The Hard Truth on Erectile Dysfunction

By Fiona McMahon, DPT

 

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Photo by Pixabay on Pexels.com

The penis is kind of like a canary in a coal mine for the male body. A penis that isn’t quite working the way it used to is something that should not be ignored.  Erectile dysfunction (ED) can have devastating effects on the psyche of the person experiencing it. ED can be an important indicator that some other component of your health, whether it be your heart, your weight, your mental health, physical activity, or muscles may need a little extra attention.  In this blog we will discuss some of the common contributors to ED as well as steps you can take to prevent and or treat it.

What’s Normal?

Erectile dysfunction is the term given to a condition in which a person is unable to maintain an erection to complete sexual intercourse. Erectile dysfunction affects many people.  It is considered the most common chronic condition affecting person. The lifetime prevalence (your chance of experiencing ED at least once in your life) is about 50% (Kaya 2015).

It is a sad but true fact that as you age, your risk for ED increases. This is because the penis relies on a mixture or hormonal, musculature, vasculature, and neural inputs for full function. As we age these systems can be impacted by diseases of old-age, medications used to manage these diseases, as well as general inactivity.

Men who are under 40 also may experience erectile dysfunction. The old dogma was that men who were experiencing erectile dysfunction under the age of 40 did so entirely because of mental health conditions like anxiety. This is no longer the belief. We know that certain other health conditions like  pelvic floor dysfunction, diabetes, high blood pressure, and obesity can wreak havoc on a man’s sexual function

Although your chances of experiencing ED increase with age, it is certainly not inevitable and we are fortunate to live in an era of effective diagnostics as to the cause of your ED as well as treatment and prevention.


How is a Normal Erection Achieved?

The physiology of the penis is fascinating. It’s like a symphony of different systems that come together to produce one result. In order to achieve an erection your muscular, vascular, neurological, and hormonal systems must all be functioning properly. We can divide erection into two phases; a vascular phase and a muscular phase. The vascular phase relies on the heart and blood vessels to bring blood to the penis and allow it to become stiff. The muscular phase relies on the muscles of the pelvic floor (the bicycle seat area of your body). These muscles work by contracting to increase the pressure of the blood within the penis. Hormones and the nervous system also help to regulate drive, sensation, and the response of your muscles and arteries to sexual stimulation. As we will see, there are many different things that can disrupt these processes and cause difficulty with erection.

Causes of Erectile Dysfunction:

Metabolic Syndrome:

Metabolic syndrome is an increasingly common syndrome in the United States that is currently affecting 35% percent of all adults and is hitting our elders particularly hard, with an estimated 50% of all adults over age 60 meeting the clinical definitions of metabolic syndrome.

Metabolic syndrome is defined as having 3 or more of the following conditions: waist circumference of 102 centimeters or more ( about 47 inches) for men, and 88 cm ( about 35.5 inches) for women, serum triglycerides of 150 mg/dl or greater, high density lipoprotein (HDL, the good cholesterol) of less than 40 mg/dl in men and 50 mg/dl in women, blood pressure of over 130/85 mm/hg or needing to take blood pressure medications, fasting blood glucose of 100mg/dl or greater, or if you are currently taking diabetes medications.

The link to ED and metabolic syndrome and other disorders associated with it (diabetes, obesity, and heart disease) is well established. In a 2015 article, Kaya and colleagues found that men with erectile dysfunction are 3 times more likely to also have metabolic syndrome. The group also found that 79% of men with ED have a BMI of over 25 (overweight) and that men with a BMI of 30 (obese) have a 3 times increased incidence of ED.

You are probably well aware that the above conditions are definitely not good for your health and can put you at risk for heart attack, stroke, and diabetes, but how does metabolic syndrome affect your penis? Metabolic syndrome can have a profound effect on your hormones, sex drive and blood flow, which are important components of maintaining a healthy erection.

Metabolic syndrome is associated with an increase in adipose (fatty tissue) around the waist.  Fatty tissue has a strong interaction with the hormones estrogen and testosterone. Testosterone is the hormone of desire and is needed for proper sexual function in both males and females. Obesity can lower the amount of serum testosterone someone has, which can actually increase the amount of fat you store. As the balance between estrogen and testosterone shifts within your body, it becomes harder to lose weight and with increasing fatty tissue your testosterone continues to lower over time making the situation worse.

Metabolic syndrome also affects the delicate and complex arterial system that goes to the penis. Just like plaque in your arteries can cause heart disease and heart attacks, it can also clog up the vasculature in your penis making it difficult or impossible to achieve an erection.  This makes the loss of erectile function a serious issue, besides the obvious effect on your sex life, because it is an important indicator of how well your cardiovascular system is working and may indicate a potentially serious buildup of plaque in other vital arteries. The loss of potency certainly warrants further investigation by your primary care provider.

Drug and Alcohol Use

Sometimes drugs and alcohol are used as an aphrodisiac to help dampen inhibitions and fuel the passion between a couple. However, there have been many studies that show that long-term and sometimes short-term use of drugs and alcohol can have a negative effect on a man’s ability to achieve and erection.

Alcohol has long been considered a social lubricant. It factors into our sexual imagery with images of couples sipping a sexy glass of champagne before getting down to business on TV and in movies. But too much alcohol can easily ruin your ability to enjoy an intimate night with your partner.

There are many different ways alcohol can affect erection and sexual potency. In the short term, alcohol is a central nervous system depressant. What that means is that it can slow down the systems that are vital to your erection like respiration, circulation, and nerve sensitivity.

As anyone who has woken up from a night of heavy drinking can tell you, alcohol can be very dehydrating. Dehydration affects your ability to achieve an erection by lowering your blood volume, therefore allowing less blood to get to the penis (a requirement for a rigid erection). Dehydration also increases the amount of angiotensin circulating in the blood. Increased angiotensin is associated with erectile dysfunction.

Long term alcohol use can also wreak havoc on your erectile and sexual function. In a 2007 study by Arackal and Benegal, 100 subjects between 20-50 who had been to a rehabilitation facility for alcohol withdrawal were surveyed for their level of sexual function. The average length of alcohol use for the patient’s surveyed was about 8.59 years. Out of the 100 men surveyed 72% reported sexual dysfunction including low desire, premature ejaculation, and erectile dysfunction. Chronic and heavy alcohol consumption can damage the cardiovascular system, limiting the blood flow available to the penis. Other drugs like opiates, amphetamines, and designer drugs have been found to negatively affect the quality of erections in long term users versus their age matched counterparts who are not using drugs. It is advisable to abstain from drug and excessive alcohol use for many reasons but also for health of your sexual systems.

Emotional

It has long been the dogma in male sexual health that difficulty in erection in young men is solely attributable to psychogenic or emotional causes. As you have seen in the previous sections there are many different factors that can impair your sexual functioning.

Erections can occur in response to touch, but they can also occur in response to visual stimulus or fantasy. The mind is a powerful sexual organ and disorders that disrupt its function can also disrupt your ability to achieve an erection.

During erection, your brain sends signals to the penis via neurotransmitters (chemical messengers). These messengers cause the release of cyclic guanosine phosphate (cGMP) at the penis to allow the capillaries in the penis to dilate and the penis to engorge. The brain must send continuous messages via these neurotransmitters to keep the supply of cGMP steady throughout intercourse or during sexual play to ensure that your erection is maintained throughout.

Emotional issues affecting erection can range from guilt, anxiety, grief and stress. Anxiety about achieving an erection can make impotence worse, thus creating a vicious cycle. Being able to achieve an erection with masturbation or in the morning (“morning wood”) but not during intercourse, is an important clue that there may be an emotional component to your erectile dysfunction.

Musculature

What do muscles have to do with my penis? A lot. The muscles of the pelvic floor play a vital role in the sexual function of both genders, and as we will explore, there is a considerable amount of muscular coordination required for erection and orgasm.

The pelvic floor is the region of muscles that reside in the bicycle seat or crotch area. The muscles of the pelvic floor have a lot of work to do for your body. The pelvic floor is divided into 3 layers. The deepest layer provides the supportive function of the pelvis. It supports your pelvic organs like the bladder, rectum, and prostate. It also provides support to the bones of the pelvis. The middle layer provides the sphincteric function of the bladder and is responsible for closing down the openings that allow urine and feces to leave the body and provides us with continence. The last layer is responsible for the sexual functioning of the body. These muscles are amazing. They have to relax enough to let blood into the penis to allow for erection, but then contract to allow the blood pressure in the penis to remain high enough for penetration.

Just like any other muscles in the body the muscles of the pelvic floor can be subject to dysfunction. Injury can occur suddenly from the result of a hard fall on the bottom, sports injury, or operation and it can also occur gradually over a long period of time from chronic stress and muscle holding, poor sitting posture, repetitive stress, or infectious process.

When something goes wrong with the pelvic floor we call it pelvic floor dysfunction. Other symptoms of pelvic floor dysfunction can include pain, urinary issues, and defecation (pooping) issues. Luckily, like other muscles of the body, the pelvic floor can be rehabbed and made to function properly with the help of physical therapy.
Treatment:

Society places a lot of weight on a male’s ability to perform sexually and it can be easy to feel a lot of shame and distress when that ability is compromised. As we have explored there are a multitude of physiological and psychological reasons that can affect your penis that have nothing to do with your manhood, your love of your partner, or your sexual skill.

Changes in your erection are potentially serious and may indicate a larger disease process at work. If you find you are unable to maintain an erection, you should make an appointment with your doctor to determine the appropriate treatment.

Once you are cleared by your doctor, physical therapy can help to ensure your muscles are in working order to achieve an erection. Physical therapy can also address other aches and pains that may be preventing you from being active enough to maintain a healthy body.

Prevention:

Now is the time to make healthy lifestyle changes, regardless of whether you are currently experiencing erectile dysfunction or not.  Studies looking at the effects of lifestyle changes and the benefit of erectile function find that the earlier in life one makes healthy changes the more effective those changes are at warding off erectile dysfunction.

If you smoke, stop. It is common knowledge that smoking pushes you closer to the grave, but it also affects the blood flow to your penis. It’s no small task to quit smoking. At the bottom of this page you will find links to resources to help you quit smoking. Some of the long-term  benefits of quitting include: reduced lung cancer risk, reduced risk of heart disease and stroke. You can even see results right away. Within 20 minutes of quitting, your heart rate and blood pressure drops, and as early as 2 weeks circulation improves helping to restore proper blood flow to your penis.

Aside from smoking, adopting healthier habits overall, can improve your sexual as well as overall function. Getting regular exercise helps to improve many of the conditions associated with metabolic syndrome. Exercise also gets the heart pumping ensuring adequate blood flow to the penis. The CDC suggest that people aged 18 and over get at least 2 hours and 30 minutes of moderate-intensity aerobic activity (brisk walking) and muscle strengthening of all major muscle groups during the week.

Diet is another important component of proper erectile function. A general rule of thumb is to eat a diet that would generally be considered good for your heart.  Reducing your alcohol, fat, sugar, and salt intake while increasing your intake of whole grains, vegetables and lean meat is a good place to start. Consulting with a registered dietitian can help to give you more specific advice for your personal goals.

Physical Therapy

Physical therapy can help to improve the function of the muscles that are responsible for erection, ejaculation and orgasm. As we described earlier, the pelvic floor muscles play in integral role in male sexual function, from erection to ejaculation. When men come into physical therapy after complaining of erectile dysfunction, a pelvic floor physical therapist will examine the muscles of and surrounding the pelvic floor to see if they are too tight or weak to generate enough force to maintain adequate blood pressure in the penis, examine bony malalignments which may be impairing the full function of the muscles and nerves of the pelvic floor, as well as many other things that may be impacting the full function of the pelvic floor.

Pelvic floor physical therapists treat their patients, employing a multitude of techniques individually selected for each patient. Treatments may utilize soft tissue techniques to reduce tightness of the pelvic floor and surrounding fascia to improve muscle function and blood flow. A therapist may guide his or her patient through a series of exercises to strengthen weak muscles. Other techniques include postural correction, biofeedback and much more.

The effects of physical therapy on erectile dysfunction have been illustrated in many studies. In a 2014 study, Lavoisier and colleagues examined the effects of a program of pelvic floor physical therapy on erectile function of 108 men suffering from erectile dysfunction. The men in this study had no neurological conditions that could affect their erectile function. In this study, the participants were given 20 sessions of physical therapy which included muscle strengthening and electrical stimulation of the muscles of the pelvic floor. At the end of the study, Lavoisier and colleagues found that that physical therapy was effective in strengthening the muscles of the pelvic floor, specifically the ischiocavernosus, which is a major component of being able to achieve erections.

In another study by Dorey and colleagues in 2005, men were given either pelvic floor physical therapy exercises or lifestyle changes to treat their erectile dysfunction. The men in the study who were given pelvic floor physical therapy did significantly better than men who performed lifestyle changes alone.

Medicine

Most of us are aware of Viagra and Cialis; Viagra, most memorably being brought to our collective cultural awareness by former presidential candidate, Bob Dole. These drugs have quite the interesting history. Viagra as an erectile dysfunction drug was actually discovered by accident. Viagra (sildenafil) was originally designed for treatment of heart conditions. It was found that treatment with Viagra improved the erection of those taking it. Conversely it was not effective for its original purpose, the relief of angina (chest pain). It works by relaxing the blood vessels of the penis to allow for blood flow and erection. Viagra does not cause people to have erections, it allows people to respond to sexual stimulation with an erection. It is not an aphrodisiac and taking it recreationally does not change sexual performance of people without erectile dysfunction. Cialis (tadalafil) works in much the same way as Viagra by increasing the blood flow to the penis via dilation of the penile blood supply. Even with the use of Viagra or Cialis, it is important to discuss with your doctor, what the underlying cause of your erectile dysfunction is, and what other steps you can take to improve your overall health and prevent further impacts on your quality of life.

Other Options:

There are other options to treat ED in more advanced cases. There are pumps that can be used to allow blood to be drawn into the penis to maintain erection. Pumps should be prescribed by your doctor to ensure effectiveness and safety.

Implants are another available option, but require surgery. There are two main types: rigid and inflatable. Inflatable implants allow for erection by transferring saline into two semi rigid rods on either side of the penis. This allows for the ability to have a flaccid penis when desired. Rigid implants consist of rods that you adjust to have an erection. The penis will remain firm but you can bend it to conceal it as desired.

Conclusion:

Erectile dysfunction is a devastating condition that can have a profound effect on your quality of life. The health of your erection is an important indicator of your overall health. Maintaining an active and healthy lifestyle goes a long way towards staving off erectile problems in the future. If you find yourself troubled by erectile dysfunction, see your doctor. There are many treatments options, including physical therapy that can help you return to living your life fully.

 

Resources:

Smoking Cessation:

American Cancer Society’s Guide to quitting smoking:

http://www.cancer.org/healthy/stayawayfromtobacco/guidetoquittingsmoking/index

 

NYC Quits:

NYC Quits provides free coaching and a starter pack of quit-smoking medications

http://www.nyc.gov/html/doh/html/living/nycquits.shtml

Call 311 or 1-866-NY-Quits

 

 

Sources:

 

American Cancer Society. Guide to Quitting Smoking. Accessed December 31, 2015

Arackal B, Benegal A. Prevalence of sexual dysfunction in male subjects with alcohol dependence. Indian J Psychiatry. 2007; 49(2):109-112

Aguilar M, Bhuket T, Torres S. Prevalence of metabolic syndrome in the United States 2003-2012. 2015;13(9)

Bang-Ping, Jiann. Sexual Dysfunction in Men Who Abuse Illicit drugs: A preliminary report. J. Sex. Med. 2009. Apr; 6(4):1070-80. Epub 2007 Dec 18

Brown University Health Promotion. Alcohol and Sex. http://brown.edu/Student_Services/Health_Services/Health_Education/alcohol,_tobacco,_&_other_drugs/alcohol/alcohol_&_sex.php.  Accessed December 23 2015

Centers for Disease Control and Prevention. Quitting smoking. http://www.cdc.gov/tobacco/data_statistics/fact_sheets/cessation/quitting/index.htm#benefits. Accessed December 31 2015

Derby C, Mohr B, Goldstein I, et al. Modifiable risk factors and erectile dysfunction: can lifestyle modify risk. Urology. 2000; 56(2): 302-06

Dorey G, Speakman MJ, Feneley RC, et al. Pelvic floor exercises for erectile dysfunction. BIJU Int. 2005 Sep;96(4):595-7

Gareri P, Castagna A, Francomano D. Erectile dysfunction in the elderly: an old widespread issue with novel treatment perspectives. Int J Endcorinol. 2014 (2014)

Grover S, Mattoo S, Pendharkar S, et al. Sexual dysfunction in patients with alcohol and opiod dependence. Indian J Psycho Med. 2014; 36(4): 355-365

Kaya E, Sikka S, and Gur S. A comprehensive review of metabolic syndrome affecting erectile dysfunction. J Sex Med. 2015;12:856-875

Lavoisier P, Roy P, Dantony E, et al. Pelvic-floor muscle rehabilitation in erectile dysfunction and premature ejaculation. Phys Ther. 2014;94:12: 1731-43

Mayo Clinic: Diseases and Conditions: Erectile Dysfunction. Mayo Clinic Staff. http://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/basics/causes/con-20034244. Accessed December 5,2015

Rajiah K, Veettil S, Kumar S et al. Psychological impotence:psychological erectile dysfunction and erectile dysfunction causes, diagnostic methods and management options. Scientific Research and Essays Vol. 2012; 7(4): 446-52

Photo source: http://globalcomment.com/wp-content/uploads/2008/09/istock_000005072697xsmall.jpg

 

Do You Speak Pelvic Floor? Guide to Antatomy Part 2: Male Genital Anatomy

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Photo by Du01b0u01a1ng Nhu00e2n on Pexels.com

Fiona McMahon PT, DPT (Pronouns: She, Her, Hers)

Hello again and welcome to part two of the “Do you Speak Pelvic Floor Series”. In the first part, we described the most common clinical language we use to describe the genitalia of those with female anatomy. In part two we will look a little more closely at the male anatomy. The male anatomy goes beyond the ‘ol twig and berries and there are specific names for the specific parts. Many folks, when they think of about pelvic floor physical therapy, think of it only as a women’s specialty. Beyond Basics Physical Therapy has been treating male pelvic disorders since 2003! In this blog, we will discuss the structures of the male external genitalia as well as some of the conditions that can affect this anatomy. Let’s read on!

Penis– The penis is one of the male sex organs and it has some pretty cool capabilities. The penis has individual compartments in it called the corpus cavernosus which fills with blood to keep the penis hard during erection. The corpus spongiousus helps to keep the urethra from collapsing upon itself during erection. We can see many issues concerning the pelvic floor muscles, surrounding tissues, and nerves that can affect the penis. Peyronies disease occurs when the penis bends, which can be uncomfortable and painful. We have a whole blog which takes a deep dive into the causes of Peyronie’s as well as treatments. You can read more about it here.

Glans- The glans is also known as the head of the penis. The glans is highly sensitive and provides a good deal of sexual sensation during sexual activities. The glans resembles an acorn. The word glans actually means acorn in Latin. The glans is often a place that will be painful with pelvic floor dysfunction. Tight and restricted muscles of the pelvic floor often refer to this area.

Foreskin- Foreskin is a really interesting structure, (stay with me, folks). Foreskin has cultural and religious importance. Many Abrahamic religions, (Jews, Muslims, and some but not all Christians) may practice circumcision as part of their faith tradition. Whether or not someone has had a circumcision is also linked to where someone lives. In the USA circumcision is extremely common, however in many countries across the pond in Europe, circumcision is much less commonly practiced. Whether or not to circumcise is a deeply personal choice that can be affected by your religion and your nationality. There are trade-offs to being circumcised and being uncircumcised and many doctors recommend that the decision is made by the family of the child.

Urethra- The urethra transports semen and urine to the outside world. Did you know that when the penis is fully erect, only semen can travel through the urethra? This prevents urination during intercourse. Men with poor pelvic floor function may experience leakage secondary to poor closure of the urinary tract into the urethra.

Testes- I have a blog all about testicles. In fact, that’s what it is called, All About Testicles. You can read about it here. Testicles create sperm. Did you know problems with muscles and nerve irritation can cause pain in the testicles, as well other serious and non-serious conditions? Read more about testicular conditions in the blog I linked above..

Scrotum- The scrotum is the sack that contains the testicles. The skin on the scrotum can get tight and restricted and sometimes cause pain in the scrotum and penis. Skilled physical therapists can teach you how to gently mobilize this tissue to treat your pain.

 

If you are having pain in any one of these areas, physical therapy may help.

Give us a call at 212-354-2622 to schedule a free consult for those living in the Tri-State Area to find out if PT is right for you.

Fiona McMahon PT, DPT practices at our Midtown Location

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Yeast the Inflammation Beast

 

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Fiona McMahon DPT, PT

You are what you eat. Trash in equals trash out. You can’t exercise yourself away from an unhealthy diet. These adages are often on my mind as I make my food choices because of the myriad health professionals who have taken time to come to our practice to tell us how we can improve our own and our patients’ health by taking more time to look at what we are consuming in our diet. Lately, many of these clinicians have been focusing on candida overgrowth and diet, which can contribute to pain and inflammation conditions.

What we eat can directly affect the bacterial and fungal makeup of the gut, AKA the gut microbiome. The gut requires a certain level of good bacteria to help us digest what we eat. Over time a poor gut microbiome can affect how efficiently the gut works. The function of the gut goes beyond just digesting food but also is vitally important for the production of neurotransmitters, which help to spread messages within the brain and throughout the whole body.  The microbiome also plays an important role in our hormones and immune system. When the microbiome of the gut is not balanced, it is called dysbiosis.

One of the most common culprits in gut microbiota dysbiosis is candida, (Yeast!). Candida is a naturally occurring inhabitant of the body and when it’s at appropriate levels, it doesn’t tend to be noticed, but anyone who has experienced a yeast infection knows that if this little guy is allowed to go unchecked, it can do a lot to make you miserable. Besides plaguing women with itching, burning vulvas, a yeast overgrowth may cause many other ailments.

Science has pointed to the role candida can play in contributing to chronic and inflammatory conditions. In one study by Kumamoto in 2011, candida overgrowth was associated with delayed healing of inflammatory lesions and was associated with pro-inflammatory cytokines (chemicals) and increased incidence of inflammatory bowel disease like ulcerative colitis and Crohn’s disease.

Yeast overgrowth can also affect the bladder along with over colonization of Saccharomyces (another form of fungus). In fact, yeast and Saccharomyces were found to be higher in women during a flare of interstitial cystitis than when their symptoms were low.

Yeast is not the only organism that can get out of balance and affect our bodies in harmful ways. There are many other players that can get out of balance. Some signs of an altered gut microbiome is a history of allergies, eczema, or repeated fungal infection.

 

What to do?

It all seems pretty dire, right. How do you control who is colonizing your gut, when you barely have enough time to make it to the gym after work? There are a few simple steps you can start with.

Avoid antibiotics, unless your doctor thinks you need them.

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The medical community has become a lot more aware of the dangers of over-prescribing antibiotics from their perspective, but it is important to keep in mind that a powerful antibiotic can wipe out good bacteria and bad bacteria in one fell swoop. If the good guys in your gut are reduced, the bad bacteria have a better chance of taking over. Take antibiotics only when recommended. Keep in mind antibiotics will not help treat viruses like the flu, they can only treat bacterial infections.

Modify your diet

close-up-cooking-cuisine-629093.jpgIncrease your consumption of good fats (omega 3’s) to help reduce inflammation.

Food high in omega 3’s includes flax and hemp seed/oils, fish (the fishier the fish, usually means more omega 3’s, for example, herring is higher in omega 3 than a milder fish like snapper). Also, reduce your consumption of processed foods which can increase inflammation levels and eliminate simple sugars and fried foods. If this is only minimally successful, try a gluten and dairy free diet.  

If simple changes are not helping consider seeing a professional

Find a naturopath, functional or integrated MD, or nutritionist who can investigate more fully whether or not you have SIBO (Small intestinal bacterial overgrowth), candida overgrowth, or other gut microbiome disorder. Or perhaps you are lacking certain ingredients, vitamins or mineral.  These professionals can tailor a diet and medication regimen to help return your gut microbiome to tip-top shape.

fiona2018

Fiona McMahon is currently seeing patients at our Midtown Location

 

If you have questions about orthopedic, pelvic, or sports physical therapy, BBPT is offering free phone consults to those living in the greater NYC area for a limited amount of time!

Beyond Basics Physical Therapy

212-354-2622 (42nd Street Location)

212-267-0240 (William Street Location)

 

 

Sources:

Kamamoto C. Inflammation and gastrointestinal candida colonization. Cur Opin Microbiol. 2011;14(40): 386-391

World AIDS Day

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Today, December 1st, 2018, is World AIDS Day. World Aids Day has been held on the first of every December since 1988. World AIDS Day works to spread awareness of the disease and to remind the general public that AIDS and HIV still must be taken seriously and that there is still a lot of work to do in order to prevent the transmission of new cases, as well as to better care for those who are infected with the disease.

What is AIDS/HIV?

AIDS (acquired immunodeficiency syndrome), is caused by a virus called human immunodeficiency virus (HIV). HIV can be treated in order to prevent AIDS, however, there is currently no cure for HIV.

HIV causes AIDS by attacking the immune cells of a person’s body, which can leave a person vulnerable to infections that otherwise would not have made them sick. These infections are referred to as opportunistic infections, an opportunistic infection is a signal that someone’s HIV may have progressed into AIDS.

As we said earlier, HIV doesn’t always have to progress to AIDS. Antiretroviral therapy (ART)  can work to help keep the immune system healthy, as well as lower the risk of transmitting the virus to others. People on ART have dramatically improved lifespans. It is imperative to get on ART as soon as possible to lessen the effects the HIV virus has on your immune system.

HIV Testing

1 in 7 people infected with HIV does not know they have the virus. Testing is necessary to start treatment and reduce the harm done to your immune system as well as the risk of transmission to others.

According to HIV.gov, you should be tested if:

  • “you a man who has had sex with another man
  •  you had sex—anal or vaginal—with an HIV-positive partner
  •  you had more than one sex partner
  • you injected drugs and shared needles or works (for example, water or cotton) with others
  •  you exchanged sex for drugs or money
  •  you been diagnosed with, or sought treatment for, another sexually transmitted disease
  •  you been diagnosed with or treated for hepatitis or tuberculosis (TB)
  • you had sex with someone who could answer “yes” to any of the above questions or someone whose sexual history you don’t know?

Taken directly from HIV.gov, click here to learn more

 

HIV/ AIDS and Physical Therapy

Physical Therapists do not treat AIDS or HIV, rather, they can treat some the symptoms of AIDS/HIV and HIV/AIDS treatment, to allow patients to live as fully and independently as possible. Both the disease itself and the treatment for it have effects like increasing fatigue, decreasing strength and endurance, and increased pain. Physical therapy can help by tailoring programs to help with pain, ability to perform everyday tasks, improve heart health, balance, endurance, strength, and flexibility.

You can mark today by doing a number of things:

Wear a red ribbon to spread awareness

Donate to groups that work to help people living with AIDS and help to prevent its transmission:

United Nations (UN AIDS)

https://donations.unaids.org/

UNICEF

https://www.unicefusa.org/donate/support-unicefs-hivaids-programs

 

Resources:

HIV/Screening:

National HIV Testing database: https://gettested.cdc.gov/

A Holiday Gift for You! BBPT is Offering Free Consults for People Living in the Greater NYC Area!

Group Serious 2

Any persistent pain or chronic back or pelvic pain can be tough. It is tough to have and often times it can be extremely isolating. Many of our patients have to go through a number of clinicians before they even get a diagnosis of pelvic floor dysfunction. If you are reading this blog, you probably have some questions about pelvic floor dysfunction and if physical therapy is right for you.

We are here to help. If you are living in the Greater New York Area and have some questions about orthopedic, sports or pelvic floor dysfunction and if physical therapy is right for you, I encourage you to call our office. For a limited period of time, we are offering free 15-minute phone consults with our licensed physical therapists to patients in the greater New York Area. For those of you living outside this area, a fee may apply to the consult but can be applied towards payment for a PT visit if you chose to visit us. Don’t miss this opportunity to learn more about your pelvic floor and what PT can do for you.

The Physical Therapists at Beyond Basics also treat orthopedic (sport and joint injuries), pediatric pelvic floor dysfunction and orthopedic injury, and much more. Give us a call to discuss how PT can help with any one of these issues!

All the best,

Beyond Basics Physical Therapy

212-354-2622 (42nd Street Location)

212-267-0240 (William Street Location)

Marathon Training: Two Perspectives

sneaker.pngAs we creep closer and closer towards marathon weekend, our very own Tina Cardenia PT, DPT, CFMT and Victoria LaManna (Vicky) PT, DPT, CLT, PRPC were kind enough to share their stories about preparing for the 2018 New York City Marathon. Vicky will be running her first marathon on November 4th, 2018 in order to raise money for Multiple Sclerosis Research. Tina was gracious enough to volunteer her expertise in orthopedic physical therapy to help Vicky have the best run possible for a great cause. If you are interested in donating to support MS research, please donate here and read more about their stories below. If you are interested in hearing more about our orthopedic and sports program here at Beyond Basics Physical Therapy, give us a call at 212-354-2622.

From the Runner’s Perspective

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Victoria LaManna (Vicky) PT, DPT, CLT, PRPC

This year I am participating in my first ever marathon in the NYC Marathon for Team TischMS. Truly, this is my first ever 5k, Half Marathon, or Full Marathon. I am traditionally an anaerobic, (short bursts energy) exerciser. I have played soccer, dabbled in Muay Thai kickboxing, yoga, and weight lifting for exercise. The mind-body challenge of running a marathon (and doing it all for a great cause!) appealed to me. But where to start?

Luckily, I am in a profession that specializes in exercise, injury screening, and prevention, as well as injury rehabilitation. One of my co-workers has also run a few marathons and pointed me in the right direction for a training schedule. To further help ensure success in my training process, I also started physical therapy and made sure I got on my co-worker Tina’s super busy schedule.

vicky.pngShe first tested my core strength, checked hip mobility and strength, as well as spine and rib cage mobility. All areas that are important for efficient running. Tina found that I had poor core-first responses to outside forces, meaning that every time my foot hit the ground while running, my core was not firing to connect my lower extremities to my trunk. This could definitely be why I was experiencing right low back pain with running, and it could actually lead to further injury and result in not being able to RUN at all! Tina also found limitations in my breathing, rib cage, and thoracic mobility. Other than back pain, my first main complaint a few weeks into training was that I could not breathe. While you could chalk that up to poor conditioning, it was something that was felt immediately in runs – as if I just did not have the capacity to take a breath in. This is where we started our treatment – rib cage and thoracic spine mobility.

From there, Tina continued treating based on observation of my running pattern. She continued to work on hip, spine mobility and core control based on what she saw was insufficient in my running. My breathing improved greatly, as well as my mobility. I began to run completely pain-free with ease.

About 2 months away from Marathon Day, I injured my right foot trying to complete a 16-mile training run. I was unable to walk without pain and was limping around the office. Tina quickly observed that I had a bone in my foot and ankle that were compressed and out of alignment. Her work to align my foot and ankle, working all the way up again through my hip and trunk helped me to get back to pain-free running.

I am all set to run the NYC Marathon Sunday, November 4th! I am incredibly thankful to Tina for helping me to get through my training pain-free, manage an injury along the way, and quickly get me back on track for race day. And I am thankful for Team TISCH for allowing me the opportunity to join their team and support a great cause that affects many men and women.

Are you training for a marathon? Looking to improve your running form? OR even improve your golf swing? I would highly recommend seeing a physical therapist for an injury prevention screen for any and all sports, recreation or exercise. Setting yourself up for optimal movement and mechanics will enhance your activity, as well as reduce the risk of injury. It worked for me!!

 

From the Therapist’s Perspective:

Tina Cardenia PT, DPT, CFMT

Tina head shot

Victoria LaManna is such an inspiration. She volunteered to run the NYC marathon this year with little to no running experience and I was lucky enough to help prepare her! I have been working with Victoria for the past 6 months and I am amazed by how far she has come and how much she has already accomplished. Each week during our PT sessions there were a couple of things that I would look at to monitor her progress. I would observe her running, assess her core with tests called the Lumbar Protective Mechanism* and the Elbow Flexion Test*, her standing posture, her single leg stance, double leg squat, single leg squat, her glut and hamstring strength and how it connects to her trunk, and trunk rotation range of motion.

I saw that Vicky’s main limitations when I was observing her run were her limited trunk rotation towards the right, poor landing control on both of her legs especially her right one, and running with her feet turned out. One of the main things I looked for when observing Vicky run is the force transfer through her body from her feet to her trunk, and how the force translates through the rest of her body. It looked as though the force transfer wasn’t as efficient as I would have liked and this repetitive stress through her back and legs could potentially lead to injury.

tina and vickyVicky’s limitation with trunk rotation correlated to one of her complaints of having difficulty breathing during her runs. It seemed as though she was only able to get a good breath through only one side of her body. Upon examination, I found that she was limited into rib cage expansion especially on the right side. After some rib mobilization and breathing inhalation retraining and working thoracic spine rotation Victoria was able to rotate more symmetrically and reported an increased ease of breath with running.

Vicky’s lack of control with landing while running meant that she had a lack of eccentric (the motion of an active muscle while it is lengthening) control through her pelvis, causing compression through her back every time she lands. This could explain the low back pain Vicky has been experiencing. To address this, I worked on increasing the mobility and range of motion through her hips, pelvis, and back. I then worked on retraining her body with specific neuromuscular techniques called Proprioceptive Neuromuscular Facilitation (PNF) and specific exercises to help Vicky create a core first strategy with her running. This means, with every step and every movement Vicky is able to initiate with her core muscles first, which prevented her from overusing her bigger muscles which tend to fatigue quickly and can lead to injury and pain.

Vicky was running with her feet turned out causing poor force absorption from her feet up to her body. This style of running can also result in muscle overuse injuries and pain over time. This could have also been contributing to her complaints of shin splints while running. To work on this, I evaluated Vicky’s foot and ankle mobility, her knee tracking with squats, and single leg squats. With knee tracking, I noticed that she went into valgus with both of her knees, but it was worse on her right. Valgus means that her knees were “knocking in” which was an issue of having weak hip strength as well as lack of mobility and flexibility through some of her leg muscles and joints.  I did a lot of manual work to restore good range of motion and mobility and a lot of muscle retraining and drills to train Vicky to use those muscles appropriately and to be able to carry it over into her running.

After all this training and all the hard work that Vicky has been putting into running, Vicky’s running form now looks great! She has much more mobility through her trunk, is able to control her landing much more efficiently and is able to connect her feet for a better push off during running! Even as Vicky increased her mileage, she kept reporting to me how much easier her runs have been feeling, how much easier it was to breathe and how much more ease of motion she had through each run, and I couldn’t be more proud of her hard work!

*The Lumbar Protective Mechanism and the Elbow Flexion Test are special tests that come from the Institute of Physical Art. If you would like to learn more about their approach to PT, click here.

September is Prostate Cancer Awareness Month

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Oliver Sjöström
 via Pexels 

September is Prostate Cancer Awareness Month. Here at Beyond Basics Physical Therapy, we treat many men both before and after treatment for prostate cancer. We focus on restoring the health of the pelvic floor and tissue surrounding the prostate to restore normal sexual and urinary function.

Beyond Basics itself has an outstanding program in pre and post operative prostate care in two locations in NYC:

 

Beyond Basics Physical Therapy (Midtown)

Pre-op/Post op Prostatectomy Program

110 E 42nd Street, Suite #1504, NY, NY 10017

T: 212-354-2622

 

Beyond Basics Physical Therapy  Downtown (Downtown)

156 Williams Street #800,New York, NY, 10038

T: 212-267-0240

 

Beyond Basics Physical Therapy offers a unique and comprehensive rehabilitation program focused on the healthcare needs of people who have

  •      Incontinence or sexual dysfunction due to prostate surgery
  •      Pain and/or bladder retention, frequency or urgency due to prostate treatment (with or without surgery)

Our physical therapists that work with these clients have extensive training and knowledge in pelvic related issues.

Pre-operative: patient will be seen by a therapist to not only evaluate their prior function, but also give them exercises to do before and after surgery.  The evaluation will include:

  • Muscle strength testing including pelvic floor and lower extremities
  • Biofeedback evaluation using either internal rectal sensors or external anal sensors
  • Education on what to expect and things to do to optimize surgical outcomes
  • Overall posture evaluation

Post-operatively: patient will be seen 2-6 weeks after surgery. Treatment will include the following

  • Muscle re-education utilizing biofeedback
  • Bladder re-education/timed voiding
  • Postural education
  • Overall core stabilization when appropriate
  • Behavioral Modifications

We treat our patients for 60 minute sessions in private rooms and use state of the art biofeedback technology.   If you have specific questions, please do not hesitate to contact us.

As always, our programs are tailored to your specific needs.