As I sit down to write this, New York City is on PAUSE, many other cities around the world are on various forms of lock-down. As a planet, we are working to slow the spread of COVID-19, the condition caused by the novel coronavirus. Those of you who are working from and staying at home, your efforts are noble and life saving. We thank you. For those of you in pain, we see you and feel for how tough it can be to feel like you have to wait to get help. Hopefully in a short period of time this virus will have passed . Follow these simple tricks to get started on tackling your pelvic pain.
Check In With Your Seat
Work from home setups can leave a lot to be desired. Designed for portability, but not ergonomics, our laptop computers can leave us curled up like little cashews or “c’s”. This position tucks our pelvis underneath us and can cause us to put extra pressure and compression through our pelvic floors, not to mention putting extra pressure on our spinal discs. Even if you only have a laptop, you can remedy this c position by imagining you are a puppy dog with a tail. You want to sit so you could wag your tail like a happy puppy. Now for some people this may actually feel a little worse, if it does, this is not the trick for you. Don’t worry I have more.
If you can, use a portable mouse and keyboard to discourage your cashew sitting tendencies. Arrange your setup so your eye line falls just about in the middle of the monitor by elevating it on some books. You should be able to access your keyboard with your elbows bent at 90 degrees.
Now it’s time to think about what you are sitting on. I recognize that those of us living in teeny tiny NYC apartments may not have a lot of options to think about. But keep in mind that pelvic floor pain can be counterintuitive and an overstuffed couch, may not be the best thing if your pelvic floor is overworking to stabilize your body while you are sitting. Likewise, your kitchen chair may be too firm. Play around, how does the couch cushion feel on the chair? Is a firmer seat better or worse? You may have to trial and error your way into a solution.
This one is so important. Depending on where you are geographically, you may be allowed different degrees of movement. If you are currently allowed to leave your home for exercise, go for a walk. Besides breaking up the day, walking can decrease the pressure from all the sitting you have been doing, as well as increase blood flow to the pelvic floor. While the requirements for social distancing remain, ensure that you maintain a distance of 6 feet (about 2 meters) between yourself and other people and wear a homemade mask.
If you cannot walk outside, and even if you can, get up periodically throughout the day. Stretch out, do some gentle air squats if they feel good. Look for some free restorative virtual yoga classes. Movement is medicine.
Just be Happy… Like a Happy Baby
I love this pose so much that I could write a love song to it. Honestly. It works to stretch not only your pelvic floor, but your entire posterior chain (back of the body).
The most traditional way to do it, is to lie on your back, bend at your hips and knees, so that your feet are in the air, and grab the outside of your feet. As you stretch bring your knees towards your armpits. Hold this pose for 10 deep, beautiful breaths.
Feel free to modify this pose. Grab on the back of your calves or behind your knees if you have tight hammies. Put a pillow between your abdomen and thighs to prevent any pinching in your hip. It’s honestly all good.
Another super important tool in your toolbox. Deep slow breathing can calm your nervous system, which can help to decrease pelvic floor spasm and guarding. In fact, in a study by Van der Velde, it was found that stressful stimuli do cause an increase in pelvic floor tightening. Try 10 deep slow breaths throughout the day and note how you feel from both a pain and stress perspective.
We are OPEN and also offering Telehealth
For those of you who are ready to get started NOW. You can. We are currently offering office evaluations and treatments, and telehealth services. Both Corey Hazama PT, DPT and Amy Stein PT, DPT are doing in person visits and telehealth visits are available with Sarah Paplanus PT, DPT. For more information contact Beyond Basics Physical Therapy at 212- 354-2622 or check out our website: http://www.beyondbasicspt.com
Van der Velde J, Laan E, Everaerd W. Vaginismus, a component of a general defensive reaction. An investigation of pelvic floor muscle activity during exposure to emotion- inducing film excerpts in women with and without vaginismus. Int Urogynecol J Pelvic Floor Dysfunct. 2001; 12 (5) 328-31
It feels like it started early this year, didn’t it? The day after Halloween the Bryant Park Christmas fair was up and running. Little wreaths and twinkly lights adorn the downtowns of the tri-state area. Yesterday, (I am sitting down to write this blog on November 11th) I saw an adorable little boy absolutely losing his mind with joy over a Santa statue at my local drug store. It was excessively adorable. It’s a sweet time of year, filled with beauty and love, but it can also be a super stressful time of year filled with obligations, travel, shopping, expectations, and the bittersweet longing for those who cannot celebrate with us this year. In short, the holidays are loaded. There are elements of the holiday that will never not be stressful. It is stressful to fling yourself from event to event while trying to maintain some modicum of self-care, but in this blog, we will discuss practical tips to protect your holiday and better yet your peace of mind during this time of year.
Oh the B-word. Boundaries. Much like a fence, boundaries can be protective and can provide your friends and family with a clear set of expectations for how you want to be treated and what they can and cannot expect from you. Sounds a tad harsh, but what’s harsher is getting upset with your loved ones when they do things that they had no idea would bother you. Boundaries should be clear cut and judgement free. A good example, for most families is discussing politics. If political discussions, especially if your family’s views vary greatly from yours, are stressful, you may want to set up some boundaries around it. You may say, “ I would prefer not to discuss politics tonight at the holiday table, if we do discuss politics, I will excuse myself to the living room”. Excusing yourself to the living room is not meant to be punitive. You are not punishing your relatives for discussing politics, you are simply excusing yourself from a potentially divisive and argument starting topic that will upset you. You cannot control the actions of others, but you can control how you react to those actions, hopefully with kindness while keeping your boundaries intact.
Another way to set boundaries is setting boundaries with your time. For most of us with the crazy schedule of the holidays there are certain rituals that fall by the wayside. It’s okay to have some elements of your routine be non negotiable, like your 30 minute jog or morning meditation session, Holding onto the activities that bring you peace can best allow you to show up and be present for all of the holiday festivities.
You don’t have to do it all. Not every party requires your attendance, not every bake sale requires your dessert, and you can allow some things to slide. At the beginning of the season decide what is really important to you. Is the “coats for kids” fundraiser really meaningful? Put it up on your list, but could you let your work friend’s party slide? Cool, buy yourself some extra time. Look at your weeks and decide what is not only realistic, but healthy for you. Maybe if there are a few parties you want to go to, you could give yourself a day or two off from your workout routine and (here’s the important part) be kind to yourself about taking a break. You can say no. I believe holiday cheer to be a finite resource so save it up for what matters to you.
Loaded, loaded, loaded topic. But the holidays are where we can fall into some really unhealthy eating habits, which can make us feel really crappy. Try to mix in some healthy food with your holiday treats. I’ve quoted this Oscar Wilde quote (which I have misattributed to Mark Twain, full disclosure), “everything in moderation, including moderation.”, which I think is an excellent mantra to take into the holidays. Sometimes you gotta have a little fun and indulge, but being mindful of how much and how often, can help us to feel our best during the holidays. Make sure along with your cookies you are getting some vegetables and lean protein to keep your blood sugar stable. Limit alcohol to the best of your abilities as it can decrease the quality of your sleep, to avoid the trap of over caffeination and requiring a nightcap to sleep.
Leave time if you can for exercise and movement and time just for yourself. It allows you time to check in with yourself and see how you are doing as well as time to sit back and reflect/appreciate the holidays.
The holidays and year’s end can be a time when we look back at our year and evaluate how far we have come. It can be easy to dwell on our shortcomings, and although they can provide important direction for our future goals, it is also a brilliant time to reflect on your achievements. You have successfully gotten yourself through another year, Heck! Another decade, where you have grown and learned valuable lessons, which makes you all that more deserving of some good ol’ holiday cheer.
How to Start a New Exercise Program When You’re Feeling Intimidated
Maybe you were an avid gym-goer, cross fitter, or yogi and then you got injured. Or maybe fitness has never been a part of your life, but now your doctor or PT has told you that a fitness regimen is necessary in order to help you feel like yourself again. Whatever the case may be, you just don’t know where to start, or you feel intimidated to return to what you were doing in the past because that is how you got injured in the first place. My advice is to start slowly. Educate yourself on how and why you got injured and what the next steps are on your road to recovery. Set goals on what you need to accomplish and build a plan to achieve them. Last but not least, train smartly. If you follow this check list, then you should definitely feel more confident moving forward!
It is imperative when you are transitioning from injury rehab to the fitness world, or starting a new exercise program for the first time, that you build a foundation. It is so crucial you stay true to your journey and not compare yourself to others. Trust that progress takes time. Resist the urge to jump right into something new if you’re unsure about form, alignment, and technique.
The first step would be to invest in private sessions. Educate yourself on what you’re getting into and find an expert in what you want to master. Having a coach who devotes the entire hour to your body and your needs will help you garner a deeper understanding of how your breath, body, and mind connect. Learning the proper form with a watchful eye on alignment, will ensure you have a strong foundation to move forward or join group classes.
Once you’ve gained confidence with your new (or old) exercise program, set some fitness goals. You’ve laid a strong foundation and now it’s time to build a skyscraper! Do you want to improve strength, flexibility, endurance? Once you have clear goals set, create a timeline. Establishing a realistic timeline will hold you accountable to sticking with your exercise program and crushing your goals!
The point I’ll end with is to train smartly. No matter what discipline you train in, if you are not focused on form, alignment, and breath control, you are only setting yourself up for future injuries. If you are in a group class, don’t be afraid to ask questions if something is unclear, doesn’t feel quite right, or if you know you need a modification. If you are doing an at home workout on your own, try to do it in front of a mirror to check out your form. If there’s no mirror accessible, simply take it slow and use the knowledge you’ve acquired from a trainer, coach, or PT. Take notes. Practice. Your exercises won’t be perfect the first time you attempt them. Be patient and mindful. It’s all about the journey 🙂
Have you noticed it yet? Everything is pink. Pink cups, pink pens, pink stickers, pink ribbons, pink everything. The flood of pink that happens every October and reminds us it is Breast Cancer Awareness Month. If you are someone you love has or has had breast cancer, chances are you don’t need any reminding. At Beyond Basics Physical Therapy we have spent a good deal of our blogs discussing the ins and outs of how PT can help with the symptoms following treatment for breast cancer. But what can you do right now to help your health? Emerging research is pointing to the profound importance of exercise on so many facets of well being for individuals with breast cancer. In this blog we will discuss some of the newest findings as well as practical ways to apply these findings in your own life. I hope you choose to read on and please share this with family and friends.
What the researchers are finding:
We know that to say breast cancer treatment can be hard is an understatement. The risk of symptoms like fatigue, sarcopenia (muscle loss), osteoporosis, cardiovascular disease, and cognitive impairments are all elevated in individuals who are undergoing or have undergone treatment for breast cancer. These symptoms can have a profound impact on quality of life, which breast cancer survivors should not have to accept. Luckily in researching this blog, I found so many studies examining how to improve the quality of life of people going through breast cancer treatment. As a physical therapist, the studies on activity naturally piqued my interest.
Three of the studies I looked at examined how structured and monitored physical activity helped out people undergoing breast cancer treatment and those who had already undergone it. The studies included workout programs consisting of cardio, resistance training, or a combination of both. The studies showed improvements in fatigue, depression, physical fitness, and quality of life immediately following the exercise program. In one of the studies that look at how long these effects lasted, the positive benefits were lost 36 weeks after completing the exercise program.
How to use these findings:
It’s probably not groundbreaking journalism on my part to tell you that exercise is good for you. But what I do find compelling is the amount that good exercise can do, even during treatment. So the question is how to make exercise work for you. First get your doctor’s clearance for exercise, because there may be some exercises to avoid, especially if you have had a mastectomy. Most of the studies I looked at examined structured and monitored programs run by a physical therapist or other healthcare professional, which I would highly recommend especially if you are not used to exercising. A skilled physical fitness professional, like a physical therapist or Pilates instructor can not only help you progress safely through different exercises, but they can also introduce you to fun exercises you may have never thought of. That said, the best exercise is the one you will actually do. Remember, the benefits of exercise will be lost if you aren’t consistent. Cancer treatment can often feel like a full time job and adding another appointment into the mix is often not very practical. The good news is that in the study by Gokal and colleagues, walking independently for 30 minutes 5 times a week reduced self reported cognitive failures in participants. So even if you can’t make it out to see someone, there still is a lot of good you can do for yourself on your own.
Start slow: be kind to you body and ease yourself back into exercise. “Chunking” or breaking exercise into smaller sessions is a great way to start
Spark Joy: (Shout out to Marie Kondo) but exercise should not be something you dread the thought of. If yoga, or walking makes you wanna crawl under a rock and hide, it’s not for you and that’s okay. Approach exercise curiously and you will find one you love, or at the very least, don’t hate.
Buddy up: in the spirit of sparking joy, having an exercise buddy will not only help you remain accountable, it will probably make the experience a heck of a lot more fun.
Get help when you need it: If you are a brand new exerciser, are in pain, or just feel like your routine is getting stale, see a fitness professional. It’s a short term investment that will pay dividends in the future by making exercise more comfortable and fun.
Keep positive, keep moving and if you have any questions, give us a call!
Dieli- Conwright C, Courneya K, Demark-Wahnefried W, et al. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Research. 2018; 20 1:24
Gokal K, Munir F, Ahmed S, et al. Does walking protect against decline in cognitive function among breast cancer patients undergoing chemotherapy? Results from a small randomised controlled trial. PLOS ONE. 2018
Penttinen H, Utriainen M, Kellokumpu-Lehtinen P, et al. Effectiveness of a 12 – month Exercise Intervention on Physical Activity and Quality of Life of Breast Cancer Survivors; Five- year Results of the Brex- study. In Vivo. 2019. 33:881-888
Witlox L, Hiensch A, Velthuis M, et al. Four -year effects of exercise on fatigue and physical activity in patients with cancer. BMC Medicine. 2018; 16:86
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 2nd 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.
You aren’t a zebra getting chased down by a lion on the Serengeti. You know that. But your body might not. Our modern day stress usually doesn’t involve us having to defend ourselves against wild animals. It often involves chronic seemingly unrelenting stress of work, relationships, and life. Stress, our perceived threats, chemically elicit the same type of response whether that is fending off a tiger or stressing over trying to care for your child while simultaneously crushing the game at work. These stress responses are governed by the sympathetic autonomic nervous system of the autonomic nervous system (ANS). The ANS is a powerful system that governs virtually every function in our body to help optimize our responses to things we encounter day- to-day. It is essential to our survival. We can get into trouble if our stress response is perpetually turned on. You can’t fight or flight forever, we must transition out of that sympathetic nervous system back into our rest and digest system, the parasympathetic nervous system. In this blog we will go over the different parts of the ANS and how we can optimize it to live our healthiest and happiest lives.
Parasympathetic versus Sympathetic
In a perfect world our sympathetic and parasympathetic operate in concert to provide us with optimal functioning. When we go out for a run we need our sympathetic to quicken our heartbeat, stimulate glucose release from our liver, and allow us to sweat. After we finish our run and settle in for our post run snack, we need our parasympathetic to stimulate some saliva production, and get digestion started for us. See how the sympathetic and the parasympathetic can work perfectly together? Check out all the functions of the ANS below
Sympathetic Nervous System
Constricts Blood Vessels
Accelerates Heart Rate
Stimulates Sweat Production
Stimulates Glucose Release
Stimulates secretion of norepinephrine and epinephrine
Parasympathetic Nervous System
Stimulates tear production and salivation
Health effects of stress
As you can see, the sympathetic nervous system provides us with some really important functions. But you can tell by looking at what it does for the body, that living in chronic sympathetic drive would be pretty uncomfortable. No one wants to walk around with their heart pounding and sweat pouring off their forehead. Beyond discomfort, chronic stress can deeply affect our health. Chronic stress can affect your immune system negatively making it harder for you to battle infections. Importantly for our pain patients, chronic stress can increase inflammatory chemicals called cytokines. This is important because that inflammation can actually make your pain worse. Chronic stress can also affect your digestion through a mechanism called the brain-gut-axis, which can affect how you absorb nutrients and the overall level of inflammation in your gut. You can listen to the details of how the autonomic nervous system can effect your gut on our Pelvic Messenger podcast.
So you’ve read this far. You may now be feeling stress about being stressed, which definitely was not the intention of this blog post. Stress is part of life. Parents get sick, our kids get into trouble, money gets tight, life can be stressful. We simply cannot control events and the actions of other people that contribute to our stress. I call these things exogenous stressors, or stress that is occuring outside of ourselves. What we can attempt to control is how we react to those exogenous stressors.
That’s where mindfulness can be so helpful. Mindfulness can allow you to look at a problem without spiraling into extra stress. Let me give you an example. Say your boss gives you some negative feedback about a project at work. You can take the feedback at face value and use it as a tool to improve future projects or you can go down the rabbit hole. You can tell yourself that your boss not only didn’t like your performance on your project, but also doesn’t like you. You can create a narrative that you are inherently bad at your job, are on the verge of being fired, will not be able to afford to live in your house and so on and so on. The place you can take yourself in your mind can be so far from what actually happened. Travelling to those places can allow you to stress about things that haven’t happened or may never happen.
A way I personally learned mindfulness was through a smartphone app. I personally used Calm but 10% Happier, Buddify, and Headspace are also great. Getting into the practice of mindfulness takes… well… practice. I suggest giving it a full three weeks before throwing in the towel. There is no one cure for everyone and it is not a reflection on you, yourself personally if mindfulness is not your cup of tea.
Exercise is another great way to blow off some stress. Honestly, any exercise you do is good but throwing in some meditative movement practices to your repertoire can help up the returns you get from exercise. Meditative movement practices like Pilates, Yoga, Qi Gong, and Tai Chi have been shown to offer a host of benefits for the body and soul.
Here’s the thing. Sometimes we can shake the weight of stress ourselves. That’s when having a professional help can be so life changing. Mental health professionals can not only lift the burden of how we react to stress, but by teaching us to manage our stress responses, they can help set the stage for real and profound healing to take place and augment your treatment at someplace like Beyond Basics Physical Therapy.
As I wrap this blog up, I ask you to make time for you. Your health and sense of well-being are one of your life’s most valuable commodities and you are worth it.
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.
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 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.
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.
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.
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 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.
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.
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.
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.
American Cancer Society’s Guide to quitting smoking:
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
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.
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
Increase 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.
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)
Kamamoto C. Inflammation and gastrointestinal candida colonization. Cur Opin Microbiol. 2011;14(40): 386-391
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
Change of nipple orientation
Discharge from nipple
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.
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).
Victoria 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
Board-Certified Clinical Specialist in Orthopaedic Physical Therapy (OCS)
Certified Functional Manual Therapist (CFMT)
The new year is in full swing, and many of us have set goals to help start things off with renewed energy. One area in which, many people make goals in is health. While some folks vow to go to the gym regularly, or eat healthily, many other individuals commit to having medical check-ups, or taking care of a long-festering issue, such as a painful knee or abdominal pain. No matter what type of healthcare provider you are visiting, it is imperative that you come prepared to make sure you are getting all the facts, and are able to advocate for yourself to ensure you are receiving the best treatment for you.
Come with a Plan
One way you can advocate for yourself is to come prepared to a medical consultation by bringing a list of questions and subjective information with you. Be prepared to discuss what is bringing you to see that health care provider. What symptoms you might be experiencing? When these symptoms began? What makes you feel better and worse? How your symptoms make you feel limited in your daily life, and what you are hoping to get out of seeing that practitioner (i.e. a referral to a specialist, pain relief, etc.,.)? Many questions can arise during a medical examination, so don’t be afraid to ask for clarification, and make sure you understand the information you have been given. Research has shown, that individuals who ask specific questions about their health, may receive more comprehensive care. For example, in a 2015 article from the Journal of Family Medicine and Community Health, researchers found that when older patients were more proactive with communication to their doctors, primary care physicians were more likely to recommend both cancer screening and cancer prevention to their patients.1
On Second Opinions
When you receive a medical result, do not be afraid to get a second opinion. People seek out second opinions for various reasons: to get reassurance on a treatment protocol, to confirm the findings of a particular healthcare provider, to verify the reputation of a given institution, and even due to patient dissatisfaction in the communication or relationship with a practitioner.2-3 Whatever your reason, know that it is your right to have a second opinion to ensure you are getting the best possible care. Some research has found that second opinions have changed the diagnosis and/or course of treatment. In two studies that look at different patient populations with cancer, they found that in cases where a specialized practitioner was consulted, the accuracy of initial staging for a diagnosis increased, treatment and management of the condition was affected in about 20% of cases, and unnecessary surgeries were prevented in about 7% of cases.4-5 Thus, getting a second opinion can be very beneficial to you. Whether it changes the course of a treatment, or simply reinforces what you have already been told, seeking a second opinion can help you make educated decisions regarding your care.
Consider Both Risks and Benefits
If you are given a diagnosis and are informed of your treatment options, make sure to ask about, and consider, the risk-benefit analysis for each. The “risk-benefit analysis” is defined as “the consideration of whether a medical or surgical procedure, particularly a radical approach, is worth the risk to the patient as compared with possible benefits if the procedure is successful.”6 What this means is, it is important to weigh any treatment’s potential outcome on your quality of life, as well as your values and goals, when determining what route of care you’d like to embark on. If the risks outweigh the benefits for you personally, then it may not be a treatment worth trying. However, that is a very specific and personal decision, that must occur between you and those close to you, under the guidance of your health care provider.
Prevent Illness Before it Happens
While it is very important to be well-informed and prepared for a visit so you can better advocate for yourself, taking steps to prevent illness or injury in the first place, is crucial to promote overall well-being. Two major changes you can make in enhancing your health are diet and exercise. According to the Dietary Guidelines for Americans, 2015-2020, 117 million individuals, which is about half of all American adults, “have one or more preventable chronic diseases,”7 which include cardiovascular disease, high blood pressure, type 2 diabetes, some cancers (i.e. colorectal and postmenopausal breast cancer), and poor bone health. Theses chronic diseases are related to poor quality eating habits and physical inactivity. Furthermore, more than two-thirds of adults, and nearly one-third of children, are overweight or obese, which is associated with increased health risks and higher healthcare costs.7 Key recommendations for a “healthy eating pattern” include: eating a variety of vegetables, fruits, grains, proteins, and oils, as well as fat-free or low-fat dairy, while limiting saturated fats, trans fats, added sugars, and sodium.7 Research has found that most Americans do not eat enough fruits and vegetables. However, those that do tend to eat more fruit at breakfast and in snacks throughout the day, while more vegetables are consumed at lunch and dinner.8 This is something that can be added to your routine easily to ensure you are consuming a balanced diet.
As previously mentioned, physical inactivity can contribute to poor health; however, engaging in regular physical activity helps improve your overall health and fitness, and reduces your risk for many chronic diseases. According to the 2008 Physical Activity Guidelines for Americans, adults aged 18-64 need at least 2 hours and 30 minutes of moderate-intensity aerobic activity (i.e. brisk walking), and at least 2 days of muscle strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, arms). The same recommendations are given to older adults over the age the 65 years.9 That may sound like a lot of time that you don’t have; however, the CDC reports that engaging in aerobic exercise for even 10 minutes at a time can be beneficial.9 So get on your walking shoes and start power-walking to your appointments, or to the breakroom at work!
Ok. That was a lot of information, so here is a recap:
Being well-informed and prepared with questions for medical consultations allows you to better advocate for yourself, and may help you to receive more comprehensive care.
Seeking a second opinion, especially when considering a major medical procedure, is something that is your right as a consumer, and can impact your diagnosis and/or course of treatment.
Considering the risk-benefit of any medical or surgical intervention is important to ensure that a given treatment is appropriate for your quality of life, values, and goals.
While being educated and engaged when dealing with a medical concern is important, helping to prevent illness or injury through diet and exercise are critical for maintaining a healthy life.
If you are saying to yourself, “this is too overwhelming; there is no way I can do this!”, then I will leave you with a quote from Audrey Hepburn: “Nothing is impossible. The word itself says I’m possible!” You have the information; now it is time to get out there and start leading a healthy life, so the energy and inspiration of the new year keep ringing all year long!
Kahana E, Lee JE, Kahana B, Langendoerfer KB, Marshall GL. 2015. Patient planning and initiative enhances physician recommendations for cancer screening and prevention. J Fam Med Community Health, 2(9), pii 1066.
Mordechai O, Tamir S, Weyl-Ben-Arush M.2015. Seeking a second opinion in pediatric oncology. Pediatr Hematol Oncol; 32 (4): 284-9.
van Dalen I, Groothoff J, Stewart R, Spreeuwenberg P, Groenewegen P, van Horn J. 2001. Motives for seeking a second opinion in orthopaedic surgery. J Health Serv Res Policy, 6 (4): 195-201.
Sawan P, Rebeiz K, Schoder H, Battevi C, Moskowitz A, Ulaner GA, Dunphy GA, Mannelli L. 2017. Specialized second-opinion radiology review of PET/CT examinations for patients with diffuse large B-cell lymphoma impacts patient care and management. Medicine, 96 (51), doi: 10.1097/MD.0000000000009411.
Lakhman Y, D’Anastasi M, Micco M, et al. 2016. Second-opinion interpretations of gynecologic oncologic MRI examinations by sub-specialized radiologists influence patient care. Eur Radiol;26:2089–98.
U.S. Department of Agriculture & U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2015-2020. Washington, DC: U.S. Government Printing Office; 2015.
Moore LV, Hammer HC, Kim SA, et al. 2016. Common ways Americans are incorporating fruits and vegetables into their diet: intake patterns by meal, source and form, National Health and Nutrition Examination Survey 2007-2010. Public Health Nutr; 19 (14): 2535-9.