What’s new in pelvic health? Reading homework included.

I love reading blogs about pelvic health, the human body, chronic pain, movement, neuroscience–and especially get excited if these things get combined together. Periodically, I’d love to simply do a blog on blogs, so that is what you get today. Basically, it is a quick list of blogs, journal articles, random articles, and possibly books that I am reading right now. There are SO many great things out there. I hope you enjoy, and have a great friday! 🙂

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1. The Pudendal Neuralgia Wrecking Ball. Of the different diagnoses in the chronic pelvic pain world, pudendal neuralgia is often a scary one for a patient to hear. Not because it’s untreatable–it IS treatable. But simply, because , and unfortunately, many patients with this type of problem (like SO many other problems related to pelvic pain) are often misdiagnosed many times before receiving help and assurance, and often find scary and less than assuring things when researching online (leading to high levels of worry and fear).  So, this article on US News and Reports came out recently. As pelvic PTs, we always love to have big news websites post information to bring awareness to pelvic pain problems. But we took some issue with exactly how that was done and some of the information which was provided…which lead to this excellent response by Stephanie Prendergast, PT of the Pelvic Health and Rehabilitation Center in California (If you don’t follow their blog, you really should! They consistently put out fantastic, high quality information.) And then, led to this response by Sara Sauder, PT, who writes her own blog, focusing all on pelvic pain (it’s great too!). Read these posts–they have great information in them!

2. Can’t Get Enough of the Diaphragm. March was really the month of the diaphragm. Not only did you get my post on the 6 reasons why the diaphragm is the coolest muscle ever, but Ginger Garner (who also has a great blog with a big emphasis on women’s health) went into great detail on this post, expanding on how important the breath really is. I’ve written a lot recently on the importance of breathing with movement and coordinating the breath with other muscle activation, but is holding the breath ever a good strategy? Julie Wiebe gave great insight into that in this post here. (And you know Julie posts awesome stuff!).

3. Movement Variability. As humans, we are designed for movement. Typically when people have pain, their movement patterns become more rigid, and they can often develop alterations where their bodies are guarding movements by pain. Retraining slow, controlled motions with a lot of variations is an important component of treatment! For those without pain, movement variety is key to keeping healthy bodies! That’s why I loved this post by Katy Bowman (my favorite biomechanist) on sitting variations while playing with her child.

4. Share MayFlowers: Women’s Health Awareness. My list would not be complete without a shout-out to Jessica McKinney’s excellent work with Share MayFlowers. SMF is a public health initiative aimed at improving awareness in Women’s Health, and Jessica has been posting excellent information all month long! She highlights women who are doing fantastic things to support WH initiatives, and links to great blogs, articles, etc. out there! A few of my faves from this month are this New York Times article which discussed an innovative form of sex education for adolescents, and this post, bringing awareness of obstetric fisulas.

Hope you enjoy! Now it’s your turn– what are you reading? I’d love to hear in the comments below!

Do men have pelvic floors too? The truth about 10 common pelvic myths

Earlier this week, I asked the Twitter and Facebook PT world a simple question:

What are the common misconceptions you hear about the body?

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My initial goal was a fun blog post on common misconceptions about anatomy, etc…but I was not prepared for the huge response I received—over 40 responses with SO many different things that people often misunderstand! Some pelvic, some general—and it made me realize there is SO much bad information out there!! So, what once was one post will become two. Today, we’ll hit on 10 common myths related to the pelvis (you knew I’d start there!). Then stay tuned for a future post hitting other misconceptions related to…well… the rest of the body, fitness, wellness, pain etc.  So, here we go:

1. Men don’t have pelvic floor muscles: They do, I promise. And guess what? The anatomy is not quite as different as you would think! The same muscles that contribute to urinary, bowel and sexual function as well as lumbopelvic stability in women do that in men too. Pelvic PTs treat men with incontinence, pelvic pain, constipation, painful sexual intercourse and much more.

 2. Vaginas need a lot of work to keep clean. No, they don’t. The Vulva (vagina really just refers to the canal itself) is actually self-cleaning. It does not need to be scrubbed with soap. You can totally just shower and run water over it, and it will be just fine. In fact, scrubbing the vulva can irritate it and even kill the good bacteria that prevent infections! I could say so much more, but you really should just read this article on Pelvic Guru by Sara Sauder, PT and this one by Dr. Jen Gunter.

 3. Abdominal pain is always caused by organ problems. Not necessarily. Now, don’t get me wrong, abdominal pain can definitely happen with ovarian cysts, appendicitis, constipation, and much more—but abdominal pain can also happen when the organ is not to blame. This is so common in men and women with chronic pelvic pain. These people often will have very sensitive nervous systems, tender muscles around the pelvis and in the pelvic floor, as well as even neural irritation (lots of nerves run through the abdominal wall!). So, if the organ has been ruled out as a source of pain and the pain persists- it may be worth considering something different.

4. Not having enough sex OR having too much sex OR masturbating too frequently causes pelvic pain. I cannot tell you how many times I have had a patient timidly ask me if there sexual habits or frequency are to blame for their pain. No. Just no. You should be able to have sex as little or as frequently as you want without any problems or pain. Now, being forced to have sex—that may cause a strong protective response of the pelvic floor muscles. But, consensual sexual activity is normal and should be enjoyed by all without worrying about pain. And if you are having pain? Don’t ignore it– go talk with your physician or physical therapist!

 5. Tight pelvic floor muscles are healthy pelvic floor muscles. Guess what? Tight ≠ strong. Flexible ≠ weak. Strong ≠ Well-timed. Functional pelvic floor muscles are non-tender, flexible muscles that are able to activate when they should activate (well-timed). We want the pelvic floor to stretch to allow you to poop and have sex, and we want the muscle to activate at the right time with enough strength to help you not leak urine when you cough.

6. If the doctor says “all looks good” 6 weeks after having a baby, it means your body is completely back to normal. Newsflash here, you’re body isn’t really going to go back to being exactly what it was like before the baby. It’s not meant to, and that is ok! It can still be an awesome, strong and well-functioning body– but you do need to take care of it. Remember that urinary or bowel leakage, constipation, persistent low back/pelvic pain, vulvar pain, and pain with sexual activity are NOT normal. If “all looks good” at 6 weeks, but you are having these problems, find a skilled pelvic PT near you to get evaluated and get some help! And even if you are not having these issues—your body has been through a lot! Take time and care in slowly getting your body back into good movements. Also, check out this article by Ann Wendel, PT on 5 myths surrounding the pelvic floor after pregnancy.

 7. If a woman had a c-section, her pelvic floor was not impacted, and she doesn’t need to think about it. Guess what the biggest risk factor for urinary incontinence is? PREGNANCY. Although mode of delivery is important, simply being pregnant and carrying a baby puts significant pressure on the pelvic floor. Both vaginal deliveries and c-sections impact the body—remember, a c-section cuts through the abdominal wall! Remember that team of muscles that work together for lumbopelvic stability? The abdominal wall is a KEY member. Regardless of your mode of delivery, seeing a skilled physical therapist after having a baby is crucial to help your musculoskeletal system function optimally, manage unwanted pain or leakage, and get back to the fitness activities you enjoy. And guess what? It’s standard care for all ladies postpartum in many countries around the world.

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8. Urinary incontinence is always due to a weak pelvic floor muscle group. I wrote a whole blog on this one, so I recommend you read it here. The short answer is, No. No problem is due to solely one muscle. Our body is a system, and we have to always treat it like that.

 9. Hips and sacrums dislocate regularly in some people. This is such a common one too—I’ll have patients come in and say, “My hip keeps ‘going out’ and I have to do this <does weird hip movement> to put it back in.” OR “My SI joint keeps ‘popping out of place.’” Let’s all be honest about this- dislocations of joints do happen, but it tends to be pretty painful, likely traumatic, and if your hip dislocates, you bet you are going to the ER. That “pop” you hear? It’s likely just a joint cavitation- basically a decrease in pressure causes dissolved gasses in the joint fluid to be released into the joint. Same thing happens when you pop your knuckles. If it happens frequently and is associated with pain, talk with a physical therapist.

10. Sucking in the stomach constantly creates a strong “core” and a flat abdomen. You know what creates a flat abdomen? Eating healthy and exercising regularly. Contracting any muscle constantly is not functional, nor does it really do what we want it to do. Sucking in the stomach actually tends to make it more difficult for your diaphragm to move well when you breathe and also can cause the pelvic floor muscles to over contract and become tender/uncomfortable. It can also inhibit movement, and we know moving well with variety is SO key to a happy body. So, relax your stomach and allow yourself to breathe (remember how important that diaphragm is!)

I hope you gained a little insight with this list—it was fun to write! This is by no means an exhaustive list (over 40 responses, remember?), and I’d love to keep the conversation going! Special thanks to my world-wide pelvic health team! It’s so fun collaborating with such a great group!

Have you heard anything else about the body that does not seem to be right? Ask here and we’ll do our best to answer! Physical therapists out there—what are your other favorite myths to de-bunk? Let’s all work to spread accurate knowledge—knowledge really is power! Have a great Wednesday!

~ Jessica

6 Reasons Why the Diaphragm may be the Coolest Muscle in the Body

I have a small confession to make– I love the study of human anatomy. Always have. It was studying human anatomy and physiology that made me shift my undergraduate degree at Gordon College away from “Biology” and into “Movement Science” (which has now become “Kinesiology”… Who would have known that years later, “Movement Science” would have been the coolest name for a major ever? Am I right fellow PTs?). The human body is fascinating and incredible. So, it should come as no shock to you that I have favorite muscles. In PT school, my favorite muscles were the ones with the most fun names… like the Gemelli brothers (who are small hip external rotators) or Sartorius (a thigh muscle…best, if sung to the tune of “Notorious“). Of course, you know that now the pelvic floor muscle group ranks pretty high on that list…but the diaphragm, well… it just takes the cake. Here are some of the reasons why the diaphragm really is so cool.

1) We can contract our diaphragm voluntarily–but it also will contract without us consciously telling it to. How cool is that? You can activate your diaphragm by taking a long, slow, breath expanding your ribcage 360 degrees and allowing your belly to relax. But, before I brought your attention to your breath, you were using the diaphragm without even thinking about it!

2) The diaphragm helps to mobilize the ribs, lumbar spine and thoracic spine. The diaphragm attaches to the 1st, 2nd, and 3rd lumbar vertebrae, the inner part of the lower 6 ribs as well as the back of the sternum at the xiphoid process. The central tendon of the diaphragm then attaches to the 3rd lumbar vertebrae. During inhalation as the diaphragm flattens to allow the lungs to fill with air, the diaphragm will “pull” slightly on each of those attachments, effectively giving you a gentle mobilization. The ribs will also move during inhalation and exhalation to allow space for the lungs to fill.

3) The diaphragm is a key member of a team of muscles which help to create dynamic postural stability. You knew that would be one of my bullets, right? I think I mention this in almost every post…but… the diaphragm works together with the pelvic floor muscles, abdominal muscles (transverse abdominis) and low back muscles (multifidus) to pre-activate and provide support to the body during movement. Together, these muscles make up our “anticipatory core” and are important muscles for healthy pain-free movement patterns. Now, no post on the diaphragm would be complete without an excellent video explanation by Julie Wiebe, PT, who is amazing and has done so much to help advance the understanding of dynamic stability in PT practice.

4)Retraining proper firing of the diaphragm can help to reduce urinary incontinence AND low back pain.  Now, that is pretty cool, right? Excellent research by Paul Hodges and colleagues has shown altered firing patterns of the diaphragm in people with low back pain or urinary incontinence.  Amazingly, when people re-established proper firing of the diaphragm leading to full excursion, both low back pain and bladder problems reduced   This is likely due to the relationship between the pelvic floor and diaphragm in controlling intraabdominal pressure within the abdomen and the pelvis.  Proper breathing helps to restore the optimal pressures needed to control movements and support the pelvic organs. This relationship is so huge that problems with breathing and continence are more correlated with low back pain than obesity and physical activity. 

5) Slow breathing with the diaphragm can calm down the nervous system.  The breath is so connected to the autonomic nervous system. When a person is fearful or anxious, the sympathetic nervous system (fight or flight response) is activated, and a person will take quick shallow breaths to bring oxygen to the muscles as quickly as possible (think: being chased by a bear)  the parasympathetic nervous system (rest and digest) is activated when in a more calm or relaxed state (yes, I am oversimplifying all of this… I know). In that state, a person will take slow calm breaths (think: sipping a cup of tea after a great massage).  The cool thing is that we can use our breath to help us move toward a more relaxed state. Slow breathing will help calm stress, anxiety and promote a person being in a more parasympathetic state. And guess what? There’s an app for that! The Breathe2Relax app for iphone/android allows a person to program in his or her breath and then takes you through a guided breathing exercise.

6) Slow breathing with the diaphragm can reduce pelvic pain. As we discussed previously, the pelvic floor and diaphragm are coordinated and work together to control pressures through the pelvis. As the diaphragm is activated during inhalation, the pelvic floor relaxes to accept the contents of the abdomen/pelvis. As we exhale, the diaphragm returns to its rested position and the pelvic floor activates slightly. Long slow breaths then encourage complete relaxation of the pelvic floor and thus can help decrease pain for people with tender pelvic floor muscles.

So, there you have it! I bet the diaphragm just moved up a few notches on your favorite muscles list (you know you want one!). If you need more reasons, and enjoy “nerding-out” with Anatomy, check out these studies:

What’s YOUR favorite muscle? Did I miss any reasons why the diaphragm is amazing? Let’s chat together in the comments below!

~ Jessica