PH101: Something’s Wrong with my What?

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Image via PlayBuzz

On March 16, 2017 at 7pm we will be kicking off our spring semester of pelvic health education class, we call Pelvic Health 101 (PH101). In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health and function of your bowel, bladder, and sexual functioning. We will also be covering how things such as alignment, posture, muscle tone and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.

Please join us at our office at:

110 East 42nd Street, Suite 1504

New York, NY 10017
Register at: pelvichealth-101.eventbrite.com

Here is our line up of this and future classes:

pelvic-health-101-spring-2017

September is Prostate Cancer Awareness Month

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Fiona McMahon PT, DPT

September is Prostate Cancer Awareness Month. Here at Beyond Basics Physical Therapy, we treat many men both before and after treatment for prostate cancer. We focus on restoring the health of the pelvic floor and tissue surrounding the prostate to restore normal sexual and urinary function. For more information about how physical therapy can help you or someone you love who is going through prostate cancer, read our blog on prostate cancer: https://beyondbasicsptblog.com/2015/04/07/physical-therapy-and-the-prostate/

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

 

Beyond Basics Physical Therapy

Pre-op/Post op Prostatectomy Program

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

T: 212-354-2622

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

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

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

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

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

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

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

We treat our patients for 60-75 minute sessions in private rooms and use state of the art biofeedback technology.   If you have specific questions, please do not hesitate to contact us.

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

Beyond Basics’, Victoria LaManna Receives Lymphatic Drainage Therapy Certification

victoria2016Victoria La Manna, PT, DPT, CLT of New York, NY successfully completed Norton’s School of Lymphatic Therapy’s Lymphedema Certification Program. The certification signifies advanced skill in the application of complete decongestive therapy (CDT) in the treatment of lymphedema.

Lymphedema is the abnormal accumulation of protein rich fluid due to a disorder of the lymphatic vessel or nodes. It is a chronic condition that will usually worsen over time if left untreated. Complex Decongestive Therapy is the conservative treatment of choice for lymphedema and is reimbursable in New York by medical insurance. CDT involves a regimen of manual therapy, medical compression (bandaging, wrapping of the area), skin care, aerobic conditioning, and isotonic exercises done during the therapy session and at home.

Manual Lymphatic Drainage (MLD) Therapy is a gentle hands-on modality used to stimulate lymph flow and its specific rhythm, direction, depth, and quality over the entire body. This technique is used to aid excess lymphatic fluid to healthy neighboring territories and return it to the intact lymphatic system. The effects of MLD consist of:
• Relaxation, analgesic, diuretic
• Increases performance of the lymphatic system
• Re-routes fluid from congested area
• Softens connective tissue

MLD may also benefit these conditions:
• Lipedema
• Phlebo-lymphostatic
• Post-trauma or post-surgical swelling and healing
• Chronic Regional Pain Syndrome (CRPS)
• Cyclic-Idiopathic Swelling
• Inflammatory Rheumatism
• Migraine Headache
• Sinus Headache
• Scleroderma
• Chronic Fatigue
• Fibromyalgia
• General Relaxation

Victoria La Manna, PT, DPT, CLT earned, and successfully received, the 140-hour Lymphedema/CDT Certification which fulfills the requirements to sit for the national certification testing with the Lymphology Association of North America (LANA). Dr. La Manna is an expert physical therapist at Beyond Basics Physical Therapy, which is located in midtown Manhattan. She began, and is currently the head physical therapist for, the Lymphedema Program, which addresses the upper and lower extremities and the trunk region in men, women, and children. She is a member of the Women’s Health and Orthopedic sections of the American Physical Therapy Association and the National Lymphedema Network. Victoria is also a member of the National Vulvodynia Association and the International Pelvic Pain Society.

Welcome Our New Intern, Denise!

By Fiona McMahon, DPT

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On the journey towards becoming a physical therapist, you have to take a lot of classes, days are long and the studying can be more than a little bit arduous. After you build up a sufficient base of knowledge in school, you get to round out your education by getting the experience to learn hands on in the clinic. Beyond Basics takes a Physical Therapy student every year with an expressed interest in the specialty of pelvic floor rehabilitation. We’ve had many students throughout the years, and both myself and Stephanie Stamas did our training here as students.

This year, our student is someone who is already close to the Beyond Basics family. Denise Small has been a Pilates instructor at BBPT for years and has played an integral role in helping our patients get back to their active lifestyle during and after treatment for pelvic floor dysfunction. When Denise decided to go to physical therapy school we were so excited, and we are so glad to have her back in the practice in her new role!

What made you want to go into physical therapy?
Physical therapy has been a constant part of my life. As a professional ballet dancer, I saw physical therapists who helped me recover from  injuries, maintain healthy joint and muscle mobility. While I was a professional dancer in NYC, I realized I needed a job on the side to make money while I wasn’t performing. I decided to get my Pilates certification because the schedule could be flexible and it was training that I had practiced as a dancer. My Pilates teachers were Certified Movement Analyst (CMAs) from the Laban school, and they approached Pilates training in a very unorthodox way. They were interested in using the Pilates method to help people with chronic pain issues and dancers who wanted to investigate their full movement potential. My teachers introduced me to really amazing PTs who went out of the box of traditional treatment, and using movement analysis to help heal chronic movement dysfunction.

Eventually, I came to the conclusion that I wanted to retire from dancing, which is a whole other story. I wanted to transition into something that I would be as passionate about as I was performing. I wanted something that would involve movement and movement analysis, but also something that had job stability, salary, health insurance, etc.  Add all those together and PT seemed like the obvious answer to me.

You have a pretty fascinating background outside of physical therapy, can you tell us what other work experiences you have had and how they shape you as a physical therapist?
Thank you! I think my experience in jobs that were centered around movement, dance and Pilates,  have influenced the way that I work with patients. My main concern is getting people to move more and to enjoy movement. We live in a three dimensional world with many different planes and directions to explore. I feel that most people only explore what’s directly in front of them, and maybe occasionally what’s behind them and what’s to their side. I believe that if people explored different heights, levels, and directions, they can break their habitual patterns and with them their chronic aches and pains.

I also believe that my undergraduate studies in psychology have helped me tremendously in my teaching skills. Realizing that there are many different personalities that are shaped by many different experiences, helps me to teach each patient in whatever way helps them best receive whatever information I have to offer. Basically, it taught me to be flexible to people’s different personalities and learning styles.

Pelvic floor rehabilitation is a pretty advanced specialty for someone to take on while they are still in PT school. What made you want to undertake such a challenge?
I’m glad you said that. It is a very difficult and complicated subject to explore for a PT student! But I think my age (I’m 36) and my life experience help me to be able to handle and understand all the different variables that go into having pelvic dysfunction. Also I am a survivor of pelvic pain and I received the benefits of what pelvic floor therapist are capable of. I, like a lot of the patients that come to BBPT, saw a few different doctors, body workers, and acupuncturists to try and relieve the pain I was feeling, but no one was able understand or help until I went to Physical Therapy. I want to be able to pay that gift forward and help others who are suffering from that type of pain.

Where did you go and what did you do for your other clinical experiences?
I have had some really wonderful experiences. At my school your affils are established by lottery, so I didn’t know what I was going to get. I was really lucky. I know not all students can say that. My first affil was at King’s County Hospital in East Flatbush, Brooklyn. It was in both inpatient and outpatient settings. I saw so many amazing cases there, working with people who had amputations, gunshot wounds, rare neurological conditions, the specific cases were fascinating and provided me with a wide breadth and depth of understanding of these conditions.

After that I was in an outpatient clinic. This clinic was the type of place you imagine when you think physical therapist’s office. I had a really great clinical instructor (CI), who was very knowledgeable and I appreciated having such a talented CI to guide me. After that, I was at Mt. Sinai on the Upper East Side in the Traumatic Brain Injury Unit. It was incredible. Again, I had such amazingly talented clinical instructors. I learned so much and I really enjoyed the patient population. In the inpatient setting with TBI patients, you are a part of restoring their basic functions like walking, sitting, standing. It was so humbling to watch these patients work so hard to achieve skills that we often take for granted. Mt Sinai was probably my most favorite of the three.

What advice do you have for an aspiring physical therapy student?
Honestly, I would say to establish a movement practice for yourself, meaning start a regime in which you can gain a deeper understanding of your own body, like yoga, Pilates, gyrotonics, tai chi, etc. If you have a deeper understanding of your own body, you can better understand how movement patterns can limit or enhance your patient’s functioning. With that knowledge not only can you have a better understanding of how to treat your patient, you can also be more empathetic toward their healing process.

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The Pain of Falling

By Fiona McMahon

I want to talk about a health risk that is seldom thought of when we think about health, falls. According to the CDC, elderly men are the most likely to pass away from a fall. White men in particular, are at risk for falls and are 2.7 times more likely to fall than their black men. Falls are the leading cause of both fatal and non fatal injuries in older women and men.

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There are simple steps you can take to limit your fall risk. A good first step is having your primary care provider review your current medications, both prescription and over the counter. You may find you are on many medications that treat the same thing. Your doctor can help determine if this is the case. Some medications, for example those that cause dizziness, can increase your risk of falls and your doctor may want to adjust them.

Another important step to minimize your fall risk is to have regular eye exams. Vision is an important part of our balance system and as we age, we may grow increasingly reliant on it. The CDC also advises seniors to get single distance lenses for outside activities like walking.

Modifications can also be added to your home to make it safer.  Adding additional handrails to your stairs, removing area rugs, adding non slip mats to your bathtub, and keeping your home neat and free of debris are all great steps to improving your overall safety.

One of the most important components in reducing your fall risk is remaining active. The old adages, “a body in motion, tends to stay in motion” and “use it or lose it” could not ring more true. Sarcopenia is the term that’s given to the gradual loss of muscle one experiences as he or she ages. We can begin slowly losing muscle fibers as early as 30 years old! With the gradual loss of muscle tissue we gradually lose strength and it becomes much more difficult to do things that were once previously easy.  Weaker muscles will make it harder to keep your balance. Remaining active and making sure you are eating enough of the right food can go a really long way towards slowing your rate of muscle loss as you age.

Even if you are not very active now, there are simple steps you can take toward reducing the rate of age-related muscle loss and maintaining your functional independence. Adding in more walking is a relatively easy thing to do. If you live in the city, get off the bus or subway a station early and walk the extra distance. You can also do your shopping at a bodega further away from your apartment. If you are a suburban or country guy or gal, park your car a little further away from the grocery store.

Another great idea is doing a little extra work when you get up out of a chair. Being able to get out of your chair by yourself is an important skill to maintain your independence. When you get up out of your chair, sit back down and get up a couple of extra times. This is like doing a mini-squat. “Sit-to-stands” as they’re called, are lovely exercises that strengthen all of your thigh muscles without having to go to the gym!

If you have fallen in the past year you are at risk for future falls. Medicare requires physical therapists to incorporate fall training into your plan of care if you have had a fall in the past year or demonstrate a risk for falls as determined by your physical therapy examination.  Physical therapy doesn’t just teach you skills that improve balance, it can also teach you potentially lifesaving skills like being able to get up from the floor independently. PTs will also strengthen the key muscles used for balance and give you exercise that gradually train your balance.

Beyond Basics can offer a little something extra to complete your fall training program. If you have incontinence either urinary or fecal, you are at an increased risk for falls. People with incontinence can fall for a multitude of different reasons. They may fall because of slippery floors that occur as a result of an episode of incontinence, or they may trip while rushing to the bathroom. Whatever the reason is, our therapists are specially trained to determine the reason for incontinence and implement a program to correct it.

You don’t have to accept falling, or incontinence, as a natural part of getting older. Whether you decide to start on your own, join a Tai Chi or balance training class at the gym, or whether you decide to seek help from a skilled physical therapist, act now, your health and independence depends on it.
Centers for Disease Control and Prevention. Falls among older adults: an overview. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html.  Last reviewed March 19. 2015. Assessed June 18,2015.

All About Testicles

By Fiona McMahon, DPT

Testicles have long been a symbol of manhood and virility. In fact, the word testis means “witness of virility” in Latin. They help produce the hormones that transition a boy into a man. They are responsible for a man’s body hair, the growth of his genitals, and his sex drive. Testicles are fascinating organs and play an integral role in all men’s lives whether they are actively thinking about them or not.

Testicles are gonads. Gonads are sex organs that produce sex cells.  Men produce sperm and women produce ova (eggs). Testicles also produce the hormone testosterone, which as stated earlier is responsible for a man’s secondary sex characteristics, like body hair, muscle bulk, and sex drive.

Testicles are housed in the scrotum, a sack of skin just behind the penis. Within the scrotum, the testicles are covered by a fibrous sheath called the tunica vaginalis and tunica albuginea. The testicles are composed of many tightly bound tubules called the seminiferous tubules. These tubules give the testicles their uneven feel. Each testicle is held in the scrotum by the spermatic cord, which is composed of the vas deferens, blood vessels, and lymph vessels.

Anyone who has watched an Adam Sandler movie knows that testicles are delicate and sensitive creatures. Even just a jostle can be enough to double a man over in pain. But sometimes your testicles may hurt for no apparent reason.  Acute scrotum is the technical name given to sudden onset testicular pain without swelling. There are many medical reasons your testicles may hurt.  Testicular pain can be a serious condition and should not be ignored.

Testicular torsion is a medical emergency that requires immediate treatment in order to save the testicle.  Testicular torsion is most common in males under the age of 25. It occurs when the spermatic cord twists cutting off blood supply to the testes. Usually testicular torsion is spontaneous and cause pain great enough to wake a man or boy out of sleep and induce vomiting.

In some males testicular torsion is contributed to by what is known as a bell clapper deformity. A bell clapper deformity occurs when there is a lack of fixation in the tunica vaginalis. Because of this lack of fixation, the testis is free to rotate around on itself and obstruct blood flow. Bell clapper deformities are present in 12% of males and in males with bell clapper deformity 40% have bilateral derformity. In neonates, extravaginal torsion can occur when the tunica vaginalis and the testes both twist in the inguinal canal. Any case of sudden and severe testicular pain should be considered testicular torsion until proven otherwise and treated as a medical emergency.

Testicular cancer is usually painless but in 20% of cases pain can be a symptom. The pain caused by testicular cancer is typically due to hemorrhage. In the overall population testicular cancer is relatively rare, however it is the most common form of cancer in young males between the ages of 15 and 35. Signs of testicular cancer include a dull ache in the abdomen and groin, heaviness in the scrotum, lump in the testicle, enlargement of the breast tissue, or back pain. Any of these symptoms warrant a visit to your general practitioner.

So what about testicular pain that is not cancer or testicular torsion? Testicular pain can also be caused by other medical conditions like epididymitis, orchitis, urinary reflux, urinary tract infection, or sexually transmitted infection. Again as stated before, any acute testicular pain that occurs out of the blue warrants immediate medical attention.

There are some men however who suffer from acute and recurrent testicular pain for which a medical cause has not been established. For these men, not having concrete answers for what is going on can be especially distressing. In a paper by Anderson and colleagues, trigger points elsewhere in the body have been found to cause pain in the testicles, shaft of the penis, and other areas in the genital region.

Trigger points are defined as areas of hypersensitive and painful spots within the muscle that can be felt as a tough or tight band. In their study, Anderson and colleagues found that testicular pain could be elicited in 80% of men with testicular pain with no other medical cause, when trigger points in the external obliques were palpated. The study also found other trigger points referring to the shaft of the penis, and the perineum (the bicycle seat area of the body). Myofascial restrictions can refer pain to testicles as well as reduce blood flow to the genitals, making erections difficult or painful.

Irritated nerves can also be the cause of testicular and penile pain in men. The pudendal nerve is most commonly associated with male pelvic pain. The pudendal nerve supplies sensation to many of the pelvic structures including the penis, scrotum, and anorecatal region. This nerve can become inflamed or strained for a variety of different reasons. Straining with constipation, boney alignment that stresses the nerve, as well as tight ligaments and muscles that surround the area can all stress the pudendal nerve and cause scrotal, anal, or penile pain.

Other nerves such as the Iliohypogastric can cause suprapubic and gluteal pain. The inguinal nerve can cause pain in the inner thigh, and lateral scrotal skin. The genital femoral is also associated with the skin of the scrotum and thigh.

If you find yourself with testicular or penile pain that has not been resolved with medical intervention, it may be time to find your way to a licensed pelvic floor physical therapist. Physical therapists can work with you to break up your trigger points, provide postural education to correct alignment, reduce constipation with bowel training, and incorporate relaxation and postural changes to prevent your pain from coming back. At Beyond Basics, we have a great team of therapists who treat male pelvic floor disorders who can help treat your testicular pain.

Sources:
Anatomy and physiology of the testicle. Canadian Cancer Society. http://www.cancer.ca/en/cancer-information/cancer-type/testicular/anatomy-and-physiology/?region=on. Accessed June 10, 2015
Anderson R, Sawyer T, Wise D, Morey A. Painful myofascial trigger points and pain sites in men with chronic prostatitis/ chronic pelvis pain syndrome. The Journal of Urology, 182;6 2753-58
Jefferies M, Cox A, Gupta A et al. The management of acute testicular pain in children and adolescents. BMJ. 2015
Mayo Clinic Staff. Testicle Pain. Accessed June 8, 2015. http://www.mayoclinic.org/symptoms/testicle-pain/basics/causes/sym-20050942
Mayo Clinic Staff. Testicular Cancer. http://www.mayoclinic.org/diseases-conditions/testicular-cancer/basics/definition/con-20043068. Accessed June 10, 2015