PELVIC ORGAN PROLAPSE ( POP)

LEVATOR ANI SYNDROME

INCONTINENCE

VULVODYNIA

DYSPAREUNIA

How can physical therapy help?

PAINFUL BLADDER SYNDROME/INTERSTITIAL CYSTITIS

CONSTIPATION

POST BREAST SURGERY

POST PROSTATECTOMY INCONTINENCE

Women’s Health Physical Therapist
recipient of Certificate of Achievement in Pelvic Physical Therapy ( CAPP)

Squeeze Before You Sneeze

When it comes to bladder control, embrace what comes naturally. Forget the prescriptions and surgeries. Simple behavior changes can create huge results. Here are 5 ways in which you can regain control of the frequency, urgency and leakage:

1) Retrain you bladder

Our parents taught us to go to the bathroom before we left the house to avoid the need to urinate while we were traveling in a car. In other words, to go while we have the opportunity “just in case”  the sense of urgency arises and we are unable to answer nature’s call. I call this a “JIC” pee. Our bladders have the capacity to hold 8-12 oz of urine. If we empty the bladder before we reach maximum capacity, we have retrained the detrusor muscle ( the bladder muscle) to hold less and to alert us sooner. Try waiting at least 2 hours between voids. Don’t practice “JIC” pees.

2) Avoid drinking 2 hours before bedtime

Imbibing beverages of any sort within 2 hours of bedtime will certainly lead to the need to arise and void during what is intended to be a time for us to rejuvenate and sleep.  Try to stop drinking early in the evening.  If you must take medicine in the evening, do so with your dinner to allow your body the time needed to process the liquid and send the waste in to the bladder.  Empty your bladder just before you climb into bed.

3) Squeeze Before you Sneeze

Perform a pelvic floor muscle contraction,aka Kegel, before you sneeze, laugh or cough. Tightening the muscles of the pelvic floor will help you to avoid leakage of urine during a forceful contraction, which occurs with the previously mentioned activities. If you are unsure how to perform a Kegel, imagine that you are trying to hold back gas from escaping or trying to stop urine from flowing.The muscles yo,u tightened for this task are your pelvic floor muscles, or your pelvic floor muscles (Kegel muscles).

4) Relax

Urination requires that one relax during the activity. In other words, one should not force the stream. Sit on the toilet, if you are a woman. Men should stand and allow their muscles to soften, not strain. Many people in jobs where their potty breaks are few are far between with an extremely short time to be away from their duties, such as teachers and nurses, are in the habit of trying to urinate quickly. They push the urine out in attempt to get done quickly. This forcefulness can cause pelvic organ prolapse, where the bladder and even the uterus can descend in the pelvic cavity and fall through the vagina. Another consequence can be excess stretch of the pelvic floor muscles, which leads to weakness. When the muscles are not strong enough to support the organs, leakage can occur. So, relax when you void.  It is, however, often necessary to push when you defecate.  Just don’t strain.

5) Exercise

If we don’t use it we lose it. Muscles of the pelvic floor are no different than other muscles in the body. To keep the muscles of the pelvic floor strong, one must practice daily. Contract the muscles 3-5 seconds, for 10 repetitions. Try to work up to 10 second holds, 30 times per day. The exercises are easiest when performed while lying on your back. Challenge yourself by sitting reclined to 45 degrees. Advance to sitting upright, then progress into standing. These exercises can be performed while settling down to sleep, while brushing your teeth or while driving to work. Check to see if you are properly performing the exercise by holding a mirror between your legs. Women will see the area between the legs, called the perineum lift with a squeeze. Men will see the penis rise a bit. If you have any doubts, ask your women’s health physical Therapist or the gynecologist to check your status.

The field of women’s health Physical Therapy has increased awareness of issues, such as bladder control, painful intercourse, pelvic pain tailbone pain, post breast surgery rehabilitation and high risk pregnancy. Physical Therapists in the practice of women’s health have completed special training to enable them to evaluate, diagnose, and treat these sensitive issues. Despite the name, men benefit from women’s health therapy as well. After prostate surgery, men should seek the services of a women’s health therapist to assist with bladder control and erectile difficulties. Most importantly, Women’s health physical Therapy is a natural method of regaining control and function of the pelvic floor without surgery or medicine.

References

1)   Pelvic Physical Therapy, level 1,2,3 course manuals

2)   The Gynecological Manual, Section on Women’s Health of the American Physical Therapy Association, 2002

3)   To find a women’s health PT in your area, go to www.womenshealthapta.org.

For more info, contact Jane O’Brien at 775-831-6600

Dyspareunia is defined as pain before, during or after intercourse. Reviews in the literature indicate a prevalence of as many as 50% of women experience pelvic pain and painful intercourse. Despite the prevalence, this problem is commonly overlooked and untreated. If left untreated, pelvic pain can deter one from engaging in sexual activity.

There are many reasons for dyspareunia including musculoskeletal dysfunction, endometriosis, pelvic inflammatory disease, post-operative scarring, and adhesions.  People experiencing dyspareunia from musculoskeletal dysfunctions may present with associated joint mobility issues, muscle pain, tension and weakness of the pelvic floor muscles.  To effectively treat dyspareunia, intervention must consider the underlying condition responsible for the pain and the secondary muscle reactions that may become a continued source of pain.

Patients with a musculoskeletal dysfunction as the cause of their dyspareunia may be referred to physical therapy for treatment. Interventions may include manual therapies such as trigger point release, joint and soft tissue mobilization, patient education, biofeedback, vaginal dilators, modalities and exercise. Studies have shown that Physical therapy treatment for short, painful and weak pelvic floor muscles can be highly effective.

The pelvis is lined with muscles which move the hips, support the pelvic organs, help with elimination and create sexual pleasure. These muscles are attached to the fascia (connective tissues) of the hip. This links the function of the pelvic floor muscles directly to the hips. If the pelvis is not level, the pelvic muscles will either be stretched (too long) or be in tension (too short). Power is equal to force times distance. If the length of the muscles is altered, the muscle force needs to change to maintain power and for proper muscle function.

An orgasm is defined as sexual climax and is characterized by intense physical pleasure accompanied by quick cycles of muscle contraction in the lower pelvic muscles which surround the primary sexual organs. Tension in the pelvic floor muscles can cause weakened contractions of the pelvic floor muscles. In other words, pelvic floor tension can lead to decreased orgasm potential!

Receiving treatment from a Women’s Health Physical Therapist who is trained in Pelvic Floor Disorders can alleviate pelvic muscle tension, pelvic pain and benefit your sex life. It is not uncommon for a Women’s Health PT to work with a patient to alleviate pelvic pain and find that a by-product of the treatments is improved orgasms.

Intercourse promotes health and vitality, creates pleasure, and provides a means for reproduction. When one person’s pleasure and desire for lovemaking increases, both partners benefit. Disorders in the pelvic region are common, but not the norm for the body. Seek help from a Women’s Health PT to improve your quality of life and recapture your sex life.

Jane O’Brien, PT, MSPT
Certificate of Achievement in Pelvic Physical Therapy from the Section on Women’s Health of the American Physical Therapy Association
Contact Us
(775) 831-6600

Reference:

1. Abrams P, et al. The Standardization of terminology of lower urinary tract function: report from the standardization sub-committee of the international continence society. Neurourol Urodyn 2002: 21:167-178.
2. www.wikipedia.org/orgasms
3. Messelink B, Benson T, Bergam B, Bo K, et al, Standardization of terminology of pelvic floor muscle function and dysfunction: report from the pelvic floor clinical assessment group of the International Continence Society, Neurourol Urodyn 2005: 24: 374-380.
4. Wurn L and Wurn B. Increasing Orgasm and Decreasing Dyspareunia by a Manual Physical Therapy Technique. Med Gen Med, 2004; 6(4): 47.
5. Fisher K. Management of Dyspareunia and Associated Levator Ani Muscle Activity. Phys Ther 2007: 87(7): 935-941.

The requirements for O’Brien’s to receive the tCAPP were studies of the three levels of Pelvic Physical Therapy classes, passage of competency skills tests for the three levels of study, passage of the didactics tests for each level, and submission of a case report on a complex patient with pelvic floor dysfunction.  O’Brien received the tCAPP which is for experienced therapists who completed training in pelvic physical therapy before starting on the Section on Women’s Health CAPP tract of study. During her studies, O’Brien acquired the skills and knowledge necessary to provide physical therapy interventions for male and female patients of all ages with pelvic floor disorders.

“This certification demonstrates dedication and advanced training in the field of Women’s Health,” according to O’Brien. Although the numbers are growing, at the current time, the field of Women’s Health PT’s is small. O’Brien is only the second Physical Therapist in Nevada to receive this certificate. Clients from all over Northern Nevada and Northern California travel to the area to receive treatment. Some clients who benefit from this type of care are those with overactive bladder, painful intercourse, post breast surgery care, prenatal and post partum orthopedic issues and pain, incontinence, pelvic organ prolapse, pudenal neuralgia and vulvadynia.

O’Brien received her Master of Science Degree from Boston University in 1992. She has over 16 years of experience in treatment of orthopedics and pain conditions. O’Brien can be reached through North Tahoe Physical Therapy at 775-831-6600 or through this web site contact form.

5 Ways to Look and Feel Great This Summer… Naturally

In it, you will find tips and techniques on how you can have your best Summer yet!

You can get your copy of this special report by subscribing to our mailing list.  Just enter your name and email address in the box to the right —–>

We hope that you find the information valuable. Please call us with any questions, or to set up a personalized warm-up routine developed just for you.

If you know someone who would benefit from this information, please pass it on.

Enjoy and have fun!

Jane O’Brien, MSPT
North Tahoe Physical Therapy

P.S. If you have any suggestions for future reports, please let us know!

P.P.S. Did you know that we do much more than Physical Therapy?  Browse this site and see what we have to offer.

HOW CAN PHYSICAL THERAPY HELP? By increasing strength, endurance and support of the pelvic floor through Pelvic Floor Muscle training, as well as, behavior modification, proper bracing and body mechanics, and reduction of exacerbating activities.

LEVATOR ANI SYNDROME — A muscle spasm of the pelvic floor, usually caused by trauma.

HOW CAN PHYSICAL THERAPY HELP? Through releasing tension in the muscles, joint mobilization and patient education.

URINARY INCONTINENCE — The involuntary leakage of urine.
STRESS INCONTINENCE — The involuntary leakage of urine during exertion – i.e. cough or sneeze, this is due to pelvic floor muscle weakness.
URGE INCONTINENCE (OVERACTIVE BLADDER) — The involuntary leakage of urine accompanied with urgency, caused by uninhibited bladder contractions.

HOW CAN PHYSICAL THERAPY HELP? A Women’s Health PT can help the client regain control of their bladder, so that leakage, urgency and frequency do not occur or are lessened.  This is done through bladder training, keeping a voiding record (bladder dairy), teaching behavior modification, muscle strengthening, if needed and following a voiding schedule.

DYSPAREUNIA — Painful penetration due to muscle spasms or organ pain.

HOW CAN PHYSICAL THERAPY HELP? With manual therapies designed to reduce muscle tension, with vaginal dilators, electrical stimulation, ultrasound, heat, biofeedback, as well as, exercise and muscle balancing around the pelvis and trunk.

AINFUL BLADDER SYNDROME — Interstitial Cystitis.

HOW CAN PHYSICAL THERAPY HELP? Though the use of biofeedback, electrical stimulation and musculoskeletal correction.

TMJ — Pain at the temporo mandibular joint, where the jaw bone meets the skull – generally associated with clicking, pain, grinding and headaches.  On occasion, the jaw may become stuck open or closed.

HOW CAN PHYSICAL THERAPY HELP? With tender point releases, postural corrections of skeletal system, including head and neck, as well as, craniosacral work.

VULVODYNIA — Pain at entrance to the vagina – associated with localized burning, itching, stinging and rawness.

HOW CAN PHYSICAL THERAPY HELP? Though the use of biofeedback, strength and endurance training and the relaxation of muscles.

FIBROMYALGIA — Chronic pain in muscle and soft tissue surrounding joints, fatigue and tenderness at specific sites in the body.

HOW CAN PHYSICAL THERAPY HELP? Through the use of Myofascial release, tender point releases and strengthening.

Electrical Stimulation

Electrical stimulation has a wide variety of clinical applications in physical therapy.  Electrical stimulation is based on the principles of charged particles flowing to reduce inflammation and control pain.  Clinical units generally use two different types of currents to electrically stimulate muscles.  An interferential current is a waveform produced by the interference of two different medium frequency alternating currents from separate channels.  An interferential current is set up with four electrodes in an “X” pattern over a large body part.  A premodulated current uses one channel to deliver a continuous waveform with a medium frequency and a fluctuating current amplitude.  Premodulated electrical stimulation is delivered with two electrodes evenly spaced over a small, inflamed area.  Electrical stimulation treatments are often combined with temperature modalities (hot packs, cold packs) at the end of a physical therapy session for fifteen minutes to control swelling after activity.

Transcutaneous Electrical Neuromuscular Stimulation (TENS) is a popular electrical stimulation modality for controlling pain.  According to the gate control theory of pain, activation of A-beta nerve fibers can inhibit the transmission of the pain signal from the spinal cord to the brain.  Electrical stimulation, when set with appropriate parameters, can selectively activate the A-beta nerve fibers and block the brain from receiving the pain signal from the body.  TENS units deliver a low voltage current and the patient feels a strong, but comfortable tingling sensation.  Patient-friendly TENS units are available for home use at affordable prices.  A physical therapist can give you product recommendations and detailed instructions on how to set the TENS unit for maximum pain relief.  Contact the therapy team at North Tahoe Physical Therapy for pricing and information.

Ultrasound

Ultrasound is a medical machine that uses sound waves to penetrate into tissue for both thermal and non-thermal healing effects.  Ultrasound functions under the principles of piezoelectricity: the ability to change shape in response to an electrical current.  An electrical current is applied to the crystal in the ultrasound “wand” called a transducer.  The piezoelectric crystal responds to the current by expanding and contracting, creating an ultrasound wave.  This wave is able to penetrate through skin using a conducting gel to tissue depths of 1-3mm to bring blood to the injured site and stimulate healing.  Macrophages are cells that work to localize the inflammatory process and recruit repair cells.  The ultrasound machine increases macrophage activity to consolidate inflammation and accelerate the cellular repair response.

Ultrasound treatment can be performed using either a continuous or pulsed setting for duration of eight minutes. Continuous wave ultrasound is used to produce heat and warm the tissues.  Pulsed wave ultrasound recruits macrophages is recommended for anti-inflammatory effects.  During the ultrasound treatment, the patient may feel a minimal sensation from the ultrasound wave.  The patient may perceive warmth from the ultrasound conductive gel.  Ultrasound can be done for a single session or repeated in consecutive treatments to produce the desired anti-inflammatory effects.

Iontophoresis

Iontophoresis is transdermal anti-inflammatory drug delivery using a low voltage direct current to move charged ions across the skin barrier. Ions are transported through skin pores to deliver Dexamethasone (a corticosteroid recommended for the treatment of inflammatory conditions) in the manufacturer recommended 40mA.minutes dosage.  This machine is set up with the medicated, active electrode over the inflamed tissue and a ground electrode at a distant site.  The patient perceives a light tingle under the medicated patch for the duration of the treatment.   Iontophoresis can be done one time, for several sessions consecutively, or in combination with other modalities to produce an overall anti-inflammatory effect.

Modern physical therapy now has several anti-inflammatory modalities from which to choose during the acute phase of healing.  Other medical professionals (MDs, chiropractors, and acupuncturists) may introduce you to similar tools in treatment designed to control inflammation.  Now that you understand the concept of inflammation and how each modality works to reduce swelling and decrease symptoms you can help your medical team make an educated decision about what combination of medical machines will work best for your body under each condition.

Nationally Certified in Therapeutic Massage and Bodywork, NCTMB as seen written behind a massage therapist name, sets high standards for massage and bodywork practitioners. It protects consumers and employers by ensuring that certified practitioners have the necessary skills and knowledge to perform their job – and that they are committed to upholding NCBTMB’s Standards of Practice and Code of Ethics. NCMTMB is an independent, private, organization established to set high standards of ethical and professional practice through a recognized credible credentialing program.

A nationally certified massage therapist represents the highest professional credential in the field. This therapist has completed a minimum of 500 hours of instruction, demonstrates mastery of core skills, abilities and knowledge, and has passed a standardized exam. This credential will help gain the therapists’ recognition and visibility, and will also increase employment opportunities.

So, is it important when searching for a good massage? Yes, I feel that it is a good thing when doing research for a therapist, yet it’s completely up to that individual. I personally have received great treatments from non-nationally certified therapists. Yet, it does show continued advancement in the profession.

-Brian A. Hrindo, LMT, NCTMB

The first thing that comes to mind for getting in “ski shape” is strengthening. I believe everyone would agree that strengthening of the lower extremity or leg muscles is top on the list. The legs are doing most of the work during a ski or snowboard run, so, focus strength training here. The muscles to emphasize are the quads (front of the thighs) the hamstrings (back of the thighs), the calf muscles, and the glutes. It is very important for one to gain strength of the proximal leg muscles, those closest to the trunk, typically called the hips. The stronger one is in the hip region, the less strain will occur across the knee joint.
A great exercise for the whole lower extremity is the squat. This uses the buttocks, the quads, the calves and the hamstrings. Also great are lunges and leg presses. These exercises directly correlate to the motions used in telemark skiing and downhill skiing. Bicycling is a wonderful outdoor activity for lower extremities. Lastly, calf raises (going up and down on tip toes) is great for balance and calf strength.

Besides strength, flexibility is highly important for all activities. A tight muscle is more likely to tear or be strained because there is no slack in the system. Stretches create length in the muscle and allow for freedom of motion.

While everyone agrees that training the lower extremity muscles is highly important, I also want to emphasize the importance of training the trunk or core muscles. The trunk is the “power center” of the body. These muscles include, among others, the abdominals, the iliopsoas, the glutes, hamstrings, and the spinal extensors. A strong core helps with speed, balance, strength, and power, quickly changing directions, improvement of skill level and prevention of injury. A training program needs to consist of trunk flexibility and strength conditioning. Having a strong and flexible core allows one to twist, turn and stabilize the body during the downhill journey. According to Douglas Brooks, MS, who wrote Effective Strength Training, the trunk is the base or foundation of the body. A body is only as strong as its weakest link. A body needs a strong base from which to direct its energy. If the core is weak, it leads to poor performance or worse, injury.

Join our email list to get our special report on the 3 Keys to a Fantastic Ski Season.  Just leave your name and email address in the space on the right side of this page.