Follow this link to listen to Evelyn’s episode of the Healing Pain Podcast: listen to podcast here
1317 THIRD AVENUE (at 76th St.)
Follow this link to listen to Evelyn’s episode of the Healing Pain Podcast: listen to podcast here
OBGYN’s hear this complaint frequently and of course, will examine your reproductive organs. However, most one sided lower abdominal pain is not due to problems of the either ovary, but mainly due to muscle tension that crosses the same region where the ovaries are located.
It could be a hip or back muscle.
This image shows your hip flexor, called the iliopsoas muscle. The x’s show where trigger points of this muscle are typically located. The red dots show the areas where people complain of pain
This image shows a back muscle called the quadratus lumborum or QL for short.
Both of these muscles can refer pain into the lower abdomen as shown in the shaded red dotted areas. This can commonly be interpreted as ovarian pain.
How to self-treat:
Hip flexor stretch:
Begin in a half kneeling position with your front left knee bent at a 90 degree angle. Next, squeeze the glutes and tuck in your tailbone, while gently lunging forward to feel a stretch in your right hip flexor. Switch sides. Do 2x 30 second holds, twice a day.
Quadratus Lumborum stretch:
Straddle a chair. Side bend to the left side and imagine you are trying to lift your right ribcage up and drop your right hip downwards, to feels a stretch on right side of the body. Switch sides. Complete 2 x 30 second holds, twice a day.
If pain persists or gets worse, see a women’s health physical therapist.
Like many of you, I spent an April 15 Saturday morning watching April the Giraffe give birth to a healthy boy calf. I think he was something like 6 feet tall and 150lbs. While watching the live stream I couldn’t help noticing all the people comment: “Why is there no one with her?” “Where’s the Veterinarian?” Of course others jumped in saying “She’s a wild animal and there are no doctor’s in the wild!”
It struck me how natural birth is, but how controlled humans have made the process, especially in hospitals.
In February 2017, the ACOG (American College of Obstetricians and Gynecologists) released a paper entitled “Approaches to Limit Intervention During Labor and Birth”. In this document, OBGYN’s are reminded that “Labor management may be individualized” and include “such techniques as non-pharmacological pain relief”
The paper also advocated for delayed admission when both the mom-to-be and baby are stable in status. Once admitted, OBGYN’s are reminded to employ: “education and support, oral hydration, positons of comfort…massage, or water immersion”. This new view point is very empowering!
COMFORTABLE BIRTHING POSITIONS
So let’s talk “positions of comfort”. Upright position on hands and knees or deep squat can be beneficial because gravity can assist with pushing, uterine contractions will be stronger, and there is less compression on the mother’s aorta (increasing blood supply to the baby). X –ray evidence even shows that the pelvic outlet is larger in upright position meaning more space to get the baby out. (Gupta et al. 2012).
There’s also lots of buzz about water births nowadays so what’s the deal? ACOG has conceded that water immersion during the first stage of labor can shorten labor and reduce need of pain medication. They do however recommend that birth “occur on land” vs. water, but women are allowed to give birth in water if they are informed of the risks. The American College of Nurse Midwives notes that there is a “large and growing body of research that supports water birth as a reasonable choice for healthy women experiencing normal labor as well as birth.”
Almost 75% of women get epidurals and may be limited in their ability to stand after the injection. They are still not limited to the traditional birthing position on their back. Several women have recently reported giving birth on their side post epidural and felt more control despite not feeling much control in other positions.
The bottom line of all research seems to be that women should feel empowered to labor and push in whatever position feels right to them at the time. So moms-to-be advocate for yourself and do what feels right!
For more information:
Gupta et al. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2012;2:CD008070.
http://www.acog.org/Patients Patient resource page from the American college of obstetricians and gynecologists
http://www.acnm.org/ official website of the American college of nurse midwives
What is one thing we all have in common? What brings us all together? We all poop! How much do you know about your bowel movements? What does it mean when your stool is a different color, shape, texture? What leads to constipation or diarrhea? How can we have a healthy bowel movement and how often should we have a bowel movement?
I am writing this blog in two parts to help you have a better understanding of the mysterious #2, because pooping is an integral part of our daily life and can tell us a lot about our health.
Lets start from the beginning, how food travels from entry to exit:
1. ORAL CAVITY & ESOPHAGUS Digestion begins in the mouth, as saliva helps break down starches. The esophagus is the portal to which the contents travel to our stomach. No digestion occurs here, but “heart burn” can occur when there is backflow from the stomach up into the esophagus through the cardiac orifice seen above.
2. STOMACH Now that the food has made it to the stomach, acids break down proteins. Food spends approximately 2-4 hours here before traveling to the small intestine through the pyloric sphincter
3. SMALL INTESTINE In the small intestine, over the course of 4-6 hours, our body continues to break down starches and proteins and tackle a new molecular compound called carbohydrates. Juices secreted from the pancreas and liver help break down starches, fats and proteins.
4. LARGE INTESTINE What’s next? You guessed it, the large intestine, which absorbs 1000- 1500 mL per day, leaving 100-150 mL along as hardened feces to the rectum. Digestive contents spend the longest time here, approximately 24-72 hours. It travels through the ileocecal valve up the right side of the abdomen through the ascending colon, across the transverse colon and down the left side into the descending colon.
5. RECTUM Using strong peristaltic waves, our bodies push stool into the rectum. That’s when we have our first urge to defecate. We have stretch receptors which tell our bodies to relax an involuntary muscle called the internal anal sphincter while we close our external anal sphincter (EAS) to keep feces from coming out until we are ready.When we sit on the toilet, our EAS relaxes along with our puborectalis muscle. This relaxation combined with a gentle increase in intra-abdominal pressure pushes fecal matter out. Placing our knees higher than our hips, via a squatty potty or stool, helps relax the puborectalis muscle even more, allowing from easier elimination as shown below. The external anal sphincter (EAS) changes its tone based on what it senses. If it senses liquid, such as diarrhea, the EAS increases its tone. If it senses, gas, it allows that to be selectively released. If it senses solid stool, our body can override our urge to defecate until we are at a toilet, so we can hold it in when necessary.
When we sit on the toilet, our EAS relaxes along with our puborectalis muscle which surrounds the rectum tightly at rest creating the “anorectal angle”. When the puborectalis relaxes it allows the rectum to have easier passage. This combined with a gentle increase in intra-abdominal pressure pushes fecal matter out. Placing our knees higher than our hips, via a squatty potty or stool, helps relax the puborectalis muscle even more, allowing easier elimination.
GOOD DEFECATION TECHNIQUE
A healthy bowel movement (BM) should not involve straining or pushing. The action of defecation is a part of the parasympathetic nervous system, which helps the body soften and relax. The first step to a good BM is making sure you are in a comfortable, safe place. Have you ever noticed it’s easier “to go” at home versus in an unfamiliar place?
If we lose our ability to properly relax with a bowel movement we may start to strain with defecation, which over time is injurious to our body.
Here are some quick, easy tips for a healthy BM.
If you feel like you are unable to perform an easy BM even with taking fiber, drinking water, or are spending too much time in the bathroom, straining often, or experience frequent constipation and bloating, consult a pelvic floor physical therapist. We’ll assess if restricted pelvic floor, abdominal muscles are hindering your function. We perform gentle manual therapies to restricted muscles/fascia of both internal and external pelvic areas, visceral mobilization to help the organs move optimally and “do their thing”, use biofeedback to retrain the pelvic floor muscles so they don’t contract when they are supposed to relax, teach breathing techniques and other home exercises.
Stay Tuned for “Pooping 101 – Part 2”!
With women’s rights being a hot button issue recently, it got me thinking: how many women really know and explore the parts that make them a woman? (Disclaimer: I’m not forgetting those in the LGBQT community who have different anatomy and identify as a woman. You do you, girl!)
So ladies…What’s down there? Grab a mirror and play along.
Externally you will see three openings:
The urethral and vaginal openings are housed in the first skin layer, called labia majora (with pubic hair) and just underneath, the labia minora (hairless layer) that protect these openings.
Also protected by the labia just above the urethral opening is a small sensitive, nerve filled structure with two hidden “legs” that surrounds either side of the vaginal opening called the Clitoris. The head of the clitoris is very sensitive and serves in sexual function for arousal when stimulated.
The clitoris is considered the most erogenous zone on the female body. Stimulation of the more than 8,000 nerve endings here can lead to the rhythmic, quick flick pelvic floor contractions that we interpret as pleasurable. Yes, I’m talking about orgasm!
Now that you are acquainted with the anatomy use a mirror to check your own lady parts. Then do some of the following movements:
Let’s take a look at the Pelvic Floor muscles.
In this image, the external skin is removed and you are now looking at the underlying muscles. These muscles are important stabilizers of the pelvis and serve many functions: bowel and bladder control, core stabilizers, involved with sexual function and support of bladder and other visceral organs.
You can check your pelvic muscles by inserting one clean finger into the vaginal opening to the level between 1st and 2nd knuckle. Assess your strength by squeezing the inserted finger (doing a kegel) by contracting your pelvic floor muscles. You should feel a ring of tension around your finger and feel a gentle pull upwards toward your head.
Assess for tension in the muscles by stretching directly to the right, left, down and diagonally up/right, diagonally up/left, down/right, down/left. No need for direct upward pressure as this is where your urethra is located. A healthy pelvic floor should feel no pain, only pressure or stretch.
I hope this helped you to feel more comfortable and aware of your female anatomy. In a study published in the International Journal of Sexual Health, scientists found that women who had a positive view of their genitals were more comfortable in their skin, more apt to orgasm, and more likely to experiment in bed. So go ahead and get to know your lady parts.
A healthy female pelvic floor has
If you experience any symptoms, consult an experienced pelvic floor physical therapist for evaluation and guidance.
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.
A unique program designed for a small group of women (15) who suffer with PGAD and chronic vulvar pain. From the comfort of your home, you’ll have the opportunity to connect with each other in a safe environment, using private encrypted meeting platform (Zoom.us) while learning evidence-based therapeutic solutions for both your physical and emotional healing process. Each class is 2 hours held every 2 weeks for a total of eight(8) classes over a four month time period.
Health care experts from the fields of physical therapy and social work will be teaching this one of a kind program: Evelyn Hecht, PT, ATC and Eva Margot Kant LCSW-R . Their combined 35 years of experience will help you learn effective self-help tools for your mind and body while connecting and supporting each other on your journey to health.
Evelyn Hecht, PT, ATC owner of EMH Physical Therapy has been treating women with pelvic pain and sexual dysfunction for 20 years. She and her team of Doctor of Physical Therapists will be teaching self-care techniques and exercises that can be easily implemented into your healing routine. The DPT’s will will answer questions about physical symptoms and exercises to the best of their virtual ability.
Physical therapy topics will include
Eva Margot Kant, LCSW-R is a compassionate sex/psychotherapist in private practice with 15 years counseling patients with chronic and sexual pain. She helps clients navigate life’s transitions, address fears and questions about chronic illness/pain. As a group therapy facilitator, she has worked with organizations including the American Cancer Society and National Multiple Sclerosis Society. Eva teaches courses on sexuality at Columbia University Graduate School of Social Work.
Talk therapy topics will include:
Additional Experts may be incorporated into the separate groups to share information and resources.
Length of Online Group Class: 7PM to 9PM Eastern Standard Time
Start Date: Thursday January 19, 2017
2017 Class schedule: 1/19, 2/2, 2/16, 3/2, 3/16, 3/30, 4/13, 4/27
Number of Classes: Eight (8) classes over a 4 month period January thru April 2017
Cost: Each two hour class is $40.00 per person. You must register and pre pay for all 8 classes, at a cost of $320 per person one week prior to the first class. The price of attending one personal session with a counselor or physical therapist can range between $80 to $250 per hour, depending on where you live. This program offers you access to speak to and learn from a pelvic physical therapy professional with experience treating PGAD, vulvodynia and a clinical social worker seasoned in treating sexual issues and chronic pain for a total of 16 hours at a reduced rate of $320.
While Online Educational & Empowerment Course for Women with PGAD &/or Vulvodynia does not substitute for individualized therapy, the evidence-based strategies, techniques and support you will gain without leaving the comfort of your home is a one of kind opportunity.
Online Educational & Empowerment Course for Women with PGAD &/or Vulvodynia welcomes a maximum of 15 attendees.
To Register: contact Cindy or Star at (212) 288-2242. Payment is accepted by check, no credit cards. Write check to “Evelyn Hecht, PT” in the amount of $320 and mail to following address:
Evelyn Hecht, PT,1317 Third Avenue,9th Floor, New York, NY 10021
Payment in full is due by January 12, 2017.
Space is limited, so please Sign Up Today
This course will only be conducted with a registration of 15 women. If the course is cancelled, all monies will be refunded.
For additional questions, please email: email@example.com or call (212) 288-2242
Navigating the pregnancy literature on proper posture, exercise and sleeping alignment can be overwhelming and the guidelines presented are often not a “one size fits all”. Afterall, everyone’s pregnancy is unique. Below you will find some quick and easy tips that I utilized and found helpful throughout my pregnancy that kept me fit, aligned and pain free throughout my work day as a physical therapist at EMH.
I am fascinated by how the body and mind work together to heal from pain and injury. To learn more about healing and how physical therapists can help patients be committed to their healing process, I interviewed my good friend Rose Caiola, founder of Rewire Me, a company with a wealth of resources, writings and teachers in fields of physical, spiritual and emotional health, all thoroughly researched and curated by Rose and her team at Rewire Me.
Here are some of the gems I gleaned from our interview:
Evelyn: Why did you start Rewire Me?
Rose: Rewire Me evolved from life lessons I’ve learned from age 13 onward, meeting various teachers and mentors who helped me on my life’s healing journey. Connecting with these teachers proved more beneficial than trying to “fix things on my own.”
Many people feel alone when dealing with life’s challenges and don’t know how to ask for help or even where to look for guidance. One method or teacher may not resonate for every person, so I thought “Wouldn’t it be wonderful to have a site with a range of authentic experts, teachers, and healers?” People can seek and access these teachers’ wisdom through writings, books and classes to help them on their healing journey”.
Rewire Me’s website includes a range of experts on topics such as relationships, parenting, physical health, spiritual growth, dealing with illness and loss – incorporating all aspects of life.
E: How can people with physical pain start their healing process?
R: The first step is to acknowledge that there is something wrong. Many people don’t want to acknowledge that they are feeling pain, so they bury it or pretend it is not there. Once you acknowledge there is a problem, then you can reach out to a friend, call a medical professional, research on professional medical websites like WebMD and go on to Rewire Me to find teachers who may inspire them.
People may reject acknowledging pain or injury due to fear of the unknown. Others may feel that asking for help is a sign of weakness, especially if they are used to being in charge or control. Pain can make a person feel out of control. In essence what this really translates into is, ‘I don’t feel worthy enough to have somebody help me. I don’t love myself enough to get the help I need.’
E: How can one rewire fear-based thinking that stumps taking positive action?
R: Set a little time in the morning before you have to start your day. Sit up, feet on the floor to ground yourself and spend 5 minutes focusing on your breath, feeling and focusing your attention to the breath moving in and out, at whatever pace. This centers you to the present.
After the 5 minutes of quiet breath, ask “What do I want to happen today so I can achieve good health, or be successful as a parent or attain a work goal”
Envision your hero, or person of history who inspires you, for example, Amelia Earhart. What would it feel to be like her? Envision and embody the emotion of Amelia‘s courage, risk taking, forward thinking. How do you think she felt when she was flying solo in the starry night sky?
E: How can we help patients stay motivated and the course of treatment; to understand that their home program as physical therapy is not a “quick fix?”
R: Well, one I think is to have faith in the healing process. So that might become their mantra. ‘Today I’m going to do what I can to heal myself.’ ‘Today I’m going to take that first step.’ ‘Today I’m going to do my physical therapy exercises.’ Not worrying about tomorrow, not thinking about anything else, but having faith that they can overcome. When and if they come up to a crossroad or a flare up, don’t give up. Tell yourself “It’s okay.” Acknowledge that it’s painful and that you’ve hit a rock or a wall. Figure out how you can go around the wall instead of letting yourself get stuck. Avoid the “Oh poor me.’ ‘This always happens to me.’ ‘This is my life.’ If you keep repeating that story, you’re never going to get anywhere. Replace them with positive statements. The brain and body are listening!
The second thing to do is Practice. Practice your home exercises, self care techniques, say your positive affirmations out loud. With practice different parts of our brain light up and those neural networks become bonded over time, overriding faulty pain patterns. If you play a sport you have to practice to compete well. But, if you don’t practice, you won’t play as well. My kids are on sports teams and if they don’t practice, they get benched. They’ll say: “Why did the coach do that? I’m so angry…the coach hasn’t put me in play for the last 3 games!” Well, if you don’t practice, why would that coach put you in the game? It’s the same with committing and doing your home program, practice allows your body to change for the better.
Third, Schedule the 2-3 times a day in your calendar where you know you can do your physical therapy exercises. They don’t take long, right?
E: No. People wouldn’t do them otherwise, so we keep them short and manageable.
R: That’s great, so patients start to feel better, get stronger and over time they’ll see the many benefits of committing to their treatment.
E: Yes! You’ve used the term “healing journey.” What does that means to you?
R: A healing journey means learning to love myself. Learning to forgive myself, including what happened in my past. Incorporating growth and love from others and building this Rewire Me community is all about healing. Healing your heart. Healing your physical, emotional and spiritual well-being
Check out Rewireme.com to be inspired and continue on your healing journey!
(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.
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!