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We loved reading about all the dog-walking, trail hiking, and playing with kids and grandkids that helped to keep people moving this past year.  Here are more ideas from the community board:

• Hula hoop!
• Walk to the park/lake and meditate at sunset
• Stand up between commercials and march
• Park a bit further when grocery shopping

As the spring weather allows, we encourage you to grab a friend, get outside, and soak up some vitamin D!

As pelvic floor practitioners who treat a variety of disorders of the digestive tract, we are proud to participate in retraining of the sensation of the bowel with a unique type of therapy. Rectal balloons have long been used in the past by gastroenterologists for diagnostic purposes to observe how patients attempt to void stool from the sphincters of the anus. More recently, pelvic floor physical therapists have been using rectal balloon catheters to aid in treating constipation by providing contact against the bowel wall. This stimulates the sensors which leads to better coordination of the pelvic floor muscles and ultimately, improved passage of stool without straining or discomfort.

​Here is how it works: The patient lies on their side and the PT inserts a deflated lubricated balloon into the rectum. The PT then begins to pump small amounts of air into the balloon to inflate it. This mimics the sensation of having a full bowel and “needing to go” for the patient. Small sensors which line the bowel walls are being trained with the presence of the expanding balloon that it is time to void; this unique sensation is historically ignored or suppressed by the brains of people with chronic constipation. Yet with the use of rectal balloon training, such people are afforded the opportunity to show their colons who is truly in charge of having healthy, soft and regular bowel movements (their own brains are!).

The use of rectal balloons might sound weird and like the stuff of science fiction. But once patients experience this treatment in the relaxing and supportive environment of a pelvic floor clinic, they often discover how they might have been contributing to their own unconscious tension which leads to a lifetime of constipation. Rectal balloon therapy has also proven to be effective for the management of people with chronic diarrhea and poor stool quality. In short, it is a wonderful adjunct to a balanced pelvic floor treatment plan aimed at improving bowel health. If you have bowel concerns, please ask us at Connect PT about rectal balloon training. 
 
Barthelemy, Anne1; Shifferd, Jennifer1; Erickson, Kim1 Balloon Training for Bowel Dysfunctions, Journal of Women's Health Physical Therapy: Spring 2009 - Volume 33 - Issue 1 - p 18

If you are experiencing chronic pain, stiffness or discomfort, what is your body trying to tell you?  Here is a short, fun practice to begin dialogue and partnership with your body.

• Allow yourself to acknowledge your body’s wisdom. 
• Acknowledge anything that feels like discomfort or pain is really not discomfort or pain, but rather your body’s desire to call your attention to it and give you information.
• Talk to the pain or discomfort. Acknowledge the part of the body from where the pain is coming and speak to it directly. 
• You may choose to use a mirror and look in the mirror as you speak to that part of your body or you may talk to the body and say, ”Body part, I love you. I am grateful for what you are doing for me. Tell me what you would like me to know”,  and then listen. 

This may seem awkward or strange at first;  it may seem silly or even uncomfortable, but if you do this more and more, you shall receive the answers and your body begins to trust you and you begin to trust your body, thereby creating a partnership for health. Through practicing this over and over you may notice that the pain begins to subside and  may eventually be gone.

You may choose to combine this with a very clear intention that it is your intention to 100% enjoy your body fully, and that your body enjoys you inside of it fully and completely. This supports  your collaboration with your body for a maximum amount of enjoyment.

Although the pain may not leave immediately, recognize that the physical form takes longer to change, but the change starts once you make a connection and change your thoughts. It is new energy; it is new consciousness; it is new awareness. Your job now is to stay in a mode of receiving and know that you have started the process of feeling better, and while it might not be an overnight healing, it will be steadfast and continuous, and with ease and grace. We want this with ease and grace in the most gentle way for you.

According to Dr. John Sarno, in his book, Healing Back Pain, for a condition like chronic back pain, once you call out the emotion that your body is repressing, there is no longer any need for the pain and the body will no longer need to generate tension. (2) 

All of us here at Connect Physical Therapy are here to support you to feel your best. ​

Finally, in this last image below, I exhale and gently start the TA turning on and do a sit up. I let my body start to take over with how much intensity is needed. I provide a gentle reminder to my deep core to turn on. D1, the TA, is widening and turning downwards.  ​

There are many online postpartum and mommy fitness programs now. Many of them are great, but for some women, you need help knowing you are doing the techniques correctly. Are you doing a TA workout and not actually turning on the TA? Are you bearing down when supposed to be pulling up/in? I recommend a visit to a pelvic physical therapist, even if it’s just a few times to make sure you are on the right track. We want you back to running, back to lifting weights, and back to the activities that make you feel good. Let us help you get your confidence back.  ​

By Bryn Zolty, PT

​Planks are one of the most well-known core exercises. Doing a plank incorporates many muscles to make us strong and support our joints. Typically an individual starting off with planks would try a modified plank and build up to a full plank. A modified plank means less difficulty when you are starting out so you can maintain a nice neutral spine, avoid holding your breath, and build strength. Two common modifications would be starting on your knees or placing your elbows on a higher surface than your feet as seen below in the Common Progression. After this position becomes easier, you can hold longer or perform more repetitions. Next you could try a full plank. Planks can continue to be progressed to have your feet above your elbows, your elbows on exercise balls, use exercise bands and more.  
​
Now let's add prolapse to the situation. Pelvic organ prolapse can feel like heaviness in the vagina and even progress to the organs (bladder, uterus, vagina, rectum) coming out of the body. These symptoms increase with gravity. The more upright you are, the more symptoms you may have. So with a prolapse, we may consider reversing the progression. We may start with your body inverted - check out the picture with the feet on a chair and elbows on the ground in step 1 of the Prolapse Progression. We also encourage you to monitor your breathing. Holding your breath can increase symptoms. Consider what happens when you breathe in and fill your system with air, and then hold your breath and strain in a position. This can push these organs down. In addition, you could consider adding a kegel, or pelvic floor squeeze, to help support the organs. Your progression might look like the reverse of the Common Progression! As you gain better control of the pelvic muscles and breathing, you may be able to progress to being more upright with less symptoms. Good Luck! Contact us if you need help modifying your exercises, breathing, or help with pelvic muscle strengthening so you can exercise with confidence.

By Karen Bruno, PT

Can self-compassion really help when you are in pain?
Let’s explore this. First, what is self-compassion? Self-compassion is giving yourself kindness, forgiveness and understanding when confronted with personal failures or discomfort. Basically, it means giving yourself the care and gentleness that you would give to a beloved friend or a child who is in need of support. In the words of Dr. Kristen Neff, a self -compassion expert and teacher, "Instead of mercilessly judging yourself for various inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings – after all, who ever said you were supposed to be perfect?" (1)  It is an acceptance of your humanness even when things don’t go your way.
​
So, what does self- compassion have to do with chronic pain? Recent research suggests that self-compassion is associated with better outcomes, such as lower levels of depression, pain-anxiety, physical and psychosocial disability, and higher levels of pain acceptance. Higher levels of self-compassion supports engagement in meaningful activities and use of pain coping strategies. (2)

What does that mean for you?

• Lower levels of depression, sadness and anxiety.
• Less physical and psychological stress.
• Higher levels of pain acceptance and engagement.
• Improved ability to perform meaningful activities and use pain coping skills.
• Better overall outcomes, function and quality of life.

Self-compassion has been found to be beneficial in situations related to the ineffective way we respond to things, how we talk to ourselves and the behaviors we engage in. So, when you notice yourself  worrying, thinking or talking negatively, isolating yourself, or beating  yourself up, choose to use a better approach of treating yourself with care, gentleness and kindness. (3)
 
What can you do?

• Meditate. Practices such as mindfulness, breath meditation or any other physiological quieting methods help us to reduce tension and train us to tune into our needs to better take care of ourselves. Here is a link to some guided meditations: https://self-compassion.org/category/exercises/
• Consider treating yourself the way you would treat a close friend or a small child. How might you respond to them with kindness and gentleness?
• Remind yourself that you are worthy of kindness and compassion.
•  Take a self-compassion break. What do you need to hear? What do you need to give yourself? How can you encourage yourself and be patient, kind and forgiving to yourself?
• Explore self-compassion through writing. Start by writing about your concerns.  Next, write yourself a letter from the perspective of a loving friend. The last step is to let yourself receive those kind words, allowing love and compassion to soothe and comfort you.
• Practice supportive touch.
  1. Putting your hands on your body and taking some conscious breaths can be relaxing. 
  2. Place your hands over your heart and breathe comfortably. Notice the rise and fall of your chest as you breathe. Do this for as long as needed to calm your nervous system. 
  3. If it is convenient, put your hands over the area of pain and breathe love and nourishing oxygen into the region. 
  4. Place one hand over your heart and one hand over the abdomen. Breathe gently and consciously- 4 seconds in and 4 seconds out. This is a great way to relax as you drift off to sleep.   

 
This PDF download summarizes the relationship between self-compassion and pain.
 
Self-care is also an integral component of self-compassion.
We have heard it before from the airlines, "“put your own mask on first, then help someone else." Remember that you are your own best advocate and as you care for yourself, you model for others how to care for themselves, you teach others how you want to be treated, and you harness the resources to be of service to others. Just do it! You are worth it.
 
"Life is full of disappointments, failures and setbacks. None of those things can permanently stop you. You have the power within you to overcome anything that life throws at you. There is nothing more powerful than a made up mind. Surround yourself with people who remind you that you matter, and support you in ways that matter most to you. No person, situation or circumstance can define who you are. Don't give up, cave in or stop believing that it's possible. It's not over until you win."
-Unknown

Notes 

1. Website: selfcompassion.org
2. Paper: The relation of self-compassion to functioning among adults with chronic pain. Eur J Pain. 2019 Sep;23(8):1538-1547. doi: 10.1002/ejp.1429. Epub 2019 Jun 11.
3. Audio: Integrative Pain Science Institute podcast

​We get a ton of questions every day about breathing and spend a lot of time teaching different breathing techniques, which can help with both exercise and meditation/prayer.

Learn about what we usually see and also what we're looking for, as we breathe with Marzena Bard, PTA, CYT.

​April through May 2020

​Marzena Bard, PTA, CYT brought yoga to our homes over Zoom twice a week, offering Chair Yoga and Relieve Stress & Rebuild Strength Yoga to help the community stay active and connected despite sheltering at home.