Pelvic floor physical therapy (PFPT) is specialized treatment for conditions of the pelvis, pelvic floor muscles and perineal structures. It is appropriate for a wide number of conditions and we often find that it plays a role in other diagnoses such as hip and low back pain.  PFPT is appropriate during pregnancy and postpartum for conditions including low back and pelvic girdle pain, diastasis recti, perineal and c section scar management, urinary leakage and incontinence and tailbone pain. It is also beneficial for conditions that are not related to pregnancy or postpartum such as stress urinary incontinence, pelvic organ prolapse, post operatively for pelvic surgery (for example, hysterectomy) and pain in the pelvic floor region (for example, pain with intercourse)

Your pelvic floor:

Your pelvic floor has three layers of muscles and acts to stabilize your pelvis, provide support for your reproductive organs, assists sexual function and aids in urination and bowel movements. It also plays an important role in the circulatory and lymphatic systems, with proper breathing mechanics and postural support.¹

https://www.kenhub.com/en/library/anatomy/muscles-of-the-pelvic-floor?utm_source=pinterest&utm_campaign=mnemonic&utm_medium=social

What does a pelvic floor PT do?

A PFPT will do an evaluation including an assessment of posture, gait, range of motion of your spine and hips and breathing mechanics. They will also evaluate the strength of your core, hip and pelvic floor muscles and assess for any muscle tension and pain. Strength and soft tissue assessment may be performed both externally and internally. Internal assessment is only performed when appropriate, when the patient is comfortable and with consent.¹ It is important to note that this assessment and pelvic floor treatment methods are intended to be gentle and minimally invasive and typically there are no stirrups or speculum involved! Often internal assessment is not performed until after an initial evaluation and there may be times it is not performed during treatment. Treatment plans may include exercises to strengthen or lengthen your pelvic floor, restore proper breathing mechanics, stretch muscles, strengthen your core and massage therapy techniques for tender point and scar tissue release!¹

Pregnancy:

Up to 90% of women experience low back or pelvic pain during pregnancy and about 30% still have this pain a year postpartum.² Pain during pregnancy often occurs due to alterations in posture, muscle imbalances and hormonal changes leading to increased mobility in the pelvis and spine.  Exercise in pregnancy has been found to improve function and limit sick leave during this period.² A PFPT can best assess why you may be having pain and prescribe appropriate exercises and manual therapy to mitigate your pain. We can also provide you with techniques to optimize your labor and delivery like perineal stretching, pelvic floor strengthening/lengthening and hip opener activities.⁵

Postpartum recovery:

There is so much a PFPT can do for you in the post-partum period! The physical demands as well as fluctuating hormones in the postpartum period cause excessive joint motion and increased demand on muscles for stability. This can lead to pain due to poor posture or weakened/tight muscles.³ One common complaint after having a baby is a “mom pooch” often caused by diastasis recti abdominis (DRA). During pregnancy, your abdominal wall stretches causing a separation at your linea alba, the connective tissue that joins your rectus abdominis muscles (6 pack abs).¹ One study found that 60% of women have DRA at 6 weeks postpartum and 30% continued to demonstrate DRA 1 year postpartum.⁴ We often see poor muscle activation patterns with decreased recruitment of the deeper core and pelvic floor muscles. This contributes to symptoms like low back pain, urinary incontinence and pelvic organ prolapse. It is important to note that the goal of treatment for DRA is not to eliminate the “gap” between muscles but to teach you how to optimally contract and control your deep core and pelvic floor muscles for decreased risk or incidence of secondary conditions.¹ This likely will also improve the appearance of your DRA. A PFPT can also address scar tissue caused by labor and delivery or other pelvic floor dysfunctions following pregnancy and birth.⁵ C-section births are not excluded from this group, as scar tissue can lead to increased fascial and muscle tension increasing the incidence of LBP, pelvic pain, and dysfunction. A pelvic floor PT can treat a painful or tight scar to help to address these conditions.⁵

Urinary Incontinence:

Urinary incontinence (UI) is urinary leakage, increased frequency of urination or both. It impacts women of all ages and stages-athletes, postpartum and post-menopausal. Risk factors include pregnancy, childbirth, menopause, hysterectomy, obesity and age.¹ Both a weak pelvic floor and a tight or overactive pelvic floor can contribute to UI. For this reason, it is important to be assessed by a PFPT to determine what the most appropriate treatment exercises and techniques would be for you. It is not just about Kegels! Your PT will design a plan that optimizes activation patterns for you! Additionally, a PFPT can educate you and address behavioral habits that may encourage UI (“just in case” peeing and “power peeing”, for example).¹

Pelvic organ prolapse:

Pelvic organ prolapse (POP) is associated with connective tissue laxity and is when the organs located above your pelvic floor drop into your vaginal canal. Risks for this include vaginal delivery, surgery, chronic constipation, systemic disease and menopause.  Symptoms are vaginal bulging, pelvic pressure, low backache and bleeding or discharge.¹ POP sounds scary, but low grade prolapse is common in women post pregnancy and is often asymptomatic. As with UI, POP can be caused by over or underactive, and non-functioning pelvic floor muscles. Thus an assessment to determine the origin of your symptoms is imperative for effective treatment.  Research has demonstrated that pelvic floor exercise and lifestyle advise can reduce prolapse symptoms, stage prolapse and improve QOL.⁵

As a PFPT I am passionate about educating women that so many of the conditions (like the ones above) are common but do not have to be accepted as “normal” due to childbirth, surgery, or age. If you believe that PFPT would help you, please go to sptny.com to schedule an appointment with me in our Wheatfield or Tonawanda locations!

1. Herman and Wallace Pelvic Rehabilitation Institute, Pelvic Floor Level 1: An Introduction to Female Pelvic Floor Function, Dysfunction and Treatment, March 20-21 2021, Remote Course.
2. Teyhen, DS et al, Pregnancy and Low Back Pain: Physical Therapy can Reduce Back and Pelvic Pain During and After Pregnancy. JOSPT, 2014 July; 44 (7): 474.
3. Musculoskeletal Dysfunction During Pregnancy and After Childbirth. APTA Pelvic Health. 2019. Available at: https://aptapelvichealth.org/2019/10/25/musculoskeletal-dysfunction-during-pregnancy-and-after-childbirth/. Accessed March 30, 2021.
4. Sperstand et. al Diastasis recti abdominis during pregnancy and 12 months after childbirth: prevalence, risk factors and report of lumbopelvic pain. BJSM, 2016, Sept; 50 (17) 1092-6.
5. Herman and Wallace Pelvic Rehabilitation Institute, Pelvic Floor Level 2b: Function, Dysfunction and Treatment: Urogynecologic Examination and Treatment Interventions. April 10-11, 2021, Remote Course.

Wheatfield

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COVID has certainly made the importance of health very clear and we have all seen how quickly things can change with an illness. While COVID is currently front and center in most people’s thoughts, it isn’t the only thing out there that can change your life. Heart disease, diabetes, strokes and cancer can all be devastating too.

Movement offers a defense

If you’re looking to be more resilient and defend against these things, physical activity can do it. The dangers of being sedentary are well known and documented in the research. Excessive sitting and sedentary time have even been called the new smoking. For many of us, sitting and being inactive is part of our jobs. However, research has shown that getting in enough movement can counteract the negative effects of being sedentary.

A large study done in the U.K. found no association between the amount of time people spent sedentary and their chances of illness. But the authors didn’t conclude that being sedentary is OK. Instead, they felt their findings were likely “attributable to a protective effect of the high volumes of daily walking.” The study was conducted in London, where people tend to spend much more time walking or standing than average. The people in the study had daily walking times that were over double the average amount reported in the U.K.

Physical Therapists Are Unequaled Experts in Human Movement

While walking was the activity in this particular study, other research has shown that all kinds of movement can help protect your health. If you’re looking to get those protective benefits for yourself you could choose to walk, bike, lift weights, dance or garden. If you’re not moving as much or as well as you’d like, see your physical therapist. PTs are the most qualified professionals on the planet to help you move better and allow you to stay healthy and enjoy life. From designing a program to get you started or moving more to helping you recover from an injury, your PT is the right person to look to for help.

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A growing trend in America is young athletes specializing in a single sport with the hopes of excelling in that sport and with goals of achieving a Division 1 athletic scholarship or even reaching the professional ranks. Although there is a degree of sports specialization and intense training needed to reach an elite level, it is important to understand the risks of specializing in a single sport at too young of an age. These risks include burn out, psychological stress, and musculoskeletal overuse injuries in pre-adolescent athletes.

Sports specialization is defined as intense, year-round training in a single sport with the exclusion of other sports.¹ There is much debate on what exactly “intense” training is. In a 2008 study of 2721 high school athletes, increased exposure was the most important risk factor for injury. Their results concluded that >16 hours per week of exposure to intense training resulted in spike in athletic injuries in young athletes. ² Reviews of studies of elite athlete specialization history revealed that, for most sports, late specialization with early diversification is most likely to lead to elite status. In addition, athletes who engaged in sport-specific training at a young age had shorter athletic careers.³

Examples of Injuries seen in young, specialized athletes:

• Muscle strains/tears
• Bone stress fractures/reactions
• Tendonitis and tendinopathy
• Traction apophysitis- irritation of growth plate where tendon attaches to bone (ie Osgood Schlatter, Sever’s disease)
• Osteochondrosis and cartilage defects

Is it ever safe to specialize in a single sport? If so, what age?

Current evidence suggests that delaying sport specialization for the majority of sports until after puberty (late adolescence, ∼15 or 16 years of age) will minimize the risks and lead to a higher likelihood of athletic success.³ One rule of thumb is that the number of hours/week of intense training should not exceed their age (i.e. 9 year-old should not exceed 9 hours/week)

Other tips to avoid over-training and injury

• Allow for rest days: young bodies need recovery too! 1-2 rest days per week are recommended.
• Communicate discomfort: Talk to your kids about communicating discomfort that may arise.
• Cross-train and diversify sports participation: Encourage young athletes to participate in multiple sports that develop different skills and that do not stress the body or body areas in the same ways.
• Consult with a physical therapist: For any injuries that arise or for further tips to avoid overuse injuries, talk to a PT! They can manage injuries and allow for a safe and timely return to sport. They can also assist in minimizing the risk of injury through corrective exercises and strength/flexibility training.

Camillus

REFERENCES

1. Jayanthi NA, Pinkham C, Durazo-Arivu R, Dugas L, Luke A. The risks of sports specialization and rapid growth in young athletes. Clin J Sports Med. 2011;21(2):157 [Google Scholar]
2. Rose MS, Emery CA, Meeuwisse WH. Sociodemographic predictors of sport injury in adolescents. Med Sci Sports Exerc. 2008;40(3):444-450 [PubMed] [Google Scholar]
3. DiSanti, J.S. and Erickson, K., 2019. Youth sport specialization: a multidisciplinary scoping systematic review. Journal of sports sciences, 37(18), pp.2094-2105.

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People usually see a physical therapist for pain or loss of function

Think of the person who has back pain, the injured athlete or the person who’s had a stroke. They all want to improve how they move and complete tasks. Now, there is good reason to wonder if physical therapists will start seeing more people who are not in pain or having difficulty moving. Why would these people come to a PT? To improve their overall health and wellness.

There is strong evidence suggesting that movement is a valuable predictor of future health and resilience against disease. Physical therapists are movement specialists, so taking advantage of their expertise makes sense if your goal is to become healthier and live longer. Here are some examples of the power of movement when it comes to predicting future health:

Gait Velocity

Gait velocity is how fast you walk. Studies have shown that if your typical walking speed is over 1 m/s or 3.3 ft/s, you’re likely able to complete typical daily activities independently. You’re also less likely to be hospitalized and less likely to have adverse events like falls.

If you’d like to test yourself, measure out a straight, flat course to walk between 10′ and 30′ long. You’ll also need 5′ or so at the beginning and the end for acceleration and deceleration. Walk the course at your typical speed and divide the length of the course by how long it took you to walk it (distance/time). That’s your gait velocity.

Get On and Off the Floor

A series of studies suggest that if you can go from standing to sitting on the floor and back to standing without using your hands, you’re a lot less likely to die than someone who can’t. It’s  called the sitting-rising test. Here’s how it works:

You start standing, and without support you sit down on the floor, then stand back up. You start with a score of 10. Every time you put a hand, knee, forearm or the side of your leg on the floor you lose 1 point. Putting a hand on your knee or thigh to help also costs a point. In a sample of over 2,000 people, they found that scoring less than 8 points made you twice as likely to die in the next 6 years when compared to people who scored higher. Score 3 or less and you’re 5 times more likely to die in the same period. Overall, each point in the test is worth a 21% decrease in mortality from all causes.

Notice that both gait velocity and the sitting-rising test aren’t specific to any one thing. The risk of hospitalization in the gait velocity studies was hospitalization for any reason. Death in the sitting-rising studies was death from anything. So while we know that exercise and healthy lifestyle reduce your risk of specific diseases like heart disease or diabetes, it appears that being able to move may provide much more wide ranging protection than we previously thought.

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“Golf is deceptively simple and endlessly complicated” – Arnold Palmer

Do you have pain during your golf swing? Do you have pain when your round is over? Have you cut rounds short in the past year because of pain? Then the Titleist Performance Institute (TPI) is exactly what you need!

Throughout the country there are thousands of TPI certified providers from all different backgrounds. Golf professionals, medical professionals, club fitters, and fitness specialists are all utilized within this system as a TEAM. One group of people speaking the same language in order to collaborate and optimize the impact they have on the golfers they work with.

The Titleist Performance Institute was created for golfers of all ages, skill, and competitive levels. Whether you are looking to elevate your game to join the pros and pose with the trophies or just want to have a round once a week where you have a good time with friends/family, you shouldn’t have pain when you play!

As a physical therapist and a golf enthusiast, I have a good grasp of the anatomy and biomechanics utilized in a golf swing. Using the TPI “11 point physical screen” I can identify anatomical and movement based limitations with each golfer that may be causing pain or limiting motion within your swing! It may seem too simple but this screen has been tested over and over again and is backed by lots of research. The bottom line is that each one of these movements MUST occur in a routine golf swing. If one movement pattern is inadequate, then the system is disrupted and different compensations can occur. The TPI system has broken these down into 12 common swing characteristics and identified which physical limitations tend to lead to which characteristic.

So where do you fit in? Whether you are in pain today or not, the TPI system can help you. Moving better = more consistency = better scores and less pain. Now I am not a golf pro, and I can’t promise any improvements in your game. But I can offer a chance to identify and address physical limitations that may be holding your game back. Using the 11 point screen we can create an exercise program to help address the physical/movement limitations that were identified which can improve the quality of your movement in your swing. This system is utilized by pros like Jon Rahm daily to make sure they are feeling physically fit enough to swing and train at their optimal level. If it works for pros like him, it can work for you!

Click Here To Learn More About Dr. Cole

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An evaluation by a Physical Therapist specializing in concussions can help answer many of your questions!

Anyone can have a concussion, and it’s a very stressful situation to deal with.  Often the symptoms are hard to explain and are not visible to others.  Many people come in to their first visit with the same questions- what is wrong with me, and how can physical therapy help my brain?  There are many things that we will be looking into at your first visit with us.  First, we look to understand how you sustained your concussion.  This gives us clues into what systems of your body we need to look at.  We ask about your medical history and about any past concussions you may have had.  This will give us a better sense of your recovery time.  We also ask you about what symptoms you have been experiencing and what activities may provoke these symptoms.  Again, this all giving us clues on how we can help you best.

Conducting Your Exam

One of the most common complaints after a head injury is headache and neck pain. We will conduct an exam on your neck and upper back to see how you are moving, how your muscles are functioning, and how the nerves, joints and muscle tissues are all moving; we might even look at your shoulders and core muscles too.  While doing this, we are taking note of what may provoke symptoms and what areas are not functioning to their full capabilities.  Those are the areas in need of physical therapy!  We create a list of the problem areas that we have found and put together a plan of ways to address them to reduce the headache and neck pain.

The Ripple Effect of Concussion Symptoms

If there are symptoms of dizziness, we will take you through a vestibular evaluation.  This exam will help to show how your balance and sensation systems in your body are working, including your nerves, eyes, and inner ear system.  This is a very complicated system in the body that is very often disturbed after a concussion. During this exam we look to be sure that the crystals in your ears (yes, we all have them!) are in place or if they may have moved during the injury, causing room spinning dizziness.  These systems all give information to your brain about your body’s position in space.  There are many treatments in PT that help regain normal balance and decrease dizziness.

If you are an athlete or active individual, we even have the capability to take you through testing to see what amount of exercise is safe for you to participate in while recovering from your concussion.  We can then formulate a safe plan to return you to all activities again.

Our first visit, which typically takes about one hour, will lead us down the path in recovering from your concussion over the course of several weeks together.

We look forward to helping you on your road to recovery!

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Now that it has been roughly a year since the COVID-19 pandemic began, many of us still find ourselves working from home as businesses slowly start re-opening and having employees come back in to work.

For those of us working remotely, it’s important to continue to practice good workplace ergonomics as being in the comforts of home can make it very tempting and far too easy to sink into a squishy chair, couch, or even bed with our laptops on our thighs, phone close by, and something to eat/drink within arms reach. While this may sound like the perfect setup to maximize productivity, it can wreak havoc on our bodies.

Our steps per day are drastically reduced as we have lost the cumulative effect of the energy needed for getting ready for work, driving to/from the job, (which also may have a walk to get into the building) as well as the little breaks throughout the day to go to the bathroom/breakroom/printer, etc. Some of us may never even leave the house as our workstation is simply in another room!

Here are some tips to help save your bodies, spines, and health as we continue to strive toward “normalcy” amid the pandemic:

• STAND: By simply getting up and standing to complete your work, you are using muscles that are dormant when sitting. This requires energy, enhances your posture, and is considerably less stress on your spine than sitting, even if you are sitting with decent form.

• MOVE: If you do choose to sit and complete your work, it’s important to get up every 20-30 minutes and walk around. Take a couple laps around the house, go up and down the stairs, clean some dishes—anything to break up the strain of sitting for extended periods of time and get some blood flowing and lubricate your joints.

• GO BACKWARDS: Sitting (or standing) with poor posture will both take their toll on you necks, backs, and shoulders over time. It’s very easy to fall into a slouched posture with our low backs rounded, our heads and necks jutting toward the screen, and our shoulders sitting forward while working for hours on end. A good idea would be to move your neck, shoulders, and backs in the opposite direction to reduce the strain placed on them with poor posture. Stand and try this:

1. Pull your shoulders back and squeeze shoulder blades together for proper shoulder alignment
2. Draw your chin inwards towards your throat to reduce the strain on your upper back and neck
3. Put your hands in the small of your back and bend backwards to decompress your spine from a rounded posture

• CONSULT A PHYSICAL THERAPIST: if you are currently dealing with pain, stiffness, headaches, or other symptoms that are interfering with your work and daily functions or stopping you from engaging in the active lifestyle you want outside of work, see a PT. In NYS, some insurance companies allow you to see a PT without the need for a prescription from a doctor. This is called Direct Access and is great way to help you get started sooner than later on addressing those ongoing aches and pains.

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Humans are built to stand upright: Our cardiovascular and digestive systems function more efficiently that way and our energy levels sustain and increase the more we move. A lack of upright movement can bring a litany of physical ailments including muscle pain in our shoulders, neck and back as well as an increased risk of heart disease, diabetes, and blood clots (DVT).

So how do we reconcile our present day work environments and screen-obsessed digital world with our more primitive need to constantly be on the move? Try these simple tips:

When sitting for prolonged periods, try to remember to stand, stretch, and walk for at least a minute or two every half hour. A twenty-minute walk will help even more – promoting healthy blood flow that brings important nutrients to all the spinal structures.

In general, moving about and stretching on a regular basis throughout the day will help keep your joints, ligaments, muscles and tendons loose, which in turn will help you feel more comfortable, more relaxed, and more productive.

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A cervicogenic headache is just another name for a headache that originates from somewhere in the neck (aka cervical spine). This is called “referred pain,” which means that you perceive the pain in a region of your body that is different from where the source of the problem actually exists. This occurs because some of the nerves that supply the neck also supply structures in the head.  If you are experiencing a headache along with neck pain, then the issue might actually be with you neck.

The neck is made up of vertebrae that form joints which allow for movement in your neck. During certain movements of your neck, the joints, muscles, ligaments, and nerves could be getting stretched, compressed, or irritated, beyond their normal tolerance and cause pain that is interpreted as a headache. A head/neck injury in the recent past, such as a whiplash injury or concussion, could also refer pain that is perceived as a headache.

Common Symptoms ^1,2,3

If you are experiencing a cervicogenic headache, you may experience one or more of the following symptoms:

• Usually one-sided neck pain and a headache that wraps around from the base of the neck, up the back of the head and into the front of the head
• Headache that is not constant
• Headache that is brought on or aggravated by certain neck movements or spending a lot of time in the same position (such as driving, sitting at a computer)
• Tenderness at the base of the head or upper neck when pressing on it firmly
• Arm discomfort in the arm that is on the same side as the head/neck pain
• May also be associated with light-headedness, dizziness, nausea, ringing in the ears, decreased ability to concentrate

Possible Causes: ^2,3

• Muscle imbalances, weakness, tightness
• Poor posture associated with repetitive or prolonged positions at work/home, sleeping, etc.
• Previous neck or head trauma
• Stress

What You Can Expect From Your PT: ¹

• An evaluation that will examine the range of motion, strength, and posture of your neck and other surrounding body regions
• Hands-on techniques such as stretching, pressing, and positioning to help move your neck to assess mobility
• Exercises focusing on improving the activation, strength, and endurance of muscles surrounding and supporting the neck
• Patient education about your condition, what your PT can do to help, and things you as the patient can do at home to help improve

It is important to remember that every individual’s body is different and everyone perceives pain differently, so if you think that you might be having cervicogenic headaches, but aren’t sure, schedule an appointment with your physical therapist to be evaluated!

**If you experience any of the following symptoms, it is important to call 911 for immediate medical attention, since they may be a RED FLAG for a more serious condition: ²

• Headaches that are progressively getting worse over time
• Sudden onset of severe headache
• Headaches associated with high fever, stiff neck, or rash
• Onset of headache after a head injury
• Problems with vision or severe dizziness

References:

1. Childs JD, Cleland JA, Elliott JM, Teyhen DS. Neck pain clinical guidelines. J Orthop Sports Phys Ther. 2008; 9(38): A1-34.
2. Page P. Cervicogenic headaches: an evidence-led approach to clinical management. Int J Sports Phys Ther. 2011; 6(3): 254-266.
3. Headache (Cervicogenic). http://www.physioadvisor.com.au/9273650/cervicogenic-headache-neck-headache-physioadvi.htm. Accessed: March 8, 2016.

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