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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:

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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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Six Ways to Help Manage Constipation

Constipation[Photo credit: PracticalCures.com]

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

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

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

 

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

 

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

 1.) Diet modifications

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

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

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

 2.) Anxiety and stress management

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

3.) Daily aerobic exercise

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

 4.) Toilet posture/positioning

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

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

 5.) Drink water, plenty of it

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

 6.) Sleep!

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

Pelvic Physical Therapy helps Children Overcome Bedwetting and “Accidents”

April Any parent will tell you, the potty training years are stressful! There are millions of resources that tell you different information, and on top of that, work and school schedules make it almost impossible to stick to a solid routine. Every day on the streets of New York City I see frantic parents running to the nearest restroom dragging their child who is doing “the pee dance” because 10 minutes ago at home they “didn’t have to go.” At some point, the chaos ends, and children have a better awareness of their needs, but what about those children who don’t?

Almost all children experience wetting or soiling accidents for various reasons during these training years. By age 5, a child’s neuromuscular system is developed to have bowel and bladder control; however 10% of children from age 5 to 7 continue to have regular day and night time accidents. This trend continues with 3% of children age 12, and 1% of children age 18 .

Persistent wetting has emotional and psychological effects on both children and their parents. Parents report feeling frustrated, stressed, bothered, sad, and helpless when their children are not as physically capable as their peers to remain continent. Children can reports feelings of anxiety, embarrassment, and generally become less sociable . So, why does persistent wetting occur?

Children experiencing persistent wetting should be evaluated by a doctor for the following causes:
• A “Twitchy” or “overactive” bladder that signals frequent urgency sensations and premature voiding
• A weak outlet system that is unable to hold back urine during laughing, coughing, or straining
• Urinary tract infection
• Chronic constipation
• Structural abnormalities within the urinary system
• Neurological issues effecting the lower half of the body
• Psychological or emotional trauma

April2      Regardless of the cause, a root issue seen with most of the conditions above is “dysfunctional voiding” from weak, over active, or non-coordinated pelvic floor muscles. In addition to the immediate psychological effects, dysfunctional pelvic floor muscles can lead to improper development of the urogenital system with connections to chronic pelvic pain in their adolescent and adult life. So what can be done to improve the functioning of these muscles?

Pelvic floor physical therapy is a specialty within physical therapy that focuses on the strength and coordination of this vastly important muscle group. When working with pediatrics, the whole family is considered, and involved as a unit. It is NOT just about kegel exercises! Therapy is focused on creating a better awareness of this area of the body, improving the child’s interpretation of the various sensations experienced at different points in the voiding cycle, and developing the strength and coordination to allow more effective voiding habits. To accomplish this, first, keep a bladder diary to keep track of every time your child uses the bathroom, or has an accident, to find any patterns in their bladder symptoms, such as time of day and frequency. After that, “timed voiding” helps retrain the bladder to void only when in the bathroom by having your child use the bathroom every hour, then slowly increasing the time until it is more optimal.

Rewards and praise are excellent motivation for children to want to use the bathroom and let you know when they have to use it. Avoid negative feedback such as reprimands or “time outs” when an accident does occur, this is very discouraging and does not help improve confidence or self-esteem. Exercise consisting of leg and abdominal stretches help keep your child’s muscles more calm rather than tense, which applies added stress and compression to the bladder. And finally, educating your child about their pelvic muscles is key! Many parents find this topic taboo, or uncomfortable to talk about. This sends a message to children that they should dissociate themselves from feelings or sensations in this area rather than really paying attention and developing that complete mind body awareness. If you find this topic uncomfortable, remember, your pelvic muscles are not solely for sexual function, and that part of the conversation does not need be discussed until your child comes closer to puberty. Educate your child on the fact that they have control over this area of their body, they can squeeze those muscles, release those muscles, and push those muscles downward (this maneuver is referred to as “bearing down” and is done during bowel movements). Most of the time, children feel excited to learn they are in control of something since this is usually a rare occurrence in childhood. The more they are taking notice of these muscles and practicing using them, the stronger they will become. In physical therapy, their strength gains are monitored using biofeedback which uses external surface electrodes to quantify the strength of the muscle contractions.

For strengthening when the muscles have significant weakness, pelvic physical therapists engage the child in play activities that facilitate the use of these muscles. Activities include bouncing on therapy balls, negotiating obstacle courses, creating dances, and other full body physical activity that is fun for the child, all the while incorporating pelvic floor contractions in a safe and supportive environment. Training and educating children is more successful when it is fun and engaging. Parents are also instructed in activities they can perform at home as a family to further increase the child’s engagement, and provide effective parent involvement.

If your child is experiencing any of the symptoms discussed, there is hope. In a matter of 2 to 3 months, muscles can be trained to work at their full potential, and you, and your child can develop the confidence and peace of mind to overcome the struggle of persistent incontinence.

Pregnancy achieved following manual pelvic physical therapy for Mechanical Infertility

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Sumer Samhoury, MSPT

Manual Physical Therapy can help some women with Mechanical Infertility achieve  pregnancy.   To understand what Mechanical Infertility is and how manual pelvic physical therapy helps, let’s first review the steps to becoming pregnant.

Mechanics of pregnancy

To achieve pregnancy, the process of ovulation and fertilization within healthy, mobile, and supported reproductive organs (ovaries, fallopian tube and uterus) without presence of adhesions & scar tissue has to occur. The steps to pregnancy are

 

  • The woman’s body releases an egg from one of her ovaries (ovulation)
  • The egg is grasped by the “fingers” of the fimbria, located at the ends of the fallopian tubes.
  • The egg travels through the open, non blocked fallopian tube toward the uterus (womb)
  • The man’s sperm joins with the egg (fertilization)
  • The fertilized egg attaches to the inside of the uterus (implantation)

Mechanical Infertility

Mechanical Infertility (MI) is defined as the inability to become pregnant due to intra pelvic and abdominal adhesions on/around or within the reproductive organs. MI affects approximately 2.5 million ( 40%) of the 6 million infertile women in the United States who have not conceived after 1 year of unprotected sexual intercourse.

Adhesions around the ovary can prevent the release of the egg (ovum) from the ovary. Adhesions can squeeze the fallopian tube (s)like a used tube of toothpaste, so the egg cannot travel to the uterus to hook up with the sperm.    Adhesions can pull the uterus out of a centered, midline position which makes implantation of the fertilized egg difficult. Adhesions within the uterus could increase uterine spasms which can result in miscarriage.

What are Adhesions?

An adhesion is a sheet or band of scar tissue that binds two parts of tissue or organs together.   Normally, with no scar tissue present, organs are slippery and they glide against each other. Adhesions can look like thin sheets similar to  plastic food wrap or they can be thick fibrous bands,  like ropes.  These bands of scar tissue can wrap around your internal reproductive organs squeezing them too tight or pull the organs out of their normal centered alignment which prevents their  optimal  function during pregnancy.

Cause of Adhesions

Adhesions naturally develop when the body’s healing/repair mechanisms respond to any tissue disturbance, such as surgery, infection, trauma, or radiation.  Our body naturally cleans a damaged area, which is followed up by the laying down of collagen fibers to replace the damaged tissue.  The replaced new collagen is haphazard, fibers get bunched up  and cross-links form. As healing time continues, cross links may grow into microadhesions, then adhesions and may eventually thicken into scars  When a woman has pelvic or abdominal surgery,  such as a C-section or other gynecological surgeries,  the only visible scar is on the outside where the incisions may have been made, but  tissue also heals on the inside,  resulting in internal scarring.

The formation of internal pelvic adhesions is known to accompany any inflammatory process, whether it be internal trauma and bleeding (ruptured ovarian cysts or ruptured appendix), Endometriosis, or sexually transmitted infections such as Chlamydia, Gonorrhea, pelvic inflammatory disease (PID).  Pelvic spasms, bowel obstructions and chronic abdominal/pelvic pain can also lead to adhesions.

The most common cause of adhesions within the uterus is due to previous uterine surgeries such as D&Cs either for abortions, miscarriages, or excessive bleeding. In addition, adhesions may be related to child birth when there are uterine infections or bleeding associated from childbirth, or if a Cesarean Section is performed.

What is Manual Pelvic Physical Therapy?

Manual pelvic physical therapy is a gentle hands on approach, no surgery, no drugs, to improve motion, decrease restriction and improve organ function. Manual therapy techniques for Mechanical Infertility can include:

  1. Myofascial Release to decrease restricted muscles and fascia (the web-like covering that surrounds all organs, muscles and nerves of the body)
  2. Visceral Mobilization to improve organ mobility and function
  3. Pelvic lymphatic drainage to reduce pelvic congestion

Myofascial Release is a safe and effective hands-on technique that applies gentle sustaining pressure to the restricted connective tissue to eliminate pain and restore motion. The slow sustained, gentle pressure allows fascia to elongate.

Visceral mobilization technique is a gentle hands on technique to release tight ligaments and connective tissue which surrounds and supports the internal organs. Just as a therapist would mobilize the shoulder for someone who has lost motion  tight  ligaments that support the organs also need to be treated.

The lymphatic system helps our body detoxify, drain stagnant fluids, regenerate tissues, filter out toxins and maintains a healthy immune system. Pelvic lymph drainage helps to re-circulate body fluids, stimulates the immune system and promotes relaxation and balance in the autonomic nervous system.

Pregnancy Achieved

In 2012, Doctor Mary Ellen Kramp, DPT published her infertility case study in the Journal of American Osteopathic Association demonstrating that 6 out of 10 women diagnosed with mechanical infertility conceived and delivered their healthy babies at full term following  manual pelvic physical therapy. These women were found to have mechanical infertility due to lymphatic congestion, sacral dysfunction and restrictions in uterine mobility and were treated with a group of manual therapies Dr Kramp described as above and  termed  “The Infertility Protocol”.

At EMH Physical Therapy, we received training to treat Mechanical Infertility and can offer this service to women to  help them achieve pregnancy.

 

Pelvic physical therapy is an effective non invasive treatment for Pelvic Organ Prolapse vs “high risk” transvaginal mesh surgery

The FDA recently deemed use of transvaginal mesh surgery to be “high risk” to repair pelvic organ prolapse.  See news link below:

http://www.philly.com/philly/health/womenshealth/HealthDay687309_20140429_FDA_Moves_Female_Incontinence_Device_to__High_Risk__Status.html

Pelvic physical therapy is a more effective and non invasive option.

In a 2014 study of 800 women with pelvic floor dysfunction (which includes pelvic organ prolapse) by University of Missouri, researchers found that ” incontinence, constipation, and/or pain improve by 80% with pelvic physical therapy”. Research shows that pelvic physical therapy plus a prescribed home exercise program works better than just engaging in one option.

Pelvic physical therapy teaches patients with pelvic organ prolapse how to build up the “floor” or muscular base of the pelvis. The pelvic floor muscles provide the main support for all pelvic organs. Kegels alone are not the only treatment option. If there is tension in the pelvic floor muscles, they need to to be released via manual therapies or risk further dysfunction. Sitting posture and good voiding habits are addressed, exercises are prescribed and body awareness improved.

EMH Physical Therapy has been providing successful pelvic physical therapy for 18 years in NYC. We have helped thousands of women return to better function. Call us today to get your prescription for pelvic health.

Women’s Pelvic Health

Women's Pelvic Health

 

 

Check out this link ( link) to see Evelyn’s interview on physical therapy for women’s pelvic health in the Los Angeles Times. The app, Pelvic Track, is now available on the Apple store.

 

 

Pelvic Health Physical Therapy app Launches November 2013

Watch for the launch of my new app: “Pelvic Health PT, The Hecht Program“. Launch Date: November 2013!!

Pelvic floor dysfunction (PFD) affects women (6 out of 10) and men (#’s unknown) and includes painful intercourse (women), painful or lack of erection (men),  constipation, incontinence after prostatectomy surgery (men), leaking of urine and/or feces with laughing, exercise or with the urge to go.  PFD can cause abdominal  bloating, urinary urgency,  straining during bowel movements,  pain in the pelvic/groin, lower back and hips.

The app, Pelvic Health PT, The Hecht Program” is a tool that I designed along with Kalpesh Wireless, a software company, to help men and women suffering from PFD, some too embarrassed to talk to their doctor about it, take action. By following some of my tips, techniques and exercises, you can regain a healthy pelvic floor.  This app is best used while working with a licensed physical therapist who specializes in pelvic floor rehabilitation.

When your physicians have run medical tests and all are negative for infection or inflammation and medication does not help, the most likely cause of your symptoms could be due to muscle and fascial restrictions, trigger points, weakness and incoordination of the internal and external muscle of the pelvis. The pelvic nerves  become pinched as they travel from your sacrum through the gluteal, hip and pelvic muscles to innervate the pelvic floor region leading to further dysfunction and pain.

For over 17 years, my practice has healed thousands of men and women with PFD by lengthening  restrictions, mobilizing the skin, muscle and nerves, teaching a tailored stretching and strengthening and postural home program.

The Pelvic Health PT, The Hecht Program  has over 50 exercises and awareness techniques to regain a healthy pelvis and pelvic function. Improved sexual function, decreased pain, improved bowel and bladder habits, and a stronger core are the results.

The  app has 4 parts: 1) Symptom Tracker 2)  Set Reminder, 3) Pelvic Relaxation & Stretching, 4) Pelvic Floor and Core Strengthening.

1) Symptom Tracker: Before starting some of my exercises and awareness techniques, go to the “My Symptoms” page and input each one of your symptoms /dysfunction. Be as detailed and descriptive as you want. Then for each symptom/dysfunction, rate the level of pain or discomfort on scale of 0 to 10, 0 = no pain or no trouble and 10 = worst pain or the most difficult.  After you input this detailed information, start to incorporate some of the awareness techniques and exercises that your pelvic floor physical therapist recommends.  If you do not have a pelvic floor physical therapist and working independently under the care of your physician, start slowly with the gentle tips/exercises incorporating one or two new things at a time. No exercise should increase your pain or symptom for more than 3 days following the exercise.  If this happens, stop the exercise and consult with a pelvic floor physical therapist.  If all is progressing well, at the 2 week or 1 month from starting Pelvic Health  PT, The Hecht Program, go to “My Symptoms” page and rate your symptoms at that point.  After 2 months, you should see some functional progress.   The symptom tracking helps you see that your body CAN change and motivates you to continue doing what you have started.

2) Set Reminder: You can program a reminder in your I-phone for an exercise or awareness technique that needs to be done many times a day. For example, a quick way to lower stress is to perform the Diaphragmatic Meditative Breath.  Program your reminder in the app for this exercise every 2 hours. You can become more calm during the day and prevent the build up of muscle tension, shallow breath and decreased oxygenation.

3) Pelvic Floor Relaxation and Stretching: Most people with PFD need to do the awareness techniques and pelvic floor relaxation BEFORE they start to do the strengthening, or, “Lengthen before Strengthen”  Anyone with pain should also do the relaxation exercises, assess their postures during the day (via photograph), adjust poor postures and do not start any strengthening exercises when first starting my program. Contracting or shortening an already tight muscle/fascial group will  cause further tension and result in increased pain.  Your pelvic floor physical therapist will guide you to become aware of your pelvic muscles, teach you how to relax and  lengthen all the muscles that attach onto the pelvis (hamstrings, inner thighs, hip flexors, plus more) before doing any strengthening.

4) Pelvic Floor and Core Strengthening: Once the muscles are stretched, the trigger points released and you are doing regular daily stretches, a gentle core strengthening program can begin. The app gives a progression from basic pelvic floor and abdominal recruitment, to full planks for maximum core stabilization training.  To insure long lasting results of pelvic floor rehabilitation, the core must be strengthened.

The app is best used while under the care of a licensed physical therapist who specializes in pelvic floor rehabilitation.   Your  physical therapist can direct you on which specific exercise to perform, teach you how to do the movements, perform manual therapies to reduce tension and trigger points and guide you on when to start a strengthening program.

PHYSICAL THERAPY TREATMENT FOR CONSTIPATION / PELVIC FLOOR DYSSYNERGIA

Constipation is a common disorder primary care physicians and gastroenterologists diagnose on a regular basis.   There are many causes, but when constipation is due to “pelvic floor dyssynergia”, which are restricted pelvic floor muscles around the anal region that contract instead of relax during attempted bowel movements, a licensed physical therapist, trained in pelvic floor dysfunction can reverse constipation and help you resume normal bowel function.

The pelvic floor is a group of muscles at the base of the pelvis that help control sexual, urinary and bowel function. These muscles, namely the puborectalis, levator ani and coccyxgeus must relax and contract properly to maintain urinary and fecal continence, sexual function and proper voiding habits. When the pelvic floor muscles fail to relax and contract properly, this can be referred to as “pelvic floor dyssynergia”.  The inability to relax and contract the pelvic floor muscles correctly can lead to symptoms of constipation, straining with bowel movements, and feelings of incomplete evacuation.

Some of the physical therapy treatments for constipation include external and internal rectal myofascial release techniques, trigger point release techniques, biofeedback therapy to help down train tight muscles and/or up train weak muscles, instruction to correct bowel techniques to prevent straining, instruction in home exercise program to stretch and strengthen pelvic floor, hip and gluteal muscles.

Manual therapy is needed to reduce the tension, adhesions, and knots in muscles that cause them to become dysfunctional.  This treatment is always with a patient’s permission, may be uncomfortable, but overall a very successful approach to rehabilitate faulty pelvic muscles patterns that resulted in constipation.

Biofeedback therapy helps retrains your pelvic floor muscle’s ability to contract and relax within their full range of motion. It is a treatment which requires insertion of a rectal sensor (sensor is the size and length of a pinky) to measure pelvic floor muscle tension through electromyography (EMG). The EMG activity is visually displayed on the biofeedback unit so you can see what your muscles are doing and learn to better control these muscles with verbal and tactile cueing from the physical therapist.  Identifying the internal sensations associated with the relaxation and how to maintain the ability for your pelvic floor muscles to be at a relaxed state throughout the day is taught as well.

Specific stretching and strengthening exercises are taught for the pelvic floor; the abdomen and pelvic girdle (the gluteal, hamstring and adductor musculature).  Manual therapy such as soft tissue mobilization and trigger point release are administered to tight and restricted tissue both to the lower abdominal region and pelvic floor musculature to help increase blood flow, decrease restrictions and promote healing.  Education regarding normal bowel function and identification of problematic toileting habits is also an important step to recovery.

By complying with a pelvic floor physical therapist’s recommendations, you can be well on your way to pain free and stress free bowel function – no more constipation!