Ph101 Why is Pooping so Difficult?



Fiona McMahon, PT, DPT

The number of Americans who deal with constipation issues is massive (4 million)! It seems like every time I mention that I’m a pelvic floor physical therapist, another friend of a friend pulls me aside with bowel movement concerns. Why is it that so many people have issues? And more importantly – what can we do about it? This is the topic of our next Pelvic Health 101 seminar  on March 14th at 7pm.

Not only will constipation be discussed but other bowel conditions, such as irritable bowel syndrome, fecal incontinence, bloating, and hemorrhoids will be addressed. The lecture will also go in depth on the role of fiber, water intake, toilet posture and pelvic floor muscles in having a successful bowel movement. You will even go home with easy techniques that you can implement immediately to help you get that smooth move! Don’t miss out on this FREE event – it’s a MUST for anyone who struggles on the porcelain throne. Seats are going fast!  Light snacks and refreshments will be served.

Check out Stephanie’s video on what next Wednesday has in store!


Register at today.


110 East 42nd Street, Suite 1504

New York, NY


Check out or upcoming courses!

Pelvic Health 101 Spring 2018 (2)

Take Charge of Your Health! How to Advocate for Yourself.

StethoscopeKaitlyn Parrotte, PT, DPT

Board-Certified Clinical Specialist in Orthopaedic Physical Therapy (OCS)

Certified Functional Manual Therapist (CFMT)

The new year is in full swing, and many of us have set goals to help start things off with renewed energy. One area in which, many people make goals in is health. While some folks vow to go to the gym regularly, or eat healthily, many other individuals commit to having medical check-ups, or taking care of a long-festering issue, such as a painful knee or abdominal pain. No matter what type of healthcare provider you are visiting, it is imperative that you come prepared to make sure you are getting all the facts, and are able to advocate for yourself to ensure you are receiving the best treatment for you.

Come with a Plan

One way you can advocate for yourself is to come prepared to a medical consultation by bringing a list of questions and subjective information with you. Be prepared to discuss what is bringing you to see that health care provider. What symptoms you might be experiencing? When these symptoms began? What makes you feel better and worse? How your symptoms make you feel limited in your daily life, and what you are hoping to get out of seeing that practitioner (i.e. a referral to a specialist, pain relief, etc.,.)? Many questions can arise during a medical examination, so don’t be afraid to ask for clarification, and make sure you understand the information you have been given. Research has shown, that individuals who ask specific questions about their health, may receive more comprehensive care. For example, in a 2015 article from the Journal of Family Medicine and Community Health, researchers found that when older patients were more proactive with communication to their doctors, primary care physicians were more likely to recommend both cancer screening and cancer prevention to their patients.1

On Second Opinions

When you receive a medical result, do not be afraid to get a second opinion. People seek out second opinions for various reasons: to get reassurance on a treatment protocol, to confirm the findings of a particular healthcare provider, to verify the reputation of a given institution, and even due to patient dissatisfaction in the communication or relationship with a practitioner.2-3 Whatever your reason, know that it is your right to have a second opinion to ensure you are getting the best possible care. Some research has found that second opinions have changed the diagnosis and/or course of treatment. In two studies that look at different patient populations with cancer, they found that in cases where a specialized practitioner was consulted, the accuracy of initial staging for a diagnosis increased, treatment and management of the condition was affected in about 20% of cases, and unnecessary surgeries were prevented in about 7% of cases.4-5 Thus, getting a second opinion can be very beneficial to you. Whether it changes the course of a treatment, or simply reinforces what you have already been told, seeking a second opinion can help you make educated decisions regarding your care.

Consider Both Risks and Benefits

If you are given a diagnosis and are informed of your treatment options, make sure to ask about, and consider, the risk-benefit analysis for each. The “risk-benefit analysis” is defined as “the consideration of whether a medical or surgical procedure, particularly a radical approach, is worth the risk to the patient as compared with possible benefits if the procedure is successful.”6 What this means is, it is important to weigh any treatment’s potential outcome on your quality of life, as well as your values and goals, when determining what route of care you’d like to embark on. If the risks outweigh the benefits for you personally, then it may not be a treatment worth trying. However, that is a very specific and personal decision, that must occur between you and those close to you, under the guidance of your health care provider.

Prevent Illness Before it Happens

While it is very important to be well-informed and prepared for a visit so you can better advocate for yourself, taking steps to prevent illness or injury in the first place, is crucial to promote overall well-being. Two major changes you can make in enhancing your health are diet and exercise. According to the Dietary Guidelines for Americans, 2015-2020, 117 million individuals, which is about half of all American adults, “have one or more preventable chronic diseases,”7 which include cardiovascular disease, high blood pressure, type 2 diabetes, some cancers (i.e. colorectal and postmenopausal breast cancer), and poor bone health. Theses chronic diseases are related to poor quality eating habits and physical inactivity. Furthermore, more than two-thirds of adults, and nearly one-third of children, are overweight or obese, which is associated with increased health risks and higher healthcare costs.7 Key recommendations for a “healthy eating pattern” include: eating a variety of vegetables, fruits, grains, proteins, and oils, as well as fat-free or low-fat dairy, while limiting saturated fats, trans fats, added sugars, and sodium.7 Research has found that most Americans do not eat enough fruits and vegetables. However, those that do tend to eat more fruit at breakfast and in snacks throughout the day, while more vegetables are consumed at lunch and dinner.8 This is something that can be added to your routine easily to ensure you are consuming a balanced diet.

As previously mentioned, physical inactivity can contribute to poor health; however, engaging in regular physical activity helps improve your overall health and fitness, and reduces your risk for many chronic diseases. According to the 2008 Physical Activity Guidelines for Americans, adults aged 18-64 need at least 2 hours and 30 minutes of moderate-intensity aerobic activity (i.e. brisk walking), and at least 2 days of muscle strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms). The same recommendations are given to older adults over the age the 65 years.9 That may sound like a lot of time that you don’t have; however, the CDC reports that engaging in aerobic exercise for even 10 minutes at a time can be beneficial.9 So get on your walking shoes and start power-walking to your appointments, or to the breakroom at work!

Ok. That was a lot of information, so here is a recap:

  1. Being well-informed and prepared with questions for medical consultations allows you to better advocate for yourself, and may help you to receive more comprehensive care.
  2. Seeking a second opinion, especially when considering a major medical procedure, is something that is your right as a consumer, and can impact your diagnosis and/or course of treatment.
  3. Considering the risk-benefit of any medical or surgical intervention is important to ensure that a given treatment is appropriate for your quality of life, values, and goals.
  4. While being educated and engaged when dealing with a medical concern is important, helping to prevent illness or injury through diet and exercise are critical for maintaining a healthy life.

If you are saying to yourself, “this is too overwhelming; there is no way I can do this!”, then I will leave you with a quote from Audrey Hepburn: “Nothing is impossible. The word itself says I’m possible!” You have the information; now it is time to get out there and start leading a healthy life, so the energy and inspiration of the new year keep ringing all year long!


  1. Kahana E, Lee JE, Kahana B, Langendoerfer KB, Marshall GL. 2015. Patient planning and initiative enhances physician recommendations for cancer screening and prevention. J Fam Med Community Health, 2(9), pii 1066.
  2. Mordechai O, Tamir S, Weyl-Ben-Arush M.2015. Seeking a second opinion in pediatric oncology. Pediatr Hematol Oncol; 32 (4): 284-9.
  3. van Dalen I, Groothoff J, Stewart R, Spreeuwenberg P, Groenewegen P, van Horn J. 2001. Motives for seeking a second opinion in orthopaedic surgery. J Health Serv Res Policy, 6 (4): 195-201.
  4. Sawan P, Rebeiz K, Schoder H, Battevi C, Moskowitz A, Ulaner GA, Dunphy GA, Mannelli L. 2017. Specialized second-opinion radiology review of PET/CT examinations for patients with diffuse large B-cell lymphoma impacts patient care and management. Medicine, 96 (51), doi: 10.1097/MD.0000000000009411.
  5. Lakhman Y, D’Anastasi M, Micco M, et al. 2016. Second-opinion interpretations of gynecologic oncologic MRI examinations by sub-specialized radiologists influence patient care. Eur Radiol;26:2089–98.
  6. “The Free Dictionary by Farlex – Medical Dictionary.” https://medical-dictionary.the
  7. U.S. Department of Agriculture & U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2015-2020. Washington, DC: U.S. Government Printing Office; 2015.
  8. Moore LV, Hammer HC, Kim SA, et al. 2016. Common ways Americans are incorporating fruits and vegetables into their diet: intake patterns by meal, source and form, National Health and Nutrition Examination Survey 2007-2010. Public Health Nutr; 19 (14): 2535-9.
  9. “Physical Activity Basics.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 4 June 2015, /index.htm.

PH101: Running to the Bathroom Again?!

Fiona McMahon PT, DPT

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

The bladder and the pelvic floor are intimately related and often times problems with the pelvic floor can cause real trouble with the bladder. Pelvic floor dysfunction can cause you to suffer from bladder frequency, urgency, incomplete emptying, slow stream, stream that stops and starts, bladder or urethral pain, or leaking. And by the way, it’s not just a female issue. Men and children can also have these symptoms. Learn from one of our experts, Stephanie Stamas, about how exactly the pelvic floor is related to bladder function and dysfunction, what you can do about it, and about common medical conditions affecting the bladder. Join us for this great seminar on March 14, at 7pm. Register here:

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


110 East 42nd Street, Suite 1504

New York, NY


Pelvic Health 101 Spring 2018 (2)

Pelvic Health 101 is back and with BRAND NEW COURSES

Fiona McMahon PT, DPT

Our Pelvic Health 101 courses are back! For those of you not in the know about our courses, they are informational sessions provided by top experts in the field of pelvic pain and pelvic function. These courses allow you to dive more deeply into topics such as bowel, bladder and sexual function and dysfunction, pelvic and genital pain, childbirth, diet, issues with kiddos, and much more.

This year we added a Gent’s Only Session to be a companion to our Ladies only session to help answer some of the specific questions you may have about pelvic floor function as it relates to sexual health, bladder and bowel health, as well as pain.

Our first class is “PH101: Something’s Wrong with my What?”, where our own Stephanie Stamas,will be going through the basics of anatomy of the pelvic floor, what can go wrong and how we can fix it. Our first class is on March 7th at 7pm. Register here:, to reserve your spot. Our classes are extremely popular so make sure you register well ahead of time.

Check out


110 East 42nd St, Suite 1504

New York, NY


Check out all the upcoming classes here:

Pelvic Health 101 Spring 2018 (2)

Why seek out a physical therapist with advanced orthopedic training? The case for CFMT and OCS

Pelvic 3By: Kaitlyn Parrotte, PT, DPT, OCS, CFMT

If you have perused our website, you might have noticed that here at Beyond Basics, we have many physical therapists who have a CFMT certification, or are in the process of completing one. Now the question lies, what is a CFMT? How is this approach unique? How can this approach be of benefit to me?

The acronym CFMT stands for Certified Functional Manual Therapist. This certification is through the Institute of Physical Art (IPA), which is an organization founded by two physical therapists, Gregg and Vicky Johnson.

With the CFMT approach, we evaluate and treat every individual’s mechanical capacity (how your tissues and joints move), neuromuscular function (how your system stabilizes itself, and the coordination of muscle activation), and motor control (how an individual moves and performs daily tasks). Furthermore, we assess and retrain how these three individual components interact to ensure each person can return to the tasks/activities they need and love to do.

What this means is, when a new patient walks through our door, we don’t just focus on one small area, such as only the knee in which you report pain. Instead, we will look at the big picture by assessing your strength, amount of limb and segmental motion available to you, posture and alignment, and movement, which can be as simple as getting out of a chair, or a higher level activity such as running, weight lifting or other sport-related activity. This will allow us to get a thorough impression of what impairments you might have, and will help us determine what the cause of your symptoms and functional limitations is (what is the driver?). From here we can figure out the most effective approach to your treatment, and will apply progressive interventions that help to ensure continued benefits from each session. We have found that this approach commonly gets you back to your activity or sport faster!

Now you may be asking yourself, “Well this sounds interesting, but why does it matter?” Looking at the whole person and treating your system overall, allows us to make lasting changes, not only to a specific body part that is causing problems for you, but also with your habits of how you hold yourself and move. By becoming more aware of your body and moving with more efficiency, you will find day-to-day activities, and even sporting activities, are easier for you to perform. Furthermore, and most importantly, if you are able to move and live in a more efficient way, you are decreasing the risk of future injury.

So whether you are experiencing incontinence, pelvic pain, low back pain, or a shoulder injury, having a knowledgeable therapist work with you, can make a significant impact on your function and quality of life. While many therapists have gone through the certification process, most of the therapists at Beyond Basics have had training in this approach, so we are all in a strong position to help address your needs. Feel free to contact our office at 212-354-2622 or at our website, or visit the IPA  for more information


Pediatric Bowel Part II: How to Make Pooping Easier for your Kiddo


Fiona L McMahon, PT, DPT

Hey everyone! We are resuming our conversation about potty issues with kiddos. In our last blog, we discussed how issues with pooping can occur with kiddos and how often times it is easy to overlook long standing constipation in kiddos with fecal and urinary accidents. We learned that although it can seem like someone is doing something wrong, potty issues are no one’s fault. Even though poo problems are no ones fault, they are problems that families can work on together to be solved.

In this blog, we are going to discuss right here and right now what you can do today to help your child poop easier. Some of the changes are astonishingly simple while some may require a bit more work and change from the whole family. Keep in mind in order for anyone’s bowel to change ( not just kids), you must be consistent, and these changes may take a very long time to occur. Be patient, you and your child will get there. Let’s go over ways to get back on the right track now.

STEPS to help with bowel issues:

Step 1: Allow your kiddo enough time to poop

Ever have to catch an early morning flight and noticed that you skip pooping that day, or even worse, you get a little bound up in the following week? Getting up early and rushing in the morning can constipate anyone and the thing is that’s what most kids are having to do. Many children have between half an hour to an hour to scarf down their food, dress, and brush their teeth before rolling out to school, leaving very little time to sit on the toilet and have an effective bowel movement. Kids then often find themselves at school with public bathrooms or single bathrooms within the classroom that don’t lock, making it hard to be comfortable enough to have a bowel movement. Then they usually must rush to extracurriculars and complete homework before bed. There simply is not enough time to poop.

Allowing your child 10-15 minutes to sit on the toilet 10-20 minutes after they eat can allow them to use what’s called the gastrocolic reflex. Basically what that means is when you eat, the body makes room for the new food by moving everything down further in the digestive canal. Therefore, after meals is the time when we are most likely to have a poop.

Allowing more time in the morning is the most easily modifiable part of your routine to start with when trying to improve your kiddos pooping habits. Get up about 30 minutes earlier to allow your child time to eat and to sit on the toilet. Follow with sitting on the toilet after lunch and after dinner.

Step 2: Fit the toilet to you child; don’t fit your child to the toilet

Studies show that toilet posture is imperative to good poops. My colleague, Sarah Paplanus, DPT, explains in detail the importance of having your knees above your hips while pooping in her blog on the squatty potty. Step stools will help your child get their knees above their hips, just remember to make sure that they keep their legs somewhat separated. Also, for the little littles, a child size toilet seat will help make sitting on the toilet more comfortable for kiddos with little tushes.

Also, check out this video on potty posture, with fellow peds therapist, Victoria LaManna PT, DPT, CLT

Step 3: Improve Diet

Most adults are aware that diet is important, but diet is equally as important with children. Making sure your child is getting enough fruits and veggies (approximately 5 servings daily), skipping sugary and refined foods like white bread, pastries, candy, and chips, and getting enough water (about half their weight in ounces) is so important to keep their stool soft and moving.

Step 3: Recognize Progress and Hard Work

Bowel issues are hard work for all involved. Make a sticker chart to track how often your child is compliant at sitting on the toilet, eating well, and having bowel movements. Make a goal for how many stickers your child will earn and celebrate when they achieve their goal. It is a long process so make sure to recognize even the smallest of victories.

Step 4: Get Help from Professionals

There is help out there. Make sure you go to a knowledgeable doctor and physical therapist to ensure your child gets the best chance at improving their bowel issues as quickly as possible. Do not accept any medical professional telling you it is normal for children to have accidents past potty training age, (age 5), or that it is your fault as a parent, or it is the child’s fault. It’s not. A knowledgeable doctor will run appropriate tests to rule out dietary allergies that could be contributing as well as starting your child on medicine or supplements to help improve bowel movements.

Pelvic floor physical therapy is a mainstay of care for kids with bowel issues, Skilled pediatric physical therapists will help your child re-learn how to use their pelvic muscles to better hold in waste as well as eliminate it when appropriate. We will teach you how to use techniques to help stool move more effectively, and we can perform hands on work to reduce pain and discomfort associated with bowel dysfunction. In addition to our clinical skills, we will help you to find doctors to help compliment the treatment your child is receiving in PT. If your child is suffering from bowel problems, don’t waste another day, call our front desk to make an appointment today!

Shoulder Pain – What Can Be Done?

Back and Shoulder Pain

Kaitlyn Parrotte, PT, DPT, OCS, CFMT

Shoulder pain is a fairly common issue amongst adults, with a reported lifetime incidence of up to 70% in various countries and estimates of cost burden up to $7 billion a year for treatments of it.

Subacromial shoulder pain is defined as pain that originates from the subacromial space, which is a very small area between part of the shoulder blade called the acromion (“roof of the shoulder”), and the shoulder joint (the glenohumeral joint). In this area lies the rotator cuff tendons and the subacromial bursa (a fluid filled sack that helps minimize friction on these tendons). Subacromial shoulder pain is commonly located on the top and outside of the shoulder, and is often aggravated by overhead activity. The pain from this area is typically caused by inflammation and/or tearing of the rotator cuff tendons, as they are pinched/rubbed against the underside of the acromion.

There have been multiple research studies that have looked into the benefit of surgery for the treatment of subacromial shoulder pain. Today, we will be focusing on one article that looks at the effect of arthroscopic subacromial decompression (a common surgery for pain by removing tissue), as compared to a placebo surgery (no tissue actually removed), and no treatment. Here is a quick summary of the study:

313 patients were randomly assigned to treatment groups: 106 to decompression surgery, 103 to arthroscopy only, and 104 to no treatment. For the decompression surgery, surgeons removed soft tissue and other structures within the subacromial space, a nearby ligament, and removal of any bone spurs. For the arthroscopy, structures were inspected and irrigated, but nothing was removed or repaired. Following surgery, both groups (decompression and arthroscopy) received appropriate post-operative care, including follow-ups with the surgeons, as well as physical therapy. Those participants assigned to the no-treatment group attended one reassessment appointment with a shoulder specialist, 3 months after entering the study, but with no planned intervention. The pre- and post-test findings were mainly based on a functional shoulder measure.

The findings in this study turned out to be very interesting, although perhaps not what the authors originally intended. Not because both surgical groups reported higher scores on the functional measure, as compared to the no-treatment group, which is something that one can expect when an intervention is appropriately applied. The main take home message from this study is not even that researchers reported participants in both surgical groups ended the study with similar outcomes. A major plot twist in this article is that both surgical groups were given physical therapy post-operatively. Remember, the group who received arthroscopy did not actually have any structures repaired or removed, yet this group made statistically significant gains after all intervention were completed, that matched, if not bested, the results of an actual surgical intervention. How could this occur? We must consider the common denominator – physical therapy! Physical therapy is the only thing that both groups had in common, so it is safe to assert that it likely played a significant role in the improvement of shoulder pain.

If that isn’t convincing enough, let’s now focus on a research article that takes a closer look at the impact of physical therapy for patients with subacromial impingement syndrome. This article published in 2012 looked at a specific exercise routine vs generalized exercise for 102 patients in Sweden, who had already failed conservative treatments for their shoulder pain, and would likely become candidates for surgery due to their continued pain. Participants in both groups received a subacromial injection of corticosteroids two weeks prior to the commencement of any exercise. The control group received general exercises that including shoulder and neck movements and stretches. The experimental group was given six exercises to perform, which included eccentric strengthening of the rotator cuff, meaning these muscles were actively controlling resistance while lengthening, stabilizing exercises of the shoulder blade, and stretching of the back of the shoulder. After performing these exercises two times per day for up to 12 weeks, and attending one physical therapy session per week, these patients reported significant improvements in functional measures for the shoulder, as compared to the control group. The authors also reported that significantly fewer participants from the specific exercise group opted for surgery after the trial was over (20%), as compared to 63% from the control group. This study not only shows that physical therapy is beneficial for decreasing subacromial shoulder pain, but it also proves that when it is tailored specifically toward the needs of an individual condition or presentation, it can still be effective even after a person has failed conservative treatment.

In summary, subacromial shoulder pain is a very common condition, that can successfully be treated with physical therapy, even if conservative treatments have previously failed to relieve symptoms. The emphasis must be on finding the correct intervention program that meets the needs of each individual patient. If you or someone you know is dealing with shoulder pain, whether it is new or old, you could benefit from a tailored physical therapy program. Here at Beyond Basics Physical Therapy, all of our therapists have extensive training and are experts in orthopedic and sports-related injuries, and will work one-on-one with you to develop a rehab program that helps you achieve your goals, so make and appointment today!




1. Cadogan A, Laslett M, Hing WA, McNair PJ, Coates MH. 2011. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskeltal Disorders, 12 (119).

2. Kulkarni R, Gibon J, Brownson P, et al. 2015. BESS/BOA Patient care pathways – subacromial shoulder pain. Shoulder & Elbow, 7 (2), 135-143.

3. Mesilin RJ, Sperling JW, Stitik TP. 2005. Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis. Am J Orthop, 34 (12 Suppl), 5-9.

4. Beard DJ, Rees JL, Cook JA, et al. 2017. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet, 17 (32457), doi: 10.1016/S0140-6736.

5. Holmgren T, Hallgren HB, Oberg B, et al. 2012. Effect of specific exercise on need for surgery in patients with subacromial impingement syndrome: a randomized controlled study. BMJ, 344 (787), doi: 10.1136//bmj.e787.