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Why Use Meditation in Physical Therapy

Meditation

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.

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Dr. Echenberg to Join EMH in October 2015

In October of 2015, EMH Physical Therapy and The Echenberg Institute for Pelvic and Sexual Pain will begin a collaborative initiative in New York City for comprehensive assessment and treatment of men and women with chronic pelvic pain.

We are pleased to announce that in October 2015, Robert J. Echenberg, MD, FACOG, world renowned for his expertise in the treatment of chronic pelvic, genital and sexual pain, will be working with Evelyn Hecht PT ATC of EMH Physical Therapy, the premier pelvic specialty practice located on the Upper East Side of New York City.

Together, we will offer our expert services in one place where men and women suffering with chronic pelvic pain/pelvic floor dysfunction can be diagnosed, educated, receive a broad range of treatments and find support.

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PelvicTrack

An App for Pelvic Floor Dysfunction

The PelvicTrack app helps you gain control over your pelvic pain or pelvic floor dysfunction.

  • Tracks symptoms and pain levels
  • Records data on bladder and bowel activity
  • Provides exercises that a pelvic physical therapist may prescribe for patients
  • Includes daily reminders for pelvic awareness
  • Shows reports of improvements gained over time

PelvicTrack Set Reminder TabPelvicTrack Exercises TabPelvicTrack Reports Tab

PelvicTrack Reports - Pain TabPelvicTrack Maps TabPelvicTrack Symptom Tracking Tab

Take charge of your pelvic floor dysfunction treatment.

The PelvicTrack app was written by a Physical Therapist who has specialized in the treatment of pelvic floor dysfunction for more than 18 years, and is ideal for anyone experiencing:

  • pelvic pain
  • abdominal pain
  • constipation
  • urinary frequency/urgency
  • sexual dysfunction

You can use it as a way to easily look up common pelvic exercises, as a personal symptom log, as a personal assistant reminding you to do your home exercises, or even to find a physical therapist in your area on our “Maps” tab.  With the “Reports” tab, you can rate your symptoms each month to see progress over time.

Always consult with your health care provider before starting an exercise program.

 

Stay Connected to your Pelvic PT

The best way to use the app is when receiving care by a pelvic physical therapist. Your therapist can recommend exercises, adapting treatment as they measure and monitor your progress. When you use the app on your phone, your therapist can help you find and save home exercises in your favorites eliminating the need for paper handouts that can get lost, ripped, or forgotten.  To keep your therapist up to date with your progress, you can take a screen shot of your reports to email or show him or her during your next visit.

Male Pelvic Pain: 3 Steps for Relief

th-1Do you have any of the following symptoms?

  • Bladder pain
  • Feeling of pressure or heaviness, deep within the groin area
  • Burning or numbness inside the shaft or at the tip of the penis
  • Painful intercourse
  • Erectile dysfunction
  • Pelvic floor muscle tenderness
  • Tail bone pain with sitting
  • Urinary urgency/frequency
  • Urinary incontinence
  • Constipation
  • Testicular pain or heaviness

If you answered “Yes” you may have pelvic floor dysfunction or pelvic pain

How to assess:

1.) Are you a “butt clencher”?

What are your gluteal muscles and the muscles and surround your rectum doing right now? Are they tense? Chronic holding in these muscles could lead to many of the above symptoms. Relax the tension now.

Quick fix: Allow the gluteal and rectal region to soften, lower, and relax. Focus on imagery that is relaxing to you, such as a beach on a beautiful day or laying in a hammock on a breezy spring day.

 2.) Are you a “slouchy sitter”?

Are you sitting with all your weight on the tail bone in a posterior pelvic tilted position?

Quick fix: Have a co-worker take a picture of you at your work desk. This will help you adjust your posture. First, have your feet firmly planted on the floor. Sit up straight on your “Sit bones” you should be able to feel them if you sit on your hands. These bones are made to bear you body weight, not the tiny tail bone that is smaller than your pinky toe bone. In order to maintain this upright position, you may need a small towel roll or lumbar roll placed in the small of your low back for support.

3.) Are you a “chest breather”?

Take a nice deep inhale. Did your chest, neck, and shoulders do most of the work to inhale? If so, you are not breathing as effectively as you could.

 Quick Fix: place your hands on your belly, and take a deep inhale focusing on expanding the rib cage and belly as the air comes into your lungs. Exhale, letting the belly relax back to your resting position. Take 10 of these deep belly breaths once an hour.

Did you find the above self-assessment helpful?

You may be a candidate for a thorough assessment by a pelvic floor physical therapist.  Don’t be afraid to speak up! Tell your MD or Physical therapist what you are feeling in order to get the help you need, and seek an evaluation from a physical therapist trained in pelvic floor PT.  Healing time will vary, but you do NOT need to live with pelvic floor pain!  Your healing journey requires a team approach; your enthusiasm and effort combined with physical therapists, nutritionists, urologists, gastro-intestinal MD’s, acupuncturists, and massage therapists. It’s time to take your health into your own hands.

 


 

References:

  1. Anderson, R. U., Wise, D., Sawyer, T., & Chan, C. (2005). Adult Urology: Infection/Inflammation: INTEGRATION OF MYOFASCIAL TRIGGER POINT RELEASE AND PARADOXICAL RELAXATION TRAINING TREATMENT OF CHRONIC PELVIC PAIN IN MEN. [Article]. The Journal of Urology, 174, 155-160. doi: 10.1097/01.ju.0000161609.31185.d5
  1. Bø, K., Berghmans, B., Mørkved, S., & Kampen Van, M. (2007). Evidence-based physical physical therapy for the pelvic floor. Bridging science and clinical practice Evidence-based physical physical therapy for the pelvic floor. Bridging science and clinical practice B2 – Evidence-based physical physical therapy for the pelvic floor. Bridging science and clinical practice. New York: Elsevier Butterworth Heinemann
  1. Dorey, G. (2006). Pelvic Dysfunction in Men: Diagnosis and Treatment of Male Incontinence and Erectile Dysfunction Pelvic Dysfunction in Men: Diagnosis and Treatment of Male Incontinence and Erectile Dysfunction B2 – Pelvic Dysfunction in Men: Diagnosis and Treatment of Male Incontinence and Erectile Dysfunction. Chichester: John Wiley & Sons Ltd.
  1. Tanner, Holly. Introduction to Female and Male Pelvic Pain. com continuing education.

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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

Exercise

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.

Diastasis Recti Abdominis (DRA) or “Split Seams” can be treated by Pelvic Physical Therapy

Diastasis Recti Abdominis (DRA) can occur in up to 66% of pregnant women due to hormones that allow ligaments and joints to relax, the increasing baby size in utero, improper weight lifting (ie heavy food bags, other children, furniture etc), a history of prior C-section or  abdominal surgery and repetitive poor mechanics during daily activities and lack of regular exercise.

Men can also develop DRA due to faulty weight lifting mechanics, obesity and chronic medical conditions that result in frequent coughing such as bronchitis.

What is a DRA?

DRA is defined as the separation and thinning of the rectus abdominus muscles (see diagram in green) and stretching of the linea alba (see diagram in blue).  The linea alba runs from the xiphoid process (base of sternum)  to the symphysis pubis (center of pelvic bone).  Both the rectus abdominus muscle and linea alba are the main support for the front of the abdomen, keeping the visceral organs in place and functioning well.  They are also maintain pelvis stability during walking, lifting, bending and squatting.

What are the symptoms of DRA?

Symptoms may include:

Noticeable small or large bulge in the center abdomen

Sharp or burning abdominal pain during bending, lifting, standing and walking

Lower back pain

Feeling like the intestines or stomach may fall out

Poor posture

Longer term problems of prolonged DRA may include Stress Urinary Incontinence, Fecal Incontinence and Pelvic Organ Prolapse.

 

How To Measure for a DRA?

The best way to measure is a finger width measurement.  Lie on your back, knees bent,head resting on floor/pillow. Place tips of 4 fingers across the body at naval or just above/below the naval per your comfort.  Now raise your head and shoulders slightly upward. If your fingers descend inbetween the  parallel rectus abdominus muscles on either side of your naval, measure how many fingers move downward.  If there is a true split of the linea alba, your finger will fall into a space that feels squishy (your intestines live here!).  A positive DRA is one where there more than 2 fingertips (1 inch or 2.5cm width)  that lower.  We have measured women with 3 to 4 inches ( 8cm) wide and have helped them narrow back to 2.5cm width

 

What to Do if you have a DRA?

Best to first consult a pelvic physical therapist for a tailored postural, stabilization and home exercise program targeting the Tranversus Abdominus (deepest and lowest muscle of our abdomen), the pelvic floor muscles and the multifidi muscles (lower back stabilizers).

Here are some tips that you can do immediately:

Avoid positions that may further separate the recti muscles, like doing sit ups, crunches and quick trunk rotation movements.  Avoid being on “all fours”  or on hands and knees for too long during exercise classes.  Assuming the yoga, “cow position” where your belly drops down as your head and hips arch upwards,  puts too much pressure on the already stretched linea alba.  Plus, the yoga position of  “Up dog” and extensive backward bends are not recommended.

Stand and sit symmetrically in good posture  (don’t stand on one leg or sit with crossed legs leaning on one hip for too long)

When you are standing, gently unlock your knees and pull  your stomach inward while breathing normally to give abdominal  support and prevent “hanging out” on your ligaments

When you sneeze, cough or laugh you you can self bracing of your stomach with your hands pushing each side of the rectus abdominal muscles towards the midline, or hold a pillow against your stomach for bracing

Wear a pelvic and/or  abdominal support product to help support the growing baby in uteruo , maintain erect trunk posture and decrease pain until your muscles are stronger by doing core exercises.

By keeping your core toned during pregnancy and taking the steps to prevent further widening of your recti muscles, you can prevent extensive DRA.

 

 

Release Pelvic Pain in 2-3 months with Pelvic Floor Physical Therapy

Many evidence based studies prove that pelvic floor physical therapy is an effective treatment approach for men and women suffering from pelvic pain caused by tight muscles and restricted tissues.  The pelvic floor muscles, namely the levator ani, coccygeus and obturator internus can develop adhesions, tension or trigger points which restrict movement and cause pain.  Trigger points are palpable spasms/knots within muscle tissue and can occur in pelvic floor muscles.  Trigger points can lead to adhesions of fascia/connective tissue of the abdomen, groin, pelvic floor and even restrict the viscera (colon, uterus, bladder, prostate gland) within the pelvic bowl.

The pudendal nerves and its branches, traveling from the sacrum (back of the pelvis) and running all through the pelvic floor region innervates the vaginal/penile and rectal areas. The nerves can become squeezed as it travels through tight muscles and fascia, which then decreases optimum pelvic floor function and increases pain.

The pelvic floor muscles are located INSIDE our bodies, in women the muscles are approximately 1-2 inches up from the vaginal/rectal region and in men, the muscles are approximately 1-2 inches up from the base of the penis/rectal region.

The pelvic floor muscles are key for four functions of the body:

1) lower back/core stabilization; 2)  normal urinary function; 3) good bowel function; 4) satisfying sexual function.

As a core stabilizer, the pelvic floor works with 3 other core muscles, the Transversus Abdominus (deepest stomach muscle), Multifidus- (deep low back extensor muscle), and deep fibers of the Iliopsoas (hip flexor muscle). These 4 muscles work together to keep our core strong, flexible and prevents lower back pain. If one of the 4 core stabilizer muscles becomes weak or injured, then the other 3 muscles have to work harder to compensate. Over time this puts great strain on the whole core, which leads to back pain/stiffness/weakness.

The pelvic floor muscles are directly involved with three bodily functions, urinary, bowel and sexual.

For functional urination, the pelvic floor muscles surround the urethral opening and should relax when you are voiding and maintain closure or tension when you are not voiding.   If the muscles are in spasm, urinary symptoms such as leaking,  or feeling a strong urge to void, or having to go to the bathroom multiple times a day (called urinary frequency) and/or being awoken at night to void more than once (called nocturia), can occur.   Women using public restrooms should not “hover” over the toilet, as this sustained half squat creates tension in the pelvis and does not allow full relaxation of the sphincters around the urethra to allow full urination. Best to use the protective toilet seat covers and sit comfortably.

For normal bowel movements, the pelvic floor muscles should be able to open and widen to allow the full passage of stool. When not having a BM, the pelvic floor maintains tension at the rectal opening to prevent leakage.  If the pelvic floor is weak, leakage can occur.  If the pelvic floor is tight, constipation resulting in sitting too long at the toilet, straining to defecate can occur. Toileting should take no longer than 5 minutes following the urge to void.  Even though you may not feel completely empty, it’s better to stand and leave the bathroom  versus continue to sit and strain. Constant straining can result in hemorrhoids and/or the development of a rectocele, which further impedes good function.

For satisfying sexual function, the toned and flexible pelvic floor allows for more intense orgasms in men and women.  A fully relaxed pelvic floor helps women experience pain free intercourse with their male partners.  Many patients who are experiencing sexual pain may experience difficulty with partner relationships or even avoid them due feeling of shame or inadequacy.

Pelvic pain due to restricted muscles can be released and return to normal function, no matter how long a person has been experiencing symptoms.

Physical therapists trained and mentored in pelvic floor work can:

  • apply targeted manual therapies to rid muscles of trigger points
  • utilize biofeedback therapy to help patients learn how to either downtrain (relax) their pelvic floor or to uptrain (strengthen) the pelvic floor
  • perform visceral mobilization to improve the mobility of organs lying within the pelvic bowl
  • mobilize and teach a patient self-connective tissue (skin rolling) techniques to abolish tight skin and fascia of the inner thighs and abdomen
  • teach patients gentle stretching techniques with foam rollers, tennis balls, knobbles, Theracane,  S –wands and dilators
  • educate in exercises for a strong core
  • teach diaphragmatic breathing and visualization to help lower tension of the pelvis and to increase oxygenation to the body and decreased stress
  • guidance in cardiovascular exercise to pump more oxygen and nutrients to the tissues
  • teach proper bladder and bowel techniques and habits

Most people start to feel better after 2 months of consistent, twice a week therapy which incorporates many of the above techniques. Some reach goals sooner; others may take up to 3 months.  By attending regular pelvic floor physical therapy and performing all the home exercises, faulty pattern are reversed and many people are pain free within 2-3 months.