The benefits of slowing down

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“Ok, let’s try that again, but I want you to do it a little bit more slowly.” 

“Let’s see if you can do that with a little bit less tension.” 

“Do you feel how your neck is working while you’re trying to move your hips? Let’s see if you can do that with only moving your hips.” 

These statements (or variations of them) are ones I tend to make most days of the week. One of the most common things I notice in the men and women I treat with persistent pelvic pain is difficulty in modulating tension. I generally can see this from the moment they walk in my office:

  • Gripping postures, sitting with the shoulders elevated, gripping the chest or the glutes, tightening the back.
  • Minimal variability of movement (basically meaning it is difficult for them to move in different patterns, fully bend and rotate their spines and hips, etc)
  • Altered breathing patterns with poor diaphragmatic excursion

This type of high-tension behavior often occurs in conjunction with a dominant sympathetic nervous system (which we have discussed several times in the past– read here and here). In these cases, the body will feel constantly threatened (makes sense if you’ve had pain for a long time and don’t seem to get better) which can lead to the “fight-or-flight” response being pushed into overdrive. When this occurs, we typically see amped up muscle tension, changes in breathing patterns, and many additional physiological compensations (which you can read more about here). And, I believe this pattern tends to also lead to an overly gripped, hypervigilant pelvic floor muscle group. Then, what I typically see is that instead of the pelvic floor activating with variability, based on the required task at hand (meaning, small amounts of activation for small tasks, and large amounts of activation for bigger tasks), we will instead see loss of force modulation with very high amounts of activation for basic tasks and an inability to let go of that force for simple tasks or tasks that require relaxation (bowel movements, sex, etc).

So, with all of that being said, one of the best things a person with persistent pelvic pain can do is to learn to slow down and control his or her tension patterns. My patients typically begin working on this within the first week or so of treatment, and we continue working on this throughout the initial phase of their care. Basically, our goal is to create awareness of movement–to move mindfully and truly feel what the body is doing to accomplish a task. Typically, as a person becomes more mindful of the movements he or she is performing, we will see an alteration in the force required to perform the movement and this, along with other treatments we are working on, encourages a shift of the body from an overly sympathetic state to a more neutral one. 

So, how can you get started with slow and mindful movements if you are struggling with persistent pelvic pain? 

First, if you are already working with a pelvic PT, talk with them about your tension strategies. Ask her if she has noticed you moving with higher tension and discuss with her integrating slow and mindful movements within your treatment program. If you are not in pelvic PT, or wish to try something on your own, here is one of my favorite exercises to start with:

The Pelvic Clock 

  • This exercise is adapted from a Feldenkrais movement (I believe). I love it because I can integrate diaphragmatic breathing with pelvic floor relaxation, and it encourages awareness of the movement of the pelvis. I tend to find that many people with pelvic pain have difficulty truly knowing where their pelvis is in space and how it moves, and this exercise can help to improve that.  So, let’s get started.

Pelvic Clock

  • Begin in a relaxed comfortable position, lying on your back with your knees bent and your feet resting on the mat (bed, floor, whatevs). Visualize a clock sitting on your pelvis as is shown in the picture above.
  • Start with slow, diaphragmatic breathing. Remember, breathing with your diaphragm will allow the ribcage to expand in all directions, the belly and chest will lift, but the muscles of your neck and shoulders should stay relaxed. If you have not read much about diaphragmatic breathing, read this post and its links before moving forward)
  • Next, we will start to integrate your pelvic floor into your breathing. So, on the next inhale, visualize the breath allowing your pelvic floor to lengthen and relax. This should not be something forceful (ie. don’t push out your pelvic floor), but rather, just focus on letting go of tension as you inhale, allowing the pelvic floor to gently lengthen and the abdominal wall to let go of any tension.
  • Next, we will add in gentle movement of the pelvis with your breath. As you inhale, the pelvic floor will relax and pelvis will gently tilt toward 6 o’clock (allowing the tailbone to fall toward the mat). As you exhale, gently tilt the pelvis back to 12 o’clock allowing the low back to slowly come into contact with the mat. Repeat this slow pattern, focusing on trying to use small amounts of muscle tension to accomplish the task. Remember that this movement and really any other movement should not cause you to guard, tense your muscles or drive up any of the pain you are experiencing.
  • Once you feel confident and comfortable with the previous step, you can begin to add the rotational component. This time, as you inhale, slowly rotate the pelvis around the clock shifting from 12 –> 3 –> 6, ending in the position where your tailbone is gently dropped toward the mat. As you exhale, allow the pelvis to rotate from 6–> 9–> 12, ending in the position where your low back is gently resting on the mat.  Repeat this pattern for several breaths, then try to reverse the motion (inhaling as you move from 12 –>9–>6 and exhaling from 6–>3–>12)
  • Challenge yourself further by trying to allow the pelvis to move through all the numbers of the clock (12–>1–>2–>3… etc).

Remember, there is no rush to performing this exercise! The purpose is awareness– to really feel your pelvis move and shut off any additional tension in performing the task. Did you feel your neck tighten as you were moving? Try again with a focus on keeping it relaxed. Are your legs tightening and moving frequently as you move through the clock? Try to see if you can calm that tension and isolate the movement to your pelvis. Do you feel your pelvic floor gripping as you move? Try to see if you can keep the emphasis on relaxing the pelvic floor during your breathing.

Are you thirsty for more? 

A few of my other favorites for slow, mindful movements are found in both Yoga and the Feldenkrais method. I love Dustienne Miller’s (she’s a pelvic PT too!) home video, yoga for pelvic pain and have had many patients benefit from using it. I also enjoy the Awareness Through Movement lessons with the Feldenkrais Method. Several free online lessons are available here via the OpenATM program.

I hope you have found this helpful! What other movements have you found helpful for pelvic pain? Pelvic PTs and patients, feel free to chime in, so we can all keep learning together!

Happy Wednesday!

~ Jessica

Your Brain is Playing Tricks on You (Part 2): Pain

~ jesspreale ~ 3 Comments

Ok, before we dive into this post, I wanted to say I am SO sorry for taking so long to get this “Part 2” out there. I was at the American Physical Therapy Association’s Combined Sections Meeting in Anaheim, CA for a week, got home and put a contract down on a new house (YAY!!), and things have just been crazy crazy! So, please accept my apology, and I hope you enjoy this post! Stay tuned for some CSM-y posts in the future!  Thanks for reading!! ~ Jessica 

—-

“Perhaps it’s time to recognize that the division between mind and body may be no more than a pedagogic device for instructing medical students– and not a useful construct for understanding human health, disease and behavior.”  V.S. Ramachadran, Phantoms in the Brain

Last post, we discussed how the brain can be tricked by both optical illusions and magic tricks. If you haven’t read it yet, you really need to…because it basically sets the stage for our post this week.

So, how does pain play into all of this? 

Well, pain is an output of the brain, much like vision. Meaning, your brain is receiving sensory information from your body (including your mechanosensation, vision, proprioception, hearing, vestibular/balance input, etc), integrating it with your prior knowledge, experiences, emotions and beliefs, and then creating an output. (ie. “This hurts, you better do something about it!” Or, “You just stubbed your toe you baby…you’ll be just fine!” Or, “Oh my gosh! Your back is never going to get better! It’s probably something super serious and dangerous!”).  Just like your brain can sometimes mess with you in relation to your visual input, the same thing can happen with pain. Let’s look at a few examples.

The Phantom Limb

This example ends up being one that is discussed frequently…in fact, much of the current research on pain was inspired by people experiencing phantom limb pain. If you haven’t heard of phantom limb pain before, basically, this is when a person will feel pain in a limb that has been amputated. Crazy, right? We know that clearly the limb itself if not a source of pain, but rather, the brain is still perceiving threat from the area. This can happen for several reasons. One of the main reasons this can occur is that, although the limb itself is gone, the brain will often still have a representation of that limb.

Homunculus

Now, this representation is changeable over time, however, smudging can occur leading to referred sensations from one area to another. This can trick the body into thinking there is a problem with the non-existent hand. Now, normally, you could look down, see your hand, feel it, and that would then confirm for your brain that the hand it actually fine…however, in cases of phantom limb pain, the limb is not there, so reducing the treat becomes much more tricky. The cool thing is, amazing scientists have developed ways to retrain this using things like mirror therapy (Check out this video from David Butler!) and other innovative treatment approaches. So, obviously, I am wayyyy simplifying this phantom limb phenomenon for this blog, and there are other known contributors to phantom limb pain as well, so I really do recommend you read more. Check out this article from Body in Mind which goes into much more detail.

When Perceived Threat and Harm Level Don’t Quite Match

Have you ever had a little splinter that just hurt so much? That you couldn’t get out of your head until is was gone? That’s a little bit of harm…but somehow the brain is perceiving a big problem. Or, have you ever heard a story about a person walking into the ER talking normally with a knife sticking out of their arm? That’s a lot of harm…but somehow the brain is able to perceive a small threat (which is super helpful in that moment so that the person can get to the ER!).

My favorite example of this is Lorimer Moseley’s story of a snake bite in the brush in Australia. Check it out. He’s hilarious and awesome.

Basically, he tells the story of being bitten by a poisonous snake while walking through thick brush in Australia. When the bite occurs, he doesn’t even realize it because his brain at that moment received the bite information and processed it, with the conclusion of “It’s just a stick. There are tons of sticks around here, nothing to worry about.” He doesn’t realize it’s a snake bite until he passes out a while later. Fast forward to a later time, walking through the brush again, feels the same poke and immediately falls down in excruciating pain…only to realize, it was just a stick. Fascinating right? In that second scenario, his brain had the memory of the first snake bite and the trauma from that, thus, the poke felt much more dangerous and threatening than the first time, and he felt a much greater amount of pain.

So, what does this mean for you? 

Basically, just like our brain can be fooled through visual illusions and magicians, we can also be fooled by pain. This is not meant to imply that pain is in your head…but rather, pain can play tricks on you. And what you feel is a problem in your tissues may not actually be a problem there…but rather could be simply the interpretation of your brain based on the information it is receiving in the moment. Pain, just like vision and hearing, is complex. And treating it thus requires a complex and integrative approach.

Wanna learn more? Check out these awesome articles/videos:

Have a wonderful Monday!

~Jessica

 

Your Brain is Playing Tricks on You (Part 1): Visual Illusions

~ jesspreale ~ 2 Comments

Falling in love is an incredible feeling, isn’t it? One we don’t tend to forget very quickly. At least, that’s how it was for me and Neuroscience. I remember clearly when the falling in love started to take place. Junior year in college, reading a book called  by V.S. Ramachadran, Phantoms in the Brain: Probing the Mysteries of the Human Mind,
for my Neuroanatomy and Physiology of Human Movement class. I remember being glued to that book from cover to cover, only stopping briefly to write down a quick quote or call my parents to tell them the amazing piece of information I just learned (Yes, I still call them to tell them fun things like that :))

The amazing thing, that I’m sure you are realizing too, is that our brains are simply incredible. We have the ability to take in millions of tiny pieces of information in microseconds, integrate it within everything we believe to be true about our world and the universe and then make decisions on what that information means. It’s incredible, really. But did you know that this ultimate perception can lead to misinformation? Did you know your brain can really really mess with you?

Optical Illusions

One of the most well-known tricks of the brain is an optical illusion. Do you see a bunny or a duck?

Illusions DuckBunny

Which square is darker, A or B? (They’re actually the same color!)

128px-Optical_illusion
By Wuhazet – Henryk Żychowski (Own work) [GFDL (http://www.gnu.org/copyleft/fdl.html) or CC BY 3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons

So, how did your brain trick you? Your nervous system is constantly gathering information about the body and the environment through multiple different inputs: visual, mechanical, temperature, proprioceptive (the position of your joints), vestibular (your inner ear). This process is called sensation. Perception, then, is your brain’s interpretation of the information it receives. The brain receives and filters the information from various sensors and then interprets its meaning to create our experience. In these cases, your brain receives the signal (visual input) and then perceives meaning based on the information, and your experience. In the first picture, your brain likely can see either a duck or a bunny depending on how it chooses to interpret the information. In the second one, your brain took into account the shadow that the green cylinder was casting on the board– thus, your brain tricked you into thinking that tile B must be lighter than tile A (although, really they are the same!) And the third one, your brain saw the arrows in the first one as narrowing in the space, and the second as expanding it–even though the lines are the same length. Pretty cool, right?!

Magic Tricks 

I have always loved a good magic trick. I remember seeing my first “real” magic show in Las Vegas at Harrah’s Casino. I was 11 or 12 I think, and was completely mesmerized by Mac King and his comedy magic show. My family just loved it! We were amazed, and couldn’t figure out how he did what he did.

(This is actually pretty close to what that magic show looked and felt like–so enjoy being transported back to 12-year old Jessica’s life!) 

I still love watching a great magic show. From street magicians like David Blaine to bigger than life magicians like David Copperfield or Siegfried and Roy, magicians have the ability to suspend our belief, challenge our perceptions and allow us to believe we are seeing the impossible.

So what are magic tricks? How do they feel so “real” to us watching?

In a way, magic tricks are very similar to optical illusions. Magicians are truly masters at using the brain to fool us into truly seeing something that did not happen. Magic tricks work based on several key principles. First, as we discussed above, your brain constantly creates perceptions based on the sensory inputs it receives from the environment. As was shown in our “illusions” section, the perception does not always directly match the visual input as our brain integrates vision with our previous knowledge, emotions, experiences, etc. to make predictions and ultimately create perception. These predictions are precisely what is exploited during magic tricks. This great article gives the example of the “vanishing ball” trick. In this trick, the magician throws the ball up in the air several times, and finally on the last one, the ball appears to vanish out of the air. But did it really vanish? Of course not! The magician used our brain’s predictions in his favor…thus, we saw the magician continuing to look up toward the ball, we saw the hand move in a “throwing pattern.” and the brain cut a few corners to tell us the ball had been thrown! While we’re busy watching that magician’s face, the ball is then palmed away, and our brain perceives it has vanished! Pretty cool, right? (check out the article for a larger, more detailed explanation!)

Magic tricks also work by confusing our brain with conflicting inputs and playing with our attention. For example, we are much more easily tricked and distracted when we have to multitask and focus on multiple different things at once. This is common with card tricks and other illusions. Emotions (such as humor, story-telling, etc) can also lead to some brain-trickery as it again creates a distraction for the brain, forcing the brain to “predict” to fill in the missing pieces.

It’s really, quite incredible, and learning about all of this actually has made me respect magicians even more as fellow neuroscientists! Check out these excellent articles if you want to dive a little deeper and further understand more of what happens with magic tricks!

Now…You may be thinking… “What the heck Jessica? This is a “pelvic-focused” blog! Why are you writing about optical illusions and magic tricks!?” Well my dear blog reader, you’ll have to find out… Stay tuned for Part 2- Your Brain is Playing Tricks on You: Pain

Book Review: A Guide to Better Movement

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One of my New Year’s resolutions was to build a better morning routine to help me use my time more optimally during the day. Part of that morning routine includes reading for 30 minutes over breakfast…and I have to tell you, it’s my most favorite part of the day. My first book of the year was Todd Hargrove’s  A Guide to Better Movement, and I really really loved it. So much so, that I just needed to share it with you!

Guide to Better MOvementI was first introduced to Todd Hargrove through his blog post back in October, “Why do muscles feel tight?” I loved it, was hooked, and ordered his book the same day. Todd is a pretty smart guy, and has a unique background being a prior attorney and current Rolfer and Feldenkrais practitioner. I love learning from people who are not physical therapists because I find it challenges my viewpoints and helps me to see my clients from a different perspective. Todd’s book did not disappoint.

Who should read it? 

  • Anyone who likes moving, should move, and wants to move better
  • Athletes (yes, this includes any of you who exercise regularly) who want to make sure they are caring for their bodies
  • People experiencing persistent pain
  • Practitioners working with humans who move
  • (Is that broad enough for you?)

What are the details? 

  • Available on Amazon.com for $17.95, paperback  (Click here: A Guide to Better Movement: The Science and Practice of Moving With More Skill And Less Pain)
  • Length: 277 pages, broken into the following sections:
    • Introduction
    • Part 1: The Science of Moving Better
      • Defining Better Movement
      • Learning Better Movement
      • The Brain Maps the Body
      • Motor Development and Primal Patterns
    • Part 2: The Science of Feeling Better
      • The Science of Pain
      • Movement and Threat: Central Governors
      • Movement, Thinking and Feeling
    • Part 3: The Practice of Moving Better and Feeling Better
      • Strategies to Move Better and Feel Better
      • Lessons in Better Movement (pgs 149-277)

What’s so great about it? As you may know, my studies recently have sent me deep into the world of neuroscience, so I love reading books that integrate the whole body rather than just focusing on specific tissues. Hargrove does an excellent job of not only teaching the science related to movement and pain in a way that is easily understandable by clinicians and patients alike, but also offers strategies and lessons for improving movement and shifting away from a pain state. He uses excellent analogies throughout his book that all people will be able to relate to and understand. On another note, his book is full of great quotes… and I’ve always been a sucker for a good quote… so you’ll see some of my favorites here :).

In the first part, the science of moving better, Hargrove discusses the essential qualities of good movement (coordination, responsiveness, distribution of effort, division of labor, position and alignment, relaxation and efficiency, timing, variability, comfort and individually customized). I especially love his section on relaxation and efficiency as I believe this to be a huge factor for the men and women I treat experiencing chronic pelvic pain. So often, these people end up in states of chronically over-activating musculature to perform tasks, and I believe changing this can make a big difference for them. “Efficient movement requires skill in relaxation… thus developing movement skill is often more about learning to inhibit the spread of neural excitement rather than extending it.” 

Next, he goes on to explain the process for learning better movements diving in to the motor control system, and then explains how the brain maps the body and the ways in which those maps can change over time. “The current organization of [a person’s]  sensory  maps already reflects a lifetime of effort to organize them in an optimal way to perform functional goals.”  He uses a great analogy here of a skiier going down a hill. The first trip down, the person has endless options on the path to take down…but after going again, and again, deep grooves in the snow are formed and it can be difficult to take alternate paths.

downhill skiing

Lastly in this section, he discusses motor development and primal movement patterns and the importance of training foundational movements with large carryover into a variety of functional tasks.

Part two, the science of feeling better goes into our favorite topic–pain science. Hargrove does a fantastic job of explaining pain and gives a plethora of examples and analogies to help the reader understand very advanced topics. Two of my faves from this section are,”Although nociception is one of the most important inputs contributing to pain, it is neither necessary nor sufficient for pain to exist,” and, “Pain is an action signal, not a damage meter.” This section also explores different options for moving past pain and discusses how the central nervous system responds with threat in order to protect the body. The last chapter in this section looks at movement and emotion and explains the way we now understand the mind to relate to the body. (Hint: the mind and the body are ONE).

The last section of this book, the practice of moving better and feeling better discusses strategies for improving movement and key components of training movement variety. Hargrove summarizes his thoughts on this in the following way, “Move playfully, experimentally and curiously, with full attention on what you are doing and what you are trying to accomplish. Focus on movements that are the foundation for your movement health, and have a lot of carryover to many activities, as opposed to movements that are specific and don’t have carryover. Move as much as you can without injury, pain or excess threat, wait for the body to adapt, and then move more next time.” 

Hargrove ends the book by providing 25 lessons to help improve movement. These are based on the Feldenkrais Method (which I liked as I currently use some of these principles and movements within my clinical practice.). Each lesson offers options for progressing and provides guidance for attention and variations.

So, in summary…. I loved this book. I have already recommended it to clients, and plan to use some of the movement lessons within my practice. I hope you love it too!

Have you read any other great books recently? I’m looking for my next one to read! 

~ Jessica

What do you want in 2016? I want to hear from YOU!

~ jesspreale ~ 2 Comments

Ok, first, I promise a real, educational post is coming this week. So, don’t fret.

In planning for 2016, I really want to help this blog be more informative and helpful to YOU my dear reader. So, I have a little favor to ask… will you pretty pretty please fill out this quick survey to let me know who you are and what you want to learn about? I promise it will take less than 2 minutes (maybe even 1 minute, if you’re fast!). It will help all of us— me, to write posts more of you are excited about… and you, to have better posts that actually meet your learning needs.

Thank you, thank you, thank you!!!! (Survey results are anonymous, FYI!)

Click here to be the most awesome blog reader ever and help me make 2016 our best year yet! 

2015 in Review! Happy New Year!

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Happy-new-year-2016
Attributed to Rajhansda10 under https://commons.wikimedia.org/wiki/File:Happy-new-year-2016.jpg

As we close 2015, I just wanted to say a huge THANK YOU to those of you who have started this journey with me to better understand pelvic health problems, pain, and really, the whole human body. It has been a wonderful blessing in my life, and a surprisingly great first year of the blog!

In this first year, we have had close to 35,000 views from 145 different countries, and that is so very humbling and exciting! I have really enjoyed learning, writing, and journeying with you all, and I am thrilled for some super fun new content to come in 2016 (hint: video editing software was on my Christmas list!)

So, to re-cap, as we tend to do at the end of a year… our top 5 blog posts of 2015 were:

#5 Is Running Bad for a Woman’s Pelvic Floor?

#4 A Pain in the Tail…bone (Part 2- Treatment)

#3 Pelvic Floor Problems in the Adult Athlete: Pelvic Floor Muscle-Related Pain

#2 A Pain in the Tail…bone (Part 1- What is it? How does it happen? How does it feel?) 

annnndddd number 1, without a contest…….Druummmrolllllll…..

#1 6 Reasons Why the Diaphragm may be the Coolest Muscle in the Body

2015 is a wrap! I’ll see you in the NEW YEAR!!

~ Jessica

Mindfulness, Meditation and Pain

~ jesspreale ~ 11 Comments

“If you get the inside right, the outside will fall into place. Primary reality is within; secondary reality without.” ~ Eckhart Tolle, The Power of Now: A Guide to Spiritual Enlightenment

meditation-338446_1920

Within many traditional clinical practices, mindfulness-based or meditation-based exercises are considered alternative, eastern, touchy-feely or even “voo-doo.” It is often seen as a complementary treatment that may be helpful…but really isn’t going to “treat” the client. I’ve had many clinicians I respect significantly tell me that they don’t use guided meditation within their practice for this exact reason. Respectfully, I have to disagree with that sentiment. I recommend mindfulness-based relaxation or guided meditation to my patients on almost a daily basis, and I believe strongly that there are so many benefits in this practice for a person struggling with persistent pain.

Pain Neuroscience 

To understand why meditation is helpful in overcoming persistent pain, it is crucial to understand what pain is, and to truly grasp the role of the brain in pain (Summary: No brain, no pain). If you are new to this blog, or new to pain science in general, you have a few prerequisites before you move forward:

Ok, I could go on and on…but I won’t. So, we’ll move on.

What is Meditation/Mindfulness Training?  

Mindfulness is described here as a “non-elaborative, non-judgmental awareness of present moment experience.” There are a few different types of mindfulness based meditation practices, usually broken into:

  • Focused Attention: This involves focusing attention on a specific object or sensation (i.e. focusing on breath moving, or focusing on a certain space). If attention is shifted to someone else, the person is then taught to acknowledge it, disengage, and shift the attention back to the object of meditation.
  • Open Monitoring:  This is a non-directed practice of acknowledging any event that occurs in the mind without evaluation or interpretation
  • Variations: There are multiple variations of these practices, usually trending toward one variety or the other. For example, there are guided relaxation exercises which will shift the focus from one body part to another, meditation exercises based on focusing on a color moving through the body, etc.

Meditation and the Brain 

The cool thing is meditation has been found to have some pretty profound effects on the brain. This meta-analysis of fMRI studies aimed to determine how meditation influenced neural activity, and the results were pretty interesting. They found that brain areas from the occipital to frontal lobes were more activated during meditation, specifically areas involved in processing:

  •  self-relevant information (ie. precuneus)
  • self-regulation, problem-solving, and adaptive behavior (ie. anterior cingulate cortex)
  • interoception and monitoring internal body states (ie. insula)
  • reorienting attention (ie. angular gyrus)
  • “experiential enactive self” (ie. premotor cortex and superior frontal gyrus)

Basically, the authors state that all of these areas are characterized by “full attention to internal and external experiences as they occur in the present moment.”

For more information on how meditation impacts the brain, check out this great TEDx talk by Catherine Kerr:

 

Persistent Pain Implications

Now, you may be thinking, why does that matter for a person experiencing persistent pain? Well, it matters because for most people, pain does not solely exist in the present, but rather, is an experience influenced by a complex neural network, integrating 1) what you know about the pain 2) how dangerous you feel it is 3) your history relating to that pain 4) your fears/concerns/worries about the future 5) how this problem relates to your family, job, relationships, home, etc. and 6) so so much more. (including everything helpful and unhelpful your health care providers have told you about your pain.)

Here’s an example. Let’s say you start having some back pain one day after bending over to pick up something off the floor. Happens right? But, what if you used to have back pain years ago and had an MRI that showed degenerative changes in your spine? And what if you have a two year old you have to carry around frequently? What if work has been difficult recently and you’re worried your job is in jeopardy? What if you had a physical therapist tell you that you should never bend down like that or you would “hurt your back?” The amazing thing is that all of these experiences, histories, thoughts, emotions are seamlessly integrated by your brain to determine the immediate “threat level” of your low back, and create an overall pain experience (ultimately, designed to be helpful and protect you against harm).  This story is a real one, and actually happened to a patient of mine…by the time she came into my office, she couldn’t bend forward at all, had severe pain, and was very worried about the level of “damage” in her low back. But, the truth was, she had really just moved in a way that her body chose to guard, and nothing was really “damaged” at all. After a quick treatment session, she was back to full motion without any pain. Now, am I magical in “fixing” backs like that? Yes. But that’s besides the point. But really, all I did was remove the threat level by taking her back to the present moment (ie. Your back is not damaged. Bending is totally fine and functional to do. This is going to get better really soon.) and restore movement to a system that was guarding against it.

So, what does this have to do with meditation/mindfulness? Well, at it’s core, meditation is about changing awareness and improving focus to the present moment. This can then change the “pain story” to decrease the threat level for the present moment, and thus help a person move toward recovery.

Does it work? 

The best part is that it actually seems to make a significant impact (although, of course, we need better larger studies!) Of course, it is just one piece of the puzzle–but I really believe it can be an important component of a comprehensive program to help someone experiencing persistent pain. And, the research actually is trending toward it being beneficial too. In fact, meditation and mindfulness-based stress reduction has been shown to be helpful in reducing pain and improving quality of life in men and women experiencing chronic headaches, chronic low back pain,  and non-specific chronic pain.  There have not been many studies looking specifically at chronic pelvic pain, but there was one pilot study I found, and it also seemed to show favorable results in improving quality of life.  Will it take you 10 years of channeling your inner guru to see the benefits? Actually, the research seems to indicate that changes happen pretty quickly. This study actually found improvements after just four sessions.

Getting Started 

If you are experiencing persistent pain, or are a human who happens to have a brain, you would likely benefit from using meditation as part of your daily exercise program (Yes, I consider meditation exercise!) There are so many fabulous resources out there to get started in practicing mindfulness/meditation. Here are a few of my favorites:

Books that are helpful in understanding meditation:

The Power of Now, by Eckhart Tolle- $10 on Amazon 

Peace is Every Step, by Ticht Naht Han- $8 on Amazon 

Free Guided Meditation Exercises ONLINE/APPS-Note, I find different people tend to enjoy different guided meditations/programs. Try a few different ones here, or even go on to youtube and do a little search. You may find some you love and some you hate, and that really is ok. Try to find what works best for you!

Relax Lite with Andrew Johnson– available free on itunes and as an app!

Breathe to Relax– available free on itunes and as an app!

Headspace– available free on itunes and as an app!

Insight Timer– available free on itunes and as an app!

Sattva Meditation Tracker & Timer- available free on itunes and as an app!

Guided Meditation for Pelvic Pain– by Dustienne Miller, PT, available free on her website.

Tara Brach– Great resources with meditations, lectures, and more!

I hope this is helpful for you! What other resources do you enjoy for relaxation/mindfulness/meditation?  Please feel free to share in the comments below!

Wishing you a very merry Christmas and a happy new year!!

~Jessica

 

 

Why get Pelvic PT first? And, join me for a webinar Thursday 12/10!

~ jesspreale ~ Leave a comment

If you didn’t know, December 1st was a day that all PTs came together to share with the public all of the benefits of seeking PT! My colleague, Stephanie Prendergast, founder of the Pelvic Health and Rehabilitation Center in California, wrote an amazing blog post on why someone should get pelvic PT first. I thought it was great (as you know…I post lots of Stephanie’s stuff), and Stephanie gave me permission to re-blog it here. So, I really hope you enjoy it. If you aren’t familiar with Stephanie’s blog, please check it out here. You won’t regret it. 

On another note, I will be teaching a live webinar Thursday 12/10 on Pelvic Floor Dysfunction in the Adult Athlete. I really hope to see some blog followers there! Register for it here.  

Now… enjoy this great post by Stephanie. ~ Jessica 

Why get PT 1st? Here are the Facts. By Stephanie Prendergast

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Vaginal pain. Burning with urination. Post-ejaculatory pain. Constipation. Genital pain following bowel movements. Pelvic pain that prevents sitting, exercising, wearing pants and having pleasurable intercourse.

When a person develops these symptoms, physical therapy is not the first avenue of treatment they turn to for help. In fact, physical therapists are not even considered at all. This week, we’ll discuss why this old way of thinking needs to CHANGE. Additionally, we’ll explain how the “Get PT 1st” campaign is leading the way in this movement.

We’ve heard it before. You didn’t know we existed, right? Throughout the years, patients continue to inform me the reason they never sought a physical therapist for treatment first, was because they were unaware pelvic physical therapists existed, and are actually qualified to help them.

Many individuals do not realize that physical therapists hold advanced degrees in musculoskeletal and neurologic health, and are treating a wide range of disorders beyond the commonly thought of sports or surgical rehabilitation.

On December 1st, physical therapists came together on social media to raise awareness about our profession and how we serve the community. The campaign is titled “GetPT1st”. The team at PHRC supports this campaign and this week we will tell you that you can and should get PT first if you are suffering from a pelvic floor disorder.

Did you know that a majority of people with pelvic pain have “tight” pelvic floor muscles that are associated with their symptoms?

Physical therapy is first-line treatment that can help women eliminate vulvar pain

Chronic vulvar pain affects approximately 8% of the female population under 40 years old in the USA, with prevalence increasing to 18% across the lifespan. (Ruby H. N. Nguyen, Rachael M. Turner, Jared Sieling, David A. Williams, James S. Hodges, Bernard L. Harlow, Feasibility of Collecting Vulvar Pain Variability and its Correlates Using Prospective Collection with Smartphones 2014)

Physical therapy is first-line treatment that can help men and women with  Interstitial Cystitis

Over 1 million people are affected by IC in the United States alone [Hanno, 2002;Jones and Nyberg, 1997], in fact; an office survey indicated that 575 in every 100,000 women have IC [Rosenberg and Hazzard, 2005]. Another study on self-reported adult IC cases in an urban community estimated its prevalence to be approximately 4% [Ibrahim et al. 2007]. Children and adolescents can also have IC [Shear and Mayer, 2006]; patients with IC have had 10 times higher prevalence of bladder problems as children than the general population [Hanno, 2007].

Physical Therapy is first-line treatment that can help men suffering from Chronic Nonbacterial Prostatitis/Male Pelvic Pain

Chronic prostatitis (CP) or chronic pelvic pain syndrome (CPPS) affects 2%-14% of the male population, and chronic prostatitis is the most common urologic diagnosis in men aged <50 years.

The definition of CP/CPPS states urinary symptoms are present in the absence of a prostate infection. (Pontari et al. New developments in the diagnosis and treatment of CP/CPPS. Current Opinion, November 2013).

71% of women in a survey of 205 educated postpartum women were unaware of the impact of pregnancy on the pelvic floor muscles.

21% of nulliparous women in a 269 women study presented with Levator Ani avulsion following a vaginal delivery (Deft. relationship between postpartum levator ani muscle avulsion and signs and symptoms of pelvic floor dysfunction. BJOG 2014 Feb 121: 1164 -1172).

64.3% of women reported sexual dysfunction in the first year following childbirth. (Khajehi M. Prevalence and risk factors of sexual dysfunction in postpartum Australian women. J Sex Med 2015 June; 12(6):1415-26.

24% of postpartum women still experienced pain with intercourse at 18 months postpartum (McDonald et al. Dyspareunia and childbirth: a prospective cohort study. BJOG 2015)

85% of women stated that given verbal instruction alone did not help them to properly perform a Kegel. *Dunbar A. understanding vaginal childbirth: what do women understand about the consequences of vaginal childbirth.J  Wo Health PT 2011 May/August 35 (2) 51 – 56)

Did you know that pelvic floor physical therapy is mandatory for postpartum women in many other countries such as France, Australia, and England? This is because pelvic floor physical therapy can help prepartum women prepare for birth and postpartum moms restore their musculoskeletal health, eliminate incontinence, prevent pelvic organ prolapse, and return to pain-free sex.

Did you know that weak or ‘low tone’ pelvic floor muscles are associated with urinary and fecal incontinence, erectile dysfunction, and pelvic organ prolapse?

Physical Therapy can help with Stress Urinary Incontinence

Did you know that weak or ‘low tone’ pelvic floor muscles are associated with urinary and fecal incontinence, erectile dysfunction, and pelvic organ prolapse? 80% of women by the age of 50 experience Stress Urinary Incontinence. Pelvic floor muscle training was associated with a cure of stress urinary incontinence. (Dumoulin C et al. Neurourol Urodyn. Nov 2014)

30 – 85 % of men develop stress urinary incontinence following a radical prostatectomy. Early pelvic floor muscle training hastened the recovery of continence and reduced the severity at 1, 3 and 6 months postoperatively. (Ribeiro LH et al. J Urol. Sept 2014; 184 (3):1034 -9).

Physical Therapy can help with Erectile Dysfunction

Several studies have looked at the prevalence of ED. At age 40, approximately 40% of men are affected. The rate increases to nearly 70% in men aged 70 years. The prevalence of complete ED increases from 5% to 15% as age increases from 40 to 70 years.1

Physical Therapy can help with Pelvic Organ Prolapse

In the 16,616 women with a uterus, the rate of uterine prolapse was 14.2%; the rate of cystocele was 34.3%; and the rate of rectocele was 18.6%. For the 10,727 women who had undergone a hysterectomy, the prevalence of cystocele was 32.9% and of rectocele was 18.3%. (Susan L. Hendrix, DO,Pelvic organ prolapse in the Women’s Health Initiative: Gravity and gravidity. Am J Obstet Gynecol 2002;186:1160-6.)

Pelvic floor physical therapy can help optimize musculoskeletal health, reducing the symptoms of prolapse, help prepare the body for surgery if necessary, and speed post-operative recovery.

Did you know….

In many states a person can go directly to a physical therapist without a referral from a physician? (For more information about your state: https://www.apta.org/uploadedFiles/APTAorg/Advocacy/State/Issues/Direct_Access/DirectAccessbyState.pdf)

You need to know….

Pelvic floor physical therapy can help vulvar pain, chronic nonbacterial prostatitis/CPPS, Interstitial Cystitis, and Pudendal Neuralgia. (link blogs: http://www.pelvicpainrehab.com/patient-questions/401/what-is-a-good-pelvic-pain-pt-session-like/, http://www.pelvicpainrehab.com/male-pelvic-pain/460/male-pelvic-pain-its-time-to-treat-men-right/http://www.pelvicpainrehab.com/female-pelvic-pain/488/case-study-pt-for-a-vulvodynia-diagnosis/)

Pelvic floor physical therapy can help prepartum women prepare for birth and postpartum moms restore their musculoskeletal health, eliminate incontinence, prevent pelvic organ prolapse, and return to pain-free sex: http://www.pelvicpainrehab.com/pregnancy/540/pelvic-floor-rehab-its-time-to-treat-new-moms-right/

Early pelvic floor muscle training hastened the recovery of continence and reduced the severity at 1, 3 and 6 months in postoperative men following prostatectomy. (Ribeiro LH et al. J Urol. Sept 2014; 184 (3):1034 -9). (Link blog: http://www.pelvicpainrehab.com/male-pelvic-pain/2322/men-kegels/

A study from the University of the West in the U.K. found that pelvic exercises helped 40 percent of men with ED regain normal erectile function. They also helped an additional 33.5 percent significantly improve erectile function. Additional research suggests pelvic muscle training may be helpful for treating ED as well as other pelvic health issues. (link blog:http://www.pelvicpainrehab.com/male-pelvic-pain/2322/men-kegels/

….that you can and should find a pelvic floor physical therapist and  Get PT 1st.

To find a pelvic floor physical therapist:

American Physical Therapy Association, Section on Women’s Health:

http://www.womenshealthapta.org/pt-locator/

International Pelvic Pain Society: http://pelvicpain.org/patients/find-a-medical-provider.aspx

Best,

Stephanie Prendergast, MPT

stephanie1-150x150Stephanie grew up in South Jersey, and currently sees patients at Pelvic Health and Rehabilitation Center in their Los Angeles office. She received her bachelor’s degree in exercise physiology from Rutgers University, and her master’s in physical therapy at the Medical College of Pennsylvania and Hahnemann University in Philadelphia. For balance, Steph turns to yoga, music, and her calm and loving King Charles Cavalier Spaniel, Abbie. For adventure, she gets her fix from scuba diving and global travel.

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

~ jesspreale ~ 3 Comments

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.

Seth-Oberst

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

Yes, Men can have pelvic pain too.

~ jesspreale ~ 4 Comments

Confession: I treat men. Lots of them. Seriously, I think my schedule is often about 30% men. This shouldn’t have to be a confession. You shouldn’t be surprised, or shocked by this, but you possibly are. I mean, my female patients are often surprised when they see a male walking out prior to their appointments. I’ve seen that same surprised look on a friend’s (or family member’s, or random person at the bar who happened to ask me what I do for a living’s) face. For some reason, pelvic floor problems are typically seen as a “woman’s problem,” and this is so so unfortunate. It’s unfortunate, because it means that many men feel embarrassed or awkward seeking help for a problem seen to be “unmanly.” It’s unfortunate, because SO many of the men I treat end up seeing close to 5-6 physicians, plus 2-3 physical therapists/chiropractors/acupuncturists, etc. before they actually end up in a place that offers them hope. And it’s unfortunate, because it means that many many men end up suffering with pain for way longer than they should. And this just has to stop. < Rant ended>

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So, today, we’re going to talk about Pelvic Pain in Men. First, you should know that pelvic pain in men is not that uncommon. In fact, this study estimates that close to 1 in 10 men experience chronic prostatitis/chronic pelvic pain syndrome. Often times, pelvic pain is first diagnosed as prostatitis, and I think this happens because of where the pain is located. Prostatitis means inflammation in the prostate… but not all men with the diagnosis actually have inflammation present in the prostate. In all seriousness, I encourage men who are having pelvic pain and receive this diagnosis to ask for a culture. Make sure your prostate is really the one who should be blamed. In some cases, it is (like with bacterial infections). But, often times, these cultures come back negative. So ultimately if the pelvic pain doesn’t go away after a few months, men will often get the diagnosis of chronic nonbacterial prostatitis (which is now categorized as Type 3 chronic prostatitis) or chronic pelvic pain syndrome.

Now, you may be thinking, “Jessica, where are you going with all of this?” Well, these men are the ones I generally end up treating. They’ve had pelvic pain for a long time. Haven’t really responded that well to many medications. And still have pretty significant pain levels. <<Side bar: Today, we’re going to talk about the musculoskeletal aspects involved in pelvic pain in men; however, we never want to downplay the role that other systems and structures can play in pain. So, make sure you are working with a multidisciplinary team and are thoroughly evaluated medically.>>

The symptoms of myofascial pelvic pain in men can include the following: 

  • Pain (which can be sharp, dull, achey, burning, pulling, etc) localized to the lower abdomen, hips, buttock, anus, perineal body, penis, scrotum and/or tailbone.
  • Changes in urination, including urinary urgency/frequency, pain with urination, difficulty starting a urine stream, intermittent or slow urine stream, dribbling after urination and/or urinary leakage.
  • Changes in bowel function including constipation, difficulty emptying bowel movements, pain during and/or after bowel movements.
  • Changes in sexual function including premature ejaculation or erectile dysfunction and/or pain related to sexual function.

So, what can a physical therapist do to help a man with pelvic pain? 

Well, a lot. First, you should know that pelvic pain is complicated (I would argue that all pain really is) and when someone has been in pain for a long time, their pain experience becomes multifactorial. We know now that when a person has had pain for a long time, his or her brain changes the way it processes the signals from the area, and many people develop what we call “central sensitization.” This study found that this happens commonly in men with chronic pelvic pain, which should come as no shock to those of you who read my blog regularly. How exactly is the brain involved in all this? I’m not going to repeat myself here…but I will tell you, to stop here if you don’t know it already, and read this, this and this.

Ok, back to what we can do to help these men experiencing pelvic pain. Let’s break it down:

  • Identification of the musculoskeletal and neuromuscular structures involved: A skilled pelvic PT will perform a comprehensive examination to observe movement patterns and identify structures that could be a component of the pelvic pain experience (including neural, muscular and connective tissue)For many men with pelvic pain, the pelvic floor muscles can be some of those components. These muscles are actually fairly similar anatomically to the pelvic floor muscles in women (although different, of course!). These muscles can be evaluated externally via palpation or internally via the anal canal. Typically, assessing both ways is the best option as it gives us a comprehensive picture of what is happening from a muscular standpoint.

 

  • Nervous System (Brain) Training: I could really just stop here…because this is our primary and most important goal in physical therapy. This should (and will eventually) be a series of posts in itself.  Basically, we know that the brain protects a person against “threatening” areas, movements, etc. when a person is experiencing persistent pain. We want to slowly teach the brain that the areas it is protecting are no longer a threat. We want to widen the “safety net” of the brain to allow for more variability in movement, and we can do that through manual therapy, downtraining the nervous system(restoring breathing patterns, guided relaxations, stress management, etc), restorative exercise/movement, and lots of behavioral education.
  • Manual Therapy Techniques: Musculoskeletal structures are often significant components of chronic pelvic pain in men, like I mentioned above. This includes the pelvic floor muscles (both the external, superficial layer of muscles around the penis and perineum as well as the deeper layers of muscle) as well as the muscles around the pelvis (gluteal muscles, adductors, hip flexors, low back muscles, etc.). Many men will also have restrictions in connective tissue around the pelvis, as well as possibly decreased nerve mobility in some of the nerves around the pelvis. Manual therapy techniques performed both externally and internally help to restore tissue mobility, improve blood flow, and improve the movement of the spine and joints around the pelvis.
  • Improving Bowel, Bladder and Sexual Habits: As mentioned above, pelvic pain is often accompanied by bladder, bowel or sexual symptoms. Part of helping a client move toward better function means making sure that habits are supporting the best possible outcome. So, we look at everything from dietary habits, toilet positioning, sexual positioning/habits, as well as even sleeping habits to make sure we are addressing as many components of the “pain picture” that we can.
  • Restoring Movement Patterns:  As we have learned previously, movement patterns are often changed/adapted when a person is experiencing pain. Although this can be a helpful adaptation short-term, these adaptations can often contribute to problems as time goes on. So, our goal is to observe these patterns of movement and identify asymmetries or dominant patterns in order to add some variety to movement and improve the fluidity of movement patterns. Basically, we want to restore the large variety of movement that you used to have before you were dealing with pelvic pain.
  • Much, much more… I know, this is a catch-all subheading. But honestly, there is SO much more that we can do to help someone with pelvic pain depending on the specific case and it would be impossible to get it all in within one blog!

So, basically, what I’m trying to say is that if you’re a man who is having pelvic pain, it’s time to do something about it! I really do recommend seeking out a pelvic PT who is skilled in treating persistent pelvic pain, and comfortable in treating men (Come see me if you live in the metro Atlanta area!). And, if you’re a pelvic PT and don’t feel comfortable treating men? Then, I want you to read what I’m about to write with the kindest, gentlest undertones… It’s time to get comfortable. I’m serious, and I’m talking to you blog reader who only accepts female clients. I understand that some women feel awkward about this…but men need us! They’re hurting, and they need help, so I really think it’s time to get comfortable. Go to a course, seek out mentoring, or whatever you need to get comfortable…but I think we all need to take responsibility to start providing these men with the care they need!

Wanna read more? Check out these great posts by my colleagues on male pelvic floor problems:

As always, I love to hear from you! Please feel free to comment with any questions or thoughts about any of this! Let’s keep the conversation going!

Wishing you an early, happy Thanksgiving! 

~Jessica