Pelvic Health & Orthopedic Physical Therapy
Addressing your questions about pelvic, women's, and musculoskeletal health. Health is a journey. Movement is healing!
What are you doing right now? Finishing up work, cleaning, getting ready for the next day? When was the last time you checked in with yourself?
It is so important to tune into your body's needs. Too often we get caught up in the chaos of the world and forget to nourish our bodies. When was the last time you thought about your pelvic muscles? Are they feeling tense? Perhaps they aren't tense, but you never stop to engage them. We don't connect with our pelvis very often. It is so important to build this connection between the mind and the muscles. Understand where your pelvic muscles are. If they feel elevated or tense it is important to engage relaxation and lengthening strategies. If they are feeling weak and lack engagement you need to work in more challenges to these muscles with strengthening. When was the last time you took a deep breath and truly filled your lungs? Place one hand on your chest and one on your belly. Are you breathing with just your chest? Can you fill the abdomen instead? Employing diaphragmatic breathing can help to mobilize your pelvic muscles and stimulate your parasympathetic nervous system to calm your body down. This is one of my favorite strategies to implement in traffic (no hands required once you get the technique). Hydration nation. WATER is crucial to your body and health. Not coffee and tea (though we may feel the need to drink lots of caffeine). No, soda and flavored water aren't the same. Your body loses lots of water throughout the day, but it also requires water to function. Water helps the bladder and gastrointestinal tract to function better. The bladder is covered in muscle. We have to drink lots of water to get the bladder to expand to its full capacity and empty fully throughout the day. If we consistently don't drink enough the bladder capacity can start to decrease. The GI tract also absorbs the fluid from the contents. So if we do not replace the water in our body, the material in the colon does not move as easily through the system. Lastly, MOVE. Move often! The abdominal cavity is made up of four distinct borders. The top is the diaphragm, the back is the muscles of the back, the front is the abdominal muscles, and the bottom is compromised of the pelvic floor musculature. The abdomen contains a pressure system in this cavity which is influenced by our breathing and the activities we do throughout the day. This pressure is called "intra-abdominal pressure".
Intra-abdominal pressure can increase when you lift something, cough, sneeze, step down the stairs, and go from sitting to standing. Additionally, this pressure can change when you use the toilet if you strain. I mean think about it, have you ever tried to lift something heavy like a piece of furniture? Instinctively if something is really heavy we hold our breath to try to make the abdominal cavity stronger to lift the item. When we implement this technique we utilize pressure to press out against all borders of the abdominal cavity. Here's the catch it's can have some not so positive outcomes on our body. This increase in pressure presses right on your uterus, bladder and intestines (if you are a woman). These organs respond by going to areas of least resistance, the vaginal vault or rectal opening. This can contribute to pelvic organ prolapse. Additionally, it can cause the bladder to feel an increase in urinary urgency or may cause some accidental leakage of urine. It may also make an existing diastasis recti more challenging to deal with as you cannot appropriately generate force through your abdominal muscles. The number one thing to remember, DON'T HOLD YOUR BREATH. Don't hold your breath with lifting, don't hold your breath during exercise, don't hold your breath on the toilet. The next step is appropriately coordinating your breath, but never forget the number one rule. It is important to brace your pelvic floor and abdomen appropriately with more strenuous activity. If you feel that managing intra-abdominal pressure is something you find challenging you should see a pelvic health physical therapist.
Always a day late and a dollar short. In honor of International Women's Day yesterday, I'd like to take a moment to discuss something that has weighing on my mind lately. I have had the wonderful opportunity to work with many independent and intelligent women in my field. My patient population consists of women of all ages from a variety of backgrounds. One commonality I find among many is the lack of knowledge these women have regarding their own anatomy and the negative body image as well as perceptions they have related to sexual identity. There seems to be this common thread in our society that females just don't understand their anatomy and how it functions completely. I think this lack of understanding coupled with current societal teachings promotes poor body image.
For instance, many women feel that their anatomy is not correct. They don't understand that vuvlas can vary in appearance and that is normal. They don't really take ownership of the vuvlar region. As such they dissociate. When we start treatment of pelvic floor musculature they can really struggle with how to access that part of their body. Additionally, they don't fully understand they pleasure centers associated with their anatomy. The clitoris is located at the top of the vuvlar area where the labia meet (and this is only the exposed part of the clitoris, there's much more to this organ under the surface of the skin). It has 8,000 nerve endings, that is double what the head of the penis contains. The density of nerve endings makes this organ more sensitive to stimulation and pleasure. Then there is the oh so elusive g spot. This is supposedly on the front wall of the vagina. There is mixed evidence regarding the presentation of this area in all women. Some women experience this sensitivity, some women do not. All in all for International Women's Day let's take a moment to appreciate female anatomy and promote positive body image!
Endowarriors is the sisterhood of women who share the symptoms and diagnosis of endometriosis. One in ten women is estimated to have endometriosis (1). Endometriosis is when the endometrial lining of the uterus begins to grow on other organs and tissue outside of the uterus. It can cause pain with periods, pain with intercourse, infertility, pain with urination and bowel movements during menstruation, GI upset, fatigue, and chronic pelvic pain (1). Oftentimes women with this diagnosis are delayed in getting treatment because it takes so long to identify what is going on. True identification involves laparoscopic surgery to identify endometrial growth . Women with endometriosis are at a higher risk for developing ovarian cancer, breast cancer, and autoimmune diseases.
The treatment available for endometriosis targets the symptoms and effects of the diagnosis, but not the cause. It slows the progression. With so many individuals with endometriosis we can do better. March is endometriosis awareness month. If you have been diagnosed with endometriosis make sure to surround yourself with a support network. There are lots of options through twitter and facebook as well as online forums if you would rather not find a local group. http://endometriosis.org/support/online-support/ https://www.facebook.com/endowarriorssupport/ https://www.facebook.com/endometriosis.support.diet.tips/ If you feel you may have symptoms consistent with endometriosis talk with your physician. It is important to be open about the symptoms you are experiencing.
References:
1. https://www.acog.org/ Congrats! Whether you are a student physical therapist or a Physical Therapist looking to make a change. Welcome to rewarding and complex specialty. It is a little overwhelming though! Where do you even begin once you know you are interested in pelvic and women's health? I am not an expert. I can only tell you my path to practicing in pelvic health and hopefully shed a little bit of light when comparing job opportunities.
I felt that I wanted to specialize in pelvic health PT while I was still a PT student. My only exposure was through my own frustrating experience of seeking treatment for pelvic pain and eventually getting treatment from a pelvic PT. I was thinking about applying for residencies so I decided to take the Pelvic Health Level 1 class through the Section on Women's Health as most residencies require a Level 1 Pelvic Class (either through SOWH or Herman and Wallace in order to be eligible for their program). The SOWH had a course in an area close to me where I had some friends I could stay with, plus they offer student discounts. So I enrolled. This course was awesome! I took it August my third year. It was very motivating and educational regarding incontinence. It also offered lots of information and practice regarding pelvic assessment so when the time came during my pelvic health clinical that fall it was not overwhelming to evaluate and treat patients. Now I know some people have some very passionate opinions regarding taking courses through the SOWH or through Herman and Wallace. As a caveat I have yet to take a course with Herman and Wallace, but would love to. I would say as a student since you are bankrolling the expenses find courses that are the best financial option for you. Both companies seem to have good instructors and offer similar information for the first installment of the pelvic health coursework. It is after the first course that the companies structure their courses differently, but you don't really need to worry about that as a student necessarily. Just check the websites and figure out based on your caseload when you are working which company works best for you. Then you have to stick with a certain company to finish the three part series I believe. Don't limit your learning opportunities to just courses though. Women's Health in Physical Therapy (Irion &Irion)is a lovely comprehensive text on women's health considerations. The chapters are short and packed full of digestible and applicable information. There are tons of journal articles available through the SOWH. Many blogs are also available with information regarding pelvic health. I would say read anything and everything you can get your hands on! Another really valuable source is social media. It has been a great way to network, learn about jobs, build a reading list, and a great resource of treatment ideas. There are quite a few groups on Facebook for physical therapists specializing in pelvic health and sub-specializing within that. Twitter has also been a wealth of information and offers many connections within the pelvic health community. So the overview of how to get started in pelvic health: 1. sign up for a pelvic health course 2. get connected on social media 3. get your hands on reading material and start building your library. In terms of jobs it is a little different if you are looking for a job vs if you are starting a program. I can only offer perspective regarding looking for jobs. As a new graduate with no restraints geographically I had a lot of options when it came to jobs, which was a blessing and curse. Wanting to practice in pelvic health opened lots of doors. There were also many things to consider though. For instance, evaluation and treatment times were something I was interested in. How long would I get with patients? I had some jobs that would only allow 45 min evaluations. Some that wanted follow up appointments completed in 30 mins. Others would allow up to an hour with patients. Some would have you split your time with a tech. This can give you more information about what your schedule would look like in a day. What are the productivity standards for that clinic and can you handle their expectations? I also wanted to know if I was the only pelvic PT at the clinic or if there would be other pelvic PT's there? This was a LARGE factor for me as a new graduate. I did not want to be the only pelvic PT in a clinic even if there was another one in the company at a clinic close by. I wanted onsite mentorship and support, but that was my personal preference just feeling a little green. Are you coming into a practice that is already established or is it expected that you build the program? If you do elect to start a program is the time you spend marketing reimbursed by your clinic? Do they allow you to do this during your regularly scheduled hours or are you expected to do this at other times? Speaking on mentorship. What does their mentorship and training look like for new clinicians? Is it structured? Is there a specific person in charge of this? How long does the mentorship last? Simply hearing yes there is mentorship is not enough. Do they offer reimbursement in terms of continuing education? What does that look like? Does it include travel for courses? What kind of support staff do they have on hand for patients? Do they have access to a social worker if necessary at the clinic? What is the typical caseload they see in the clinic? (Women, men, children? This is more for self-reflection. Are you comfortable seeing the caseload the clinic sees? Are you willing to treat men and children?) Is it primarily pelvic health or is it a mix with orthopedics or some other specialty? What does that mix look like typically? This is certainly not an exhaustive list. The overall environment and people are so important! These are just some considerations as you begin your search for a job in pelvic health. Best of luck and again, welcome to the pelvic health community! Happy Valentine's day! While you may be getting ready to spice things up with your partner don't forget to grab a good lubricant. Lubrication is key to an enjoyable intimate experience for you and your loved one. The female body produces a natural lubricant with stimulation and proper foreplay. Sometimes though it just isn't enough. This can be the case after menopause. Women stop producing estrogen after menopause and that natural lubrication system just doesn't work as well.
So on this day celebrating love and intimacy make sure you take care of your lady parts. In terms of lubricants you want to steer clear of petroleum based products like KY and things with a laundry list of chemicals. Your vagina has a microbiome of bacteria that can be irritated by the use of these types of products. You want to try to get a water-based lubricant. Brands include: Slippery Stuff, Sylk, and Blossom Organics. These can be purchased mostly online through your drugstore or Amazon. Additionally, you can utilize coconut oil for lubrication. However it CANNOT be used with condoms as it can break them down. So if this is your primary form of birth control look at a water-based product instead. If you are continually experiencing vaginal irritation and/or dryness throughout the day or pain with intercourse make sure to discuss that with your physician. Valentine's Day is only 13 days away, but it is never too early to start thinking about your heart and heart health. There is a misconception that women do not have as many heart attacks as men do in the United States. However for women heart disease is the LEADING cause of death (1). More women die from heart attacks than men. Women don't always recognize the symptoms of a heart attack as they can be more vague than when a man experiences a heart attack. So what symptoms should you look out for? According to the American Heart Association you may feel (2):
If you are experiencing these symptoms seek medical attention immediately. Call 911. Women may not experience the crushing chest pressure that most men experience so oftentimes they confuse a heart attack with some other diagnosis. It is important to screen the health of your heart and vascular system. Go to the physician regularly for check-ups. Ensure that your blood pressure is within a healthy range as well as your cholesterol. You can add heart healthy foods into your diet and stop smoking. Additionally it is so important to get cardiovascular exercise into your week. Based on your heart rate you should be getting 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity every week to keep your heart healthy. References:
1. Leading Causes of Death in Females, 2014 (current listing). Health Equity. https://www.cdc.gov/women/lcod/2014/race-ethnicity/index.htm. Published January 11, 2017. 2. Heart Attack Symptoms in Women. http://www.heart.org/HEARTORG/Conditions/HeartAttack/WarningSignsofaHeartAttack/Heart-Attack-Symptoms-in-Women_UCM_436448_Article.jsp#.WnO0tWinHrd. Published December 5, 2017. Recently I was on Twitter and I saw a woman discussing the lack of postpartum care she received. It was distressing to say the least, but not necessarily unique. In fetal-maternal medicine most of the resources and focus are geared towards the baby. Even after giving birth the focus is on the new bundle of joy. Which is contributing to the rising rate of complications leading to death of mothers in the United States. Now fortunately this individual was very well educated in terms of her health, she seemed to advocate for herself and knew she needed to see a women's health/ pelvic PT. Unfortunately the one in her rural area was out on maternity leave. Thus she could not get the care she needed.
Most of the time women feel that the symptoms they experience postpartum are "normal" or they are embarrassed to talk about them so they don't share them with their OB/GYNs. Their OB/GYN may not even ask about symptoms of diastasis recti, urinary incontinence, organ prolapse, constipation, fecal incontinence, or pelvic pain at their check-up. If you are feeling symptoms of any of these things ADVOCATE for yourself! You know your body best! There is help out there. No one will know what is going on if you don't speak up and tell someone and then push for the services you want. Now here is my second soap box. The specialty of women's health and pelvic physical therapy is the second smallest specialty in the field of PT. This means that in some parts of the country, usually in more rural areas, there are no health care providers that treat individuals with these conditions. They are not trained to. Personally I have patients that travel over an hour to a few hours every week to get treatment and that is just unacceptable. We need more current and future PTs to be trained and treat men, women, and children with pelvic floor dysfunction in all parts of the country. There is no reason that individuals can't get care because they have to drive a few hours away every week. That is a large burden! If you feel that you require pelvic floor or women's health PT services please check these two databases for providers in your area. Just as an aside, not all clinicians may be listed as they must add their names to the list so I would also do a google search and ask your doctor if they know anyone locally before referring you to a different area. https://pelvicrehab.com/ http://www.womenshealthapta.org/pt-locator/ 3...2...1....Happy 2018! Have any resolutions lined up and ready to go? Still working on that perfect beach body from last year? Health is a physical, mental, and emotional journey to improved well-being. Taking small steps is the key to making larger changes.
Weight Loss So let's talk about the most popular resolution out there, losing weight. The intention is good, the application can be really tricky. Weight loss is a combination of positive attitude, healthy diet, and exercise. It is important to have all three. It's also important to keep your expectations reasonable, losing 5 pounds a week isn't healthy or sustainable! You are just going to gain all that weight back plus some once the diet, exercise, or pill you are on stops. So what is reasonable? Shedding 1-2 pounds of weight a week is reasonable and healthy if you are correctly nourishing your body. You can track your food and calorie intake as well as exercise and the amount you are losing on applications like MyFitnessPal or FitBit. Diet In terms of diet there are SO many fad diets out there. You really can't beat increasing good ole fruits and veggies and cutting down on processed foods. Decreasing the amount of sugar or fried food you have is also important. Maybe you decide just cutting down on how often you eat out because a lot of times those restaurants could be prepare your food in an unhealthy way even if it seems healthy. Drinking more water is another excellent New Year's resolution. Our body's crave water especially our bladder and gut, yet we oftentimes are not getting nearly enough water throughout the day. (The dry air in the winter months also dehydrates our bodies). Exercise Don't rush out and buy a gym membership unless you REALLY want to work out at the gym. It's not for everyone. There are so many forms of exercise out there. You may just start with a brisk walk to get your blood pumping! Our bodies need moderate exercise multiple times throughout the week. So make sure whatever you are doing you are increasing your blood pressure and getting a little sweaty. Try a few things and find what you like! Biking, hiking, running, tai chi, yoga, pilates, zumba, aerobics, swimming, weight lifting, crossfit...the sky is the limit. A lot of places will let you try a class for free or even let you have a few classes discounted before purchasing a full membership. So shop around. Mental Health Don't forget to take care of your mind! Managing your stress is so important. Maybe you set a goal to meditate or journal this year. Maybe it is to recognize more positivity around you. Maybe you finally take the plunge this year to link up with a counselor or psychologist. Environmental Health The space you surround yourself with is important to your well-being as well. You may find yourself making resolutions about your environment. Are you going to keep a cleaner house? Recycle more? Cut down on the plastic water bottles you use? How will your environment impact you and vice versa? There are no limits to the options for resolutions. There are so many new and exciting things on the horizon whether you pursue a goal with your personal health or do something broader! It's that time of the year. The chill of winter nips at every exposed part of skin. You constantly feel dry. It is already almost the end of December. Everyone is caught up in the hustle and bustle of the holiday season. It is supposed to be a joyous and relaxing time of the year, but for most it is a time of insurmountable stress. Stress about meeting deadlines. Stress about finances. Stress about holiday shopping. Stress about time with family. Stress about lots about different things. Heck I feel it just when I am trying to get in and out of the parking lot at Target. I might just stop going until the holidays are over so I don't get hit.
Stress and anxiety can not only cause negative psychological health effects, but it can also have physical effects on the body. Stress can change your bowel movements, make you nauseous, change your sleeping patterns, make you feel less rested, and lower your ability to fight diseases. So during the craziness of the next few weeks remember to take a few minutes for yourself each day. One great way to practice self care is deep breathing and meditation. Utilizing the diaphragm (a muscle that sits under your lungs) to breathe deeper can help to relax your body and nervous system. It can also make you feel more well rested. Oh gosh you don't know how to meditate? There's an app for that, quite a few actually and YouTube videos galore. Here are just a few for your viewing pleasure: 1. Stop, Breathe, Think: Meditate 2. Smiling Mind 3. Aware: Meditation & Mindfulness 4. Headspace 5. Calm So download an app to your phone and set aside a few minutes before you start your day and at the end to help keep yourself in a positive space during the holiday season. |
AuthorHello! I am Caitlyn, Doctor of Physical Therapy and Board Certified Women's Health Physical Therapist working in St Louis, Missouri. Faculty in developing residency program. Endowarrior Categories
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