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.

 

 

PH101: I’m Pregnant – Help!

Having a baby is exciting, fascinating, and nerve wracking. If you have never been through the process before, chances are you have a lot of questions and concerns about what changes your body will go through during your pregnancy, what the birthing process entails, and how your recovery will go once you’ve had your baby.

Join us and childbirth specialist, Ashley Brichter, in our Pelvic Health class to discuss the ins and outs of having a child.

Register at pelvichealth101.eventbrite.com   today.

Location:

110 East 42nd Street, Suite 1504

New York, NY

10017

Time: 7pm on April 25, 2018

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!

Sources:

  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 freedictionary.com/risk-benefit+analysis.
  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, http://www.cdc.gov/physicalactivity/basics /index.htm.

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: pelvichealth101.eventbrite.com, to reserve your spot. Our classes are extremely popular so make sure you register well ahead of time.

Check out

Location:

110 East 42nd St, Suite 1504

New York, NY

10017

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.

 

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!

 

 

Sources:

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.

The Special Care Needs 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, GNRH 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