Category Archives: Patient Care

Prioritizing Self-Care

So, as you may have realized, I periodically write about topics that hit close to home. This was especially true while I was pregnant and trying to live the advice that I often give to patients (Teaser: Do as I say, not as I do.). As a mom to a now 1-year-old, the topic of self-care has been on my mind quite a bit recently. I remember when my daughter was 6 months old, going to the dentist. As I tried to come up with a reason why they hadn’t seen me in almost a year, the best I could do was to honestly say, “Really, I haven’t done much of anything to take care of myself since my daughter was born.” And guess what? It was totally true. I was having a hard time getting back to exercise. I wasn’t sleeping all that well (I mean, who sleeps well with a new baby? If it’s you, don’t tell me.) And, I had skipped many of the typical self-care things that I normally enjoy doing regularly.

My experience unfortunately is not that unique to many new moms (and old moms, and lots of other people too!). In discussing this with my friends and patients, I often find that people live very busy lives and struggle with prioritizing themselves amidst an often hectic schedule. By the time we wake up, make lunches, get everyone out the door, work a busy job, cook dinner, tidy up the house, prepare for the next day, etc… there really doesn’t seem to be time left. The idea of adding in an hour for exercise, meal-prepping or seeing a doctor/dentist/physical therapist can feel impossible.

But, the truth comes down to two key points:

  1. We have time when we make time. 
  2. When we care for ourselves, we actually care better for others. 

Did you know that stress can worsen chronic pain? And that stress is connected to all sorts of illnesses (like heart disease, among others?) Did you know that exercise has all sorts of amazing benefits? (see the awesome whiteboard video below)

In short, when we care for ourselves through exercise, quiet time/meditation, quality time with friends/family, or necessary medical/dental/physical therapy visits, we actually equip our bodies with the tools we need to better handle the stress that comes our way and ultimately, to better care for the important people in our lives.

So, how do you make time for self-care? 

  • Set a realistic expectation: If you do not currently exercise at all, don’t start with a goal of exercising every day. You will probably fail. Instead, make a goal at exercising 2-3 times in the week. If you know that your mornings are completely hectic and busy, that may not be your best time for quiet time/meditation. Instead, perhaps in the evenings as you are wrapping up your day may be a better time.
  • Be specific on your when, what and how:  When I was in PT school, we learned that goals should be objective, measurable and achievable.  This not only sets our patients up for success, but lets us evaluate if our intervention is working. So, if your goal is to exercise, try being specific on your when, why and how. For example, I could aim to run 30 minutes on Tuesday and Thursday evenings after work.  The more specific and scheduled, the more likely you will be to achieve success.
  • Get help when you need it: If it is challenging to hold yourself accountable, talk to a friend or a partner to get some help. Verbally expressing your goals and detailed plan to another person can often help provide the necessary support and accountability for success. If you know you need more tangible help to be successful, make sure to ask for it. This may mean something like planning ahead with your partner to manage childcare responsibilities or it could mean finding a friend who will actually go and exercise with you.

What other strategies do you have for self-care? How have you been successful in the past?

As always, I would love to hear from you!

~Jessica

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Can physical therapy help menstrual cramps?

Did you know that over 80% of women experience painful periods? And for some women, the amount of pressure in the uterus from those cramps can be just as severe as labor pains?

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As someone who has been in labor recently, I can tell you that it is no cakewalk. The truth is that menstrual pain (Dysmenorrhea) is a significant problem for many women. In fact, this study found that in a group of 269 female college students, 84% experienced pain in the abdomen and back, 84% experienced mood swings and 48% experienced dizziness. Another interesting stat from this study: 48% felt like their academic performance was impacted. (and I would bet women out of school probably feel like their work and home life are impacted too!)

With menstrual pain impacting women as much as it does, it is surprising how few effective pain-reducing options we have. Most women turn to pain relievers like tylenol and ibuprofen, but the effectiveness of those in actually reducing the pain isn’t really that great. The great news is that there are many ways in which physical therapy can actually help with menstrual pain, and several studies have shown that many physiotherapy interventions are just as (if not more!) effective as pain medications.

So, what can physical therapy do to help with those painful cramps?

Movement-based Approaches

Movement is what we do in physical therapy, and certain exercises which help with movement of the spine and abdomen can be very helpful in improving pain levels. This study, in particular, found that certain yoga postures–Cat, Cobra and Fish– helped with reducing pain. Another study found that a physical therapy program including aerobic exercise, strengthening, stretching and relaxation led to a reduction in pain during menses.

Modalities

So, modalities sometimes get a bad rap in the physical therapy world. And I get it, they are passive (meaning you, as the patient, don’t really have to do anything), and they are frequently over-used in cases when an active approach can be more helpful. But, certain modalities have been shown to be very helpful in reducing menstrual pain. In particular, applied hot packs were found to be equally beneficial to pain medication in this study! Transcutaneous Electrical Nerve Stimulation (TENS) applied to the low back/sacrum and/or abdomen has also been shown to have excellent results. The great thing about both of these options is that they are easy, reusable and effective options for a woman to use monthly without having to ingest medication.

Manual Therapy Interventions

The research regarding manual interventions for painful periods is honestly not fantastic, however, there have been some studies that have shown that treatments such as connective tissue mobilization, massage and acupressure have been helpful in reducing menstrual pain. When I used to work at a large clinic, many of my female co-workers would seek connective tissue mobilization and other soft tissue mobilizations from colleagues when having painful cramps. Clinically, I have seen that working with someone to reduce muscle sensitivity and tenderness (both in the pelvic floor muscles as well as muscles around the pelvis) does seem to reduce cramping during menses. I’m not positive the exact mechanism for this, but my working theory is that improving the “threat level” from muscles and tissues around the pelvis has effects that transfer to other situations (like cramping during periods), so the “threat level” during this situation is also reduced. I also think that hormones play a role in this as the tissues at the vulva/urethra are sensitive to estrogen, but also impacted by muscles and blood flow. So, hormonal changes that occur within a normal cycle (that lead to cramping, etc) could then be impacted by a decreased blood flow and decreased tissue mobility, thus causing the discomfort from cramping to be worsened.  There you go, that’s my working theory.

So, in summary, if you’re having pretty bad cramping during your periods, know that there are some options to help! Often times, women are the WORST at just dealing with problems they have (and things like painful cramps are often blown off by friends, family members and other healthcare providers!) If this sounds like you, it may be worth seeing a pelvic PT for a consultation to help you build a robust and effective toolbox for managing your pain!

What other options have you found helpful in reducing cramping pain during periods? I always love to hear from you! Have a great week!

Jessica

**Note: If your menstrual cramps are severe and truly limiting your life, make sure that your healthcare provider knows about it! There are some medical conditions which can contribute to severe cramping, and there are treatments available. 

Interview with Jessica Drummond, MPT, CCN, CHC on Nutrition for Pelvic Pain

This past week, I was grateful for the opportunity to interview Jessica Drummond, MPT, CCN, CHC on the topic of nutrition for pelvic pain. Jessica is incredible, and doing such amazing things for patients with pelvic pain and really, in women’s health in general! Check out the interview below to learn more about nutrition, common dietary intolerances/sensitivities, probiotics, and what steps to take to help yourself (or your patients!) I hope you enjoy! ~ Jessica

(Note: This was my first of what I hope will be many expert interviews! Disregard my initial awkwardness with being recorded (Ha!). If you have any ideas for people you would like me to interview, let me know in the comments!) 

Head, Shoulders, Knees…and Pelvic Floor!

I spent my first few years of practice going deep into the pelvis… and my most recent few years, desperately trying to get out. Now, I know that may seem like a strange statement to read coming from me, the pelvic floor girl. But bear with me. I love the pelvic floor, I really do. I enjoy learning about the pelvis, treating bowel/bladder problems, helping my patients with their most intimate of struggles. I like to totally “nerd out” reading about the latest research related to complex nerve pain, hormonal and nutritional influences, and complicated or rarely understood diagnoses. However, the more I learned about the pelvic floor, the more I discovered that in order to provide my patients with the best care I can possibly provide, I needed to journey outside the pelvis and integrate the rest of the body.

You see, the pelvic floor does not work in isolation.

It is not the only structure preventing you from leaking urine.

It is not the sole factor in allowing you to have pleasurable sexual intercourse.

It is not the only structure stabilizing your tailbone as you move.

It is simply one gear inside the fascinating machine of the body.

And, the incredible thing about the body is that a problem above or below that gear, can actually influence the function of the gear itself! And that is pretty incredible! One of the patients that most inspired me to really start my journey outside of the pelvis was an 18-year-old girl I treated 4 years ago. She was a senior in high school and prior to the onset of her pelvic pain had been an incredible athlete– playing soccer, volleyball and ice hockey. Since developing pelvic pain, she had to stop all activities. Her pain led to severe nausea, and was greatly impacting her senior year. When I examined her, I noticed some interesting patterns in the way she walked. With further questioning, she ended up telling me that a year ago, she experienced a fracture of her tibia (the bone by her knee) while playing soccer. She was immobilized in a brace for about a month, then cleared to resume all activity. (Yep, no physical therapy). Looking closer, she had significant weakness around her knee that was influencing the way she moved, and leading to a compensatory “gripping” pattern in her pelvic floor muscles to attempt to stabilize her hips and legs during movement. So, we treated her knee (She actually ended up having a surgery for a meniscal tear that had not been discovered by her previous physician), and guess what? Her pelvic pain was eliminated. BOOM. If you want to read more about her story, I actually wrote the case up for Jessica McKinney’s blog and pelvic health awareness project, Share MayFlowers, in 2013.

So, what else is connected to the pelvic floor? Here are a few interesting scenarios:

  • Poor mobility in the neck and upper back can actually lead to neural tension throughout the body– yes, including the nerves that go to the pelvic floor. (I’ve had patients bend their neck to look down and experience an increase in tailbone pain. How amazing is that?)
  • Being stuck in a slumped posture can cause a person to have decreased excursion of his or her diaphragm, which can then put the pelvic floor in a position in which it is unable to contract or relax the way it needs to.
  • Grinding your teeth at night? That increased tension in the jaw can impact the intrathoracic pressure (from glottis to diaphragm), which in turn, impacts the intra-abdominal pressure (from diaphragm to pelvic floor) and, you guessed it, your pelvic floor muscles!
  • An ankle injury may cause a person to change the way he or she walks, which could increase the work one hip has to do compared to the other. This can cause certain muscles to fatigue and become sore and tender, including the pelvic floor muscles!

Pretty cool right? And the amazing thing is that this is simply scratching the surface! The important thing to understand here is that you are a person, not a body part! Be cautious if you are working with someone who refuses to look outside of your “problem” to see you as a whole. And if you have a feeling in your gut that something might be connected to what you have going on, it really might be! Speak up!

As always, I love to hear from you! Have you learned of any interesting connections between parts of your body? For my fellow pelvic PTs out there, what cool clinical correlations have you found?

Have a great Tuesday!

Jessica

Wanna read more? Check out this prior post on connections between the diaphragm and the rest of the body!

 

Got pelvic health problems? There’s an app for that!

Technology in our current time is incredible. With our smartphones so quickly at our finger tips, we have apps for pretty much everything. Need to find a good restaurant near by? There’s an app for that. Want to quickly edit your photos into beautiful photo masterpieces? Just download the app. Last year over Christmas, I even found an app that turned anyone’s face into Santa Claus. (The results were amazing if you’re wondering).

And pelvic health is no different. There are so many apps available for people with pelvic problems or for general men’s and women’s health needs. I absolutely love apps for my patients that help them with the problems they’re experiencing or enhance their home programs. Here are some of the great ones out there! (Note: Special thanks to my colleagues on the Women’s Health Physiotherapy Facebook Group who added their suggestions to this list. I plan to keep this updated regularly so it can be a great resource for colleagues and our wonderful patients!) Enjoy!

Apps

 

Bladder/Bowel problems:

  • iDry: Free version includes a tracker for pad usage and bladder leakage. Premium version includes options for interventions (including pelvic floor exercises!), a more detailed chart tracker, reminders, and options to send to your health care providers!
  • UroBladderDiary: This app costs $1.99 but allows tracking of urinary frequency and volumes, leakage, and fluid intake. Also allows tracking of urgency level. Allows conversion to a PDF to e-mail to health care provider.
  • Bathroom Map: For those struggling with strong urinary or bowel urgency and/or incontinence, this app may become your best friend! It uses your location to quickly identify all of the restrooms nearby. It also grades each bathroom as green, yellow or red to indicate the availability of the restroom, comfort and cleanliness of the facility.
  • Poo Keeper: This app is a  quick tracker for someone struggling with bowel problems. Allows you to snap a quick photo of your stool and track your stool consistency.
  • BM Classic: For those with bowel problems, this app not only allows you to track your bowel frequency and stool consistency (using the awesome Bristol Stool Scale), but also allows you to track stress level, water intake, and dietary habits. Could be a great resource for someone struggling with bowel problems.

Pelvic Floor Exercises:

  • Squeezy: This app was designed by pelvic physiotherapists in the UK and is endorsed by the NHS. It allows for a personalized exercise program, has reminders, visuals and keeps a record.
  • Kegel Trainer: This app includes information on how to use pelvic floor muscles, and has various levels of exercise based on different contraction/relaxation intervals. Free version only includes first level, paid goes up to 15 levels. Includes reminders and an exercise tracker.
  • Pelvic Floor First: This is an awesome organization out of Australia, and I have used their website and handouts frequently for my clients for the past several years. Their app definitely does not disappoint! It offers a nice progressive exercise routine for someone struggling with pelvic floor weakness (like we commonly see with urinary incontinence, pelvic organ prolapse, and postpartum difficulties). The programs go from Starting Out (30 min), Moving On (40 min) to Stepping Up (50 min). Just be sure to chat with your pelvic PT before you jump in the program!
  • If you prefer a device for strengthening (and your pelvic PT thinks that would be helpful to you!), the following are apps that sync to insertable devices: Pericoach, Elvie, KGoal
  • BWOM: This app is great because it starts with a short quiz to help identify where someone may have a pelvic floor problem. It then has exercise programs (available for a small $$) based on that problem, including relaxation exercises! Designed by pelvic physios.
  • GoldMuscle: This app is focused on improving sexual performance rather than on those who may have pelvic health problems, so definitely has a different look to it. It includes various programs to focus on both endurance and quick contractions of pelvic floor, allows you to track progress, and get reminders for your exercises.

Pelvic Pain/Relaxation Apps:

  • RelaxLite with Andrew Johnson: This is one of my personal faves. Basically, it’s a 10-15 min guided progressive relaxation. He has a paid version too with lots of additional upgrades, but the free meditation is great!
  • Headspace: Free version includes a free 10 minute meditation to teach basics of meditation. Upgrade provides access to tons of different meditation options. Great way to start learning meditation.
  • Calm: Another great meditation app. Free version includes the “7 days of Calm” introductory program to learn the basics of mindful meditation, and also incluees access to soothing sounds to help relieve stress. Upgrade allows access to all of the different meditation programs (for sleep, calm, etc)
  • Insight Timer: Meditation community app, includes a timer to track meditation with different sound options, and includes over 1300 guided meditations. Also includes discussion groups and meet-up groups.
  • Binaural- Pure Binaural Beats:  This app allows you to listen (use headphones) to various sounds to promote brain wave activity correlated with relaxation, meditation, problem solving and activity. And all of it’s free!

Women’s Health: 

  • iPeriod: Paid versions only. Use to track periods, ovulation and fertility; Graphs of data available and includes availability to export data to take to physician visits. Lots of personalization options too!
  • Clue: Period tracker that predicts dates for your next period, and also allows you to track symptoms as they relate to your cycle (including pain, which is awesome!)
  • My Days: This app tracks and predicts periods, ovulation and fertility. Also allows options to track basal metabolic temperature, cervical mucus and cervix for those trying to become pregnant.

Pregnancy/Postpartum:  

  • Pregnancy Pelvic Floor Plan: This app by the Continence Foundation of Australia has both a tracker to see weekly milestones during pregnancy, but also has great information on pelvic floor health. Includes option to receive regular reminders to perform pelvic floor exercises.
  • Gentle Birth: This app promotes a positive pregnancy and birth experience. Includes mindfulness, breathing techniques, affirmations and hypnosis, combined with evidence based research. Customized programs based on the woman’s needs. Free for a sample program, then requires paid subscription.
  • Mind the Bump: Meditation app geared toward pregnancy/postnatal populations. Includes different meditations for different periods of time (first trimester-postpartum)
  • Pregnancy Exercise- Weekly Workout: This app by Oh Baby! Fitness (based out of Atlanta, and generally very evidence-based!) includes a new exercise for every week of pregnancy based on pilates, yoga and strength training. Through 10 weeks is free, then $5 to unlock the rest of the weeks.
  • Rost Moves: This app provides recommendations for body mechanics/movement options when performing different regular home activities. Especially a great app for new moms or pregnant women with pelvic girdle/low back pain.

Hope  you found this helpful! Did I miss any of your favorite apps?? Let me know in the comments below! I plan to update this page regularly for new apps we discover! Have a great week! ~ Jessica

Guest Post: Rib cage position, breathing and your pelvic floor

I am thrilled today to have my colleague and friend, Seth Oberst, PT, DPT, SCS, CSCS (that’s a lot of letters, right?!), guest blogging for me. I have known Seth for a few years, and have consistently been impressed with his expansive knowledge and passion for treating a wide range of patient populations (from men and women with chronic pain, to postpartum moms, and even to high level olympic athletes!) Recently, Seth started working with me at One on One in Vinings/Smyrna, which is super awesome because now we get to collaborate regularly in patient care!  Since Seth started with us, we have been co-treating several of my clients with pelvic pain, diastasis rectus, and even post-surgical problems, and Seth has a unique background and skill set which has been extremely valuable to my population (and in all reality, to me too!). If you live in the Atlanta area, I strongly recommend seeing Seth for any orthopedic or chronic pain problems you are having–he rocks! So, I asked Seth to guest blog for us today…and he’ll be talking about your diaphragm, rib cage position, and the impact of this on both the pelvis and the rest of the body! I hope you enjoy his post! ~ Jessica 

The muscles of the pelvic floor and the diaphragm (our primary muscle of breathing) are mirror images of each other. What one does so does the other. Hodges found that the pelvic floor has both postural and respiratory influences and there’s certainly a relationship between breathing difficulty and pelvic floor dysfunction. (JR note: We’ve chatted about this before, so if you need a refresher, check out this post) So one of the best ways we can improve pelvic floor dysfunction is improving the way we breathe and the position of our ribcage. Often times, we learn to breathe only in certain mechanical positions and over time and repetition (after all we breathe around 20,000 times per day), this becomes the “normal” breathing posture.

Clinically, the breathing posture I see most commonly is a flared ribcage position in which the ribs are protruding forward. This puts the diaphragm in a position where it cannot adequately descend during inhalation so instead it pulls the ribs forward upon breathing in. The pelvis mirrors this position such that it is tipped forward, causing the muscles of the pelvic floor to increase their tension. (JR note: We see this happen all the time in men and women with pelvic pain!) Normal human behavior involves alternating cycles of on and off, up and down, without thinking about it. However, with stress and injury we lose this harmony causing the ribs to stay flared and the pelvis to stay tilted. Ultimately this disrupts the synchrony of contraction and relaxation of the diaphragm and pelvic floor, particularly when there is an asymmetry between the right and left sides (which there often is).

Rib Flare PRI

Rib PRI

Jessica has written extensively on a myriad of pelvic floor issues (this IS a pelvic health blog, after all) that can be caused by the altered control and position of the rib cage and pelvis that I described above. But, these same altered positions can cause trouble up and down the body. Here are a few ways:

  1. Shoulder problems: The ribcage is the resting place for the scapulae by forming a convex surface for the concave blades. With a flared, overextended spine and ribs the shoulder blades do not sit securely on their foundation. This is a main culprit for scapular winging (something you will often see at the local gym) because the muscles that control the scapulae are not positioned effectively. And a poorly positioned scapula leads to excessive forces on the shoulder joint itself often causing pain when lifting overhead.
  2. Back pain: When stuck in a constant state of extension (ribs flared), muscles of the back and hips are not in a strong position to control the spine subjecting the back to higher than normal forces repeatedly over time. This often begins to manifest with tight, toned-up backs that you can’t seem to loosen with traditional “stretches”.
  3. Hip impingement: With the pelvis tilted forward, the femurs run into the pelvis more easily when squatting, running, etc. By changing the way we control the pelvis (and by association the rib cage), we can create more space for the hip in the socket decreasing the symptoms of hip impingement (pinching, grinding sensation in groin/anterior hip). For more on finding the proper squat stance to reduce impingement, read this.
  1. Knee problems: An inability to effectively control the rib cage and pelvis together causes increased shearing forces to the knee joint as evidenced in this study. Furthermore, when we only learn to breathe in certain positions, it reduces our ability to adapt to the environment and move variably increasing our risk for injury.
  2. Foot/ankle: The foot and pelvis share some real estate in the brain and we typically see a connection between foot control and pelvic control. So if the pelvis is stuck in one position and cannot rotate to adapt, the foot/ankle complex is also negatively affected.

So, what can we do about this? One of the most important things we can do is learn to expand the ribcage in all directions instead of just in the front of the chest. This allows better alignment by keeping the ribs down instead of sacrificing position with every breath in. Here are few ideas to help bring the rib cage down over the pelvis and improve expansion. These are by no means complete:

**JR Note: These are great movements, but may not be appropriate for every person, especially if a person has pelvic pain and is at an early stage of treatment (or hasn’t been treated yet in physical therapy). For most clients, these exercises are ones that people can be progressed toward, however, make sure to consult with your physical therapist to help determine which movements will be most helpful for you! If you begin a movement, and it feels threatening/harmful to you or causes you to guard your muscles, it may not be the best movement for you at the time. 

**JR Note: This squat exercise is very similar to one we use for men and women with pelvic pain to facilitate a better resting state of the pelvic floor. It’s wonderful–but it does lead to a maximally lengthened pelvic floor, which can be uncomfortable sometimes for men and women who may have significant tenderness/dysfunction in the pelvic floor (like occurs in men and women with pelvic pain in the earliest stages of treatment).

Here’s another one I use often from Quinn Henoch, DPT:

Our ability to maintain a synchronous relationship between the rib cage and pelvis, predominantly thru breathing and postural control, will help regulate the neuromuscular system and ultimately distribute forces throughout the system. And a balanced system is a resilient and efficient one.

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Dr. Seth Oberst, DPT is a colleague of Jessica’s at One on One Physical Therapy in Atlanta, GA. He works with a diverse population of clients from those with chronic pain and fatigue to competitive amateur, CrossFit, professional, and Olympic athletes. Dr. Oberst specializes in optimizing movement and behavior to reduce dysfunction and improve resiliency, adaptability, and self-regulation.

 

For more from Seth check out his website and follow him on Twitter at @SethOberstDPT

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

LIVE Podcast with Ivy Radio on Pelvic Health– Tomorrow 3/11 at 1pm!

Tomorrow at 1pm, I will be chatting live with IvyRadio on all things pelvic health! Tune in tomorrow live at http://www.ivyrehab.com/ivyhealthhub/la-radio/ The podcast will also be available online after the show!

Hope some of you can make it! If you have any specific topics you hope I’ll touch on, let me know in the comments!

Happy Wednesday!

~Jessica

Learning Summary: Becoming the Best Event- Interview with Jessica Drummond

As you may know, part of my goal in writing this blog was to have a forum to process things I learn, and of course, to allow you to benefit from my nerdiness in learning. This week, many of my physical therapy colleagues from across the nation are traveling to Indianapolis for the American Physical Therapy Association’s Combined Section Meetings—basically a week of excellent presenters, networking, and seeing old friends. Of course, my heart is SO sad that I won’t be there this year—so I just had to find a way to learn on my own!

Thankfully, Jessica Drummond clued me in on Twitter to the Becoming the Best Event– a week long summit of (FREE) interviews with top holistic health professionals in the country! I read the bios, and I was in. I have been following Jessica for years (Didn’t know you had a stalker, did you Jess?:) ) and I have truly enjoyed learning from her. Jessica is a physical therapist and the CEO and founder of the Integrative Pelvic Health Institute. She has created a unique model of treating the whole person—managing the hormonal and dietary aspects as well as the physical—and she is pretty awesome at doing it! I was fortunate to collaborate with her this past year in caring for a wonderful woman who was experiencing sexual pain, and I can say from my experience that Jessica really did make a difference in her life!

Jessica Drummond

So, here is a summary of what I took from Jessica’s Interview:

  • In treating women, Health Care Providers (HCPs) must work to normalize women’s health issues. We should all ask about a woman’s menstrual cycle and reproductive history the same way we ask about diet, bowel movements and sleep habits. For some reason, women are taught from an early age that our normal cycle is something to hide and be embarrassed about. However, it is so important and can be one of the only clues to us that something is off! Did you know that an abnormal menstrual cycle could even be an indicator of Celiac’s Disease? I didn’t, until today.
  • Just like we individualize nutrition based on the person, exercise and fitness recommendations should be individualized based on the person. Jessica said this awesome statement during our interview, and I absolutely agree: “I actually don’t think there is any specific form of exercise that is bad—it’s the way, the intensity and your body’s readiness for it.” 
  • What about high impact activities (running, jumping, gymnastics)? Not “bad” either but can put women at risk for problems if they do not understand how to adequately use their pelvic floor muscles.  Increasing pressure on the pelvic floor without adequate timed recruitment can lead to problems like incontinence/prolapse. Jessica recommends that all athletic women should be mindful of their pelvic floors (not always Kegels!) and all HCPs working in wellness should ask questions and encourage seeking help when needed.
  • Women often ignore the benefits of our hormonal cycles—we are always encouraged to hide it from the time we are 12 years old! Estrogen and testosterone are at its highest right before ovulation (2nd week in the cycle). Women actually have more energy at this time, and will burn more fat when exercising these days! We can capitalize on that by eating a higher fat meal a few hours before we exercise to encourage our bodies to burn more fat. So, at mid-cycle- we should eat less sugar, healthy protein and good fats to encourage our body to utilize the natural hormonal environment. In the second half of the cycle, the body actually prefers using protein as energy! If a woman has a big fitness event at the end of the cycle- she may need to eat more often and will probably need more support since hormone levels are at their lowest. And what about running with gels and gus? Jessica actually says that doing this does not encourage our body to use the right fuels but rather pushes a simple sugar energy.
  • Women exercising intensely daily without modulating for hormonal cycle can end up being a negative thing—this does not necessarily allow for adrenal recovery and can negatively impact the system. Estrogen can become lower and this will put someone at risk for cardiovascular dysfunction (and poor bone health too!- JR add)
  • What about for pregnant women? There are some specific things that can be done to tweek a fitness program and get maximum benefits. First, it is important to recognize that the uterine environment is a very important environment to build. That environment can pre- program the genetic expression of the fetal genes. Weight issues, DM, PCOS, Metabolic issues can impact the environment. Clean eating (low sugar) with regular, healthy eating. Insulin sensitivity decreasing as pregnancy progresses can lead to big blood sugar swings which are also not ideal for womb environment. Eating healthy foods at regular intervals can help- focusing on eating nutrient dense foods, healthy fats and minimal sugars. Exercising (even just walking 30 minutes per day) can also help to control blood sugar and promote healthy blood sugar for the baby. Of note, pregnant women should be careful of actively detoxing during pregnancy and while nursing. Stored toxins are “hidden” from the baby and trying to “release” them can actually transmit those things to baby. That being said, a more intense detox before pregnancy can actually be a good thing.
  •  Hormones are of course significantly impacted during menopause. Did you know we can help prepare for menopause? Jessica recommends women focusing on building strong adrenal function during their 30s and 40s, emphasizing addressing stress, nutrient density, and controlling blood sugar. Doing this can impact the entire hormonal environment and create better health for women as they age. During menopause, women lose the estrogen support from ovaries–but having healthy adrenal glands can help a woman make enough estrogen to minimize menopause symptoms (including hot flashes, discomfort and brain fog!)
  • And lastly, what about us health care professionals? How do we avoid adrenal burn-out? It is essential for us to create a fairly strict list of priorities focusing on our vision for our life: What do you want life and work to be like? What must your health be to support this life? Jessica encourages prioritizing self-care and in an oh so inspiration way, encouraged us to “Be an inspiration for patients rather than being the person resposible for ‘fixing them.'” She also encouraged eliminating the guilt we often feel from being unable to cure everyone. She said, “You are not everyone’s healer.” We cannot heal everyone, but there are specific people out there who need our specific skill sets. Our goal should be to provide the knowledge, wisdom and skills patients need to allow themselves to heal. When they see us as an inspiration, they will take the responsibility to own their healing, wellness and healthcare. And this is a total mindset shift! We don’t have to feel guilty when we cannot help someone! And this frees us to really be what we need to be for the people who need us.

Thanks so much Jess for all of this great information! Please check out Jessica’s website for more information about her and the awesome work she is doing! If you would like more information on the Becoming the Best Event, please feel free to check it out here! You can access all of the interviews for free for 24 hours after they air, or you can pay $97 to access them whenever you would like!

Hope you enjoyed this summary! Please let me know any thoughts/comments you have below! ~ Jessica