Pelvic Health 101 is back! Come to Our First Class on September 20th

On September 20th, at 7pm we will be kicking off our fall 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: pelvichealth101.eventbrite.com

Here is our line up of this and future classes

Pelvic Health 101 Fall 2018

Hypo-ed up? The use of Hypopressive Abdominal Exercise in Pelvic Floor Dysfunction

balloons

Joanna Hess, PT, DPT, PRC, WCS

I’m a recent transplant to NYC. For the last four years, I was living abroad and working at a interdisciplinary sports hospital. I loved learning about physiotherapy culture around the world. We each had different contributions – the Greek wheel, Scandinavian eccentrics, Australian pain science, and Spanish hypopressives. Hypopressive exercises were magic exercises that helped resolve low back pain, prolapse, incontinence, and diastasis recti abdominis. So of course, I wondered, “Are Americans missing the boat?”

What are hypopressive exercises? And how do they work?

Hypopressive abdominal exercises (HAE) were developed by Marciel Caufriez as a response to the obsession with “the core” and the corresponding exercises (primarily crunches) that would increase downward pressure. Hypopressive abdominal exercises use a pressure gradient between the thorax (the upper part of your trunk) and abdominal cavity to create a “vacuum” effect. By creating a vacuum that draws pressure upward, your body automatically recruits transverse abdominis (TrA) and pelvic floor muscles (PFM). Both the PFM and TrA are core muscles and are important in many functions. The HAE sequence begins with static positions and progresses to dynamic and difficult movements. The set up for the exercise is:

  1. Three breaths filling the ribs making sure the sides are expanding.
  2. Breathe in focused on expanding ribs out and lower ribs up while minimizing belly movement.
  3. Then, breathe out working on spinal elongation and keeping ribs up and out. Hold the exhale for creating the vacuum and relaxing the diaphragm. The belly button should start to move up.
  4. Close the throat as if you were at the end of a swallow to lift, expand, inflate rib cage further increasing the vacuum and pressure differential—like an inhale, but without taking in air.

In diaphragmatic breath, inhalation causes the diaphragm to descend which increases intra-abdominal pressure and a reflexive eccentric contraction of the pelvic floor and abdominal wall(an eccentric contraction occurs when the muscles lengthen). Exhalation is a passive return to the diaphragm’s resting position and if it is a complete exhalation, the PFM and TrA will also contribute some activity. For the hypopressive vacuum, inhalation relies on upper chest and neck muscles instead of the respiratory diaphragm and intercostals (rib muscles). The inhalation lifts the rib cage up and gives more volume. The exhalation activates the PFM and TrA to compress the abdomen which increases the pressure of the abdomen. The pressure difference between the diaphragm is augmented by the closed inspiration and creates the vacuum that creates this automatic response. With HAE, the abdominal cavity has the same increase in pressure, possibly more, than with diaphragmatic breath, but because of the suction upwards, it feels like a different pressure.

What’s the relationship between hypopressive exercises and core coordination?

As measured by surface electromyography (EMG) and dynamic ultrasound, HAE consistently have comparable or less activation of the pelvic floor muscle and transverse abdominis than isolated, well-cued exercises (1-4). However, to increase TrA contraction, HAE with pelvic floor muscle contraction recruits more fibers more than pelvic floor contraction alone (4). HAE biases activation of deeper stabilizers–transverse abdominis, internal obliques, and pelvic floor over the more superficial rectus abdominis and external obliques(6). No research has evaluated the HAE claims of decreased downward abdominal cavity pressure. While HAE are progressed with consideration for increasing challenge, they are not incorporated into everyday positions which has an impact on the body’s ability to integrate into a task.

So, will hypopressive exercises fix my problems?

The solution for downward pressure gone wrong is not forcing upward pressure, but addressing why the body lost its adaptability for life’s demands. I rarely use hypopressive abdominal exercises as treatment for problems of the pressure system–pelvic organ prolapse, stress incontinence, diastasis recti abdominis, lumbar disc herniations, and ventral hernias. Studies show that HAE do not have an advantage over conventional TrA and PFM exercises (8) in losing postpartum weight (9), improving pelvic organ prolapse symptoms (2,4,5), or correcting diastasis recti (10).

Besides being less effective than conventional exercises for strengthening and symptom relief, HAE exchange downward and outward pressure for upward pressure and compensatory muscle patterns. This could show up as gastroesophageal reflux disorder (GERD), hiatal hernias, hyperinflated lungs with increased sympathetic drive (and immediate lightheadedness), restricted diaphragm, forward neck posture, or thoracic outlet syndrome. The respiratory diaphragm has a mechanical advantage for respiration over upper chest and neck muscles which have other postural functions.

Escaping gravity is not yet sustainable which means, normal life—breathing, digestion, walking, and laughing—includes downward pressure. If the goal is to decrease pressure on the pelvic floor, lying down with hips elevated, headstand, downward dog, or inversion table—none of these translate into movements of everyday life, but they also do not alter the body’s normal respiration and stabilization patterns. “First do no harm.”

If someone is having difficulty isolating the PFM and TrA, I would connect with diaphragmatic breath, vary effort level, try different verbal and manual cues, and modify the relative position of the pelvis to the spine (7). After correcting the mechanical “pressure problem,” I would use HAE if an individual is still having great difficulty identifying the transverse abdominis and over-recruiting the rectus abdominis. But, I then would progress out of HAE to a isolated strengthening progression integrated into functional movements. HAE is also one of many tools that can help in decreasing acute low back pain associated with muscle spasm.

I nod at the centuries of wisdom of yoga that note benefit from hypopressive practices for posture, digestion, invigoration, and automatic recruitment of core stability. But let’s also remember the time-tried basics of a healthy movement-filled lifestyle. As more studies are published, I look forward to learning more about subgroups and larger functional goals for which HAE have benefit. For now, the magic bullet for pelvic floor dysfunction is not hypopressive abdominal exercises. Isolated pelvic floor and transverse abdominis activation may be old-school, but are well-researched with strong support and are overwhelmingly more beneficial than HAE at addressing symptom alleviation and muscle strengthening.

 

Thank you so much for reading our blog, if you think physical therapy can help you. Please give us a call at either our midtown location 212-354-2622 or our downtown location 212-267-0240. We are offering free phone consultations at both offices for a short period!

Joanna Hess is a treating therapist at our downtown location

Joanna Lee Hess

References

1. Brazalez BN, Lacomba MT, Mendez OS, Martin MA. The abdominal and pelvic floor muscular response during a hypopressive exercise: dynamic transabdominal ultrasound assessment. Br J Sports Med. 2018;52(Suppl 2):A22

2. Resende AP, Stüpp L, Bernardes BT, Oliveira E, Castro RA, Girão MJ, Sartori MG. Can hypopressive exercises provide additional benefits to pelvic floor muscle training in women with pelvic organ prolapse?. Neurourology and urodynamics. 2012 Jan;31(1):121-5.

3. Resende AP, Torelli L, Zanetti MR, Petricelli CD, Jármy-Di Bella ZI, Nakamura MU, Júnior EA, Moron AF, Girão MJ, Sartori MG. Can Abdominal Hypopressive Technique Change Levator Hiatus Area?: A 3-Dimensional Ultrasound Study. Ultrasound quarterly. 2016 Jun 1;32(2):175-9.

4. Stüpp L, Resende AP, Petricelli CD, Nakamura MU, Alexandre SM, Zanetti MR. Pelvic floor muscle and transversus abdominis activation in abdominal hypopressive technique through surface electromyography. Neurourology and urodynamics. 2011 Nov;30(8):1518-21.

5. Bernardes BT, Resende AP, Stüpp L, Oliveira E, Castro RA, Jármy di Bella ZI, Girão MJ, Sartori MG. Efficacy of pelvic floor muscle training and hypopressive exercises for treating pelvic organ prolapse in women: randomized controlled trial. Sao Paulo Medical Journal. 2012;130(1):5-9.

6. Ithamar L, de Moura Filho AG, Rodrigues MA, Cortez KC, Machado VG, de Paiva Lima CR, Moretti E, Lemos A. Abdominal and pelvic floor electromyographic analysis during abdominal hypopressive gymnastics. Journal of bodywork and movement therapies. 2018 Jan 1;22(1):159-65.

7. Sapsford R. Rehabilitation of pelvic floor muscles utilizing trunk stabilization. Manual therapy. 2004 Feb 1;9(1):3-12

8. Martín-Rodríguez S, Bø K. Is abdominal hypopressive technique effective in the prevention and treatment of pelvic floor dysfunction? Marketing or evidence from high-quality clinical trials?. Br J Sports Med. 2017 Sep 4:bjsports-2017.

9. Sanchez-Garcia JC, Rodriguez-Blanque R, Sanchez-Lopez AM, et al. Hypopressive abdominal physical activity and its includence on postpartum weight recovery: a randomized control trial. JONNPR. 2017; 2 (10): 473-483.

10. Gomez FR, Senin-Camargo FJ, Cancela-Cores A, et al. Effect of a hypopressive abdominal exercise program on the inter-rectus abdominis muscle distance in postpartum. Br J Sports Med 2018;52(Suppl 2):A21

The Special Care Needs of the LGBTQ+ Community

Happy Pride Month!!!!

We are reposting an old post broadly discussing the LGBTQ+ community, with special focus on transgender individuals. Please keep checking back as we continue to discuss specific issues relating to the care of the LGBTQ+ community.  

Amy Stein PT, DPT and Fiona McMahon PT, DPT

rainbow flag

Who are LGBTQ+ individuals?

At Beyond Basics Physical Therapy, we have been meeting and studying with experts about the LGBTQ + community. LGBTQ+ refers to individuals who do not identify as heterosexual or do not identify as cis- gendered (although these two categories are not mutually exclusive). Cis-gender means you identify with the genital anatomy you were born with. People who belong to the LGBTQ+ community can be cis-gendered (meaning they identify with the genital anatomy that they were born with) and be gay/lesbian/ bisexual/ questioning etc.  They can be trans-gender and heterosexual or some combination thereof. Basically LGBTQ+ is a term that includes people who are not both cis-gender and heterosexual. LGBTQ+ is an acronym for lesbian, gay, bisexual, transgender, queer/questioning, and other individuals.  

Never Assume. Listen, Ask.

We were excited to understand and learn more about how we can help, specifically with patients experiencing pain or weakness in the pelvic floor. We met with an LGBTQ + advocate and he recommended the following when it comes to treating patients both within and outside the LGBTQ+ community.  First rule of thumb:  with all patients, don’t assume and be open to any questions or discussion. Ask if your patient would like you to stay away from certain terms regarding their anatomy, as well as their preferred gender pronoun. Use language that they want us to use.

 As with all patients, we need to use a biopsychosocial approach. With any patient, Richard Green at Bellevue hospital says that we always want to know exactly what is going on with our patient. We must subjectively understand why they are visiting us.  Has there been trauma, surgery, complications, or anything that has worsened their symptoms? What hormones and medications are they on? Don’t single anyone out. These questions are important for every patient.  

We want to get the medical and surgical history during or prior to the visit. There is no standard one surgical procedure or hormonal protocol in trans care. Hormones, either testosterone, estrogen, lupron, puberty blocking, testosterone suppressing can be used in many patients, but are also used specifically to aid in transition in transgender patients. Many hormones have consequences or side effects and our patients need be educated on the various options.  There is research on hormones and bodily changes, however there is no good research on how the hormones affect the pelvic region. Anti-estrogen hormones may result in vaginal drying and atrophy, more tissue tearing, and pain with penetration.  Endometriosis can be worsened with testosterone hormones.  Hormones can be administered via injection, pellets, patches, creams, gels, and pill form.  It’s important to realize side effects and risks of hormones for each patient. Dosage depends on body type, weight, previous surgeries, etc.  Hormone therapy can be given by a primary care provider or endocrinologist; however, many are not familiar with a specific protocol but at the same time each person may have different goals.  Progression of hormones can be monitored for each patient and according to patients wants and needs.  

For those who opt for surgical transition, it can result in pelvic pain and or weakness as organs are moved and or removed. Like we mentioned before, there is no one surgical protocol and it will vary from surgeon to surgeon, from changes in hormones from the removal of certain organs.  Knowing what tissues have been removed or moved and or where scar tissue could have been formed, is important to addressing a patient’s complaints. Also, it’s important to ask if the patient was having these symptoms or pain prior to any of the surgeries or hormonal medications. Surgical transition can take a long time with various surgeries and various symptoms that arise throughout. Some issues that  can occur are fistulas or fissures and when dealing with nerve implants there could be nerve damage and restrictions.

 

How is care for the LGBTQ+ community funded and regulated?

Medical coverage for the LGBTQ + community is non-regulated and different in each state. The Affordable Care Act, (ACA) covers some therapies and surgeries. You can try to appeal with each insurance which have their own policies on gender affirming care.

How can physical therapy help?

At Beyond Basics Physical Therapy, we specialize in abdomino-pelvic disorders, including pain, weakness, bladder, bowel and sexual dysfunction.  We also specialize in orthopedics and functional manual therapy.  We treat the LGBTQ+ community and we welcome any questions at desk@beyondbasicspt.com or call 212-354-2622. We are happy to help and look forward to hearing from you!
Resources: Center of excellence for transgender health.

WPATH center for care Endocrine Society

  • speaks on hormone therapy (however some information may be out of date).

 Adolescent Health Center

Joint Changes in Arthritis are Permanent, but Pain Does Not Have to Be

stick man

Fiona McMahon PT, DPT

May is arthritis awareness month. Arthritis can come in many different forms. It can be a result of wear and tear or it can be a response to an autoimmune condition. There are many different types of arthritis, but the fact remains that in all of these different types of arthritis, once the damage to the joint is done, it is done. Currently, we have no way of repairing the joint outside of joint replacement. You may be thinking, if the damage is done, why bother spending my precious time and money in physical therapy? The reason is that physical therapy and lifestyle management can make a huge difference towards reducing your pain, improving your function, and even preventing the progression of joint break down. Physical therapy has been proven to help reduce pain and increase function, and in many cases, avoid surgery.

Physical therapists are movement experts. It seems obvious that they should be the providers directly involved in restoring function to individuals with diseases of the joints. For both rheumatoid conditions as well as osteoarthritis, physical activity is considered the first line intervention for improving pain and function. This is not to say that exercise will replace disease modifying arthritis drugs (DMARDs) in cases of rheumatoid arthritis. It is saying treatment is not complete until you address the strength, pain, and range of motion problems that occur with arthritis.

Physical therapy will not change the conditions of joints that have been damaged by arthritis; however, physical therapy is paramount to improving the prognosis of arthritis by helping to improve the strength around the joint, range of motion, and stability of the joint to prevent further cartilage and joint break down. Physical therapy can also have a marked effect on the pain and function, and can open up your world to things that were once too painful. In a meta-analysis study conducted by Sampath and colleagues, two common physical therapy techniques, manual therapy (work on the joints) and exercise therapy were examined to assess the efficacy of these techniques on pain and function in individuals with arthritis. The study found strong evidence that exercise therapy and manual therapy were good at reducing pain and improving function in people with arthritis.

Physical therapy is so worth the investment. It is an investment in your comfort, the ability to do the things you love, and commonly helps people stave off needing a joint replacement. Full disclosure, I’m partial to our clinic, Beyond Basics Physical Therapy (understatement of the year, I know). What makes us so special is that we have the manual therapy, exercise and orthopedic experts. We all come from various orthopedic (joint and muscle PT) backgrounds including the Postural Restoration Institute (PRI) and the Institute of Physical Art (IPA) and many of us have earned advance orthopedic certifications such as the Certified Functional Manual Therapist (CFMT), Certified Orthopedic Specialist (OCS), and Postural Restoration Certification (PRC) distinctions. What this means is our therapists have the knowledge and skill set to go above and beyond the basics in our hour long treatments to treat you head to toe, improving the way your body moves and more importantly, how it feels. Click here to read more about the ins and outs of the CFMT certification and how it can take you to the a place of less pain and more function here.

Another thing to keep in mind is your weight. When it comes to management of arthritic conditions, additional pounds put additional stress on your joints and can hasten the progression of joint break down. Losing pounds can be a big task when your joints are not feeling their best. Your physical therapist can guide you through exercises that are efficient for weight loss and do not exacerbate your symptoms. We also can provide a valuable link to get you set up with proper nutritional support to help manage weight.

Once the damage is done by arthritis it is done; however, that does not mean you are condemned to pain, decrease function and continued deterioration. Get physical therapy today for pain relief and to get moving again!

We have two clinics. One in Midtown Manhattan and one Downtown. We also offer Pilates and personal training at our clinics, which can help get you back into an exercise routine.

Give us a call today to find out more:

212-354-2622 (Midtown)

212- 267-0240 (Downtown)

Heidari B, Rheumatoid Arthritis: Early diagnosis and treatment outcomes. J Capsian Internal Med. 2011: 2(1) 161-70

Hootman J, Murphy L, Omura J, et Al. Health care provider counselling for physical activity among adults with arthritis. Morbidity and Mortality Weekly Report. 2018; 66(51-52) 1398-1401

Sampath K, Mani R, Miyamori T, et al. The effect of manual therapy or exercise therapy or both in people with hip osteoarthritis: a systematic review and meta-analysis. Clinical Rehab. 2016; 3-(12) 1141-55

Wang Y, Lombard C, Hussain S, et al.Effect of a low-intensity, self-management lifestyle intervention on knee pain in community- based young to middle-aged rural women: a cluster randomised controlled trial. Arthritis Research & Therapy. 2018; 20(74)

What Pelvic Floor PT is and What it is Not

 

PelvicTrigger Warning: This piece briefly discusses sexual assault.

Fiona McMahon PT, DPT

Last summer, a reporter came to our office. This is usually not a tremendously unusual circumstance at Beyond Basics Physical Therapy. We often have reporters come to our office to research conditions like dyspareunia (painful vaginal intercourse), endometriosis, painful bladder syndrome/interstitial cystitis, prostatitis, and the many other conditions we treat. This time was different. This reporter was researching legitimate medically necessary pelvic floor physical therapy to put into context what was currently happening in USA gymnastics and the Larry Nassar story.

The Larry Nassar story rocked the pelvic floor world to our core. Larry Nassar was a USA Gymnastics Team physician who sexually abused girls for decades, under the guise of providing “pelvic floor treatment”. For those of us who have spent our lives promoting, educating, and treating both men and women with pelvic floor dysfunction, to see pelvic floor treatment perverted into a way to systematically abuse women and girls, it was truly heartbreaking.

We at Beyond Basics PT feel it is imperative to ensure that every patient knows his or her own rights and what to do if they feel uncomfortable. Although we are writing this in the context of pelvic floor physical therapy. Keep in mind, that much of what we talk about applies to interactions with other healthcare professionals.

Before we get started, let’s discuss why one might need to have their genital region examined in the course of physical therapy treatment. Pelvic floor dysfunction refers to a whole host of symptoms mainly felt in the pelvis, although they may appear in other parts of the body. These symptoms may include and are not limited to both male and female pelvic pain, urinary, bowel and sexual issues. Treatment may include external manipulation of the pelvic floor and genital region as well as manipulation of the pelvic floor muscles by inserting a gloved finger into the anus or the vagina. These techniques are used in combination with other osteopathic techniques to improve muscle length and strength, as well as reducing spasm within the pelvic floor and surrounding areas. To read more about what pelvic floor physical therapy is, click here. Pelvic floor physical therapy can be life changing when performed appropriately. It can allow an individual to go back to work or back to school, or the tolerance to sit on a plane to visit family, when doing so would have been too painful prior to physical therapy. It can allow an individual to have painless sex (male and female, same sex or opposite sex sex), and it can allow someone to regain continence who before was socially isolated. Pelvic floor physical therapy is a legitimate means of improving the health and quality of life of an individual. We will include peer reviewed articles below if you would like to read more.

Given the intimate nature of the treatment as well as the power dynamic that sometimes may exist between patient and clinician, it is important to discuss what rights you have as a patient in order to make yourself feel more comfortable. The following outlines your rights as a patient receiving any type of medical treatment.

Consent

When you step through the door of any medical office for the first time, you get handed what feels like fistfuls of paperwork. In that paperwork, there should always be a consent form. This form must be signed before you are treated, the exception being in medically emergent situations, when you become unconscious and consent is implied for life saving medical intervention.

Remember, just because you signed the form before treatment, doesn’t mean you consent to any and all treatment. You may always revoke your consent by saying you don’t want to participate in a procedure or intervention by saying so.

We want you to feel comfortable. If a treatment course makes you uncomfortable, tell us. Gritting your teeth and tolerating an uncomfortable treatment can sometimes do more harm than good. It is also appropriate to revoke consent to be treated if you are unsure why a treatment is being done or suspect it may not be necessary. Our jobs as clinicians are not only to treat but to educate. If you don’t know why we are doing a certain technique, we need to take time to educate you in order to do our job correctly. Revoking consent can be as simple as telling your practitioner you do not want to engage in a certain activity. Practitioners may take time to explain why they feel that intervention is necessary; however they should never make you feel ashamed for revoking consent. Remember, you are not in the clinic to please us. You are there for yourself. To get better. That is it.

Even if you truly need a pelvic floor treatment, often times there are other parts of the body that should be addressed to aid in certain pelvic conditions. Skilled practitioners can delay pelvic floor treatment by treating other parts of the body until you are ready. This can often be done while still maintaining forward progress.

Chaperone

Chaperones are individuals who accompany you to medical and physical therapy exams and treatments. If having a chaperone attend a visit or visits would make you more comfortable, you should be allowed to bring one. You should be able to bring a family members, or a friend into treatment. If you don’t have someone to fill this role, you can ask the facility to supply you with one, (usually asking ahead of time will ensure a staff member is available). In very few cases, such as surgery or trauma interventions, is it appropriate for a patient to be denied a chaperone if he or she requests it.

Second Opinion

What if your clinician gives you a diagnosis or suggests a treatment that doesn’t sound right? This is where a second opinion really comes in handy. Getting a second opinion is not “cheating” on your doctor, it can allow you to explore other options or be more confident in your original provider’s course of action.

Respect and Comfort

Feeling respected by your clinician is essential to healing . If you feel that you are not getting the respect you deserve or even if you are not connecting with clinician for whatever reason, you have the right to change clinicians. You don’t have to feel obligated to explain why you are changing clinicians if you don’t want to. Most healthcare providers realize that we might not have the right clinician for every person, and we are trained to not take it personally. It is okay to put yourself first.

Red Flags in Pelvic Floor Physical Therapy

  1. Feeling coerced, bullied, or shamed into a pelvic floor treatment
  2. Therapist does not wear gloves for treatment
  3. Therapist insists on not allowing chaperone
  4. Therapist fails to offer adequate reason for treating the pelvic floor
  5. Therapist is not licensed
  6. You therapist acts in a way to make you feel unsafe or uncomfortable

The truth is, there are so many wonderful physical therapists out there who treat the pelvic floor. Being a physical therapist is one of the greatest jobs in the world, because we get to help people do things that before were difficult or impossible. Pelvic floor physical therapy changes lives. We sincerely hope this article helps you feel empowered to go to physical therapy and know what your rights are and what to expect.

Further reading on pelvic pain:

Association

International Pelvic Pain Society: www.pelvicpain.org

International Society of the Study of Women’s Sexual Health: www.isswsh.org

 

Books

Heal Pelvic Pain

By: Amy Stein DPT

http://www.healpelvicpain.com/

Healing Pelvic and Abdominal Pain DVD

By: Amy Stein DPT

http://www.healpelvicpain.com/

When Sex Hurts

By: Andrew Goldstein, MD and Caroline Pukall, PhD

Healing Painful Sex

By: Deborah Coady, MD and Nancy Fish, PhD

 

Scholarly Articles

Anderson R, Wise D, Sawyer T. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-60

Anderson R, Sawyer T, Wise D, Morey A. Painful myofascial trigger points and pain sites in men with chronic prostatitis/ chronic pelvis pain syndrome. The Journal of Urology, 182;6 2753-58

Fitzgerald M, Kotarinos R. Rehabilitation of the short pelvic floor. I: Background and patient evaluation. Int Urogynecol J 2003; 14:261-8

Fitzgerald M, Kotarinos R. Rehabilitation of the short pelvic floor. II: Treatment of patient with the short pelvic floor. Int Urogynecol J 2003;14: 269-72

King H. Manual Therapy May benefit women with interstitial cystitis and pelvic floor pain. J Am Osteopath Assoc. 2013;(113)4: 350-61

Morin M. Bergeron S. Pelvic floor rehabilitation in the treatment of dyspareunia in women. Sexologies. 2009; 18:91-4

Shafik A, Shafik I. Overactive bladder inhibition in response to pelvic floor muscle exercises. World J Urol. 2003 May; 20(6):347-7. Epub. Apr 4

Wurn B, Wurn L, Patterson K. Decreasing dyspareunia and dysmenorrhea in women with endometriosis via a manual therapy: results from two independent studies. 2011;3(4)

Beyond Basics is Visting Brooklyn!!!!

Brooklyn

 

Fiona McMahon PT, DPT

Have you got pelvic floor questions? Have you desperately wanted to go to one of our PH101 classes, but can’t swing 7pm in midtown in the middle of the week? Well, I have great news and GREATER news. I know, right… how much great news can you handle? The first bit of awesome, is that Beyond Basics’ Physical Therapists’, Dr. Fiona McMahon and Dr. Sarah Paplanus are hosting a forum and open discussion on pelvic floor health and treatment on Saturday, April 28th at The Floor on Atlantic (310 Atlantic Avenue in Brooklyn) at 12 noon. We will be there to explain the ins and outs of the pelvic floor, what can go wrong with it, and best yet, how you can heal it. It is a must go to event. RSVP here. Also, it’s FREE!

So what’s the other news, Fiona? Well, it’s that although we are not in Brooklyn, we have opened another office just across the river from Brooklyn, Beyond Basics Physical Therapy Downtown. In enlarging our footprint we hope to expand access and convenience to patients living downtown and in Brooklyn. We will be hosting a Grand Opening and 15 year anniversary celebration at our new location: 156 William St, Suite 800 New York, NY 10038 on Thursday, April, 26th from 4pm – 7pm. Come and enjoy food, drinks and meet our Physical Therapists. RSVP here.

 

 

May Is Pelvic Pain Awareness Month!

Mayis PelvicPainAwarenessmonth

 Kaitlyn Parrotte, PT, DPT, OCS, CFMT

While there are many causes to be aware of and advocate for, one close to our hearts at Beyond Basics Physical Therapy is pelvic and abdominal pain, and we are excited to report that May is Pelvic Pain Awareness Month! This designation for May was created by the International Pelvic Pain Society last year. So let’s talk a few moments about what is abdomino-pelvic pain, how impactful the diagnosis can be, and what we can do!

According to the American College of Obstetricians and Gynecologists, chronic pelvic pain is described as a “noncyclical pain of at least 6 months’ duration that appears in locations such as the pelvis, anterior abdominal wall, lower back, or buttocks, and that is serious enough to cause disability or lead to medical care.”(1) While the incidence and prevalence of chronic pelvic pain in men and women are reported in an inconsistent manner,(2) some estimates compare its global prevalence to asthma (4.3%-8.6%), and another to the prevalence of low back pain (23.2 +/- 2.9%).3 Individuals who suffer from chronic pelvic pain also often present with other complicating factors such as depression, anxiety, poor sleep, difficulty with work, and/or relationship issues. Also, many people with chronic pain are commonly disabled by fear that activity will make things worse.(2) Furthermore, pelvic pain is puzzling as it is a multisystem disorder, which includes sexual, bowel, urinary, gynecological, and musculoskeletal symptoms. It is challenging to determine a clear mechanism of pain with this diagnosis, and the term “pelvic pain” does not take into account the many signs and symptoms that may be occurring outside of the anatomical pelvis.(2 ) 

Due to the complicated nature of this condition, there is a significant economic burden associated with management of it. In the United States, approximately $881.5 million was spent on chronic pelvic pain to cover the costs of direct healthcare. Additionally, approximately $2 billion was spent as an overall cost, which includes direct medical costs and indirect costs, such as those related to absenteeism from work.(3) Besides economic burdens on individuals suffering from chronic pelvic pain, there are also many challenges for the healthcare system to deal with. For instance, while a diagnosis of chronic pain in the United States typically yields more than 80% of physician referrals, it is estimated that only about 15% of individuals with chronic pelvic pain consult primary care providers, and only 40% of this group are referred to specialists for further investigation. (3) Furthermore, if specialist care is involved in the management of chronic pelvic pain, it is often spread between multiple specialties, such as urology, gynecology, urogynecology, colorectal services, pain medicine, and even occasionally spinal services, rheumatology, and neurology. Thus, there is a risk that patients may be passed back and forth between different teams of the same specialty, or between different specialties, and may not receive consistent or effective care.(2)  In a nutshell: chronic pelvic pain can be a debilitating condition that can have significant consequences on an individual’s physical, mental, economic, and social well-being.

Hopefully, if you were not already passionate about raising awareness of pelvic pain, you now have some insight as to why this cause is so important! Now the question lies, what can you do? How can you get involved?

On May 31, 2018 the staff here at Beyond Basics PT will be hosting a fundraising pub night at The Green Room, located at 156 East 23rd Street, New York, NY 10010, from 6.30-9pm. At this event, we will be uniting healthcare practitioners to raise funds for research and educational programs that will promote more effective diagnosis and treatment for those suffering from pelvic pain. All our proceeds will go directly to the International Pelvic Pain Society, so come out and support our cause!!

If attending this event is not possible, please consider visiting the website for the International Pelvic Pain Society (www.pelvicpain.org) and donating funds for educational and research programs (https://wjweis.association-service.org/securesite/ipps/donations.aspx). Together, we can help bring chronic abdominal and pelvic pain into the forefront of healthcare, to ensure individuals dealing with this condition are receiving consistent and effective multidisciplinary care.

 

Sources:

  1. Andrews J, Yunker A, Reynolds WS, Likis FE, et al. Noncyclic chronic pelvic pain therapies for women: comparative effectiveness. AHRQ Comparative Effectiveness Reviews, Rockville (MD), 2012.
  2. Baranowski AP, Lee J, Price C, Hughes J. Pelvic pain: a pathway for care developed for both men and women by the British Pain Society. Br J Anaesth. 2014;112(3):452–9.  
  3. Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17(2):E141–7.