PH101: Running to the bathroom, again?

By Fiona McMahon, DPT

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Do you find yourself with a full map of every public restroom along your daily commute in your head? Do you find yourself competing for the aisle seat at movies so you can sneak away to the bathroom? Does it hurt to go? Do you get up multiple times a night? If you answered yes to any of these questions, this week’s Pelvic Health 101 is for you.

On Thursday, March 23 at 7pm, join Stephanie Stamas, physical therapist at Beyond Basics Physical Therapy, for all of the ins and outs of bladder health. Learn how the bladder works, common bladder disorders, and practical tips for helping your bladder symptoms. Light refreshments will be served.

Register at pelvichealth-101.eventbrite.com  today.

Location

110 East 42nd Street, Suite 1504

New York, NY

10017

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March 6th is Lymphedema Awareness Day!

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Victoria LaManna PT, DPT, CLT

March 6th is Lymphedema Awareness Day! The lymph system carries the body’s waste products, dead pathogens, and water. Eventually these substances are cleared by the body. Problems can occur if the lymph system gets blocked and cannot clear these substances. Problems with the lymphatic system can cause swelling in affected limbs, and sometimes pain, as well as fibrotic changes in the skin.

You can be born with issues in your lymph system which can cause primary lymphedema or you can have damage to your lymph system because of surgery or radiation treatments, especially for breast cancer.

If you are living with lymphedema, try these tips from the Mayo Clinic to keep your limbs as healthy as possible:

  • Avoid injections, vaccinations, blood pressure monitoring, or IV’s on the affected limb
  • Don’t wear tight fitting clothing or jewelry
  • Avoid exposure to extreme temperatures, like hot baths, or saunas
  • Monitor your affected limb for signs of infection, and go to the doctor if you suspect infection

 

You can also check out our list of Self Care Tips 

Physical therapy can help manage lymphedema, which requires a very specialized lymphedema certified therapist.  At Beyond Basics Physical Therapy, we are lucky to offer lymphedema treatment with our own Certified Lymphedema Therapist, Victoria LaManna, PT, DPT, CLT . If you are interested in starting your lymphedema treatment journey, call and make an appointment with Victoria today!

For more reading on lymphedema, check out our previous blogs:

Lymph Drainage  Therapy for Breast Health at Beyond Basics Physical Therapy

Beyond Basics’, Victoria LaManna Receives Lymphatic Drainage Therapy Certification

 

Sources
Ness S. Living with lymphedema: Take precautions, get support. 2011. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/cancer/expert-blog/lymphedema-management/bgp-20056387. Accessed February 10, 2017

Spring Pelvic Health 101 is Coming

Fiona McMahon, DPT, PT

Pelvic Health 101 is back with some old favorites like, “Something’s wrong with my what?” and “Why is pooping so difficult?” We have also added a new course on pediatric pelvic floor issues.

If you have questions, we have answers. Join us for lectures and question and answer opportunities with expert pelvic health physical therapists, childbirth educators, and nutritionists. Please reserve your spot early at pelvichealth-101.eventbrite.com. Remember spots fill up quickly. As always, light refreshments will be served.

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BBPT Health Tip: HOT or COLD? That is the Question

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Fiona McMahon, DPT.

 

What’s better, heat or ice? This is a question that most medical/health type professionals get all the time. The answer is, it depends. Both have fabulous benefits for different sets of circumstances. Let’s explore these cheap, safe and effective pain relievers.

Heat

In the biz, ( no one calls physical therapy “the biz” yet, but if I try hard enough, it may stick) we call heat, thermotherapy. Fancy, right? Thermotherapy is great for pain that is a result of a trigger point, or muscle spasm. Think deep neck, back pain, or pelvic pain. It’s great for menstrual cramps and can  create a nice soothing effect.

For any active inflammation or infection however, heat can be harmful and can actually make it worse. You do not want to place heat over joints affected by autoimmune disease like rheumatoid arthritis. It’s also not good for new, fresh injuries, like a muscle strain or a injury from a fall. Heat is really good for chronic long standing pain conditions.

Heat comes in types, dry and moist. Dry is the kind that’s emitted from like an electric heating pad or a microwaved heating pad. Sometimes people may find that dry heat, dries out the skin. Moist heat comes from things like moist towels or moist heating pads (these are the kind we use in our clinic). Moist heat tends to penetrate deeper into the muscles.  

 

Safety Considerations for Heat:

  1. Don’t over heat. Sounds simple, but in the throes of severe pain, many people may find themselves with the more is better mantra.  It’s not.
  2. Don’t apply to open wounds, on individuals with peripheral vascular disease, deep vein thrombosis, or on people with reduced sensation or ability to remove the hot pack.

 

Cold

Physical therapists have a fancy name for this one too. It’s cryotherapy. Sounds super futuristic doesn’t it? Ice is awesome. It really is. It is great for acute (recent) injuries like a sprain or a strain. There are actually studies that show that ice within 36 hours of injury speeds recovery better than heat. Ice can reduce pain in the area it is applied, reduce guarding and spasm, and reduce swelling.

 

Safety Considerations for Cold:

  1. Never use on people with reduced sensation, ie. Raynauds, actively healing wounds, circulatory issues, or hypertension
  2. Less is more. Keep cold packs on for 20-30 minutes once every 2 hours on newly injured body parts. Keeping the ice pack on for longer can cause increased blood flow to the area which will reduce the helpful effects of the ice.

When in doubt as to if you should use cryotherapy or thermotherapy, consult with your physical therapist or healthcare provider.  At Beyond Basics we treat injuries beyond those to the pelvic floor and we can help with your injury questions. You can also find a physical therapist with the APTA’s PT finder tool

Prostatitis What it is and What to do About it

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Fiona McMahon DPT

Introduction

Prostatitis is a common diagnosis we see at Beyond Basics Physical Therapy. If I have a new evaluation on my schedule, who is male and between the ages of 18-40, we can place a pretty good bet that they are coming to see me for issues pertaining to non-bacterial prostatitis. It is estimated that 35-50% of men are reported to have prostatitis symptoms  in their lifetime (Rees). Prostatitis can be classified into different types based on their causes and response to treatment. Prostatitis is a vexing condition for many patients. In cases of non-bacterial prostatitis, which makes up 95% of all prostatitis, it’s often very difficult to determine what brought it on, and often times our patients have been bouncing from practitioner to practitioner trying to find answers and effective treatment. Let’s dive into the causes, symptoms, and treatment in order to help shed light on this condition.

 

Prostatitis Symptoms,

Although there are different types of prostatitis, the symptoms of prostatitis are mostly the same between types. That isn’t to suggest that every man with prostatitis experiences the same symptoms, quite on the contrary. Men with prostatitis may experience almost all of the symptoms listed below or they may only notice one or two. This melange of symptom possibilities can add to the confusion of having prostatitis and getting down to an effective cure.

 

Symptoms:

  • The sensation of having a golf ball stuck in the rectum
  • Hesitant urinary stream (having trouble getting the urine to start flowing)
  • Post void dribble (spotting of urine on underwear following voiding)
  • Pain that radiates into the abdomen (this is one of the differences from symptoms of benign prostatic hyperplasia)
  • Erectile dysfunction and decreased libido
  • Painful ejaculation
  • Painful or burning urination
  • Genital pain: penile, testicular, groin and perineal pain

 

Types of prostatitis:

Here’s where it gets a little more complicated. There isn’t one type of prostatitis. There are four. Each type of prostatitis is a little different in terms of etiology (how it developed) and how it’s treated.

Type 1: Acute bacterial prostatitis

This type of prostatitis is caused by an infection by a microbe. It is relatively rare. In addition to the symptoms above, a person with this type of prostatitis will feel the symptoms of an ongoing infection, including pain in the body, fever, and chills. This type of prostatitis generally response well to antibiotic treatment.

Type 2: Chronic bacterial prostatitis

Chronic bacterial prostatitis can occur after multiple infection or when there is an ongoing low grade infection. The symptoms, particularly those of infection are dampened in this form of prostatitis than those of type 1. Type 2 is often more tricky to treat and may require multiple courses of antibiotics

Type 3: Chronic Prostatitis/ Chronic pelvic pain syndrome (the most common making up 90-95% of all prostatitis and WHAT WE TREAT!)

This type of prostatitis occurs with no evident infectious cause and makes up the majority of cases. This is the classification that is one of the more frustrating for patients to deal with because the causal agent is much harder to ascertain; however the majority have musculoskeletal dysfunction, which we now know can be treated effectively through expert pelvic floor physical therapy.  Type III prostatitis can be further categorized based on the presence or absence of white blood cells in the urine or prostatic fluid, inflammatory and noninflammatory respectively.

Type 4: Asymptomatic inflammatory prostatitis

As the name implies, this type of prostatitis is usually not noticed unless semen or urine analysis is being performed to diagnose another condition. Typically this type is left untreated.

 

Causes

Here’s one of the universal questions that patients with prostatitis have: “why do I have this?”  Sometimes patients may find themselves blaming their prostatitis on something they have done in the past, like masturbating or poor hygiene habits as children. The fact is, prostatitis can occur for a multitude of reasons, and it’s usually something one has no control over like a fall on the bottom or an infection. It’s unfortunately something that happens, and as noted in the introduction of this blog, it is quite common. Here are some possible causes:

 

  • In chronic nonbacterial prostatitis/ chronic pelvic pain syndrome 90-95% of cases- no definitive cause ( or very difficult to ascertain); however pelvic floor dysfunction is a prevalent contributor.  
  • Bacterial infection, which can have good results with antibiotics
  • Chronic bacterial prostatitis, recurrent infection
  • Inflammation to the pelvic area
  • Central and peripheral sensitization- meaning a past injury in the area caused your pelvic nerves to perceive non painful stimuli as painful
  • Trigger points (irritable points of muscle) in the pelvic floor and abdomen

 

Treatment

Treatment is evolving in prostatitis. Increasing evidence supports a multimodal approach to treating prostatitis and its symptoms, meaning that not only is medical intervention used, but psychological, nutritional, and physical therapy.

From a medical perspective the first line of treatment for prostatitis is the “3 A’s”, antibiotics (especially the quinolone class), anti-inflammatories, and alpha blockers. Antibiotics obviously clear up any infection that might be causing your symptoms, anti-inflammatories to bring down the pain and discomfort, and alpha blockers to improve urine flow. Sometimes this is just what the doctor ordered (literally), especially in individuals with type 1 prostatitis and they are on their way with no further treatment needed. Since the vast majority of people with chronic prostatitis fall outside of the type one category and into more difficult to treat types, their recovery may require a more involved intervention to effectively treat their symptoms and the 3 A’s may not be the answer, or the complete answer for these patients.

 

Physical Therapy: Anderson and his colleagues described the relationship between the presence of myofascial trigger points and symptomatic prostatitis. They also showed that physical therapy intervention, including manual release of these trigger points was effective in reducing symptoms of prostatitis. The benefit of physical therapy was shown again to be more effective than placebo in a 2011 paper by Nickel. In addition to treating the trigger points themselves, PT’s work to determine what lead up to the formation of the trigger points in the first place, whether that be poor habitual posture, poor strength, or tight muscles in other parts of the body. They also teach patients how to avoid clenching their pelvic floor to prevent exacerbating symptoms.  This type of therapeutic approach was found to be effective in reducing pain in 72% of participants in a study conducted by Anderson and colleagues in 2005. The therapists at Beyond Basics Physical Therapy work to go beyond simple treatment of the trigger points themselves.  We develop plans and treatments to prevent their recurrence in the future.   Some other effective physical therapy techniques that we use include but are not limited to, joint mobilization to assist proper structural alignment, therapeutic exercise, postural and neuromuscular re-education and a detailed and individualized home exercise program.

 

Dietary Modifications:

Avoiding irritants to the bladder and gastrointestinal system is another simple and effective place to start. In some men, avoiding spicy foods, alcohol and caffeine can work wonders in making symptoms more manageable.   

 

Phytotherapy:

Preliminary data shows that there is evidence to support the use of saw palmetto, quercetin and bee pollen extract in reducing the pain of prostatitis. If supplementation interests you, consult with your general practitioner or urologist.

 

Stress Reduction

As clinicians who have seen a lot of cases of prostatitis, high stress is a contributor that we see with the vast majority of our patients. Studies have shown that high levels of stress are correlated with higher pain and disability scores in individuals with prostatitis. Stress can also perpetuate unhealthy holding or clenching in the pelvic floor, which causes or contributes to trigger points discussed earlier in this section. Stress reduction is a key component to expediting your recovery and is something we recommend to nearly all of our patients.

 

Final Thoughts

  • Prostatitis is a common and aggravating condition to be living with, and the fact is, every case of prostatitis is different. You may fall into the category were a course of antibiotics does the trick or you may fall into the category where you require physical therapy alongside medical intervention which can be much more slow going. Regardless of where you fall, be patient, there usually is a lot that can be done to help the more complex cases of prostatitis clear up. If you are suffering with this condition, make an appointment with an expert pelvic floor physical therapist today. There is so much we can do.

 

Sources

Anderson R, Sawyer T, Wise D. Painful myofascial trigger points and pain site in men with chronic prostatitis/ Chronic Pelvic Pain Syndrome. J Urol. 2009;182(6): 2753-8

Anderson R, Wise D, Sawyer T. Integration of myofascial trigger point release and paradoxical relaxation training treatment of chronic pelvic pain in men. J Urol. 2005;174(1):155-60

Chronic nonbacterial prostatitis (chronic pelvic pain syndrome). Harvard Health Publications. Harvard Medical School. 2007. http://www.health.harvard.edu/newsletter_article/chronic-nonbacterial-prostatitis-chronic-pelvic-pain-syndrome. Accessed December 11, 2016

Duclos A, Lee C, Shoskes D. Current treatment options in the management of chronic prostatitis. Ther Clin Risk Manag. 2007; 3(4):507-12

 

Rees J, Abrahams M, Doble A et al. Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline. BJU Int. 2015; 116(4):509-25

 

Nickel J. Prostatitis. Can Urol Assoc J. 2011; 5(5): 306-15

World Aids Day

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Today, December 1st 2016, is World AIDS Day. World Aids Day has been held on the first of every December since 1988. World AIDS Day works to spread awareness of the disease and to remind the general public that AIDS and HIV still must be taken seriously and that there is still a lot of work to do in order to prevent the transmission of new cases, as well as to better care for those who are infected with the disease.

What is AIDS/HIV?

AIDS (acquired immunodeficiency syndrome), is caused by a virus called human immunodeficiency virus (HIV). HIV can be treated in order to prevent AIDS, however there is currently no cure for HIV.

HIV causes AIDS by attacking the immune cells of a person’s body, which can leave a person vulnerable to infections that otherwise would not have made them sick. These infections are referred to as opportunistic infections, an opportunistic infection is a signal that someone’s HIV may have progressed into AIDS.

As said earlier, HIV doesn’t always have to progress to AIDS. Antiretroviral therapy (ART)  can work to help keep the immune system healthy, as well as lower the risk of transmitting the virus to others. People on ART have dramatically improved lifespans. It is imperative to get on ART as soon as possible to lessen the effects the HIV virus has on your immune system.

HIV Testing

1 in 7 people infected with HIV do not know they have the virus. Testing is necessary to start treatment and reduce harm done to your immune system as well as risk of transmission to others.

According to AIDS.gov, you should be tested if:

  • You have had sex with someone who is HIV positive, or someone whose status you were unsure of since your last test
  • Had tuberculosis or hepatitis
  • Used shared needles
  • Been diagnosed with another type of sexually transmitted disease

HIV/ AIDS and Physical Therapy

Physical Therapists do not treat AIDS or HIV, rather, they treat the symptoms of AIDS/HIV and HIV/AIDS treatment to allow patients to live as fully and independently as possible. Both the disease itself and the treatment for it have effects like increasing fatigue, decreasing strength and endurance, and increased pain. Physical therapy can help by tailoring programs to help with pain, ability to perform everyday tasks, improve heart health, balance, endurance, strength and flexibility.

You can mark today by doing a number of things:

Wear a red ribbon to spread awareness

Donate to groups that work to help people living with AIDS and help to prevent its transmission:

United Nations (UN AIDS)

https://donations.unaids.org/

UNICEF

https://www.unicefusa.org/donate/support-unicefs-hivaids-programs

Sources:

AIDS.gov

Resources:

HIV/Screening:

National HIV Testing database: https://gettested.cdc.gov/

Lymph Drainage Therapy for Breast Health at Beyond Basics Physical Therapy

Victoria LaManna, PT, DPT, CLT

lymphAs Breast Cancer Awareness Month comes to an end, we at Beyond Basics are working hard to help spread the word on the importance of regular self-examination and early detection. For further review, please see our blog post from earlier this month.

In addition to regular self-examination, regular breast massage is shown to help increase the circulation in your breasts. Therapeutic breast massage can also lessen discomfort associated with breast cancer treatments, help relieve post-surgical symptoms, and reduce discomfort during pregnancy, breastfeeding and weaning. Breast massage also contributes to improved skin tone while promoting relaxation and balancing your energy.
With regular massage, you will help diminish benign breast cysts while helping to flush lymph nodes and stimulating your glandular system. The breasts are soft tissue and do not have muscles to help them move, therefore they require assistance for improved circulation and lymph flow.
If you have been diagnosed with breast cancer and have undergone lymph node removal, mastectomy and/or radiation, you may experience lymphedema. About 15-20% of women who have axillary lymph nodes removed during breast cancer surgery will develop lymphedema. Working closely with your medical team to manage lymphedema is key! A Certified Lymphatic Therapist (CLT) can effectively apply gentle hands-on techniques to help enhance circulation and drainage.
Lymphedema is an accumulation of protein-rich lymphatic fluid in the tissues that contributes to swelling secondary to blockage in lymphatic flow when nodes or vessels are damaged. Individuals who have lymphedema may complain of discomfort in the affected limb, feeling of fullness in the limb, fatigue, or decreased flexibility. They may also complain of breast pain, tight-feeling skin, difficulty fitting into clothes, or tightness when wearing rings, bracelets, or watches. Venous insufficiency and obesity can contribute to lymphedema.

Complete Decongestive Therapy (CDT) consists of Manual Lymphatic Drainage (MLD) that aids in the circulation of body fluids, drains toxins from the body, stimulates the immune system and the parasympathetic system, reduces pain and/or muscle spasms, increases ROM, and decreases swelling. CDT can be used to treat conditions such as post-surgery and scars, fibromyalgia, chronic fatigue syndrome, infertility, painful periods, constipation, and irritable bowel syndrome. In conjunction, it is important to have an exercise program of stretching and strengthening to get the maximum benefits of CDT. After treatment, the patient may experience increased urinary frequency or increased amount of urine, increased sleep time or better quality of sleep, tension release and/or emotional release, or improved senses.

If you are seeking treatment, you need to see a licensed healthcare provider that is trained in Lymphedema Drainage Therapy. To find a specialist in your area, go to www.apta.org and click on “Find a PT”, specializing in LDT. Alternatively, you can search through the National Lymphedema Network or the Lymphatic Association of North America (LANA).

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 as on our website at: www.beyondbasicspt.com/lymphedema.