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.
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.
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.
Ahangari A. Prevalence of chronic pelvic pain among women: an updated review. Pain Physician. 2014;17(2):E141–7.
It’s that time of year again! It’s time to lace up our sneakers, hop on our bikes and start gearing up for Cycle for Survival for the THIRD year in a row, and Amy Stein’s (founder of Beyond Basics Physical Therapy), 6th year! Cycle for Survival is a nationwide event that raises funds to support research for rare and often underfunded cancers. What is really special about Cycle, is that 100% of proceeds are contributed to the research.
We are hoping to raise $4,000 dollars to support this life saving research by taking turns on bikes cycling our hearts out.
If you would like to consider donating, please click here to access our team page, and please ask your company if they will match:
Hi everyone! It’s Fiona from BBPT. I am writing the day after the 2017 NYC Marathon sore, tired, but happy. It was a great training season, in which I pushed myself harder than I had before and had a great physical therapist, Jessica Babich PT, DPT looking after me the whole way.
Let’s not bury the lead any further. As of today, we managed to raise over $3,500 to support research for multiple sclerosis (MS) through NYC Team Tisch MS and as a group Team Tisch raised over $100,000 dollars to further the goal of making TISCH MS history.
ALSO…. physical therapy definitely payed off. I shaved over 17 minutes my last NYC marathon in 2013, going from a time of 4 hours 0 minutes and 4 seconds, to 3 hours 43 minutes and 2 seconds. Not only was it a personal record for the course, but it was 8 minutes faster than my previous all time best at Sugarloaf in 2011.
This was my first time getting physical therapy during training for a race, rather than having to turn to it when some type of disaster struck, be it a rolled ankle, irritable knee, etc. This is the first time I’ve had someone care not only about my core, but whether or not it engaged when it was supposed to.
I would advise anyone who is considering engaging in an athletic endeavor, especially a new one, or when competing in a sport for time, to strongly consider getting an experienced physical therapist with expert skills in manual therapy and a keen eye for function. They can evaluate problem spots from head to toe (literally, in my case, Jessica worked on both my neck and ankles). They can help you tailor your training to get the most out of your exercises to allow you to perform at higher levels. Jessica kept me healthy and motivated, and her work allowed me to train safely and effectively at an intensity I hadn’t yet explored independently.
Thank you all for your support. If you still care to donate you still can here.
If you think you would benefit from PT at Beyond Basics, click here or call today.
Fiona McMahon PT, DPT & Jessica Babich PT, DPT Fiona: Hello everyone, for those of you who didn’t get a chance to catch my blog a few weeks back, Beyond Basics Physical Therapy is joining forces with the Tisch Multiple Sclerosis Research Center of New York to raise money to support multiple sclerosis research, through Team Tisch MS NYC, in this year’s New York City Marathon. Our goal is $2,500 and WE ARE SO CLOSE, if you care to donate, please click here. I will be running the marathon in November, and Beyond Basics Physical Therapy is working to support my fundraising endeavors as well as showing the running community the invaluable benefits of having a sharp, perceptive, thorough and expert physical therapist on your side during training; and that goes for ANY sports training!
I just had my first evaluation with Jessica Babich, PT, DPT, who is both a pelvic floor physical therapy expert as well as a functional movement specialist with an extensive background in orthopedics and sports-related injuries. Jessica was super thorough, she took an extremely detailed history, she looked at my posture, joint mobility and mechanics, strength, core function, and even how my shoes were constructed to see if they were good enough to run in! The shoe part was super wild! In this blog you will see where I stand from a physical therapy perspective, and where I hope to go. Both Jessica and I are authors in this blog so keep an eye on who is talking so you can get the full scoop from both the physical therapist and the patient perspective
Jessica: When I look at runners, I first assess the individual as a whole and identify which area in their body seems to be driving inefficiency. I look at the 3 pillars of functional efficiency, (Mechanical, Neuromuscular, and Motor Control) when examining my patients. Within the mechanical capacity, I examine which structures such as joints, muscles, viscera, neurovasculature, etc., that could inhibit optimal functional performance. Specifically with a runner, I am interested in his or her alignment as well as range of motion through their rib cage, spine, pelvis, and lower extremities. Looking at a patient’s posture in both walking and running, allows me to determine the momentum driving the patient forward. This can be helpful in finding out what and where a dysfunction may be that could affect a runner’s performance. With a runner, I am interested in how he or she initiates his or her run. Are they able to drive force through their lower extremities into their trunk without spinal compensation. Does the runner have adequate strength and endurance to maintain appropriate form and movement strategy throughout their run? I also examine what happens to the patient’s form during walking when you slow him or her down. Breaking down the whole movement pattern and looking at individual parts helps to further expose any problem areas. I examine dynamic stability and controlled mobility to ensure my patients are moving efficiently. From there, I examine the basics, is there a lack of movement (is something stuck or tight) that can affect a runner’s ability to powerfully push off the ground when they run and absorb force when they land. Lastly, I am evaluating Motor Control. If the mechanical capacity and neuromuscular function is present, how does this individual choose to move, or what is his or her strategy to get from point A to point B. This is where a lot of the training comes into play.
Fiona: I told Jessica about my previous injuries, almost all have occurred secondary to decades of running (It truly is my favorite activity), currently I am feeling some left sciatic pain, which has become fairly bothersome.
Right hip labral tear
Right knee pain (patellofemoral pain syndrome), which comes and goes but is currently under control
Occasional left knee pain (patellofemoral pain syndrome), much less bothersome than the right side
Mild to moderate left calf pain, which also comes and goes
Right ankle sprain, from a failed handstand (don’t ask), no longer bothersome, but not properly rehabbed
Largely unremarkable, neural tension secondary to Arnold Chiari Type I malformation. Chiari occurs when part of the brain (the cerebellum) herniates through the skull opening into the spinal cord. It sounds pretty awful, but for me, it’s not too bad and I only experience occasional dizziness as a symptom.
Current Exercise Routine:
I’m pretty regimented and break most of my workouts into 2 daily sessions. I run in the morning, currently I am working on speed training and run something between 3 and 8 miles daily, 5-6 times weekly. I am following one of my favorite marathon gurus, Hal Higdon’s plan, which you can see for yourself here. I have used Hal’s plans for 2 of the 4 previous marathons I’ve run, and I really like how he organizes his plans. I would advise anyone thinking of trying a marathon, to use a training plan. It allows you to ease yourself gently into upping the mileage, rather than panicking at 5 weeks before the race that you haven’t taken your long runs over 20 miles. Following my run I do a mixture of stretches, use my stick ( it’s like a foam roller) and a trigger point ball to roll out my muscles. 4 nights a week I do PM weightlifting sessions, which last about 40 minutes. I split my lift into upper body and lower. I do a mixture of stabilizing and traditional exercise. When I’m done I’ll stretch again and this time roll out on a foam roller. In order to support all that exercise I drink a ton of water and try and fill my diet with lots of whole grain carbs, lean protein, and healthy fats (I’m looking at you avocados!)
Fiona has a posterior/posterior alignment. ( This terminology comes from the Institute of Physical Art (IPA), and is a wonderful training program for PTs) Meaning, her ribcage is set posterior in relationship to her pelvis and her ribcage is tipped posteriorly.
Range of Motion (ROM):
Poor lumbar spine ROM, with an inability to reverse the curve in my lumbar spine
Why this is important: my spine should have motion in order to absorb the shock from repeated foot falls, also an immobile spine may inhibit the core stabilizers from firing properly
HISL testing ( another IPA test): Positive at the right (hip) at 90 degrees, with poor glide of the femur down on the left side. Positive at left (hip) at 100 degrees.
How do we translate this into non-physical therapy speak? First of all the HISL stands for Hip, Innominate, Sacrum, and Lumbar. It measures the relationship between the bones of the upper thigh, pelvis, and low back. What my results tell us is that my hips are stuck and cause my innominate (bone in the pelvis) to move too early. This is not so great because it causes the bones further up to have to move extra to compensate. We have to clean this up.
Strength and Function :
Instead of testing muscles one-by- one, which is commonly done in traditional physical therapy practices, we decided to take a look at functional movements. Who gives a hoot if I have strong quadriceps while sitting on an exam table, if they can’t function properly during actual running, right?
LPM (Lumbar Protective Mechanism)( another IPA test) : absent in all quadrants
Dang! Lumbar protective mechanisms refers to the ability to stabilize your spine and protect your core in response to bumps and jostles. I didn’t stabilize at all. This is important because running is essentially a series of bumps and jostles, running on an unstable spine and core can increase your chances of injury as well as reduce your power during push-off in running leading to slower times (HORRENDOUS!).
Sagittal Plane Lunge: I have deficits with initiation and weight acceptance on both sides. I compress my arms in prayer position to create stability and when taken away I have a loss of trunk control. My right ankle more unstable than the left.
Runner’s Start Jump: difficulty coordinating movement on both sides, but significantly worse with initiation from right side at the ankle.
Remember my ankle sprain? Well, apparently that’s still holding me back and decreasing my ability to push off the ground. You could imagine how this could become a problem over the course of 26.2 miles. Moral of the story, see a PT after you hurt your ankle!
Also we see deficits in core control again. I think addressing this with Jessica will really improve my time.
Shoes and wear:
Apparently my shoes were good! Jessica told me that sometimes right and left sneakers can be made in different factories and have different densities, which can really mess you up while running. Also if the back part of you sneaker extends too far it can make your brain think your foot is larger than it is, leading to injury. The wear of the shoe is also important to see if one foot pronates or supinates more than the other. If this was the case, Jessica could work on the alignment of the bones in my feet, ankle and foot strength, as well as teaching me how to tie my shoes in a way that better support my feet.
Assessment and Take Away: Jessica’s Assessment: Fiona, like a majority of our athletes presents with deficits in the 3 major pillars leading to functional inefficiency. The goal of physical therapy, isn’t always to reduce pain, it is to get you to function better, which in turn will decrease wear and tear that contribute to common pain patterns.
Fiona: I can’t say I am surprised by much of what we found. I am slightly disappointed with my core activation finding, because I had been focusing on that particular issue for months and months in the gym. Jessica told me she thought part of my issue was that my lower (lumbar) spine was so rigid, it might be hard for me to get into a place where my deep core muscles can work to facilitate stability. It goes to show, even as a physical therapist, you need someone else to literally watch your back. As a physical therapist, my evaluation showed me that now is the time for help. Although I am strong and spend hours working out, my core stability is something I need more help with, and I simply cannot work my way out of my weakness alone in a gym. I’ve tried long enough. I need gentle manual therapy and proprioceptive neuromuscular feedback to wake my lazy deep stabilizers out of their hibernation and orthopedic work to allow the joints of my spine and pelvis to move more efficiently and effectively. Although this body has its deficits, I’m really proud of what it has done so far, and I’m really excited to see where Jessica will help me go!
Improve the movement of: right foot, trunk, and cervical spine
Improve core stability and strength to allow for more power and reduction of injury risk
We will achieve these goals through manual work, neuromuscular re-education in order to teach the muscles to activate better and a strong home program to maintain changes made in physical therapy.
Jessica: My goal is to treat the mechanical deficits inhibiting her neuromuscular system and then functionally reintegrate the parts into the whole system to enhance performance efficiency.
Long Term Goals:
1: (12 Weeks) | Patient to demonstrate core first strategy with transitional movements to improve stability, energy efficiency and decrease risk for injury
2: (12 Weeks) | Patient to demonstrate optimal ribcage over pelvic posturing for automatic core engagement and decrease mechanical load on system.
3: (12 Weeks) | Patient to improve R foot positioning for stability and push off in gait
Home Exercise Program:
So far I have one addition to my workout routine. It is a split stance at the wall designed to wake up my stabilizers before I go running. I stand at the wall with one leg fully extended on my toes and the other bent at the knee and the hip, with my toes pointed up. I hold for 30 seconds per side and then I get going. It has been a couple days since this exercise was assigned, and I’ve done it on about 50% of my runs. Remembering to do your home program is one of the biggest challenges of physical therapy. My strategy to combat this is to leave a sticky note on my door reminding me before I leave the house. I will report back on future blogs to let you know how my strategy worked out.
I just signed up for my 5th marathon, and second New York City Marathon, but this year it’s a little different. This year I am running on behalf of Beyond Basics Physical therapy to raise money for Team Tisch MS. Team Tisch MS is a charity team dedicated to raising money to support the Tisch Multiple Sclerosis Research Center of New York (Tisch MSRCNY). Team Tisch is dedicated to the goal of having “a future without MS”. Tisch MSRCNY has broken new ground in clinical research of multiple (MS) treatment and is now conducting a FDA- Approved Phase II Stem Cell Trial that has shown reversal of disability in MS patients. Now is the time to donate. It is so important to generate funding to keep momentum on this crucial work.
Over the course of training, I will be providing you with updates on my progress, tips and tricks for becoming and remaining your best runner, as well as discussions on how the work we do at Beyond Basics Physical Therapy can help patients with MS live more functional lives. You can check out my long form blogs here on wordpress to see updates and photos of my day to day running adventures.
My reason for wanting to be support Tisch MSRNY is personal. When I was in highschool, my mother died of a degenerative disease that stripped her of her independence and function in a way similar that MS affects people who suffer with it. Shortly after I graduated college, I got a job at a research lab in hopes to eventually become a research scientist to fight diseases that rob individuals of their ability to do the things they love. During that time I began running marathons, and shortly thereafter injured my knee, (I wasn’t a physical therapist yet, and was too silly to give a hoot about stretching) . The injury was severe enough that I had difficulty managing the short walk between the produce section and the dairy case. I went to physical therapy and as my abilities slowly began to return, I thought of my mother in her final months. The reason why those months remained sweet and rewarding for her was because she had had a physical therapist who taught her how to manage with a cane, how to efficiently get out of a chair, and how to conserve her energy so she could continue to treat her patients and support her kids in our numerous extracurricular activities. This marked the point in my life that I realized my passions and talents would be most useful in the pursuit of reducing morbidity ( negative impact on quality of life) in patients suffering from injury and disease. Although I have shifted to the clinical side of management for injury and disease, I remain keenly invested in the eradication of degenerative and disabling disease. I would love to see a day in my lifetime where my job is reduced to treating musculoskeletal injuries, because groups like Tisch MSRNY have done the research to get rid of degenerative and disabling disease conditions.
Now is the time to donate. We are so close to getting somewhere. I liken it to mile 20 of a marathon’s 26.2 miles. I have a request. My 30th birthday is in June. I would love to receive at least 30 donations of at least 30 dollars by the end of June. Please donate here today, not tomorrow, but today, right now. Amy Stein and Beyond Basics Physical Therapy said they would match my 30 for $30 donations on my birthday!!
Thanks and stay tuned for all sorts of fun running and fundraising stuff coming soon.
It’s that time of year again! It’s time to lace up our sneakers, hop on our bikes and start gearing up for Cycle for Survival. Cycle for Survival is a nationwide event that raises funds to support research for rare and often underfunded cancers. What is really special about Cycle, is that 100% of proceeds are contributed to the research. Last year Beyond Basics was lucky enough to be part of a team that raised $47,000. This year, we are offering incentives to help push us well beyond $50,000. Individuals who donate over $30 dollars will be able to receive a free 15 minute phone consultation with one of our excellent therapists.