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

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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)

PH101: Ladies Only Session

By: Fiona McMahon, DPT
Hey Ladies!!! In the next installment of our Pelvic Health 101 course, we are hosting a women’s only session to allow for a safe and non-threatening place to discuss many issues that can affect the health of your pelvic floor. This class one of Stephanie Stamas’s (the founder of PH101’s ) favorites and is definitely not to be missed. Hear more about it in her video below! Join us at 7pm on October 25th, 2018. Please register at pelvichealth101.eventbrite.com

 

 

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Pelvic Health 101 Fall 2018

PH101: Pain and Sexuality: is it all in my head?

 

By Fiona McMahon, DPT

Sex should feel good… really, really good. But when it doesn’t, you may start to wonder, what’s wrong with me? Am I broken? Am I a prude? Am I frigid? Painful sex isn’t something we talk about. No one would look at you twice if were complaining of pain in your elbow, but in your genitals is a different story.

On October 18th, we at Beyond Basics are breaking down those taboos and having an educational seminar, followed by an optional question and answer session at the end. We will discuss the many causes of sexual pain and how physical therapy can help.  The event will be hosted by one of our expert therapists, Stephanie Stamas. Stephanie will give a detailed seminar about pelvic health and take time to clear up some common misconceptions many people have concerning their bodies and sexual function.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth101.eventbrite.com

Here is our line up of this and future classes

Pelvic Health 101 Fall 2018

 

 

 

The Special Care Needs of the LGBTQ+ Community

Happy Pride Month!!!!

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

Amy Stein PT, DPT and Fiona McMahon PT, DPT

rainbow flag

Who are LGBTQ+ individuals?

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

Never Assume. Listen, Ask.

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

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

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

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

 

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

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

How can physical therapy help?

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

WPATH center for care Endocrine Society

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

 Adolescent Health Center

May Is Pelvic Pain Awareness Month!

Mayis PelvicPainAwarenessmonth

 Kaitlyn Parrotte, PT, DPT, OCS, CFMT

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

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

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

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

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

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

 

Sources:

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

Continuing our Education: Vestibulodynia, Vulvar Pain, and Beyond

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Fiona McMahon PT, DPT

In a blog a few posts back, we covered some of our new skills we developed with our friends, Kelli Wilson PT, DPT, FAAOMPT, and Sara Sauder PT, DPT in addressing issues of the male pelvic floor. In this post, we will cover the new techniques and latest information we learned in issues concerning pelvic floor dysfunction in individuals of the female anatomy.

As experienced and expert physical therapists, we are all extremely comfortable with treating disorders of the pelvic floor, but the thing is, there is so much new information coming out, that even if your latest training was two years ago, chances are, there is a lot of new information out there to discover, which can really help your patients.

One of the most interesting things we learned about was in regards to hormonally mediated vestibulodynia and vulvar atrophy. Although many of us know how to spot these conditions, learning about the specific mechanism that causes them in cases of long term birth control use was fascinating. Long term birth control use can actually suppress the production of estradiol and testosterone from the ovaries and cause the liver to increase levels of sex binding hormone globulin, which takes even more of these hormones out of circulation. When this happens, the vulvar tissue can shrink, become thin, and friable (tear easily). This can cause burning and pain. It is important for PT’s to be able to screen for this condition so we may refer our patients to MDs who can get them on a different method of birth control or prescribe them topical treatments as needed.

We also learned more about conditions such as interstitial cystitis, lichens planus and sclerosis, pelvic congestion, vaginal adhesions, as well as other current medical treatments that are now available for our patients who are in pain.

All in all, it was a great course and we look forward to bringing our new knowledge to our patients to help them be more successful in our physical therapy treatments.

For most of last year, myself, Sara, and Amy worked together to contribute a chapter to the International Society for the Study of Women’s Sexual Health latest textbook on female pelvic pain which will be available soon on Amazon, and is an essential tool for practitioners treating pelvic and sexual pain from both a medical, mental health and physical therapy perspective. Check out the following excerpts from our chapter detailing treatment of pelvic pain here:

On who is an appropriate candidate for physical therapy:

“Ideal candidates for pelvic floor physical therapy referral are patients with pelvic floor musculoskeletal dysfunction or those who have been treated by clinicians for pelvic pathology but have not experienced symptom resolution. Clinicians can identify appropriate patients by palpating the vulva, performing a digital examination of thevaginal and rectal muscles, and performing a moist cotton swab test on the vestibule. If the patient reports reproduction of any of her sexual or pelvic pain symptoms with this examination, she is likely affected by pelvic floor dysfunction”

On what pelvic floor physical therapy is:

“Physical therapy intervention for the dysfunctional pelvic floor incorporates a comprehensive approach addressing specific tissue characteristics, strength, alignment, and neuromuscular control. Manual therapy is a hands‐on approach to correct tissue restrictions, improve alignment, and enhance blood flow. Different manual techniques may be used to achieve different objectives.”

Check out the full text: Musculoskeletal Management of Pelvic and Sexual Pain Disorders available here.

 

Sources

Pukall C, Goldstein A, Bergeron S, et al. Vulvodynia: definition, prevalence, impact, and pathophysiological factors. J Sex Med. 2016; 13(3): 291-304

Burrows L. Basha M. Goldstein A., et al. The effects of hormonal contraceptives on female sexuality: a review. J Sex Med. 2012;9 (9) 2213-23

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)