What is Fibromyalgia and How Can PT Help?

treatment room EMH Physical TherapyFibromyalgia is a chronic syndrome that is composed of a group of symptoms.

The symptoms associated with fibromyalgia are varied and may include:

  • Musculoskeletal pain that is widespread
  • Fatigue
  • Sleep deprivation and sleep disorders
  • Loss of memory and cognitive difficulties
  • Mood disorders such as anxiety and depression
  • Tingling in hands or feet
  • Tension headaches
  • IBS
  • Joint pain and morning stiffness
  • Dysmenorrhea and urinary problems
  • Restless leg syndrome
  • Jaw pain
  • Nausea

The cause of fibromyalgia is still largely unknown; however it has been linked to injuries, illnesses, repetitive injuries, infection, surgery, trauma or stressful events, and possibly genetic factors.

If you suffer from fibromyalgia, there are some things you can do to help control fibromyalgia symptoms, which include:

  • Gradual and regular exercise performed in moderation
  • Relaxation techniques to reduce stress levels
  • Get adequate amounts of sleep
  • Limit caffeine intake
  • Eat healthfully

Chronic pain found in fibromyalgia may be initiated by trigger points, and after this pain is generated, the central nervous system amplifies the pain and results in hypersensitivity. This means that pain symptoms from specific causes are increased exponentially and even some sensations that should not be painful are interpreted as painful. So in order to decrease symptoms of pain, it is important to treat the causes to allow the nervous system to unwind from tension. Trigger points, tender areas in the body, and musculoskeletal imbalances are treated by physical therapists to help manage fibromyalgia pain and improve quality of life.

For further information on fibromyalgia:

National Fibromyalgia Association: http://www.fmaware.org/

American Chronic Pain Association: https://theacpa.org/

Prolapse: My Organs are Dropping- What Now?

Pelvic Organ ProlapseWhat is it?

Pelvic organ prolapse is a common condition that occurs most often in women following childbirth or menopause. The muscles inside the pelvis become weakened and lack the endurance or strength to support the body’s internal organs. This can result in a descent of the bladder, uterus, rectum, or even the vagina itself into the vaginal canal. The degree to which the pelvic structures descend can vary greatly. Some women with pelvic organ prolapse may have no signs at all and be completely unaware of their condition, while other women may have a larger grade of loss of support to their pelvic organs and develop more significant symptoms.

How might you know if you have a prolapse?

Some symptoms of pelvic organ prolapse include:

  • Sensation of a bulge/protrusion- feeling like something is coming out of the vaginal canal
  • Pressure and/or heaviness in the vagina
  • Urinary leakage, frequency, or urgency
  • Weak urinary stream, hesitancy with urination, incomplete bladder emptying
  • Painful sexual intercourse
  • Feeling of incomplete bowel emptying
  • Fecal incontinence or leakage
  • Low backache
  • Vaginal bleeding or discharge

What are the risk factors for pelvic organ prolapse?

While women who have been pregnant or given birth vaginally are the most at risk, especially in cases where the mother has given birth to a large baby or experienced prolonged pushing during labor, there are many other causes of pelvic organ prolapse.  Some are work or lifestyle related, such as heavy and frequent lifting.  Others stem from other medical symptoms such as chronic coughing, chronic constipation and/or straining with bowel movements, connective tissue disorders, prior pelvic surgery, or obesity.  Pelvic organ prolapse may also occur as a result of a genetic predisposition or from increasing age.

How can physical therapy help?

A healthy pelvic floor is vital in preventing pelvic organ prolapse, inhibiting further descent of organs that have already begun to fall, decreasing symptoms of pelvic organ prolapse, and as an effective conservative measure to avoid or delay surgery. A study performed by the American College of Obstetricians and Gynecologists in 2007ⁱ found that women with prolapse were found to have defects in the pelvic floor muscles, specifically the levator ani, and were found to produce less power in closing of the vagina with muscular contractions. Pelvic floor physical therapy will directly assess the strength and endurance of pelvic floor and core muscles, look for trigger points within the muscles themselves, help restore shortened muscles of the pelvic floor to their optimal length, and improve awareness of control of pelvic floor muscles with daily activities.

Pelvic floor physical therapy treatment of pelvic organ prolapse includes:

  • strengthening the pelvic floor and core muscles
  • biofeedback to help with improved awareness in using the muscles correctly and effectively
  • education in how to protect from further descent of pelvic organs
  • education in activities to avoid or modify

Women with symptoms of prolapse or who are at risk for pelvic organ prolapse should seek a consultation with a licensed pelvic floor physical therapist to have the best results in long-term pelvic health, function, prevention and management of pelvic organ prolapse.

How Can I Get Started?

Here is one exercise to begin:

Exercise for to help prolapsed organsLie flat on the back with feet propped up and supported on a wall. Place a pillow beneath the pelvis so that the hips are slightly elevated. This will put your pelvic floor in a gravity-reduced position to improve the ease of contractions and encourage an upward movement of the pelvic organs. Next try a pelvic floor contraction by exhaling and drawing the pelvic floor in and upward.  Hold this contraction for 5 seconds and then fully release, allowing the muscles to rest for 5-10 seconds. Repeat 10-20 times.





For more information, please go to: http://www.pelvicorganprolapsesupport.org

ⁱDeLancey JOL, Morgan DM, Fenner DE, et al. Comparison of Levator Ani Muscle Defects and Function in Women With and Without Pelvic Organ Prolapse. Obstetrics & Gynecology. 2007; 109: 295-302.

Six Ways to Help Manage Constipation

Constipation[Photo credit: PracticalCures.com]

Constipation is a common condition that affects up to 42 million Americans which is usually caused by:

  • Dysfunction with the nerves, muscles, or hormones in the body
  • Pelvic floor dysfunction leading to an outlet dysfunction
  • Delayed transit through the colon
  • Lifestyle and dietary habits

Specific factors such as medications, lack of physical activity, dehydration, lack of fiber in the diet, pregnancy, aging, travel, laxative overuse, diseases, and IBS form the majority of reasons a person develops constipation.


Constipation is currently diagnosed through a cluster of symptoms, which include hard stools that are difficult to pass, straining for 25% of defecation, a sensation of incomplete evacuation for at least 25% of bowel movements, and fewer than 3 bowel movements per week.  If your constipation results from a dysfunction of the nerves, muscles, or hormones in the body, you will need to consult your doctor and may need to seek out a physical therapist specializing in pelvic floor dysfunction; they can also assist you in making the necessary changes if your constipation results from lifestyle and dietary habits.


However, here are some simple lifestyle changes to help manage constipation:

 1.) Diet modifications

Certain types of foods can increase constipation (processed foods, cheese, white rice, red meat, bananas, dairy products).

Increasing fiber intake is important for the health of the digestive system and can help alleviate constipation. There are two types of fiber: soluble and insoluble. Soluble fiber helps to soften and bulk stool, while insoluble helps to promote movement through the colon.

  • Soluble fiber examples: fruits, vegetables, legumes, nuts, seeds, oats.
  • Insoluble fiber examples: whole grains, brown rice, oat and corn bran, some vegetables and root vegetable skins.

 2.) Anxiety and stress management

Stress is a common cause of constipation. Increased anxiety and stress triggers the sympathetic nervous system (our “fight or flight” response) and deactivates the parasympathetic nervous system (the “rest and digest” system).  This not only decreases the activity of the digestive system, slowing transit through the colon, but also decreases the body’s ability to relax the muscles of the pelvic floor to allow for defecation.

3.) Daily aerobic exercise

Moderate levels of aerobic exercise increases blood flow to the digestive system and improves function. Any form of exercise is beneficial, and can be as little as a 10-20 minute walk.

 4.) Toilet posture/positioning

Proper toilet posture can help assist in relaxation of pelvic floor muscles to allow for improved ease of bowel movement and decreased straining. Modern toilets typically create a sitting posture that does not allow the anorectal angle to straighten, which may increase difficulty with voiding.

For improved ease of bowel movement, the best toileting position is one that mimics a squatting posture. Placing the feet on a stool to increase the amount of hip flexion while sitting is a simple solution to create a better toilet posture.

 5.) Drink water, plenty of it

Dehydration is a common cause of chronic constipation. Decreased fluid intake can lead to firmer, harder stools that are more difficult to pass. Current recommendations for fluid intake vary depending on activity level, health status, and the environment. Generally, a good rule is to aim for around 2 liters of water intake per day.

 6.) Sleep!

Sleep deprivation can slow the intestinal slowdown and decrease bowel regularity. Sleep recommendations vary based on individual needs, however most resources continue to suggest aiming for 7-9 hours per night.

Why Use Meditation in Physical Therapy


Photo credit:  giphy.com

Meditation’s Benefits

Many people hear the word meditation and instantly think of trendy yoga girls, cheesy narrated audio guides, and Buddhist monks.  While it may be tempting to write off meditation as part of a new age spiritualism that you’re just not into, meditation does not have to be tied to specific philosophy or religion.  Meditation is really about quieting your mind, listening to your body, and allowing yourself to release thoughts of the past and future, if only for the moment.  The reality is that anyone can meditate, and there are as many varieties of meditation as there benefits.

[Read more…]

The TOP 5 Exercises to Reduce Pelvic Pain

Written by Kirsten Hober, PT, DPT

If you are experiencing pelvic, abdominal, hip, and pelvic floor dysfunction these 5 exercises can help your body relax, allowing more oxygen to flow to loosen tight muscles and fascia that may be causing your pain.


1.) Diaphragmatic breathing

Deep breathing is an excellent way to calm the nervous system and relax.  In particular, diaphragmatic breathing is a specific pattern of breathing closely related to the functioning of the pelvic floor and enables relaxation of those muscles.

The diaphragm is a dome-shaped muscle that lies below the rib cage. As the diaphragm contracts, it expands downwards and resulting pressure pulls air into the lungs. This downward pressure and expansion of the muscle also results in descending movement upon our internal organs. As this happens, the pelvic floor muscles receive a gentle stretch and expansion as well, facilitating a relaxation of those muscles. This pelvic floor expansion can be felt upon inhale with a diaphragmatic breath.

Diagram of how human breathe


To begin, lie on your back in a comfortable position with one hand over your chest and one hand over your abdomen just below the rib cage. Breathing in through your nose, let the air fill your belly and feel the expansion of your abdomen as your hand rises. Meanwhile the hand that is placed over your chest should remain still and you should not feel any chest expansion upon the inhale. As you exhale, feel the abdomen drop back down towards your spine. Continue to breathe, feeling your belly rise and fall with each inhale and exhale. Performing this exercise for 5-10 minutes per day will help allow the pelvic floor muscles to relax.

Once you have become comfortable with diaphragmatic breathing while lying on your back, you may also try the same techniques for this breathing pattern in sitting, and even standing.

Incorporating diaphragmatic breathing into the following four pelvic floor exercises will increase your awareness and ability to fully relax these muscles.

Diaphragmatic breathing exercise diagram


2.) Deep Squat

Bringing your legs wider than your hips, squat down towards the ground until a stretch is felt through your legs and you reach the deepest comfortable position.  You may choose to hold onto a stable surface for support, or you can bring your arms inside your legs as a counterbalance. Hold this pose for 30 seconds as you breathe deeply into the belly using the diaphragmatic breathing. Try to feel the expansion of the pelvic floor muscles in this open position. Repeat 5 times throughout the course of the day.

Deep squat pelvic floor exercise holding on to something sturdyDeep squat balancing pelvic floor exercise


3.) Happy Baby


Lie on your back on a comfortable surface. Bend your knees and lift your legs off the ground, gripping the outside of your feet or your ankles with your hands as you separate your legs wider than your torso. Remain in this posture for 30 seconds and breathe deeply using diaphragmatic breathing to expand the belly. As you inhale feel the expansion of the pelvic floor muscles. Repeat 3-5 times throughout the day.

Happy baby yoga pose

4.) Child’s Pose


Begin by kneeling on the ground on a comfortable surface. Separate your knees so that they are open wider than your torso. Bend forward at the hips and bring your forehead to rest on the ground or a pillow. You can either reach your arms forward in front of your head or back to rest by your hips. Bring your hips back so that they are resting by your heels. Relax into this position, letting your body fall towards the ground, releasing all tension in your body. Once you feel relaxed fully, focus on diaphragmatic breathing. Allow your belly to expand into the space between your knees as you inhale. Feel your pelvic floor muscles relax and melt towards your hips and feet as you inhale. Remain in this position for 30 seconds to 1 minute. Repeat 3-5 times per day.

Child's pose in yoga with arms frontYoga pose child's pose with arms back

5.) Legs Up Wall

Sit down with your hip 5-6 inches from a wall. Lie down and swing your legs up onto the wall so that your heels are resting supported against the wall and your legs are relaxed. You may choose to let your legs fall out to the sides so that you feel a stretch through the inner thighs or you can allow your legs to remain closer together. Once you have found a comfortable position, focus on diaphragmatic breathing. Allow your inhale to increase the expansion of your pelvic floor muscles as your belly expands. Breathe deeply in this position for 3-5 minutes.

Inverted wall stretch exercise


Watch Kirsten demonstrate these exercises below.