The Hard Truth on Erectile Dysfunction

By Fiona McMahon, DPT

 

bananas basket blur close up
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

 

Breast Cancer Awareness Month

awareness cancer design pink
Photo by Miguel Á. Padriñán on Pexels.com

Fiona McMahon, DPT

Have you noticed an increase in the amount of pink on just about everything the last couple of days? The increase of pink everything is because October is Breast Cancer Awareness Month.  Breast Cancer is an extremely common cancer. According to the Nation Breast Cancer Foundation, 1 in 8 women will be diagnosed with breast cancer in their lifetime. Men can also get breast cancer, however, it is much rarer for men to develop breast cancer. Luckily with early detection and treatment of early stage and localized cancer, the 5-year relative survival rate is 100%. That being said, early detection is crucial and it is important to catch breast cancer early to ensure the best possible outcome. Let’s take some time to review the signs of breast cancer and recommended screening protocols.

Signs and Symptoms of Breast Cancer

  • Change of Sensation/ texture of the Breast or Nipples
    • Lumps, change in texture in the breast, nipple, or underarm area
  • Change in appearance of Breast or Nipple
    • Swelling
    • Shrinkage
    • Dimpling
    • Change of nipple orientation
  • Discharge from nipple

Detection

Recommended Screening:

Mammogram

  • Recommended every 1-2 years for women who are 40 years old or older.
  • May be recommended for women who are under 40, but have increased risk of breast cancer.

 

Genetic Testing

For some types of breast cancer, there is a very specific link to a person’s genes and her or his risk of developing breast cancer. BRCA1 and BRCA2 are genes that are responsible for the production of certain tumor-suppressing proteins. In some populations, there are mutations in these genes that disable their tumor-fighting properties. These gene mutations are relatively rare and currently, screening is recommended just for individuals with increased risk of harboring these mutations. According to the National Cancer Institute, individuals who are at higher risk and should consider genetic testing are:

  • Individuals who have a male relative who has developed breast cancer
  • History of BRCA related cancers within family history
  • People of Ashkenazi (Eastern European) Jewish ancestry
  • Breast Cancer diagnosed before age 50 in family
  • Multiple cases of breast cancer in family

Individuals that test positive for BRCA mutations may consider increased screening, prophylactic surgery or chemoprevention.

Mastectomy and Physical Therapy

Mastectomy, removal of the breast is currently the most common treatment for breast cancer. Some women chose to have their breasts reconstructed after their mastectomy and others do not. It is obviously a very personal choice.  Like any surgery, mastectomies require close postoperative care to ensure maximal function and recovery.

You may have read the last sentence, and thought, “What is the function of the breast, besides breastfeeding and for sexual pleasure?” The breast lies in an important intersection in the body. The armpit (axilla) contains bundles of nerves, blood vessels, and lymph vessels that course through it, serving the arm down to the fingers. After a mastectomy, their course can be interrupted by scar tissue, radiation damage (if your treatment included radiation), causing painful conditions such as nerve entrapments, frozen shoulder, and lymphedema, ( a backup of lymph fluid, if left unchecked can cause permanent damage and deformation of the arm).

victoria2016Victoria LaManna, DPT, CLT, is our lymphedema expert. If you have had a mastectomy and are unsure about lymphedema care, she is an excellent resource. She will be able to instruct you in self- care and lymphedema prevention measures. Physical therapy can also help to release scar tissue in the breast and upper arm area, regain strength in the arm, and ultimately improve your function. Visit us, and read up on Victoria’s bio here, as well ask on our website at:  www.beyondbasicspt.com/lymphedema

Sources:

http://www.nationalbreastcancer.org/. Accessed: September 24, 2016

National Cancer Institute. BRCA1 and BRCA2: Cancer Risk and Genetic Testing. https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet#q1. Accessed September 25,2016

http://www.beyondbasicspt.com/lymphedema

Ph101 Why is Pooping so Difficult?

toilet 2

Fiona McMahon, DPT

The number of Americans who deal with constipation issues is massive (4 million!)! It seems like every time I mention that I’m a pelvic floor physical therapist, another friend of a friend pulls me aside with bowel movement concerns. Why is it that so many people have issues? And more importantly – what can we do about it? This is the topic of our next Pelvic Health 101 seminar  on  October 11th at 7pm.

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

Register at pelvichealth101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Check out or upcoming courses!

Pelvic Health 101 Fall 2017

 

Time to PUMP SOME IRON! September is Healthy Aging Month

WeightsFiona McMahon PT, DPT

The idea of strength training can conjure up many images, like the funny images of  Saturday Night Live’s Hans and Frans, or Arnold Schwarzenegger. It can also be intimidating. The idea of walking into a crowded weight room full of young and fit people, who seem to all know what they are doing can stop a newbie in their tracks. But resistance training has so many benefits, for health, function, and longevity. It goes way beyond looking good in a swimsuit, although it certainly can help with that. In honor of September’s Healthy Aging Month we at Beyond Basics are taking a close look at how adding a safe strength training regimen to one’s daily routine at any age, can boost so many indicators of health and quality of life.

Everyone understands that muscles are essential for everyday tasks like rising from a chair, carrying your shopping, and many other instrumental tasks required for independence. The thing about muscles is they are not static, and as we start to age we lose muscle, especially if we do not work to maintain our muscle mass. Believe it or not, we slowly start losing muscle mass at age 30, (bummer, I know), but after 60 is where things get really crazy. After age 60 we start losing muscle mass at a rate of approximately 15% per year. The less active someone is in their life, the quicker this loss occurs. Low muscle mass is called sarcopenia. You will see this term a lot in this blog. The condition of sacropenia brings with it functional impairments from lack of strength and can put a person in a position where they are more likely to require assistance for everyday tasks. Furthermore, when sarcopenia and obesity occur at the same time, which we often see in the elderly, the functional impairments associated with sarcopenia and obesity are greater than either sarcopenia or obesity alone.

But there is hope. Aging isn’t a slippery slope into weakness and frailty. It is what you make it. Even sarcopenic muscle can respond and strengthen in response to proper training. In fact, it adapts to the demands of strength training at the same rate as younger muscle. Weight training can actually reduce fat and build muscle, helping to reverse the condition of sarcopenic obesity. Many studies indicate that resistance training can prevent and or reverse age related losses in function. Even with all the benefits of strength training. Only an estimated 10-15% of older folks regularly participate in strength training exercise, leaving a huge percentage of the population missing out on strength training’s myriad benefits, which we will cover in more detail below.

Benefits of Strength Training

 

Balance and Fall Prevention

Falls are a serious cause of injury, disability, and death in the elderly. People over the age of 60 have a once yearly fall rate of approximately 30%. Resistance training in combination with balance training under the care of a skilled physical therapist can go a long way to reduce one’s risk of falls. If falling is a concern of yours, please check out our other blog on falls and fall prevention.

 

Pain Syndromes

Pain symptoms in individuals with Fibromyalgia Syndrome improved following a 12 week high intensity strengthening program (Mayer).

 

Osteoporosis

Osteoporosis, a condition characterized by low bone density, increases a person’s risk of fracture. Fracture brings along with it risks of prolonged pain, depression, issues with function, subsequent fracture, and even death. Individuals with vertebral fracture have a 2.7 increased likelihood of death and are likely to have an additional fracture within a year of the original fracture.

There is evidence supporting resistance exercise as a useful tool to increasing bone density in osteoporotic individuals. With people with extreme cases of osteoporosis, there is increase risk of accidental fracture from dropped weights, poor form in transitions and adjusting weight machines. In these individuals, and all individuals for that matter, it is extremely important to work with a physical therapist to construct a safe and beneficial routine.

 

Function

Many studies have found significant improvements in function following a resistance training program. Physical therapists like to use a few specific tests when getting a general idea of someone’s function. A couple of our favorites are the Timed Up and Go (TUG) and the 6 – Minute Walk Test. They measure the time it takes to rise from a chair and the amount of ground covered in six minutes, respectively. Pretty simple, right? In all of the studies I read that were using these outcomes, both TUG and 6-Minute Walk scores significantly improved following strengthening intervention. These tests are really special because they have incredibly strong correlations to functional independence and risk for falls and hospitalization. On top of improving scores in these tests, patient’s themselves also reported improved mobility in their daily lives.

Frequency and Duration

Out of the studies examined, most advised participating in a resistance routine 3-4x weekly in order to see an increase in muscle mass in 6-9 weeks. Continued training will sustain this effect. Most recommended 3-4 sets of 10 repetitions and 65-85% one rep max. Bands and free weights have found to be effective for strength training in older individuals. As stated before, exercise machines tend to have an increased risk of fracture in those with severe osteoporosis and therefore, should be avoided unless one is certain they can adjust the machine with correct form. Repetitions should be slow and controlled. Cardio and weight training are life long commitments.

So Where To Start?

The first place to stop is at your local and experienced physical therapy office. Your PT will be able to determine if you are safe to exercise and what types of exercise will work best for your body and your goals. Will exercise bands work better for you? What the heck is 80% one rep max? When can I progress? Am I doing this right? All of these questions will be answered by your physical therapist. At Beyond Basics Physical Therapy we work to not only improve strength, but also efficiency of movement to allow our patients to get the most from their time with us as well as their time spent doing resistance training. If you think weight training is right for you and are eager to get started, make a call to us at BBPT or to your local PT, to make an appointment today!

Chen M, Jiang B. Resistance training exercise program for intervention to enhance gait function in elderly chronically ill patients: multivariate multiscale entropy for center of pressure signal analysis. Comput Math Methods Med. 2014

Giangregorio G. Papaioannou A. MacIntyre N. Too fit to fracture: exercise recomendations for individuals with osteoporosis or osteoporotic vertebral fracture

Liao C, Tsauo J, Lin L, et al. Effects of elastic resistance exercise on body composition on body composition and physical capacitiy in older women with sacropenic obesity. Medicine. 2013. 96(23)

Mayer F, Scharhag-Rosenberger F, Carlsohn A. The intensity and effects of strength training in the elderly. Dtsch Arztebl Int 2011; 108(21):359-64

Irritable Bowel Syndrome and Physical Therapy

IBSFiona McMahon, DPT

Hello everyone! April was Irritable Bowel Syndrome(IBS) Awareness Month. Although, we are a bit late, we wanted to take some time to talk about IBS and what can be done to help with its symptoms. IBS can present in different ways. People with IBS may experience diarrhea or constipation, or both. At Beyond Basics, we work with issues associated with IBS, from ensuring that your digestive organs move well in order to function properly, to toilet posture, to training the pelvic floor to have the coordination to help you toilet comfortably.

Tips for living with irritable bowel and other digestive symptoms

Posture

Over the years we have used our blog to discuss many different tips, tricks, and techniques you can use at home to make the process of having a bowel movement just a bit easier. The first thing you can do is super simple: sit on the toilet with good posture. There are heaps of ways to sit on the toilet and believe it or not, there is an optimal way to sit and poop. The reason why the way we sit is so important is the anal rectal angle. The anal rectal angle refers to the angle of your rectum. When we stand and sit our angle is more bent or acute, which makes it harder for poop to drop out of out of our rectums (yay!), which increases our chances of continence. But when we are trying to poop, we want our anal rectal angle to straighten out so it is easier to poop and we don’t have to strain. The position that best allows us to do that is squatting, the way one would over an eastern style toilet. Most of us have western style commodes that don’t allow for a nice anal rectal angle opening squat. So we have to get creative. By placing a stool or the now ubiquitous squatty potty under your feet you can simulate a squat and allow for easier passage of stool. For more on posture, check out Sara Paplanus’s blog on posture and bowel movements.

Diet

veggies

Diet is a very important thing to consider when trying to optimize your bowel movements. The first thing we usually consider is fiber. There are two types of fiber. Soluable and insoluable. Soluble dissolve in water and allows the stool to absorb water and adds mass and heft ( in a good way) to your feces. Insoluble fiber does not dissolve in water and can help push the poo out. The fact is we need to balance both types and most of us aren’t getting enough. In addition, some people need more of one type and some need more of the other or else you can end up with increased gas and bloating. Read how you can increase your fiber intake here. If you are having difficulty balancing the two or are not sure which to add, it is best to seek advice from an expert nutritionist in abdomino-pelvic pain and IBS.

Water Intake

The colon, the last stop for poop before it enters your rectum is the place where water is absorbed from the stool. In cases where you are too dehydrated, your body will recycle water anywhere it can, including your stool. If too much water is taken from your stool, it can be dry and hard to push out. We suggest drinking about one half your body weight in ounces of water daily and even slightly more if you are constipated, sweat a lot or suffer from IBS. For example, if you weigh 200 lbs, drink 100 ounces of water to make sure to ease your bowel movements.water-life-crop

Physical Therapy

Pelvic floor physical therapy can help a lot with issues with IBS. In last year’s IBS awareness blog, we discussed the benefits of pelvic floor PT

“Dysfunction in organs can also cause dysfunction in the skeletal muscles that are close by. This is called the visceral-somatic reflex. One of the most common examples is when someone feels left arm pain when they are having a heart attack. The dysfunction in the heart causes pain and spasm in nearby muscles. The same thing can happen when the gut is irritated in conditions like IBS. Typically, people with IBS will feel pain and spasm in the muscles of their abdomen and pelvic floor as a result of repeated irritation in their gut. To add insult to injury, spasm in the pelvic floor, (specifically the levator ani and sphincter muscles) can adversely affect the passage of stool out of the body and make symptoms even worse.

Pelvic floor physical therapy can help symptoms caused by the visceral somatic reflex greatly. At Beyond Basics we have an excellent crew of pelvic floor physical therapists with expertise in visceral mobilization and pelvic floor dysfunction. Our physical therapists can work to eliminate painful spasms, mobilize restrictions, retrain the muscles and teach self-management techniques to keep symptoms at bay, or to eliminate some of the symptoms in the future.”

 

IBS is an important condition that affects many different people. Although there currently is no cure for IBS, there is a lot you can do to make living with this condition more manageable. If part, or all, of the symptoms are from musculoskeletal dysfunctions of the pelvic floor and abdomen, than there IS a cure and we are here to help! If you are suffering, please make an appointment with us today.

Sources

R Saeed. Impact of Ethnic habits on defecographic measurements. Arch Iranian Med 2002; 5(2) 115-16

The use of Breath in the Pilates Method

Denise Small PT, DPT

The following series of Pilates blog posts will focus on the principles that define the Pilates method.  Joseph Pilates developed his methodology using eight basic movement principles: whole body movement, breathing, balanced muscle development, concentration, control, centering, precision, and rhythm.  Today’s blog will focus on the principle of Breathing.

pilatesBreathing is a natural phenomenon that is performed thousands of times a day. Our daily intake of oxygen and expulsion of carbon dioxide is needed to cleanse our blood, and maintain the functioning of our body systems.  That being said, there are different ways to manipulate one’s breath to help facilitate certain physiological functions. For example, there have been many BBPT blog posts about diaphragmatic breathing, where one breathes into their abdomen to get a stretch of both the diaphragm and the pelvic floor muscles. Well, Pilates had his own approach to breathing, which was a variation on Diaphragmatic breathing.  Pilates approach to breathing was aimed at getting maximal air intake and release to give the body, what he called, “an internal shower” to rid the body of “toxins”. Pilates focused specifically on lateral expansion of the diaphragm, whereas traditional diaphragmatic breathing focuses on the vertical expansion of the diaphragm. In order to achieve this, Pilates encouraged maintaining the engaged tone of the abdomen, while breathing into the front, sides, and back of the ribcage. See the image below for further explanation.

 

Pilates- Ribcage/ Chest breathing versus Belly/Diaphragmatic breathing

This is an overly simplified view of the actual mechanics. However, both versions are very important. With the ability to differentiate between ribcage and diaphragmatic breathing you can offer your diaphragm a 3-dimensional stretch and the ability to work on abdominal contraction as well as endurance. If you have any questions you can ask them in the comments section. Or come visit me at Beyond Basics for a Pilates Private session!

BBPT Health Tip: Seated Hamstring Stretch

Fiona McMahon DPT, PT

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Fenitra, of BBPT shows the correct way to perform this stretch. Notice how she doesn’t curve her back forward in order to perform the stretch

Seated Hamstrings Stretch

Hello folks! Beyond Basics Physical Therapy’s latest health tip is the seated hamstrings stretch!

Why seated you ask? In selecting this stretch over other hamstrings stretches, I wanted to pick something that most everyone can be able to do. This stretch is particularly beneficial for those of you who have difficulty getting on and off the floor. Although if you do have difficulty getting off of the floor, it is important to go to physical therapy and get the training to do so, as being able to independently get up off the floor is imperative for maintaining independent function as you age.  Another point: if you have any sciatic pain or sitting pain, please seek a physical therapist before attempting this stretch.  

Muscles involved: Hamstrings, gastroc soleus complex ( your calf) and to some extent your sciatic nerve

Stretch Type: Static: Best if performed after workouts on warm muscles. Exercise caution if stretching cold muscle, because unwarned muscle doesn’t stretch as well as warmed up muscles.  

Caution: It is possible to overdo it. Stop the stretch or ease up if you feel tingling in your legs or pain in your low back.

As always: No stretch should ever be painful. If a stretch is painful, stop and consult your physical therapist for modifications.  

 

Directions:  Sitting in a sturdy chair, ( don’t do this on a rolly stool or office chair, please!). Straighten knee of leg to be stretched and point toes up. Lean forward at the hips until you feel a gentle stretch in the back of your leg. Don’t round your back. Keep in mind, for those of us with tight hamstrings, you will feel the stretch without too much of a forward bend.  So take it slow!

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Fenitra demonstrates a straight knee and pointed toe while performing her stretch
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Fenitra demonstrates this stretch