Happy Friday! Here’s a little humor to get your weekend started off right… Enjoy! – Jessica Reale, PT, DPT, WCS
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Excellent post by Sue Croft giving lots of resources on understanding persistent pelvic pain! Read on for book recommendations, videos and blog posts!
My blog is a wonderful resource for me and my patients. It’s like having a great big library of all the things I want patients to read at my finger tips. When we physios teach a vast amount of seemingly complex medical information in an hour to an hour and a half- its pretty certain that most adult learners will take in about 20% of what you’ve said (at the time of the consult)- if you are lucky. That’s why every patient I see gets a 14 page handout plus some extra pages if there are specific tests I want them to undertake (for example- a simple corn or beetroot test to check their bowel transit time; or a handout on the causes of faecal incontinence- and if they have pelvic pain they get the normal pelvic floor dysfunction handout as well as a dedicated pain handout). They also get a copy…
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New post published by the New York Times this week highlights how exercise may reduce perception of pain. The post focuses on a new study published this month in Medicine & Science in Sports & Exercise. In this study, researchers found that people who exercised had less perception of pain when a stimulus was applied to their arm compared to people who did not exercise. See the full article in the New York Times Here!
Aerobic exercise is often something we recommend here at Proaxis Pelvic PT for men and women struggling with chronic pelvic pain, and many do find it to be helpful. What do you think? Have you found exercise helpful in reducing your pain? Let us know in the comments!
This post comes to you from our current student intern, Kerry McLaughlin, who is completing her final year of her Doctor of Physical Therapy degree at Duke University. Sex during pregnancy often is filled with lots of questions- and this will be part 1 of a 3 part post to help you better understand how you can still have a healthy sex life throughout your pregnancy!
There are so many misconceptions women and men have regarding sexual activity during pregnancy! Our hope is that this post will help to answer some of the questions you may be having. As always, remember that all women experience different pregnancies and there may be circumstances where couples must modify their activity or abstain altogether. Make sure to discuss any specific concerns you may have with your health care practitioner to make sure you are safe throughout your pregnancy.
Is it safe to have sex during pregnancy?
YES! For normal progressing pregnancies engaging in sexual activity is safe. However, there are circumstances where sex should be avoided. These include if the mother:
- Is at risk for premature delivery (has a history of preterm labor or premature birth)
- Has cervical incompetence (cervix begins to open prematurely)
- Has placenta previa (placenta partly or completely covers cervical opening)
- Has unexplained vaginal bleeding
- Has leaking amniotic fluid
- Has a partner that is positive for an STI (HIV, Syphillis, Chlamydia, Gonorrhea, and Herpes simplex virus are some of the STIs that can be transmitted either in utero, during delivery or breast-feeding). **This may vary per person, so please be sure to consult with your OB if this effects you.
Will we hurt the baby?
NO! The baby is protected by amniotic fluid and the strong musculature of the uterus so vaginal penetration will not harm the baby. The baby is also protected against infection by the thick mucus plug that seals the cervix.
Can sex cause a miscarriage?
Engaging in sex generally isn’t a concern. Early miscarriages are most often caused by chromosomal abnormalities or developmental dysfunctions.
Can sex cause preterm labor?
Very unlikely. Many couples think that sexual orgasms may induce labor, but female orgasms, which can be caused by sex, nipple stimulation and prostaglandins in semen, are just mild non-labor uterine contractions.
Is there anything my partner and I should avoid?
Although sexual activity is typically safe, there are a few things to be cautious about:
- Blowing air into the vagina during oral sex could potentially block a blood vessel (air embolism) that could be fatal to the mother and the baby.
- It is not safe for your partner to give you oral sex if he has or ever had oral herpes (especially concerning during the third trimester)
- Anal sex isn’t recommended during pregnancy because it could potentially allow infection-causing bacteria to spread from the rectum to the vagina. Most women generally aren’t interested in anal sex during pregnancy anyways because of pregnancy-related hormonal side effects and physical discomfort.
What other questions do you have about sex during pregnancy? Were you scared to have sex when you were pregnant?
Stay tuned for Part 2 coming next week, titled, “When will I be in the mood while I’m pregnant?”
Written by: Kerry McLaughlin, SPT
This past week, I was fortunate to evaluate a nice middle-aged woman referred to me by her urogynecologist for urinary incontinence. When we first sat down, she looked at me and said, “I’m not sure why I am here. My doctor specifically told me that I have a strong pelvic floor. I really don’t think you can help me.” I smiled. I hear this same thought process on a weekly basis (See my previous article on common misconceptions of pelvic physical therapy) You see, at some point the world became convinced that from a musculoskeletal perspective, urinary leakage is always due to a weak muscle. And the best way to fix a failed muscle is to strengthen, strengthen, strengthen. But, if that’s the case, then why do I have so many patients walking into my office telling me that they have done “Kegel” exercises and still leak? Why would a patient like the one above have a “strong” pelvic floor that cannot hold back urine? Why is urinary leakage associated with low back pain and pelvic pain- disorders that we know can often include tight and irritated pelvic floor muscles?
Now, as a caveat to this article, let me say now that it is sometimes totally appropriate for a person to start a pelvic floor strengthening program. In fact, the person with a truly weak, overstretched, poorly-timing pelvic floor will likely be prescribed a strengthening program. With that being said, the truth is that the majority of patients referred to my clinic for evaluation of urinary incontinence are not issued a traditional kegel exercise program. Jenna and I actually tend to be surprised when we evaluate a new patient who truly needs to start a strengthening program for their pelvic floor at the first visit. The reason behind this is that Incontinence is not simply a failed muscle, but a failed system.
The urethra is supported within the continence system by fascia, ligaments, as well as muscular structures. When a downward force is applied to this system as occurs with coughing, sneezing, lifting, bending, etc, these structures function in a coordinated way to compress the urethra and prevent urine from leaking. In fact, Hodges et. al. in 2007 examined musculoskeletal activation occurring when a person performed an arm movement and found that the pelvic floor muscles pre-activated to prepare the body for movement. But, from a muscular standpoint, stability of the lumbopelvic structures (organs included!) requires optimal function of the diaphragm, the deep abdominal muscles, the deep low back muscles as well as the pelvic floor muscles.
When any of these structures are not functioning well, leakage can occur. Now, the tricky part here is that optimal functioning requires both strength, flexibility and proper timing. A tight irritated muscle then becomes equally as dysfunctional as a weak over-stretched muscle. And, a strong, flexible muscle that doesn’t have the right timing contributes to a very dysfunctional system.
So, treatment for incontinence then must include retraining and reconditioning the system to ensure its proper functioning—which for me includes a bit of detective work to truly identify the faulty structures. And, when it comes down to it, typically does not include doing 100 kegel exercises a day. More often, it includes learning to relax the pelvic floor, learning to coordinate the pelvic floor with the diaphragm, eliminating trigger points and restrictions, and then retraining the motor control of the lumbopelvic girdle as a system.
So, for now, take a deep breath and relax. We’ll save Kegels for another day.
For more information, check out the following:
- Diane Lee on Stress Urinary Incontinence and the Pelvis
- Pelvic Health & Rehabilitation on “Why Kegels are bad for your tight pelvic floor.”
- Me on “How to lift a bale of hay and not wet your pants”
Written by: Jessica Powley Reale, PT, DPT, WCS
We are hosting our quarterly Pregnancy Seminar, this time in Greer, SC. If you are expecting, or trying to conceive, we would love to meet you and spend ~ 1.5 hours educating you on the journey you’re about to embark on. Light refreshments provided.
Location: Proaxis Therapy. 315 Medical Pkwy STE 150. Greer, SC 29650
Time: 6:30-8:00 PM
Dry Needling to Restore Muscle Function… OR… Why I voluntarily submitted myself to 3 days of needle sticks.
Let me start out by being completely honest. I have a needle phobia. A strong phobia. A “pass-out when I get a flu shot” type of phobia. I have mild panic attacks at the dentist when I get cavities filled, and specifically try to avoid any type of injection that isn’t completely necessary. BUT- with all of that being said, I spent the last 3 days being voluntarily poked an estimated 75-100 times (likely more). Why would I do that? Am I completely crazy? (possibly) Did I attend some weird desensitization treatment program for people with needle phobias? (in a weird way, yes).
I actually spent the weekend attending Kinetacore’s Level 1 Functional Dry Needling Class with Jenna. And I did it because I had to. Because I recognized that this treatment would be integral in helping my patients get better faster, and get more complete relief. And afterward, I was and am excited. I cannot wait to start using this intervention with my patients, and I hope that you will be just as excited by the end of this.
Brief Story: About 6 months ago, I was working with a wonderful woman who was experiencing pain during sexual intercourse. She had severe trigger points and restrictions in her adductor muscle group, and we had worked on these restrictions for at least 6 visits. They were still there. I finally recommended that she see a co-worker for dry needling to her adductor longus and magnus. The visit afterward, her trigger points were eliminated, and we were able to really improve her pelvic floor flexibility. 2 visits later, she experienced pain-free sexual intercourse.
Yes, it can be that powerful.
But, first, before we go to the why, let’s spend a few minutes discussing what exactly functional dry needling is. In a sentence, functional dry needling utilizes a fine filament needle inserted into a dysfunctional tissue to treat the neuromuscular system and reduce taut muscle bands, improve motion, and either up-train or down-train a muscle’s activity. These fine filament needles are thin, solid needles—very different from the hollow hypodermic needles used for giving injections. In fact, these needles are so thin, that they can literally fit inside a hypodermic needle. These are the same types of needles utilized for acupuncture, however, that’s where the similarities end. Let’s look at some of the differences:
Functional Dry Needling vs. Acupuncture
Functional Dry Needling
|Utilizes solid monofilament needles||Utilizes solid monofilament needles|
|Aims at dysfunctional musculoskeletal tissue based on a neuromuscular and musculoskeletal assessment||Aims at specific points based on Chinese Traditional Medicine along specific “meridians”|
|Utilized to address musculoskeletal and neuromuscular dysfunction||Utilized to address dysfunction in “energy-flow” or “chi”|
So, as you can see, there are significant differences between acupuncture and dry needling. Now, let’s get into what the needle actually does:
1. Increase blood flow
Kubo 2010 actually found that blood flow was increased following dry needling. This effect actually increased after the needle was removed and was increased compared to that of a hot pack!
2. Decrease muscle banding
Those tight irritated trigger points you feel in your muscles? Needling can actually reduce the banding, restore your normal muscle length and improve the efficiency of your muscles.
3. Decrease spontaneous electrical activity
Chen 2000 found that spontaneous electrical activity in a dysfunctional muscle quieted after the twitch response that was elicited with dry needling. This leads to a more relaxed muscle that isn’t having to work so hard.
4. Influence muscle biochemistry
Did you know that the chemicals in your muscles change when they are dysfunctional? They do! And dry needling can help to reverse that! Dry needling has been shown to decrease inflammatory chemicals and pain-modulating chemicals (Substance P, CGRP) and actually increases endorphin levels creating a natural opioid response. (Hseih 2012)
5. Impact the Central Nervous System
Dry needling creates a sensory and proprioceptive stimulus that will drive the gate control of pain. In addition, neurological changes are seen at the muscle and spinal cord level to change how your body is responding to pain, and decrease the pain chemicals. (Hseih 2007, Chou 2012)
So, as you can see, the impact can be huge! These responses together help to improve muscle range of motion, decrease pain, and restore a person to function. So what does that mean for pelvic pain? It means that now, I have a new tool in my toolbox to get my patients better faster and more efficiently. Men and women with pelvic pain often have restrictions in the muscles all around the hips, the abdomen, and of course the pelvic floor. Utilizing dry needling within my treatment approach will help me to reduce dysfunctional tissue more quickly to get my patients back to their normal function as soon as possible! It will also help me in the process of retraining pain perception at the neurological level. I am very excited to see how this treatment tool works with this population—so far, the results have been awesome!!
Let me know if you have any questions or thoughts! We love hearing from you!
Written by: Jessica Powley, PT, DPT, WCS
References taken from Functional Dry Needling Level 1 Course Manual
From all of us here at Proaxis, we want to wish you and your family a very happy Thanksgiving! Life can get hectic over this time of year, and it is so important to stop and take a moment to appreciate all of the blessings we all have in life. As Pelvic PTs, we are so very thankful to YOU–our patients (and colleagues!)– for the support you give us, for the inspiration you provide us, and especially for sharing a small part of your lives with us. We want you to know that YOU are the reason we come to work each day! You motivate, encourage, and challenge us to be better clinicians and better people. Thank you for letting us play a small role in your recovery process!
We wish you all the best over this holiday season!
Jessica, Jenna, Kim, Sabina, Karen & Marti
We would like to welcome Marti Layden, PT, DPT to our Pelvic PT team!
Marti just completed Pelvic Floor Level 1 through Herman & Wallace Pelvic Rehabilitation Institute, and did absolutely STELLAR! Jessica and Jenna were teaching assistants for the course with the amazing Tracy Sher and Kathe Wallace. It was a fantastic weekend, and we are so thrilled to have Marti begin practicing in Spartanburg come February.
So, what does one learn at a Pelvic Floor Level 1 course? Here are some of the course objectives that Marti was able to meet:
1. Identify the muscle layers and specific muscles of the pelvic floor
2. List the pelvic floor muscle functions
3. Describe and perform pelvic floor muscle evaluation techniques with observation, vaginal palpation, and SEMG biofeedback
4. List appropriate outcome measure tools for urinary incontinence, pelvic organ prolapse and pelvic pain
5. List precautions, contraindications, universal precautions for pelvic floor examination and treatment
6. Identify specific pelvic pain conditions (vulvodynia, IC and CPP) and common physical therapy interventions applicable to the physical therapist
7. Identify the various types of urinary incontinence and behavioral treatment options applicable to the physical therapist
8. List two diagnoses that would benefit from applications of electrotherapy
9. Describe the applications and instrumentation parameters of SEMG biofeedback for the pelvic floor
10. Develop evidence-based treatment plans and progressive clinical goals for female pelvic floor dysfunctions
Here are some photos from the weekend! Be looking out for some great things from Marti in the future!
Why did you decide to specialize in Pelvic PT?
- I think I get asked this question every day! Well, I have always been intrigued by human anatomy and the complexity of the pelvis really sparked my interest. But it wasn’t until my last clinical rotation, here at Proaxis therapy, where I was able to shadow Jessica and learn a little more about what she does. I was immediately hooked! The patients were amazing, their stories were so powerful, and the more I learned, the more I wanted to know! Pelvic PT is truly a perfect fit!
What is one of your most memorable patient experiences?
- It is very difficult to narrow my amazing experiences down to one, but recently a patient of mine who had been suffering with vaginismus for ~ 7 years found out she was pregnant! When she told me we both broke down into tears. She never dreamed that she would be able to get pregnant, let alone have pain free intercourse. I plan on continuing to see her one time weekly through her pregnancy to prepare her for this amazing journey.
Is there anything that surprises you?
- I am always surprised at how long my patients have been suffering. They either did not realize there was help for their problem or they have been poorly managed by a variety of specialists. I would advise that you be your own advocate. If you are suffering from bowel, bladder, or sexual dysfunction, or have been in pain for too long… SEEK HELP. It’s out there!
What do you see, or what would you like to see, in regards to pelvic PT?
- In a perfect world I see an amazing collaboration of pelvic specialists. This would be a place, or places, where urologists, gynecologists, GI doctors, psyche, nutrition, and PT would be under one roof. I have this amazing vision of someone being able to come in for a urology appointment and leave with a better understanding and treatment of pelvic floor dysfunction from a holistic approach.
If you could provide someone with just one piece of advice in regards to pelvic health, what would it be?
- Do not be ok with dysfunction and know that you ARE NOT alone!