Endometriosis Awareness

Happy Endometriosis Awareness Month ( a little late….)

Endometriosis is defined as the presence of endometrial-like tissue outside of the uterus. These deposits are found mainly in the pelvis, but can be find in other sites in the body including the bowels, diaphragm and even the brain. In the US alone, it is estimated that endometriosis affects approximately 5.5 million women; 10-15% worldwide. Symptoms include pain in the abdomen, low back, legs, and pelvis. Pain may be cyclical, but not always! Endo can be challenging to diagnose because of it various presentations, which often mimic musculoskeletal impairments such as sciatica. Many women experience a delay in diagnosis of 7-12 years, while seeing an average for 5 providers. Other symptoms may include rectal pain, ovulation pain, pain with intercourse or orgasm, fatigue, infertility, constipation and nausea/vomiting. Physical therapists that specialize in abdominal and pelvic health such as Dr. Miller, PT, Dr. Scott, PT, Dr. Watson, PT, and Carson Miller, PTA have a unique role in helping women who experience endo symptoms. Treatment includes manual, exercise, and muscle retraining techniques to treat pain, urinary or bowel disorders, sexual dysfunction and fertility issues. Specialized PTs can also address lifestyle modifications, provide nutritional support, and assist in stress management techniques relevant to women with endometriosis or chronic pelvic pain. The best evidence shows that physical therapy in conjunction with deep excision surgery best addresses endometriosis and it’s symptoms and minimizes the risk or recurrence. #fightlikeagirl

Nutrition Matters!

Nutritional recommendations for Endometriosis involve eliminating foods and beverages that provoke systemic inflammation and exacerbate pain, as well as adding foods that promote healthy digestion and improve gut-brain connection. Specifically, you should focus on normalizing gut flora (probiotic supplementation or probiotic foods such as Kombucha), healing leaky gut, a gluten-free diet, and vitamin D supplementation. Please refer to your PT/PTA for questions and more information regarding nutritional correlations specific to pelvic rehab.

Labor and Delivery: Pushing with an Epidural

Did you know pelvic physical therapists can help you determine which position would be best for you to labor in?

Epidurals can make it more challenging to move during labor, but with a little bit of planning, you can still get into an optimal position!

WHAT’S AN OPTIMAL POSITION?

For vaginal birth, we want to be in a position where the sacrum can MOVE. The sacrum is that bony triangle between your butt cheeks that ends in your tailbone. Having the sacrum free to move during childbirth can increase the size of the pelvic outlet by up to 28%. Laying on your back pins your sacrum against the bed and makes it more difficult for the sacrum to move. Most hospitals require you to stay in bed when you’ve had an epidural, but that doesn’t mean you have to stay on your back! There are many ways to promote mobility of the sacrum, even if you are required to stay in bed.

The sidelying position is one of the most comfortable pushing positions with an epidural. It allows your sacrum to move without requiring too much work to hold yourself up. Try propping a pillow under your top knee or having your partner hold up your top leg.

In the sidelying position, you can have your partner apply counterpressure to your glutes as you push with your top leg into their abdomen. Some women report this push/pull pressure is helpful for pain management.

Quadruped (on all 4s) position allows the sacrum to move and can be a great position for relaxation of the pelvic floor muscles. Try letting your upper body rest on an exercise ball to decrease fatigue through the arms and back.

Another way to take pressure off your upper body while on all fours is to raise the head of the bed.

If you do choose to labor on your back, you can still take pressure off your sacrum by raising the head of the bed and placing a towel roll under your lower back. This also allows gravity to work in your favor rather than staying fully horizontal.

At Progress PT – Midlothian, we help moms have a more educated and empowered labor and delivery! A pelvic physical therapist is a great addition to your birth team. We can help you figure out the best birthing position for your musculoskeletal needs, help you practice pain management techniques, pushing techniques, and even optimal positions for feeding baby postpartum to reduce back pain! With 20 years combined experience, we have treated hundreds of pregnant mamas. We would love to help you have as smooth a birth as possible!

Postpartum Care for Mom (and What You Can Do to Help!)

You have put (approximately) 40 weeks of pregnancy behind you, gone through the long hours of labor and delivery and are finally a mother. Congratulations! Now begins the transition from pregnancy to postpartum, which brings with it many new questions and symptoms.

In many European countries, postpartum or pelvic floor physical therapy is the STANDARD OF CARE to help new moms navigate the weeks following childbirth. Unfortunately in the United States it is often harder to initiate these important services. Progress PT wants to make sure our patients past and present know that we are here for them and their needs.

Post-partum physical therapy can help with:

Urinary retention, urgency, frequency & incontinence
Constipation & fecal incontinence
Painful intercourse
Diastasis Rectus Abdominus
Restoring core strength and return to exercise
Pelvic, low back, and hip pain
Pelvic organ prolapse prevention or treatment

Symptoms such as those listed above can occur both during and after pregnancy. If any of the above resonate with you, don’t delay in coming for an evaluation. Ideally, postpartum care for all mom’s would begin with a screen 6-8 weeks after delivery, but our therapists can help new moms at any stage of their recovery!

Good exercises after delivery:

Gently engaging your pelvic floor muscles as if you were going to hold back gas or stop the flow of pee
Diaphragmatic or “belly” breathing
Light aerobic exercise like walking or elliptical for 20-30 minutes
Yoga For Pelvic Floor video from Yoga with Adrienne on YouTube

Remember, the postpartum period is a time to be kind to yourself and body. If any of the above are causing pain, discomfort or coning of the abdomen, schedule with your pelvic floor PTs at Progress before continuing.

Contact your US Representative today to advocate for postpartum care!

There is currently a bipartisan bill being introduced in the US House of Representatives fighting for postpartum care for Medicaid patients. The Optimizing Postpartum Outcomes Act (H.R 8181) designates pelvic floor physical therapy services as a treatment option covered under Medicaid and the Children’s Health Insurance Program (CHIP). If the bill is passed, funding would be allocated towards establishing best practices for providers to follow and screening and referral tools to get patients where they need to be faster. Even better, this bill and the funding included would require the Department of Health and Human Services to educate providers AND postpartum women about the need for pelvic health and pelvic floor physical therapy after baby. How amazing is that! The hope is that if a federal insurance program starts providing postpartum care, private insurance companies will start picking up on the importance of offering the same services to their clients.

How to advocate:

Find out who your US Representative is. This website is super helpful! https://www.house.gov/representatives/find-your-representative#:~:text=If%20you%20know%20who%20your,the%20U.S.%20House%20switchboard%20operator.
Go to the website of said US Representative and find their Contact tab.
If email is available, copy and paste the below information into the body of the email.
Submit! Yay, you’ve just advocated for pelvic health services!

Email body:

Please consider cosponsoring the Optimizing Postpartum Outcomes (OPO) Act (H.R. 8181), legislation which raises awareness of the availability and importance of pelvic health services, particularly pelvic health physical therapy, for postpartum women using Medicaid and CHIP. This legislation was introduced by Reps. Jaime Herrera Beutler (R-WA) and Lisa Blunt Rochester (D-DE).

Pelvic health physical therapy is a vital part of recovery in the postpartum period. It can aid in muscle control, tissue repair, and help heal internal portions of cesarean section and perineal scars. However, many mothers lack access to and awareness of the benefits of pelvic health physical therapy. Even some health care providers may not be aware of the importance of pelvic health physical therapy in the postpartum period.

As federally and tax funded agencies, it is important that Medicaid and CHIP recipients and providers are aware of the services to which they have access. Failure to receive timely pelvic health physical therapy could result in postpartum mothers developing life-long conditions that may have physical, mental, and financial consequences. This legislation would ensure Medicare and CHIP recipients and providers are aware of and using this vital care.

H.R. 8181 is designed to address knowledge and access gaps by providing guidance to state Medicaid and CHIP programs administering pelvic health services performed during the postpartum or neonatal period. It also authorizes programs to raise both provider and patient awareness of the importance of pelvic health examinations and pelvic health physical therapy.

Pelvic health physical therapists diagnose and treat individuals across the gender spectrum and lifespan for pelvic health related conditions that include, but are not limited to urinary dysfunction, bowel dysfunction, musculoskeletal dysfunction, sexual dysfunction, cancer-related rehabilitation, and the peri-partum state. After performing an evaluation and making a diagnosis, Pelvic Health Physical Therapists create and implement personalized plans based on best available evidence to help their patients improve mobility, recover from injury, prevent future injury, and manage pain and chronic conditions. They are part of a collaborative care team aimed at empowering patients to be active participants in their care and well-being. We must ensure that patients in need of pelvic health understand its importance and know they have access to it when needed.

I urge you to promote the well-being of postpartum mothers by co-sponsoring H.R. 8181. Thank you for your consideration.

Relax, Rest, and Digest for Better Health

Are you feeling stressed, anxious, and over-stimulated? Have you noticed a change in your digestion and bowel health? Increased gas? Diarrhea? Constipation? Your body’s internal organs are regulated by the autonomic nervous system (ANS). The Autonomic Nervous System is made of two systems: 1) sympathetic nervous system or the “fight or flight” response, and 2) parasympathetic nervous system or the “rest and digest” response. Together, these systems create a sense of balance for our internal system.

If you are stressed, your body activates the sympathetic nervous system. This prepares your body for action. Some changes your body experiences include increased heart rate, pupil dilation to improve sight, bronchial tube dilation to improve respiration, muscle contraction/tension, and decreased or slowed digestion. This system gets you ready and alert. It is normal! However, your body needs the parasympathetic system to balance these actions.

The parasympathetic system is responsible for balance and maintenance of the body’s systems. It restores the body and allows it to relax and repair itself. Some functions of the parasympathetic system include decreased heart rate, bronchial tube restriction, muscle relaxation, digestive enzyme release, and urinary output. These changes are necessary for long-term health and assist in appropriate digestion.

How do you activate the parasympathetic system? Engage in activities that make you feel relaxed! Take 5 minutes (or more!) EVERY DAY. Seriously! It is vital to your long-term health. Below are for some suggestions to activate your parasympathetic system.

Activate your Parasympathetic System:

Belly Breathing
Light exercise (walk on the treadmill, pilates, yoga)
Meditation
Read a book
Engage in a hobby

Restorative Yoga Poses for Stress Reduction

Supportive Child’s Pose

Position: Get onto all fours with your knees wide and toes together. Place a bolster (or a rolled up blanket) on the ground under you. Gently move your buttocks towards your feet, resting your chest against the bolster. Settle into this position.

Directions: Close your eyes. Let your hips release and relax into this position. Allow the bolster under your chest to support your body. Inhale and exhale gently.

Savasna

Position: Lie on your back, arms out to your side, palms up, head supported on a pillow. Place a bolster or pillow under your knees. Stay warm, use blankets to avoid feeling chilly.

Directions: Close your eyes and focus on your breath. Inhale through your lower lungs, exhale and release the tension in your body. Let your hips release and relax. Let your mind be quiet.

May is Pelvic Pain Awareness Month

What is Chronic Pelvic Pain (CPP)? Any pelvic or abdominal pain that lasts for more than 6 months or pain without an obvious cause that has been present for less than 6 months is considered CPP. CPP is a common and debilitating health care problem, and is estimated to affect about 25 million women. More than half of these women have to decrease their daily activities 1 or more days per month, 90% have pain with intercourse, and 25% have to spend 2-3 days per month in bed because of their pain. Although less common, CPP can also affect men and is often diagnosed as “chronic prostatitis”. People across the gender spectrum including transgender, LGBTQ and gender non-conforming, are also affected by CPP. It is poorly studied in this patient population at this time, and healthcare is often not easily accessible.

How is Chronic Pelvic Pain Treated? At Progress PT – Midlothian, we take a careful, thorough history and perform a full head-to-toe examination including a postural and gait assessment. Based on this evaluation, we can begin to determine the cause of your pain. CPP often has multiple sources including the original “injury” such as an ovarian cyst or bladder pain, referred pain from organs, skin, or muscles, myofascial pain which presents as trigger points or tender areas in the muscles of your abdomen, back or pelvis, and the influence of your brain, emotions and behavior. To successfully address CPP, we work closely with other health care providers including urogynecologists, psychologists, gastroenterologists, primary care physicians, pain management specialists, acupuncturists, chiropractors, and dieticians.

Can what you eat affect your pain? The research says YES! Studies show that reducing or eliminating foods and beverages that provoke systemic inflammation such as processed meats and trans fats found in fried food, increasing anti-oxidant rich foods, eliminate toxins such as aspartame, and adding probiotics can help reduce chronic pain. One recent study showed that a strict gluten-free diet was associated with lowering the odds of peripheral nerve pain by almost 90%. Vitamins D and B12, and fermented cod liver oil have been shown in multiple studies to help reduce pain. Certain foods, such as bone broth, can help normalize inflammatory processes, or be alternatives to NSAIDS. For more information about specific foods, please ask your PT or PTA!

Breastfeeding and Exercise

Exercise and Breastfeeding: Common Concerns

Regular exercise is an important addition to the postpartum period for both physical and emotional benefits. Exercising can help speed up the process of physically recovering from birth, as well as help improve sleep and reduce stress. Some women report concerns regarding exercising while breast feeding including: decreased milk output, increased lactic acid in milk, and decreased milk acceptance by the child. Recent studies have shown that these concerns are not supported and that exercise is safe for breastfeeding women and their babies.

Exercise will not reduce milk output – so long as hydration is adequately maintained. It’s important to increase water intake before, during, and after exercise since water will be lost through both sweat and milk production. Studies show that mild to moderate intensity exercise (walking, light jogging, yoga, etc) does not lower acceptance of milk post-exercise either. There may be a minimal increase in Lactic Acid (a substance our bodies produce with activity) in breast milk following high intensity exercise, but that was not shown to lower the baby’s acceptance either. So it is safe for both of you to get back to exercise while breastfeeding!

Exercise Guidelines while Breastfeeding

There are some steps post-partum moms can take to make exercising more tolerable and more productive while breastfeeding!

Increase water intake on days that you exercise
Ensure adequate caloric intake on exercise days to best support both exercise and breastfeeding demands
Nurse/pump before you exercise to make working out more comfortable
Find a bra that is supportive but not too compressive. It can be challenging to find a bra that fits both pre- and post-nursing, but consistently pumping pre-exercise can help with finding a size that fits well
Add in calcium and vitamin D supplements if diet does not provide enough of these vitamins. Breastfeeding can cause a decrease in bone mineral density, so supporting bone health is important throughout (plus exercise is a great way to increase bone mineral density!)
Avoid strenuous/high intensity exercise until after you have been evaluated by your doctor and your physical therapist. Mild exercise is well tolerated initially postpartum, but make an appointment with one of our PTs at Progress PT – Midlothian to evaluate your readiness for more intense exercise!

How to Measure Intensity?

How do you know if you are exercising too hard or just enough? The Rate of Perceive Exertion (RPE) Scale is useful to put a number on how hard you are working. This scale can be used for any activity (including formal exercise and yard/housework) to gauge intensity. This is useful both for yourself to keep track of how you progress because as an exercise starts to feels less strenuous you know you are getting stronger! It is also useful for your PT so that they can know how you are tolerating activity and better prescribe exercise.

Generally, during the early postpartum period it is safest to stay within the 1-5 range until cleared by your PT.

Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP): The Facts

Pelvic organ prolapse occurs when there is a loss of support for one or more of your pelvic organs. These include your rectum, bladder, and uterus. So what exactly is happening? To simplify, there are three ways by which our bodies support these pelvic organs, including: 1) the passive structures like fascia and ligaments, 2) the active structures like pelvic floor muscles and how strong they are, and 3) the neuromotor system or how well you use your muscles. For example, if you pushed to vaginally deliver a child, have weakness and/or atrophy in your pelvic floor muscles, or do not automatically contract your pelvic floor and deep abdominals prior to lifting, coughing, etc you are more likely to have POP. Additional risk factors include connective tissue disorders, chronic coughing, heavy or repetitive lifting, trauma during vaginal delivery, and multiple pregnancies/births. POP can be graded by your Gynecologist or Urogynecologist on a 1-4 scale (1 being minimal prolapse), and vaginal wall laxity can be assessed by your pelvic floor Physical Therapist.

What Are The Symptoms of Pelvic Organ Prolapse?

Many women report a feeling of vaginal bulging or fullness or a feeling of falling out vaginally or rectally. Often, these symptoms are aggravated by prolonged upright activity such as walking, carrying children, or exercise. Some women experience pain with intercourse and difficulty emptying their bowel or bladder. Upon inspection, one might see a bulge or protrusion at or extending from their vaginal opening.

What is the Treatment for Pelvic Organ Prolapse?

At Progress PT – Midlothian, your Physical Therapist will do a complete head to toe functional assessment that includes an in depth look at your abdominal wall and pelvic floor muscles. By doing this, we can assess your passive, active and neuromotor systems that provide support to your pelvic organs. We are looking for strong pelvic floor muscles that work with your deep abdominal muscles to support your pelvic contents throughout daily tasks such as getting out of a chair or lifting/carrying children or groceries. If we do not see these qualities, we can provide you with an initial PT program to address any dysfunction identified. If one of these three systems is not functioning fully, you can worsen your prolapse or your symptoms by performing the wrong exercises/activities or by not managing your abdominal pressure correctly. Occasionally, your PT or doctor may suggest a pessary to support your pelvic contents while you are working through your PT program. Depending upon the severity of your prolapse, a small percentage of people may need surgery after physical therapy to address remaining deficits.

Concerned about a possible prolapse? Call us today at 804-918-8515 to make an appointment for an evaluation!

Trigger Point Dry Needling

NOW OFFERING!

What is Dry Needling?

Dry needling (also called trigger point dry needling or myofascial trigger point dry needling) is a treatment technique used by medical professionals to release active, painful trigger points and create positive change in the central nervous system. The clinician inserts an extremely fine, monofilament needle into the targeted tissue. The appropriate needle size is determined based on the depth of the targeted tissue. Dry needling has been a viable treatment technique for myofascial pain since the 1940’s, and has continued to improve with modern medical advances. Thanks largely to the physician-researcher Janet Travell M.D., the use of dry needling has become more popular today.

How does it Work?

Muscles can develop knotted areas called trigger points. When these trigger points cause a pain signal, they are called active trigger points. They can be a source of referred pain (pain that affects another part of the body). Within the trigger point, the muscle is shortened, overlapped, and chemically bound into a tight knot. When the needle is inserted into the trigger point, it releases the chemical bond between muscle fibers. This allows the muscle to release and return to its normal resting length. Hence, you get better mobility and control of your muscles.

Physical Therapy Approach

While dry needling can be an important part of physical therapy treatment, it is best used in combination with your normal physical therapy regimen that includes exercise, range of motion, stretching, posture correction, soft tissue mobilization, and breathing strategies. Interested? Call us at 804-918-8515 to be scheduled with Shaunna Mayers, PT, DPT.

What is Diastasis Recti Abdominis?

Diastasis recti abdominis (DRA) is a separation and lack of tension across that linea alba that commonly occurs with pregnancy and abdominal weight gain. This can happen due to muscle imbalances, core weakness or nonoptimal muscle recruitment strategies with every day tasks such as getting out of bed and higher level tasks such as core strengthening exercises.

One hundred percent of women have a separation of their rectus abdominis muscles during pregnancy, but the muscles approximate postpartum in many women on their own. If the abdominal wall is unable to maintain tension across the linea alba, the risk for pelvic organ prolapse, pelvic pain, and back pain is greater. It is imperative that women know how to assess for a DRA during pregnancy and postpartum. If your abdominal wall “cones” with activities such as getting out of bed or with exercise you have a clinically significant DRA that needs to be treated by a specialized Physical Therapist. At Progress PT – Midlothian, we assess for DRA by palpation, muscle testing, and rehabilitative ultrasound imaging. Based on our findings, we teach each patient individualized exercises to help tension the abdominal wall and approximate the rectus abdominis muscles during functional tasks. During these times of social distancing, we can also offer virtual visits over numerous digital platforms to assess and treat your abdominal wall dysfunction. Our goal is to help you get back to painfree, safe activity as soon as possible!

Call us at 804-918-8515 for more information.

In the news…. Sexual Health and PT

A 2019 article published in Sexual Medicine Reviews Amy Stein, PT, MPT, DPT, BCB-PMD, IF, Sara K. Sauder, PT DPT, and Jessica Reale, PT, DPT, WCS discuss the role of pelvic floor PT in sexual health for men and women. Amy, Sara, and Jessica reviewed the most updated, peer-reviewed literature and determined that pelvic PTs successfully treat sexual dysfunction through multi-modal, individualized treatment. Pelvic Health Physical Therapists such as Dr. Miller and Dr. Rexrode perform an evaluation for sexual dysfunction by taking a thorough history and performing a complete musculoskeletal screen. This means your PT is looking at you from head to toe to assess for various musculoskeletal impairments such as pelvic stability/mobility, spinal mobility/stability, hip mobility/stability and of course pelvic floor muscle function. Your plan of care is then determined by synthesizing the data from the history and screen, with consideration for your specific goals. The PT or Physical Therapy Assistant (PTA) will select treatments consisting of manual therapies, patient education, muscle re-training, and exercise to address the problems found and help you meet your goals.