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A Pregnant Physical Therapist’s Top Tips for Your Healthy Pregnancy

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.

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Sitting is Detrimental To Your Health

“In the interest of keeping our  current and prior patients healthy (and happy) I am pleased to introduce “EMH Physical Therapy Better Health & Movement Blog”

Today ‘s article is about posture. The key to a healthy spine, pain free neck and lower back is to maintain a neutral spine throughout the day, work or play.

EMH Physical Therapy offers manual therapy to release restrictions,  low level laser therapy to stimulate healing and tailored exercise programs. Yes, we still offer individual 45 minute treatment sessions by one licensed Doctor of Physical Therapist.

The-health-hazards-of-sittingWritten By: Lauren Calado, DPT, PT 

Our bodies have 650 muscles and their function is to contract, stretch, fire up… MOVE.

Did you know that more than 80% of us sit for over 10 hours a day? As technology in the work-place and at home increases, physical activity is rapidly declining.

A New York Times article reported, “Jobs requiring moderate physical activity, which accounted for 50 percent of the labor market in 1960, have plummeted to just 20 percent” (2011). Add on more time dining, watching television and more than 75% of your day could be spent sitting. This is a functional contradiction to human anatomy and physiology and has a negative impact on your health.

The health risks of prolonged sitting include low back pain, muscle weakness, impaired posture, neck/shoulder pain, nerve impingements, decreased flexibility and pelvic floor dysfunction. Other disorders that may develop as a result of long periods of sitting are decreased cardiovascular endurance, obesity, poor circulation and decreased life span. Yikes!

Tips to decrease the health risks of sitting:

• Take one flight of stairs up/down instead of taking an elevator to your floor destination
• Walk to a co-worker to talk instead of calling/texting/emailing
• Stand up during TV commercials
• Perform a few different core/strength exercises such as standing squat, push up, or an abdominal exercise 10 reps twice a day.
• Wear one of the new fit bracelets to track your walking or cardio results
• Park your car further away from the office or your house
• Enter/Leave the subway station that is one stop away versus the closest station to home/work

Research shows that your brain needs a movement break after 50 minutes of working, thinking, sitting. Get up for the last 10 minutes of each hour to take a walk, pet the dog, do a quick errand. Your brain will be refreshed and creative thinking will be enhanced.

If you are experiencing sitting related problems, consult a physical therapist. Physical therapists have 7 years of education in advanced anatomy and physiology, movement science and interventional healing therapies. The Direct Access law allows you to consult a PT first, so you don’t have to see a doctor, get a prescription and be referred to physical therapy. We can help you heal from sitting related dysfunction.

 

Pelvic Pain App developed by Evelyn Hecht, PT

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“She inspires us to not accept the status quo, to strive for wonderful things and not just acceptable things. There’s a lot of good nuggets of wisdom and interesting ways of looking at the profession. Some Apps are fun but the best are more about life”-  Dr Joe Simon

 

I felt this quote was the best to describe my thoughts about this interview. Dr Evelyn Hecht has been treating patients with Pelvic Floor Dysfunction (PFD) longer than there has been a doctorate program at my alma mater. But innovation is not the key to riches. Evelyn saw a need in the marketplace and decided unlike many in our industry not to wait for someone else to do it .

Lately i have consulted with more and more physicians and surgeons on their legacy or exit strategy. Evelyn is no where near the end , matter of fact , she is on the cusp of a new road in healthcare. Apps are a highway of free traffic from possible clients from around the world. Evelyn has just made it easier for the vast population to accept her as the expert in the field.

Pelvic floor therapy is a growth factor for practices across the country. This new specialization is growing with a medical network from physicians, physios & psychologists.

INTRODUCING, PELVIC TRACK a new app to help PATIENTS and practitioners to work together. The challenges associated with communication with the therapist dealing with pelvic floor therapy. Again , it was not looking for a better mousetrap but to create one that doesn’t exist from the need of her patients and her therapists.

The motivation for our new grad and younger (not age but career wise)  listeners. Evelyn has made strides and conquered the niche market. Marketing pelvic floor therapy through facebook, through her blog and now through her App is something i would ask all my listeners to take a deeper look at.

I hope you find the takeaways that I did.

For more info or to read the article directly click  HERE

To purchase or for more info on Pelvic Track App click HERE

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.

Evelyn Hecht PT receives award for 20 years as member of HSS Rehab Network

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Evelyn Hecht, PT receives an award from Hospital for Special Surgery on February 25, 2014.

Her company, EMH Physical Therapy was recognized for 20 years of excellence as a Charter Member of the HSS Rehabilitation Network

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.

Good Posture is Key to Healthy Body

Good posture is a key factor in preventing many pelvic, hip, lower back, mid back and neck pain.  If we spend most of our day sitting in a slumped position, our knees crossed, our shoulders  rounded forward and our head  jutting in front of our body, and do nothing to counterbalance via exercise or change of pattern, overtime, muscles  become tight, joints lose their flexibility, nerves get pinched, our breathing is compromised, our abdominals become flabby, and off to the doctor we go.  These common problems related to poor posture are treatable with the appropriate lifestyle changes, daily postural exercises taught by a physical therapist and by making ergonomic changes.

TAKE THE PHOTO CHALLENGE:

Let’s tackle some basic lifestyle/ ergonomic issues.   The first step in knowing good posture is to become aware of your postures during work and home.  An easy way is to find out is to have your coworker take some random photos of you throughout the work day (no poses!) The best shots are the side and back views where you can see your spine curves. At home, have a family member take photos of you preparing meals, reading on the couch, etc.  Later you can look at the photos and marvel how upright, centered and how you maintain your natural spine curves throughout the day (probably not!)

Just by looking at your photos, you can figure out some of the changes you need to make.  Good posture is based upon keeping the natural curves of the spine during most activities.  This is called maintaining a “neutral spine” and requires flexible muscles, joints and having strong muscles.   Our body should not be placed in extreme positions for hours at a time. For example a hyperextended position, ie standing with both knees locked can cause lower back tension, conversely, a hyperflexed position , ie sitting in a slumped, rounded posture  can cause back and pelvic pain.

GOOD SITTING POSTURE – Detailed

Sitting is what we do most of our day – to work, eat, learn, watch TV, read and  mostly sit during transportation.  Over time, poor sitting positions causes muscle tension, joint restrictions, strength deficits and pain that physiatrists diagnose and physical therapists treat every day.

Set up your computer/reading/art /work space to fit your body, to help support and maintain your natural spine curves instead of having your body adjust to the space.  The chair seat should be at a comfortable height, so that both feet (heels and toes) can touch the floor. Feet that are unsupported create tension in hips/legs/lumbar spine.  If your body is more of a petite size, so your feet do not touch the floor, use a footrest.

When sitting, the two bones at the bottom of the pelvis where your hamstrings attach, called Ischial Tuberosities  (IT’s), and the center of your pelvis inbetween the IT’s should be in contact with the chair seat.  Your lower back should rest against a lumbar cushion, either already built into your chair back, or purchased separately and strapped around the chair back. The lumbar cushion gently pushes your lower back forward to maintain its natural inward curve.  You should not slump backward to sit on your tail bone (coccyx) nor should you lean too far forward to bear weight on your pubic bone. Don’t sit on one side/hip as this creates imbalances at your sacroiliac joint, hip and lumbar spine.  (See photo 250)

With your lower back resting against the back of your chair against a lumbar cushion, this frees the thoracic spine , shoulders and neck to stack one on top of another, versus careening forward.  If you find yourself hunching forward to see the computer screen or to reach the keyboard, adjust the placement of this equipment so it is brought closer to you so you do not strain forward.

Lastly, during every hour of sitting, work/read/draw for 50 minutes, then get up for the last 10 minutes to take a brief walk, do a stretch, pet your dog, do something else.  Research shows that 50 min work/ 10 min of change recharges your brain/thinking powers. This timing is a great way to re-evaluate your posture and prevent build up of faulty postural patterns.

POSTURE EXERCISES

A  Upper body lift:  done either in sitting or standing position and has 3 distinct parts

If doing this exercise in sitting, keep your pelvis centered on the seat as described above, your lower back resting against the lumbar cushion. If doing this exercise in standing, keep both knees slightly bent.

1) Think of an invisible string gently lifting your sternum (the bone in front of your chest) upwards    You should feel your upper body move from a rounded upper back to a more elevated posture Hold this as you:

2) Roll your shoulders up towards your ears, then backward, then down.  This opens your front of your shoulders Maintain this position as you finally:

3) Gently tuck your chin towards your neck (think of creating a double chin position)

Hold all three positions together for a count of 20 seconds up to one minute.  Make sure to breathe slowly while holding the position   Repeat.  Do three times a day.

B  Thoracic twist combined with deep hip rotator stretch

While working at a computer we tend to get into a rounded upper back and forward head position. Our midspine, called the thoracic spine can become restricted as well as our hip muscles. Here is a simple stretch to open both areas\

R Spine twist:

Sit in a sturdy chair your buttocks slightly away from the chair back, feet comfortably touching the floor or on raised step stool

Cross the R ankle over the L knee

Place L hand on outside of R knee.

Place R hand on the chair seat behind you

Turn your upper body as far as possible to the right while gently pulling the R knee towards your L shoulder. Keep your neck centered over your chest, not to twist your neck too far

You should feel a stretch along your spine and in R buttock/hip region Hold for 10 up to 30 seconds while breathing slowly.

Return to center and repeat once more.  Repeat to the opposite side two times  Do twice a day

 

C Wall Angels

Do you remember making snow angels as a kid?  “Wall angels” are the grown up version of snow angels This exercise increases strength of  your upper back, posterior shoulder to counteract the effects of a forward head, rounded shoulders posture.

1)      Stand knees bent, your buttocks, lower back, upper back and back of your head are against a wall. Tighten your stomach to keep your core stable.  Bend your elbows comfortably by your sides with the back of your hands touching the wall.

2)      Keeping this body position, slowly slide both hands along the wall raising both arms until your hands meet overhead.    Slowly lower. Repeat 10 reps.  If it is difficult to go full range, try ½ or ¼ range.

 

There are more excellent postural exercises, for example keeping your abdominals, pelvic floor and lower back muscles flexible and strong is key.   Consult your local physical therapist to learn a tailored exercise home program  that is right for you.

 

Painfree sexual intercourse during Menopause: Helpful tips by a Pelvic Floor PT

Physical therapists have helped women in menopause return to painfree, satisfying sexual intercourse. These women could experience pain with intercourse, even after rehydrating their vaginal tissues under the guidance of their GYN, due to pelvic floor muscle tension.   The pelvic floor is a group of muscles located at the bottom of the pelvis  surrounding the vaginal canal.  Intercourse requires that the muscles be flexible to be able to receive the penis and strong enough to contract to provide more intense orgasms.    All healthy muscles have a normal length during rest.  Unhealthy muscles have knots/fascial restrictions so they are stuck in tight position during rest.  So with a tight pelvic floor, the penis cannot enter and women can experience pain.

How to gain a healthy pelvic floor?  Treatment by a physical therapist trained in pelvic floor dysfunctions is optimum as we provide you with tailored manual expertise and guidance to heal.  Here are some helpful tips:

1)      STRETCH HIP/GLUTEAL MUSCLES Stretch the large muscles of your hip, and buttock region as they can actively refer pain into the pelvis and cause the pelvic floor muscles to overwork or be strained.  By actively stretching the hip flexors, hip external rotators, inner thigh (adductors), groin and hamstrings,  the pelvic floor is released and can function optimally.  Hold each static stretch for 30 seconds, done twice,  2x’s times a day.

2)      VISUALIZE A RELAXED PELVIC FLOOR   Chronically tight pelvic floor muscles need many reminders to relax throughout the day.   Every time you look at the watch or your mobile phone, ask yourself, “Where is my pelvic floor?”   Think about the area softening, melting, widening. Use any visualization that is calming to you, send a healing color to your pelvis to bring awareness and “let go”.

3)      BREATHE  Diaphagramatic breathing helps to relax the abdominal and pelvic regions.   Lie on your back, pillow under your knees. Place your hands on your stomach, bent elbows resting by your sides.  Inhale slowly through your nose for a count of 5 seconds.  During your inhalation, allow your stomach expand into your hands. Visualize your pelvic floor muscles widening as well.   With each inhalation,  imagine or visualize the pelvic floor muscles expanding in all directions, front, back , left , right.  Slowly exhale for 5 seconds. Repeat 5 times. Do once in morning and at night.

4)      NEUTRAL PELVIS Set up your computer/reading/art work space to fit your body versus your body having to adjust to the environment.  The chair should be at a comfortable height so your feet are supported either on the floor or a raised footrest.  “Good posture” is when a neutral spine in maintained.  When sitting, your weight should be on center of your pelvic bowl, your lower back resting against a lumbar cushion. The lumbar cushion gently pushes your lower back forward to maintain it’s natural curve.  You should not slump back to sit on your coccyx bone, nor too far forward on your pubic bone and no sitting on one side/hip for hours at a time.      Here is where a PT can really help you gain knowledge and best position of your body.

5)      SELF STRETCHING INTRAVAGINALLY  This is a technique where you can stretch the intravaginal tissues by inserting a clean left thumb intravaginally up to the level of the first thumb joint. Gently press or sweep your thumb along the right vaginal walls providing a deep stretch.  Do a few sweeps from the midline towards bottom of the right vaginal wall.  You can hold a few areas that feel tight or uncomfortable.   Then insert the right thumb intravaginally and sweep or apply pressure points along the left side of the vaginal wall.  Repeat a few times each side. Do once a day.

6)      DILATORS Dilators are also used to help women prepare for intercourse and to apply pressure to tight spots within the vaginal walls to stretch. Your PT can guide you on how to use them.

7)      PELVIC FLOOR STRENGTH   Once your pelvic floor muscles are lengthened, a basic pelvic floor strengthening program can begin. Your physical therapist can teach you how to best recruit these muscles without co contraction of the hip adductors, hip extensors, and breath holding.  A basic pelvic floor strength exercise can be done by holding a contraction for 10 full seconds, resting/relaxing for 20 seconds. Repeat this 10x’s.   Then do 10 quick contractions and quick relaxations, repeated 10x’s to stimulate the fast twitch fibers of the pelvic floor which are innervated during orgasm

8)      SQUAT Squatting exercise helps to lengthen the pelvic floor and increases the strength of your hip and buttocks muscles.  When performing either a quarter, half or full squat in good alignment, this provides great balance of the pelvis and pelvic floor muscle function.

9)      AN ORGASM A DAY… Yes, an orgasm a day keeps all the pelvic muscles happy and healthy

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.