.com/

 

Integrated Women’s Health Institute: http://integrativewomenshealthinstitute.com/

 

Link to hear Amy and many other wonderful pelvic health experts speak in December about the female athlete and pelvic floor dysfunction:

https://km132.isrefer.com/go/WIWH/AStein/

 

Pelvic Health 101 is Back and With ALL NEW Courses Added

Fiona McMahon, DPT, PT

Pelvic Health 101 is back with some old favorites like, “Something’s wrong with my what?” and “Why is pooping so difficult?” as well as some new additions to our curriculum such as “Does my diet really matter?”, a look into how diet can affect pelvic floor conditions, and “ How does pregnancy & birth affect my body?”.

If you have questions, we have answers. Join us for lectures and question and answer opportunities with expert pelvic health physical therapists, childbirth educators, nutritionists, and yoga instructors. Please reserve your spot early at pelvichealth-101.eventbrite.com. Remember spots fill up quickly. As always, light refreshments will be served.

Pelvic Health 101 Fall- (003)

Why Do I Still Look Pregnant: Part II

Fiona McMahon, DPT

Diastasis-Recti-Repair

Diastasis recti (DR) can be the bane of many women who are trying to decrease the size of their stomach following pregnancy. DR occurs when the two six pack muscles (rectus abdominus) separate from one another, leaving the appearance of visible gapping and bulging of the stomach, creating the look of a belly or paunch. We most commonly see DR following pregnancy; however, it can be seen in men and women with abdominal obesity, children with bowel issues, and people who have undergone abdominal surgery. Aside from its cosmetic effects, DR can also cause problems with the low back, bowel, and bladder.

Most physical therapists are trained to recognize and treat the musculoskeletal components of DR. We know to release the tight structures that are preventing the full closure of the abs, we correct alignment to reduce pull, we use sports tape to encourage the abs to activate, and we strengthen our patients’ core. It usually works wonderfully, but what if it could work better?

Staff physical therapist and resident “thinker outside of the box”, Melissa Stendahl, PT lead an inservice earlier this May to instruct the crew at BBPT on how to incorporate visceral mobilization to improve the results of traditional DR treatment.

 

If DR is a dysfunction of the musculoskeletal system, why treat the viscera?

In pregnancy the uterus grows and as it enlarges and becomes an abdominal organ. The intestines don’t have much say when this happens and get pushed behind the uterus in order to accommodate their new neighbor. After pregnancy the uterus returns to her old home, however the intestines may remain “sticky” from the trauma of being squashed by the uterus, leading to pull on the abdominals from the inside, which prevents the full closure of the abdomen. By treating the organs (AKA the viscera) we can help reduce one more factor impeding the full closure of the abdominal muscles.

How do I know if my organs are playing a role in the failure of my diastasis to close?

Some of the signs of visceral involvement with DR include low back pain, left sided sciatica, lower extremity joint pain, distention or bulging of the lower abdomen, difficulty digesting raw vegetables, and weakness in the lower extremity following workouts, secondary to reduced bloodflow.

What type of results can I expect from visceral mobilization?

According to Brandi Kirk, pioneer of this approach for DR, resolution of DR using visceral techniques can take from 12 visits to 1 visit depending on the severity of the separation.  She was able to demonstrate in her visceral mobilization class the following closures:

 

Class 1

Patient Diastasis Width Before Diastasis Width After
A 2 finger widths 0.5 finger widths
B 3 finger widths 0.5 finger widths
C 1 finger widths 0 finger widths

 

Class 2

 

Patient Diastasis Width Before Diastasis Width After
A 2 finger widths 1 finger widths
B 3 finger widths 1.5 finger widths
C 2 finger widths 0.5 finger widths

 

If you have struggled in closing your diastasis independently or are experiencing some of the symptoms mentioned above, it is time for a little extra help. Come see the physical therapists at Beyond Basics, who are trained to give you the most complete treatment for your DR. You deserve it!

Postcard from Ryanne’s Exercise Inservice

This week the BBPT team went back to BASICS with exercise programming. Ryanne, one of our staff PTs, led us through basic routines and their progressions with a focus on different manual and verbal cues that can be used with each exercise. Every patient begins physical therapy at different levels of exercise experience, as well as differences in body awareness. When starting patients on an exercise program, even if they are avid exercisers, it is important to start with the BASICS to see HOW exactly they are performing them and to be able to screen for any dysfunctional movement patterns:

.We went over different ways to facilitate the core to allow the for symmetrical engagement in exercises like pelvic tilts, bridging, and planks. Through the use of facilitation, we can actually CHANGE the motor plans (how one moves) of our patients to more efficient ones, thereby reducing their symptoms.  These techniques are useful for patients that are recovering from injury and even those wishing to return to high level fitness classes.

Below, Ryanne is leading us through a basic bridge exercise with different manual and verbal cues, resistance and progression

 

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facilitation

Denise and Amy trying their hands in facilitation

Ryanne

Fiona and Melissa trying it out themselves

We encourage you to work with a physical therapist to begin or perfect your exercise routine!

PT In-Service: Alignment and Core Exercises

By Amy Stein

Our famous Dania Kafka, who is an amazing physical therapist and Pilates instructor, recently discussed alignment, posture and core exercises correctly at our latest PT In-Service. She helped us with proper cueing because we don’t want pelvic pain patients to utilize the pelvic floor muscles, or limit their use, with any core stabilization exercises. We went over how to gently engage the transverse abdominus, which is one of the core muscles and helps with pelvic and trunk stability. If this muscle is weak and the patient is overusing their pelvic floor, they can end up with pelvic pain. Core and trunk muscle imbalances can be one of many reasons a patient ends up with pelvic pain and/or pelvic weakness. Therefore, it is important to have a strong and balanced core. Dania proceeded to lead us through a series of transverse abdominus exercises that were adapted by Shirley Sahrmann, PT, and we incorporated diaphragmatic breathing with each exercise. We practiced neutral spine versus posterior pelvic tilt to compare the difference, and discussed with which populations we would use which position.

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With any pain condition, if there are active trigger points, tightened and/or shortened tissue, you need to address these impairments prior to strengthening these muscles. Otherwise you can exacerbate trigger points and continue to shorten tissues. It is essential to make sure these conditions are resolved prior to starting a core exercise to that specific area.

With regard to pelvic floor weakness, including incontinence and post surgical weakness (prostatectomy, prolapse, etc.), it is important to strengthen the pelvic floor muscles correctly and the transverse abdominus correctly, as well as the rest of the core muscles.

Monitoring each patient with each exercise, is essential for their recovery, in order not to worsen any condition. Starting slow and in a controlled environment is key.

If you have any questions with regard to Pilates and core exercises and when to introduce them for pelvic pain, or pelvic weakness, feel free to call us and ask for any of our PTs. Or, attend our upcoming Pelvic Health 101 this spring!