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

BBPT Health Tip: Eat your Fiber

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Fiona McMahon, DPT, PT

What is fiber?

Fiber, it’s the hot ticket. It is being marketed to us like crazy. But why is fiber is so important? What fiber is best? Should you get more fiber with supplements? Let’s take a closer look into the benefits of fiber in this edition of BBPT’s Health tips.

Fiber is the part of food that we cannot digest. It is separated into two types, soluble and insoluble. Both bulk up the contents of your stomach and colon, which can help you feel more full but after that, the similarities end.

As the name implies, soluble fiber dissolves in water but insoluble does not. Insoluble fiber increases the mass of the stool and helps to get things moving, in terms of passing feces. Soluble fiber absorbs water. The truth is, most people are not getting enough fiber. Less than half of people in the United States consume the recommended amount of fiber. Let’s discuss the benefits of fiber and how to make sure you are getting enough.

So what if you don’t have issues going number 2? What else can fiber help you with?

Fiber has been shown to help with reducing the risk of the following conditions:

  • Coronary artery disease
  • Stroke
  • High blood pressure
  • Diabetes
  • Obesity

Fiber has also been shown to:

  • Improve insulin sensitivity in people who have diabetes
  • Enhance weight loss
  • Improve GI conditions like acid reflux, duodenal ulcers, diverticulitis, constipation, and hemorrhoids
  • Enhance the function of the immune system

How much to eat and where to get it?

Men under 50 years and under should consume at least 38 grams of fiber daily, Women under 50 should consume at least 25 grams of fiber daily. Women over 50 should eat at least 21 grams and men over 50 should get 30.  Those who suffer from constipation may add more to your diet.   We suggest contacting a nutritionist for proper amounts of soluble versus insoluble in these cases and anyone with a history of GI issues.  Also, please discuss with your doctor before making any drastic changes to your diet.  

Adding  fiber to your diet when you are not used to it can sometimes be a little difficult. If you add too much too quickly, you may experience gas and bloating. Start slow and work your way up.  Also, drink plenty of water.

Start by adding in whole wheat items (unless you have a gluten sensitivity), legumes, fruits, and vegetables slowly to your diet. Check out the Mayo Clinic’s full list of fiber rich foods here .

Sources

Anderson J, Baird P, Davis R, et al. Health benefits of dietary fiber. Nutr Rev. 2009. 67(4)188-205

Family Doctor.org Decermber 2010: http://familydoctor.org/familydoctor/en/prevention-wellness/food-nutrition/nutrients/fiber-how-to-increase-the-amount-in-your-diet.printerview.all.html. Accessed November 11, 2016.

Medlineplus. Soluble vs. insoluble fiber.https://medlineplus.gov/ency/article/002136.htm. Accessed November 17,2016.  

BBPT Health Tip: Diaphragmatic Breathing

just-breathe-in-cloudsFiona McMahon DPT, PT

WE LOVE DIAPHRAGMATIC BREATHING! We do, we really do and we hope you will too. What is diaphragmatic breathing you ask? Diaphragmatic breathing is a form of deep breathing where you breath deeply into your stomach. As you breath in, you will actually see your belly extend and get bigger, and as you breath out, your belly will return to it’s old spot. It’s not like our typical breathing patterns where we breath from the chest; it is a much more deep and deliberate breath.

Why We love Diaphragmatic Breathing

Diaphragmatic breathing accomplishes a lot in the body. First of all, it supplies the body with a large dose of oxygen, which is pretty obvious, but it is a much more robust breath than a simple chest breath.

Diaphragmatic breathing also works wonders on the tissues of both the abdomen and the pelvic floor. By taking a big diaphragmatic breath in, the diaphragm lowers and provides a gentle stretch to the tissues and organs of the belly as well as the pelvic floor. As you breath in you are actually providing a nice stretch to the pelvic floor.

Deep breaths can also calm down the nervous system and allow you to better relax. When you are more relaxed your body can attend to the day to day tasks such as digestion and healing. It really is amazing what some deep breaths can do.

How to breathe diaphragmatically

Start off by putting one hand on your chest, at about the area of your breastbone. Place the other hand on your stomach. You can do diaphragmatic breathing just about anywhere, so get in a position that is comfortable for you. Start by slowly breathing in. In order to tell if you are using your diaphragm, you should feel the hand on your stomach move more than the hand on your chest. As you breath in, bring your awareness to your ribs and feel them expand out to the side and back.  Finish by slowly breathing out. The out breather should be longer than the inhale. It is really that easy.

How does one actually use diaphragmatic breathing?

Really you can use it in anyway you need too. Some people find it tremendously helpful to do 10 diaphragmatic breaths every hour, while others employ deep breathing techniques in times of stress or pain. The important thing about diaphragmatic breathing, or any exercise for that matter is consistency. Try to at least get in 20 deep breaths a day.

Ph101 : Pelvic pain, meditation workshop with Ryanne Glasper, DPT & restorative yoga, calming down your pelvic floor

Fiona McMahon, DPT,

Enlightenment in nature

Earlier this summer, we discussed the nature of pain. In Putting Pain Into Context, We discussed how pain is comprised of two distinct components: the physical stimulus and how our brain interprets that stimulus. Both meditation and yoga are helpful techniques to help retrain how your brain responds to pain.

Join us on October 13th at 7pm for an introduction to both restorative yoga and meditation. Learn more about the science and try it out yourself with Anne Taylor, yoga instructor specializing in chronic pain and Ryanne Glasper, Physical Therapist and yoga instructor.  Come find out how these techniques may be helpful for you!

 

Register at pelvichealth-101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

Check out our upcoming courses:

Pelvic Health 101 Fall- (003)

Breast Cancer Awareness Month

o-breast-cancer-awareness-facebook

Fiona McMahon, DPT

Have you noticed an increase in the amount of pink on just about everything the last couple 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 more rare 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

bfab76550709826284e190dd6efc1a76Self Exam

  • Recommend for women of all ages
  • Should be performed every 12 months
  • Check in the shower: move the pads of your fingers over your breasts in a circular motion. If you find any lumps or skin abnormalities, visit your healthcare provider.
  • Visual exam: examine your breasts in the mirror. if you note any changes in your breasts such as bumps, skin changes, nipple orientation, dimpling, shrinkage, or swelling, visit your healthcare provider
  • Lying down: moving the pads of your fingers, check for breast abnormalities. Squeeze nipples to check for discharge. If you find any lumps or skin abnormalities, visit your healthcare provider.

 

Recommended Screening:

Mammogrammammogram-ultrasound-equally-effective-to-detect-breast-cancer

  • 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

brca12For 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 breast feeding 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 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

 

Breast cancer is extremely common, but luckily outcomes continue to improve, but early detection is key.  This October, let’s stand together to commit to regular self exams and educate the women in our lives to screen themselves as well. Let’s reduce the impact of breast cancer, one step at a time.

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