Improving Orgasm in Men and Women

The ability to achieve a healthy, strong, satisfying orgasm is a gift. When we have low libido, inability to orgasm or our quality of orgasm is not as strong as it used to be, can anything be done?  Plenty! For women and in some cases, men, their low libido may be due to hormone imbalances. Levels of testosterone and other sex hormones can be checked by a doctor specializing in sexual medicine and you may be prescribed hormone replacement therapies. To find a doctor with this knowledge, go to www.isswsh.org.  For most men and women, it’s a simple matter of becoming aware and retraining their pelvic floor muscles – the ability to be strong, have good endurance like any other muscle in the body, as well as the ability to relax.

 

WHERE TO GET ASSESSED for your Pelvic Floor

Consult a physical therapist who has been trained and is practicing in the field of pelvic physical therapy;

To find one:

The Section of Women’s Health of the APTA – American Physical Therapy Association, www.womenshealthapta.org.

Herman and Wallace Pelvic Rehabilitation Institute, hermanwallace.com

Both organizations have lists of Practitioners that have attended and received certifications in the field.

 

ASSESSING PELVIC MUSCLES

In pelvic physical therapy, we assess your core, hip, external pelvic and internal pelvic floor muscles – how relaxed, tense and strong they are using manual and biofeedback methods.  We check your ability to breathe using your diaphragm.  The breath and core/pelvic muscles work together in unison.  The pelvic floor aka “Kegel” muscles are located inside your pelvis, running from the front of the pubic bone, attaching to your tailbone and to the sides on the deep hip external rotator muscles.

Pelvic floor muscles have two types of fibers: The slow twitch or the endurance fibers – they are the ones that hold against gravity if you jump, run, sneeze, laugh or cough.  Fast twitch muscle fibers – these rhythmically contract during orgasm -10 – 15 contractions during an orgasm. We focus on strengthening the core muscles and the fast twitch muscle fibers for the pelvic floor. We find that 50-60% of our patients do not know how to recruit these muscles without holding their breath or using other muscles.

 

RELAXING THE PELVIC MUSCLES

To have a really good orgasm, your pelvic floor muscles need to be relaxed during the day – not in a high tense state, always on guard. Breathing properly and being mindful your pelvic floor can prevent automatic tension that occurs in the pelvic floor during a stressful situation (work, home, relationship, life stresses).  Most people don’t realize they are holding tension in their pelvic floor, like a tight fist.  If the pelvic floor muscles are constantly tense, it can lead pain to with sexual intercourse in women, difficulty in achieving/maintaining erection in men and for both, the ability to have a satisfying orgasm.   Plus chronic PF tension can show up as difficulty in going to the bathroom, urinary urgency, frequency, bladder pain, abdominal bloating and bowel issues  – chronic pelvic floor tension is a major contributor to Constipation.

 

EXERCISES FOR RELAXING PELVIC FLOOR

 

Child’s Pose

Start on all 4’s.  Sit back onto your heels. If your buttocks cannot reach your heels, place a pillow so you can fully rest. Lower your head to the floor, resting on a pillow if needed.

Slightly widen your knees apart to provide space for your stomach to expand as you inhale. As you inhale, your stomach expands and very subtly, your pelvic floor muscle expands as well.  As you exhale, your stomach deflates and the pelvic floor return to the rest position. Do slow, deep diaphragmatic breaths, inhaling for a count of 4 seconds, exhaling for a count of 6 seconds. Do 3 times. Once a day.

 

Happy Baby Pose

Lie on your back, bring both knees to your chest. Grasp underneath your knees and bring your thighs wider to each side and slightly down to open your groin/pelvic floor.  For more advanced, grasp both feet and gently pull the feet and knees toward the floor. You are stretching and opening your pelvic floor.  Inhale for count of 4, Exhale for count of 6. Do 3 times. Once a day.

 

 

Inner thigh groin stretch

Sit on the floor. Straighten both legs and comfortably widen to either side. You may need to place a small folded towel under your seat if you’re rounding hunching forward too much.   Place both hands on the floor behind you as this will help you keep an upright posture. Hinge your body slightly forward from the hips.  The inner thigh muscles attach to the pubic bone. If they are tight and restricted, it will affect how the pelvic floor works. Hold for 30 seconds to 1 minute. Do 2’x. Once a day

 

 

 

EXERCISES THAT STABILIZE AND STRENGTHEN

PF Slow twitch exercise

In lying or sitting position, Inhale.  As you exhale, Squeeze your anal and vaginal/penile region tight for five seconds (“one-one thousand, two one thousand”, to five). Breathe as needed versus holding your breath.   Avoid contracting your larger gluteal or abdominal muscles. Work up to ten seconds. Release slowly and relax fully for ten seconds before trying again. If you can contract for ten seconds, rest for 20 seconds. Do 2 sets of 10 repetitions twice a day.

 

PF Fast twitch exercise

Squeeze your anal, vaginal/penile area strong, quickly holding one second (“one one-thousand”) Fully relax for about 2 seconds.

Exhale in a faster pace during the squeeze, inhaling during the relaxation

Do two sets of 10 reps twice a day.

 

 

CORE EXERCISES

 

Plank

Lie on your stomach. Elbows bent on the ground, Bent toes on the floor. Exhale as you tighten your abdominals and lift your

body off the floor keeping shoulders, hips, knees is in a straight line.

Hold for 10 seconds, up to 30 seconds. Do 2 sets of 10 reps. Once a day

 

 

Bridge

Lie on your back, knees bent, feet hip width apart, arms by your sides, palms down.

Inhale. Exhale as you first think of bringing your pubic bone upwards towards your navel (recruiting the Transverse Abdominals) then squeeze your gluteals (buttocks muscles) together, raising your hips off the floor. Hold end position for 5 seconds.  Lower your hips to the floor, fully releasing the abdominal and gluteal contraction as you inhale. Exhale and repeat.  Do 2 sets of 20 reps. Once a day

 

At EMH Physical Therapy, we offer a PelviCorFit Program http://emhphysicaltherapy.com/pelvicorfit-program/ that teaches you how recruit and relax your pelvic floor muscles in 1-3 sessions.

 

My app PelvicTrack , free on iTunes store has a compilation of pelvic and core exercises.

If anyone in NYC needs to see pelvic floor physical therapist please visit us  http://emhphysicaltherapy.com/pelvic-floor-dysfunction-therapy

 

 

 

Don’t miss your chance to listen to Evelyn Hecht, PT, ATC speak about modern pain science and how she’s been using it to help heal chronic pain

 

Follow this link to listen to Evelyn’s episode of the Healing Pain Podcast: listen to podcast here

Chronic Pain Solutions for Complete Recovery Pt. 2: Movement

In Chronic Pain Solutions for Complete Recovery Part 1, we discussed “neuroplasticity”, the ability for the amazing brain to change and grow for the better.  For a quick review, check out this cool, short YouTube video  on neuroplasticity. Part 2 Movement will focus on how and why movement is crucial to help decrease chronic pain.

Motion is lotion.

The body and brain loves movement.  A sedentary lifestyle associated with fear of movement or lack of motivation to move leads to weakened muscles, stiff joints, weight gain, increased inflammatory cells, brain atrophy and… more pain. Movement grows new neuronal connections within the brain, basically rewiring the faulty circuitry associated with our internal pain alarm. Remember the burglar and alarm analogy from Part 1?

Use it or lose it

Above is an illustration of our brain. The region highlighted in rose color is the called the motor cortex, which basically  is a map of our body located on the brain, our virtual body. Each body part is represented on a specific region of our motor cortex. The tongue and hands have a lot of real estate on the brain compared to the knee because the tongue & hands are critical for survival.

For example, when you speak, the tongue section of the motor cortex is activated.  When you turn your head to look at an attractive person passing by, the neck and upper back  on your brain’s map light up like a Christmas tree.   However, if  you have chronic neck pain and can’t rotate your neck fully, your “virtual neck” doesn’t fire as quickly or intensely and can even atrophy.  The good news is that we can retrain our brain, restoring these lost connections which reduces pain because of the brain’s neuroplasticity.

No Brain, No Pain

OK, so we know that without a functioning brain, we cannot feel pain. With chronic lower back pain, patients have a smaller “virtual lower back” on their motor cortex as compared to healthy subjects.1, 2, 3. The good news is that no matter how long you have experienced chronic pain, with consistent practice of various techniques including daily movements we’ll discuss here, the brain can learn healthier patterns which results in 1) reactivation of the motor cortex and 2) less pain.

A study in 2010 looked at motor cortex activation of patients who had 4+ years of low back pain who either participated in a  walking program or a core exercise program4.  The group who participated in the deep core exercise program gained more lower back “real estate” on their motor cortex (ie showing more brain activation) and they reported a significant decrease in lower back pain.

The group who did the walking program showed no changes in pain nor brain activation. Walking can be very helpful for the joints, muscles and heart, but specific exercises targeting the area in pain can improve brain activation and lower pain.

Core Training

Below are three videos on training the deep core muscles (Transverse Abs, deep lower back). These videos are not to be used in lieu of seeing your medical doctor or physical therapist.

Level 1 Core Video

Level 2 Core Video

Level 3 Core Video

What about other areas of the body in pain? Generally speaking, there are actually core muscles for your neck which are the deep cervical flexors; the core muscles for your arms are the scapular muscles and the core stabilizers of your legs are glutes and pelvic floor.  Exercising these muscles can help change the brain to look and act similarly to those without pain.

Strength Training

When you think of strength training what do you visualize?

 

 

 

 

 

 

 

 

 

 

 

Do you picture the bulky weightlifter power-cleaning hundreds of pounds? While this is technically strength training, so is lifting 1 lb. dumbbells for 3 sets of 5 reps.  Your “heavy” is not your boyfriends “heavy”, is not your mom’s “heavy” and may not be your ‘heavy” 2 months from today.

Strength training streamlines the body and can create a more toned, slim appearance. It helps breakdown fat up to 72 hours after a workout, stabilizes your spine so your posture keeps in good alignment and nerves can function more easily. Strength training also prevents osteoporosis by building bone density, decreases visceral (abdominal) fat linked to heart disease, helps control appetite and decreases inflammation throughout the body5. Most importantly, it can help rewire the brain and eliminate pain just like core training does.

Here are three strengthening level 1 basics for anyone. Remember these are suggestions and if you are having pain, best to first consult with your physical therapist to get tailored advice.

Squats

Region targeted: thighs and glutes Frequency: 2-3x/week
Joints stabilized: hips and knees Intensity: heavy with minimal discomfort
Helps with: bending, lifting, sit to stand 2-3 sets 8-12 reps, 30s rest -> 3-4 sets 6-8 reps, 1-2’ rest

Bent Over Rows

 

 

 

 

 

 

Region targeted: back, shoulders, trunk, arms Frequency: 2-3x/week
Joints stabilized: shoulder, elbow, spine Intensity: heavy with minimal discomfort
Helps with: pulling, lifting, carrying 2-3 sets 8-12 reps, 30s rest -> 3-4 sets 6-8 reps, 1-2’ rest

Push Ups

 

 

 

 

 

 

 

Region targeted: shoulder, chest, upper back Frequency: 2-3x/week
Joints stabilized: shoulder, elbow, spine Intensity: heavy with minimal discomfort
Helps with: pushing, carrying, lifting 2-3 sets 8-12 reps, 30s rest -> 3-4 sets 6-8 reps, 1-2’ rest

Daily Movement

Another great way to begin to counteract sedentary lifestyle, especially if you sit for work or school, is to track your steps via a pedometer or on your phone. Depending on your fitness level and pain levels, aim for 5000 steps every day and gradually increase to 8000 then 10,000 steps (over time). Research shows that doing high impact cardio workouts is too stressful for many people with chronic pain so walking can promote similar benefits6.

Even if you are house bound, taking a stroll around the house/apartment once an hour can start to add up your steps. Instead of going to the mall to shop, let it be a destination for a comfortable walk with plenty areas to rest anytime you need.  If you work, walk an extra few blocks to the subway/bus stop, or park your car farther away from your home.  Instead of taking an elevator to your exact floor, take it to the floor below.

Once walking becomes easier, begin a targeted core and strengthening program for all of the benefits listed above. There are so many! Move every day, avoid being too sedentary, get guidance to help you find your best exercise plan and most importantly keep practicing this for at least 3 months. You’ll be amazed to feel less pain by that time.

References

  1. Strutton PH, Theodorou S, Catley M, McGregor AH, Davey NJ. Corticospinal excitability in patients with chronic low back pain. Journal of Spinal Disorders & Techniques 2005;18(5):420e4.
  2. Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain 2008;131(Pt 8):2161e71.
  3. Flor H, Braun C, Elbert T, Birbaumer N. Extensive reorganization of primary somatosensory cortex in chronic back pain patients. Neuroscience Letters 1997;224(1):5e8
  4. Tsao H, Galea MP, Hodges PW. Driving plasticity in the motor cortex in recurrent low back pain. European Journal of Pain, 2010; Feb 22
  5. Tatta J. Heal your pain now. Boston, MA: Da Capo Press; 2017.
  6. Kristen M. Beavers, Daniel P. Beavers, Sarah B. Martin, Anthony P. Marsh, Mary F. Lyles, Leon Lenchik, Sue A. Shapses, Barbara J. Nicklas; Change in Bone Mineral Density During Weight Loss with Resistance Versus Aerobic Exercise Training in Older Adults, The Journals of Gerontology: Series A, , glx048

Pooping 102

Here’s the second part of  Poop 101

What should my poop look like?

Have you ever heard the expression ‘you are what you eat’? Well, it’s true! What we put into our bodies affects the health of our gut, which has more neurons than is in our brains! Say what? So, it’s helpful to occasionally take a peek at the color, shape and size of your poop.

The chart above reflects this. Imagine if you’ve barely had any water all day, as you are busy rushing from place to place. Maybe you grabbed a sandwich or pizza for lunch. Your stool may end up looking like Type 1, separate hard lumps, difficult to pass because you are dehydrated. The stool is hard because the intestines have absorbed all of your fluid, leaving nothing behind but what looks like rabbit pellets.

If you’ve ever had a stomach virus, you may have had type 7 or diarrhea. Your body also may have trouble digesting certain types of foods such as products with lactose or artificial sweeteners. Generally, softer stools are associated with inflammation.

Normal, healthy stool is type 3 or 4, sausage shaped which is not too lumpy and stays together as one solid mass.

If your stool is not diarrhea, but comes out in soft blobs with clear-cut edges, you may be lacking fiber in your diet. Fiber can prevent and relieve both constipation and diarrhea. Insoluble fiber moves bulk through the intestines and balances the intestinal pH, whereas soluble fiber binds with fatty acids and slows transit time. The best form of fiber is from natural sources, such as fruits and vegetables.

How frequent should I go?

The frequency of a bowel movement (BM) varies frequently from once a day to every 3 days and that can be completely normal. Again, you do not need to poop every day to be normal and healthy. Remember, it takes up to 72 hours for the stool to pass through the large intestine alone. Everyone has their own version of normal. Now, what is abnormal?

Diarrhea is defined as loose stool more than 3 times per day. Constipation is defined as straining to pass stool or a feeling of incomplete emptying with a frequency of bowel movements less than 2 times per week.

As a general rule of thumb, the longer digestive contents are in the intestines, the harder the stool and greater chance of constipation. The opposite is true of diarrhea. In other words, if the intestines don’t have time to absorb fluid, the feces are more likely to be soft or liquid. Remember, the intestines absorb 1000 – 1500 mL of liquid leaving just 100- 150 mL for the stool. If the body doesn’t have time to absorb this liquid, diarrhea can occur.

What factors affect intestinal motility?

  • Amount of feces
  • Chemical makeup of feces
  • Intestinal hormones
  • Nervous input to intestines
  • Female hormones
  • Emotions
  • Visual and olfactory input
  • Time of eating, schedule
  • Systemic diseases – anorexia, diabetes myelitis, hypothyroidism
  • Activity level

What Can I Do To Poop Better?

 

You can improve bowel regularity through exercise;  find out the side effects of medications, especially beta-blockers and opioids; learn some easy ways to relieve your stress and eat regular meals.

Other helpful tips to stimulate a BM:

  • drinking warm water w/ lemon in the AM to stimulate the bowels
  • do an “ILU massage” or self-intestinal abdominal massage
  • taking a morning walk or do some yoga poses

An example of a self-intestinal massage is shown above. Provide light strokes in the direction in a clockwise direction as shown for 1-3 minutes or until you hear a “gurgling” of your stomach.

References

Doughty, D. (2002). “When Fiber is Not Enough: Current Thinking on Constipation Management.” Ostomy Wound Management 48(12):30-41

Force, A. (2005). “An Evidence-Based Approach to the Management of Chronic Constipation in North America.” American Journal of Gastroenterology 100(S1):S1-S22.

Hawkey, C.J., Bosch, J., Richter, J.E., Garcia-Tsao, G., &Chan, F.K. (Eds.). (2012). Textbook of clinical gastroenterology and hepatology. John Wiley & Sons.

 

Multi-Disciplinary Approach is best for relieving Chronic Pelvic Pain

Evelyn and her DPT staff traveled to Chicago for the International Pelvic Pain Society conference to learn about the evolving sciences and evidence based treatment for pelvic pain.

Pelvic pain is typically located in the lower part of your abdomen & pelvis and can stem from the reproductive, urinary or musculoskeletal systems. The cause of pelvic pain can be complicated, involving interactions between gastro-intestinal, genito-urinary, musculoskeletal, nervous, endocrine systems and can include socio-cultural factors.

So it’s important to have a medical team working with you. Your team can include a urologist, pelvic physical therapist, gynecologist, gastroenterologist, psychologist, radiologist acupuncturist and sex therapist.

In our experience we find that patients just need 2-3 team members such as a medical doctor well versed in pelvic pain to guide on medications and general health, an experienced pelvic physical therapist who provides education, manual and movement therapy, and a talk therapist to address underlying emotional traumas. 

UPOINT  helps MD’s find best treatments for Male pelvic pain

Most men with symptoms of chronic pelvic pain syndrome (CPPS), such as penile pain or discomfort, urinary urgency/frequency, inability to sit, testicular pain and/or ED, have been given a diagnosis of “Non Bacterial Prostatitis” and prescribed antibiotics. I often hear from my patients that the medicine didn’t help, as their prostate gland was not infected, which is what antibiotics target. Many men were not getting pain/symptom relief from antibiotics and doctors needed a better system to determine the cause of CPPS.  UPOINT was developed to help.

 

UPOINT is a classification system to determine the specific diagnosis and treatment for male CPPS. The white boxes below represent the cause of symptoms, which in the case of CPPS, can be multiple. The higher the number of causes, the more severe the symptoms.  The gray boxes show the appropriate treatment options depending on the cause(s).1

 

 

A study of 100 men assessed and treated with the UPOINT system saw an 84% reduction in pain and disability. 2 CPPS can have multiple classifications including Psychosocial, Neurologic/Systemic and Tenderness of Skeletal Muscles.  These men healed with a combination of pelvic floor physical therapy, medication that targets nerves and talk therapy. By using the UPOINT system doctors can prevent the natural increased anxiety and pain escalation that these patients experience the longer they experience pain.  

Women with Endometriosis benefit by a team of providers

The BC Women’s Centre for Pelvic Pain and Endometriosis utilizes an interdisciplinary approach to treat women with endometriosis which resulted in 45% of their patients feeling “much better” in regards to pain and quality of life. Twenty three percent (23%) reported feeing “somewhat better” and only 20% reported feeling the “same”. These results were seen at the completion and at the 1 year follow up of the program.3

 

What does this interdisciplinary approach look like?

BC’s approach included education in the recent science of pain – how the brain is involved in sending pain signals as a form of protecting the body and how the brain can be retrained to lower or stop sending those signals. BC clients received pelvic physical therapy which involved manual therapy to release adhesions of muscles, fascia & intestines and movement/exercise prescription. They were also assessed by a gynecologist, received counseling (stress management), nursing care management and  BC’s team would meet to discuss their patients to ensure great outcome.

Create Your Medical Team

Women may not have access to nor can afford an extensive program like BC’s, however they can use the same approach with their own care. An experienced pelvic physical therapist can be the liaison between the medical doctor and all other healthcare providers as we tend to spend dedicated 45 minutes to an hour of interrupted time with our patients.  Being open to explore other treatment options such as cognitive behavioral therapy, acupuncture and nutritional guidance as this can also lower symptoms of endometriosis.

 

 

Pelvic Physical Therapy helps Cervical Cancer Survivors

 After being diagnosed and successfully completing cervical cancer treatment, we learned that 66% of cervical cancer survivors suffer from urinary issues such as leaking. Thirty three (33)% percent have a “storage dysfunction” which means the bladder sends the “Gotta Go” signal when it is only a quarter or half full, making women go to the bathroom too many times a day. Fifty (50) % have voiding dysfunction, which means there is left over urine in the bladder or the time it takes to pee is markedly increased.4

Pelvic physical therapy is an accepted treatment option for these women. Gentle manual release of the lower abdominal, inner thigh and pelvic floor/perineal regions and pelvic floor muscle training using biofeedback can significantly improve urinary incontinence, sexual function and quality of life for women who survived cervical cancer. Progressive use of vaginal dilators can help promote optimal healing of vaginal tissues after radiation.5

We want all women to feel good and confident about their body after cancer treatments and are thrilled to see this research.

  1. Nickel JC. C. Paul Perry Memorial Lecture “Clinical Approach to Male CPPS”. 2016.
  2. Shoskes DA, Nickel JC, Kattan MW. Phenotypically directed multimodal therapy for chronic prostatitis/chronic pelvic pain syndrome: a prospective study using UPOINT. J Urol. 2010;75(6).
  3. Allaire C. Innovations in the Evaluation and Care of Women with Endometriosis. 2016.
  4. Katepratoom C, Manchana T, Amornwichet N. Lower urinary tract dysfunction and quality of life in cervical cancer survivors after concurrent chemoradiation versus radical hysterectomy. Int Urogyn J. 2014;5(1).
  5. Lyons M. Women, Cancer and Pelvic Pain. 2016.

 

 

 

Chronic Pain and sexuality: How Eva Margot Kant, LCSW-R helps people navigate these issues

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(Image courtesy of Eva Margo Kant, LCSW-R)

The National Institute of Health (NIH) defines chronic pain as pain lasting more than 3 months and it affects more than 100 million Americans today.  As a pelvic floor physical therapist, I help patients with both acute and chronic pain, more specifically pelvic pain, on a daily basis. Due to the private nature of pelvic floor issues, sexual dysfunction, or bowel and bladder complaints it can be difficult for patients to feel comfortable talking about their symptoms.

The famous quote, “no man is an island,” rings true for healthcare providers who treat chronic pain as multiple specialists working together is more effective than one. I recently met with Eva Margot Kant, LCSW-R  with 12+ years of experience helping people deepen their self-esteem, navigate life’s transitions, and address fears and questions about chronic illness/pain which includes topics of sexuality and sensuality. Eva taught me some great perspectives on how she helps people heal their emotional/sexual wounds and how they can be a source of chronic pain.

Eva runs workshops about sex and disability, sex and aging and trains medical students how to talk about sex with their patients. Her goal is to help people “unpack their feelings” that are attached to physical pain and anxiety. Anxiety increases the output of the limbic system, the emotional flight or fight, and memory areas of our brain which results in pain.

Eva believes that “understanding how the body works is the key to understanding you”.  Her job is to help people understand what their sexuality is to them and to own how they view and understand it.  Eva believes that “the body always remembers.” She likened the reflexive blink of an eye that’s about to be poked to the feeling a woman with sexual pain feels if her partner demonstrates affection. The woman may fear that any show of affection may lead to sex which is painful for her, so she avoids this.

Eva’s goal is to help patients learn if some physical reflexive tightening may be due to thoughts involving shame, guilt, or embarrassment.  She helps clients decide when to disclose to a new partner about their chronic condition. She stressed the importance of self-care with their partner and to feel emotionally safe. People who have chronic pain/illness may go thru life as if they are “holding their breath.” Often times Eva finds that partners want to help, they just don’t know how. Demystifying chronic pain/illness allows partners to be supportive and an active participant in healing.

Eva’s upcoming book and course work, called “The Holy Trilogy of Sex (c),” guides patients and their partners in sensuality, sexuality, and intimacy; none of which are possible without communication, sensation, and connection. She encourages partners to engage in body mapping: offering each other a “menu” of intimate ideas that can promote togetherness without causing more pain.

As a Pelvic Physical Therapist, I invite my patient’s partner to a session to observe, learn, and understand what my patient is experiencing and teach the partner ways they can help. I work on the physical aspect of pain with my manual, movement and exercise therapies while Eva addresses on the mental and emotional aspects of chronic pain which leads to a more efficient outcome.

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EMH Team; Jennifer Jurewicz, Tova Laufer & Charissa Morrisroe with Eva Margot Kant, LCSW-R

If you have chronic pelvic pain consider receiving both physical and talk therapy to get your life back on track.  Consider visiting us at EMH Physical Therapy and Eva Margot Kant, LCSW-R if you are in the NYC area. Your pelvic floor with thank you!

Resources:
http://evamkantlcsw.com/
http://www.ninds.nih.gov/disorders/chronic_pain/chronic_pain.htm

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EMH Physical Therapy Goes To Chicago for The International Pelvic Pain Society (IPPS) Conference on Chronic Pelvic Pain

                                     

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screen-shot-2016-10-07-at-11-40-39-amAt EMH Physical Therapy, we support an interdisciplinary approach to treating our patients. We are in constant communication with primary care physicians, urologists, psychologists, gynecologists and other healthcare providers to make sure all our patients have a strong team working for them

A team based approach to medical care has been shown to prevent medical errors (1), improve patient-centered outcomes and chronic disease management (2-4). 

This week the EMH team are packing our bags and headed to Chicago to attend the International Pain Societys annual fall meeting on chronic pelvic pain where well hear practitioners of various disciplines discuss advances and techniques in treating pelvic pain. Some topics were excited about exploring include the mind-body” connection, psychosocial aspects of pelvic pain, cancer and pelvic pain, cystitis, hormone treatments, vulvodynia and more. 

The International Pelvic Pain Society (IPPS) was established in 1996 with the goals of educating health professionals on how to diagnose and manage chronic pelvic pain and to bring hope to men and women who suffer from this pain by raising public awareness (5). 

Their website, pelvicpain.org, contains articles which can help to educate patients on a wide variety of conditions and find healthcare providersWe are excited to share the information we learn at IPPS conference with all of you when we return to New York City next week! Stay tuned.

P.S. Well be active on Instagram, @emhpysicaltherapy, and Twitter, @EMHPH, while were away, so keep up with us there!

Resources:

1. IOM (Institute of Medicine) To err is human. Washington, DC: National Academy Press; 1999.

2. Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: The chronic care model, part 2. Journal of the American Medical Association.2002;288(15):19091914.

3. Ponte P, Conlin G, Conway J, et al. Making patient-centered care come alive: Achieving full integration of the patients perspective. Journal of Nursing Administration. 2003;33(2):8290.

4. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: Translating evidence into action. Health Affairs. 2001;20(6):6478.

5. International Pelvic Pain Society. Pelvicpain.org

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A Pelvic Physical Therapist’s Approach to PGAD: Persistent Genital Arousal Disorder

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What’s your first reaction to this image? Laugh? Sigh and Roll your eyes at the tasteless joke?  Did you think: “How can anyone REALLY have this?”

What if you were experiencing sexual arousal or multiple orgasms on a daily basis, for hours at a time, day or night, with no one medication or method to relieve symptoms on a consistent basis?

What if you had the guts to talk to your doctor about the embarrassing (or what may even feel like devastating) symptoms and find out that your doctor either never heard about PGAD, or worse was a medical professional that did not believe you?

This is the suffering that people with PGAD or PSAS, Persistent Genital Arousal Disorder or Persistent Sexual Arousal Syndrome, experience and continue to endure. Sadly, the condition has even led some patients end their own lives as recently as a few months ago in 2016.

What  is PGAD?

Persistant Genital Arousal Disorder, a “monster sexual dysfunction”, as coined by Irwin Goldstein, MD (1) is a condition characterized by 6+ months symptoms of high levels of genital sexual arousal in the absence of desire (2). Genital arousal does not dissipate, with orgasm nor by medication alone.

PGAD sufferers describe their symptoms as intrusive, unwelcome, unpleasant and sometimes painful. Multiple, frequent disturbing orgasms (not pleasurable) occur spontaneously, at work, home, school and create tremendous embarrassment and anxiety, which eventually can lead to depression, frustration, and social withdrawal. It causes major stress for personal relationships. Seventy five percent (75%) of women with PGAD report moderate to high distress levels and report feelings of shame, isolation and suicidal thoughts (3).

PGAD: Subset of Chronic Pelvic/Abdominal Pain

PGAD has similar qualities, fluctuations, flares like and is starting to be viewed as a subset of chronic pelvic/abdominal pain.

Chronic pelvic/abdominal pain diagnosis is also made after 6 months of pain, burning, stabbing, cramping  + other symptoms involving 1 or more “private “areas: bladder (urinary frequency and bladder pain) bowel, (IBS) reproductive organs (endometriosis, vulvodynia), groin, buttocks and pelvic floor muscle pain.

As chronic pain takes 6 months to develop, the tissues that were involved at the initial onset of insult or trauma  may not be the main or only source currently producing chronic symptoms.  Rather, a highly sensitive brain/nervous system that is persistently on High Alert, “Danger-Danger!” mode perpetuates the symptoms.

PGAD Research

PGAD alone has not been researched extensively. We do not know the cause, the amount of women and men with symptoms, nor do we have effective, evidence based treatment – yet. With the push of some PGAD “warriors” and a relatively young organization, International Society of the Study of Women’s Sexual Health (ISSWSH), www.isswsh.org, research on PGAD is now being conducted. ISSWSH will have their annual conference in February 2017 where the PGAD Significant Interest Group will present state of the art research as well as testimonials from sufferers.

PAIN comes from the BRAIN

Chronic pain research has made amazing strides in the last 10 years due to the ability to incorporate MRI studies of the brain in all sorts of pain research. Our brain’s main job is to protect us. For example, we don’t keep our hand on the hot stove, or step down further onto the nail under our foot as the brain instantly weighs information coming from sensory nerves and makes a decision on how to react – i.e. PROTECT.  Pain is the brain’s response to incoming nerve reports.

Research shows hundreds of areas in our brain “light up,” or simultaneously become active when experiencing pain, including areas in the brain that process Sensation, Movement, Emotions and Memory. This knowledge helps us understand how a certain movement, emotion or even noise & light can lead to a pain reaction, especially if the brain is persistently on the faulty “Danger-Danger!” mode.

“Neuroplascity” is the ability for the brain to make new neural connections throughout our whole lifetime, to adjust, to change.

How can we help our brain change from being on a highly sensitive “Danger Danger!” mode to a more functional mode?

PGAD TREATMENT Step 1: EDUCATE yourself about Pain & Know your Triggers

Once medical diseases have been ruled out, the first step of effective treatment of PGAD is to change the brain from high alert to a healthy functional mode, by educating yourself on the science of pain (stay with me!)  and to write down all of your possible triggers for symptoms. Lorimer Moseley’s and David Butler’s Explain Pain (www.noigroup.com) and pain educational website www.retrainpain.org are great resources for pain/PGAD sufferers and their loved ones.

Write down all the actions (riding in a car, walking up stairs, showing affection to partner, etc.) and write down what fears/thoughts (not knowing the “cause” of pain, not being able to work, loss of partner, inability to care for children etc.) that stimulates PGAD symptoms (4).

Describe each symptom related to the trigger and rate the intensity of symptom on scale of 0-10. This will give you and your medical team a baseline to measure and monitor progress.  You have to be an active participant in your healing because each person’s cause of symptoms and how your brain reacts with pain/PGAD symptoms is unique.

PGAD TREATMENT Step 2: Find your T-E-A-M

Find your team of practitioners who understand PGAD and who will work with you. A Medical Doctor and a Pelvic Physical Therapist is a good start.

  1. MD/DO – for prescription medicine, trigger point injections, superficial nerve blocks, botox – treatments to  give the faulty nerves/brain activity a break
  2. Pelvic Physical Therapist – who is up-to-date with the recent pain research information, provides manual treatment and offers paced, gradual movement/exercise therapies to pelvic floor, abdomen, pudendal nerve and viscera – see below for more details
  3. Psychotherapist – to  address any possible childhood traumas/abuse issues that over 50% of PGAD sufferers experienced, as these experiences may be held (remembered) in their genital region  (see EMH Physical Therapy’s blog on Somatic Experiencing (http://www.emhphysicaltherapy.com/what-is-somatic-experiencing-and-how-does-it-heal-traumachronic-pain/1450/). Therapy can help manage the depression and anxiety that accompanies PGAD.
  4. Acupuncturist – to help lower the “high alert” brain/nervous system, releasing the “fight or flight” pattern or stimulating the sluggish, depressed pattern

PGAD TREATMENT Step 3:  Pelvic Physical Therapy

Physical therapy treatments are individualized as no patient is alike in their presentation – their symptoms of PGAD /pain may be similar, but the causes are different. Education about brain/nervous system and motivating patients to become active partners in their healing process has the best outcome.

There is no one “magic bullet,” no 1 medication or 1 technique for symptom relief. Receiving regular pelvic PT treatments plus doing a daily exercise/movement program (the brain loves movement!) is part of PGAD therapy. Treatments can include:

Manual Therapy – incorporating movement and awareness for both the external & internal muscles of the pelvis, abdominals, hips, fascia and skin; calming  the “fight or flight” reaction allows for improved blood flow, oxygenation and balances the nervous system.

  • strain / counterstain
  • myofascial release
  • connective tissue massage (aka skin rolling)
  • trigger point release
  • pudendal nerve glides
  • visceral mobilization

Biofeedback – to promote awareness of pelvic floor muscle tension and teach coordination training.

Breath and Meditation – deep diaphragmatic breath expands the front, sides, back of the ribs & abdominal cavity, relaxes the pelvic floor muscles, massages the internal organs and improves oxygenation to tissues. A simple 5 minute meditation where one focuses on the sensation of slow inhalation and exhalation calms the brain.

Desensitization Techniques:  Strategies to lower the high alert nervous system as used in treating Complex Regional Pain Syndrome, is applied to our PGAD patients with promising results.

Stretching and Stabilization Exercises to lengthen and strengthen, stimulate the core stabilizers, soften the pelvic floor. Cardiovascular exercises to improve general blood flow are performed daily at home. Exercises are paced and applied gradually as the patient reports responses in their symptoms.

Modalities such as TENS, Low Level Laser and use of dilators can also be used as part of our treatment.

Final Thoughts

PGAD, like chronic pelvic pain is complex and requires patience by both the patient and the practitioner. Results are best if patient and practitioner work consistently together and the patient performs daily home/self care exercises, paying attention to responses and slowly increasing the pace and challenge of the new movement. Neuroplasticity takes persistence and develops over time.

Further research in measuring the efficacy of all the treatment techniques mentioned above and the importance of a concurrent multi-specialty approach to PGAD still needs to be done. My team and I at EMH Physical Therapy will continue to help patients heal from PGAD.

References

1 Goldstein I. Persistent genital arousal disorder- update on the monster sexual dysfunction. J Sex Med 2013;10:2357-2358

2 Jackowich R, Pink L,Gordon A, Pukall  C. Persistent Genital Arousal Disorder: A Review of Its Conceptualizations, Potential Origins, Impact and Treatment. Sex Med Rev 2016;1-14

3 Leiblum SR, Brown C, Wan J, et al. Persistent sexual arousal  syndrome: a descriptive study. J Sex Med 2005; 2:331-337

4 Butler D,Moseley L, Explain Pain, Noigroup Publications Adelaide, Australia 2013

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PelviCorFit™ by EMH Physical Therapy Grand Opening

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Have you been working out for years, but neglecting a crucial muscle group??

At EMH Physical Therapy we recently launched our brand new PelviCoreFit™ program designed to whip your pelvic floor muscles into shape. Proper firing of pelvic floor muscles is not only essential for pelvic health but is also a key factor in overall core strength and fitness.

Visualize this:

screen-shot-2016-09-20-at-2-03-35-pm

The pelvic floor muscles form a sling that transmit forces from the ground up and from your head down. If pelvic floor muscles are weak and unaccustomed to firing during exercise, you could be promoting a faulty movement pattern in the chain. Neglecting the Pelvic floor muscles can potentially lead to more serious conditions such as chronic hip, back or pelvic pain, urinary or fecal incontinence, GI and bowel disorders, and erectile or sexual dysfunction. At EMH Physical Therapy we will help you identify and strengthen the pelvic muscles during your general workouts to help prevent future dysfunction!

Additionally, did you know that the pelvic floor muscles play a fundamental role in breathing through connections to the diaphragm?  Think about doing cardio, executing a heavy lift, or performing a Vinyasa flow with a sub optimal breathing pattern. Strengthening the pelvic floor muscles can improve breathing which will help to optimize your workout efficiency.

Come try out our discounted  PelviCoreFit™ program, learn about proper activation of the pelvic floor muscles and bring your workouts to the next level!

We offer 2 options:

“PelviCorFit™ #1” – One fifty minute session with a DPT + Fitness Guru that includes 15 minute pelvic floor/core education followed by a 30 minute PelviCorFit™ workout, then Q&A. Regular price is $200. New Client price is $50

“PelviCorFit™ Pack” – Three (3) fifty minute sessions with your DPT + Fitness Guru. The first session is similar to the description above. The 2 follow up sessions include 45 minute PelviCorFit™ workouts plus instruction on how to implement pelvic floor awareness into your fitness program. Regular price is $500 for 3 sessions. New Client price is $130

To register call 212-288-2242

or

email info@emhphysicaltherapy.com

For more information click here

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“Cupping”: not just for Olympians

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Were you watching the Olympics this summer wondering about those red circles on Michael Phelps’ shoulders? Those marks, called “sha,” are from an ancient Chinese healing technique known as “cupping.

Cupping has been around for over 5,000 years. It’s practitioners stated it released toxins and helped correct imbalances in the flow of energy.

There were two cupping types: dry and wet. Dry cupping is performed when a glass bulb with a smooth rounded lip is suctioned onto the skin via heat. Either a cotton ball is lit on fire and used to generate heat inside the cup, or alcohol is rubbed around the rim and lit on fire before being placed on the skin.

The heat inside the bulb generates a vacuum like effect, producing a negative pressure on the connective tissue or fascia under the skin pulling the skin upwards (1).

The resulting  “sha” are painless broken skin blood vessels which heal in 3-7 days.

Wet cupping was administered in the same way, except the skin is slit prior to application to allow blood to escape (2).

This method is rarely used today.

Myofascial Decompression – cupping in the 21st century

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The modern application of cupping by physical therapists is known as “myofascial decompression.”

The purpose of myofascial decompression is to:
  • reduce adhesions, scar tissue of skin and connective tissues
  • restore normal mobility
  • improve efficiency of movement.

Instead of glass bulbs, hard plastic cups are used and instead of heat generating a vacuum, a hand pump suctions the skin. This allows for a more precise application of pressure.

The application of cupping is done with the “cup” device left in place for 5 – 10 minutes or slowly moved back and forth over the restricted area.

How can we – non super-human species – benefit?

While more studies are needed the literature thus far shows some positive effects from myofascial decompression (3), including decreased neck (4) and low back pain (5).

Empirically, we at EMH Physical Therapy observe that the cupping technique combined with functional movements reduces pain and releases tight tissues quicker for patients with painful cesarean scars, plantar fasciitis, scoliosis and other conditions.

Keep in mind that cupping is an adjunct treatment, used alongside other types of manual therapy, therapeutic exercise and neuromuscular re-education at the discretion of your physical therapist.

References

1. Kravetz, R.E., 2004. Cupping glass. The American Journal of Gastroenterology 99, 1418.
2. Xue, C.C., O’Brien, K.A., 2003. Modalities of Chinese medicine. In: Leung, P.-C., Xue, C.C., Cheng, Y.-C. (Eds.), A Comprehensive Guide to Chinese Medicine. World Scientific, Singapore, pp. 19–46.
3. Cao H, Han M, Li X, Dong S, Shang Y, Wang Q, et al. Clinical research evidence of cupping therapy in China: a systematic literature review. BMC Complementary & Alternative Medicine 2010;10:70.
4. R. Lauche, H. Cramer, K. -E. Choi et al., “The influence of a series of five dry cupping treatments on pain and mechanical thresholds in patients with chronic non-specific neck pain—a randomised controlled pilot study,” BMC Complementary and Alternative Medicine, vol. 11, article 63, 2011.
5. Y. D. Kwon and H. J. Cho, “Systematic review of cupping including bloodletting therapy for musculoskeletal diseases in Korea,” Korean Journal of Oriental Physiology & Pathology, vol. 21, pp. 789–793, 2007.

 

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